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HomeMy WebLinkAbout020-1370-45-000.~/isconsin Def artment 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)]. TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ Z / i ( Dosing y 7~/ 7 ~ Z ~ ~ f ~, U i Aeration Holding PUMP/SIPHON INFORMATION Manufacturer S Model Number , _ _ , J ~b ~r~o.~.d 1 I ~o Z. ~ TDH Lift Friction Loss System Head TDH Ft '•l7y 6 Forcemain Len~th / Dia. `r Dist. to well L SOIL ABSORPTION SYSTEM y_ BEDITRENCH Width Leng~t,h No. Of Trenches DIMENSIONS ~ ~ ~ 3~ • ~ ~ SETBACK SYSTEM TO P/L BLDG WELL INFORMATION _ ~, ~ , DISTRIBUTION SYSTEM _~_// ,._ county: St. Croix Sanitary Permit No: 399547 State Plan ID No: Parcel Tax No: 020-1370-45-000 STATION BS HI FS ELEV. Benchmark Z . 2,l~ ~ ~~ 2, I ~ Alt. BM l~/ Bldg. Sewer J~o 9 S Ht Inlet is yb qa , ~a SUHt Outlet Dt Inlet Dt Bottom ~ 0 ,~~ ~ Y ~ p L 9S v Header/Man. ~~ 1 ~, jU B~ O l Dist. Pipe t . L O ~ /1 Q 7 Bot. System 4 t ~, yz Q ~~ .}~ final Grade ~~ (o OQ, St Cover PIT Dia. Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake 3 i / ' Length l/ Dia ng - S Dia Length Spac SOIL COVER Y Pro¢¢~~rc Svetum¢ Only YY Mnund Ar ot.Grade Svstem9s Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil (~ Yes [~ No [] Yes ^ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~L/ L~/QL Inspection #2: / / Location: 983 Parkwood Lane Hudso~~, WI~~54~~016 (NW 1/4 NW 1/416 T29N R19W) Parkwood Meado ~'` Parcel No: 16.29.19.2211 1.) Alt BM Description = ~ ~ ~'>~'~l f.~ y ~U.a W~~~ // ~ 7-i v~a,~ 2.) Bldg sewer length =L/ ~ ~ 75 ~ rz-U ltee`~~.v - amount of cover = > ~ ~ Plan revision Required? [~ Yes No Use other side for additional information. Z ( ' SBD-6710 (R.3/97) Date Insepctor's Sign re Cert. No. ermit Holder's Name: City Village x Township LaCasse Custom Homes, Inc. Hudson Townshi ST BM Elev: Insp. BM Elev: BM Description: ANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic ~ ~ q Dosing ~v ~ Aeration Holdin ~ ~ 3 ~r (c, ~ooa! L.ctrl ~ 3 Co Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. ~ See reverse side for instructions for completing this application - P4 Box 7302 2 isconsin Departure ~+1 of Commerce Personal information you provide may be used for secondary purposes [Privacy Law s. 15 04(1)(m)] Madison, WI 53707-7302 (Submit completes form to county if not , . state owned.) Attach complete plans (to the county copy only) for the system, on p s than 8-1/2 x 11 inches in size. County State Sanitazy Permit Number ^ Check if revisi o vip app icja~loq State PIan I 'D' 4 ber ~ q T I. Application Information -Please Print all Information ``~, cation: Property Owner Name t~ ~ ~ erty Location /Q 1/4 ~~/4, S ~ ~jT ~ , R' lH~or) Property Owner's Mailing Address _ # .. - bP umber Block Number ~ City, State Zip Code Phon er , ~ division N e or CSM Num r r~S ~' o /` 7/ ( II. Type of Building: (check one) i' i ~ 1 or 2 Family Dwelling - No. of Bedrooms :~~. ~ ~~+---~ ^ City ^ Village ^ ublic/Commercial (describe use): ~ Town of _ ~/ ^ State-Owned ~ - 1~5-" Neaz t Road ~. c ~ .