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HomeMy WebLinkAbout020-1447-02-000 N ° p o Fn ° v3 p u u d o W a� 0 0. 0 0 0 0 b y M N (D2 N a) oQ, E.'� E E.� �.0 N . - c<o@ y ccaco cn aDN m ON me ' MO ' aO cLi a U a Fs' a 3 : o c o 'c m 0 m .0 o - - E I O c 0yN m D D D a= c c c � :3 c y cu a 0 00 c�ca�3� �m a) O � E X E 0 n 00� �.0 o Z D cn o m @ o Z -0L O CO co o 3 m o rnd d�00 ° rn60- -m-0cc 4j u) .0 I l LL O Q N4 C. O Q'X [2 a) O CL Q ° c y 0) 0 (L) CD Q$ c of a 0 as I v z E E ns 0) Cn 0 y w £ 0 o Z a m c c rn H Z 3 c c 3 c c [2.2 O 2° 0 0 Z:i c 0 c w 0 o f w c o C 0 a_0 0 d Z o m c o z E °E "O Y _0 ur M N a) Cn 4) N N 0 C C •o � d c al - R' ca I N ' a' a3 _ 0 N a O C � Q 0. O •� d N •= O O O M D 4 n a O N O U 0 ZEE Q 4 Q Z= Z - o - a N z m E Z 0 c - 0 @ `° N cc E " v O G o a E> > m E� > > c cc U N m 1 H 1 U U t�vv o 3: R: � a U) cn z a cn cn 0 •N R i a a a Z5 Fi n- O N C O O 0 O O O N J U 0 0 0 Z Z Z Z tU N_ N = ao rn = O O O U E a> O O al al L o a) L ` a m Q c» a a � ?� Q Z 'v) Z cn o a z U) Z V) o 1L 0 .r O y C p O ch O C N M 3 c C C co o U d 0 0 N C N U CL p O O O O C d C N C E 1] N N h E m E c E cv N c co m a> oo p �^ of o 0) lU� r 17 17 V) O Y N N O a) C a- b N N ' ' C C N • O � o 2 M o Z N Z d Z Y i� Z m d Z Y cn V = E t E m L. EL ti a a • 4 7 5 .V (D C E w c 0 0 [_/ i0 A U Q* N U Wisconsin Dbpar, nent of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Divisiog INSPECTION REPORT Sanitary Permit No: 453454 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Bast, Kernon I Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: Sectionrrown /Range /Map No: OIL . a /,5 .Z.29.19. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 12� Bench V�drrE S(Q (.� �.y Dosing 14 Alt. BM M I(' • ' t Aeration Bldg. Sewer 9 -� �D �i/ . O Holding St/Ht Inlet 10.35 02.1. TANK SETBACK INFORMATION SVHt Outlet �D.qD �oZ , sa y TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic it I �/ 1 a I Dt Bottom Dosing � / Header /Man. (14 I� O Aeration w Holding Bot. System E E 3. Final Final Grade 1 PUMP /SIPHON INFORMATION cu. J Manufact er Demand St Cover � bQ'. GPM Model NumbeN u TDH Frictl ss System Head DH Ft orcemain Length Dia. Dis : to Well SOIL SORPTION SYSTEM RENC Width Fit � No. f Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM NSION ! GL �7 SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Mee gfac r INFORMATION CHAMBER OR Type ► Of System: / UNIT Model N er: � 1 A a M/ r7 DISTRIBUTION SYSTEM Header/Manifold IDistrib.tion x Hole Size x Hole Spacing Vent to Air Intake e 1� Length Dia Length is Spacing y 1 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xdde d xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No c p __ , COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: - DO / Inspection / Location: 939 Pup Circle Hudson, WI 54016 (NW 1/4 SW 1/4 14 T29N R19W) Coyote Ridge Lot 2 Parcel No: 14.29.19 1.) Alt BM Description by 2.) Bldg sewer length - amount of cover = - -- , Plan revision Required? Yes ,_ No Use other side for additional '* fOrmatio L_.._ 1_ SBD -6710 (R.3/97) Date Insepctors Signature Cert. No. T Safety and Btlilditlgs Division County 201 W. Washington Ave., P.O. Box 7162 S G'y `X N vislconsi w n Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (08) 266 -3151 Sanitary Permit Application state Plan I.D. Number In accord with Comm 83.21. Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, sl5.04(1)(m) Project Address (if different than mailing address) 1. Application Information - Please Print All Information - 39 FL& ct Property Owner's Na me A �� Pare Lot # Block # ti e �.- Ll�)7 Property Owner's M ailing Address - roperty cation - `W 1 A,Section ! S City, State V 'Lip Code Phone Number ?? (circle 11. Type of Building (check all that apply) CT S t T N; R E o W i 1 or 2 Family Dwelli - — i �- y g - Number of Bedrooms Subdivision Name CSM Number -- - -- - -- ❑ Public /Commercial - Describe Use �!Q' f 1_icit) 1 illageETownship or 5 5_4 � ❑ State Owned - Describe Use C ,t III. Type of Permit: (Check only one b on lin A. o mple te line B if ap 'licab e) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only L Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ C'hange of - Permit Ttansfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner j L IV. T ype of P Sy-te ( Check alt that a pply) Yf r nn _Prpcc.r ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil At- Grade ❑ Single Pass Sand Filter ❑ Constructed Weiland u Pressurized In- Ground ❑ Holding Tank ❑ Peat Fitter (' Aerobic Treatment Unit ❑ Recirculating Sand Filter n Recirculating Synthetic Media F ilter WLeac 1j Chamber D "p Line CJ Gravel -less P�+c ❑ Other (expla V. Dispersal/Treatment A rea I nfor ma ti o n: t - .0 / X 44td lc Design Flow (gpd) Design Soil Application Rare(gpdsf) 'spersal Xrea Required (s f) Dispersal Area Propose (sfl S stem on rVI. Tank Info Capacity iny Total Number T Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tattk Ll) l � . C r: 1, I Aerobic Treatment Unic ` _ Dosing Chamber - 3 Y��_ —a -�_ - - -- -.._ �-- _ - -- -i- -- VIL R esponsibility Statement I, the u ndersigned, as sume respo for s Nation of the POWT5 shown on the attached plans. Plumber's Na me ('Print) Plumber's Si gnature M Number — - Business Phone Number i Plumber's Addre ss (Street, City, State, Zip Code) VII Cotmt /De artment TJse Only —� Approved EIIID.�isapproved anitary Permit Fee (includes Groundwater 1 to ssu uing :Agent gna a (No Surcharge Fez} �? !I ner Given Reas f Denia 1X. Conditions of Approva easons for Disapproval / L 1 eptic tank, effluent filter and � $ � dispersal cell must all be serviced / maintaned W d 1 S, q as per management plan provided by plumber. 2. All setback requirements must be maintained kaf k"a � Nom, S* f. 0, - 7 rA as per applicable code/ordinances. dts Gc. Cdjs M ('rXJV7,t_.t' Attach complete plans (to the County only) for the &Ydeiifon PdOr s 3M x 1 in. s SBD -6398 (R. 01103) a_f 10 Z j q ( U jk 9r, Y Y r Sy s e vrcf ell Awl k wl Qivc D . "7 bpd /jq�raf�- o 4 BENCHMARK TOP OF 1" IRON PIPE ELEV. = 901-36 5 2T A , LOT 5 LE LOT 7 2.18 ACRES 94880 SQ. Fr. L.B.O. = 906-50 Z46 N 1 &0 DRAINAGE EASEMENT - V L44 L43 % 100 YR H.W.L. ELEV. = 904.45 -­L42 S89 1 wl5lw 531, 1 L 55 vp LOT 6 co ' LOT 3 2.04 ACRES 88 548 SQ. Fl. 8 3.06 ACRES L.B.O. 906.45 133385 SQ. Fr. L.B.O. = 876.00 A l \% ...... .. LOT 20 LOT 2 S 93905 SO. Fr. x L.B.O. = 876-00 Z ...... ...... ....................................... .... ... ... ... ......... . ........ - --- --- - --- --- - N87 374,74C -2'7A CD ..... .................... LOT 27 LOT 26 m 2.05 ACRES 2.04 ACRES 89313 SQ. FT. ll p 88716 SQ. Fr- L.B.O. = 894-50 LOT 28 2.01 ACRES 87708 SQ. FT. • N I • �r • s re ti IRS le A r i �l. L f � L v n� � YN STANDARD CHAMBER �-- - - - -- -- 52'_— Quick4 Standard Chamber !- - - - - - - -- - 48"— (EFFECTIVE LENGTH) i 1 1 2" ILI - - - - -- 34 -- -- - -- SIDE VIEW SECTION I MuitiPcrt End Cap - - - -�= -- _. r7 l — -- -- — 34" - - - -- -- - — SIDE VIEW TOP VIEW FRONT VIEW Quick4 Stasda b�r A1 t � lVlaiiaort`�nd Ca'+�minai S�ecFflcations > r�''� f�< Size (W ' k L 3 x 52" x 1 Size Eff ective Length _ 48" , invert Height 8" or 1.25" Invert Height 8" INF�TI�ATO SYST �i��- ,- t���T bill €a WA��TY 1 I JtU J d, I ra 't i alllXr ord tAI Vv &1g, U Olaf! aa,HSSC ' G ar I VI )., 1. I f k n tr '..n IS I Y IH t II 6lalled a -d OneralOC; nlir.Fd o A - ysil TI r. unSuncR w I i Uf 3 nst wi n wa art , [u 1 N r g Hall p� �t�,M. -Nd �9 st defearvs nl Ie "' }id w. kn Vlship I )Ix yrar k,ar f l ads iha II! upi y nu Vaal I) tl(r fiCV11 5yb Fm Coniai r,ly Ind Utl> k.Yl,'iEd ht}rgvf», rf a if a serllr Ixmu s not -a,u red r,, aW Ica4I law tlul al ar y r an od w' I L�gln upOr Itq date t tai t _(alaliCY1 of the •,c l% sY .lam ammm=nccis . a u "e is va aMy r;}Ihls HUdel null qtly 1lGlira(Or n wi ll 'y } ! l,uoxafe Neac luanars rr i :'Ay Crxuretei aq witlfut tAteen 115) Z " N )r ho alloyod dew wi a cx r 1 sty;U r Ie I 1I to tl t t ram rrak+ cimm.:ced fly InI tc till C—On oy tins 1-4 t Vr'arra •rJiG mooly srecl4Cliily exck,i,da ,he L0.1 a Ierric— _ d l'. lIwj J Il :! Ir1P, Un la. f L IT(C V ARRAN.' A 7O RF fAFUEES IN WbPAr c PAF P - I WF L ' U Nl } It RE' ARE NO C HEII .ry AR8A%I L;y VW I rat SPEC. O tr tl O T t H{ N. (.., INC litvt Ft'7 'k. tFC 'vVARRANTiE;' ')F Ml C WIN AU 'ri 7 TNFF I - (-H A 0 IFI(;ULAR F'IHP()bC S YST E M S UA r t I I L if,>(i K e3 Ill 4!tall l a d I any a t t tlKi c t -1 r are [ - t al '.f I ll 0;. T e Lr d Wa arA ioas 1 o 5 Aas 1 of r'•Px of *" aY 10 f Y'' ave rater r c t at r r ^n ,:3.. a luteadaltxl rn,,rglr rt uae. y It"S of EhVI%I11MOR I�l11AAl IOn B/te WQSteWSteP.�►olutions� 4 war tl a a .,a rtr l and Hato i,a!s, +vanc� �d: is th,r k _e. rr r r,,x oy re I.tld cr any wr7,:a it I.x a,:y eltCP fy 16R 1 I r. ' Llm.la,^ War anty cov - ' go pre dam`a s 10 till Uni t'! J ie Ip ur a y d I r, rit dnSVt 'IU.ic4M1, RN51r6E, PLUSi, ney}IUCr fi 1 HIS - r,ll 6': .- .lNl «I dIJ af1rK•�•GN t,r,' 1, .rS ' rl ! H1 T P'1�y'ha taiat�J'. 1 51NLIi0ns,(aIUIP n:3tialnthe 6 (3usirtgss park Road P.J. fox 768 1� r I nrm r rUl.nt, va +s set Iprr i ' ho Ines( I{atlp 1 sU'ucl , rs Ihr G - we .nl n lmpr q rr t alra als HO the 4Y T ,yetrn. cpntaRlif!y tty lJn 6 aiiure of t y the .mra Or 111 sentir. suSlaln 0" t0 imPrope- srfirg u' imprope si2rv.