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HomeMy WebLinkAbout020-1376-76-000 O a-°i R a ~ 0 I ~ I 00 ~ ~ d I h a N i ~ °' ~ I ~ ~ o3w ~ ' ~ ~ ~ Z I .~ ~ U U ~y O C U ~ ~ L_ U d y 3 0 ~ E o ~ ~ r ~ O Q ~ p N ~ U U ~• C Z O ~- X 7 f6 O LL O O d ~ ~ 3 :_. ~ ~ ~ I ~ m m ,~ d ~~ v I 3 ~ I I ~ O Z a I Z ±' ~ ~ ~ Z ~ ~ °'w am I ~ ~ o I O Z~ c ~ I ~ ~ ~ N H ~ c a ~ o I E v I N M N r ~ ~~ v ~ I ~ ~ ~ • N N 7 a ~ O7 -~ ~ g I ~ O Q N Q z m z w I N m z' y c I E N N t~q -. .. ~ ' 'p (~ d ~ w H d V m N c O ~ o o a ~ ~ - ~ cn r rr r r- a o N ~' I Z • ~ aaa ~ ~ ~ N a ~ ~~ ~a ~ ! J U a p p ~ N f i } ~~ O N ~ = O N O Z ~ ~ N N ~ ~ C O O ~ = E 0 -O ~ y 'C ~ ° °' [0 ~ c ~ v rn a I ~ I ~ ti m d o <n m ~1 m `° I ^ ~+ LL H N i ^i ~ O _ O O O y C ~ O O ~.. C O M O O i O IA d O U d O ~ ~ N ~ I ~ C ~ ~ ~ ~ I ~ ~ O O Y O N OU ~ d '6 N ~ O' N ~ N ~ .O. N ~ ~ L ~ I 0~2 m°vo z° ca ~<n ~ ~ ~ ~~ ~ r \ V ~ v~ ~ •~ d a ." ~ a ~ ~` ~ a `I ~i +~+ E c c w ~ w rr _1 A c°~a~ Ovid , Safety and Buildings Division County ` ~ ~ 201 W. Washington Ave., .O. Box 7162 ~r; /SC~nS~ri n, WI 5370 - ~ 'Number (to be filled in by Co.} Department of Commerce 608) 266-31 .I ~ .,~ ~ ,,~ ~ ~~ Sanitary PePmit A 1 lOri .: State Plan L Number -~_ ';: i In accord with Comm 83.21, Wis. Adm. Code, pens al i ormation you ovide ~~ may be used for secondary purposes Privac Law, (1)(m) Project Addr ss (if different than mailing address) 1 %Ki! ,~;;V'f I. Application Information -Please Print All Information N!f~,`rv C% r !,_ r, ~ Q _ °'r^l~ ~- ' /` Property Owner's Name ~ # t Block # Parcel # Lo ~/ ~n ~ ~ti~C~~ ~~ 7~ Property Owner's Mailing Address Property Location 1~v ~/~- , SF ~ Section ~ ~"~~ City, State Zip Code Phone Number _ , . / Cl•e, ~ n ~ ~ T 5 u~1 ~ / ~ i/jcircle/y~Aye) II. Type of Building (check all that apply) or 2 Family Dwelling - Number of Bedrooms y Subdivision Name CSM Number ^ Public/Commercial -Describe Use `~ ~~" ^ State Owned -Describe Use ^City_~ ill a Township of III. Type of Permit: (Check only one box on line A. Complete line B ifapplicable) - ~ b0 A' New System p y ^ Re lacement S stem g p y ^ TreatmenUHoldin Tank Re lacement Onl ^ Other Modification to Existin S stem g y B• ^ Permit Renewal Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner ~ p ~. IV. T e of POWTS S stem: Check all that a 1 ,~.j~lon -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 ~eaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersal/Treatment Area Information: X /~ / = Desi gn Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation // ClJ d ~ ~ ~ Li // ~ G (O Vl. 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 ob ~~ i L Aerobic Treahnent Unit Dosing Chamber ...