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HomeMy WebLinkAbout020-1447-22-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM F~fety 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 Swavel ,Jason & Jessica Hudson, Town of SST BM Elev: Insp. BM Elev: BM Description: a~ ~ ~~T TANK INFORMATION n TYPE MANUFACTURER ~~~ i CAPACITY Septic ~~"e iFtll.~.ti. /ZvZS FDesrnLf - ~0 1 a /2. ~Z5 Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air IIL stake +v '~- ROAD Septic g c 7~ ,/l~„ C h / ~ w 7L O J ~, Dosin Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Nu TDH Lift Friction Loss S s ad TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. CroiX Sanitary Permit No: 515160 0 State Plan ID No: Parcel Tax No: 020-1447-22-000 SectionlTown/RangelMap No: ~y'f+4~29.19.2853 STATION BS HI FS ELEV. Benchmark ~, ~ (~ , ~ / AID M ~ Z a, / Bldg. ewer 7~0 ~~ St/Ht Inlet .~ ,~ /, ~ ~, I jr St/Ht Outlet 4.Z 4 •? ~ G I Dt Inlet 1, i_ Dt Bottom `~ Header/Man. ~ ~ ~ G ~ Y Z 7 Dist. Pipe CJ • al ~o• Z ~ ~Z. 5 . ~ Bot. System ~b~ Final Grade 5. /00 .7 St Cover ~ Z ~Q ~~ C~ BEDITRENCH DIMENSIONS Width 2 Lengt ~? ~''~~ vv No. Of Trenches T Z IfewL~ PIT DIMENSIONS ~- No. Of Pits `~ Inside Dia. ~_ Li uicLd Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer;,,. ,~ , ^~ ~d1. ~ tY Type Of System: ~ } ~ i Z5 r /1 ./(. UNIT Model Number: Q , DISTRIBUTION SYSTEM !~! l 7l ~~ ~Z L.~~s~- Header/Manifold ~ ~7 ~/ Length ~• 7 Dia /( [.~ i Distribution Pipe(s) ` Length ` Dia ~ Spacing x Hole Size ` x Hole Spacing ~ Vent to Ain Iota ~rK Q SOIL COVER Y Prnec~~rn Ructnmc (tnly YY Mnund Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mul hed Bed/Trench Center ,,.,,,, 5• ~ ~, J Bed/Trench Edges \ Topsoil , Yes [] No Yes (] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 922 Coyote Lan~Hudson, WI 54016 (NW 1/4 SW 1/4 14 T29N R19W) Coyote Ridge Lot 22 Parcel No: 14.29.19.2853 C'r, ~ ~ ~J~_ ~,~... a.: ~ ~ e t~,, a vim. 1.) Alt BM Description = 1 u.. 2.) Bldg sewer length = 23 - amount of cover = ~ CailJ~, 4 Plan revision Required?0~ Yes ~No Use other side for additional information. SBD-6710 (R.3/97) - - ~(~ ZZ ~~ -- ---- - --- ---_~ ~--- __- -----_ Date Inse tor's Si ature Cert. No. ~'AI~ commerGe.wi.goV ;, ~ Safety and Buildings io -, 201 W. Washington Av Bt7162 County s~~ Y-O , t ~ s e o n s i n Madison, WI 5 - 162 r Sanitary P ermit Number (to be filled in by Co.) Department of Commerce / 5 / 5 ~tp Sanitary Permit Application StateTransa~ Number / ~, In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governme ntal ~ { unit is required prior to obtaininb a sanitary permit. Note: Application forms Ibr state-owned POW"fS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary w oses in accordance with the Privac Law, s. 15.04(1 (m ,Stars. ~ ~~ ~ ~ 1 A li i I f i ' ~ Q . cat on n ormat on -Please Pr AI nforntation r H Prope n y Name e f p e ' - sa ~ Ye (~ n o1~~ O ~ ~~U9 ~/~ ~ l.