Loading...
HomeMy WebLinkAbout020-1464-16-000.Jisconsin Departmen `of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division • ' INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Beer, Richard Hudson, Town of CST BM ElevC, \~/ . J Insp. BM ~l/lev: ~ . S V BM Descr' 'on: ~~ r -.~-_. TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic `~Q Dosing Aeration !~ Holding ~ ~~ TANK SETBACK INFORMATION TANK TO P/L r' " WELL BLDG. Ve~ it Intake ROAD Septic ~ I p ~ / Dosing , ~ ~ Aeration Holding PUMP/SIPHON INFORMATION ~~~(~ ~-~b ~~ ELEVATION DATA County: $t. CroiX Sanitary Permit No: 479463 0 State Plan ID No: Parcel Tax No: Section/Town/Range/Map No: 11.29.19. STATION BS HI FS ELEV. Benchmark t t~ ~, ~ 3 .~ ~~ ~ ! ~6 Alt. BM ~ ~ , Bldg. Sewer G~ ,? St/ Inlet 0. ~• j? , ~ ,~ s- SUHt Outlet ~. f~ Dt Inlet ~ ~/ Dt Bot~om i , ~a. ,( 9 ~ 3 Header a~.~- /~ ~-~ b '~ tv ~, 6 Dist. Pie ~~_, b , c f Bot. Syster>y~_ s __~~"" ~r ~~ W ~ ~O ~ Final Grade - ~~ ~~ h.- _q,,,. 3 .rj ~D-J, St Cover ~~z 3, `~ TDH Lift ~/ Friction Loss Systdrq H~a ~ TDH Ft `~ Jv , Forcerty in Length~~ / Dia. ~ ~~ Dist o well _ ~- ---- SYSTEM BED/TRENCH Width / Lengt No. Of Trenches PIT DIMENSIONS Of Pits No Inside Dia. Liquid Depth DIMENSIONS •JC h ~ /(j) %v i SETBACK SYSTEM TO P/L BLD WEL LAKE/BYRE LEACHING anuf re INFORMATION CHAMBER O T f S tem: Yp ~ ~ ~ / ~ ~~ ~ Model Number. DISTRIBUTION SYSTEMS 1`-l'l.. ~in,r.~-Lr 1L+t~( Header nifold Distribution Lt SJ,~n' x Hole Size x Hole Spacing Ve it Intake Lengt Dia y , ( ^'/ Pipe(s) ~~DDjj `T I N t!~' ~ Length Dia_ Spacing ~_ ~ /~ ~ SOIL COVER v Prossurc SVS+PmA C]nly ru Mound Or At-Grade SVStemS Only Depth Over t r ~/ '~ ~ Bed/Trench Center Depth Over Bedfrrench Edges xx Depth of Topsoil xx Seeded/Sodded xx Mulched I ~ N ~ ~ Yes ~ ~ No : o ~ Yes i i COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/U Inspection #2: / / Location: Hudson, WI 564016 (SE 1/4 NW~/4 11 T29N R19W) Mound View Estates II Lot 16 ~ ' A,~ , ~ Parcel N~o/1~1.~29.19.,~,~ 1.) Alt BM Description = ./ ~ w~~ Z ~~~~,/ /~ Q~w`~` ~ ~'~L"iN~'` ~ r~ 2.) Bldg sewer length = 3~ ~, (~(J7Gi(inCf-~ ~ vl~littQ, 6 -amount of cover =~ 0 / ~ ~D ~~~ D ,~v~ --, -- - ~T Plan revision Required? j ~ Yes ~ , No ~ ~'}'~ I ~ Use other side for additional information. ~.._i 1 __ ~ ~ w~ ~__ __f _ ~'~ Date Insepctor's Signat re SBD-6710 (R.3/97) /, .. - ~~ ~ ~ - C ' ~ Safety and Buildings Division 201 W. Washings -------------_-_.. _.... _ __------- unry - ~~~d , r ,~ r,~n~~~ Medtson, [ 537 ~-_ Sa 'wry Permit number (to be fikled in by Co ) Department of CommerCt? -------__ _ _ ~ (608} bb-31St _ ~, ~9 `~~ 3 __, --~-~~~ _ ~ Sanitary Permit Appi~cat~ ~'~ t ~ ~ Ste Flan LD. ri'umber ' ~ f fn accord with Comm 83.21, Wis. Adm. Cade> persotu(1 informati you Lir4v~UlX ~pUNr ' ~ may be used far secondary purposrs Privacy I.aw, s1S.AA( )(m) ? '~~NING OFFICE ___ I. Application Information -Please Print At] lnfonnation `, ~ , ~ . ' ct Ad ress (if different than mailing address; j ! ~ ~ 7 ~"~ ~ i ~„~ ' f22~~d ~~ Property Owner's Na me I'atee! ~- -~--- f p T ^ Block M j L-_...,' v ~ fr r'~ t/' LLB ~ ~' ~~• ~~r _ ~ Property Owner's M ailing. Address ~ -____~_._. _._._. ~ Property Location -~ ~~-_ 115 y ~~~ f ~ Cir .Stan r Zip Cade Phone Number u,~~!4,Section ~! __ ~ JL"c!O ~~ i ~ 5~.._. L~ ~ r II. Type of BuildlnE (check alt that ap l ) ~ (circle o ) ,r'fj N: R i'~ E or V~ --L I p y a~ ~ 5 `~ ` ~ ~ ' or 2 Family Dwelling -Number of Bedrooms ~~ T _ ~Qe,,,,,5 . ' '- ~= -- ---- --- _.._____• .- . _-__. _.... ~ Subdivision Name ~ ~ I Public/Commercial - E)escribt Use --- --- ---_ - - -- - - .._ ~"._~. ---- ~ ~ " • ~ J/ G~ LLB ~s~ f 61.1.110 jJ •_ _ __ __ ~' `.i Statr Dwncd -Describe I'se ._. ---- -----_-~~L -T---- - --"-r ^C:ity_~Village~'ownship t~f~ /„~~ ` ~ II]. Type of Permit: (Check only one box on tine A. Complete line B if apptlcaltir> __ ~..._. _.______,.. .-,~_ __ .