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Projec Address (if different than mailing address) L Application Information -Please Print All Information .;;`.!' ~ ~ ~~ ~ f)~ ~f/ Property Owner's Name arcel # Lot # Block # / Property Owner's Mailing Address ~ Property Location / ~ S / ~ ,' / ~~ % ~~/. Section Cit State Zi C d b Ph N ., , y, p e o um er one (d T OC -/ N; R11 E orQNJ II. Type of Building (check all that apply) _ or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number ~ ^ PubliclCommercial -Describe Use ~ ^ State Owned -Describe Use ^City_^Vil age Township of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) ~ -~Q Q A. New System ^ Replacement System ^ TreatmendHolding Tank Replacement Only ^ Other Modification to Existing System I3 ^ Permit Renewal ,Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration ~ Plumber Owner /J s~ 7 ~ ~ - 7~ N. 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 Wetland ^ Pressurized [n-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Leachin Chamber ^ Dri Line ^ Gravel-less Pipe ^ Oth r (exp ) V. Dis ersaUTreatment Area Information: U / "" Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Propos (sf) System Elevation ~/s ~7 ~~~ ,~3 y,ss 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 or Holding Tank ~~~ ~ ~dd~ / C Aerobic Treatment Unit _/ / Dosing Chamber ~~` V ~ / ~~ VII. Respon s ibility Statem ent- I, the undetsi ned, assume responsibility for installation of the POWTS shown on the attached plans. Plu r' N e (Print) ~t pp y Plum s Sign r PRS Number Business Phone Number ~~~ //~//Iz(1(J~C/ ~ ~ /fl aa~ ~s7 ~~s = a~ ~ - ~ ~~ Plumber's Address (Street, City, Stat ,Zip Cod //~~ ~ ~ l~ ~ 1~1~~ ~~`bc, VIII. oun /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (i eludes Groundwater ~)~ Surcharge Fee) ~ Date ssued ~' Iss ' g Agent ignat (No ps) ^ Owner Given Reason for Denial / V / ~ ~~ 0 IX. (:onditions of ApprovaV Reasons for Disapproval // A ~ / / n ,, , ` 7~ ~Gf G^~ vl'G~l~r1G~~'/ /~~~~ ~ ~~~ GU~L~u~ Attach complete plans (to the County only) for the system on paper not Tess Wan 8112 x 11 iaches in aiu SBD-6398 (R. 01/03) 3 N6 -ldD ~~ . a 1, ~-~~ ,~~°~'s iN~' ~~ y s~~~ ~~ " D jh~ ~~o~s> COMBINATION SEPTIC/DOSE CHAMBER TANK & PUMP SPECIFICATIONS PER COMM 84.25 CODE CHANGES 2/1/2004 Access Opening, not top of cower, must adend to a point no greater than 6" Belsw Finished Grade Cover with Sr~IGA'f}~ Lockingg Device ~j~, (tYPical) NI I.UNvI~ SEW t~ > 301:=r: ~42,~ o~ TNSULA~ ply ~_.~_. Min. 23" Access Opening Ouh:t Effluent Filter ~ Inlet Baffle '89~ Access Opening, not top of cover, must e~dend at least 4" Above Finished ~G ade . ~ ~PP rZe~D CA ~ IFinished Grade I lZ NM,N/rh um ..~ Min. 23" Access Opening ~ 2 ~, PiYG ~~ C~/hi4 /~ rv /'rN If ~~o-'c SC~'E ~ ,Union ~ppeoYE?~ ~/PE" 3 f~T 3 ",Sand cr na,~f' ~h~y unQler u~~~!