` O-~ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. P l umber's Name (Print) Plu is Si nature PRS Number Business Phone Number 1 ~ ,v ~/ Gp 7`G-~ ~ a oZT~ mss" ~ 7i.s - o~~ o ~ X99 Plumber's Address (Street, Ciity, State,~tp Code) j~ ~ f J ~ ~ , VIII. unt /De artment Use Onl proved ^ Disapproved Sanitary Permit Fee (in ludes Ground ter Date issued Issuing A ign ure (No Stam Surcharge Fee) ~ / /1 ~ 9 ~~ C ^ Owner Given Reason for Denial (~V IX. (:onditi=ns of Approval/Reasons for Di sapprova l ~ ~~ / C d / ~ ® Gl~ ~ 'fah C~~ Attach complete plain (to the County only) for the system on paper not less than 81/2 x Il inches in siu SBD-6398 (R. 01/03) COMBINATION SEPTIC/DOSE CHAMBER TANK & PUMP SPECIFICATIONS PER COMM 84.25 CODE CHANGES 2/1/2004 Acces: Opening, not top of cover, must extend to a point no greater than 6" Below Finished Grade COVef with ~CA?F'~ lockingg Device ~j~ (typical) ~~ ,3oifi X42-, o~ i Pi ~ ,__.. Min. Z3" Access Opening Octet Effluent Filter ~ i Inlet Baffle Access Opening, not top of cever, must extend at least 4" Above Finished Glade . ~~v` Y~~ ,,~ ~` b~ ,Bay PP~'a~D CH ~ ~ N Finished Grade lZ r Min. 23" Access Opening ~~f~'~1~ i 2 "p~yG ~G~c~mgi~ ~ .Union ,eoYE.A f /PE 3 Pr, I diP.7, O/~1a .SOS-/D S`O/(_ 3 ",mod ar ravel ~n~yuna~el- c,~i~h c~eh~2r 2,. ~ol,~er khan QdyP.s Two ComparFment SepticlPumpTank /~ ~Q.,, ~/Q`jf o~ ~~i~(e G(J~~~) SPECIFICATIONS TANK MFR: TANK SIZE: SEPTIC / 0 ~ GAL. DOSE a GAL. ALARM MFR: ~ ~.ca.-~~~` MODEL # G. Switch type: PUMP MFR: G- z- MODEL #: = 6 SWITCH TYP E: REQUIRED D ISCHARGE RATE ~~ GPM DOSE VOLUME: o~ GAL. (INCLUDES FLOWBACK & <20% OF DWF) CAPACITIES: A = ~ ~~a /INCHES = ~ ~l GAL. B = 2_INCHES =~_GAL. C = , 7 INCHES = C~a ~ GAL. D = ~ INCHES = GAL. PUMP & ALARM WIRING PER COMM 83.43(8)(e) VERTICAL DIFFERENCE BETWEEN PUMP OFF & DISTRIBUTION PIPE (LIFT) = g~ 37 FT. + FT. MINIMUM NETWORK SUPPLY PRESSURE (DISTAL & NETWORK PRESSURE) _ ~FT. OF FORCEMAIN x 1. /o FT./100 FT. FRICTION FACTOR ...... _ + ' ~ ~~ FT. TOTAL DYNAMIC HEAD (TDH) _ ~ 6 FT. INTERNAL TANK DIMENSIONS: LENGTH ;WIDTH ;LIQUID DEPTH ~' ~ DOSES PER DAY: MP/MPRS SIGNATURE: ~ ~ LICENSE NUMBER:_,~ ,~, 0 3S ~GOULDS PUMPS APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability; 'J•" maximum. • Capacities; up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1'/z" 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, 1 SSO 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 S17W with three prong grounding plug. Optional 20 foot length, 16/3 S1TW with three prong grounding plug (standard on EPOS). 2003 Goulds Pumps EHechve July, 2003 83871 • fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- maticmodels 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 a o ~ a W x v a z 0 0 5 a 3 z 1 10 5 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~, Canadian Standards Assouation _ File # LR38549 Goulds Pumps is Is0 9001 Registered. _ :_ _ ^. '~~~-- 5 GPM z.s FT _i \__ ._ ..... . _ .. ._. EP04 ~ EPOS ~T1~, /~ ,......... ~ o ... o ... 20 30 40 ~ S0 GPM 0 z a 6 8 10 12 m~/h CAPACITY _ Goulds Pumps ITT Industries aJisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buil~:isg Division K ~ 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 Bast, Kernon Hudson Townshi ;ST BM Elev: ~ Insp. BM Elev: ~ BM Desc ~ption; TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing )~1M ~ Cs - _. Aeration" Holding TANK SETBACK INFORMATION r ~ l .y~,~~,~ _t.,., t,.. y, TANK TO P/L WELL a BLDG. Vent to Air Intake ~, ROAD Septic rr l~'~}/ ;~(~ ~ ,~ I r ./ Dosing r Aeration Holding PUMP/SIPHON INFORMATION ~ ~p ~ - T /G~VrtY~%l~ ~? ~i. E~ Ft Forcemai e t / Dia. I ~? I s. o weu ~~r i ~ y~~r SOIL ABSORPTION SYSTEM I,,, „~ ;,,,,t.