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Home My WebLink About020-1039-30-000Wisconsin Department of Commerce PFcIVATE SEWAGE SYSTEM Saf91 and Butlrf?g 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)j. Permit Holder's Name: City Village X Township Hudson Rod & Gun Club Hudson Townshi CST BM Elev: ~ Insp. BM Elev: BM Description: (~w~ ~ G~- /~ /p(~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ti ~ ~~ pjcrt,~ Y.J. Z®~ Dosing r ~ ~ ~ \0 ~~ ~ ~- ; ~.~.~. ~sva TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ,~ /t1Zt ~ ~oy ' ~~ / ~~ ~ -~ Dosing ~ ~~ ~ 7~b, ~ rJ' ~~' ____ ~~ 7 ~or~f Yg' /g ~ / $ ' -- Holding ? /~ ~ 3d~ ~ Q / ~ g ~ PIIMP/CIPI-1(1N INF(1RMATI(1N ELEVATION DATA county: St. Croix Sanitary Permit No: 463045 0 State Plan ID No: Parcel Tax No: 020-1039-30-000 Section/Town/Range/Map No: 18.29.19.165 STATION BS HI FS ELEV. Benchmark 5 /os, /~ Alt. BM // l' ,1 ,~ ~t'` Bldg. S wer #' (o-`~ 9 SUHt Inlet y ` ~ ~ ~/ ~.7 SUHt Outlet ~ ~ 1 ( ~~ Dt Inlet Dt Bottom ~ ~~ ` ~ $~ , Header/Man. ~i p•~ ~y -I~~~ Dist. Pipe ~. $~ 5 $,3 7q i Bot. System rn q, ~ g•3 ~S• Final Grade J •9 J~ `('`~I • ~ J r ~ ~•S r~'•(o "~ ,~ ~.~ 7q. ~ 11 ~ o sy ~ `~ k;~-~ - ~ ~ ~ 7,1 1~ Manufacturer ~o Demand ~ dy~, ~C, ~~~' GPM Model Number TDH Li Friction Loss System ad TDH Ft ~•~ 5-~~ 1g~~3 Forcemain Leng2th~& ~ Dia. ~ :i Dist. to Well ~ ~G ~ SOIL ABSORPTION SYSTEM BEDITRENCH Width / Length ~ No. Of Trenches PIT DIM NSIONS No. Of 'ts Inside Di~ Liquid epth DIMENSIONS ~ G7 ~L ~ r~~~~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ~ ~~ ~ INFORMATION CHAMBER OR eZ, r _~ Type OT S6 y~m: r d~ 7 /moo ~ /Q~ ~ ~ sb , ~~ UNIT Model Number: ~~` DISTRIBUTION SYSTEM 7_'~ P r..rL G i /d~ Header/Manifold ~ Distribution x Hole Size x Hole Spacing to Air I take , Vent Q ~ ~ V ~~ Pipe(s) ~ ~ ~ ~ ~ / v C~,~ ` ''~ ' Dia Length Length Dia Spacing ,F ~a SOIL COVER x Pressure Svstems Onlv xx Mound Or At-Grade Svstems Onlv ~,t ~~ ~~ Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center / / ~~` Bed/Trench Edges ~ Topsoil \ Yes 0 No ,~a; Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / /, Location: 258 Krattey Lane Hudson, WI 54016 (SW 1/4 NW 1/4 18 T29N R19W) NA Lot _. JY~'~i ~ ~ J ~. 1.) Alt BM Description = 2.) Bldg sewer length = ~(o - amount of cover = ~ ~ Plan revision Required? Yes o q ~~,j g Use other side for additional information. SBD-6710 (R.3/97) Date Inspection #2: / /_ Parcel No: 18.29.19.165 ~ ~ r` ~I~' Cert. No. ' .~ ~ ~$~~~ Safety and Buildings Division 201 W. Washington Ave. M " ~ Co~ , J g,~ adison, WI 3707 ~ ~ ? SanitatGr• Permit Number (to be filled" in by Co.) De artment Af Commerce (~8) 2 3151 ~ 30c~Ls- Sanitary Permit A SEA pphcation rate P I.D. Number ~~~-~ In accord with Comm 83.21. Wis. Adm. Code, personal information y provide ~ may be used for seconda r ;<v+~'~"" '• l; `' 29~'~~ 7nf}ItfS• /,(~, ~; ry purposes Privacy Law, s1i.04(1)( ST. ~roJec d ZONIN~~ OFFI ress (if different than mailing address) ' I. Application Information -Please Print All Information ~~ Property Owner's Na me _~~ Parce! rr f SOS Lot >Y Block ~~ Property Ownet's M ailing Address • Pro L t i per y ocat on y ~ City, State Lip Code I Phone Number S GC ''~~~~, 'b,Section /~, ~~ x~~Sd,.v ~' ~'y i II. Type of Building (check all that a iv ~ I PP ) ~ {circle } T ~ N; R E . ^ 1 or 2 Family Dwelling -Number of Bedrooms Subdivision Name CSI A'umber ~ Public/Commercial -Describe Use ~ t , •,,~~,. _~/ ____ ~ _ -- 7`- ~~Q CK-(i ~ .S - ^State Owned -Describe lJse~~ _ ~ ^CityY^Village t`~ownship of ~a ,$~D/ III. A Type of Permit: {Check only one box on line A. Complete line B if applicable) (iGU • to 3P^`~o -~ G2A -Io 34-2m -- . ^ New System Replacement System U Treatment:'Holding Tank Replacement duly - ^ Other Modification to Existing System i B ^ P i R ^-~' _ ^ ~_~- Li • erm t enewal ; Permit Revision ^ Change of ^ Permit Transfer to New st Previous Permit Number and Date issued Befare Expiration ~ Plumber Owner IV. Tvnc of PC)WTC Cvctnn,• !