Loading...
HomeMy WebLinkAbout020-1359-25-000Wisconsin 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 McKenzie, Chad Hudson Townshi :ST BM Elev: Insp. BM Elev: BM Description: cagy . 01 tsp . o / T W Ia'f" s~+'~c.t. ':. c.sr 6-u'tE. i ~A dll! IAICACIIAATIAd1 CI C\/ATInAI r1ATA TYPE MANUFACTURER CAPACITY Septic ~.e..~`~6tt. Z,a~o QoU Dosing ~ tr Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~s ~ r!~~ 3 (7 r ~~ Dosing k ~t u I Aeration Holding PUMP/SIPHON INFORMATION Manufacturer ~-' Demand S GPM ~~~`~ ~~ Model N ber /~~ ;~ TDH Li Friction Loss System Head TDH Ft Forcemain Length t Dia. ~ Dist. to well !~ ` w ~ 2, (_ SOII ABSORPTION SYSTEM ; ~ " ~ ~. ~ 9 n ..,... c°unty St. Croix Sanitary Permit No 404902 0 State Plan ID No'. ~~ Parcel Tax No: 020-1359-25-000 STATION BS HI FS ELEV. Benchmark `~ .3u ~ o°t.3o ~ ~' 0 Alt. BM 3 ~ / 0~.~ Bldg. Sewer ~ ~ ~ ~ ~ O I.2o/ SUHt Inlet ~ I~ I~• (~l St/Ht Outlet Dt Inlet Dt Bottom )2 ,~-- ~ •~ Header/Man. ~. • o (;~{ ' ~, 301 Dist. Pipe ~ ~ o x.90 19 ~/ Bot. System In .SZ, I]. ~ 1 q~. Final Grade sc,~..~o m St Cover v C ~~'~ idth Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ 3 q3 ~. ~Z SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Map}~facturer: 17 t DD ~F~'~"~S~J~ INFORMATION Type Of System: ti 35/r ~ ~ 3 ~ ~~ ~__ r' UNIT Model I~i~mber: A ~ JLaJ~ •e v • x w DISTRIBUTION SYSTEM Header/Manifold I t Length~e `Dia Distribution Pipe(s) Length Dia Spacing x Hole Size x Hole Spacing Vent to Air Intake Coll (`C~VFR ., o.,,«....e c.,~•e.,,~ n„1.. Y,. RAn~~nrl nr At_r,rarle .RVSYPmS Only Depth Over Depth Over xx Uepth of xx Seeded/Sodded xx (tlulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 'f'~. / 2-~" / ~y Inspection #2: `t-~-.L~,_ Location: 939 Daily Rd Hudson, WI 54016 (NW 1/4 SW 1/4 16 T29N R19W) Parkwood Meadows Lot 25 Parcel No: 16.29.19.2121 /~ /~ ~ 1.) Alt BM Description = I ~~~ t-~-d~~°-'•. ~ l~.'`s~~~~~~~y, ~0-~- !.~~ -- ~i~ y I~R-ll tit ~''' 2.) Bldg sewer length = 3 p V ~ r -amount of cover = ~ 3 G• " - t~Lr',t. _~ ~r ,~~'~ ~~~..''~~ _ ._ ~._ _ _ ~- 1 Use otherts de foruadditional i f atlo~n.v%" (v~~", Z_ ~~ `^~" '/ ~` I ~ ~ / ~ D~e ~ Insepctor's Si~natuf~ q ` Cert. No. SBD-6710 (R.3/97) , ~ ~' ~ G~ (~~ _ _ j . ~Co , , n 1 1 (/jS"~(~ ) 9 Safety and B Idin i, 7 6~ ~ Coun ~~ ~ --~ ` L ~ 20 W. Washingto Ave., P.O. Box ,Q -a~, ~~~O~~,n _ M so 53707 - ? 162 Sanity Permit Number (to be filled in by Co.) Department of Commerce 6 66-315'f ,:i d ~ Sanitary Permit p n -`' ~ ~ t;~:ulx co~;~,-, ' r . ~~f} personal informs m ~n~~ b~id~;!a (~-~i Wis. Adm. Code In accord with Comm 83.21 ~E , , may be used for secondary purposes Privacy Law, s15.04(1 xm) ro ct Address (if different than mailing address) [. Application Information -Please Print All Information G ~ y /) ~~ Property Owner's Name Parcel # Lot # - Block # ~ as Property Owner's Mailing Address ~ / Prope ati ozo ~ -3s9-25'- l 70 , ' ~ ~ y c S ~h, Section ~ /" ~ %. City, State Zip Code Phone Number _ , ,$-%b ~~ /S - 3 ~'f - syos a ~ ~ circle one) T N; R~E or W e of Building (check all that apply) II T . yp ~l or 2 Family Dwelling -Number of Bedrooms Subdi ~sion N e C'6i.Hiamber /C i l -D ib Us ^ P bli c ommerc a escr e e u ^ State Owned -Describe Use ^City_^Vill ge.