~ BED/TRENCH DIMENSIONS Width ( ~ ~J Le~gthg C 3 ~~ No. Of Tren~s SETBACK SYST EM TO TO P/L P/L BLDG BLDG INFORMATION Type f System : I !1 ~-f~1Wn,d ~~ y-~ /aZ ~~ r11CTRIRIIT IC)N RVRTFM ELEVATION DATA county: St. Croix Sanitary Permit No: 404981 0 State Plan ID No: Parcel Tax No: 020-1376-76-000 STATION BS f. HI FS ELEV. Benchmark / _ ~ I//~~~ /-V~~ ~ Alt. M ~ Z~D ~ Bld .Sewer Gd.~ -r(Z C~Iti /S Ht Inlet „Z,~G St/Ht Outlet Cvm ~ V'P~r' ~(. ~ i SAY Dt Inlet hucrl~~~ '~ Dt Bow ~fJF~~t Header/Man. -~-e i- ~rtid ~ ~ ~,, 3 g 7 / n Dist. Pipe [. / ~ q 5 U ot. System ~ / a,, ~ Final Grade ~u ~ N/iz, s ~ ®I ~ q l ~_ ~~L Cover ( 3i/b a N La PIT DI E/NSI NS No. Of Pits ./ ~~_ . LAKE/STREA LEACHING CHA UNIT Inside Dia. (Liquid Depth /. -~'-. Model Header/Manifold t ` t-~ / Length Dia I Distribution 7~~~ t~ Pipe(s) ~• ~ I Length ~ Dia Spacing x Hole Size ~ x Hole Spacing /. Vent to Air Intake ` ~~ / J SOIL COVER it Procm~rn Svc4amc Only YY Mnund Or At-Grade $VStemS Only Depth Depth Over xx Depth of xx Seeded/Sodded xx Mulched B ren~enter ~ )~ /! i Bedlrrench Edges Topsoil (~I Yes ='~ No ~^~~~ Yes [ ; No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ ~~ /~ Inspection #2: / / Location: 968 Fraser L]]n~~. Hudson, WI 54016 (SE 1/4 NW 1/4 14 T29N R19W) Sweet Grass Farm of 76 ~ Parcel No: 14.29.19.2337 1.) Alt BM Description = "Ta~ d9~ ~tlM1r=~~1~'Tv~i~%~ " V"~.Sf 5ic~- 2.) Bldg sewer length = 3.3 i - amount of cover = / © , , • r ~1;1~: `~- ~ CtL~ G~C_'~ ~ _ t~ !2 U C' LtL'vn !~ ~;^t s. ` 5 _ - - - -, Plan revision Required? es ~~;'j No ~ , i L`~C~ OS Use other side for addition ormation. ~~"___ _1 ~ j Date Insepctor's Signa re Cert. No. SBD-6710 (R.3/97) ,~ v, ~~ y ° ~,~ `~~ ~ ~_ , _ '.?~~~ i ~ ~ ~~ C _ I~ 1. v, ` ~~ ~ ~ ~ ~ ~ ~~ 'I~ - ~ ~ ~` ~~ r( ~ Safety and 13uildings Divisio C~ty~.~, I 201 W. Washington Ave.. P.O. Box 7162 c~~ iseonsin Madison, WI 53707 - 7162 Sine Addttss CQ~ De artment of Commerce . Salutary Permit Application Sanitary Permit Number ~q ~ ~ In accord with Comm 83.21, Wis. Adm. Cade, personal iffiormation you provide ~ ^ Check if Re ton m ma be used for ses Priva Law, s15. 1 _ I. Application Information -Please Print All Information ~ E State Plan I.D. Number ~~' Property Owner's Nattx 1 N r ~~ ~ q ~ ~ 9. 2331 aP oa - ~ 37 -~~- ~PeriY ~'~ Address ~ ~ ~~~ ~• ST. Cf~O1XC ~perty don / jJ /UGI.I!i; S ! l T N, R ~ E / City, State Zip Code Phone Number FF/C t N ben Block N ben Subdtvtsion Name CSM Number t- ' (J`'`~ // / ~'7 0/ II. Type of Btnlding (check all that apply) ^Ciry J~ or 2 Family Dwelling -Number of Bedrooms ^Village ^ Public/Cottttnercial -Describe Use owrtship , Q (~ ~ ^ S Owned Nearest Road ,~~~ ~ (` ' (`- ' Vw ~ o on line A (ntrmbertng scheme or internal use). Complete line B if applicable) e b on1 y o n of Perm (Check A. > Ncw 2 ^ Replacement System 3 ^ Replacetent of 6 ^ Addison to For Cottnty use m Taak Onl Exis ' stem