~. _ >' --- _ N~ m i ~. y r; Rrplacenreru System ~ TreacmenUHolding tank Replat:etnent Uirly _ ___._._._._. ~_____-..__.._ ~^ Other Modification to Existing System __ i __.__.__....al ~_~ Permit Revision ~ ! -1 t'hange of ~" r~ Permit Transfer to New ore kx Ri ~ n._. ..- - f'I ~ ~~ ~'. Be ~ tst Prevt(ws Permit Number.-__..._.._ `, ~ and Date Issued f Plumber I Owner ` I ~ rv. Type of P()WTa Svstem: (Check alt that a 1) 2 r ~~ ~ W~~G~~,~ ~, ~~ r Z• ---- - •--...,..« .. .............. ,_> .vwu,w _J L'1 tie. u~ ~IitldUle SUII CursUUCted Rretlartd ~ ~ Pressurized In-GroundU Holding Tars ~.7 Recirculating Synthetic Media kilter Leaching C.ham_b_ar _ ~ D~ i V. D-SOerSat/Tr'e8tment Area Inrnrmatinn~ ~~ :,r mOUncn ~ ts- ill. Or s:ntanie SOU Li Rt-Grade U single Pass Sand toter ' ~_~ Peat FilterI-.J Aerobic Treatment Unit `-~ Recirculating Sand Etilter i ip Line ^ Gravel-less Pitr~ % i~ Other (eic3fai«; ~ ~ ~ ~. v r ..a .~ vr_.r_„ . Design Plow (gpd) Design Soii Application Rate(gpdsf'i Aispersapl Area Required (si) Disp+ersal ea Pro sed(sfi ~~ Syst Elevation ,~ ~~ VI. Tatyk Info t'apacity in Total Number Mant!facturer 1, Prefab Site Steei,; Ft~9er i pl (ialions Gallons oT Units Concrete {:onstNCted ;Glass tN 1 ~a~a.k' ~-- r oo F ~,,.a.~~ Tanks Tarts ' + ~ Ne+~~ GTTxtsiin _.-__-_._ _._.____._ ~ + f _._ _ ~ ~._._ __. _ i If aepuc ur ticsiditig Tank ,,1~~ /~s~ / ~ ~~ y ~"`_ -- US, l ~ r r ' Aerooac Ttratmera Unit ~ , ~~~ ""`-"' Dosing Chamber ;y ---_~ ~ --_.~_---_------ - YII. R_~onsibility Statement- I, tht: ustdrrsigned, :usumr responsibility lilt ing~atlatinn of the t?l7WTS shown on the aniched otatu. rrutnper's Na me (Priori fI Plumber's Si gnature P1tS Number -""TBusinass Phone ,tiunrber Y UC tuber's Addrt ss (Street, City, State. Zip Code) ~~- / + Y]]I C ~ ~ _ . oun_t I}N artment Use u ( j- _ ___ Approved ~_) Dt~appraae~~/ Sanitary Permit Fee "includes Grounc!water Date Issued issuin gent Signan~rr t:No Stamps) l _- ~ 'Surcharge Fee) ~ ~ _ ~ ; a 9 ~ ~ J~`° van Rcaaon for Denial J _ _ _._ ---_ i IY Co di i ~~ ' ~ . n t ons gP Ap / I SYSTE NER: 3 ~ ~ ` s ~ S ~ ,~" ~ ' ~a ~ S~~'~`+~.c-sue ''1~ _~ -~ r, 1 Septic tank, effluent filter and cQQ~ o~ `~-~ S ~ti `(~ c~~V- i S rt9-n ~.,~-~-~ dispersal cel- must all be serviced /maintained n ~ { Q~ t S as per management plan provided by plumber.. - reC~cQp~ l 2. All setback requirements must be maintained i as per applicable code/ordinances. ~) ~ro ~~ ,y~,, "~ II, ~i'`'~e"v~e"n~ --~ c~f -= Q~ / ~/ ?~ _-^-r-__ r--- ..- ~_ .... _~ - ~ ._. -,.. 1 __.. r r.. ...,,. w......w ..,,~ .. s a uwaas ur aoa F k .,.. ~ ' O v ~~~ ~-.~ ' 63 c~ 9~ s%.3~ ~~`G~ia-rO~ ,U ~e Y f ~CPrr~ ~~ ~' !y l~// „ ~ %~~%~~ L ~~ ~. 63 :~ y ~• Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page _ ~ _of _ in accordance wrrn wmm ao, vvrs. Horn. ~.we t Pl i i County ~ r an mus n s ze. Attach complete site plan on paper not less than 8 1/2 x 11 inches include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and 1oc~tion and distance to nearest road. Parcel LD. Please print all fnforrrration. Persona! infoimalion you provide ma :be us t' (Prly y Law, s. 15.04 (t) (m)). Re ' ed by Date ~ r d9 Property Owner """ ~c1~ rd Property Location Govt Lot S' ~ 1 f4 r(jly 1l4 S I ( T ~ N R ~ E (or Property Owner's Mailing Address -~ ~ t~Z~ ~ Lo! # I (.~ Bbck # Sutxi. V ew -S I City State ~ Cod ~n ~ OFFICEr ^ Crty ^ Village Town rest Roa New Consirudion Use: ~ Residential I Number or izedrooms 3 '_~ Code derived design flow rate _~U~ ~Q ~ ___~_ GPD ^ Replacement ^ Public or commercial -Describe: _ -_- ~_ ---_- - --------- --- ._ . Parent material _-O U~ c~ 511_ ._--_--__ Fbod Plain elevation if applicable _-_~!1-~---_--_ h• General comments s yJ ~~ /Y~ ~ .Q V / ~ ~- d and recommendations: / ` a Boring # ~ Boring ~ i ~ pit Ground surface elev. _YL-~U ft. Depth to Ilmiting factor _-I~- in. Solt A lication Rate Horizon Depth Dominarit Color Rodox Description Texture S'trudure Consistence Boundary Roots GPD/fF in. Munsefl Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 2 d y/ -- S ~ ~ 1 2 t,-, sbk ,~ c 5 - . 