(J Property Owner's Mailing Address nvtX GvuIH t't Property Location ~ t PLiWNIN ~~2' ~' ~ '~G ~ ~ G ~ ZONING OFFICE 2 2 ~~ ~ ~~ (J ~,UG . Govt. Lot • City, State Zip Code Yhone Number ~~~~~ ~'-'! /.,~ /+, Section ~ / ~~sd,~ ~ ~ iC'~ ~// ~J ```' . (circle one R~Eo~V T~ N I I T f B ildi k L # _ ; . ype o u ng (chec all that apply) ot 1 or 2 Family Dwelling - Numher of Bedrooms __ a.2 Subdivision Name O~ ^ Public/Commercial -Describe Use • - ^ Ci y of 5u bnnt ot) ^ State Owned - Dcs ri c lx Use CSM Number ^ Village of // ++ ~~ ~~ ~ Z ~ZZ `' Town of ~LL~„rr-'dit~ 1 L.~L tu r fit. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' .New S stem y ~~ ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System (explain) l3. ^ Pet~iit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner I V. T ~ e of POWTS S stem/Com onentlDevice: Check all that a ~ I ^ ~NOn-Pressurized In-Ground ^ Pressurized In-Ground ^ At-Grade ^ Mound >_ itt. ofsuitabie soil ^ Mound < 24 in. of suitable soil ^ Holding Tank ^ Other Dispersal Component (explain) Pretr evice (explain) ~ V. Dis ersal!['reatntentAree Information: ~'(.^~ G Design Flow (gpd) Design Soil Application te(gpdst) ia{~''~'t Area Re Dispersal Area Prop (s f) System Elevation GOd ~ 7 ~,S'? .~ .~ ~ 7 ~ e ,le w ~o,~ 1'l. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units ~ ~ o ~„ ~ New Tanks E i ti T k ~ "' x s ng an s w e~ ~ 1>Dk. 5Z v c a. U ~ ~ in ~, ~ v1 ii. C7 a. Septic or Holding Tank y ~l• ~ d j L ~~ sev x DosingChambcr A VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation ofthc PO~VTS shown on the aNached plans. Plumber's Name (Print) Plunber's Signature P PRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) ld ? 4 ~ ~ ~ '~- o~ ~ ~.,d . ~ S YO l G VIII. ount /De artment Use Onl pproved ^ Perm it e e F Date Issued Issui~;g nt Signature ^ f ` ' ~ ~ ~ $ - ~` ~d ~ 0 tven Reason enial • ] ! J IX. Conditidy~~easons for Disapl.roval 1. Septic tank; ePflui!rtt-Ater and dispersal cell must all be services /maintained as: per management plan provided by plumber. 2. Ail sei~ttctt tetttitrerriertts mu~it be mairtained CAds f o~dktanas. Attach to complete plans ro: the system and submit to the County onl~^ ou paper not Icss than S I/2 x I I inches in size z SBD-6398 (R. 01/07) Valid thtu 01/09. r ~~-So ~ S~C+I L°~.~i ~ ~ti/ ~ c~~ a ~ G G~ ~ 6 ~~ ~ ~9'~ % d ~,U d ~= .~~ sir ~~ ~ ,~ 1 ` ; ~~~ ~~' / t~-fie ~~'~- 3~ ' ~ 7 ~~C O PY 1~~~ ~Q~~.-ryry~' x/°02.2 ~ 9 90 lD/~fa 9 .~~ ORIGINAL Wisconsin Department of Commerce Division of Safety and Buildings PAID SOIL EVALUATION REPORT Page of m accoraanr;e mui ~.vrnm oa, vvis. ram. ~.vue COUnty t"' L Plan must Attach complete site plan on paper not less than 8 1/2 x 11 inches in size T t . indude, but not limited to: vertical and horizontal reference point (BMj, direction and Parcel I.D. ~I ~~ ~ - '~~ '<' 2 ~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. T - ~! Please print all inforl-1~~.`EfVED Review by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). /~ b' a Property Owner OCT O 6 ZOOS Property Location ~ r~ U ~, Govt. Lot ~(/(,(, 1 /4~(~/4 S T N R E (o W Property Owner's Mailing Address ~ ING if ZONING l~E Block # Subd. Name or n~ ~ 1 CANN (~ ~a ~ r C City Sts Zip Code Phone Number ^ City ^ Villa wn N est Road / Construction Use~~Residential / Number of bedrooms Code derived design flow rate ~~ GPD ^ Replacement ^ Public or commerdal -Describe: __.