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HomeMy WebLinkAbout020-1376-11-000 ~ I eC o ° ' N ~ ~ n ~ ~ ~ +.~ ~ ~ ~ ~ `o I h °o '_ ~ ~ to I N y n h O V L N y ` O C Y •C ~ O C ~ C O ~ ~ C f ~ 0 ~% r ~ a Z I ~ ~ :°• N ~ I O` w N S ~ ~ N p ~ C ~ ~ r ~ y ~ N Z ~ a v c o o ~ ~ I 7 LL U ~ ~ C c (O ~ N ~ C ~ .. .. O b9 -p O- p O '~ f6 V a as ~rnv vOi I M 3 I I v e i Z y ~ Z v !' p z r a m ~ ~ N I o I v O Z ~ ~ r • ~ 7 N '_ y Z ~ fn F- r O` Of ~ O ~ Z c ~ ~ I ~ ~ ('7 1 N _ ~ ~ .C > N •~ i ~ ~ t O O w I Q Z Z Z ~° N € Z ~ ~ I ~ ~ y ~ y ~ ~ ~ ~ ~ W d L N O ~ G D a ~ v ~- /~ 3 r CO ~ 01 v _'N ~ r ~ ~ ~ _ O ~N ;~ _ a a a ~ N I ~i a ~ ~ I (~J 1 _ ~ w ~ V C N N v ~ N ~ }~~ fA J y O O N N 7 } v ~i 7 = N N N ~ -~ ~ O O ~ J ~~ p~ OJ r C d ~ ~ y y d N ~ CA a n U3 ~ m ~ d l0 LL y N ~ O '~ oc c O ~ y c ~ O C~ ~ n ~ N C ~ p 4 ~ r ~ ~ r c~ F" ~ C C = . 0 N_ ~ V ~O M~ C Y N ~ 7 ~ y 7 N . ~ r a y - m d~ O C N D ~ ~ ~ N~ 3 o S N p m v o C N Z_ a U ~ cn ~ 0 a ~ v ~ ~, ~ ` € a `Ira +~-+ a ~ •~ c c r r A Ua~ ONti f ~) Safety and Buildings ' Counrys ( ~ ` ~ ~ 201 W. Washington Ave., [ .O. Box , ~~p--C, , ~sconsin 07 - 7162 Madiso ry Permit N u mber (to be filled in by Co ) Sanit a Department of Commerce ~y ( 8) 26*'[ ~ ~ i ~ / ~! ©L~ /p~ Sanitary Permit Applic tion ~ ~"" -• to Plan LD. Number N In accord with Comm 83.21, Wis. Adm. Code, personal in rmationytlu~ptovae., may be used for secondary purposes Privacy Law sl 5.04(1 xm) - _ ! ~ , ~ Project Address different than mailing address) I. Application Information -Please Print All Information ZQNI /X C~'~1NT Y NG ~~ S GF- Property Owner's Name Parcel # t # Block # / / Propert y Owner's Mailin g Address Property Location C / / - n L ~ ~°~ '~ ` /~~'/. Section ~ % City, State Zip Code Phone Number , , . ` AJ-^_ w- ~~-~s"~'rV v ` ~ / ~l tc7 ~~s a yG -sx.~ G T ~ / N; R ~ cEcl) II. Type of Building (check all that apply) ~l or 2 Family Dwelling -Number of Bedrooms ~ Subdivision Name CSM Number ^ Public/Commercial -Describe Use ^ State Owned -Describe Use ^Ciry_^Vill ge Township of III. T ype of Permit: (Check only one box on line A. Complete line B if applicable) - aCy Z A' ~ New S stem y ^ Replacement System ^ TreatmenUHolding 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 OHmer L/ ~ ~~ _ ~ `rn _ ~. J ~J N. T e of POWTS S stem: Check all that a I Non -Pressurized In-Ground ^ Mound >_ 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Leaching Chamber ^ Drip Li ave - ther (explain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispers ea Required (sf) Dis al Area Proposed (sf) System Elevation ~ /sv 7 ~ ~ S y ~ y q , VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Ta~ilcs Septic or Holding Tank l~ U b / U / ~ , I ( ` ~- Aerobic Treatment Unit ~ ~ Dosing Chamber ~ D VII. Responsibility Statement- I, the undersigned, assume res onsibility for in Ilation of the POWTS shown on the attached plans. Plu is Name (Print) ~~ ~~ Plum r s Sig ure PRS Number Business Phone Number as 3s7 ~~s- a6 U - ~y .