4 - ~ 3 -l `tll~ - 5 ~5 m I - - . ~ ~ . Z Boring # ~ Boring ~~~ I' ~, pit Ground surface elev. ~ ft. Depth to Jimiting factor __`-_- in. Sorl A lication Rate Horizon Depth DominaneColor RedoxDescr~rtion Texture Struduro Consistence Boundary Roots GPDlft= in. Munsefl Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 (~ - } U f - 5 ~ ( ~ rvr~r C ~ ~ Z 13- (© f `I i c l 2 m 1 m~'r c 5. - . ~-I 1P _ Efliuent a#1 = BODS > 30 < 220 mg/L and TSS =^30 < 150 mg/L `effluent r~1 = t3UU5 < ;iu mg/i. and r 5~ ~ 3u mcyt. CST Name (Please Print)nature ~~ CST Number C1 Address Date Evaluation Conducted Telephone Number ~- I I_'~ ~(~;~'' ~-~ `~r~a ~'~~~5~-~ , lx! I -`~-tl-~ Z~ ~-1- I ~ - ~z-4 _l l~j -7Co 0 - CU Z7`~ ~S ,~ ., Property Owner __-~e~ ~ ------ Parcel ID # Page __ ~ of __~ ~ U Boring ~ U 3 Bo ring # ~ Pit Grou Q Oft nd surface elev. L(1 • ~D , D epth to limitin g cture Str factor Consistence in. Boundary Roots Soa A ica6on Rate GPDIft? Horizon Depth in. Dominant Color Munseil Redox Description Qu. Sz. Cont Cobr Texture u Gr. Sz. Sh. •E~ Eff#2 Z ~ 3( I ~ 4 -- 5' c 2 bk ~ ~ ` ~ 3 9 ~ ~~~ Lf Boring Boring # ft. Depth to limiting factor _____ in. ^ Pit Ground,surface elev. _________ Soil A liCation Rate Horizon Depth in. Dominant Color Munself Redox Description Qu. Sz. Cont Cobr Texture Structure Gr. Sz. Sh. Consistence Boundary Roots `Etfi#GPD/ft'Efi#2 'Boring Boring # Ground surface elev. _________ R. Depth to limiting factor ____ in. ^ Pit Soil A lication Rate Horizon Depth in. Dominant Coior Munsell Redox Description Qu. Sz. Cont Cobr Texture Structure Gr. Sz. Sh. Consistence Boundary Roots `Eff# GPD/ft~Eff#2 Effluent #1 =GODS > 30 < 220 mglL and TSS >30 < 150 mglL `Effluent #2 =GODS < 30 mglL and TSS < 30 mglL "fhe 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. sari eilo~a.auo<p ~~e ~ l ID # P Page -- ~ of _ Property Owner ___~-.~ arce ------ ^ Boring a 8orin9 # v ~ Pit Ground surface elev. [~~ 1 ~ U in. ft. DeP~ lD t~9 facbr Soa ICdtion Ra Horizon Depth Dominant Color Redox Description Texture Strudura Consistence Boundary Roots •E~GPDHFEff#2 in. Munsetl Qu. Sz. Cont Cobr Gr. Sz. Sh. Z- 3-3(c i b ~I- 5' c- bk r ~ _ - LJ Boring Boring # ^ Pit Ground,surface elev. _ ___ ft- Depth to limiting factor _- in• Soil A lication Rate i Texture Strudure Consistence Boundary Roots GPD/ft~ Horizon Depth in. Dominant Color Munsetl on Redox Descript Qu. Sz. Cont Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 U "Boring Boring # Ground surface elev. ___-_____ ft. Depth to limiting factor __~_ in. ^ Pit Soo A lication Rate Horizon Depth in. Dominant Color Munsetl Redox Description Qu. Sz. Cont Cobr Texture Strudun: Gr. Sz. Sh. Consistence Boundary Roots GPD/ft' 'Eff#1 'Eff#2 "Effluent #1 = BODS > 30 < 220 mg1L and TSS >30 < 150 mgfL "Effluent f#2 = BODS < 30 mglL and TSS < 30 mglL "flte 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. SB D-b] 301 R.07l00) y ~ -~ ~ ' PAGE~OF~ NAME: (3~ ~ r LOT#~LEGAL DESCRIPTION:~1/4Nwl/4,S~TZ~,N,R,~E(or~ SCALE: I"= yd r _ s ~+ ~ \ ELEVATION:_ ~ 0 U O - _ + - BM 1 DESCRIPTION: o ~~~ILC ~- BM 2 ELEVATION: q ~ ~ Lo O _ ~ BM 2 DESCRIPTION: D ~ ~--~~ SYSTEM ELEVATION:_~/ S . ~ O SYSTEM TYPE: ('O n u e /~ ~','u r` 0. N~K g,~ Is i~ I r:' 6- 3 rJ ~- Z 2• s 1 ~, ~> (~p,S ~, S ~ ~ ~~ .TUBE: ,~-~~ ~ ~C- i~ DATE:_~ ~t , . .SEPTIC TANK € PLrrtP CHAMflFR LRCSS SE(;TION_P.!?D SP::C;IFICf~TIONS ~+" CI VENT PIPE '12"MIN. ABOVE GRADE ~ ? 25' FRgM-_;T~O-OR;, WINAgW qR FRESH AIR INTAKE FINISHED GRADE -- 4" CI RISER -°~^ 18" IN. 6" MAX. N L E T ~ `-~ ~ ---"~ WATER TIGHT SEALS ~ .~.... { A .PPR4V ED .-}-~-. 