-F, t~eh-~er 2„ /atuer fah Qd~Ps Two ComparTment SepticlPumpTank ~,~,p ~~,„ ~~~ o~ pride G(l~/~) SPECIFICATIONS TANK MFR: LLB.. TANK SIZE: SEPTIC I ~~~ GAL. DOSE (gSG GAL. ALARM MFR: i MODEL # Switch type: ~~'I,~-~--y,~ PUMP MFR: Cr- MODEL #: ,E_ /, ~~~ . SWITCH TYPE: ~Yu-~,--~ ~. REQUIRED DISCHARGE RATE GPM DOSES PER DAY: DOSE VOLUME: ~ 3 GAL. (INCLUDES FLOWBACK & <20% OF DWF) CAPACITIES: A = 17S~INCHES = ~ ~, I AL. B = _2_INCHES = 3 y` o~AL. C = I ~~ ~O~I,NCHES = OZ~GAL. D = ~.Sr INCHES = Z~ ~SS~GAL. PUMP & ALARM WIRING PER COMM 83.43(8)(e) VERTICAL DIFFERENCE BETWEEN PUMP OFF & DISTRIBUTION PIPE (LIFT) = g~ .~ FT. MINIMUM NETWORK SUPPLY PR~SSURE (DISTAL & NETWORK PRESSURE) _ `~ ~C~ FT. OF FORCEMAIN x ~~~ FT./100 FT. FRICTION FACTOR ...... _ + ASS FT. TOTAL DYNAM{C HEAD (TDH) = FT. INTERNAL TANK DIMENSIONS: LENGTH ;WIDTH ;LIQUID DEPTH 3 MP/MPRS SIGNATURE: _ ~ LICENSE NUMBER: ~~ ~ 3S GOULDS PUMPS Submersible Effluent Pump ., ~~ EP 04 & EP 05 Seri es APPLICATIONS • Fully submerged in high ^ EP05 Impeller: Thermoplas- ^ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed desi n for following uses: lubrication and efficient g heavy duty ball bearing improved performance, construction. • Effluent systems heat transfer, ^ Casing and Base; Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms manual operation. Auto- superior strength and corrosion • Heavy duty sump matic models include resistance. SP, Canadian StandardsAssouaaon • Water transfer Mechanical Float Switch ^ Motor Housing: Cast iron _ File ~ LR38549 • Dewatering assembled and preset at the for efficient heat transfer, Goulds Pumps is Is0 9001 Registered. SPECIFICATIONS factory. ~ strength, and durability. ^ Motor Cover: Thermoplastic • Solids handling capability: FEATURES cover with integral handle and '/~" maximum: ^ EP04 Impeller: Thermoplas• float switch attachment points. • Capacities: up to 60 GPM, tic semi-open design with ~ Power Cable: Severe duty • Total heads: up to 31 feet. pump out vanes for mechanical rated oil and water,resistant. • Discharge size: 1'/z" NPT, seal protection. • Mechanical seal: carbon- rotary/ceramic•stationary, BUNA-N elastomers. • Temperature: 104 °F (40°C) continuous 140°F (60°C) Intermittent. METERS FEET • Fasteners: 300 series ro '~ -----__.~__________ stainless steel. ~ - • Capable of running 9 30 dry without damage to ^'~~-SGPM --_-'. 8 ,..__. components. _ _ __ ,~ zs 2.sr~ 0 7 __~I Motor: a :...... W _. ..................... _ __ _ • EP04 Single phase: 0.4 HP, v 6 zo 1 15 or 230 V, 60 Hz, 1550 a '~'~'~-'--- -- _.._ i __ RPM, built in overload with } s ~ - .. _ _ automatic reset. ~ t s • EP05 Single phase: 0.5 HP, ~ a --- ;..... ~...__ 115 V or 230V, 60 Hz, 1550 ° EPOS RPM, built in overload with 3 10 i automatic reset. I Z ....... _..... . • ower cord: 10 foot EPOa standard length, 16/3 ~ S i. _.. ... _ SJTW with three prong " ~ ~ i -, grounding plug. Optional 20 0 0o f ' foot length, 16/3 SJTW with t o - i' 20 30 40 three prong grounding plug so GPM (standard on EP05). o z a Ei 8 10 t 2 m~/h CAPACITY Goulds Pumps ~ 2003 Goulds Pumps EHecnve July, 2003 638J7 ITT Industries Wisconsin 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 