~- Plumber's Address (Street, City, State, Zip Code) ~`~-~ ~ ~~ VI I. n ~1De artment Use Onl pproved ^ Disapproved Sanitary Permit Fee (includes Groundwater Dat ]ssue uing Agen ig lure tamps) Surcharge Fee) add ~ Z~ ^ Owner Given Reason for Denial Q 0 . IX. (:onditions of Approval/Reasons for Disapproval ~~. ~~ .~ ~ Sys ;fa;~,,f~- ~~, ~~- 3~~- ~-~- Athch complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in siu SBD-6398 (R. 01/03) COMBINATION SEPTIC/DOSE CHAMBER TANK & PUMP SPECIFICATIONS PER COMM 84.25 CODE CHANGES 2/1/2004 Access Opening, not top of cover, must e~end to a point no greater than 6" Below Finished Grade Cover uuith ~nlcn~rl-l Lockingg Device ~~ (typical %VILWNl~ ~v~/~ > 30 ~r: ~.q~ ~, 0 ~. iti15U~'~ PIS --~-- Min. 23" Access Opening Ouh:t Effluent Filter ~ Inlet baffle DOSE VOLUME: ~3 GAL. (INCLUDES FLOWBACK & <20% OF DWF) 3 "S~+1d or~,-~ t~ l bedd~n~ uncle l~ w i ~h c~Qh~2f- Z •• /acuer fah Qdc~PS Two Compar ment SepticlPump Tank (~ L _ _ _ ~,/Q~ o ~ ~~;de `/~/~) SPECIFICATIONS TANK MFR: DOSES PER DAY: TANK SIZE: SEPTIC ©O GAL. DOSE ~ GAL. ALARM MFR: ~ MODEL # 17C, U Switch type: PUMP MFR: l...o MODEL #: ~ c> SWITCH TYPE: ~%/_ T- REQUIRED DISCHARGE RATE o~~S_ GPM CAPACITIES: A = ~O'_INCHES = GAL. Access Opening, not top of cover, must eHtend at least 4" Above Finished G ade ~ S,yY ~PP~`~ CAS Finished Grade 1 !Z NM ~N/~ um .-~- Min. 23" Access Opening Z „ f,~rs ~F6,~ cEiyiA/N j w~~ if ~~O/c S!~'E ~ ,Union 2cVE~ ~/PE 3 pT, i~M ON`1 a SOL /D SO/ L. B = _2_,INCHES =~_GAL. C = ~~INCHES = ~~_GAL. D = S INCHES = GAL. PUMP & ALARM WIRING PER COMM 83.43(8)(e) VERTICAL DIFFERENCE BETWEEN PUMP OFF & DISTRIBUTION PIPE (LIFT) _ ~~ ~d ~ FT. MINIMUM NETWORK SUPPLY PRESSURE (DISTAL & NETWORK PRESSURE) _ + '--~ FT. ~~_FT. OF FORCEMAIN x 1, /C~ FT./100 FT. FRICTION FACTOR ...... _ +~FT. TOTAL DYNAMIC HEAD (TDH) = Jai/y FT. INTERNAL TANK DIMENSIONS: LENGTH ;WIDTH ;LIQUID DEPTH MP/MPRS SIGNATURE: LICENSENUMBER:_ %o7b,3S~ ~GOULDS PUMPS APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: '/<" maximum. • Capacities; up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1'/z" NPT. • Mechanical seal: carbon- rota ry/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • EP05 Single phase: 0.5 HP, 115 V or 230V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length, 16/3 SJTW with three prong grounding plug. Optional 20 foot length, 16/3 SJTW with three prong grounding plug (standard on EP05). 0 2003 Goulds Pumps Effective July, 2003 83871 • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- matic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller: Thermoplas- tic semi-open design with pump out vanes for mechanical seal protection. METERS FEET 10 9 30 a 0 a W x u a } 0 J 0 6r 20 s 4 3 z 1 0 5 00 Submersible Effluent Pump .. EP04 & EP05 Series ^ EP05 Impeller: Thermoplas- ticenclosed design for improved performance, ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover: Thermoplastic cover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water,resistant. 