'IPE 3' ~ $ INTO St}LID ~tI I L C PUMP OFF ELEV . FT . ~ --~-- D tv~.1MBER DOSES PER DAX : 7 3" APPROVED BEDDING UNJ~ER TANK APPkOV EJ MANHGLE CGUF,k '~I PADLOCK ~ WARN?NG i•AB£L --4" MT_N . ~~ ~/APPROVEfl JOINTS WITH ALM APPRpYED PIPE pN 3' ONTO SpLIO SOIL OFF' ~~` RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL CONCRETE PAD GPECIFIGA'IONS SEE'TIC I DOSE . TANK MANUFACTURER: ~ ~'~<~~..R TANK STZES: SEPTIC l~~Q +~AL. ~~ DOSE y~ GAL. ALARM MANUFACTURER: „ ,~~~ MODEL NUMBER: 'Qt..~1 SWITCH TYPE : 'h1~„i~,S„ PUMP MANUFACTURER : Asti MODEI. NUMBER : P d SWITCH TYPE: rne~C RE~tiIRED DISCHARGE RATE yl7 GPM DOSE VO~liME INGLUDT_NG ~'LOwsacx: I~'9 cAl. CAPACITIES: A = ~,~ INCHES =GAL. ~IEATHERPROUf ~JU~;CTION BGX WITH CONDUIT # ,. ......1. • ~l 6 ~ 1 GAS- , ' :'IGHT ~ t6 SEAL ' ~ ~ i ~ s ~ B ~ 2 INCEiES = ~~ GAL. C = ~ INCHES = AL. D = __~__ T NC HE 5 = ~_GA L . PUMP ~. ALARM WIRING AS PER Ii.HR Ib.23' WAC `IFRTiCAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE ~~e~. FEET ~° MINIMUM NETWORK SUPPLY PRESSURE 7.5 F£E'T + (~ D FEET FORCEt~iAIN X~I'T/iaR FT. FRICTION FACTOR ~~r £ET TATA~ DYNAMIC HEAD = FEET I!JTERNAL D?MENSI©23S OF PUMP TANK: LENGTH ..~- ; WIDTH .--~' ; DIAMETER --- I.IQUID b£r~TH"' ;3 ~ " ~ I ~,.r4~ p~R 1 ~ ~IGh'ED: .~,,./,~,~~,~r LICENSE NTJMaER: ~~.`~ Qq ~ DATE: 1J88 (~'. GOULDS PUMPS 5ubrnersible Effluent Pump 3 Q ~ ~ EP04 c~ EPOS APPLICATIONS Specifically designed for the following uses: • Eilluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: 3h' maximum. • Capacities: up to b0 GPM. • Total heads: up to 31 feet. • Discharge Size: t'/:" IJPT. • Mechanical set: carban- rotary/ceramic•stationary, BONA-N e{astomers. • Temperature: 144°F (40°h continuous 140°F (60~ intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. • Fully submerged !n high grade turbine q{l fpr lubrication and effkient heat transfer. Available far autdmist~c and manual operaliorl. Auto- metic models irMdpde Mechanical Ford Switch assembled and preset at the factory. FEATURES t EP04 Impeller; Thermoplas- tic Semi-open design with pump out vanes foI mechanical seas protection. EP05 impeller. Tr-errraptas• t!c enclosed design for improtrgd performance. Easing acid Base: Ragged thenn4p~stic design provides su~tior strRngth and corroswn ra#istence; St Pe+otar ficusfnp; Cast iron fpr efhdent heat transfer, stratgtl~; and durabUihr. >M Mentor Cover. Thermoplastic satri>!r ttiith ifdegrai handle and floift;witch atwc#tnnent prints. Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY_LISTING ~• tan~dfen Stanlmds Auodanon (CSA listed mode! numbers end w~p~ K iso soot ~y~rd. Motor: •EP04 Singfe phase: 0.4 HP, 115 or 230 V, 60 Hz, t 550 RPM, buih in overload whh automatic reset. • EP05 Singgle phase: Q.5 HP, t t 5 V, ti0 Hz, t 550 RPM, built in overload with automatic reset. • Power cord: l0 foot standardfength, t613 S170W with three prong grounding plug. Optional 20 foot length, t W3 S1TW with three prong grounding plug (standard on EPOS). METEkS FEET - _ ._ .,.,._ _....._.... . to _. 9 30~ -•... ~ ._. i `~~ B ~. , __ ' __ . 2.5 FT 25•_ ,._ .. ,,,. _ ._ __ . _ . . _ .., _ _ .. 2 i '^~. a 5 4 F ;, ;,._ _ EPOS o ~ ` ~ 10; .. . _ . ; ..._ .. . __ ... __.. _. a .. .. _ .. _ : - EPtNt 2 5. ~., i ' ._ O ~ L 0 , % d0 r 40 50 GPM o ~ ~O 4 ~ lr... A ' J.- _L.....~.__-_ 9 2 d 6 8 t0 .L m~fh cAPacirv Goulds Pumps ~ 20ooG0uida Pumps ~ !TT Industries Effective F•bru•ry. 2000 93871 ...~ Quick4 r~, STANDARD CHAMBER Cluick4 Standard Chamber MuEtiPort End Cap FRONT VIEW ~`x~~3if'~~.~~c ?'~ 'duicird.Ctan 1-.~-,r f r, , ~ ~ } ~_ L-______ _._.1.~_-.~._. '. SIUE VIEW Size ('rN x l: x H) ~ 34' x 52" x 12' Effective Length ' 48" Invert Neight g• INFI ATOR~Y$TEMS, INC. $JANDARD LiMITTT~D, WARRANTY TOP VIEW - - __t. - ..r.... ..... Size(WxL~xH} `~ 34"x16"x12" Invert Height - 8" or 1.25" ia7 1 ne aUuelurnl .nlegrSy of r!ach ciramtJrx, anU Plata watlga and other accasory rrarxrfaclurod Uy Iplllha'.o: { "Ur"1!i J, when rrtsl?Ned ar u) nlxxalrx3 ;n a iea,'Idieid of an onsi!a Si:C~IiG System xl acCnrdarlce w:'Ih inf;lifatcr'<. u5lrucf:en;, .c wanarllnt! IU Iln (xigula: 'iLVCha3er (`Hnldar') nya;ny delactrva n.!aiena!s ano wor"nwnartg~ for ono year Irrxn the date that UM sr'Ulti perntil is i6vrer7 W tl:e rxtptic syslmn cu; rtaurutg Iha Unirs; PrnvrLlP,U, h!!wevor, !bar tl a Selxic permit is rut re~uirM W aDGlir:rWle law, tha warranty {uuin3 w;U bog"t c,<wn tM; Ca7P 7hfi nnlmfatx,n d the septro system come;arr_as. i> a ymise i15 wanardy ngl7t5.. Holder mu51 ndtl!y Infipratpr in vriling al ds ux[Krale HBadµrrvler.