~ ownship of III. Type of Permit: (Check only one box on line A. Complete line B ifapplicable) - ~ ` A' New System ^ Replacement System ^ TreatmenUHoldin Tank Re lacement Onl g p Y ^ Other Modification to Existin S stem 8 Y B. ^ Permit Renewal ermit Revision ^ Change of ^ Permit Transfer to Ne~v List Previous Permit Number and Date Issued Before Expiration Plumber Owner ~ - / 2 ~ Q O ~ ~ / N. T e of POWTS S stem: Check all that a 1 i~Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) S stem Elevation ~ ~i` Vi ~~~,~ - ~ gS-~ /Q~ a" ~~~L~~ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plas[ic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Taidcs Septic or Holding Tank /~l~V „~ /~~ / Aerobic Treatment Unit Dosing Chamber ~ .-- U~ / VII. Responsibility Statement- I, the undersi ned, assume responsibility for installation otthe POWTS shown on the attached plans. Plumber's Name (Print) Plum r s Si ature /MPRS Number Business Phone Number ~~ u~~ as~~s~ ~~s--a~~-~y~ Plumber's Address (Street, City, tate, ~p ode) ~ / / ~ O~ VIII. Coun /De artment Use Onl pproved ^ ~ Bisaot~ ve Sanitary Permit Fee (incl es Groundwater Date Issued Issuing gent Signature No Stamps) ~ , Surcharge Fee) ~/A ` bCJ ~ 2~ ^ Own iven Reason for enial IX. ('onditions o pproval easons for Disapproval f~ I ~. ~ ~ Q ~j `~ AtMch complete plans (to the County only) for the system on paper not Tess than aarz x It tnchea to size (. z(2 SBD-6398 (R. 01/03) ~GOULDS PUMPS APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability; 1/." maximum. • Capacities; up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1'/J" NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°f (60~) 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 S17W with three prong grounding plug. Optional 20 foot length, 16/3 SJTW with three prong grounding plug (standard on EP05). ~' 2003 Goulds Pumps Ette<<we July, 2003 83871 • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer, Available for automatic and manual operation. Auto- matic models include Mechanical Float Switch assembled and preset at the fanory, FEATURES ^ EP04 Impeller: Thermoplas- tic semi-open design with pump out vanes for mechanical seal protection, METERS FEET 10 9 30 s _.. _. 