0 2 4 6 CAPACITY ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING s P, Canadian Standards Assodation ,_ File # LR38549 Goulds Pumps is ISO 9001 Registered. $ 10 12 m~/h Goulds Pumps ITT Industries . Jisconsin department of Commerce PRIVATE SEWAGE SYSTEM Safety and r~uilding Division INSPECTION REPORT GENERAL~INFORMATION (ATTACH TO PERMIT) Parcnnal information you orovide may be used for secondaN Purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Bast, Kernon Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: r i11"rwwATlAwI FI FV~TION ATA NIYn IIYr V111r1r1 ~ w~~ TYPE MANUFACTURER CAPACITY Septic ~ ~ P~ Dosing ~~'~ ' '` ? Aeration ~i~ ~ A / " Holding ~7~'~ renll[ cGTR~rK INFORMATION ..~%~,.,~-~z 1,~,,~ ~;~ aiti ~ ,c4 ~ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~/ ~ / ` ~~ / ~~ / ~~ / .~ Dosing Aeration Holding PUMP/SIPHON INFORMATION l'1~t~-vl1,~r.-~.~ ~.Yc./I Manufacturer ~U~ ~-~ s Model Number _ TDH Lift ction Loss System Head I Force L t ~ Dist /~; ~~' . _.. - ~......-.w~. . ve~Trww i .. .. / county: St. Croix Sanitary Permit No: 404922 0 State Plan ID No: Parcel Tax No: 020-1376-11-000 STATION BS HI FS ELEV. Benchmark a a ~~Z" v~ .~5 /(~~3 ~ EGG Alt. M ~ ~ o-~ kc3~- ,~~, n~ ~. ~ ~ C~J Bldg. Sewer ~r~ f3. S G Iv S Ht Inlet ~ ~ O~ o SUHt Outlet Vul~~ d Dt ~~~ ~'`~ -Jz~, D~tom ~ ~ 1,' tti :~ , ~~ ~~~ S Q '] 0 / • 3~ Hem ad r/Nl~ LV`C- ~13f' Dist. Pipe/ ' Bot. System 4I Orl ENc'~ f L (, ~ Z(~ ., l 3 Q• ~~ ~7 ~ / 9 ~' Z / Final Grade I^ ~ p v St Coven ~Dv ~ ~ ~ nG G/ I BED/TRENCH ~ ./ No. Of Tre hes Width ( Lengt ' ~ P~DIMENSI No. Of its Inside D~ liquid D~tf' DIMENSIONS ' ~ (, ~f' , ' SETBACK P/L BLDG WELL SYSTEM TO LAKE/STREAM LEACHING Manufy~urer ~ " 1~ r CHAMBER i C~ L i..~ INFORMATION Typ Of System: I ~ ~j ~ d l ~ ~ITNIT Model Number 11~[~TPf lr1~ ITIlIA~ cvc-r~nn v.v .. ~~r+ ...........- . Header/Manifold ~... Distribution /- I x Hole Size x Hole Spacing Ve Ir ~ Pipe(s) ~/j t ~ ~ " -''-. ~ rp S ~ Dia Length " Dia Spacing VJ Length ~' ~~u i+weo ...-_--_-- ^--._~_ ~_i.. .,.. ~w.,.....r n. Ar_r_r~no wsrems unnr De t er-,, r-- p Depth Over xx Depth of xx Seeded/Sodded xx Mule... /Trench Center ~ ~~ 2 p Be ___. Bed/Trench Edges Topsoil / Yes ', No r i Yes =, No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:.~/. `7 ! U=% Inspection tF'1: / i_ Location: 965 Fraser Lane Hudson, WI 54016 (SE 1/4 NW 1/414 T29N R19W) Sweet Grass Farm Lot 11 Parcel No: 14.29.19.2272 1.) Alt BM Description = ba Ufa-Y'n J ~~~~ ~~ I ~~ 2.) Bldg sewer length = 2 7 1 - amount of cover = ~ ~ d 1 G ~~ ~ :.~u~~~ /'"~`"' ` ~~'~``~ I" "~' Plan revision Required? es ~I No ~ Q~ ~ ~!p ~I (J77~ Use other side for addition ion. ~_ ~1 ~ -- • Date Insepctors Si nature Cert. No. SBD-6710 (8.3/97) ~ ~~/ ~~ r/ ~bS,.~t'V •vt,. ~C,c"~.~ c~ Girn~?hJ ~y ~t1Yr'~-ds nt to Air Intake d ~~~ o ~54~ ~ ~ ---,ti ,~ ~~ I i -~- ~~ ~ ~,2,~ ~? . .