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HomeMy WebLinkAbout020-1376-70-000~ ~ I o ° ' oar ~ p I m a w ~ ~ ~ I ~ ~ I h O ~ _ E p_ ( N <na p3E I ~ _a poy .o 00 ; m '' m y I w U OD Y > O ik C N ~ +~ Y .~„ y c rn y o m a L ~ f0 U O I ~ ~ ~ w U O 'O N U .3 T ;3 a o I ti ~ L ° c~pp E U I In ~ N 7 y O7 U 0 p p ~ N .' 0 p :0 ~ 'O o,o d-av ~ Z c L I O y~ ~0 ~ 7 {L C E O L O ~'O C ~ O N O y rte-' 'p .c0 ~ N N >. ~ O ~ Q a~yaowm,~ v ~ I I Z y I rn ~ ° I ~ ~ o = z ~ N ~ an d a m I ~ ~~-z I o I O 2 ~ ~ v ' w ~ r d Z ~ ~ ~ Q ~ ~ O fn F ~ ~ m fA ~ Z c d ~ -a 'O c N (~ C ~ N • h N d ~ ~ s C ~ D p p ~m ~ w U I Z m Z z N w I ~1 ~ N V tp ~ t6 °' d T ~ C7 - a ~ m ~ ~ o o a` .° ~° °- I o o N rNr r~r ~I ~ ~ 3 3 z ~ ~ y ° ° '\~ v~ J U '... o o -p N N x O O ~ } ~ ~ ~ O O w O Q ~ ~ J m 0 C a ~ '~ d~ y v ~ Q n~ ~ o I m ." ~j IV O ~"~ 00 O N N C ~ O ~ O C p' M ~ ~ l17 C a 00 r ` l ~ ~ N H -7 C C IC N N v ~~ Y M y ~~ r 'p ~ N O N E d a> `n .~+ y ~ C N to v • N~ 7 o x O O Y v o O C f0 z a I ~~ O I -L v r/~ `m R € a I I rw r ~ A ~ c°)a~ ov~ic°~ Safety and Bttldings Division County ST ` 201 W. Washington Ave., ox 7162 isconsin Madison, WL'~537 - 71 Sanitary Permit Number (to be filled in by Co ) Department of Commerce (608) 266 151 ~ ~ d..5- ~~ Sanitary Permit AppliQ,at>< ~`#°~" . State Plan LD. Number In accord with Comm 83.21, Wis. Adm. Code, personal inform ton you provide ` " ( may be used for secondary purposes Privacy Law, sl . 4(1)(tta~j'~ roject dress (if different than mailing address) `~ . `~ I. Application Information -Please Print All Information ~~`~~i'~, ~' / ~~jj G ~ t (i ~ ~ /~ f Owner's Name ~~, ~ Property ` arcel # Lot # Block # TT ~l./L3/~, ~ 7~ rty Owner's Mailing Addre Prop e Property Locatio n / ~ / ~ ~j " ~~ ~/ ~,Q~~~- ~ V ' ~ ~ L ~c.~/. ~~ '/. Section City, State Zip Code Phone Number , _ , ~," v ~5- a C~ ~ b rrclS~) ~J; R~B ir_W T II. Type of Building (check all that apply) . I or 2 Family Dwelling -Number of Bedrooms Subdivision Name CSM Number ~ ^ Public/Commercial -Describe Use ~' ^ State Owned -Describe Use ^City_^Vi~l~ge ~T wnship of j~'~ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) ~ 'l0 O A' ,New System ^ Re lacement S stem P Y ^ Treatment/Holdin Tank Re lacement Onl g P Y ^ Other Modification to Existin S stem g Y B• ^ Permit Renewal ermit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner U~~ > / / ` C ( ~ ~ s~ ~ ( 3 IV. T e of POWTS S stem: Check all that a 1 .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 Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersaUTreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (st) Dispersal Area Proposed (sf) System Elevation ~ / ~ ~ , 7 8s7 9v ~ a= g~,~s VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tacks TaiJcs Septic or Holding Tank Id oe !Jf _^ / ?o o 60~ / ~ Aerobic Treatment Unit Dosing Chamber ~~ ,_ ~ , VII. Responsibility Statement- I, the coders ned, assume responsibility for lation of the POWTS shown on the attached plans. PI tuber's Name (Print) - u~~ ~3 Plum r' Sig lure MP PRS Number - Business Phone Number - ~? , ~a a 3s 7 7~s - ~~ g -6y Plumber's Address (S tr~eet~City, Sta e, Zi Code)' / / V[II. nt /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (ir udes Groundwater Surcharge Fee). ~/ Dat Issued ~ Issuin gent Si nature (No S ^ Owner Given Reason for Denial Q (0 °~'~ b IX. Conditions of Approval/Reasons for Disap prow al / ^ Q~G~C~7~/ h G%t.CY.r~- L%Yl~c~,. " _ ~~~.