Becker, Edward Hudson Townshi ST BM Elev: Insp. BM Elev: BM Description: , 'A NFORMATION ELEVA ON DATA TYPE MANUFACTURER CAPACITY Septic ~~ /ODD Dosing C~~ [ O ~ ! ~j Aeration ~~ / ~f Holding ~ ~ ~ /}/~~~ TANK SETBACK INFORMATION TANK TO P L WE B~. Vent to Air Intake ROAD Septic - > I I ~ ~ ZD , Dosing / ~ Aeration Holding PUMP/SIPHON INFORMATION Manufacturer / Demand ~q~ GI~ y~ Model Number D // 1 ~ TDH Li ~ Frictio Loss System _Hlea .a T ~ ~ Ft a ~/ /~ Forcemain Lengt Dia. ~ ~ 'st. to well ~- Yi K SOIL ABSORPTION SYSTEM ~ (' f J / 7 BED/TRENCH Width ~ ~ Length ~ p No. Of Trenche~ DIMENSIONS 2 (~ SETBACK SYSTEM TO P/L BLD WE INFORMATION _ System: BUTTON SYSTEM SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ Bed/Trench Edges Topsoil i Yes ~j No ~l Yes j Ji No ~k COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:_~/ 22/~ ~ ~ ~no~~/ Location: 964 LaBarge Rd Hudson, WI 54016 (SE 1/4 NW 11414 T29N R19W) Sweet GrasnsnFarm Lot 4 Parcel No: 14.29.19.2265 1.) Alt BM Description = r ' ,( tl, ~(~ (~(..tQJCX-I j~ 1~ ~ L r~c~ /~ 2.) Bldg sewer length = z (~ ~ / V v~dl~.(-ns (~,/l /7i ~~ ~ - - amount of cover =~ , 11 !~ -~-e Plan revision Required? '_- ' es j No ~ .~ ~ - / ~~ ~~ ~ Use other side for additional information. _ ~_ _ ~ ~ ~1~~ ~. I ~-~- SBD-6710 (R.3/97) Date Insepctor's Sign ure Cert. No. , ~ ~ ~ I t~,' County: St. Cr01X sanitary Permit No: 405173 0 State Plan ID No: Parcel Tax No: 020-1376-04-000 STATION BS HI FS ELEV. Benchmark `j /1~3.e ~1~, Alt. BM - ~o ~s ~~ 2.~' ~0~ 6 Bldg Sewer ~ ~S r / ~2T "'_ 1/( ~~ SUHt Inlet ~Z 2 ~D` SUH~ tlet ~ ~~ Dt Inlet / ,,,~~ Dt Bottom ~ n - I~-~ ~ ~-~ Header an. (p .- ~ ~ , Dist. Pipe 7 s• Bot. S stem Final Grade NE ~~ .~ X03-~ St Cover )f~2'K~ ~~ YI t N i PIT DIpdEP}SIONS No. Of Pits LAKE/STREAM LEACHIN CHAMBER v ~'~ Depth ?,,,1 s/ I c i m. Header/M nifo~d `, h~ Dia_ Piper`s; tion ~~ ~ Length/ Dia Spacing x Hole Size ~- x Hole Spacing_ ~__ Vent to Air Intake ~ ~ ~ ~~a~` ~~. t Safety and Buildings Division 201 W. Washington Ave.. P.O. Box 7162 CO°a~' ~~ /S~O~~I~ Madison, WI 53707 - 7162 Siu Address De artment of Commerce ~(-i -O t. 535 Sanitary Permit Application ~~' Pernut Number OS / Ia accord with Comm 83.21, Wis. Adm. Code, personal information you provide ^ Check if Revision ma be used for ses Priva Law, s15. 1 m I. Application Information -Please Print All Information Stau Plaa I.D. Number _ / /V property is Name •~ CEIVED Parcel Number ~ 37 -p -O~ Property Owner's Mailing /-~ress Property Location ~ y~ T~ JUN 1 3 2002 ~; S T N, R City, Stau Zip Code Phone Number Lot r Block Number a '- CROIX COUNTI' S ~ . ONII~G OFFICE Su 'd ' ame CSM Number 5`' yol b ~ u~ II. of Building (check all that apply) /~.Pisc.