~rzs , e-cc~ / / (,/ J - A mber(s Pazce~ i _ ~ -~ L- , ~ ~ 7 - C~ III. Type o Permit: (Check only one box on line heck box on line B if applicable) 2 A) 1. Newer 2. ^ Replacement 3. ^ Replacement of 4. 5. 6. Addition to System System Tank Only Existing System B) Permit Number Date Issued ^ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ion-pressurized In-ground (/ ^ Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade ^ Aerobic Treatment U 't ^ Recirculating ^ Other: ~ ~) ~ x 3.~~ rte. V. Dispersal/Treatment Area Information: t r 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required - Proposed Rate (Gals./day/sq. ft.). ~ e~~~r Min./inch) ` Elevation cam CO s ~~ . ~ ~ , ?o , VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS sho on the attached plans. Plumber's Name (print) Plumber's 'gnature (nos PRS No. Business Phone Number Plumber s Address (St reef, City, State , Zip C o de) // , ~ ~ ' / ~~y ~ 9 ~^ IX. County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued ssm g t Signature (No stamps) ~pproved ^ Owner Given Initial Adverse Surcharge Fee) ~a-~.~ ~i 6a ~ ~ " L- v l ' Determination X Conditions of Approval/Reasons for D~~ccapppr val: ~v ~ ai ~ y~ ~ P ~e ~~1n,ev %f i'..cs~dhSibCe 'Ca/'~ Hi ~hvln~~c,--~J, ~ '~. 'f lv u~ l'TL ~ ~ e f-Fl ~..d"~t r ~t.~ n~ ~~~ f ~ ~-t ~` " 55 ~ an . ~(, K ~P S'( z ~ ,~ ../tl~ tntiv s -F I.s.e. cL ~^.` r n . ~ Z S ~ t' r6 m, +- vr. ~ n , cIZ S0 -~ f -F/'~ `~ . , o. / 4' 5,17~~ /tt u .~. SBD-6398 (R. 07/00) ~`rS ~/~,'~'~'"~" ~l~tl~,5 V`f v~ S~l~' ~ ~~ ~` p~u,~o ~iI^~X~»-bG/ tP~ ~~a -~ Y~ ~ ~~ ld Sv sT ~,~_ ya, ~ - /s mil,.,-~- T~-~_ c: oT y-s r -iy ~.d.-L-~ T~ per M ~ -boo ~~. s~ ~ 9~ • ~o f f/-~o ,t3/~ - A,G7`" 1 oa•YO No.~ ,~.,- cro~ T,tz~ y~r r /~ /O ~~ IL ~~ ~'~ k X ..~ ~ --1 ,C• ~ ~1 ~`C'~^~v" ~`~ ~w ~ ~, Y ~ ~,~ ~3" ao a3 y= Nd ~ n~ /% -boo ~~~ s~ ~ 9~•7o r y-~o ~ ,~M - g,ct ~ oa~ vo N~ ,~-:- ~ r u~r ~ 6 /~ io ~3' ao ~~~ ~~,j~-~ e l~ ti~ ~P ,, ~~~ ~ ~ 1 ;~- ~ ~ ,c ~ 1 `~ a P~ j ` ~ ~rS Q~`~r` ~,/~ as a3 l ~~ i. - 70 ~~ ~ \~ ~ ~ ,p X07' ~ t~~ `/ ~ ~'~ W OCCI Y716aQat,. ! 4t`' i9ald ~ ~. R+y f6 f'^+ M \~ ~wrk /~ era c_ it,~ ~.=r -- - - - --- - - -••• ~...+~~a~.R LKOSS SECTION AND SPECIFICATIONS ----_ - - - 4" CI VENT PIPE 12" MiN. A80VE GRADE E YCpTyER PROOF ~ 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE NITH CONDUIT MANHOLE c FINISHED GRADE 4• CI RISER W/ PAOLOC 6" MIN. WARNING 1 A80V E G AD~+_ ~_ -~-- -- v ~~ M I t 18" ?lIN. b" MAX. ~ - -` T NLET • ~ ~ ;. ~. ~ • \ ~ ; WATER TIGHT SEALS GAS_ ' TIGHTS T ' ; CI PIPE BAF A SEAL ~ FLE ~ APPROVED 3' ONTO . B ~ LM JOINTS V/ SOLID "'~'- ~ ON PIPE 3' 0 SO! L C ~ SOLID SOI PUMP OFF ELLV . FT, ~ -- ~' OFF *~ RISER D PERMITTCD IF TANK MANUFACTU? 