~~• ~~ ///, 1'_~-t , ~/~ ` 4 ~ I j,/A w o~ ~ ~., /' W ~~~IV~uC..f/~ ~( s(~r~/~1.~' .iG/V ~ ~ ~_~~ ~ L'~~~~~~~~L~Sv. ~ _ „`."`iiiiLLi Attach complete plans (to the County only) for the system on paper not less than is-/2 x 11 inches to sue Yi-• SBD-6398 (R. Oi/03) ~/ ~~ o~ ~ ~~~- ~ ~/~~ ~ /~/~ 1 = /~~ ~ ~~ ~ ~~~ ~%~ J~ -/ ~" / I'_ )bo f ~o-~ 7th V /~O ,~ 13~~ ~„ ~~ ~'~e, ~P ~~o~~~ COMBINATION SEPTIC/DOSE CHAMBER TANK & PUMP SPECIFICATIONS PER COMM 84.25 CODE CHANGES 2/1/2004 Access Opening, not top of cower, must e~end to a point no greater than 6" Beivuu Finished Grade Cover uuith ~Cq~-/ Locking Device ~j~ (typical) ~V 1 L U//v(~' ~EV~ ~~ i > 3o Fr. X42 ~~ 0~ i - Pl ~ --'-- Min. Z3" Access Opening Owlet Effluent Filter ~ Inlet Baffle Access Opening, not tep of cover, myst erdend at least 4" Above Finished G ade . ~ S~yy ~PP~~v CAi~ Finished Grade 112 N ,.r Min. 23" Access Opening z>~~~ .M ~N./~ vm ~ Z "plvG ~b~cErng/N ~ ru/~ if ~~pvc S[.~'~ ~ .Union ;;4~2nYE.A ~/P~ ,3 PT, ~ ~p~ ON`7a SOL/D SO/L SPECIFICATIONS TANK MFR: Cti~-t-~lJ~ TANK SIZE: SEPTIC /;~Cx~ GAL. DOSE ~ GAL. ALARM MFR: MODEL # , C/ Switch type: ,~ PUMP MFR: MODEL #: ,~ p.,S' SWITCH TYPE: REQUIRED DISCHARGE RATE °2 GPM ~ ~n~gunal~(~ with c~en~er2"/a~verSLhan Pdyps ComparFment SepticlPump Tank ~~ ~ Gve ~~j. f. o n oc~s~'a~e ~t ~~t) DOSES PER DAY: DOSE VOLUME: GAL. (INCLUDES FLOWBACK & <20% OF DWF) CAPACITIES: A = ~~NCHES = 33a~L. B = 2 INCHES = ~ ~ GAL. C = - I a 3gINCHES = ,~l c~ GAL. D = ~~ INCHES = JD,~ GAL. PUMP & ALARM WIRING PER COMM 83.43(8)(e) VERTICAL DIFFERENCE BETWEEN PUMP OFF & DISTRIBUTION PIPE (LIFT) = 13~ ~ ~' FT. MINIMUM NETWORK SUPPLY PRESSURE (DISTAL & NETWORK PRESSURE) _ + ~ _ FT. lt7 FT. QF FORCEMAIN x /. /O FT./100 FT. FRICTION FACTOR ...... _ + ' FT. TOTAL DYNAMIC HEAD (TDH) _ ~ S~ FT. INTERNAL TANK DIMENSIONS: LENGTH ;WIDTH ;LIQUID DEPTH S ~r MP/MPRS SIGNATURE: LICENSE NUMBER: G~o~ ©3~i 7 ~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'/i" NPT. • Mechanical seal: carbon- rotary(ceramic-stationary, BUNA•N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: •EP04 Single phase: 0.4 HP, 1 15 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 10 foot length, 16/3 SJTW with three prong grounding plug (standard on EPOS). 2003 Goulds Pumps Effectwe July, 2003 838)t • 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. Submersible Effluent Pump .. ~ EP04 & EP05 Series ^ EP05 Impeller: Thermoplas tic enclosed design for improved performance, ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing; Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover: Thermoplastic cover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water.resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING S A, Canadian Standards Assodation ,_ File ~ LR38549 Goulds Pumps is ISO 9001 Registered. METERS FEET 10 `-' 9 30 R .......