25 o ~ Q W x v 6 20 ~ 5 ~ 15 Q 4 o 3r 10 2 5 1 ° °o 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 waterJesistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING sP, Canadian Standards Assodaaon ,_ file # 1R38549 Goulds Pumps is ISO 9001 Registered. ,\,_ i -- t- 5 GPM ~ --- 2.5 FT ' __ _ . _. .. .......... . t. _ _ 0 2 4 5 8 CAPACITY ~_ 10 12 m~/h Goulds Pumps ITT Industries COMBINATION SEPTIC/DOSE CHAMBER TANK & PUMP SPECIFICATIONS PER COMM 84.25 CODE CHANGES 2/1/2004 Access Opening, not top of coact, must adend to a point no greater than 6"Below Finished G*ra~de Cover with W~~~ Lockingg Device ~j~ (typical) ~~ ---- > 3o Ifi ~4Z is O~ 1A15Ul.A'~ Min. 23" Access Opening PIS Ouh:t Effluent Filter ~ i Inlet Baffle Access Opening, not top of cover, must e~dend at least 4" Above Finished Glade . ~(v~ r' Y~riT' ,~^~ ~ b~ ~89a' pp~Ze~v C~ I~ ~ N Finished Grade /Z .r- Min. 23" Access Opening 'fin-~k,~ .M iN.n~ vrr+ ~ rv/~! if ~~P1% S~'E ~ .Union ~,eoYE~ !~/P~ 3 pT, C 3 "Sand orq rave-f' ~n~y un e1~- w~~h c~eh~er 2,• ~ocuer shah pd~P.s Tw+o Compar ment Septic/PumpTank ~,~ ~ ~~~. on o~Side G(~/Lt) SPECIFICATIONS TANK MFR: '~Ul.~~-`- DOSES PER DAY: 3 TANK SIZE: SEPTIC ~~~~ GAL. DOSE ~ GAL. ALARM MFR: L, MODEL # Switch type: /I,~-~-~~ , PUMP MFR: MODEL #: G SWITCH TYPE: ,~~ REQUIRED DISCHARGE RATE ,GPM DOSE VOLUME: 7© GAL. (INCLUDES FLOWBACK & <20% OF DWF) CAPACITIES: A = ,6~1NCHES = ~y~,u-GAL. B = _2_INCHES =~~,_GAL. C = INCHES = GAL. D = ~ INCHES = GAL. PUMP & ALARM WIRING PER COMM 83.43(8)(e) VERTICAL DIFFERENCE BETWEEN PUMP OFF & DISTRIBUTION PIPE (LIFT) _ ~ = y~ FT. MINIMUM NETWORK SUPPLY PRESSURE (DISTAL & NETWORK PRESSURE) _ + -- FT. ~~ FT. OF FORCEMAIN x ~~ l tU FT./100 FT. FRICTION FACTOR ...... _ + . 5 FT. TOTAL DYNAMIC HEAD (TDH) = FT. INTERNAL TANK DIMENSIONS: LENGTH ;WIDTH ;LIQUID DEPTH MP/MPRS SIGNATURE: / LICENSE NUMBER: O?o? ©~S Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 ~~ IsCOns`~ Madison, WI 53707 - 7162 Address De artment of Commerce o zv m Sanitary Permit Applicati ~ ~ /,..,i ~ S'°'~r," P~N, y~~ ~ In accord with Comm 83.21, Wis. Adm. Code, personal i~'o provide ' •9 ^ Check if Revision ma be used for seco sea Priv Law, m '~ /~// t ~~ , I. Application Information -Please Print All Fnformation Plan I.D. Number ` O ~ F Property Owner's atrn ~ ~ ~ ..P I Number -~ ~r~~ ~~~~ 1 L G _. ~ o -1 - o0 Property Owner's Mailing Address ,~ G ~ ~ ~ `~ rty Location 3 ~ /~' °\1;' C' ! ~ Iv lV~ 5E ~~5i; S T~ N, R E City, State Zip Code P ~n ~ Lot a er Block Number Subdivision Name CSM Number ~-t~' S ~ld`~ ~s- 3 81-~yo II. Type of Buil ' (check all that apply) ^Ciry ~ ~.1 or 2 Family Dwell umber of Bedrooms ^ Public/Commercial - Descn se age ownship ^ State Owned ~ - no i-iyu~ = l -/ st Road III. Type o Permit: (Check only one on line ( baring scheme for internal ). Co p ate line B pplicable) A' 1 New 2 ^ Replacement System ^ Replacement of 6 ^ Addition to For Cou~y use stem Onl E~tis ' ate B. ^ Check if Sanitary Permit Previously Issued ermit Number D~te Issuer ~ IV . Type of Permit: {Check all that apply)(numbe scheme is