B. Permit Number ^ Check if Satitary Permit Previously Issued Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) us 44 Non -Pressurized In-Ground 21^ Moues 47 ^ Sam Filter 50 ^ Consavcted Wetland ~ ~~ ~ J,. ~ ^ Drip Line ~ i 22 ^ Pressurized In•{'rrouttd 41 ^ Holding Tank 48 ^ Single Pass 51 ~ I ~ 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other ;-~' V. D' rsal/'IYeatment Area Information: ~~ F7ou, (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System El adon Final Grade G Required Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) Elevation VI. Tank Info Capacity in .Tonal Number Manufacturer Prefab Site Stcel Fiber Plastic C°ncrete ~ Glass Gallons Gallons of Tanks New Existing Tanks Tanks ~ 7 A ~ l~smg Chamber VII. Responsibility Statement- I, the undersigned, ttssttme responsibility for ' tion of the POWTS shown on the attached plans. Plumber' a tint Plumber' Sigaa RS Number Business Phone Number Pl is Addre s (Street City, Sta ip Code) ~~ /~f 0a ty ~ ~(~ ~ d / VIII. Count /De artment Use ~nl Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) roved ^ Disapproved ~ A . pp Surcharge Fee) ^ Owner Given Initial Adverse ~ ~~~•-, ~ e , e Z t ~ ` ~'~"' ' snadon Deterat _ ~ ~A1oo~~~lons 9~~pr / ~o{-easons f~~P~ tea. --~! ~~'-~~~~ -~ A(,l s~ ^~- be ~~{>K~ oA P°' bp~4,t~~1.-_t~'r~'t.cQt~t'HICQ, - SBD-6398 (R. OS/O1) -wi s(n Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings $urea~ 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 """'' include, but not limited to: vertical and horizontal reference point (BM), direction and S'~'" Gct.a percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # 4 Page ~ of APPLICANT INFORMATION -Please ~-~forma~ion. ~ Reviewed by Date Personal information you provide may be used for sec aTy.purpo~es (Pr~Vacy Law, s. 15.04 (1) (m)). , ~~sY`o~, `"^'` 2 ZCOZ Property Owner ~ , '' ' Property Location Govt, Lot ~ ~ 1/4~~ 1/4,S ~!~/ T~ ,N,R ~ E (o~ ~t..~ ~. Property Owner's Mailing Address S - ° ~ Lot fk Block# Subd. Name or CSM# T 3 ~w~ -E-~k ~ ,~ -~ r=. ~;~ ~ ~-e-e-~ ~.. rcz sS City State Zip Code ~ ~' Phonq fytm~b8r ~ ~ ~:~~ ~] City ^ Village [~ Town Nearest Road S~ f~ W ~ $'~/vz-S` ~.~~~ ~ ) S 5' 9 -~. ~ 3/. - ,'~ cJ cQ ~ C~ ~ru Z -e ~ ~ a r -a ...... [~ New Construction Use: ®Residential /Number of bedrooms 3 _ ~ Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow ~ ~~ gpd Recommended design loading rate _~bed, gpd/fl2 ~ ~ trench, gpd/tt2 Absorption area required F~5`7 bed, ft2 7~d trenzzch, ft2 Maximum design loading rate ? bed, gpd/tt~_fLtrench, gpd/tt2 Recommended infiltration surface eleva^^tio//n(s) ~~' J ~ tt (as referred to site plan benchmark) Additional design/sitec~onsiderations "V`t~f - ~ ~ ' ?J Parent material -~C~~,~r ~5 LI 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~j CAII IIFCCRIPTiAN RFPART Ivo.. 1 ~ ~n - TJl~. ~ . ~.0'~Ja ~`•~ Boring # 1 Ground elev. R~'~9~ tt. Depth to limiting factor // 3 in. Boring # mm Ground elev. 99.9G n. Depth to limiting factor lu S( ~., Horizon Depth Dominant Color Mottles Structure i B d R t GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. stence Cons oun ary oo s Bed ,Trench i o--z oe .