�, z..a va —t oc a ImprcY7hr 9,11 Ulctx or ,mp t1 er or era'icn; o' 011d Saybrook, t, CT Q064 75 ogre- even! no( caused by Inf0lrahx. Tills rs umi(od ar 4r ry ;hall t-E d A Ve :'.older tars .o com,�rl whih of of Ina tem75 aeI forth in t! ds L;mittsri wa wt ' 860- 577 -7000 " FAX 860 -577 -7001 Fu tt� i to even! ail Irit allx GC r%3p[etsiWa his ally Ic ,1 0 damage i Ine OI Jcr I U c, or .Iny Ir: re party remu;t,ng from w s1a1kAEOn cr st.;p. p f► �y lr��{ m nl r tr ri ant prurt i l 'abAily t,ldsns cf HW3er or -an.,;w Party. Fc ihl LAn IEJ W atty to ap(Av t: o I k A I !7a irrs(ai7ed i.r rxomanca V�i��Gi 1 �4• Wen ai, Mt , ml , ells reOki , A by state and bcaf - -0.ies; all oIt er aP fi` 3II a la-5: 3aA it i l'tw S inS.irlai oS instruclw*' ' (J)1 rrpreseliW'ive ,?) `rlfilUatW Ikls the a thoify IO ,�lellge v' etlerid Ih : Li. nitA1 W. „r,4 „ly Nn warrnit'Y bMit -s tO a; N pally ti e- I!'3 It.. Ones Hal Holder. TI s atx.ve apre ,qri.. !Ae All d 3 U V i x„ lh`Jnaoty r.YemJ oy inri, .._; x A im tod r. m,L I a.'I•e. ani ix,,,r.res , ava mltd'nni my rr e- r,. A ry po ui rwly, 5 )Ul l C e u l ly t ees t ,e rt6p an(rrs rn , i L, .v, Conna,. u�vl. r .i .;u:n t,urcnase, to obraln a upv e! the apple.al,is .�arra':IY, an7 atuwkt aHetu!N read tnat vrananlY prig •n +s:e uerclw ^•e ai Wt;l<. S. a nu -' A /J9 661 077,04!, 5,15p.488 5,336,077 5,401 70; 7,401 9 5,6 Z i)Gd, 5,716 c , e; 583 M; 5 K39,844 � acar a F d'cnts t 3 9 999; 2,pp4,564 Ottuar patants pondtng �'(+� tbI UOI Equalizer ana S•'.deWir,der are registered trauarnarks o I't1lI SeSIE (s Irf . !IIII (cx is a regis(ered ' %Remark in FrdnCts. intillra(or Systems Inc. �iJ s a reg;srale i tradel7ar in hdexito CcuTtouc Contour Sw Y i• Coy i C 'un, MlcruLaatn l .3. PolyTuH, SnapLack.. Chan berSpacar, Patik tck, Qu ckCul. OuirkPlay AECYCLI PAPUA and Quick4 are InA(l imarks %)t fnfdtraler Gystarns Inc ® 20113 irifi ;tralw 8ysierns no. Prinled in U S.A. '1 wN T PXPL 12" MIN. 6 15' FROM DOUR, WINDOW OR 4CATHERPROOF FRESH A2R INTAKE JUNCTION BOX APPROVED WI Ti3 CO NDU T T V-INFOLE COVE: r46 NISN£ GRADE W1 PAL' LOC K b WAKNIWG .'.ABEL It i' , 1r; ,• k LT ! I i WAMM ,+... R • ive{i SEALS + GAS- TIGHT < < PROVE ;PPROVE�3 A SEAL JOINTS WIT 'IPE 31 i 8 ! A Lm APPIOYED PIPE XTO SILID 3' ONTO ML O ' �' SOIt�. SGIC PUMP OFF ELEV . -•-- -- F &�' RISER EXIT r � + PERMI CNLy IF TANK MANUFACT'JRER 2" AMOVED BEDDING u'N3£R TANx W APPROVAL C0NCRITE PAD aEPTIC DOSE :AXX MANUFACTURER: uUS£S PER JAY: »1Vk SI £S: DOSE E -Lgo-d GAL, .,.-, L'OSL" I�G:u;'►E IA�C:�JOrNG dv GAL. � L4tti9ACK: l GA �, . �,LAF�M MARtUFAC'ILR,ER: �� MODEL MiM9ER: CA PAC + ES: A « '. 1JNC1 ES * ,. sAL. SWITCH TYPE.- . r � . --- ,,,,G,... --- 8 s 2 ,.,.,,,,, J IwC HE S ,, GA i . �'. MANUrAC � init MODEL NUMBER : __ ,.r ,_ C T t GAL , SWITCj3 TYPE: :EQ D ,...�,., i NC DIES '� ..�..- ._.�GA L . �iiRED Di5Ct�314RGE 1tAT `� ^P:; PUMP f A:rA " W -1 T n.. R*'= AS PER ILHR 16.23 C ERT +CAL Dlrr& - RZKCE SE. OFF ANa 'Jti . PIP MINIMUM NETWORK SUPPLY PRESSURE E ! 