(''ho..tr ~n .i.~..,.. ..r.., v ..:~ . - ~~,• Tvi-~t---•-+-~ -~---r -~ Non -Pressurized In-Ground ^ Mound > 2~ in. of suitable soil C~ Mound < 24 in. of suitable soli G At-Grade ^ Single Pass Sand Filter i ^ Constructed Wetland ^ Pressurized In-Ground Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter Recirculating Synthetic Media Filter Leaching Chamber"~_-b-irro--~-6 avel-les~ipe ~ ~' ('~r ~°-"Y'-~~ __ V, Dispersal; Treatment Area Information: / 13 2(r, ,~D ~T- Z ~ , 2!7 `-- rtow (pd) Design Soil Application Rate{gpdsf) Dispersal Are• squired (s Dispersal Area Proposed (s System Elevation. 2 • ~ ~ ~ A5~ a a qh~•G~ ___ _ ----.r.__ _- ___---~_ k In o Capacity in Total Number Manufacturer Gallons G ll ' _ -r--_ y_L~~ _ _ T Prefab Site ~ SteeE~ Fiber Plastic i a ons of Units . I Concrete Constructed Glass ' New Existing ~ i j Tanks Tanks J i 'Septic or Holding Tank ~ ` ~ ~ ~% ~S 1' ~. _ Dosing Chamber -- - VIL Responsihillty Statement- I, the undersigned, assume respotuibility for i • .allation of t i~i Plumber's Na me (Print) Plumber's Si gnature P FRS Num I he POWTS shown on the attached plans. ~~ ber Business Phone Number T ~/ t~~ 7~'~' Plumber's Addre ss (Stre et Ci ty, State, Zip Code} ~ l ~/S- 3 ~"C'- 3/~/ ~ y ~ ' ! ~ , ~GLJ~I ~~~G~ ~_.._.~~, F~ ~-~.-. - VIII. Count /1)e art t men s Approve~d ^ Disapproved Sanitary Permit Fee i dudes Groundwater Date Issued Is uing ens Signatur Na Stamps) Surcharge Ferj ~ ^ Owner Given Reason fur Denial ~ ~ , ~ f'~j -- --.-~-----•---...,.,..U ..,. ,...,orN.~.r.. SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. 3) `~-~,~. r,~.>~-~ -~nt~,o.~ Lys complete plans (w the County only) for the system ou paper not less than 8112 x 11 Inches in size SBD-fr39$ i;R. O1/03) ~ ~ _~ ~' ~ 0l8 3 .:ice li"J.'. i '~ - B To Caq~eex+aie 1M-+e i ~ ~~ t 1 ~, 1 ' { ~I l ~~ ; ~ ~~ ~ 1 Loeh = tiQ !t SitC Plait Hudson Rod, Gym and Archer~r Club swli~xwl~a Sec. 18 T29N R19W i Town of Hudson - St Croix ~Co. Cells ~ 3'x 93'eeslrr{~SYmrdmd C7emrebeia Upslope Cell3y Eler~atlon 9S.N!' Cell Bleealioa =94.90' I,oeMer CeQ BM =Top of 3/4" PVC Pipe HRP =Same ASSUMED ELEV. = 100 BM #2 =Top of 3/4"PYCPq~e 97.20' PropasedSds 402"For~eeMaAe 98.20' ServlGe Drive eb be provide~d~ Runk seabeteetmeca ~~ Propwred one 1Peeser Comte iP1500-3~ Gsmselntahoepte~ond one i~2S00-hlRHoldingA~nkAo Wesel the Holding Tank rrgra>mnent~ for Abe h~chen waste ~~ op Rese„•do~a farfi~eoie p>~ar8nmtt eoait if neyed Note: All P/L > SO' Note: AGmedoai failte~g system po• Cavan 8333 • WELL Hud4ae 1?oaland Gem Club DiPFojlheeing8all f~~~ps 92~SOgi-d' ~ T,~ l3~era~d F!o-n i = 690 Propa~cd lPieaer Condwe1P2000~ ~l w ~~mA~-1~ ~irtmst PYlter ~ed~iuaeeQlp ---~~[ m m neoteriol alandmds of /1_ Comm 84.10 Piopaead l~ Caeu~e WLP7S0~ Permp L9Fa°>tb'er'w/DgpJerP~Pe 4 ' ~commerce.wi.gov ~ Wisconsin Department of Commerce Safety and Buildings 10541N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264-8777 www.commerce.state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary Apri107, 2004 CUST ID No.224059 KEITH E STONER 23220 WOOD CREEK RD SIREN WI 54872 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/07/2006 SITE: Hudson Rod Gun & Archery Club 258 Krattey Ln Town of Hudson, 54016 St Croix County SW1/4, NW1/4, S18, T29N, R19W