______ __ _-_________ ___ Parent material Dtl ~r L~~~,p,.J Flood Plain elevation if applicable ~L/l~} ft. General cornrrter>ts and reoornmendations: System Type ~1~1i(~,~,~te±.~~.~ System Elevation ~~iC/ Boring # Boring Pit Ground surface elev./ D i v ft. Depth to liming factor ~ in. Soil ligtion Rate Horizon Depth Dominant Cdor Redox Desaiption Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 I ~ ~ 3 ~~ `~ ~ ~~ i ~ ~ v n /~ ~ i! ~ .~ .JG (~J ~j ~ i v l ~~ '' b ~~ # ^ Boring ~ ~~ pit Ground surface elev. ft. Depth to limiting factor ~=~-'~- in. Soil Iication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 2 5'-ya s ~ ~ ~~ ~ - ~ -~ r t 'Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 'Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~~r~ v9 715-246-4516 ,~ `r Property Owner Parcel ID # Page of Boring Boring # 'pit Ground surface elev. / G' / ~ ft. Depth to limiting factor ~ y o in. ~l lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/it in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 i o~ ~ 31L ----- C.~- ,~,,~ , D i Boring # ^ Boring U U Pit c~rouna sunace elev. n. vapu~ io nnnmx,) ~auui ~~ ~. Soil lication Rate Horizon Depth Dominant Col Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Boring Boring # I~J U Plt v~w~ ~..ow..... ~''"' •" """"'a . _._ .. Soll ication Rate Horizon 'lepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. •Etf#1 `Eff#2 • Effluent #1 = GODS > 30 < 720 mglL and TSS >30 < 150 mglL 'Effluent #2 =GODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-877?. s1 SBD-8330 (R.N00) P`upertyo~r=--~--- ~~ Boring # ^ Boring `~ Par~ellD# Page of 1n5!n. edit .s v~rru ~........,, o....a..o ~.~ _ .,~.N ~ ....~.~~.. y ,~,..,. ,,,~ ~. 5a7 Fiaoe Ftorfmn Depth Dorninar}t Col« Radox Deso~tior- Texttra Stnrcrire Consistence t3oundary Roots GP D!!P in. Munsell Qu. Sz Cont. Cda Gr. Sz Sh. 'F1~1 'Eft#2 4 D- ~ ~ -----r ~.r- ,r.~. , D _ ~ ~ ~: ,3 ~~ # ©Bo~' ^ Pit Ground awface elev. ft. Depth m irrrting factor Yi. Soil liratron Rate Horizon Depth t)omtrta~ Color Ftedox Description Terdure Strtxxure C.onsisterice Boundary Roots GP DRF in. Murtael! Qu. Sz Corti Gobr Gr. Sz. Sh. •Etl#1 'Efr#2 i ~~ # Q ~nBl r ..,.r e, ~~ro .r... # M..N. M C...:a..., a.....,- r. u nc ~ ---- - - -- ---- --- Soi icatianRate Horiaon ')epth Dorninarti Gda iZedoat Description. Texture Structure Considence Boundary Roots GP DHf In. Murtsel Qu, Sz t..ont Cobr Gr. Sz Sh. •Eff#9 'ER#2 I i I ` Eflluant #1 ~ B~s > 3t) <_ 2Z0 mgq. and TSS >30 ~ 15Q rngA. • EflMrent #2 = BODs < 30 mg!}. and TSS < 30 mgA _ i 'Fhe Deparnnent of Co ~merct is an equal oppotwniry service provider and employer. If you need assistance to access services or need mattt~l in an alternate format, please contact the department at 6a8-266-3151 or TCY 608-264-6777. sans~w ago) Z•d d60~s;0 EO 6Z aea Soil Test Plot Pla Project Name Jason Swavely S ird Address g22 Coyote Lane Hudson Wi 54016 Lot 22 Subdivision N W 1/4 S W 1/4S 14 T 29 CSTM #226900 Coyote Ridge ate 10/5/09 N/R19 W Township Hudson Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1" pipe ~. System Elevation TB~ *HRPSameasBenchmark ~~ ~ ~ ~ ~ ,,, "" ~' -'--~. NftO 50'4 . __ ,. ,- /~ _ -- - __ f-_--___-___ ,~. - -- -- --. X10. m; --. _.