1'£E r X FEET FORCEMAIN ,�,;,,i„G FT/ .. y 0O !':M FEET , . FR:;.T «c�N FACTOR � , ...... %U L L YNAMIC D F rET ! "TERNAL DIMENSIONS OF F'E6.6 LI Gv,zD YI�'p'";q-� WID ?H --- •? /, Vvc„ / �• ? C" E'NS lv HGOULDS PUMPS Submersible Effluent Pump 3871 EPO4 EP05 APPLICATIONS • Fuliy submerged in high ■ EPOS Impeller: Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication and efficient improved performance. construction. heat transfer. ■ Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and • Farms manual operation. Auto- Superior strength and corrosion t mdim andard :Assoda6oe • Heavy duty sump matic models include resistance. 4 st _ • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "F" or "Cu.) factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic Goulds Pumps6 ISO 9001 necjiAKW- FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. 3 /4" maximum. ■ EPO4 Impeller: Thermoplas- E Power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: 1 NPT. seal protection. • Mechanical seal: carbon - rotary/ceramic - stationary, BUNA -N elastomers. • Temperature: 104/F (40 continuous METER FEET 140 60 intermittent. t ° � •Fasteners: 300 series stainless steel. 9 ^-- -- 30 • Capable of running dry without damage to e 25 FT components. 25 .._._ _.. C 7 Motor. x • EPO4 Single phase: 0.4 HP, �' 20 115 or 230 V, 60 Hz, 1550 a RPM, built in overload with automatic reset. 4r giros • EP05 Single phase: 0.5 HP, o 115 V, 60 Hz, 1550 RPM, r 3 ' 10 _......,, built in overload with Ewa automatic reset. 2 • Power cord: 10 foot 5. standard length, 16/3 SJTOW with three prong L. grounding plug. Optional 20 ° ° 0 10 20 30 ao 50 GPM foot length, 16/3 SJTW with three prong grounding plug (standard on EP05). 0 2 4 6 8 10 12 ml /h CAPACITY Goulds Pumps ® 2000 Goulds Pumps ITT Industries Effective February, 2000 83871 Eand :in wsoonsin oepartrmtor EVALUATION REPORT Pace � of 3 Divisiom of safety and 85. YIRs. Adm. Code Com* 5 r. cR 0/ 9 - Mach complete Site plan in size. Plan must / inc�de. but not lb. or)torrtai reference point (BM), direction and PaoM i.D. sir' . � `,& 4V percent slope. sole or clitmensions. noft arrow. aril kxxMm and distance to nearest road. Ple"o print *8 Infonnadon. PmsoW kftm fation you provide mry be used torsseaWary PWPmm Wdv+LY Low a 15.04 (1) (MW I N &J of S£ I SECT• l Pmpertyomw Pnopertyt.oc adon k4i5F,eAA9 V /3AS 7.— Govt Lot Nw 1141 Ira s A/ T 19 N R /I 4&(or) w Property Ownm's Malting Address tot # t3todc #i Sibd Name or CSMN E.v N �l y L • 0 Cry � ' Z " co Yo ne ,R 11PI&-E " ffUD.So� wi. s � ( mom M919M ?IS 3 8 • 00W O "� ®Town Nearest Road 5 /fuP5,o j - New Construction Use:Qd mwc w "i mm*erof be*mm 3 " code dermo design flow rate ca O'a GPD © Replacer"M ❑ ftft er oummerdol - Desodim Parent m S� S& , now Plain elevation N apple abie i(J 0. C3eneral camrerrts M") m- ' •4�E'� �4- T+�'sT� Sc� 1734 fn�e �� jv��ov�cs� I � F u /° a pt Graud surraoe eig,► I D l n Depttr m tamer f/O in. soli AppkAon Race t lorfmon DapM Dominant Cdm Redo Deea"on Texlm a Slruc km Cowiscence Boundary Rods Qm In. M mod Cam SL Cont. Color or. Si Sh •Et�tt 'Etf#2 / 0 i0 M 3<3 G / Shy S w a l• s /0 yR SQL s d- k c-5 c • Z • 3 qs Rv F p[ Pit acu ci surface etev. f Dq* to Wrift rarSor in g� ftalmacm Rate fWWn DepTh Dortrinant Redm Description T"d" structiwe cowstenoe Boundary Roots c3PDn� M. Mursed (au. W - Cant. Color Gr. W. ft. 'E1f#1 •cr.