3" APPROVED BEDDING UNDER TANK HAS APPRO' CONCRETE pqp SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER : ~~(~~ ~rnNx S2ZtS: SEPTIC nZ O GAL. DOSE GAL, /ALARM MANUFACTURER: MODEL NUMBER: SWITCH TYPE: t'UMP MANUFACTURER: KODFL NUMBER SWITCH TYPE: ~~~, REOUTAED DISCHARGE RATE ~ GPM NUMBf.R DOSES PER DAY: ,3 . DOSE VOLUME INCLUDING . F LOiiIBACK: (~ , GAL . CAPACITIES: A = a1- INCHES = "~~~~~ B = _?r INCHES = 1 ~ O C = 0~ ~ INCHES = >~o~ c D = ~ INCHES = _ l Q PUMP E ALARM WIRING AS PER ILHR ~ 16.23 VERTICAL DIFF'ERCNCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . • MINIKUH NETWORK SUPPLY PRESSU E .~~ FEET • --L~_.d____ FEET FORCEHAIN X /~ Y~ FT/ 100 •FT. FRICTION FACTOR ~ . '- ~ FEET TOTAL DYNAMIC Hip _ -1~PEET TMTERNAL DIMENSIONS OF PUMP TANK: t_rurw.u FEET IGNED DIAMETER LIQUID DEPTH a ~" LICENSE NIIMOER :~//L /~,~ (/'~ ~~ Q~.ww. S`/ ~s ~ / .. i /, /~ ~ ~ ° ..,,~.. Goulds Submersible Effluent Pump C~ 3871 EP04 EP05 APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS Pump: EP04 • Solids handling capability: 3/z" maxrmum. • Capacities: up to 55 GPM. • Total heads: up to 24 feet. • Discharge size: 1'!2" NPT. • Mechanical seat: carbon- rotary/ceramic-stationary, BUNA-N elaslomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series starNess steel. • Capable of running dry without damage to components. Pump: EP05 • Solids handling capability: '/~" maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1 %z" NPT. • Mechanical seal: carbon- rotary/cerargic-stationary, BUNA-N elaslomers. • 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, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length, 16/3 SJTO with three prong grounding plug. Optional 20 toot length, 16/3 SJTW with three prong grounding plug (standard on EPOS). METERSIIFEET tOF 0 a w x U a z } J 0 >- 9 8 7 s 5 Q 3 2 • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Automatic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller: Thermo- plastic Semi-open design with pump out vanes for mechanical seal protection. ^EP05 Impeller: Thermo- plastic 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: Thermoplas- tic 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 SP Canadian Standards Association (CSA listed model numbers end in "F" or "AC" ) 30 -~.~~-- 5 GPM 2.5 FT 25 L 0 0 t0 20 0 0 2 4 30 6 CAPACITY 40 50 GPM 8 10 12 m~~h Wisconsin pepartment of Industry, SOIL AND SITE EVALUATION R E P O R T Labor an~Human Relations flivi^i~n o Safety & Buildinns :.~ 11 1 u.:_ w.a..., n_~_ Page 1 of 3 - 111 GiVVV1V .11111 ILI 111 VV.VVf ••IV• ~ ~v.... vvvv ~ , - .. ~ + COUNTY ,-•_~ PI rnust include but er not less than 8 1/2 x 11 inches in size Attach com lan on a lete site St. Croix , p p . p p i ~pe, sca{e orb,, not limited to vertical and horizontal reference point (BM), direction and % y~f s RCEL LD. # . dimensioned, north arrow, and location and distance to nearest road. cs .~` ~C''~ti iR,~:-,~ r 020-1028-90 r '"' APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATI ~~ ;,. (~~, E ED BY _ DATE r ~ -.; ~~~Z~d ~ PROPERTY OWNER: ~ -~ROPER~j-L~~ATI ~ „~ -_ LaCasse Custom Homes, Inc. ;Ci,OVT L0~0 ix 1/4~ ; '1/4„JS 16 T 29 ,N,R lg ~ (or) W PR05F,(il McCutchMeon G A~DRESS -EC~T.