Identification Numbers Transaction ID No. 982995 Site ID No. 671557 Please refer to both identification numbers, above,. in all correspondence with the agency. FOR: Description: Holding Tank 690 gpd. plus Kitchen Greasy Waste Object Type: POWTS Component Manual Regulated Object ID No.: 948816 Maintenance required; 929 GPD Flow rate; System(s): Holding Tank Component Manual, SBD-10571-P (r.6/99), In- ground POWTS Component Manual, SBD-10705-P (N.O1/Ol) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "In- ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10705-P (N.O1/O1). • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Holding Tank Component Manual for Private Onsite Wastewater Systems" SBD-10571-P (R.6/99). A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of FT. construction/installation operation. ~~~~' In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions ~" should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. ` ~ • , ~t ,~ r -v~ c,` KEITH E STONER Page 2 4/7/2004 J ~ ~ Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincer y Thomas E Devereaux Plumbing / POWTS Reviewer II ,Integrated Services (715)634-3026 , 7:15 am - 4:00 pm Mon. -Fri. tevereaux@commerce.state.wi.us Fee Required $ 60.00 Fee Received $ 135.00 Refund Amt $ 75.00 WiSMART code: 763.3 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Fogerty Plumbing & Perk Testing, Inc. 1-8 Index and Title Sheet Project: Hudson Rod, Gun and Archery Club Property Owner: Same Address: 258 Krattey Lane Hudson WI 54016 Legal Description: SW1/4- NW1/4 Sec. 18 T29N-R19W Township: Hudson County: St. Croix Subdivision Name: NA Lot: NA Comp. #/Parcel ID: 020-1038-90-000 CONTENTS Page: 1 Index and Title Sheet Page: 2 Sizing Calculations Page: 3 Plot Plan -Plan View Page: 4 Holding Tank Cross Section Page: 5 Cross Section of Distribution Cell Page: 6 Pump Chamber Cross Section, Pump Curve and Duplex Control Panel (6 a,b+c} Page: 7 Holding Tank Management Plan Page: 8 In-Ground Soil Absorption Component Management Pian (8 a,b+c) d0I ~~~y Holding Tank Component Manual Used =SBD-10571-P (R.6/99) y~s ~ F orr~ti"F~, In-Ground Soil Absorption Component Manual Used ~ SBD-10705-P (N.O1/O1) ~~~ A`y~ ~ Designer : Keith E. Signature: Date: 3/22/04 °~~ ~IISCp~,r * ......,,. iy ONE 0 q -,~, s• S,~ . n, WIs, d'•••.........• ,a ''~~ ~ i~ . `S' j G N E R . . ~ ~~~ s Designer# 1575-007 '" ~`'~~NGE n~~Y~2Yf~ - - # (715) 653-2324 RECEIVED MAR 3 0 2004 SAFETY & BLDGS DIV. ' Page 2 of 8 Sizing Calculation for the Hudson Rod, Gun and Archery Ctub The sizing for this system will be based upon the dining hall public wastewater flow of 7 gallons per meal served. The rationale for this choice is that only a single meal will be served on those days that meals are prepared. It is my understanding that most of the meals will be prepared off site and catered in. The club members have chosen to split the wastewater flow from the kitchen and restrooms to eliminate the potential of high strength waste, which would require pretreatment. The kitchen waste will be served by a holding tank and the bathroom wastes by a conventional lift system. Kitchen waste = 690 ~aVdav estimated. 160 meals x 4 gallon = 640 gal. 2 Floor drains x 25 gallons = 50_gal. Total estimated daily flow = 690 gal. 690 gal, x 1.5 design factor = 1035 DWF Holding tank sizing = 690ga1./day x 5 day estimated daily wastewater flow = 3450 gal. Plus the grease interceptor requirement of 1440 gal. = 4890 gal. total required holding tank ca aci C=MxGxH 2xP M =Meals served per day G = 3 gal. per meal H = hours per day meals are served P = Meal periods per day C= 160 x 3 x b C= 2880 = 1440 gal. 2x1 2 Grease Interceptor proposed is a Wieser Concrete W2500-MR Grease Interceptor along with W2500-MR Holding Tank to meet the required gallonage. Grease Interceptor Sizing: Per Comm 82.34(5) (b) (2) b Bathroom Waste = 619 gaVday estimated x 1.5 design factor = 928.50 DWF 160 meals x 3 = 480 gal. 4 Floor drains x 25 gallons = 100ga1. 