- OCiry 1 or 2 Family Dwelling -Number of Bedrooms ___) -NLO'>t.a~-~ ^Village public/Commercial -Describe Use owruhip ^ State owned ~ T~lCk~ 3~X 7"' ~ X Nearest Road f D ~ ~ ~ ~ •~ ~ _ ~ r ~ f lII. Type of Permit: (Check only one box on line A (ntrmbe a for internal use). Complete ' e B if ap cable) A 1 New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to For County use m Tank Onl Exis ' sum Permit Number Dau Issued B. ^ Check if Sanitary Pemlit Previously Issued FV. Type of Permit: (Check all that apply)(ntrmbering scheme is for internal use) l6 d ~ 50 ^ Constructed Wetland ~~Sil'~3~ ~ ' ^ Sand Filur 44F~Non-Pressurized hrGround 21^ Mound 47 22 ^ pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other V. Dis tment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area / Soil Application Percolation Rau System Elevation Final Grade tion Elev lI h Required proposed / f ~ ~/ a ) ~ nc Rate(t,;als./Days/Sq.Ft~ (Min. " GILG/J• LSD ~ ~ ~s3 l ~S ~~ d , ~. Tank ~p Capacity in Tonal Number Manufacturer Prefab Site Steel Fiber Plastic Coacreu Cottsutrcted Glass Gallons Gallons of Tanks ~ ~~ New Existing ~ Tanks Tanks Septic or Holding Tank ~ .~ l 0O Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume rescpoasibility for ' tloa of the POWTS shown on the attached plans. Pl 's N (Print) Plumber' /tv~RS Number Business Photte Number ~ u ~ a~.D.~~- ~ pis - ago - ~~ Plumber's Address (Street, City, S u, Zip r~~ N ~ ~ ~.~~ ~ o0 VIII Cotmt /De artment Use Onl Sanitary Permit Fee (includes Groundwaur Dau Issued I at Signature (No Stamps) Approved ^ Disapproved Surcharge Fee) ~ i Q ~ ~'~~-~ ^ Owner Given Initial Adverse ~¢- ~" -~ S r ~ " ~f ~"yG- Deurmination iX. Conditions of ApprovaUReasons for Disapproval `J`"~"' ~~ ~~ - tic -~~ ~ 3 ~ c~3 _ /, ~ ~ ~ t? G~ 92~~a ~~ ~n . . .e infi ~ G"<.~2.« vh:~~rt;~G~E;¢~t.~., '~.rt. > Z S' .~'rdY>7 ~~ fiLr.ik~ > $ 0 ~ ~~.I~ ~v~~i~.~ , i ~ . _ .1- n_ ~> ._ ~ / ~~ / _ -~ • - n _ l~ . ,r,-Y AiL:tr-- ~~ ~~ _ 1'A.f. //)~~.. i...ld ~D t~~ ~~O~~Td~ '~ ~ ~ ~'~ (/~ AgaCh pi p (to tLe County only) for tfte system on PoPer' not fns t5en 8112 11 f t size ~ ,~I,(zy/1/J r SBD-6398 (R. OS/Ol) S~ ~~~v 3-~~~D ~, ~vo u~" ~d~D 5 T D~ /O ~~ l ~~ ~ q p r '~ ~D ~ = ~d~ TO~ ~ I ~ J~(~L ,A~a f & ~ i o,~ z ~, crT p ~~" - ~~~ r i3-I !~-~ 3 ~ ,oo ~ -- ~a ~'-~ ~`-3-y ~M ~~ Z ~---. G~~ t~-~o S ~ tf-io 4351 (~~ ~ s~- y.s ii y O \ ~~S o~ ~ -J S~ o ~ ~ ~ °~' o C7 c ~ ~ ', c ~ ~ 3 ,~~ y1 ~ ~ ~ ~ ~ ~ 3 ~ r: '.~ ~ o~ ~ ~ _ . O Z~ Z O O H = A N - ~( `C • o W, ~ ~ ~ ~ ~ o ~ ~r~ n ~' `2 '~, ~ ~ A R O fD a N ~- 7 N p ~ ° ~ p S _ - 7 N O '~,. ~ -e O ~ « ~~ cn Z D ~i ~ ~ a v ', cn D `~ a WI I i m Q- ~ c° ~~ ~ ~ ~ +~wVl I m °' I 2 o N °°-~i yea 3 '~ ~ ~ C '0 p ~ ~ A !n M~ ~ N ~ ~ p I ~ ~/~ a IQ v O v rn c ° W ~ • ^^ V ' ~ ~ a ~ ~ y ~ ~ ~ .. ~ N o I O I (~ D D ~ ~ V l ~ Q m ~ m t ~• I I ~ N N N ~ tN D C N I ~ a I ~ ~ m ~ ~ -~ A Z n o c ~_ ~ .,! a A ~ ~ //~~ J V/ ~ J n -~ Z a ~ , A' ~ I , c z m y ~ < ~ ~ ~I i W i Q O ~ C o a I IN I ~ ~ x i b' ~' c a '~ I a N ~ O ~ ~ ~ ~ ~i I b Op b I ~ 0 I A ~ a a ~ ~ O ~ ~ . .,.