~.... _...... ... .: 2~ o ~ W v_ 6' z 0 a > 5 ~ is 4 o 3r 10 z 5 1 0 00 ~d i '~~'-SGPM~ I ._ ~ zs rT _-_ :... ~ _ ' r . ,.... _..... ~ i ............. _. ,.__EP05 ,. 1 i ._ C ' . . ................... _.. ._. EP04 _ , _,..... _~_ , 10 •- 20 30 40 50 GPM o z a 6 g 10 12 m~/h CAPACITY Goulds Pumps 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 Koe ke, Jim Hudson Townshi :ST BM Elev: In~ BM~lev: BM Des~tio ~ ~ ~/~ C SANK INFORMATION 5 ELEVATION DJATA TYPE MANUFACTURER CAPACITY Septic / ~~ osing eration Holding TANK SETBACK INFORMATION TANK TO P/L WELL ~~ BLDG. Vent to Air Intake ROAD Septic f I Z !!~ Dosing 3 ~.~ 1 7 Aeration Holding PUMP/SIPHON INFORMATION Manufacturer errand GPM~' Model Number ~0 ~' .~~~'l~' //lVJ TDH Lift ~ n o n Loss Fricfi, System a TD FZt • ' , ~ ~ ` 6 7 Forcemain Len t / Dia. ~ 1~ Dist. o well SOIL ABSORPTION SYSTEM /~ / CQ,L.f' County: St. CroiX Sanitary Permit No: 405136 0 State Plan ID No: Parcel Tax No: 020-1376-70-000 STATION BS HI FS ELEV. Benchmark ,. Alt. BM r , ,t `' L~ T ,~. ~~ Bldg. Sewer l~ ~ ~ I (.~~ Ht Inlet !~,~ ~r' ' r •~ .SJ SUHt Outlet f ~---~ Dt Inlet ~~ Dt Bottom 7i I ~~ /~~ Header/Man. ~ `~ Bot. System ~ B. / ~C) , Final Grade r J ~ . ~ / S St Cover ~ ~ ~~ ~ ~7 f , BED/TRENCH Width Length , No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~, SETBACK SYSTEM TO P/L BL G W LAKE/STREAM EAC NG Manufae rt• INFORMATION CHAMBE R / T Of System: ~ 3d ~ ~ ~ Model Number: S~ DISTRIBUTION SYSTEM ~GrtO.a!`'~ _. o1~t.~"-- Header Distribution ~ / Pipe(s) ~ ~ x Hole Size ~- x Hole Spacing ~! Vent to Air Intake Length Dia O Length b Dia Spacing ~.Pit,~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Onlv Depth Over Bed/Trench Center ~ ~ Depth Over Bed/Trench Edges xx Depth of Topsoil xx Seeded/Sodded N Y xx Mulched N Y es ~ o o ~ es 0 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/.~~/ Inspection #2:~/~/~s Location: 942 Fraser La~ne/Hud/s~o~n,,~W~I 54016 (NW 1/4 SW 1/4 15 T29N R19W) Sweet Grass•Farm Lot 70 Parcel No: 15.29.19.2331~Q 1.) Alt BM Description = ((VQ,`r`~4 r'• ~'$r'1~,,. y~~' 2.) Bldg sewer length =~ ~ - amount of cover =', 3/ j1 (~ _ f ~ ~f ~~:'/t.~.tL ` J~~""~"-' ~ 5~/~~-~~'' "/ G~~~~ ~~(~ a }1~ 7 ~ %~X-fete l.6 L_ I Plan revi ' ired~ Y No ~J ~~ O~ ~~ /_~ ~,~M / Use other side for additional information. _/ (~ v~ ~ SBD- Date Insepctor's Signa re ~ ~~ ~~~/~ O,h C rtC rt. NJ~ ~~y'~~ ~~ ~'' ~~~5/+e ~ ~ ~~ Safety and Buildings Division C~tY< 201 W. Washington Ave., P.O. Box 7162 C / ~ ~ ~ ~sconsin Ma~son• WI 53707 - 7162 SiteGAddress ~ ~ De artment of Commerce - -OZ 3~ ~~ ` ~ /`~-- 5anitary Permit Application s~~y Permit Number 22 ! In accord wide Comm 83.21, Wis. Adm. Code, personal information you provide ^ Check if Revision / d ~ ~J 10 ma be used for seco ses Priva Law, s15. 