~ -, ~ ~~, I ~~~ ~ i ~! ~p~' ~~ ~~,~~~~ ~ Safety and Buildings Division County C ~ ~ 201 W. Washington Ave., P.O. Box 7162 (~{° - o ~ ~ ,~~~ns,~ Madison, WI 53707 - 7162 ite Address ~ ~~• Department of Commerce Sanitary Permit Applicati~~- ,~ ~~PertnitNumber ~ ~ / ZZ In accord with Comm 83.21, Wis. Adm. Code, rsonal info n you pmvide-- Pe ^ Check if Revision ma be used for seco ses Privac Law, s15: 1 m ., I. Application Information -Please Print All Information State Plan I.D. Number . ,~ Property Owner's Name r , . r 1~ _~ ~' ~~~~~ ' P 1 Number ~b ao - 137 /~-boo Property Owner's Mailing Address ~` ' ',. =~7t1f4TY .i _ . _~ -;P perry Location ~'~ , ~ liMGt~ffipF , ~ ~i 54 ~ 54; S T 2 N. R City, State Zip Code phone Ntttnber ; `•. . .. ~_ ' Lot N ber Block Number r f t ~ i ~ . , ,. '°~.`~ Subdivision Name CSM Number ~ ~ ~..~-..~ Sfr~f~ 7~s-o~Y~ -s ~ ~.~ ^Ctty II. Type of Building (check all that aPP1Y) ~ ~- ( ~1 or 2 Family Dwelling -Number of Bedrooms ^Villago ^ PubliclCommercial-Describe Use ~1'ownship Nearest Road ^ state owned.i ~ _ l~ ~ ~ Z 3 ~ x 68 • ~t ~) ~ III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A For Coumy use 1,~ New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to stem Tank Onl E7USrino cWM.~• B. ^ Check if Sanitary Permit Previously Issued Permit Number ~~ ~~`~ ~ ri~~ ~ lV. Type of Permit: (Check all that apgly)(numbering scheme is for ~~.~ ,~q~N- ~ ~ 44 Non -Pressurized In-Ground 21^ Mound 47 ^ - ~ I ~ `~ ''~ , ~~ A ~ ~ ~ '~ `-- ' . Tank 48 ^ and 41 ^ Hol 22 ^ Pressurized In-Gro dm8 /~L~-/" ' - " Q 1 -}~ p • it 45 ^ At-Grade 46 ^ Aerobic Treatment U t 49 ^ ~-~J v~ '~^~" G o ~ '~ , l~ V. D' rsaU'Treatment Area Information: - / ~ ~ 1 e ` Design Flow (gpd) Dispersal Area Dispersal Area Soil Applica Required Proposed Rate(Gals./1; ati ~I , ~ ~~ ~~ ~ ~ - ~ 1f ~ ~a ~5 ~ fiber Pl ' a VI. Tank Info Capacity in Total Number b ~~ ns of Tanks ~ ~ lass G ll ll G a o ons a New Foisting y~~`J` _ Tanks Tanks Septic or Holding Tank ~~ ~O ! Dosing Chamber VII. Responsibtl3ty Statement- I, the undersigned, assume responsibility for tioa of the POWTS shown oa the attached plans. Plumber's Name (Print) Flambe Si RS Number Busittess Phone Number Plu~ is Address (Street, City State, Zi e) ~ ~ _ fj U t,~-~-~- .~~60 VIIL Count / d A De artment Use Onl roved ^ Disa Sanitary Permit Fee (includes Gr water Date Issued Issuing Agem Signature (No Stamps) pprove pp Surcharge Fee) ~ ^ Owner Given Initial Adverse ~~ ~-~ Determination IX. Conditions of ApprovaUReasons for Dis ova! ...,, .... ~ ..,. o ~S. -- Y ^„'~ ".- (~ _ oamplete phms the C only) for the system on papenr~not less than 81/Z x 11 dlnchea In sae ..~, A-~~ S2J~~n-mss hµ,,p~~ rnnG~-i. •.~ dG ~2,~ ~.[~Y~,T CW~t~ C~ ~ art.or-1~tGCd , SBD-6398 (R. 05!01) 1 1 t ~~~"` , ~ ~ U~~-~°' ~~~~ ~ ~ ~ ~ ~ ~ ~~ ~~~ .~ s ~ ~~ ~..~~ ~s ~r aos s ~ ~.~ ~~ ~ 11 wi~corisir apartment of commerce SOIL AND SITE EVALUATION Page f of Didion of Safety and Buildings Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1!2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM}, direction and '[" L2o , percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION -Please print,,all i(nfarin~tlon " ~•., Reviewed by Date y , N. Personal information you provide may be used for seconda purposes (Privacy law, s. }5.04 (t.) (m)). s"; Property Owner y ~ ~ ~ ~r+ ~ Govt. lotLo~~ 1/4~j <c~1/4,S ! Y T 2 ~ ,N,R / ~' E (or~ Property Owner's Mailing A dress X ~ :~,"'~ r Lot #: ; Block# Subd. Name or CSM# City State Zp Code ..Ptrone Numti~N'°Y Nearest Road ~ -.,~i ~ ,L... _ ^ ¢ity ^ Village [~ Town c~ W ( ~? I,5) `~ ; °' 6~ bra (~. New Construction Use: (~-Residential / NumbeT-e#-bedreorYSs 3 -y Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow ~ gpd Recommended design loading rate ~~ bed, gpd/ft2 ~ trench, gpd/f12 Absorption area required g~.bed, tt2 7S~ trench, ft2 Maximum design loading rate~~bed, gpd/fl2 ~ ~ trench, gpd/ft2 Recommended infiltration surface elevation(s) Q S ~ G ft (as referred to site plan benchmark) Additional designlsite considerations ~G~ ~P'~l- Parent material ~ `~~~ ~.~ ~ Flood plain elevation, if applicable ~ ~ ft ' S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fifl Holding Tank u = Unsuitable for system s ^ u ^ u ~ s ^ u ~ s ^ u ^ S I~ ^ s ~ u SOIL DESCRIPTION REPORT lJ~,,J Gam- ~. ~;~~~ S ~ ~ ~'~ 7 Horizon Depth Dominant Color Mottles Structure B d t R GPD/fiz in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence oun ary oo s Bed ,Trench Z iy-~b tO H N -- L r~AMaK a; ~S S'. 6 Remarks: Boring # iZ Ground elev. gR~f~ft. Depth to limiting Z Sri-y6 Ia Y `~ 5, ~ ~ cs -- s ' .~ r0 y 6 ,,~ c , LS . ~- ~ .Is A,E- 9s-, S•~ ' r. ~ gr ~ c- ~~ • 3 z ' factor In91n Remarks: CST Name (Please Print) Signatur Telephone No. cr ~ (7~ s Z~l ~ -~( rn Address Date CST Number Z.i i 3 8~~ ~-~ . o ~- ~ 5'025 ~(-4~-ov zs33o9 PROPERTY OWNER ~~~ ~ SOIL DESCRIPTION REPORT PARCEL I.D.# Boring # J~ Ground elev. eft. Depth to limiting factor Iln in. Boring # ~ Ground elev. 9 9, ~~ tt. Depth to limiting factor hj.9 in. Boring # S Ground elev. ~.~F~c ft. Depth to limiting factor ID in. Boring # Ground elev. ft. Depth to limiting factor in ,~ . . ~~ Page L, of ~, Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench 1 -1 p I ~-- S ~\ ~ 1'ti ~ L ` 1D i -~ H ~t - ~.l Zri.~-b nMr~ ~5 ;. ~ 3b-Ifo to Y 6 ~'^E o ,,~ ~ ~5 ~ ;. ~ S;S6 qs~/ , .8 $'Z.Y ,yZ .S~r Remarks: Z - a ~ `~ -- 5 ~ zr-ti k -~-~-~ ~S -- .s ~.6 3 -~ w,-s o5 ,ti,., ~ ~. ; Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/fl2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench i b-w ~o t ~ - s ~ 1~ w.~,rL 5 ~ ~.3 b --- ~, L ~- , ~- ' , $ ovf~r 9S c~ . 8 82, a . SL Remarks: Remarks: SBD-8330 (R.9/98) e r ~ `Is PAGE~OF NAME s ~UC> -~-- LOT# (~ LEGAL DESCRIPTIONSE '/4.(.~W/4,51 ~ T7~(N,R 1~1 E (or)jGJ, i SCALE: 1"= ~(~Dp q BM 1 ELEVATION I l BM I DESCRIPTioN Mpo~ l i "pvc, P~ p~ (arh ~/FIa~ BM 2 ELEVATION (UU • V BM 2 DESCRIPTIONtvT~ l~~~D~Q~`yc Iurh~/r"~a~ SYSTEM ELEVATION ~ 5 , S ~O ALTERNATE ELEVATION ~ y• CONTOUR ELEVATION /U/~- I - }- - i x / y ~- y-4U POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of X11 F INFARM~TI[)RI Owner SLR-~-ll~ Permit # ~ Z~ DESIGN PARAMETERS Number of Bedrooms 3 ^ NA Number of Public Facility Units ^ NA Estimated flow (average) ~ Q gal/day Design flow (peak), (Estimated x 1.5) ~ gal/day Soil Application Rate ~j