*2 / n • 0 2 31 G. 1-fsb,� cs 3 f • s ,i 2 to l o — ----- .Sl L/ f S k A 4 CS l f o ,,P s 6.5 c• i y • • Efterd #1= BOD 30 220 "Yok and TSS NM 150 mgL • Mont 42 a BOO _< 30 mglL and TSS <_ 30 nWL Nunirer 'R a (!.� R tb e 1c, z z c, 3 - r s Addrm Date C-vakeion Condo led Telephone Nurrtrer IIioU• 13-.o3. q Private Sewage Consultants p 2812 10th Ave. SIN • S I��2 TD]',q•G o/� O Spring Valley, WI 54767 Z O • to 2 '7 • Z o � D O 2.D ! ,a.'7 30 2-0 • 017 • yp . Oza o �t C) yD TIF k6ERtio,v l3f! T P"opert G o y Owner Parcel ID # pa of 3 51 / Depth to factor f in- Bon o &- - 1 5 Pit Ground surface elev. R Horizon Depth Dw*wd Redooc Sad Rate Description Texture Struct<re Cons�enoe Boundary Root (3ppdit n. Munsell Ou. Sz. Cont. Color Gr. Sz- Sh. 'Eff#1 'Eft#2 l /o V/Z 3l L 2-f S b� cQs e 3 •l /02 SiL l s w .Z .3 z 3 s L f des �s • `f J 0 S Borhg # ❑ e� ❑ Pit Ground surface elev. ft. Depth to kTMo bC6or in. Horizon Depth Dorr*wd Redox Description Texture StucUue C Sod Rate Boundary Roots GPDVrE in. Munsell OU. Sz. Cord. Color Gr. Sz. Sh. Tdw Bork # ❑ Borkv ❑ pit Ground surface etev. tz Depth to factor i<, Hart= Depth Do *wA Redwc Texhre Structure C.ac ce Sod Rate Bamdery Roots GPDR'i< In. Mutsed CkL Sz. Corn Gr. Sz Sh. 'Eft#1 •Eff#2 Effluent #1 = 801) > 30 < 720 ffg& and TSS >30 1150 nV L • Mat #2 : BW, < 30 moll, and M < 30 mg& The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or teed material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608- 264 -IrM. SOD.utoprA" (LO 3 ZjV3 f A, L� o T Z. Iql p a o� y t o � err - a S� 1 9 4 d 132- 18t 4 t �, -roh S' cROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwneriBuyer Pmt n .� ( O Mailing Address ° Property Address (Verification required fforn Plannin Dapa:tment for new construction) Cit y /State /State � � w s-- parce Idant ficatiar. Number __.- ----- ry t ECIAL IDsT,CC^'QTPTYM Cation t) i., 1 /4, Sec. , T �U.N-R�Q, Town of Property Location t ,Lot# oZ Subdivision i Certified Survey Map # Volume , Page # Warranty Deed # Volume .A .�.. Page # ._ + t � � �' - �--- -- L- f Spec house jR yes C1 no Lot lines identifiable y C no waes Improper use and maintenance 01 your sepd:. system could result in its pre narue f siiure to ad What st p ut p into the ura consists of pumper out the septic tam every three years or Sooner, if needed by a licensed pump Y ou P can affect the Atnction of the septic tank as a treatment lug* in the waste disposal System. eery owaez agraas to submit to St. Croix Zoning Department a cartificition form, signed oy the owner and by a The property pumper verifaing Aysm master plumber, journeyman plumber, restricted plumber or a the the c ank 1 ss 1 /3 of sludge is in proper operating condition and/or (2) after inspection and pumping (i eP ywe the undersigned have read the a b o ve requirements and agree to maintain the pr i va te e9 ur of } Wis Unsinh + Certific ati a set fot2tt, heroin, as set by the dopattment of Corrtmorce gad the Degaxtmont of Natural R sta ' t your septic systoat has been rasinuined must be completed and returned to the St. Croix County Zoning Office within 34 006 three year's on dau �� r, DATB S