for in nse) ,, ~~,,~( 44/,Y~.Non -Pressurized In-Ground 21^ Mound 47 abe Filter 50 Consttuc 22 ^ Pressurized In-Ground 41 ^ Holding Tank Single Pass 45 ^ At-Grade 46 ^ Ae is Treatment 9 ^ Recirculating V. D' rsal/TYeatment Area Informat ion: - O Design Flow (gpd) Dispersal Area Dispe Area ff icadon Percolation Ra soem Eleva6 Final Grade Required Proposed te(Gal ays/Sq.FtJ (Min./Inch) IIevation ~UD Sod ~/ ~~ / 7 I 9S ~ , ~ . VI. Tank Info Capacity in .Total N r Mamrfac r Prefab Site Steel -Fiber plastic Gallons Gallons anks Concrete Constructed Glass New Existing Tanks Tanks Sepdc or Hokiiag Tank ~ .~ Dosing Chamber VII. Responsibility Statement- I, the ,assume t~esponstbllity for oa of the POW7'S on the attached plans. Plumber's Name (Print) Sigffiture RS Number Business Phone Number ~~y u~~ d a a .~~- ~ ~, _ ~a - ~s~~ P umber's Address (Street, Ciry, State, e) /O r ~~ J d ~ VIII. Cotmt /De artment U Onl Approved ^ Disappro ~tarY Permit Fee (include roundwater Date Issued Issuing Agent Signature (No Stamps) , ^ Owner tven Initial Adverse Surc a Fee) ~ Determination ~~ , . 3 IX. Cl(on~d~i{~,iypns o~ Appro ons for D' ppro~v/~ ~ " i``'`ce 'a+w"jL,.r~l~ v1/~4-Lti~ai'iW 4.d ~Gl. ~s~~l ~ ~ /(rte. ~~~~~~ ~. C~vv~cv,u-,..,. VW.I-~C ,,,~U,(, - op ~~ oanp ate a Camty y) for the x 11 inches is ~` S . SBD-6398 (R. OS/Ol) as~ T~ N~ ~~ i ~~ ~',~j$, 9S ~~ ~~ ~` do ~- as_ ~.°~ ~- i~ T ~. >s T I ~~. ~gr ~~ /d°o~~~ as o.3s7 ~scorrsin'Department of Comrperce SOIL EVALUATION REPORT Page ,~ of Division of Safety and Buildings Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County ~ /A include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D_ percent slope, scale of dimensions, north arrow, and location and distance to nearest road. Please print all information. R 'awed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ . ~ 3 2 Property Owner Property location !/~GC 4 S ~ ~p ,~ Govt. Lot W 1 /4 SGT 1 /4 S / ~j T N R ~(or) W Proper~t+y-Owner's Mailing Address - f I ,, D 0 G ~ ~ Lot # Z~ Blodc # Subd. Name or CSM# ~ ..y~ ~ d N~ CJT ~ F- J ~ ar a-a /i ~QGx°r~/S City State Zip Code Phone Number ~ City ~ Village [Town Nearest Road o w l ~/ (7l S) 3 5`/-.~ ~ cCs a r~ a~aw eo ~ , New Construction Use: ~ Residential / Number of bedrooms ~ Code derived design flow rate ~o O O GPD Replacement Public or commeraal -Describe: Parent material ~ y-~ rti~ ~ Flood Plain elevation if appligble /L/~- ft. General comments 6a fc~1.m, ~~ ~~5 e~~-.o~- ~.C c9-~~ .~ V.Z~c" and recommendations: J So: CS Boring # ^ Boring . r pit Ground surface elev. ~OZ-~U ft. Depth to limiting factor l~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDiftz in. Muns ell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 2 / / 7 !~ G S U~ /~ 1 ~ ~_ '~' r r ~_- Q Boring # ^ Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 =GODS < 30 mg/L and TSS < 30 mglL CST Name (Please Prin i lure CST Number Address y,~, Date Evaluation Conducted Telephone Number Z ~~ 3 $' °' .