# SUt3D,•NAI~IE OR CSM # Add i G R na n. rst P~rkFfood Meadows F CITY, STATE ZIP CODE PHONE NUMBER =•~~]UIILAGE`°,a .>JV~IN NEAREST ROAD Hudson, WI. 54016 (715)381-5405 -~' [x] New Construction Use [~] Residential / Number of bedrooms 4 [ ]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) 96.70 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 CONVENTIONAL CAS ^ U MOUND ~] S ^ U IN-GROUND PRESSURE g7 S ^ U AT-GRADE ~ S ^ U SYSTEM IN FILL ~J S ^ U HOLDING TANK ^ S ~J U U =Unsuitable for s stem SOIL DESCRIPTION REPORT Boring # 1> Ground elev. 100.7 ft. Depth to limiting factor +90" Boring # >? 2 ................. Ground elev. 10Q..~' Depth to limiting factor + " Depth Dominant Color Mottles Texture Structure Consistence r Bourtda Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. g Bed Trench 1 0-10 10yr3/3 none 1 2msbk dsh cs 2c .5 1 .6 2 10-3 10yr5/4 none sil 2csbk dsh gw lc .5 .6 3 32-9 7.5yr4/6 none cos Osg ml na na .7 .8 ~ ~ --_ w ~~ Remarks: 1 0-12 10yr3,13 none 1 2msbk dsh cs 2c .5 .6 2 12-3 10yr4/4 none sil 2csbk dsh gw lc .5 .6 3 32-8 7.5yr4/6 none cos Osg ml na na .7 .8 -~~ r :--> ~ u~ Iv 't ' Remarks: CST Name:--Please Print G L. Steel Phone: 715-246-6200 Address: 1554 200th. Ave. ew Richmond I 54017 Signature: Date: 10-1-99 CST Number: m02298 PROPERTY OWNER LaCAsse Custom Homes, SOIL DESCRIPTION REPORT PARCEL I.D. # 020-1028-90 Boring # .................. ................. ', 3 Ground elev. 100.3t. Depth to limiting factor + ~~ Boring # 4 Ground elev. lOQ 7 ft. Depth to limiting factor + ~~ Boring # 5 Ground elev. 100.1 ft. Depth to limiting factor + ~~ Boring # .................. ................. .................. ................. .................. ................. .................. Ground elev. ft. Depth to limiting factor Page 2 ~~, of 3 ., <, ~ Horizon Depth Dominant Color Mottles Texture Structure Consistence BaX~dary Roots ~ GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 1 0-18 10 r3 3 no e 1 2msbk dsh 2c .5 .6 2 18-36 10yr5/4 none sil 2csbk dsh gw 2c .5 .6 3 36-90 7.5yr4/6 none cos Osg ml na na .7 .8 Remarks: 1 -10 10yr3/3 none 1 2msbk dsh gw 2c .5 '.6 2 10-34 10yr5/4 none sil 2csbk dsh yw 2c .5 '.6 3 4-90 7.5yr4/6 none cos Osg ml na na .7 .8 Remarks: 1 -12 10yr3/3 none 1 2msbk dsh gw 2c .5 .6 2 12-28 10yr4/4 none sil 2csbk dsh gw lc .5 '.6 3 8-84 7.5yr4/6 none cos Osg ml na na .7 `.8 Remarks: Remarks: SBD-8330(8.05/92) R ' ~ ~ STEEL'S SOIL SERVICE Gary L. Steel LaCAsse Custom Homes, Inc. CSTM2298 NWgNW4 S16-T29N-R19W MPRSW-3254 town of Hudson lot #45-Parkwood Meadows First Addn. 1554 200th Ave. New Richmond, WI 54017 (715) 246-6200 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.. N 1"=40' BM.= top of 1" pvc pipe C el. 100.00' Atl. min.= nail in Oak tree C el. 102.90' ~n ~ i !3 0~ ?7 ~ 1~ • "y too' 3 1` ~~ Gary L. S 10-1-99 3-86-1995 8:29PM FROM P. 2 PRpP~t~Y81NNEA LaCAsse ~ Homes, SOIL DESCRIPTION REPORT ~/ ...~# Psge 2 of 3 Pisac~t.t.~.s 020-1028-90 ~~,2~v~bc7~- ~ ~ 1R ~ al 1 rST /4C~c~X~ ~Dl ~~ c. Boring # Grotxad eie~. L0~ Depth to firrriting facror ~. Boring ~ .