1 m I. Application Information - Ptease Print All Information ~ State Plan I.D. Number Property ow4er's Name R E C E i !e E D Parcel Number ~,~,~,, c~a b ~6 --7~ -~ o 0 property Owner's Mailing Address / / MAY `~ 1 2 O d 2 . ~Pe~ I.ocadon / ~ ~ ' ~', f City, State Zip Code Ph O y Lot i~um~er Block Number ZONING OF F CE S ~ ~ .S-S~ o ~ 7~s- - ~~ -~~Qo Subdivision Name CSM Number S c~.Q7~ G ~ f II. Type of Btn'lding (check all that aPP1Y) ~ arty ~ J~-~ ~1 or 2 Family Dwelling -Number of Bedrooms ^Villago ^ Ptrbiic/Cotnmercial -Describe Use ~ownship 3 °? ~ ^ Nearest R I ~ ) S ~ f ~ State Owned ~ /~ ~ III. Type of Permit: (Check only one box on line A (ntrm scheme for intern use). Complete line B if applicable) A' 1~New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition W Foc County use S stem Tank Onl Ezis ' stem B. ^ Check if Sanitary Permit Previously Issued Permit Number DaOe Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) ~~ o ~,~ /'~ ~ at and C/.SfF- 3~ W e il 44 ~ Non -Pressurized In-Ground 21^ Mound 47 ^ Sand Filter 50 ^ Constructed , ~ ~ / 22 ^ pressurized In-L',round 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line / "~ ~'1! ~I?(~(ii'N' 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recin7rlating 30 ^ Other V. D rsal/Treatment Area Informati on: Design Flow (gpd) Dispersal Area Dispersal Area oil Application Percolation Rate System Elevation Final Grade 1 Required ~1 Elevado~ posed (~, Raoe(Gals./Days/Sq.Ft.) (Min./Inch) 0 ~- T ~ =y° ~ 3. -- ~~ ~~ r- a = SS ~ ~ ~ 7 ~ s - VI. Tank Info Capacity in Gallons .Total Gallons Nttmber of Tanks Manufacturer Prefab Concrete Site Constructed Steel Fiber Glass plastic New Fisting Tadrs Tanks Septic or Hokliug Tack ~ Q r0 C~ ___-_ la ~ l _ ~~~ Dosing Chamber VII. R onsibility Statement- I, the undersigned, assume responsibility for ' tion of the POWTS shown on the attached plans. Plumber's Name (Print) ~1~Y uTG~ Plum Si RS Number a~©3s 7 Business Phone Number ors ~ a~ S ~ ~y~~~- Phrmb/er's Address (Street, Ci ,State, e) ~ f ~,(~.~ VIII. Count /De ent Use Onl roved ~~Y Permit Fee (includes G ater Date Issued Is ent Signature (No Stamps) d ^ Disa A pp pprove S~rrchar a Fee) ~ - !~ / ~ ~/ ~, ~~ ^ Owner Given Initial Adverse ~ ~ ~ . ~ ~ Determination IX. Conditions of Appro easons for Disapproval ~_ ~j~p~ ~, ~j Ub ~i~d O.7~Pd/~ . /~ - rnmplete (to the t;o~mty omy) ror me syxem on uva +~ .+.... o.... ~ ~G /( ,/ / y-~ j ,L,, ~ ~~l n~.~~un:2~.~" ~ t~-`5~'~oc~" -j'~~G~ ~ -~- ~,,e.~t. / ~(~f !! L/r, SBD-6398 (R. OS/Ol) y'~A~a N~ ~-~D Z~~ ~~.i~fx2~. ~az~~Z ~~ ~~ ~ -~~o r-~ = yo' ~ SUt 7`- a = 88 ~I~'i - a = ~o0 7~0 ~l '/a ~U~ ~ ~s- P •/ .~ ~ ~. r ~ ~. ~ ~ a 7-- & X3.5 A ~i 1 ~ 1 ~~~~ r Q~~ ~ o~ ~~1~ ~ icon n Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page ~ of ,~ Bureau of Integrated Services in accordance with Comrr~,$3.Q~,..Wis. Adm. Code ~" ~ d s Attach complete site plan on paper not less than 8 1/2 x 11 inches in size ~ must County include, but not limited to: vertical and horizontal reference point (BM), oti,rsn an " 5 L . ,... percent slope, scale or dimensions, north arrow, and location and dis ' ce.to near r®~d Parcel I:D. # ` 0~ ~/3 "7~ ~ 70 -CYO ,''_, A APPLICANT INFORMATION -Please print all inform~tlvn. - .. ~6.: ,t~ev' e ~ Date Personal information you provide may be used for secondary purposes (Pnvacy Ga`Yv, s, 15.04 (1) {rd)):~ ~ Z Properly Owner ~ P ~~ ~ ~~ .