~ ~orw-S~ ~ w ~ Sy6zs~ z -iZ . oZ ~~s-z ~'~ - y~ Z Wisconsin Department of Industry, SOIL AND SITE EVALUATION R E P O R T L.abor,,rRnd,Human Relations , 10ivisinn of Safety & Ruildinnc •_ _ _ _ _ _~ ...:.~ n , , n .,., .,r ...:_ w ~.,.., n_.a_ Page 1 of 3 . - - III GiVVV~V ..~~~I ICI II ~ VV.V V, .~V• „V•••• vvvv ~ COUNTY Plan must include but a n 8 1/2 x 11 inches in size lan on er not less th Attach com l t sit St. Croix , p p . p e e a e p not limited to vertical and horizontal reference point (BfJI~,-dir~ctien-aDd % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distan ,~gn~airest rbad~,~`~ti, ~ 020-1029-30 ~' ~' ' '' ~~ APPLICANT INFORMATION-PLEASE P ~~'LL INFO~MATfO.N'~, IEWED BY DATE .,, 3_' PROPERTY OWNER: ' ~_ ~ PROPERTY LOCATION LaCasse Custom Homes Inc. _.. f~0~'T. LOT 1VW 1/4 SW va,S 16 T 29 ,N,R lg f(or) W PROPERTY OWNER':S MAILING ADDRESS to ~ ~~ `L0~# BLOCK # SUBD. NAME OR CSM # 521 McCutcheon Rd. ,~~ 3r Cf#0 '~-~~5 na Parkwood Meadows CITY, STATE ZIP CODE - Ot~j ,, ~ ITY ^VILLAGE [MOWN NEAREST ROAD Hudson, WI. 54016 ~~ ) ! ~$5 ,~` " Hudson Meadowood Ln. [x] New Construction Use [x ] Residential / Nu f brQo~rr l4 [ ]Addition to existing building j ]Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd/ft2 •8 trench, gpd/ft2 Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate . 7 bed, gpd/ft2 .8 trench, gpd/ft2 Recommended infiltration surface elevation(s) area A=98.05/B=98.95 ft (as referred to site plan benchmark) Additional design /site considerations na Parent material outwash Flood plain elevation, if applicable na ft S =Suitable for system U =Unsuitable fors stem CONVENTIONAL ®S ^ U MOUND ®S ^ U IN-GROUND PRESSURE ®S ^ U AT-GRADE L~ S ^ U SYSTEM IN FILL ~ S ^ U HOLDING TANK ^ S CCU SOIL DESCRIPTION REPORT Boring # 1 _' Ground elev. 101.2ft. Depth to limiting factor +84" Depth Dominant Color Mottles xture T Structure Consistence Boundar Roots GPD/ft Horizon in. Munsell Du. Sz. Cont. Color e Gr. Sz. Sh. y Bed Trench 1 0-9 10 r 3 3 none 1 2msbk mfr f .5~ .6 2 9-18 10 r 4 4 none sl 2tns k fr 3 18-84 7.5 r 4 6 n n ~- 9B• ~ 3~. 0 3.8 ~ ,~".~ Remarks: Boring # .... 1 0-12 :.:.:: 2 .:;.. 2 12-20 Ground 3 20-84 7.5 4 6 elev. 101.2 ft. Depth to limiting factor +84" 3~'8 3 ~ Remarks: CST Name:--Please Print Gary L. Steel Address: 1554 200th. Av>~, New Richmond, WiI 54017 Phone: 715-246-6200 Signature: ~~ X Ny2~77~ ~ Date: 7-10-99 CST Number: m02298 PROPERTY OWNERLaCasse Custom Homes, B101L DESCRIPTION REPORT PARCEL I.D. # 020-1029-30 Boring # ., 3 ',. Ground elev. 102.3 ft. Depth to limiting factor +Ann Boring # 4 Ground elev. 103_2 ft. Depth to limiting factor +90" Boring # <5~' Ground elev. 103.