__ - ~ _. / ~ - -_ ,. " ~~ ...... ® ~ .. .. ,` ,~~ ~~~ ,` ~. /~ / ~ ~, ~. ~ /. ~C ice/ // '~ `~ LOT 18 ~ ~ LO' ,~ ~ ~~ /~ ,.'~/ Fs~, 228 ACRES ~ ~ 2.11 ~ ~1, / ~~.,' ~~,p4~ 99335 SO. FT. 92006 / ,. ~ / ' ~, ..: ,~ h ~. ,` LOT 17 ~ 2.43 ACRES ~~. 105829 SGI. FT. `~ ti -~ h `~ ~° ~"~ 311.5 ~\ i LOT 2.32 A( 101223,E s~r~~, ~2.F~~ i _I~ ®~ •- ~ ~ LOT 23 e ~ e errQCC sa-: ~. 547.30 N87°40'16"E 870.9 LOT 21 3.30 ACRES _ L17 143828 SQ. FT. ~._. EASEN ~ ___ '• 20' r L ~ i i ~ `~OD ~ j Z 1 ............. ® .-iai - iii 1 L14 ~ / r- -- ~' ~ ~~ /_ ~; ~- _.~ /" -~ ' /, ,.- f i ~20 .'~ % ............. i ~ ~~~ % ~~ "~ ~; ~~ .: ,i '' i~ ~ ~~~~ ~ ~ ~. LOT 24 .. 2.03 ACRES :, ~~.. 88486 SD. FT. z ': ~~. .' RAQTEMP{ °O°"TM °LAT °" COYOTE RI00~ LOOA7[O IN PA11T OP TM N[1M OP 77'1[ M1Al AND ii 7X[ NYYIM OP 7N[ i[7H W NCTON 1[ AND IN P/NIt OP 711[ NwtM OP TNi 1{W7H OP i[CTION 1~• ALL 7N TiM1. Rtf W. 70WN OP NYOiON. dT. C1100(000N77, N11i00NNN1 INCLVOINO LOT 7i Or 7N[ PLAT OR ~ ORA[i fAlp.7. ~~., I ~II~ ~, ~ ~1 _-_ ~ .l +^~~ _I._..-L-~.1~ 7[Ml, w7iw .,,.,~,..~., 76 9 93~ >. .~,~ W urtr4! LDI\\-x~,HlMf_tai.OEMRY/a i uis7[isornts arrton-.mwsu ~~nrs+a wmP.wFn c+.-aw, mo¢u~-~~. nawvrE • av rurarsxa~aMmoaw.crwwrwnw~.a~~ura rt.amaw ~ w~a ~..mn roimvwoaiwra~nunam n.O niELRI MIMMNIm~fIL~WMO[ ~ I. l1 ~ s 1 ~,~'ri p~ ~ ! _ ~ wean. i wart ® M ~ ~'a°n O ® uA.Y t ® ~ [ ~ ® LOTS. ~ [ •!.~ ~ i ~ Yplan. ff Lwo.-sw 1/KIO ~ ti ~r..an. ® ® _ :. _r .- auir r _ _... __ ® w.. Rwr~.. 11d1an. •\` ," PP7l11Y[w17~. _... ... ,., / %. ~ :.: ~ / s .` \ / .. LOTS[ A LOT It ~ ~ i .mss / ~ ~ . Ban. i1lan.w I I a \ ..SR /~ i W 1~ ® rl ~ ~\. IGe % ~ ~. ~L~.ai11n ~ wa ~o...w. ji i i6 ® ~. e :. ~=. Larr , Ay' IIIAPO `\~ 1 ~ ~-~~" ®® ~, ;,. Y ~. .~~, / ~ - LOf 17 , iP J • Lr~aa art. "i..ii ~# ~ .^~ ~ :.~.'- 'a 1~iG... y.. :.'r7~ - j~ / .A f1' ® ~. ~ / MIe \\` J, L. .era n. LOf K J a ~ qn. ~, ® Q7 /~ ; 1 L07 JM IOf 11 ~ rn + 1/"/~•%~~/ LOTH i ~ ~H.n~. (A Y' ~ 101.100 t ;OTN 011f1an. ~~ i ® 0000 t} ~ ~. lwwan. p ~` LOT 0 0 ®. N'GIN. ~ ` O N P ~ ~.~• ._._•_._•~-._. __._.--._..__.___-.-__.-_~.._-.__.11~7~RIb liJLCL64 ~Qalf[®AP/mV00!!il• _. ~~ Y~ __ ~ ~ ~ - e ~gN11 ~. _ ,P.~,aL~.,~Lnw I - r - 1 ~`„ ~ -_~ ~~ ^ !eR « ton. ~~~' ~ I ..~... ~s - ~,. v ow,8 ~--- ~„~... w ~ _- - - w11ww..w.~.rn.n~..amlwLeu.ar.eA.r.l.law... wnL[wn[r 1•.700 -....- _ - _I ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ,~ Je~ SGyt /Gc~q V'L Mailing Address ~ C.~O~d~~ Property Address ~p?o? ~d~~a/E / (Verification required rom Plamling & Zoning Department for new construction.) ~ # ~ City/State !''~fJ~p~ ~ ~ Parcel Identification Number o zo --~ /~f~`J- ZZ - 6,pa LEGAL DESCRIPTION ~~ ~ ~~ 53 Property Location ~ '/4 , ,S"l~ '/4 ,Sec. ! ~ , T ~~~ N R~W, Town of i~o~~~-'o~J Subdivision Plat: Certified Survey Map # Warranty Deed # Spec house yes n Lot # ~~ Volume ,Page # (before 2007)Volume ,Page # Lot lines identifiable'~~_; no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, 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. Owner maintenance responsibilities are specified in §Counn. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1 /3 full of sludge. liwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms _~_ SIGN TURF O PPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) POWTS OWNER'S IIA,ANUAL ~& MANAGEMENT PLAN Page r of FIRE INFORMATION 4wnerTQSa,~ .s't'tJc~ tdL° ~t~ Permit # ~~ UCS1l7rY YNl'IAML- 1 L~li:•i Number of Bedrooms ~ ~ NA Number of Puialic Facility Units [~ NA Estimated flow (average) +~ O O al/d Design flow ipeak}, (Estimated x 1.5} ~j (g ~ i/da Soil Application Rate al/da /ftx Standard InfluentlEffluent Qualty Monthly ayerspa " Fats, Uil & Grease IFOG) € S30 mg/L Biochemical Oxygen Demand (BODsi i 5220 mglL. I; I NA Total Suspended Solids (TSS) <150 mglL Pretreated Effluent Quality Monthly averaj~e Biochemical Oxygen Demand fBODg1 530 mg/L Total Suspended Solids iTSSI 53Q mg/L Q NA Fecal Coliform (geometric mean) 510" cful10E?ml Maximum Effluent Particle Size Ya in die. (~ NA Other:~~ q ~iA 'Values typical for domestic wastewater and septic rank a flysllt. wwn~w~rcwlnunc c~nucneu a SYSTEM SPECIFICATIONS Septic Tank Capacity l~5' p al ^ NA Septic Tank Manufacturer ~ ~ ~S.~,tZ ^ NA EtfluQnt Filter Manufacturer ~' ~Lct~/~ ^ NA effluent Filter Model -`....z-~i__.. 3',~,,~' ^ NA Pump Tank Capacity g ~ t~ al ^ NA Pump `tank Manufacturer ~ ,~ S e ~ ^ NA Pump 11~anufacturer ~, ~ v..~ ~ ^ NA Pump Model ~ ^ NA I°retteatment Unit ^ NA iQ SandlGravel Filter ^ Peat Filter CD Mechanical Aeration ^ Wetland d pi:3infection ©Other: 4ispersal Cell(s) ^ NA E] In«+Ground (gravity) ^ In-Ground (pressurized) ~.1 At-C3rade ^ Mound t~ prEp-Line ^ Other: Gith4rs ' ~ ^ NA Qther; ^ NA Service Event Sarvlca Frequency inspect condition of tankls} At I month(s) aSt once every; ~ Pq earlsi (Maximum 3 years) ^ NA Pump aut contents of tank{s} Wh cornbined sludge end scum equals one-third lY3} of tank volume ^ NA '' inspect dispersal cellis} At I ^ monthlsi (Maximum 3 yearsi ^ NA eat once every; ~ ~ yearis) _ Clean effluent filter At I ast i)ndd every: ~~ ~ ~YeB~( }lsl ^ NA _ -'T ~ Inspect pump, pump controls & alarm At ! ^ NA ~ ear{s,tsl ast orct3 every: *--. Y ---- Flush laterals and pressure test At le ^ month(s) ^ NA ant Qnce every: ^- ©year{s} Other. At least pnae every; ^ monthls) ^ NA '~ ^ years} other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and disperse! cells shall be m$de py ttn Ind#viduail carrying one ofi the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; ROWTS lrlepectar; POWfiS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank($i to idaittifY aqy missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and, to eh~ick far any back up or pending of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the efflu®ttt levels In the observation pipes and to check for any parading at effluent on the ground surface. The pending of effluent ort t},e ground surface may indicate a failing cond'+tion and requires the immediate notification of the local regulatory authority. When the combined accumulation of siud{}e and scum. ir, any tank equals qae-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servioln~ Operator end disposed of in accordance with chapter NR 113, Wisconsin Administrative Cod®. 