^, in Okl .`Jryhrc"Jk, Cmtrr9clidut wrlnin rry9gn { 15; Uays of the allalJed UCtav.:l. !nltlra!ur mn71 supply rrpLioenrant Uni16 for Unas cietnrmirreA try ;n1~9iratrx F~ C7p covered by Ihis LhrWad Yv,~rrartry. Innltrators liad:lity sj>BC.JoCaly excluCaS the cost cl removal ar7d/or Inslalleiro~: o{ tea Vnits. '~,i TF6_ LIMt7EU WARRAN I'i ANp RcMLDIES IN SUdPARAGRAFH {-J) ASiE EXGLU6Nti. 7N14RG ARE NO U1HER WARRAM7ES WITH RF_SPF.CT i': ; HL tirJrr, iVC'_ULNN~ n!L IMP"eG NlAiiRANTlES OF MEFII'HANiAL'iL1TY OH 1-17 NO'S I UI. A Fy~R1iCUlAH F1JRF'IiSL-", lr%1 ~ t ~+>-mitts W 7th s.',an l rd i. an} at t Ju. 9,ar 7br sY le.n n.r r 1 I ie Uv r-y. na a I r. + nr r ~rli era- The Lln't n Wa r2 xy odes' nil e ~ t .nd to ;nc 7e tsi ;.on,urluanrar. Y:k'tFil r u,A rer:t clan39r . i:!rat ~r ,hat nn: ttA; dde 6> pn a r,.. <" lir7uigefed ciao atlm i r,ramy Ir,as r>I produUivn anU P uhl', L, Gor and 7 aleria!S, arras .ran co51s m orlrer bases tx exlie7sas rrnaed by the H:)fUa! ~x any thirU Party. Spdr:iCU'aIN rx IuUari from Lim tc,l JJsranry canerago am carnage to um Urns due to ordinary waa. ar U roar, a::oralxxr, accidml misuse, abuse or rwr7a;t of lie. Jnits: tr,u Udls haing sutNn~!ed to •re~ac;a UaCic or Mhef cond'•rans which are nut or. mitlrxJ Dy the rrrtaCalicn itslruolaxls: failure Io rnair"ain the rni ,rnifm ground ClNerc set ICxth iR tho a151a11a4TN1 instructions, the pfacerrrent of XnPr`-71!rr materials 19fo the systHm crx7i2irw7p ?he. U7rits: lallura of irm unxs or the septic syslr7rn due Io improper siting s irrrproper srzin{j, excesSNe wa!cx t7sada, irnprrJpef arnasa gispossl, a rmpropsr eperslbn; a any ollwr event '~ldf caused try InW.Vaior. -this lanilr7d Warranty shaN'na vc"1 it l^a }JCJger fail:; to wrnpry with al! of lhA !arms Set b*NM ir7 ttris LhnHr,d wanmtty, fuartr it rw a'anf shall YrGllralrr be err ponsihla ter any krs5 or dama?e ^,a tha HU4it/, fh~: Unls. dr any ihinl Lv:Jty resuflmg kar, inslatlalion w ship- mGril ) from arty pn,UUq Iaoilay c4r•ma of Huider a any !bird Party F4)r Ihis hmilr7d W,rranly to apC ~y Rre - I^x;5 must be n7sta!lec! in accrxdanr~ mlr, all ste r.~ rd fa s rtiuuir:aU by slate atvl Me=al cocas: all ollwr appliczible i2ws, anU fnallr lnr$ urSlallanU¢'. r{;tM:!iGns. inj No represanlal;vs 61 lnri!tra;u has Ilia aullxnNy' t0 CnanyO Jr aMltlrY.7 Ihis Lirrnlrrcl 4Y'arrar y. Nn wananly apdiaS fo ary parry uthm than me W1(;i- nal rWlder I hn ai"Y+u rrpreSr+~'li5 fhe Standard landed Warranty !171a[y,'f by InldlrllOr A ti; n,u:[I nrxnilP.r of ~tale> and WI,nIraS Irava dxlaranl wmrmtty rm¢rira nranls. Any pun,trasar OI UrNls shuulU tnntact Nliitraux'S Carrurate Haadhuarlers in UW Sayhruuh, (.Dons<:Leur, Irrnr to such Wrchasq, ru obtan a crSC'y df the applicable wurranry, and shWlU carelulry reed that wanacly pour to the puroha,e et Uu!s- ar ~ • r ~Y~TEMS I N C Environmieva`tai Onsite Wastey+ater Sotutrons`" 6 E3usiness Park Road • P.O. Box 768 Old Saybrook, LT 06475 860-'577-7000 • FAX 860-577-7001 800-22f-4436 u ~. atenty: a.