~ ,• Ground etev, ., . IQQ,~ ft. Depth to limning factor n Boring # ~~ 5 Ground e!~- . 100, i ff. m factor ~. ~~ Horizon depth +n. D°MinantCoior Munsett MoiVes Ou. si. Cork Color . Texture Strwcturp Gr. Sz. Sh. C~ ~,~y Aoo~ GPD/ft. Bpd 1 18 1 1 h 5~ .6 2 18-36 30y~r/4 none sil 2csbk dsh c,~rr 2C ~ ..5 ~ ~ .6 3 6-90 ~ . 5y't4/6 zone cos Osg nt2 na na . .. 7 .8 i . ., Reins-4n• 1 10 10yr3/3 none. ~ 1 2msbk dsh err 2c .5 .6 2 10-34 10yr5/4 none sii 2csb~k dsh yw 2c .5 .6, 3 4-90 7.5yr4/6 none cos Osg mi na na ,7 ~,$ Qer„s.i,Q• 1 -1Z 10yr3/3 none Z 2msbk dsh Bw 2c • .5 '. .6 2 2-28 10yr4/4 _ none sil 2csbac dsh gw 1a ~• .5 , ~ .6 3 0- b ~~~ .5yr4/6 none cos Osg ml na na .7 ~.8 n6f nar Ry, Boling # . ~. G101NId • etev. ft Depth 10 . limidn~ lector r. r~r~e ^veno~feTlnU POWTS OWNER'S MANl1AL 8~ !"lAr~tivc~-~ct~r rw, "!VG ^^~^ v.~. -.~-. 1 Owner Peninlt # ~5 ~ ~' vG~rva~ ^ r..w ........~ Number of Bedrooms ~ NA. Number of Commercial Units ^ NA Estimated flow (average) ~ gal/day Design flow (peak), (Estimated X 1.5) d~ gal/day Soil Application Rate lc ~ gal/day/ft2 InfluentlEffluent Quality Monthly average* Fats, OiI at Grease (FOG) <_30 mg/L Biochemical Oxygen Demand (BODs) <_220 mg/L Total Suspended Solids (TSS) <_ 1 SO mg/L Pretreated Effluent Quality ' ^ NA Monthly average* Biochemical Oxygen Demand (BODs) <_30 mg/L Total Suspended Solids {TSS) 530 mg/L Fecal Coliform (geometric mean) <_l04 cfu/100m1 Maximum Effluent Particle Size ~ inch diameter MAINTENANCE SCHEDULE Service Event Inspect condition of tank(s) Pump out contents of tank(s) Inspect dispersal cell(s) Clean effluent filter inspect pump, pump controls $t:alarm Flush laterals and pressure test Service Frequency At least once every D months year(s) J (Maximam 3 yrs. ) When combined sludge and scum equals one-third (Ys) of tank volume At least once every At least once every At least once every At least once every At least once every ^ months (~year(s)~(Maximam 3 yrs.) ^ months ~ year(s) ~y..S~- ^ months ^ year(s) ^ NA ^ months ^ year(s) ^ NA ^ months ^ year(s) ^ NA Other: At least once every ^ months ^ year(s) ^ NA MAINTENANCE INSTRUCTIONS Inspectioru of tanks and dispersal cells shat[ be made by an individual carrying one of the following licenses or certifications: Ma Plumber; Master Plumber Restricted Sewer; POWTS inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspecti~ must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure volume of combined sludge and scum and to checent levelsbncthe observatioln p pes alnd t ~ heck fo~any ponding of ffluent o cell(s) shall be visually inspected to check the efflu 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. the entire When the combined a aN be iremovedsb ya Septage Servicing Operator land di piosed o)f in ac~ordan eew th h INR 1 13, Wisco contents of the tank sh Administrative Code. The servicing of effluent filters, mechanical or prestsu~ oed SOW l be performed by a certified POWTS Ma n~tainer.ny other maintenance or monitoring at intervals of 12 mo A service report shall be provided to the focal regulatory authority within 10 days of completion of any service event. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other c en that may impede the veatment process and/or damage the dispersal cell(s). If high concentrations are detected have the cont nr rho ran4(S'~ ramovP~ ~=Y a Sent~e cervicinR operator prior to use. SYSrEr>t sr>tc~r~c.A~ wn~ Septic Tank Capacity al ^ NA Septic Tank Manufacturer ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model - a© ^ NA Pump Tank Capacity gal ^ NA Pump Tank Manufacwrer ^ NA Pump Manufacturer ^ N? Pump Mode! ^ Np Pretreatment Unit ^ N~ ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Manufacturer Dispersal Cell{s) ^ In-ground (gravity) ^ In-ground (pressurized) ^ At-grade ^ Mound ^ Drip-line ^ Other: * Values typical for domestic (non-commercial) wastewater and Sept tank effluent. * * Values typical for pretreated wastewater. P~~c _ of,_ System start up shah not occur when soil condtdons are frown at tlw Inflltradve wrface. During power outages pump tanks may flli about nomul hlghwater keels. When power fs r+estored the excess wucewater will be discharge4 to the dispersal cell(s) in one large dose, over(oadlrtg the cell(s) and mry result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a SeptaCt Servking Operator .prior to restoring power to the effluent pump or contact a Plumber or POWTS Malnalrrer to assist in manually operadrtg the pump controls to restore normal levels wlthln the pump tank. DO not drive or park vehicles over links and disperses) cells. Do not drNt or park over, or otherwise disWrb or tontpact, the area wlthln 1 S feet down slope of any mound or at•grade sod absotption area. Reduction or elimination of the following from the wastewater stream may Improve the performance and prolong the lik of the POINTS: antiblotia; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental Ross; diapers; dlslnfectanu; tat; foundation drain isump pump) water; fruit and vegetable peeprrgs; guoNne; Crease; herbiddes; meat scraps; medications; oil; wlntlna vroducu: aesticldes: sanitan napkins: tampons; and wacer softener brine. A1sAN DON EM ENT When the POWTS tails and/or >s permanently taken out of service the following steps shall be taken to Insure that tht system is properly and safely abandoned In compliance with ch. Comm 83.33, Wisconsin Administrative Codes • All pipln¢ to tanks and Alts shag be disconnected and the abandoned pipe openings sealed. • The contenu of a!I tanks and plu shall bo removed and properly_ disposed of by a Septage Servicing Operator. Aker pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with spit, grave( or another Inert solid material. CONTINGENCY PLAN if the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: d A sulUble replacement area has been evaluated and may be utilized for the loadon of a replacement soli absorption system. The replacement area should be prote<ud from disturbance and compaction