~ ~ ~~ 1i3$ ~~ ~(~~ ,~ ~1 ~ ~~ ~~~ u ~~ w ~~~ ~'~ v~ + \,~. Parcel #: 020-1376-04-000 02/16/2005 10:23 AM PAGE 1 OF 1 Alt. Parcel #: 14.29.19.2265 020 -TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * =Current Owner EDWARD J & CABBIE BECKER "BECKER, EDWARD J & CABBIE 964 LABARGE RD HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description " 964 LABARGE RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.080 Plat: 2530-SWEET GRASS FARM LTS 1/78'00 SEC 14 T29N R19W PT SE NW SWEET GRASS Block/Condo Bldg: LOT 04 FARM LOT 4 2.080AC EZ-U-1558/119 EZ-U-1708/617 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 14-29N-19W SE NW Notes: Parcel History: Date Doc # Vol/Page Type 03/18/2004 756978 2529/242 WD 06/04/2002 680839 1904/328 WD 08/31!2000 629124 1539/081 WD 08/25/2000 628820 8/8 PLAT 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 50164 288,500 Valuations: Last Changed: 06/06/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.080 48,200 175,000 223,200 NO Totals for 2004: Gen eral Property 2.080 48,200 175,000 223,200 Woodland 0.000 0 0 Totals for 2003: Gen eral Property 2.080 48,200 175,000 223,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount 018-RECYCLING SPECIAL ASSESSM ENT 27.00 Special Assessments Special Charges Delinquent Charges Total 27.00 0.00 0.00 scons.~ Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings` Bureau~of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Page f of Attach complete site plan on paper not less ttran S 1/2 x 11 inches in size. Plan must """`r include, but not limited to: vertical and horizontal reference point (BM), direction and _ j.~ ~,,,Q~; X percent slope, scale or dimensions, north arrow, and locatio distance to nearest road. parcel I.D. # ~,~,'` 1. ; _ ,, ; n. d 2~- l 37(0- a - ~a APPLICANT INFORMATION -Pleas ~fdrtall in~rmarion: ~'~, Revie by Date Personal information you provide may be used fors oitdaty purp~{R4ivac~Law, s ~15.04i(1) (m)). ~ j :~r~ Property Owner ` ~ Property Location ~ ~ ~ ~• ;~ ,~ 1 ~ ~ ~~~ ~ Goy .Lot SSE ,~ 1 /A?/G/ 1/4,S ~ y TZ a( ,N,R t ~' E (or) irk Property Oywnre~r's Mailing A~d/~dress 1 ~ r, .~ tJ~;::,~~: Lo # Block# Subd. Name or CSM# t J~J ~ (r1V~1Gt. ~L~ ~~ ~~~ ~Ir • ~Jl}N?"ti <~ ~ City State Zip Code 'Phone um er ~ City ^ Village ® Town Nearest Road ~v bs ~~ I w ~ i s ~t o 16'~1,~ I ~`• jr5ii4 <tt0'~ ~`° ~ u c! 50 n `0. G New Construction Use: 'Residential /Number of bedroorr ^ Replacement ^ Public or commercial -Describe: 3~ Addition to existing building Code derived daily flow (soy gpd Recommended design loading rate • 2 bed, gpd/fi2 ~ trench, gpd/ft2 Absorption area required X55 bed, ft2 7 ~'tren ft2 Maximum design loading rate ' 7 bed, gpd/ft2 ~~ trench, gpd/ft2 Recommended infiltration surface elev~at~i/on(s ~ S~ ~~ ft (as referred to site plan benchmark) Additional design/site considerations /iT ~'t ~~ ~ /,, Parent material ~ U'"~ w a. 5 ~ Flood plain elevation, if applicable ~ ~` ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ®S ^ U ~ S ^ U ~ S ^ U ~'S ^ U ^ S U ^ S SOIL DESCRIPTION REPORT Boring # Ground elev. `~S~ ft. Depth to limiting factor ~_in. Boring # Ground elev. 9'~7.