+o-J,ti6r; b,Ut /,U47; S,i S6.488; 5,33b 01 % 5,40t t t6; 5,4C 1 45 f: b S1 ,,JUG; 5,716,163; S,SfS8,7'A, S,E339,t344 anadian F'arenU 1,329,959; 2 004,564 Olner paten!5 pendin; Ir tiflr£rre Ecp,a!:zer and SideWind¢r are rer~rstered trade.rarks of InGltrak)• ay- Ir~ms text. frrflltrulor is a «a0istexed trarlomark in France. InfNtrafor Syatems Inc. ~, a reyislered trademark in Mexh;o. Coniotlr, Contour ~rvivel Connection, Mk;roLeadrng Porytulf, Srwpt-ocx, Ohamt7erSpacer, Posii.ock. 0~:~:kCw, fluicxFfat' aecvc~eavwea StG11UIV VIEW POWTS ~WN~R'8 MANUgit, & IIi~ANAQEMENT PLAN ~~ ~~~. ~ row ~ ~- ~: \ ~ : i31f ~~ fliPEClFlCAnoN: 1 Permk x ~ ~°I , !,n ~ ~" DE8tON RAMMf:TERs Number of 8adrooma 4{' C1 NA Number of Public Facility Units, ~ ~ NA Estimated fbw laveragsi ~ peaign flow lpeak}, (Estimated x 1.5} GQ p aUda Soa Appficatbn Rate f!d /ft° Standard !nf}usnt/Efffuent Quality Manihly avafagif" Fats, Oii ~ (3raase IFOG) S30 mp/l. BiochemioN Oxygen Demand tBOO`l 5220 rnglL Q NA Total &uapended Solids (TSSi 5160 mQ1L Pretreated Effluent Quality Monthly average Siachamicsi Oxygen Demand f13ODs} 530 mgli. Total Suspended Solids ITSSi s30 mgJL !~ NA Fecal Coiiform lGaometric mean} S1O` ofullUQrnl Maximum Effluent Particia Size Kin die. q NA Other: » NA ~Valuas tyf~ f~' damsetk wastewater and septic tank sftlupM. f p'ee or $pptic Tank Capacity ,~ lJ of DNA B+fptfc Tank Manufacturer ~ d NA Effluent Flltar Manufacturer ' ~ ~ {~ NA &1!f~nt Fitter Mode! Sd' C~ NA Ramp Tank Capacity al DNA Pur>7p Tank Manufacturer ~reS ~,Y, d NA Pump Manufacturer ~,,F4 / Q NA Pump Model Q NA prftr~arment unit Q /gravel Fliter Q {N~ohanicai Aeration p piak~faction O Peat Fllter v wstleuui D Other: O NA DiepNraaf Cstl(af Q in~i3round igravltyi Q Ai-tirade U Drip-Liras O NA Q M-round iprossurizedi D Maund ^ Other: i"s ©NA Oth.ri DNA ^ NA MAINnfNANCE SCHEDULE Sarrrka Event Sarvia Frs~ency inspect condition of tank(si At least once every; ~ a s (Maxlrrwm 3 ysa-s} DNA Pump out oonteinte of rankle! When combined sNddgs and scum equals one-bird ~Yg! of tank volumo t~ NA inspect dispersal celliai At Isast once every; ,~ month(a} tMaxEna+m 3 yaara} earts>s} DNA Clean effluent fEter At bast enca every: ~ ~ montlilei eats} ©NA inspect pump, pump controls & alarm At Bast Grace ivory: r--- mottthle} a earls} DNA Flush Istsrafs and pressure teat At igast once every: r-- 0 ""a" el al Q NA other: At lessee ancp every: .._- o m ~sitsi ^ NA Other: G NA MAINnE1iANCE INSTkUCTlONB inepectiona of tanks and dispersal cells shall be made by an individual carrying one of rho taflowinp licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; pOWTS Inspector; PC}WT5 MamtaMer; Saptage Servicing Operator. Tank inspectIane must include s visual inspection of the tankls) tc id~dntify any missing ar broken hardware, identify any cracks or teaks. measure the volume of combined sludge end scum and to ohecfe for any back up or ponding of effluent on the ground surface. The dispersal cefflsi shall be visually inspected to chock iha eftluar-t levels in the observation pipes and tc check for any ponding of effluent on the ground surface. The ponding of effluert on did Around outface may indicate a failing condition and requires the immediate notif~ation of the local regulatory authority, When the combined accumulation of sludge end scum in any tirftlf equsie one-third lY'1 or more of the tank volume, the entire contents of the tank shall ba removed by a 5eptaae Ssrvicinp pperstCr and disposed of in accordance with chapter NR 113, Wiscanain AdmlMatrathre Gode. Alf other services, Incfud}rag but not limited to the sgrvi4ing of effluan# tNtars, mechanical or pressurized gomponents, pretreatment units, end any servicuoq at intarva1s of S'12 months, steal) be performed by a eertif'red POw'rS Maintainer. A service report shalt be provided to the Local regulatory autharlcy within f0 days of complatbn of any service event. •apa~ en,iBJlBtul~R~/ ursuaasiM '!E) S iZ) 'il)45'68 ~p 1t)>~tPlit)(Q)jr;l~t'~i~ wwo~ ~sul8ya yyM aausiidu,oo u} pe~RJp tYM ioau,{haop ~yl , • o~~ ~ )--E euot~ auoud h ~~ N~ ~..I ,vns~~ y~l c~11~ - ~ S eweN _ • _ euJeN JLLIaOH1f1tl Aa011/lilOS!! 1tla01 1l3dWfld! tlOlV 3d0 •l;1NIOIAlHS 9pVtd3s 4d auufN li3N{VINIVW 8 Od »'11V1SN! S1MOd - - S1N3WW00 'IVNOLLIGGV '3'18185~i3dWl ilti ,L1fSDli~ ~ AVW SNVI d ~O 1lORI31N! 3Hl WOtl3 NOSli~d a d0 3t10S3a '11t18SSd AVW H1V30 'g~ONV/lSWf101d1~ AN1i- »~dNO ;IN~I111N~w1V3tl1 tl3Hio a0 dWrid 'OIld38 d 1lS.tN~ lON Ot! 