and should not be Infringed upon by required setbacks from existing and proposed strucwrr, lot tines 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 ~t that dyne. O A suitable replacement area is not available due to setback and/or soft timltatiotu. f3arring advances in POWTS technology a holding tank may be installed u a last resort to replace d1e fasted POWTS. O The site sus not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a sot( and site evaluation must be performed to locate a suitable replacera~teM aria. If no replacement area h available a holding tank may be Instilled as a last resort w replace the failed POWTS. O Mound and at•grade soil absorption sysums may be retonspltCted in place following removal of the biomat at the Inflivaclve surface. Re<onswalons of such systems must.compty with the rules In effect at that time. < <wARNrNC> > SEP71C, PUMP ANO OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, Pl1MP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT, RESCUE OF A PERSON FROM TKE INTERIOR Of A TANK MAY 6E D{FF{CULT OR IMp(1CtiRl i. ADOrTIONAL COMMENTS POW75 1 N STALLER Name Phone SEPTAGE TERVICING OPIERATOR (PUMPER Names D nn• POWTS MAINTAINER .Name Phone LOCAL REGULATORY AUTHORITY Age~y ~S7'; l~.o-~t hon - S'1' C1tO1~C COUNTY SLl''1'IC 'l'n1JIC MAIN'I'I?NANCL AGItI?LM~N'1' ANn OWNI?ItSIlll' CI?It'1'11~ICA'1'ION I~OItM Ownct/Buyer Mailing Address _ ~~'j ~ ~~ ~ /~ ~, ~~ ~~~~ I'roparly Address (Verification tcquilcd lion! I'lanniug Ucpallnlcnl fi,r new consUuc City/Sluts ~~~~~~ t';trccl tllcnlilic;Uinn Nunll)cr ~~ -- ~,~7~ -- ~~-(~~ LrGAL DrSCRII''I'ION Properly Location ~~ 1/,, .~(~ 1/,, Sec. ~~ •t' ~ tJ-It~W, 't'own c)f „~~ SuUdivision Ccr•lificd Sur-vcy Mup t'E WurrAUty llced # 1'nge ~l VO~U1111: I'tlgc # Vc)lunlc Lo l ~l - ~~'~.-. Spec 1-ouse O yes ,I~'no Lul lines idcntiiinlllc I~cs Q no SYS'1'I~M MA1N7'I~NANC!!; huproperuse and maiulenauceuf your scl,lic syslenl soul,! Icsuil in its plcnlalnle failwe to handle wastes. Cropermainlenanee coasisls of pumping out the septic tack evcly Ihlcc ycals or sooner, if needed by a licensed punq)cr. Wha! you put into the system can atT'ect the fwlctiou of the septic leak as a tleaUncnl slags in the waslc disposal system. 'I'IIC properly owuer agrees to submit to St. Croix Zoning Dcpaltnlcnt a celti(icalion tuna, signed by the owner and by a masterpluulber, journeyman plumber, rest! isles! plumber or a licensed punq)cr vcl ifying Ihat (I) the on-silo waslewalerdlsposal system Is 111 I)rOpCr Olleratlllg CUIIdIt1U11 alUl/Ur (2) Attcr IIISpCCt1Ul1 allll pUlllpillg (If IICCCSSAIy), the acplic tank is Ices !hart 1/3 full of sludge. 