~- t Zl~~b r ~5 ~ r 5 z-x ~ 4 6 - os ~.., _ Remarks: 1 b - t+ 2 -- 511 2.mA~bk tM ~. ~ F ~ ~ \l-Nr 1 ~ '11F ~ i / s b 3 ~ a a ti ` ~ ~ p5 w.,~ CS - ~ ~ ~ ~ 9b • 3 c{3 . . z- , Ramarkc• SST Name (Please Print) Si nature Telephone No. Address // Date CST Number PROPERTY OWNER PARCEL I.D.# _ Boring # .3 Ground elev. /~~ ft. Depth to limiting factor !CV in. Boring # `~ Ground elev. q9• r!G tt. Depth to limiting factor / ~ ~ in. Boring # .S Ground elev. 99. ~u ft. Depth to limiting factor /min. Boring # Ground elev. tt. Depth to limiting factor 'n S-~t~-F-- SOIL DESCRIPTION REPORT 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 ~ 0-~y l0 3 /z - S~ Z ~+ ~F C `v F S ~ ~ Remarks: 3 -It. 10 ~ d ~ was os ~1 ~ - ~ X13- Z ~. 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 ~ 0-t3 10 3 ~ Z ~- S - ~ x..-~b W~ Fc>; CS ~ U r' S ~ ~ 13-40 6 ~ `- Zw.4 'h~ ~ ~ ~ ~ / s ~ i Remarks: ' Remarks: SBD-8330 (R.9/98) PROPERTY OWNER PARCEL I.D.# S -Ff tr-~-- SOIL DESCRIPTION REPORT -~ Page ~of ~, . Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench 0-~y l0 3 /z -- Sa Z ~ ~F C ~ v F S~~ 3 -t o / - o -- ~- ; ~~t• ~~ • ; Remarks: Z a `t _ ~ rh~-bk ~_' - 5 ' X13• Z ~. 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 ~ o-~ ~0 3 ~ Z ~- S , z ~a w~ ~ c~ ~ v ~_ ~ ~ ~ Z f3-40 b ~ "_ Zy„~~ ~ r= ~ ~ "' S v a y~6 - ~ ~; fs io~in. Remarks: Bonng # Ground elev. ft. Depth to limiting r ~- .~ ,r .5 ,~ .r .S .~- factor In' Remarks: SBD-8330 (R.9/98) PAGE 3 OF~ NAME S~w-~ LOT# 7Co LEGAL,DESCRIPTIONSF 1~4,y1,V~4,J 1N Tl~t ,N,R+~ E(or~V SCALE: I"= ~ OV BM 1 ELEVATION ~ (~(~ , U BM I DESCRIPTIONtvp or I~~c U~ ne ~athr~uNa~ BM 2 ELEVATION ~ UU • ~ BM 2 DESCRIPTIONfopo.L/~"~ o~~~~ w~ +%_ SYSTEM ELEVATION °I (D. ~J C~ ALTERNATE ELEVATION ~ ~ . 3 CONTOUR ELEVATION ~I~Oq - + - ~'b `~~4 NAB „tV 0 n o s I o P-~. • 33 • 3'~ . ~ ,p v'~ 1 ~5 (3' ISR~ c• a'~; i V' I . ~'. ~' ,~ ~a~o ~ ST ~ N~ ~Q~ i''_ icy ti~ ~~ I ~~s ~h ~i~~~- ~ ~~~ ~ r~ ~_ s~ ~ 96.3 ~ l ~vtJ Z,+~~ ___ _,~ D ~.1%u`~ ,~~3~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FII F INFARNIATIAN Owner Permit # ~ ~ ~/ DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units - ^ NA Estimated flow (average) ~ gallday Design flow (peak-, (Estimated x 1.5) ~~ gal/day Soil Application Rate al/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) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand IBOD51 <_30 mg/L Total Suspended Solids (TSS) <_30 mg/L ^ NA Fecal Coliform (geometric mean) <_104 cfu/100m1 Maximum Effluent Particle Size Ye in dia. ^ NA Other: ^ NA `Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity ~ al ^ NA Septic Tank Manufacturer Ll.L.t~` ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model ~ 1D0 ^ NA Pump Tank Capacity al ~NA Pump Tank Manufacturer ,IS`~NA Pump Manufacturer ~2[NA Pump Model ~ ~NA Pretreatment Unit ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: ANA Dispersal Ce(lls) ^ NA ~ In-Ground (gravity) ^ In-Ground (pressurized) '^ At-Grade ^ Mound ^ Drip-Line ^ Other: Other: A Other: ~q Other: A MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ^ month(s) (Maximum 3 years) year(s) ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third IY31 of tank volume ^ NA Inspect dispersal ce(lls) At least once every: ^ month(s) (Maximum 3 years) yearlsl ^ NA Clean effluent filter At least once every: / ^ month(s) ~ year(s) ^ NA Inspect pump, pump controls & alarm At least once every: ^ monthls( ^ year(s) NA ' ^monthls) NA Flush laterals and pressure test At least once every: ^ year(s) ~ Other: At least once every: ^monthls) ^ yearlsl A 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 tank(s) 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 ce(lls) 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 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 <_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 tanklsl 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 tanklsl 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 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 Isump 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: • Alt 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: I~L 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 f. ~, jr POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name ,S~ ~ Phone ~gb ~ 7!P S~ This document was drafted in compliance with chapter Comm 83.2212)Ib11111d1&If- and 83.54111, 121 & 131, Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTBNANCB AGRBEMBNT AND OWNERSI~ CERTIFICATION FORM OwnerBuyer o~ ~~ Mailing Address ~ o ~7~-/ `/~"` ~O/ property Address (Verification roquired from Planning Deparhnent for new construction) 3 7 ~ -7t! - aeZ~ City/State ,_ .G~!/05~/ G+%~ Parcel Identification Number c'~,b _ f LEGAL DESCRIPTION ~~ Property Location ~~ %, NGK `/s, Sec. ~ T~.N-g~11..w• Town of Subdivision .~ J~"~x~'! .Lot # Certified Survey Map # _ , Volume -, .Page # - ,}~ 7 ~ ~ -~ Volume ~ ? Page # __~~1~ Warranty Df~ # Spec house yes ^ no Lot Lines identifiable ^ no SYSTEM M_AiN?`ENANCE Improper use and maiatenantxof your sepfic system could result is its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if aeoded by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. t a certification form, signed by the owner and by a The property owner agrees to submit to St. Croix Zoning Deparmmon 9iat (1) the on-site wastewaterdisposal system masbCrplumber, jouuneymanplumber, restriciedplumber or a licensedpumpcr the s tic tank is Less than 1/3 full of sludge. is is proper operating condition and/or (2) after inspoction and pumping (if necessary), eP I/we, the undersigned have read the above regairuxnents and agree to maintain the private sewage disposal system with the standards set forHr, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification that s tic em has been maintained must be completed and retained to the St. Croix County Zoning Office within 30 stating Y~ cP sYst days of the three year expiration date. ~y ATt]RE O APPLICANT DATE QWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) lmowledge. I (we) am (are) the owner(s) of the property described abov , by