'NdOAXO iy3lOiddflSNl 1!C/ON1f 83SSV'J '1dN.J~y NIilJ.N00 A~IIN I;SNVI J.NSW11/31~1133H10 ON < C ONiNSOI~.LMd93> •awlx is'yi ie 1o$;;a ui svtnJ •yx yilm AldWoy xetiua su»isi~to gone;o suo!~nJisuooa>j •aos;Jns onlieJi!!1u! eyx 18 iewo!q ayx ;o IQnowaJ BulMOilo; aveid u! palotuisurip~J, eq Aew sWO;eAs uond~osge iioe epsJB-ie pue punoyy ^ ~usi ~' 1 ~ ails 'S1MOd pollal ayi oasldoJ of ~2bseJ 3fRi a sg pal{slaw eq neuJ ~lusi Bulploy a ABolouyaw S.LMQd u! seouenpg BuuJSg •suollatluay floe Jo/pus ~aagio0 of anp algaflone lou sl aaJa iu•uJaoe~deJ a{geilns t/ [] •owyi teyi is ioe~}a w selhJ ayx yllm Aidtuoo isnw swaie~ls xuawao4)da~ '~aaJa xuauiaoeid•J etgei)n¢ a y$)iq~~A ox uoiYah~tno ails pue floe Mau a Jo; paau ayi u! lineal plM B9J@ iue-uvoeldaJ •yi xoaioJd ox aifl)ie~ •s11sm puff sou)I 'lOi '~~l13onJ~a pasOdoJd pue Su-is!xa ~uoJ; s~loegias pea)nbeJ Aq uodn peBuiJ;ui eq iou pinoys pus uaiioedwoa pus A~upgln~eip wv~; peiao~o~d aq p)noys seas iuaweaeldeJ ayl •u~ais~ts uo!idJOSge llas iuauJ•oeideJ a ;o uotieaol +ayl Ja; pazipxn sq X#w pua peilt•r{(~na uasq sey seas iuewaa+aide: aigeiins y :wels~ls iu•wao•;del iuetildwoa apoo a aplnoJd of 'uo~lei oq isnui Jo 'uaaq snot' seJnaeeus dulMO~to; oyl poJtedaJ eq xouuso pugNs~d AaN30DN1 NCO •!¢lJaisw ptlos iJeu! Jayious Jo 1a11eJ8 'floe yiiM papi~ aaeds pton ayi pus panouJa~ s.~anod Jiay3 Jo panawe~ pua paiensoxo eq Heys sild pue s~u•i !~¢ `8u}dwnd Jai;y • •JOieJedp 8urotnJag aBe~dag a Aq ~o posod~r~ ~~~sdo~d put panuuld~ eq geys slid pue s~iuei tte;o siueiuoa ayl • •palevs s8uluedo wild p•uopuoge oyl puQ pa~oaUUOOSIp oq ileys si!d pus s~lual of Bwdld !ly • :apo~ enlleJislulwpar ulsuoae)M `£6'£8 wwo0 Jaiddub yi!m aouelidutoo ul pauopuege Ale;es pue AlJadoJd sl weisns ayi ieyi eJRSUI of ue~le3 aq l{eys edeis BulMb(~; syi apinJSS ~b inb ue~lel tillueuewJad sl Jo/pue ells; S,1(y~Od syl ueyM ,;,NSWNO4N~fSt1 •au!Jq Jsuex;Os Js3ann pue :IIUOdwsJ :sul~deu Jueilues :saplallsad :sionpoJd 6uliu!ad :lio :suolieo!peuJ :sdsJOS ieew :sapioigJay :as~a~8 :euiioso8 sbu(~ead a(gela~en pus x)nJ; :JexsM (dwnd dwhs) u-eap uoiiapuho; :ie; :siueio®;uis!p :sJedelp :ssol; {eiuap :sJassaJCep ;sgercns uoiioa :swopuoo :ssinq aueJeB!o :sadlM ~lgeq :so!lolgliue :S1MOd eqi ;o a:{l{ ayi BuolaJd pue aoueuuo}Jad eyi enoxiwt Aew weeJas ~bxeMoxs~lnir oyi woJ; 9ulMOllo; oyi ;o uoliewwlla Jo uoiiaripgd •sOJL UOi;dJOSgd lloo Wp+rJ6-i¢ ~o punow Aue }o adols uMOp iaa; g 1 ulyi+,M esJe ayi 'losdwoa ~o gJnlslp oslMJOyio Jo 'Jano ~IJQd ~o enllp lop bb •s{laa 1ss~odslp pus s~lue2 Jano salalyan ~iJed Jo anlJp iou o0 '~1U82 dtuAd 8y2 ulyilM slanal l6WJOU aJOlSaJ o; s~aiuoo dwnd ayi pu!ieJado A!ienusw ul is!sse of iou~eau(~y~j $.lMbd ~c legwhld g ioeiuoo Jo duJnd luani;;a eyi of JenROd BuIJOiIISJ of JolJd JoieJadp buioinJag aBsid•g s Aq panOwa~ ~jU61 du)nd ayx ~o s3uaiuoo ayi ansy uoilenils sly3 pane of •luehlHa ;o a6Jeyosip eaa~ns Jo dn~aep eyi u! ilhsaJ Aeui pus isliiaA ayi Du!peo!Jano 'saebp able= suo ui {s)Ilao IssJadstip ayl of pa82eyasip 2q IIIM JaieMBi9@M SsB~%9 al{i paJO1SeJ 8i JahtOd u$yM 'spans! ~igM4a44 taWJCU enoga lll; stew s~lusi dwnd Se6e211o JAMOd QulJnd •eog;J/1s anpaJSlllul q4i ;a uosoJ; •Ja sdolllpuoa floe ueyM Jn~oo lou peya do IJOiS wois~cg ~asn b1 1d!jd JdigJada 6ulolnJas o8eldas a ~tq p•nouJaJ is)~luol ayi ;o sauaiuaa ayi a~~ay paiaaiep ale suo!xeJiu93uoo y$ly ;t `(s)ll~o ig~JsdsEp ayi ofJawep Jo~pue sssaoJd iuawieaai eyi apeduli Aew ieyi sleo~wayo Jayia Ja sionpoJd 9ulauled ;o aouasaJd ayi Jo; i~)ilust lueua>>se~i ~{fls+;a S1MOd 842;o asn of NO ~.atd3d0 ONV dtl liidl3 ;o aged sT c~totx cavlvT~r SBPTIC TANK MAINT'I~hIANCB AQREI3MENT s ,9 Al\1J OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address _- ~ 1 S~O ~. , ~ ~,~_ ~ v~S ©N ~~ Proptuty Address -- _ _ _ , ` .. City/State (Verifeation t~equirod from planning Department for new Parcel 1dtnNfioation Number ~^ - _ ~ n __~~ ~~ ~/ Prop LocatYOnS ~ 1/ ~~ ~ ~Y _____ +, ....~. !