$I ft. Depth to limiting factor /b ( in. Horizon Depth Dominant Color Mottles Structure i B d ts R GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Cons stence oun ary oo Bed ,Trench ~ b -t0 O 3 _ s :~ Z f~ ~i~ L ' Z ~® in - S~~ 2imAa +~, Cs ' ~ 6 -t Q 6 ~` t'~5~ Y~~ 5. ll~= 52, g., , Yg.(o~ ' Remarks: ~~~ ~~~/ ~-s~Y'" 3 3~-wt b "" v'h5 ~ ~ ~.5 ' ~ Remarks: ~~'f' ~~~` :.ST Name (Please Print) ignature Telephone No. edam Sch~ raker G~ C~ ~ s~ Zy 7 - ~1 Address Date CST Number Z~13 ~6D~ S~• So -~- I 'S`-IUZS ~I-~I -DU L533o5 PROPERTY OWNER S~'~' PARCEL I.D.# Boring # 3 Ground elev. 9~i. ~J I ft. Depth to limiting factor `t in. Boring # Ground elev. Q~~ ft. Depth to limiting factor Ilil in. Boring # 5 Ground elev. ~$3r ft. Depth to limiting factor .~~in. Boring # Ground elev. ft. SOIL DESCRIPTION REPORT Page Hof Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench ~ 0--16 i0yt~ Z 5 ~~ 2 Mq ~~ C5 I F ~~ 6 1 16-`11 ~ b R y ~ i 2 m, C S - ~; -6 -u i 'i ~ ._ ~5 w~ ~ C ~ ~ ~ ~ N 87.~y Remarks: .PiQ ~ ~~yS r~~t 1 -I ti~ z - ` ZW~A6~ M~ C5 ~vf~ 5 ; 6 _ o-Jb yl 6 ~ was n..,L ILL cs ~' ~ ~ Remarks: ~LT f~'12G~ Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/f12 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench ~ o _ta ~ 3 t .L r-- 5, Z,~gr: t,,,.,~,,z ~ S 1 v F S~ 6 o y ~ b -- ~ ~~ ~t ~S ~- ; S ~~ ~~~ / , S `f `' ' _ J) _ Depth to limiting factor in. Remarks: SBD-8330 (R.9/98) PAGE~OF~ NAME S'~U ~- LOT# ~-I LEGAL DESCRIPTIONS '/4~Lty'/4,S/y TZ~f,N,R-R E (orYGJ~ r SCALE: 1"= (CX~ BM I ELEVATION (~~U , U BM I DESCRIPTION.-.,,Po.~ ~ ~~~ ~L ,~,,P2 lu-i~w/ F~~ BM 2 ELEVATION ~, O BM 2 DESCRIPTION tvpo~ ~ ~ ~~~~p,.~e~ (c,.~~'b,,~.,~~~[~~ SYSTEM ELEVATION ~J` ~ ( ALTERNATE ELEVATION ~~ 3 ~ CONTOUR ELEVATION A,f/d4 I I ~L xaaL 1_ r~ B. P~ , M° ~`~ ~5 43 2 ,~~~ ~~ ~~ .2 6 [~~"~ w ~(~ ~5 ~ ~ 1lATF. ~- / ~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION Owner Permit # 5,--~~3 DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ~--" ^ NA Estimated flow (average) al/day Design flow (peak), (Estimated x 1.5) ~ gal/day Soil Application Rate (~ . ~ gal/day/ftZ Standard Influent/Effluent Quality Monthly average" Fats, Oil & Grease (FOG) <_30 mg/L Biochemical Oxygen Demand (GODS) <_220 mg/L ^ NA Total Suspended Solids (TSS) <_150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand IBODSI S30 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Coliform (geometric mean) S10° cfu/100m1 Maximum Effluent Particle Size Ya in dia. ^ NA Other: ^ NA 'Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity `Q(~~ al ^ NA Septic Tank Manufacturer G,~c.c~~. ^ NA Effluent Filter Manufacturer ~ ^ NA Effluent Filter Model ~- ®Q ^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer [ia-f~ Pump Manufacturer ~A Pump Model ~ QNdA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ^ NA D' Its -Ground (gravity) ^ At-Gra e ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tankls) At least once every: ^ month(s) (Maximum 3 years) ear(s) ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third IY31 of tank volume ^ NA Inspect dispersal cellls) At least once every: ^monthls) (Maximum 