virtue of a warranty deed recorded is Register of Deeds Office. SI TtJRB OF APPLICANT DATE t bc• revoked by the Zoning Department. «««««« «««««« prey information that is aus-represented may result is the sanitary p~ m8 «« Include with thts application: a stamped warranty decd from the Register of Deeds office a copy of the certified survey map if reference is made is the warranty decd 1724~-~f 218 ti STATE BAR OF WISCONSIN FORM 2 - 1998 657335 WARRANTY DEED _t::-I, wal_sN .- SiFk [tF fiEELS Document Number ,.. , ,:.ih.i ~; ,;1, , wI _ nECc'iVED FOR KEGORD This Deed, made between --.------ ~~-~~-~'~o. s:2~a an ATrunun n emnrrm .,a .Taurm n cmn~ -r _husband_and wife,' ' iJflRkAHTY De'ED __._ -•_-•-.- . _---, Grantor. ci(u'IGi q and -- _-- .~ . GEfiT GOpY FEE: L;Jr; : i- httq a^A y( fe., -aAnSFEF•FEE: I'>E7.30 ________ _ Grantee. PAO~,.. 1 Grantor, for a valuable cortslderation, conveys and warrants to Grantee the following described real estate in Rt _ Crni x County, State of Wisconsin: _ Lots 75, ~ 77 and 78, Plat of Sweet Grass '"'~""" Farm, Tor,,~~of Hudson, St. Croix County, Name and Return Address Wisconsin. ,~ F[_~ 020-1376-75-000 020-1376-76-000 P I il' i~ e' nn20-1376-78-000 T61s homestead property. (U (is not Excepctonscowarrantles: easements, restrictions, rights-of-way and covenants of record. Danted this (~71 ct day of SeptpmhPr 2001 ~Q 1~ltJti9.f~.a(~C~ tl~~ (SEAL) n '~-~" / _~G~~ ~'~ _. (SEAL) Richard O. St.t1}~t Janet P Stout (SEAL) AUTHENTICATION Slgna[ure(s) authenticated this day of , T[TLE: MEMBER STATE BAR OP WISCONSIN . ~'~ ••»..~ti ~ ([f not. P ~,, authorized by §706.06. Wis. Stats.) a ~ J ~Fi~ THIS INSTRUMENT WAS DRAFTED BY 'j~ Janet P. Stout <`~ _ 1353 Awatukee Tr ~ Hudson, WI 54016 (SEAL) ACKNOWLEDGMENT State of Wisconsin, ss. St. Croix Cotmty. Personally came before me this 21~~__ day of Se~ember . ~ L. the above named AiCharcL_ StOUt anr3 .Tanat P _ -_. . C ~ ~ ---------....- .... -------~------___._....____.-- to me known [o be the person ~__._ who executed the foregoing lnstrumen nd nowledge t same. ^ • G Notary Public, State of Wisconsin My commission is permanent. (If not, state exptra[ion date: (Signatures may be authenticated or acknowledged. Both are not _1 / 3d •qs~~ .) necessary) ' Names of pawns signing In any capacity must be typed or printed below their signauue. STATE BAR OF WISCONSIN Wscansln Legal ewnk Co., mc. WARRANTY DEED FORM No. 2 - [998 Mnwaukne. ww. uww~u uv ~ u w~w~ I -- ~• I ~ I I • EXISTING DRIVE --'+'t I I ~ I I ~_ - ~_ N89°S4'a 1 "E 2641.38' N~4e~ao~E 1 os4.9r ~ I N ~ !o . .8 'N.W.L. =928.7. I R4 LOT 78 ~ MIN BUILDING 2.74 ACRE8 I ELEV. ~ 990.0 119498 8Q FT I a99.ee I d89'48'a0•E 11 88.02 I I i ~ 7 I. . Z LOT 7 Q $ ~t $ 2.78 AiCREB I J J E 11 ~8 N89'48'a0'E 1 11 88.14' Q H.W.L. •980.0 g MIN BUILDING )ING ELEV. =991.0 w.a E 1090.9T MIN BUILDING ELEV. =931.0 I l1T 7d 119882 8C1 FT MIN BUILDING ELEV. •980.0 - . - . - . MIN BUILDING ELEV. •931.0 LOT 76 2.7s ~-~cwEs 119993 80 FT LOT 75 2.83 AiCRE8 114476 8G FT •• / '_ .~~ ~~ ~ ~/ ~® ~r~~ cd~-~# 'gym $ ~ • I ' m ~ ~ ~ 1s •~ ../~ ~~ r~ o ~~ N ~ ~~