<, Sac. ~ ~ , T a°~N-R ~ W, Tawn of cS~So t~.~ , Subdivision m c ~~ ~ ,~e:., ~ -~.,. ,~ Lot # I l.? , Certified Survey Map # ~_" Volumo -_- - _ ~-Pogo # Wur~tnty Deed # 2- ~ l I o Volume _ ~{0 3 _ .page # ~ ~~ Spec house ^ yes O na Lot lines identifiable (~ yos ©no &~'STEM MA,INTENANt:.'E Improper use and maituenaa~x of your septic systemm could result in its prematut+e failure to handle wastes. proper maintenance ooosists of p~~ oat the sR;ptic tank Query three years or sooner, if needed by a licensed pumper. What you put into the system can affect the fwiction of the septic tank as a treatment mge in the waste disposal system. the properly owner agrees to submit to St. Croix Zoning Department a oettIficatfon form, signed by the owner nand by s ~rPI~~. f ouraaYrnan PIS. restricted plumber or a licensed pumper verifying that (I }the oa-alto wastewater disposal system is is prgxzr operating condition and/or (2} aRor iaupection and pumping (if noccssary), the sepHo tank is Iess than 1/3 hull of sludge. I/vre, the undersigned have read the abovo ngoiremcnts and agree to auintain the private sewagt disposal system with the standards set forth, herein, as sot by the Deputmcat of Commetre and the Ikpartment of Natural Resources, State of Wisconsin. Cexti£ication stating flirt your septic system has been tuaintaiat:d must be completed sad returned to the St. Croix County Zoning Office within 30 days of the three year expiration daft. 'to ~ G SIQNATURB O APPLICANT DATE QWIYER CERTIFICATION t (wt) txrtify that all statements an this form are true to the best of my (our) larowledge. I {wc) am (are) the owner(s) of the pt4petty described above, by virtue of s warnaty decd recorded is Register of Deeds OtYice. SI(?NATiJRB Olt APPLICANT DATE «««««« Any information that is tail-raprescnted may tssuit in the sanitary permit boing revoked by the Zoning Deparnaent. «s ««* '« Include wfth this sppllcatlott: a stamped warranty doed from rho Register of Deeds office a Dopy of the certified survey asap if rofaronce is made in tha wamnty deed n ". ~Pti d- ~ lt' "~ . {(~ t rb~srtta ran ~~. '`?~~ ~ ~~'~ ~r '+ _ ~ _ ~; _Y, ' .' ~' } t:. ,. ~~S.: ~: ~ ~~ fAN!D~,i i`1! :n,. ..[' ~ ~ s L~AIr * r~~.7 A _ '.,~:. ~ s. L ~ r , ` ~~ ~ ~~ ~ ~~ ~ a~i ~; }~' ~ - s ~~~~ \ \ ~ ~ ~ I ( I / 1 ~~ r`~~ I _ I ~ E~ _ ~ea~r a~aaooooarb~a~ ~ ~ M M~MfQ/plfllM W \~• ~ ~ ~ ~ I 4 ~ / ~ ~ I .~ a~ / ¢E ~ ~ ~"' ~ r ~,. ti - • -~• . ~~ -~ N ~I ,~ 0 -- ~' z ~ .- ~ ~ $~ ~~ ,~ ! ~~~ .M z ~ ~ ~ ! ,,~ ~~ ~~! .~~ ~~ ~ ~ ° ~ . j I ~ ~ a~ _ i '~ ~~ i~ A ®~ ~}~~~~~~~~~~~~~~~~~~a~~ ~ ~t~~~~~~g~~~~~~~~~~~~~~ ~ tti~~i~ig3~goae~~~i~~a~ M ~ ~~~~~~~~~~~~~~~~~~~~ - r ~ utt~w..va u vwr~r '~~ ~aaaf < sn /i ~o-ui Z Ml Y mOp01 ll~ ~S t= i 4 ~ L ~ E ~N ~ ~ ~~~ ~ ~~~ ~ ~~ ~ ~1~ 4YY94999YY9Y44999 ' y~~~i~ r c a z s z~ - - aaa.aaaa.aaaaaaa~ iii ; s~ :~ ~ ! Q!. i `ff ~` ~ ~ o ~ ~ i i - - - i dig' ~:~~ !t1 a _~niwo i~~Nra n • ~.» N os nivoo w li ~ ~ ~ ~ •-----••------... _ ~ ~ M'N ~pH ~ ~ .A 3 z N F- Z U W , .~, ~I ~ ~ ~i~ ~ ~~ ~~~ q~ ~G e x~~ _ Ke ~a K€ ~4'Ee ~~ Z U N Z 0 U X O OC U H °~i N ~i~ *: Z ~ q .i ~~//~~ I V! ~ O ~~ s~ ~' 2 i Kn' LL ~ QL O z 3 0 ~MMM11F3~tl~~~~Y~lK~~ `~~ .!!@3l~9lQ~lQ9iQQ4~! ` ~ r~9~~~3~~~3~i~~3~~~3i ~~,.,~:~~a~~~:3~a~aaaaa~a ,~! •~"` , ` ' e i a ~i~~r: ~~~~~'. .itl3 1yZ' ~ttE~: ~~~~~~ .Z11l ~pplr~o~ ~ 1~~~~1 ~I1Iii 3l~~~:~ ~r ~ ~qyq, P s~skesvgv:;ssgq~q e~~ trrtttttttrrettrt ' ZK~~Iq 9 E~~~ee a .tt~}} ~ j~3J]s ~=~~~s ~~~~~~ .eooaq .~~~:~ Y'~i I ~w ,K¢'M ~ ~ .- ~ ,, ,- ,r - ' ,~ 3'' L , ~~~ ~' ~~ /~ / ~/• ~ / ~; ~~; ,~ ~; dam, ~' C ~~~ , J ~ ~'. ,.~ .. Jam' t.._ ~ ~ ~ •'~'" ~ ~,.__ j ~ ~i; I ~ a -~- ~ ~ ~ I J ~ f °~~ I ~ I j i t j I , r , ' i i r ~ ~ o ~ ~ i J~ ~~ , f ~ G/ I ~ ~ f =~ 1 f 1 ' ~~ ' ~ ~ "1 i I' h C i ~ ~ i ~ I ~r- f . ~ J QI I ~'~~W / f ! ~ ~ w / I "I] i r~ ~ f ~ l ~ ~•~ r ~ i / r •. i ~~; 3 : g ~ i'~ ~ I t N ~>R ~ I ~ ~ r I 0~ \ "~~ ~ r~~ I j ~~ I, ~ I ~ I ~ I i ~ ~triR ~~- , I ~ ~ $~ ~ ~ y I 1 .' ~