gal/day/ftZ Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODS) 5220 mg/L ^ NA Total Suspended Solids ITSS) <_150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (GODS) 530 mg/L Total Suspended Solids ITSS) 530 mgJL ^ NA Fecal Coliform (geometric mean) <_10° cfuJ100m1 Maximum Effluent Particle Size Y8 in dia. ^ NA Other: ^ NA "Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity a~ © al ^ NA Septic Tank Manufacturer ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model ^ NA Pump Tank Capacity al '(~NA Pump Tank Manufacturer 1~NA Pump Manufacturer I~NA Pump Model ~ I~$NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ~lA Dispersal Cell(s) ~'In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized- ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA MAl1UTFNAN[_F Cr`41Ft1111 F Service Event Service Frequency Inspect condition of tank(s) At least once every: ^ yea~lsl(s) (Maximum 3 years) ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third (Y31 of tank volume ^ NA Inspect dispersal cell(s) At least once every: ^ month(s) (Maximum 3 years) ,~ year(s) ^ NA C{ean effluent filter At least once every: J ^ month(s) / yearlsl ^ NA Inspect ump, pump controls & alarm p At least once ever y' monthlsl ^yearlsl ~A Flush laterals and pressure test At least once every: ~ ^ month(s) ^ yearls) f~-NA Other: At least once every: ^ month(s) ^yearls) A Other: ~'7VA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankls) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a fai{ing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY31 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. ST CROIIX COUNTY SEPTIC TANK MAINTBNANCS AGRBBMSNT AND (J'VVNBRSHIP CBRTIFICATION FORM O~Buyer E Mailing Address ~~ proptxty Address (`/crifieation roe;uirrd from P1~1IIg ~rbmemt for new consaucti.r- (qty/Stets /`~ v~a~ ~ P~'~1 Identification Number ig.[~A, Z3ES~~TIQN %4, _ ~ ~ ~• .___~_: T--- N R'----~' Town of properly Location ~,/1 t~~~ ~~~ Lot # Swr gnbdivislon Volume .Page # Certified Surveil Map # ~ ~,3 Volume 17a ~ .Page # wtu~rantp new ~ S go~~3'yes ^ no Lot Lines ideaitifiable~es ^ no P~ rr•r•a,.,r ,~retrty~'FNANCE tur~failuntolsandlewastes.propcrmaintenancc ~`~' i-~--~ a u reof ourseptic system couldresultm its prema ou t into the system improperisse; aadmam~ y. threei~years ear sooner if needed by a liexnsed Pumper what Y Pu consists of pumping out the septic tank every m the waste disposes een effext the functi~ of the septic teak ss a tre;atme•at stage . a certification foam, argued by the o'a-ner and by a •The property owner agc+ees to submit to S't. Croix Zoning ~t~ fy~g drat (1) the on-site wastewatcrdisp°sal sy~' mastecPlumbor= journey~nplumber, restrictodplumber~ ~ neceesasary~. ~ sesptic tank is less than 113 full of sledge. ~ ~ prop" opaut~ condition and/or (2) after inapecti ~~ ~. ~ undexsigaed have read the above regain end ag~ec to maintaia die private sewage disposal system wI~ cation ant of Commerce and the ~partmesnt of Natural Rcaoaroe:s, State of W ~~ within 30 set forth, hexeini, as sect by the Departm Ieted and returnesd to the St. Croix Couaty Zoning stating that your septic system has bean ~~ must be comp days of throe expiration date. DATB ~ T[JltI3 F APPLICANT OWNER ~RTIFICATION our knowiedge. I (we) am (are) the ownes{s) of I (we) certify that all statements oa this form are true to the beast of my ( ) $cscrt above, y t-irtue of a warranty deed recorded in Register of Deeds Offices. the p Z.