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, sh$11 be pe_rformeff by a .certified POWTS Maintainer. A service report she{I be provided to the (oval regulatory authority within 10 days of completion of any service event. 8TART UP ANO OPERATION Far new construction, pNar to use of ifie POWTS bh~k trlb~ifr that may impede the treatment process andJor dartt~j~ ~hrr S~EI of the tank(sl removed ay a septage servicing opera~~i pr1~r xi System start up shall not occur when soil conditrona iiN'e fftgi~aa During power autagas pump tanks may fill shave nrtrrnr~! Itl~ ~}? discharged to the dispersal cellie- in ana large doss; ci~~~~ir efftuent. To avoid this situation have the contents d~ ~Mf! pp1~ power to the effluent pump or contact a Plumber 4it ,l~Vi~7 restore normal levais within the pump tank. Qo not drive ar park vehicles aver tanks and dispaf>li~l . within 15 feet down slope of any mound or at-grad! ppll 4ieduction or elirhinatioM of the fallowing from the w POWTS: antibiotics; baby wipes; cigarette butts; tllf(j foundation drain lsump pumps water; fruit and va~pii± painting products; pesticides; sanitary napkins; tatt~oK~ Page ~_.. at ...___... N'it tl~rrkial for :the presence of painting products or other chemicals ar~~il ~~~~~~?. If high concentrations ,aria detected have the contents at ~.11}~IiEh~ttve surface. Il~~" .Ii1V+~~, '(J~hen power is restored the excess wastewater will be t~ QA~~~s~ i~i'td may result in the backup- or surtaoa discharge of 1i~C .:t~i~lt4ylld .by a septage Servicing Operator prior to restating ~t#tdln!W' to assist in manually operatir-g the pump controls to r14t ~-1vq pr'°park over, or otherwise disturb or compact, the area Ian ~d~, rl<t~y iifiprove the performance and prolong the life e# the ~~t'i!'1;~~ i ~tegreasers; dental floss; diapers; disinfectants; tat: il~~g; il~~~i~f grease; herbicides; meat scraps; medications; oil; ABANDONMENT When the POWTS fails and/or is permanently takeki qUt~ d1s I;Ee~i~~( ~h~' fel~l~4V~Irg steps shall be taken to insure that the system is properly and safely abandoned in compliance with Bltl~t$i<ar p!'t~"~,~i S~f~f~ansin Administrative Coda: e Ali piping to tanks and pits shall ba discohrl~$1ll;p~ ~ihd ~~p Mb~Pfdll~li~ pipe openings sealed. ~. • The contents of all tanks and pits shall ba r~k"!'llf!Vi' fili(cl prbp~tply dil-po~d of by a septage Servicing Operator. • After pumping, all tanks and pits shall be aftg~±Q~#d ~t~d tdi~gitr~q ~t their covers removed and the void space filled with soil, grave) or another inert solid material. CONTINQENCY PLAN If the P4WTS fails and cannot be repaired the fckllia:~gl~,~ .i'~~~stll+~la .1!~vei p!~1en, or must be taken, to provide a node compliant replacement system: © A suitable replacement area has been evailltlt~ itli'+#, tt~ ii ,i~Ilt U~1li>~+~! for the bcation of a replacement soil absorption system. The replacement area should be pl'~f~ ~l"g1riY ~iptsyfb~4p,~nd compaction and shnukl not be infringed upon by required setbacks from existing and propo6llit) r;+1~9t I;e~! ~~~ ~p',wells. Failure to protect the replacement area will result in the need fpr a new soil and site ev~~u,~Rid#i ~alryrr~lil~l~M~ it ilE~#tgble replacement area. Repiacemertt systems must comply with the rules in effeot at that time '.' , D A suitable replacement area is not availtlt~li~ ~Ilatl ~~} g~1e~~~k !I~!