~t. Depth to limiting factor + " Boring # Ground elev. ft. Depth to limiting factor Page ,Z of~~ '. ti Horizon Depth Dominant Color Mottles Texture Structure Consistence Bax~ary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends 1 0-12 10 r mfr 2f .5 .6 2 12-24 10 r 4 4 none sil 2msbk mfr gw 2f .5 .6 3 24-~0 7.5 r 4 4 none o Osg ml na na .7 .8 _ `"" Z u~" `18.~s"~ ~~ ~~ ~{O , 2/ Zr ~ f" '~ Remarks: 1 0-9 10 r 3/3 none 1 2msbk mfr gw 2f .5 ?.6 2 9-24 l0yr 4/4 none sl 2msbk mfr gw 2f .5 !.6 3 2 7.5 r 4/4 none cos Osg na na na .7 .8 •4f t Remarks: 1 0-12 10 r 2/2 none 1 2msbk mfr gw 2f .5 .6 2 12-28 10 r 4 4 none sil 2msbk mfr 2f .5 .6 3 2 -90 7.5 r 4/6 none cos Osg ml na na .7 .8 o " 4~ • o t3.6 Remarks: Remarks: SBD-8330(8.05/92) ~ ~ / STEEL'S SOIL SERVICE Gary L. Steel LaCasse Custom Homes, Inc. 1554 200th Ave. CSTM2298 ntw4Sw4 s16-T29N-x19w New Richmond, WI 54017 MPRSW-3254 town of Hudson (715) 246-6200 lot #25-Parkwood Meadows This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. "=40' ,~= top of SW lot stake C el. 100.00' ...F~ BM. = top of NW lot stake ~ el . 101.00' ~^'I °~ Gary L. Steel 7-10-99 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATIO Owner ~ ~ ' Permit # O '~ DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units A Estimated flow (average) QO al/day Design flow (peak), (Estimated x 1.5) ~ al/day Soil Application Rate ~', gal/day/ft2 Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (RODS) <_220 mg/L ^ NA Total Suspended Solids (TSS- 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (RODS) <_30 mglL Total Suspended Solids (TSS) <_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. SYSTEM SPECIFICATIONS Septic Tank Capacity Q al ^ NA Septic Tank Manufacturer ~~ ^ NA Effluent Filter Manufacturer ~l QO ^ NA Effluent Filter Model ^ 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) ~In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: NA Other: A Other: A MAl1V 1 t1VHryGt .~l.r7tlJV Lc Service Event Service Frequency Inspect condition of tankls) At least once every: ^ month(s) (Maximum 3 years) year(s) ^ NA When combined sludge and scum equals one-third IY31 of tank volume ^ NA Pump out contents of tankls) Inspect dispersal cellls) At least once every: ^monthls) (Maximum 3 years) a 'year(s) ^ NA ^ monthls) ^ NA Clean effluent filter At least once every: year(s) ^ month(s) ^ NA Inspect pump, pump controls & alarm At least once every: year(s) ' ^monthls) ^ NA Flush laterals and pressure test At least once every: ------gyfear{s) Other: At least once every: ^monthls) ~- ^ year(s) ^ 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 cellls) 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 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 tank(s) 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 cell(s) in one large dose, overloading the califs) 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: XA 