3 years) yearls) ^ NA month(s) ^ NA Clean effluent filter At least once every: ~ year(s) ^monthls) ^ NA Ins ect um pum controls & alarm p P P. P At least once eve ry~ ^yearls) ' ^monthls) ^ NA Flush laterals and pressure test At least once every: ^yearls) Other: At least once every: ^ monthls) ^yearls) ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS (nspections 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 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 IY3) 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, shalt 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. Page of S7749~1' UP AND OPERATION For new construction, prior to use of the POWTS check treatment tanklsl for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal celllsl. If high concentrations are detected have the contents of 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 celllsl 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 and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ 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 ~ ~ ~~ POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) OCAL REGULATORY AUTHORITY Name Phone L Name Phone ~~~ • ~ - This document was drafted in compliance with chapter Comm 83.22(211b11111d)&If) and 83.54111, 12i & (31, Wisconsin Administrative Code. ~ ~ 3Jdd ~130~If18 ~1371~38 ~ OI Wd8S ~ ~T f1Hl Z00d-6-1,dW C}wn~r/Buyer Mailing Addrt;ss ST CROIX CUUNTY SFPTiC 'T'ANK MAIN7'ENANCB AGREEMENT AND t]'I~VNERSHIP C;~RTIFI~,a,TION FORM 3 LcJ,Z _ ~S~~I Property Address O % ` S ~/(, S ~/y~Gl ,Dast,Yl/ GcJ ~ .S~S~~ G (Veriticafion required from Panning I3cpartrnent for new cons#rr~Gtion) CitylState f~u DsoA/ G~~ ..~ Parcel Identification Number clot 0 _ (v ~ `t 'OO ~G~AL AESCRTPI'~bN Property Lacati~zt .,~ i,, N ~i~, sec. ~ T~N-R~W, 'town of _,~~UOS ~ ~ - Subdivision .SGt9 G~2 SS Lot # ~ ~- Certid Survey ~Ylap # Volt3mte _ .Page # 'Warranty Deed ~# VoItune Page # ~,. Spec house yes ^ uo IZ Lot iiaes ideutifialaie ~L yes ^ ao ~ `'~ ~IYANCE ~~ a~ II~~£J/Olir SCptIC Sy3t~ CDr]~~ rZSirlt rn 1tg preinatnr+e~failme W handle wastes. Pmp~r jr_nanr-r CORLSis~ Of ~~ ~lrt thG Septic ~[ cQery three y~ ar BppQEli ~ seeded by S hceused FVhat t C~ a~Ct IhC firart;o$ pf' tb~ Septic tam as a trcatuient ~c III t~G waste dzcpOSBi system ~ ~ ~~ ~+ 8ys~iDl master I~ ~~ $ to st~mit to St. C`.s~ix Zo~ng I)epar[ment ~ cation Toms, segstcd by the awn,cr and b3' a is in ~ ~~j°3'~P,rGStrictcdpluusberorali~dPump~'ve~y~g~(2)Neon-site~vastewate~rdisposalsysDem ~~ ~ edition ~d(or (2j al3cr inspection and p'miPi~g (if aoassary), ~ c sank is less tbsa 1/3 fur! of sludge Uwe, the undersign have read the aba~+c retitt and agrx to maize ~ private sewage disposal system with the staod~ands set forth. heroin, aS cot by the Departcoent of Gdmutezxx and the bepartment of Natural ~~ that ~O1i c $3' has been ~. State of Wisconsin. Certi~eatian maiai~exi moat be c~ztzplcted andretuzaed to the 5k 4aix County Zoning Office within 30 days tie tYnrce year •aa da , SIGNA'I'(JRB {3F L,ICANf ! ! ©'Z DATE QWNER CF~CAT~UN F {we) comfy that aIi ststemcuts ore this farm arc Brae to ehc best of mY (~)1~towledge. F {wo) am {arc) the owner(s) of ~ desezibed , b}' 'hrtuc of a warranty deed recorded irz Register o£ Deeds Office. SIGNATLTR'lr aF APPLICANT ~ ~ ~ ~ DATE """** Any informatiozz that is mis-rcprescntedmay result in the soul «~,.