NATURE OF PLICANT (We) certify that all statements on this form are true w the best of my {o knowledge. I (we) am {are) the owner(:} of ro described abo virn: tTanty deed recorded in Register of Deeds Office• DAT SI N kT OF PLI,CANI T ir�•wr l�` * + + *�' Day in that is mis- ropresented may result in the sanitary perm - it being revoked by the Zot inj Department. wazran deed from the Register of Deeds office Include w sw IlCaitIOQ a st ry a tars a PP a copy of the certified survey map ii reference is made in the warTanry d eed POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 1 of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity , _ g al _ D NA Permit a S 3 14 S Septic Tank Manufacturer O NA DESIGN PARAMETERS Effluent Filter Manufacture -e D NA Number of Bedrooms Y ❑ NA Eff luent Filter Model ❑ NA Number of Public Facility Unite O NA Pump Tank Capacity Q al 0 NA Estimated flow !average} g aliday Pump Tank Manufacturer rreS lev ❑ NA Design flow (peak), (Estimated X 1.5) © a1 /da Pump Manufacturer ,,e,�/ 0 NA & C l Sod Application Rate al /da /fts Pump Model O NA Standard lnffuwWEffluent Quality Monthly average' Pretreatment Unit 0 NA� Fate, Oil & Grease (FOG) S30 mg /L 0 Sand /Gravel Fitter O Peat Filter Biochemical Oxygen Demand (800 5230 mg /L O NA C7 Mechanical Aeration O Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other. Pretreated Effluent Quality Monthly average Dispersal Cell($) O NA Biochemical Oxygen Demand (BOD 530 mg /L a In- Ground (gravity) Q In- Ground (pressurized) Total Suspended Solids (TSS1 S30 mg /L 0 NA O At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100nil O Drip -Llne ❑ Other: Maximum Effluent Particle Size Y in d'ia. C3 NA 0 � r ' D NA Other: [3 NA Other: C] NA *Values typical for domestic wastewater and septic tank effluent. aha O NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tanks) At least once every: 3 a ss a (Maximum 3 years) 0 NA Pump out contents of tanks) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cells) At least once every: 3 on h ls) (Maximum 3 years) 17 NA Clean effluent filter .S At least once every: , ® . r e) O NA Inspect pump, pump controls & alarm At feast once every: E3 month(*) D NA D (s) Flush laterals and pressure test At least once every: trot► (a) O NA a e) Other. At )east once every: months) p NA a (s) Other: D 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 trust include a visual inspection of the tankle 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 (Y 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 s certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. •apo' OAileJisiulwpV u194,10091M '(E) R (Z) 'I 1)05'B8 pus (1) 1P)tl)iq)IL)tL'6P wwoz) J0ide40 411m 9aue11OW00 u! 