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 POWTS MAINTAINER Name f w,� / ' Name Phone Phone S- _ ��� _ ��//G S SEPTAGE SERVICING OPERATOR IPUMPER) LOCAL REGULATORY AUTHORITY Name Name Jr ZA, . aj Phone Phone 7/q - 3,676 - y6 trd This document was drafted in compliance with chapter Comm 83.22121(b11111dl&(fI and 83.5411), 12) & 131. Wisconsin Administrative Code. 02107 ' 02 12 37 02~e~~2ee2 12:06 Owllcl/Duyor FAX~651-778-4238 LACASSE CUSTOM F~OMES ~#'!' Ctt01X COUN'k'1` St~N`!'IC '1'AlJK iMA1N'l"UNANCiI ,AdR13f~M13N'1' ANn UWt~l3itS[I11' Cl3ll'l'!1=!CA'!'!~N POkM PAGE P~ e2 Mnillllg AJclrose 1 n 1 ~ ns W - ~~ytp _ _ .~ Properly AddrQSe "!.~ ~ •f~l~~,~ --~rjct~n ! ~j~~~G ~_._. (Ve#UiGAliun ~oqulrc,l liour i'1^nalug (~cpoUulcnl fur uow ctn111nwlim-) Cily/8tato,~-~J~Q(~ w (/~ ~ . t-iu~ual lri~i{lificr~liun f~Jun-Iro-• bo70 - ~3,~°1 ' ~'~,_C~(.'70 Lr+ ~: .~ Properly Loc>tllon ~_ %,~ ~ ~'/,, tiCU. ~.~, 'I'~tJ-lt~, W, 't'uwu of ~,,, Subdiviaioll ~ l.ul ~~ ~,.~, Ccr•llfied 6ur+ray lytap # ~,,,, ~ _, Vt-!an{c , 1'48+! 1l ~'Vnr•rnnty bce~! ~l ~D2S ~ 3 , Vc-1uu{ts ~2~ t'ago lE 8p~a !1a>A19v I.1 ycs (~ 11v I.t-! tI11A5 lde111111i1I~iC !.i ycs ^ l1~ 6Ys'r>Ii:M MAtn~r~1`ieN~ Improper uto and n1^lalalr^uacuf ynnl scltUu MyN~m cutd,.t -caull is Il^ prent^huo flaihue lu 1laudlo wKtdnt. hroitiesr ~t-eb~lau-^nca cotulblr oFpuratpiPB our (lta ^el,Ne 1^~,k ava-Y lb,ao yours nr auather, i! neodetl lty r llceated pu-ul+ar. WFta1 ynu ltul brio the ^yu,w~ con Mllbol We fWlolien oC 1110 tallio Itgk u a ltealutaul logo lu 1ho w^e1e dispea^1 ty^lem. 'lire ~ollarly aw1-er 1lgreat to eubuti- 1u 6l. Croix xunlua peptuu-oot N c~111fip11llu{1 tuna. tlgnad by 111e nrrllor oral by a tntNprpluntlwr, lourneymul pluurbar. rethiclad ph~ulbcr ur a Hccnted pulrgtcr vct ifyll-a Iha! (t) tbo ae1.1111e w^s-owlrta dltpau^1 sy^tan~ It I1~ i>ral-or opopling cu-ktliiun oncUur (Z) oiler iuapcclitlu And puulpblu (it -leceaaaey), rho ^cptla took i^ I^^^ Ihn1 1/3 A-il of oludge. l/we, 1110 uader^igued baltro tc^d dte.ltave rcquitc:uleu-^ ^ud ^pree l+s ulobtlaia the privalo tewt~o dlal~atal tyrteta with lbe sl^nd^rdt rel 1"ptl{f, l-arebl, 1111 sal by ll1R 17opPtt111eAt of C.,.,tTn-,orco tnd d1o I)cp^tlmenl of Nalurell ltetuur~t, BlAla of Witcnndn. Celtifiealiou tlaUng Ilul your aepUp tytlenl 11^>I Uceu 1ut<inl^luu) onrsl Lo aungtlaf~,) rtul tc{nn,cd In the 15L Crol: Cuuucy Zooblg OtYlce wlQdq 30 J^y^ of lire lbree ye^s eKp;rollolt due. S!©NA'('Uttti OF APCLICAN'I` ~~ I)~l'I'13 ' ., r ~ . I {we) uerq!'y llu{ dl si^letnerua e~1f Ihla l;,nu ntc Itue to -bc bca{ of u1y (1»t-) kuuwlFdga. ! (wa) ao1(ua) rho owocr(t) of ll'Q h~nl~rlY deaarib^d •4avo, by viuue of a w^t~aely +Iot:A -eco-dc,l lu Ilcblalcr of 1)ceda OlMica S11CITfATUtiI3 olz Atrt't+le~N7' fJATB "'~'•• Auy L~fam,^tlmr 1.h^1 la ~nla-rcptet~nlal utay rcaull In {hc s^ulluy l~4tutlf,lwbte tcvuke~t by iitc 2oelrlg Del-aMtueut, ~~'~'• I D ~ 3 f1 COf1PANY 7153016541 ~• Ipc1ud01Ylllt rill. ipirlloAlloal: ^ .tamped wat1o111y dead llru-n 1110 ElCglaler of 1)oetlt otfica ^ col+y u~ rho cctNfled aorWey map tf {afalegco it au~lo In 0{o wnnauly deed ' ' /O a. ' 1523Ppc.51 ~ ~ voi ` . 