~ Govt. Lot ~~< .114~~ 1/4,S ~ ~ T Z~ ,N,R ~ C~ E (or V~ bd. Name or CSM# Property Owner's Mailing Address `~ot# l~l©ek#'>. 1 ~ ~3 ~ ~2 2 ~-- r, _' ~_ ~e-2-E- r-a S.S City State Zip Code Phone Number ^ City '.~^ .Village ® Town Nearest Road '~~~Or+, (,ter ~`Ic'16 h~S )Z-y7-~~ dJ.S~-~ ~rAz-e r- /~ n2 I [New Construction Use: ^ Replacement [Residential /Number of bedrooms ~ - y Addition to existing building ^ Public or commercial -Describe: Code derived daily flow ~ © gpd Recommended design loading rate ! bed, gpd/ft2 ~ trench, gpd/ft2 Absorption area required ~_bed, ft2 rench;it~-----~-desig~o_ading rate ~ bed, gpd/fit ~ ~ trench, gpd/ft~ Recommended infiltration surface elevatio u~d~r ~~• CCU ~~` ~ ~ ~ d U ft (as eferred to site plan benchmark) Additional design/site considerations ~Q-~,£ (,~~a./' ~ Z • I D Gam"' ~(" ~d ~ ~ Parent material _~ y-+-C,~rczS~i 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 ~ U Boring # Ground elev. q_~.UUft. Depth to limiting factor ~G in. Boring # _ ~~ r Ground elev. 9S' 4v ft, Depth to limiting factor q ~( in. SAIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Structure i t C B d R ts GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. ons ence s oun ary oo Bed ,Trench ~ Zq ~o ~ 4 l ~ ~---- 1'~S ~ w.,L ~ s - ~' !/ Remarks: r ~-~~''''~~.~r T ~ Z z~_w c~ y ~ ~ Ls r~s w.. ~ ~ ~ ~ ~ Z6 `(q k7 b Remarks: 1`~ `~ ~ ~~~~ ;,ST Name (Please Print) ignature Telephone No. Address Date CST Number PROPERTY OWNER ~vT SOIL DESCRIPTION REPORT PARCEL I.D.# Boring # Ground elev. ~~ 70 ft. Depth to limiting factor ~_in. Boring # y Ground elev. qs yat. Depth to limiting factor ~~in. Boring # 5 Ground elev. 9isa tt. Depth to limiting factor ~f ~ in. Boring # Ground elev. ft. Page ~ of Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench t o-~~ ~o ~'- S,1 ~ f~ I^'~~ ~~ 1 v F 2~ 3 Z Ifs-z~s ~o ~ ' L -.~ ~ - ~- ; ~S 3 z ~ -^^5 <s - ~ _~--- , .D ~ t~ p ~j 0 f ~~ , Remarks: ~/~,~y-rt.~4.r~ S' ~ ~~ -1 O ~ --- ~ ~ `y~.a --2 ~ ~ ~ 2 ~ Z r - ~o _ ~ ~ ~-S ~ ~•2 - ~ ~ ~ Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench i a- fa ~o z ---- S, I 1 ~~~~. war ~ c.~ 1 ~ ~ z ; -~ o - i' S I iti• ~ ~ - ~- iZ h~5 ~S - `~- ~ !/ ~~ Depth to limiting factor in. Remarks: SBD-8330 (R.9/98) PAGE~OF~ NAME ~~'UV+ LOT# 70 LEGAL DESCRIPTION,bw '/45W'/4,S ~W T29 ,N,R(~ E (or)(~ SCALE: 1"= ~aat BM 1 ELEVATION ((~U ~ y BM I DESCRIPTION+~p czC ~ ~Qnc 0 ~t lu? h us/ ~=1a g BM 2 ELEVATION ~ U(~ ~ U -~ BM 2 DESCRIPTION ~to(~et~ z p~~ ~;()e_ (t~~'h y~l Fdic~ SYSTEM ELEVATION~,~atr KU. U 0 emu, c < ~g. Ua ALTERNATE ELEVATION„p,~,/tr /G 2 . q y w { r`~D.gO CONTOUR ELEVATION ~V 1 ~- X -!- - • • ~Z fl~k~ CTy ~ ~ a~~ ~ c~ ~~.