3 Employees x 13 gallons = 3~gal. Total gal/day estimated = 619 gal. Septic tank sizing = 92$.50 DWF x 2.088 = 1938.71 gal. Septic tank proposed is Wieser Concrete W 2000-MR Dispersal cell sizing = 928.50 DWF / .7 soil loading rate = 1326.43 sq. ft. / 31.10 = 42.65 or 43 Standard Infiltrator leaching chambers. Propose 3 cells of 15 leaching chambers. The lift station will consist of a W 750-MR Wieser Concrete tank with a Duplex pump system. C ~~ Page 3 of 8 i ~ ~ BM ~ bAt~ B~ ,` ~, a ~~----~ ~~ ~~~~ Site Plan ~ `~ n Hudson Rod, Gun and Archery Club 9s.2o' SW1i4NW1/4 s, Sec. 18 T29N R19W Town of Hudson - St. Croix ~Co. ~. ~- BM =Tap of 3/4" PVC Pipe ~~': ~`'~ ~- '~, ~. S~ Lf-7-rlVl~liiD ~iJ.~L' V. a iW 5'~`. 'i ,~' kS BM #2 = Top of 3/4"PYCPipe ~~` `'` IhiNe 97.20' }' 9810''2. .Proposed Scli. 40 2"Face lift .Servloe Drive to beprovrded,~ tmut AtQir+terrmtcG ~--'" Proposed otte JPteser Con~ete iPZ500->~R (rraasel axat wee W2300-~ Hddtng tart Ao z~ dre liolaiiatg Z'~+~,~'or Rite Iai~rt watrt~ Res~rwed miaa, f~frtaa~e ~~' Nate: dbaddon fm'lrogP,er' Consort 83.33 To ~~C~~e1,TLLs~~~ 3'x 9~^3+~-'~'r~'rsbgs~dmd Nr/HU~g./~J.~ ~v~ ~{ a /~~~ a ~{ a/GYQ//(//t s 79.7Y' IAwet' Cell ~ WELL Hrdsaw Rod acrd Chat Club DWFoflAteotgHall ~ .~~~9s 928.SO~d 'T Sslabtratod Plow gi~clttat = b90 Page ~ of 8 HOLDING TANK SPECIFICATIONS Two Concrete Tanks In Series If one- or two-family, number of bedrooms 690 And/Or....Non-residential estimated flow per day 3450.0 Minimum holding tank volume required 5000.0 Total holding tank capacity pro osed {gal) 2500.0 Tank 1 capacity (gal) I~JX for round tanks 2500.0 Tank 2 capacity (gal) Wieser Concrete Products Tank manufacturer ~,~ S.J. Electro Alarm manufacturer w~~ Tank Alert 1 or 4X Alarm model number Tank in Exterior Dimensions (in) Ibs fbs in ft Information Li Level Length Width Height Tank Wt Anchor Wt Soil Cover Max Bury Tank 1 51 159.5 93 71 15205 41842 42.5 8 Tank 2 51 159.5 93 71 15205 41842 42.5 8 HOLDING TANK CROSS SECTION 12" min. 4" min. ~~ Junction box ~- Vi ~ BNnd plug to seal ~ t oPeninp _~ _ _ _ 12.0 in Service alarm on 39.0 in Tank 2 Manhole cover vvitfi locking device and warning label Note: Manhole and vent locations may be reversed. Tank 1 Finisheld grade W 18" Inlet 3 in. min. bedding under tanks. Anchor tanks as necessary to negate buoyant forces. Electrical as per NEC 300 and Comm 16. Note: All tank joints, and joints between tank openings and piping are seated watertight. Project: Hudson Rod, Gun and Archery Club Transaction Number: Pg. 6a of 8 DoseTank Component Cross Section Approved Manhole Covers with warning Labels and Locking Device / 4" Min. Above Final Grade weather Proof Junction Box Electric per NEC 300 dt COMM. 4" ~, 40 y~ ~ 16.28 wAC > oar = to 12" Above Final Grade n 4' Inlet Note: Pump switch and alarm m be ~ A wired m sepeaate circuits. C Tank Mtr. wiener Concrete 750 gal. D Pump OffElev. 