«+.~ tary pClrnit being revoked by t1zC ZA[ring Dcgarimetii. «` Frzelude with this application: a stamped ~NKranty deed frorxi the Rcgiater of Deeds office a copy of the certified ststvcy map if reference is zezade in the warranty decd i=d WaZS:OZ ~00~ 60 '~~W 00ZS9b~SZZ 'ON }Cb~ rJNIldfld~X~ ~~0~1~1 WO~Id r U 190ti N 328 ~~ 1 ' STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED Document Number This Deed, made between RICHARD O. STOUT -nd TAN>:'T P 4TOUT _~lii_t._..,ay~_,~ FEaI ~. - Grantor, -"-- - -- A MARRIED PERSON and _ F.BWARB- , ------ ---'" ___ __, Grantee. Grantor. for a valuable consideration, conveys and warrants to Grantee the following describ real es a in $~ f+s^617L County. State of Wisconsin: Lot 4, P at of Sweet Grass Farm, Town of Hudson, t. Croix County, Wisconsin, 680839 KATHLEEIi H. NALSH REGISTER OF DEEDS ST. CROIK CD., NI RECEIVED FOR RECORD 06-04-2002 12:30 Px NARRRNTY DEED EXEMPT i REC FEE: 11.00 TRANS FEE: 176.18 COPY FEE: CERT COPY FEE: t+.: ;I:;,t,,, a..,,, PAGES: 1 "~eEp~~r~'~~i'LgLEY BANK, NA 133y {.'rOU~cB P~ PO 3iox 7U ,, Hudson, WI 54016 n_2n ~~~F_na-oon parcel Identification Number (PIN) This ~ ~ riothomestead property (is) (1s not) Exeeptions to warranties: easements, restrictions, rights-of-way and covenants of record. ~-' ~nn2. Dated this ~ day of ~~~ ~ ~' ~jfiyt.t~ ~ ~Z~ - (SEAL) a ~ n (SEAL) u;rhard O. Stout . Janet P. Stout (SEAL) AUTHENTICATION Signature(s) authenticated this day of (SEAL) ACKNOWLEDGMENT State of Wlsconsin, ss. S Croix ',Ju~tY Personally came before me this l day of May 2 ° D 2 ,the above named n ,- Stout --- TITLE: MEMBER STATE BAR OF WISCONSIN (If not, me known authori2ed by §706.06. Wis. Stats.) tns[ntn , THIS INSTRUMENT WAS DRAFTED BV Janet P. Stout 1353 Awatukee Tr. _ Hu son, WZ Notary ut My mtr (Signatures may be authenticated or acknowledged. Both are na[ necessary) ' Names of yersoru signing m any capacity must be typed or primed aeiow their signature. STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2 - 1998 __ to the [oregoing J. BAST „ v . State of W sc nsin m t~ p ~ ent. (If not, state exp_ir}at~iton~date: WlacOn$In Legal stank l:o., InC. Milwaukee. Wis. ~~ =~ P b. T~~' 4' `' ~. Ey,~: N V (D,' -t ~~ ~ ~ N IVl)•OVN .I .\ ~ A ~bJ'96l . .. ~~'' -I- •~- I ~~'••. .. I........... ...I 1 I I ~ 1 ~ j ~ N !~•~ V -+ ~ A ~. M/'a4 r ~g o ~ ~~ 1 O T~ ~~ ~ ~; ~ ~ ry ~z , r~ -'~ g O D ~ ~ ~ ~ ~ ~ W cn --~ fl ~, ~ o ~ c ~ i ,, ~ ~ ~ -P . . ~ ~ _~• ~ x ~~ ' ~ .~~ ~ ~. j I ~ o ' ~'' $ ,6Y'E8913.9p,44o00S i I M:. :~; ~ I ~~ t.~ rlqu~3s 3rln d/ t N1noS - wuboa a,,~:,: ` °~11~~e'7 ,OS'LOL l 3~. l,t~ lopOS I T I ~ _ 1 I ~Q ~~~i]c~G`JCnI I