~ /ZjO~.... _____--- DATE ~ •~R,g PLICANT ~,~***« Any information that is mis-representesd may zusult is the sanitary Pexmit bousg evoked by the Zoning DCP~ sse=ss+s ss licsdon: a stamped warraaty deal from the Registex of Deeds office t1CCd Iadude with this ApP a copy of the exrtif ed survey map if refesruuse is maele in the wa~tY ' ~~).1724~-~f198 • ~ ' STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED Document Number This Deed, made between RT!`HARTY n STC1[]T and TANF.T P RTAi1T~..__ hn~fiand and wife,, _ __ Grantor, and K .RN~ON ?- SST.-and DQNA7.i~A ,T SPF.F.R_AART_ ,_._. u=~ ^~ and wife, _ ,Grantee. Grantor. for a valuable consideration, conveys and warrants to Grantee the following described real estate in St Croix County, State at Wisconsin: Lots 8, 9, 10 and 11, Plat of Sweet Grass Farm, Town of Hudson, 5t. Croix County, Wisconsin. << _. - , _ _... _. 020-1376-08-000 020-1376-09-000 ~~~~~~'~-~'~r ~~~0 This ; = not homestead property (is) (is not) Exceptions to warrantle:: easements, restrictions, rights-of-way and covenants of record. Dated'~t'his- ~QQ21 st cdayy of -~S-eptember _, 2001 1`~~/~+tJ~ ~• v`)l?~-•~ (SEAL) / -~ ~ (SEAL) Rir~hard n. Stout • Tanet P Stout ._ (SEAL) AUTHENTICATION Signature(s) authenticated th{s day of , TITLE: MEMBER STATE BAR OF WISCONSIN ~; ' (If not, r ty authorized by §706.06. Wis. Sta[s.) #~~ THIS INSTRUMENT WAS ORAfTEO BY Janet P. Stout Hudson, WI 54016 P~ J a~~ 657333 F:r:t~,iaTE:k OF DEEDS a~ccluEl? ~orz Becartn iiFliil~tiTY :ecC k CGr'ti : E. iiiiiNS' Ek~ FEE: 527.3 c~OFDi^IG -... 11. G0 ;fit"":~~~ : i Ficrrx,lv,;; Ar.,:, Name and Retwn Address ~~ L C ACKNOWLEDGMENT (SEAL) State of Wisconsin, SS. St. CroiX County. PermnaBy tame before me this 21 St day of _ n emh r ,2901 ,the above named Rir•hard C] Sts~tlf and TanPt P___ Stour _ _ _ ._ [o me ktwwn to be the person ~- who executed [he foregoing ~[: a and acknowledge the same. .~J7 ~ -- Notary Public, State of Wisconsin My commission [ permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not ~_ 3 Q-- •' ~') necessary.) ' Names of gersoru signing In any opacity must ha typed n printed below [heir signature. STATE BAR OF WISCONSIN w~scons~n taga~ Blank co., k,c. WARRANTY DEED FORM No. 2 - 1998 Maweukee. wis. f t , Y ~ S .~0 ~ .L~~HS ,TATS ~NI7 H~,L i~At ~~ ~..~~. ~9 i ~ '~~~. ~ \ . \ ' \ s~ f ~ \ ., ti~,~ ~ as>~. ~. ~~ ~ .. ~, >. . . ~. ~• ., \ .. ., • i. ~ ~. ~~ -_ i ••. ~' a r, . ~ ~ ' ~ ~~ f ~ 3Nd'1 ~l3S`~ . \ ~ i ~~ w L V I ~ I. a ~ ~ W ~ i N O i ~ ~ a ~~ ~ ~ ~ ~ a a N a ~. r ~ g~ ~ --~ ~~ j S j ~ o a A q ~ ~~9'QOE ~A LAS 4.008 ~.~ ,00•YOS AO'00L ,OO'8a@ iAt~~~•008