87.00' Dose Tank Elev. Vertical Differenoa Between Pump Off and Disan Pipe = 9.45' Minimum Required. Supply Pressure ...................................... = NA 290' FT. of Force Main x 1.94 Friction Factor/100FT.... = 5.63' Total Dynamic Head .................... = 15.08' B Alternate Outlet Location w/A~mved 4" Sleeve Ford Main Dian. = 2 " deep Hole or Anti siphon Device 86.00' Number of Doses ... = 5 Per Day Gal. PerDay/ #af Danes =185.70 GaL Vohmre of Back$ow .................................................................... = 47.27 Gal. Total Dose Volume .............................................. .................. =232.97 GaL A1~ ~, SJ. Electro Total= 37 750.36 Alarm Model 101-01H Proposed SJE-Rhombus Mode1122 Daplex Pump Comml Panol .Bed Tank per COMM. 83.45(5) Anchor Tank as necessary to negate buoyant fones pet COMM. 83.43(8. Pump Tank Capacity 750.36 ~~ ~ Inches ~~ Pump Taak Vohme 20.28 C~I/Indeh A 11.51 233.42 B 2 40.56 Pump Mfr. Gould C 11.49 233.02 Pump Model Mode13871 EPO-4 D 12 243.36 Minimum Discharge Rate = NA GPM aor. 35 ~~ Page 6b of 8 (~ GOULDS PUMPS 7 6 s a 3 2 1 0 w APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling gpability: '/," maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1'h" NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40~) continuous 140°F (60~C) intaTnittent. • 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 or 230V, 60 Hz,1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length, 1613 SITOW with three prong grounding plug. Optional 20 foot length,16/3 SJTVV with three prong grounding plug (standard on EP05). ®zool ~a,,lds ~,~,QS Effective May, 2001 638x1 • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- matic models irtdude Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller: Thermoplas- tic Semi-open design with pump out vanes For mechanical seat protection. METERS FEET 10 9 30 a 25 0 Q i v r 0 a 0 20 1s 10 s Submersible Effluent Pump 3871 E 05 ., ^ EP051mpeller. Thermoplas- tic enclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and conmion resistance. ^ Motor Noosing: Cast iron fa efficient heat trar>Sfer, strength, and durability. ^ Motor Cover: Thermoplastic cover with integral handle and float switch attachment poirrts. ^ Power Cable: Severe duty rated oil and water resistant. 00 10 20 30 0 2 4 6 8 c1-PAaTv ^ Bearings: lJpper and lower heavy duty ball bearing construction. AGENCY LISTING Canadian Ssandards A4soda6on (CSA listed model numbers end in ..C„ ~ .,F,,,) Guilds Pumps is 1909001 Ragsa~red. 40 50 GPM t 0 12 m3/h Goulds Pumps lTT Industries ~_~ The Model t22 control panel is designed to aftemateiy Control two 120, 208, or 240 V11C single-phase pumps in water and sewage insta+lations, The alternating actign equalises pump wear. In addition to the atternatfng pump control, this system provides over+ide control should either pump fait, tf an alarm condtrion occurs, an alarm switch activates the audio/visual alarm system. Common applications include pump chambers, sump pump basins, irrigation systems and ]ift stations. Mdttel Shaw 'l22iWiy4X 1. Enclosure measures 12 X 10 X 6 inches (;30.48 X 25.4 X 18,24 Gm). Choice of NEtV1A 1 (steel for indoor use), or NEMA 4X {ultraviolgt stabilized tnermoplast±c with removable flanges for outdoor or indot3r use). '4ptians selected mey increase enclosure size and change Component layout. 2. N+agnetic Mo#qr Gontactgr controls pump by switching hot eloctrical lines. 3. tiOA Switches for manual pump Control {mounted on circuit board). 4. Control t;ircult Board provides pump cornrot and 3ltematian {U.S. patent 5.908,352). 5. Green pumA Run Indicator Lights (mounted on circuit board). &. Sctternstlc t Wiring Diagram 7. Incoming Pump Power Terminal Stock /Pump Terminal Bl+flck fi. CfrCUit Breakers (optional} provide pump discannevt and bronco circuit protection. s. Controf OwlO~ Switch (mounted on circuit board). 10. Ground t_ug 11. Terminal Block Insteliation Label tz. Float Status Indictor Lights {mounted an circuit board). 