~ ~ h ~~ I R~ ~~~ ~~ ~- ~'-~~ ST CROIX COUNTY SEFTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP C;~RTIFICATIQN FORM Owner/Buyer __~~,~~ ~~ Ivlaiting Address ~7 lL` ~Gt v°5~_ !-'1",~ ~ . Property Address Clay/$~tE LEGAL DESCRYp'I'IOI~f ~ ~ ~ wG~.~-~- h'n SS"c~ S"~- Parcel Idtntification Nuanber ~ nl d ~- / ~, 76 `'~O -~ C?~ C} Property Location .~ ~ ;, ~;~ :/, Sec. ~„~,7 T~N-R~W, 'down of Subdivision Lot # ~ ~ . Certified Survey Map # Volume ~_~____ paw # Warranty Deed # a Volume _~_~~~ Page # Spec house O yes~no Lot Iiucs idt;nti.~abls,~yes o no sYS~ 1~-zA~'a'EI+tANCE caasists of ~ us~a amci mai~nanxof pour s~ptie systesu could result is its P~f~ure to handle wastes. Pzoperrlaafatenance can affect ~ ~ ` ~k `v`~y three years or soaai~ if deeded by a Iiceased p What you P~ into the .system septic tank u a treatment stage is the wasbc ,disposal systeaz. mastar Iu~mberpz a~~ agrees to sttbtnit to St. 4oiz Zoning Department a cesd~CC~on form, signed by tine owner and by a P ,1 ~J'~aFlwaber,zese'ict~edplurAberoralieansedpuu:perve:ifyiag~,atf1}theou-siacwastowaterdisposaisystcm is is proper apeLatitsg coadizioa andlor (2) afeer inspection and purnpiug (if necessary}, the septic tank is Tess tl~aa I/3 fuli of sludge. Uwe, the undcisigned have t:+ead rho about roquitemcuits and a set fob, herein, as set by tin D Sx'DC to maintain the grivau sewage disposai system vvit4 the standards ~ ' that ~ of Co'~~ ~ ~ Department of Nata~1 Resources, State of Wiscoas~ Ceatific~tion ~ Yom" septic system has beect ts~tainzd must be cowpleted and rettuned to tho St. dayS,Qf t~c}thrce Year q~piration da ~ ~Y ~~ Office within 30 t ~ i ~ . !l. GNATURE OF PLICANr ~ Jr I >N/ d DAVE O~W IER CL~RTIFICA,~ ZZON 1(we) certify that aIi statements on this fotYrl are true to rho best of my (our) knowledge. I (we} am (are) the awner{s) of the petty described about. by of a tY deed recorded in Register of Deeds Oflicc. i ATURE Op' APPLiCANI' ~-i-~--~ DATE s sacts~ Any 1nf0[IIlatlOn that is 7ttrS-represented mAy ieStlli I>1 the Saar s s s s s • tary permit being revoked by cite Zoning Deparmtcnt. " Include with this application: s stamped warranty deed from the Register of Deeds office a copy of the ccttiFied survey map if reference is made in the wazranty deed (Verification required from Planning Department for new Ed wdzb:~e ~eeir Et ~~~w 00Z59bZSIL ~oN x~d ~NIlHrltiJX~ ~1'l0a~i :woad •+ PO'aNTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION Owner Permit # ~~ DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ^ NA Estimated flow taverage) vU gal/day Design flow (peak), (Estimated x 1.5) ~ gal/day Soil Application Rate ~ gal/day/ft2 Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODS) 5220 mg/L ^ NA Total Suspended Solids (TSS) <_150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODS) <_30 mg/L Total Suspended Solids ITSS) <_30 mg/L ^ NA Fecal Coliform (geometric mean- <_10° cfu/100m1 Maximum Effluent Particle Size Y8 in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity Q al ^ NA Septic Tank Manufacturer ~ ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model - ~Q ^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer ^ NA Pump Model ~ ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ^ NA Dispersal Cellls) ~Ip-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ Nq Other: ^ NA Service Event Service Frequency Inspect condition of tankls) At least once every: ^ yearl 1{s) (Maximum 3 years) ^ NA Pump out contents of tank(s) 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 ears) ,0. yearlsl y ^ NA Clean effluent filter At least once every: ^ month(s) yearlsl ^ NA Inspect pump, pump controls & alarm At least once every: ^ month(s) ^yearlsl ^ NA Flush laterals and pressure test At least once every: ~ ea~~s~ts) Y ^ NA Other: At least once every: ^ month(s) ^ yearls) ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankls) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third 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 <_12 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. Page of START UP AND OPERATION• For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cellls). If high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater wilt be discharged to the dispersal cellls) in one large dose, overloading the cellls) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or-must be taken, to provide a code compliant replacement system: ^ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soft 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 ~ S _ a~ ~ _ ~ / POWTS MAINTAINER Name ~„ Phone SEPTAGE SERVICING OPERATOR (PUMPER- LOCAL REGULATORY AUTHORITY Name Phone Name T Cticr~- Phone /~' ~ -- This document was drafted in compliance with chapter Comm 83.22121(b111)(d)&(f) and 83.54(1), 12) & 131, Wisconsin Administrative Code. u 1~ybt' X62 'STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED Document Number This Deed, made between , RTCHARD O STQ JT and TAN .T P RTnitT+ husband and wife ~ Grantor, and Tnt~t~,S--~~. -Ir~fliy$E~ and PAi+4Ef,~ tT. ~~~iyR . Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee- the following described real estate in ~t~ .~~~~~~ County, State of Wisconsin: Lot 70, Plat of Sweet Grass Farm, Town of Hudson, St. Croix County, Wisconsin. 6 7 9 7 6 0 REGISTER OF DAEEDS ST. CROIX CO., MI RECEIVED FOR RECORD 05-22-2002 3:00 P>y WARRANTY DEED EXEI~pT ~ REC FEE : 11.00 TRAAS FEE: 176.10 COPY FEE: CERT COPY FEE: PAGES: 1 Recording Area Name and Return Address Edina Realty title 400 S. 2nd St., #115 Hudson, WI 54016 ~,~s~3~~ 020-1376-70-000 Parcel Identification Number (PIN) This i G nc~t-_ homestead property. (is) (is no[) Exceptions to warranties: easements, restrictions, rights-of-way and covenants of record. J y,~~ $ 5 ~ ~ Q W O ~ r ~~Y V _ . 3 ~iNb~ ~iO ~ O~ ~o g~~''= y p d ~ ,~,~ ~ ENCED TO THE b1 S * ~ W BEARINGS ARE REFER 14E ASSUMED TO BEAR Npp"10'21 MION ,~ ~~~~ Q ~7~ '~'~~`~" ~~ T~ ~~- '~j~~ 0 0 g00'12'20'E 490.41' ~•~, ~ 170.OT __ 11 .r- ~ a ~_.__. 1- ---' ,' .I. rD • ~ . ~' i ~ ~ 0 ril O ~ ~' 3W q Q pr ~~ W ~ ~ Q ~ ° iq p G*. 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