1/wc, tiw uudcrsigncd have read the above Icgnilcnlculs and agree to Maintain the privets sewage disposal system wiUt the standards set forth, 6ereiu, as set by the DeparUnent of Conuucrce and the Ucpaltnlcut of Natural Resources, Stale of Wiseonsip. Certlt'icatiou stating that your septic sy rem has bceu maintained nulst be conlplctcd and rcUuncd to the Sl. Croix County Zoning Ofl"tee within 30 llrce y are iralion date. ~~ 'I'[JRL~ Or P ICAN'1' ~~/• I)A'1'L' ~'YNTR CLRTIhtCATIO I (we) certify that I slalcnlculs on Ibis tuna ale Uuc lu the bcsl of my (our) knowledge. I (wc) aln (are) the owuct(s) of Il` )erly descri dab e, b vithle of a wauanty decd Iccoldcd in Register of Uceds Otlice. SI(3NA RL~ OF PL ANT ~U ~ UAT)? ••r•*« Any information that is ulis-ICprescnlcd n,ay Icsuil in the sanilaly pcnnit being revoked by the Zoning Department. ****** ** Iueludc with this applicallon: 8 61a1111)Cd Wpltallly dCC(1 ffUlll Ills Regislcr of Uccds otTice a copy of tllc calificd stuvcy map If reference is Inallc iu the watraaly deed w ~~ `~ w x ... x° ~ x {' ~ f o X \\ ~ -~. ~ . w ~ __-..- w--_.__ fv \ c0 ~rj/ ~ N O p~ a~ O ~ N ~~ ~~`` n CJl D cD I m \ ~ Oo x o ° m y ~ ~ _. u ~ W N co XZ ~ 100' ' `~~__ \ ~~'---- ~ ~ m ~ oz I V o ~ I o x 50"~ SE'i BAC ~! ~ _ ----Z6 • ~ Ar , Z~° t ~ ~ x ~ ~~~- ~, ~ ' `''= N 04°00' 51 " W 449.39' I o ~ 34 1 ~ ~ pox x `° - - ~ ' -' BACK LI E i ~ ~, 50' ~ `° I ~ ~i ~ ~ ~ N 100' I W W N .{+. J I' I`cx m'n~i X Cn fD x co ~' N ° \ rn ~ v N ~~ N ~° W O~ \ v x 00 bo I '~ 00 N p O O CI1 O I T 1 O V~ O N ~ ~ i m ~ ~ ~ ~. ~ D ~ x ~ ~ ~ m w ~I m "' ~ ~ X `° N ~ ~ 1 i I _r i I xl~ N ~~ m ~ I ~ ~ V ~ x Cn (U I ~ ~ W N ~ '~ 3 ~ ~ 1 99 ~^ Io° ~ x ..~ x I x o ~ /~ N °36' 11" W 131 $ ~ `'' ~x ~ / co ~ .~ I ., ~ S"PATE BAR OF WISCONSIN FORM 1 - 1998 I WARRANTY DEED Document Number ~ This-Deed, made between Howard LaVentLr~, rP -f i f rhs (3/5) interest in and A~.1_Q.n° T air°ntttrP Two-fifrhG 2 Grantor, and LaCasse Custom Home nc Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate In St ..Croix County, State of Wisconsin (the "Property"): Lot 45, Parkwood Meadows First Addition, Town of Hudson, St. Croix County, Wisconsin ~~~ ~ ~~ ~~~~ ,i~ * Arl °na T.a~/°ntUr2 Grantor warrants that the title to the Property is good, indefeasible In fee simple and free and clear of encumbrances except all liens, covenants and restrictions of record, if any and any liens or encumbrances created by act or default of the Grantees and will warrant and defend the same. September 2001 Dated this day of ' C•>`.!~ (SEAL) (SEAL) * This deed is given in partial satisfaction of certain land contract dated February 19, 1999, and recorded in Volume 1404, Page 616 as Document Nhmber 598116 which was subsequently assigned by assignment dated May 28, 1999 and recorded in Volume 1431, Page 352 as Document Number 60323. Together with all appurtenant rights, title and interests. AUTHENTICATION Signature(s) Howard LaVenture Arlene LaVenture authenticated this T _ of Se tember 2001 * S muel R. Car * Hnmarrl T aVPntura (SEAL) ~~ ~' ~ L~~~ (SEAL) Recording Area Name and Return Address LaCasse Custom Homes, Inc. 573 County Road A Hudson, WI 54016 020-1370-45-000 i Parcel Identification Number (PIN) This is not homestead property. ~s~ (is not) ACKNOWLEDGMENT State of Wisconsin, ss. County. Personally came before me this day of ,the above named to