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(11)1100 lesJ9dslp 94; 01 peBJ aq 11!M J91eAA9ls9m 9893x9 94, psJolsoi 91 JsMod uomM 'sleAai Je1eM4B.4 lewJau an0ge ills Aew si1ue3 dwnd s0Belno J9MOd DulJnp - e3eluns OAlle Jll! ;UI 0411 Ua204 019 9uO!I!pUO3 t109 u94M Jna3o 1ou 11e4s do 3Je111 we19AS •99n of Jolid Joltiodo au131AJas 013sides 9 Aq p9AOWOJ (Shu91 041 ;o siuewoo ayi engy p93361eP aJe suolieJlu9au03 4514 A '(s)lleo lesJedslp 941 aBewep JO/pus seaooid iuewieen 041 epedw! A 1041 sieo!we43 Je4lo Jo slonpoid Buliuled ;0 93u9seid ey1 Jo; ls)Jiu81 luawlseJi A0 51MOd 841.4 a11n o1 JolJd 'uoilanJieuoa Mau Jod N011VV3d0 ONV do J.HV1S 40 e8ed f KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., MI STATE BAR OF WISCONSIN FORM 2- 2000 RECEIVED FOR RECORD Document Number WARRANTY DEED 01/07/2004 12:35PH WARRANTY DEED THIS DEED, made between Kemon J, Bast, a married person, EXEMPT # 8M Grantor, and Kernon J. Bast and Donalda J. Speer -Bast, husband and wife, REC FEE: 13.00 as Survivorship Marital Property, Grantee, TRANS FEE: Grantor, for a valuable consideration, conveys and warrants to Grantee COPY FEE: the following described real estate in St. Croix County, State of Wisconsin: CC FEE: PAGES: 2 SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: Edina Realty Title, Inc. 400 S. 2 St. — Suite 115 Exceptions to warranties: Hudson, WI 54016 Easements, restrictions and rights -of -way of record, if any. 412540 20- 1027 -40 -000 & 30 -000 &20 -00 Parcel Identification Number (PIN) This is not homestead property. Dated this 6th day of January, 2004. * emon J. Bast * * AUTHENTICATI ACKNOWLEDGMENT nature Si s i Signature(s) () Gha PU NA G STATE OF WISCONSIN ) O n ' ST. CROIX COUNTY. )Ss. authenticated this 6th day of J� Personally came before me this January 6, 2004 the above * named Kernon J. Bast, a married person to me known to be the person(s) who executed the foregoing instrument and TITLE: MEMBER STATE BAR OF WISCONSIN acknowled A the same. auth or, authorized by § 706.06, Wis. Stars.) THIS INSTRUMENT WAS DRAFTED BY *Cheri Brown Notary Public, State of Wisconsin Edina Realty Title —Doug Berg My commission is permanent. (If not, state expiration date: 400 South Second Street #1 I5, Hudson, WI 54016 3/11/2007 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000 f U 2987P 121 EXHIBIT A The NE '/. of the SE '/. and the NW '/, of the SE '/., all in Section 15, Township 29 North, Range 13 West, St. Croix County, Wisconsin, EXCEPT a parcel described as: Beginning at the E '/4 corner of said Section 15; thence South 00 degrees 47 minutes 33 seconds East, along the east line of the SE '/. of said Section, 407.27 feet; thence South 89 degrees 08 minutes 15 seconds West 535.46 feet; thence South 14 degrees 10 minutes 34 seconds West 93.31 feet to a point on a 80.00 radius curve, concave southwesterly, whose central angle measures 25 degrees 34 minutes 33 seconds, whose chord bears North 54 degrees 32 minutes 33.5 seconds West and measures 35.41 feet; thence northwesterly along the arc of said curve, 35.71 feet; thence North 14 degrees 10 minutes 34 seconds East 76.12 feet; thence North 01 degrees 07 minutes 26 seconds West 400.07 feet to the monumented south line of Certified Survey Map recorded in Volume 1, page 217 at the St. Croix County Register of Deeds Office; thence North 88 degrees 51 minutes 13 seconds East, along said south line, 570.78 feet to the point of beginning. c '' '0 1 0) m a CD - 0 rr X (A CD -P. 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