~i'Qr soil limitations. sorting advances in POWTS technolggy a holding rank may ba ins#allad ~~ ~ ~~l~t r,je~r~ ~ r~i~lli~i~.:~Me failed POWTS. ~~~Ci The cite` as not an evaluated tc identl~i ~ a~rll~ ~~~~iigirll~iilk}~t .area. Upon failure of the POWTS a soil and site evaluatfan be pertormed to locate a si,tit$~ NI r aka. if no replacement area is available a hokfing tank may b efle s a last resort to replace #i1Mi~i~~~11 ~' Cl Mound and at-grade soli absorption systel~l¢•::li1~Ir q~ Ci11~~i~}l'~IiPtl1~ in place following removal of the biomat at the infiltrative surface. Reconstructions of such ay~i~ftgti r~u~ir ~~r>SpW v~iXh the rules in effect at that time. < <wA~IUiNO> > Siz~'1'iC, PUMP AND OTHER TREATMENT TANKS Alfl~~' ~ ~ ASSES ANDIOR iN$UFFICIENT OXYGEN. DO NOT ENTitaR A SEPTIC, PUMP OR OTHER TREATMENT ~'~~'~ aisITANCES. DEATH II~AY RESULT. RESCUE OF A PERSON FRt)M THE INTF..R10R OF A TANK MAY BE Is ;~ , ,,~ ADDITIONAL COMMENTS POWT$ INSTALLER ~~ ; ~ : TAiNER Name `1A ~ L R. ., ~4 - SEPTACf SERVICING OPERATOR (PUMPER) ' iIsATORY AIiTHORITY Name _ , I~ ~ /o: w ~~ Phone hp-~n~; ~ ~S . 38(x- y This document was drr~ttad in compliance with chapter Comttl eA,F~I>y~lalltll~ili~if( +~~ 1~~,6AItl. (21 $~ 131, Wisconsin Administrative Code. TIC TANK ~ PUMP CHAMBER CR~~S SEC ION P.ND SPECTFIC~!TIONS S E P ,.~~.--- 4" CI VENT PIPE 12" MIN. ABOVE GLADE ~ WEATHERPRQOF > 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED ' LE COVER WI H CONDUIT MANHO FRESH AIR INTAKE T W/ PADLOCK ~ FINISHED GRADE ------WARNING LABEL 4 " C I R 15 ~ ~____~_ 1~_ 4 " MIN , 18" IN. 6" MAX. ~~ ~~ :; ~ ~~ t N LE T ~ ~~ ' ' ~ ~~ WATER TIGHT SEALS GAS- ' ~t TIGHT ~ ~APPROVED SEAL ` ~ JOINTS WITH ~FPROVED -- ~ ; ALM APPROVED PIPE 'IPE 3' ~ ~ ON 3' ONTO INTO SOLI4 ' ~ SOLID SOIL iOlt ~,~,,~ ~ ~ OgF ~~ RISER EXIT PUMP OFF ELEV . ~ FT ~ PERMITTED ONLX IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BE~?~IN(3 u~DER 'I'A~tK CONCRETE PAD S FEC I~' ~ CACTI 4iV SEPTIC / DOSE TANK MANUFACTURER: l~ `E,~~..R. TANK S I2ES : SEPTIC 1 `~,~ Q GAL . ~`~ DOSE T ~ bb_,,, GAL, ALARM MANUFACTURER: cry MODEL NUMBER: 'p1.`V SWITCH TYPE: M~ PUMP MANUFACTURER: G~,y~ MODEL NUMBER : ~ P c~ SWITCH TYPE: !^r~~e~C REQUIRED DISCHARGE RATE ~ ~ GPM NUMBED DOSES PER DAY: „ ? DQSE VOI'~iM£ INCLUDING F LOWBACK : I ~ 9 GAL . GAPACITIE~1: A = ~~ INCHES =`GAL. B ~ 2 INCHES = ~~ GAL. C = 0 INCHES = ~$ GAL. D = 1o INCHES = a ~ GAL. PUMP ~ AIrARM WIRING AS PER ILHR 15.23 WAC '1ERTICAL DIFFERENCE BETWEEN PUMP ()~'#' AND DT.STRIaUTION PIPE Io~L FEET + MINIMUM NETW©RK SUPPLY PRESSURE 2.5 FEET + ~pQ~ FEET FORCEMAIN X ~~60FT~10A E~'. FR~C~'ION FACTOR . -~~~LFEET T,fl~~L AYI3AMIC HEAD - FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ....•- ; WIDTH ..--~• DIAMETER --' SIGNED: _~,.~•a~'.~-°' LICENSE NUMBER: ~.~.