6~2~'7Es3 sTATEBAROFWISCONS[NFOltM2-1999 KATHLEEN H. 6iALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO., WI This Deed, made between LsCasse Custom Homes, Inc., a RECEIVED FOR RECORD Wisconsin Corporation 01-03-2000 9:30 AM WIRRAHTT DEED Grantor. and Chad A. McKenzie and Lisa M. McKenzie, husband and CERT~COPY FEE; wife A y ~ ER FEE: 122.70 AHSF T R RECORDING FEE: 10.00 ~DR6E5: 1 Grantee. Grantor, for a valuablt consideration, conveys to Grantee the s ' following described real estate in St. Croiz County, ' State of Wisconsin (if more space is needed, please attach addendum): Rewrding Ares Name and Return Address Lot 25, Plat of Packwood Meadows in the Town of Hudson, St. Croix EAGLE VALLEY BANK, N.A. County, Wisconsin. 1301 Coulee Rd., Unit 2 Hudson, WI 54016 020.1359-32 Parcel Identification Number (PIN) This is ant homesteadpropeny p6) (is not) Exceptions to warranties: Easements, restictions and rights-of-way of rewrd, if any. Dated this ~ ~'~ day of Juee 2000 LaCasse Cust~om)Homes, [u + Richard W. I.aCasae, President + AUTHENTICATION Signature(s) authenticated this day of `t ~~NC R. ~ '+i TITLE: MEMBER STATE BAR OF WLbS~S.A ' . ~'L (If not, ~ • authorized by § 706.06, Wis. Stats_ THIS INSTRUMENT WAS DIfp*FTED~Y~ G •• Attorney Kristine Oglaad ~:~ {!$~.~ ~ nom ,c _~. ' `~ (Signatures may be autt:entictted or ackrwwledged. Names ofpersons signing in any capacity must be h WARRANTY DEED r ACKNOWLEDGMENT STATE OF WISCONSIN ) ` / n ) ss. ~i . l-fU ~ K County ) Personally came before me this c~7 ~ day of June 2000 the above named LaCasse Custom Homes loc. a Wisconsin Corporation by _ _ Richard W. LaCasse, President _____ .to me known to be the person(s) who executed the foregoing instrrsment and acknowtedaed tlae same. Mct.~ l~n-e -i~= t_. n ~ Notary Public, State of Wisconsin My Commis b is p rmanent. (If not, state expiration date: `~ k~aUU 1 ~~ or pnntea oetow au;v signazus. STATE BAR OF WLSCONSIN FORM No. 2 -1999 kr+rmelbn Profw+bnWr Cpnprry, Fatl tlu l.K WI aooassaozt .. ~ ~ ~ ~I t ~~ V ~~ ~ ~ U ~ QN N ~ ~ N ~ ~0 ~ M a0 ~t• 6i ~''? ~ d Od C*! ~" ~ ~ ~ ~ W V- \ ~ (~ Q tt3 i ~~ 1` N 1 ~~ ~ } CS ~ i r- 1 _ ,OtJ'S9Z . ~ . ,OA'~0 ~ ;~ ,8 ! 000 i~ N ~ cQ ~. ~~ ~ ~ ~ Q CO N W I ~-~ I N !~ N ~ V3 ~ C3 Pr} 0 ! ~ ~ ; ~ ~ CVO ~ ~ '`~ ~ 6. ~ ~ ~ ~ ,¢ ~: ,n M „6Z ,~ i 000 N . • _ ~ - o ~ z m ~ ~c~t d- ,l0.OlZ••~ _ m ~ ~ ~:. ,0S to ~ ~~~~ ~ ~~ ~:~ a 0 N O •~ --: cy N ~' .....4....... ~. ,05 ~ ~ •~ to ; CD N ~. o~ ,a- - ,~L•99 ~ ~NI - ,fiZ ,~~o0i ~to ~ - I~ w °°~ O l ~'~Z9Z M „fiZ ,~ L 000 N f~ - r SaN`d~ ~~l.L~~d~fl • ~~C Counfy i~~r~s~~r ~~ ~~ ~„ `