13. Control 1 A1erm Rower Indicator Light (mounted on Cirouik board). S'IAAtldl~ll ALARM PA~A+CE (other options available) 14. Red Alarm 8eacorr provides 360'' visual check of alarm condition. iVote: NEMA i style utilizes a door mounted indicator in IIeU of a beacon. 15. Alarm Hgrn provides audfo warning of alarm condition (83 to $5 decibel rating), NgtB: NEMA t style utilizes sn internally mounted btt«.er (83 tv 85 decibel} 10 lieu of hom. t8. Exterior Fionn TestJPlortnatlStlenca S1~ritch allows alarm hom to be silenced and testing of hom and Ifght to ensure proper operation Qf alarm system, Page 6c of 8 '° ~" -a D * •i ~i ittdaor i~Mi00!/Ottt~r t Entire control system (panel and swftdtes) fs Ut_ Listed to meet and/or exceed industry safely standards 1 Dual safety certification for the United Sts#es and Canada s Standard package includes three 2p' Sensor t=lost[" control switches Complete with step-by-step instatlatlan instructions / Trrea-year limited warranty c~Lns USTEO •) 4 T OL 6J ELi¢TRo 9rST[MS.[gs. Pp Box # 708, Detrgft Lakes. MN 58502 1.888-DIAL.-SJE • 2-218-847-1317 1.218-847.4617 Fax email: sje~sjerhgmbus,com w~nitr.slerhombos.cam S-iu~¢ie phi duplex ali#eruatin~s pump control Wirth override. Page 8a, of 8 Private 4nsite Wastewater Treatment System Management Pfan Septic Tank And Gravity fn-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the !n-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: Svstem Design Specifications Sanita Permit Number Number of Bedrooms NA Desi n Flow -Peak 928.50 d bathroom waste onl Estimated Flow - Avera e d 690 d kitchen/619 bathroom Se tic Tank Ca ac' al 2000 Pum Chamber Ca ac' al. 750w/ Du lex um s Soil Absor tion Com onent Sizes . ft. 3 3'x93' Cells w/ Leachin Chambers T e of Wastewater Commercial Table 2: Soil Abso lion Com onent -Limits of Reliable O eration Se tic Tank Com onent Soil Absor tion Com Went Desi n Flow -Peak d 1938.71 1326.43 s .ft. Maximum Influent Particle Size in NA 118 Maximum BODS m /L NA 220 Maximum TSS m NA 150 Maximum FOG NA 30 Table 3: Wlaintenance Schedule Se tic Tank Ins ct and/or service once eve 3 ears Outlet Filter Should ins Ct once a ear and clean once eve 3 ears Pum Chamber Ins and/or service once eve 3 ears Solt Abso ion Com onent Ins ect once eve 3 ears Effluent Testing Sample effluent from the pump chamber biannually for the first two years to verify that effluent standards faff within design parameters. Annually thereafter with any change in use. Metering Bathroom Flow Optional/ this would establish an actual use in gallons to ve ' that the s stem is desi Wed ro r1 . Seutic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis, Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Page Sb of 8 • •' ~ Management Plan for a Septic Tank and Soil Absorption Component Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at (east once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent fitter alarms may indicate surge flows or an impending continuous alarm. The septic tank sha{t have its contents removed when the volume of scum and sludge in the tank exceeds 113 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Pump Chamber A pump chamber if part of the component package also requires monitoring once every three years or at the time of a problem, complaint or failure. Inspection should include checking the dose rate, volume and frequency. Warning: The dose chamber may fill due to flow continuing during pump malfunction or power outages. One large dose when the power comes on or when the pump is repaired may cause the