~ QqU DATE: ~./aa ~GOULDS PUMPS Submersible [fflueet Pump ~'~~ 3871 EP05 APPLICATIONS Speafirally designed for the following uses: • Effluent systems • Nomes • Farms • Heavy duty sump • Water transfer • Dewatering SPEClFICA;IONS • Solids handling capabit'tty: 't+" maximum. • Capadties: up to 60 GPM. • total heads: up to 31 feet. • Discharge size: 1'/:" NPT. • Mechanical seal: carbon- rotaryJceramiastationary, BUNA-N eiastomers. • Temperature: 1O4°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, li0 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: i0 foot standard {ength,1613 5)TOW with three prong grounding plug. Optional 20 foal length,1fi/3 SffW with three prong grounding phag (standard on EP05}, Q 2000 Goulds Pumps ENective February, 2000 83877 • Fully submerged in high grade turbine ail for lubrication and eftldent heattransfer. Available for automatic and manual operation. Auto- matic models indude Mechanical Float Switch assembled and preset at the factory. FEATURES ~ EPO4 Impeller: Thermoplas- tk Semi-open design with pump out vanes for mechanical seal protection. METERS FEET i.._...._..........._......... 10 ..j..__ _.... f.. . .. 9 30~ .............~._.~ i...... _........_. _ ... A u~ z V 0 0 3 z ^ EP051mpeller. Thermoplas- tic endosed-design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength anti corrosion resistance. ^ Motor Housing: Cast iron for efficient heat uar~fer, strength, aml durabNity. ^ Motor Cove: Tlrennoplastic cover with integral handle and float switch attachmertt points. ~ Power Cable: Severe duty rated oil and water resistant. o z 4 s c~-Pnc1TY ^ 8earingr: Upper and lower heavy duty ball beanng construction. AGENCY 1.15TING ~• Candlan standards Atsadatlon {CSA listed model numbers end in "F" or "C".) Goulds is tso Boot rteymrFea• 8 1o t2 m~lh Goulds Pumps 1TT Industries 8c97~Z STATE BAR OF WISCONSIN FORM 2- 2000 Number ~ WARRANTY DEED THIS DEED, made between Kernon J. Bast and Donalda J. Speer- Bast, husband and wife, Grantor, and Jason Swavely and Jessica Swavely, husband and wife, as Survivorship Marital Property, Gr_ a^y. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Lot 22, Plat of Coyote Ridge in the Town of Hudson, St. Croix County, Wisconsin - _ Recording Area KATHLEEN H. NALSH REGISTER OF' DEEDS ST. CROIX CO. , MI RECEIVED FOR RECOf~D 07/17/2006 10:00AM MARRANTY DEED EXE~7 # REC FEE: 11.00 TRANS FEE: 362.70 COPY FEE: CC FEE: PAGES: 1 Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. ~t~~~-fit ~ - * Donalda J. Sre r-Bast 020-1447-22-000 Parccl Identification Number (PIN) This is not homestead property. Dated this 12th day of July, 2006. * Ke on J. Bast * AUTHENTICATION Signatwe(s) authenticated this 12th day of July, 2006 TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED 6Y Peterson, Fram & Bergman -Steven H. Bruns 50 East Fifth Street, St. Paul, MN 55101 (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 1 of 1 3 Return Address: alty Title, Inc. ~ ~~ St. -Suite 115 ~~q,~2 O W154016 l .J ACKNOWLEDGMENT STATE OF WISCONSIN } ST. CROIX COUNTY. ) ss. Personally came before me this July 12, 2006 the above named Kernon J. Bast and Donalda J. Speer-Bast, husband and wife to me known to be the person(s) who executed the fore g instrument and acknowledged the same. 1, *Pamela A.Willman Notary Public, State of Wisconsin My connnission is permanent. (If not, state expiration date: 2/25/2007 ) Pameoa ~,. vviiur~~ar Notary Public ciarp of Wisconsin FORM No.t-2000