dispersal system to have problems. In this situation, the pump chamber should be pumped by a licensed pumper before pump cycling begins or other measures shall be used to dose the component with only the proper amount of influent. This may include manual operation of the pump controls until such time the pump chamber has reached its normal level. Septic tank and Pump chamber manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent acadenta! or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full complianc® with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment or holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWfS component. Soil Absorption Component 2 ~_ . Page 8c of 8 Management Plan for a Septic Tank and Soil Absorption Component The soil absorption component serving this structure is designed to accept commercial wastewater from a commercial facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. Plantings of deep-rooted trees and shrubs dirnctly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. The soil absorption component reserve area if one is provided should be kept free of any structural encroachments and left undisturbed. Contangency Plan A contingency plan for this site would be to install a new system in the tested area available or excavate existing leaching chambers to determine component failure, then remove the clogging mat and replace with ASTM G33 sand if necessary. Once this is completed, Gean and replace leaching chambers and backfill. This may require and individual site design. Component Owners Contact List Fo ert Plumbin Dave F ert /Plumber 715 635-9609 St. Croix Ca. Zonin Office Steven Fisher 715 386-4680 Wieser Concrete Products Maiden Rock WI 800 336-3416 Zabel Filter Co. 800 221-5742 Tri-Count Sanitation 715 386-0114 3 ~ ~ ~ - RECEIVED 1396 8 20~QIL ALUATION REPORT Wisconsin Department of Commer D ~ C 1 .ii Page 1 of 3 Division of Safety and Buildings in accordance with Co 85. Wis. Adm. Code Steel Soil Service Aitach complete site plan on pa r not I~ t~~.~r ~i size. Ian must County St. Croix include, but not limited to: ve and hor~Sdt~ll h#fer~df~ i ion and percent slope, scale or dimemsi , an oca on and distance to nearest road. Parcel I.D. 0 1038-90-000 Please print all information. Re 'ew d Date Personal infomra6on you provide maybe used for secondary purposes (Privacy t.aw, s. 15.04 (1) (m)). ~ ~ ~+ ((/Ylivt. 3 < 6 Property Owner Property Location o / (p Hudson Rod, Gun & Archery Club Govt. Lot na SW 1/4 NW 1/4 S 18 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 258 Krattey Ln na na NA Q City State Zip Code Phone Number J City ~ Village ~ Town Nearest Road Hudson ~ WI 54016 715-386-9955 Hudson Casperson Dr. New Construction Use: JResidential / Number of bedrooms 0 Code derived design flow rate 1159 GPD Replacement ~ Public or commercial - Descri e:Public ~,~J sld-~ ~rl Parent material Stream terraces and pitted outwash plains Flood plain elevation, if pp i bie ~S na General comments and recommendations: Conventional system, system elevation 96.20ft. Trenches spaced and depth to code 3.OOtt below grade. Boring # ~ Boring Pit Ground Surface elev. 99.20 ft. Depth to limiting factor ~ 20 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-6 10yr3/1 none sl 2msbk mfir cs 1c .5 .9 2 6-10 10yr4/4 none scl 2msbk mfr cs na .4 .6 3 10-28 7.5yr4/4 none grco osg mvfr gw na .7 1.6 4 28-66 7.5yr4/4 none cos osg ml cs na .7 1.6 5 66-120 7.5yr4/6 none ms osg ml na na .7 1.2 Boring # ~ Boring iY Pit Ground Surface elev. 99.20 ft. Depth to limiting factor 120 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Raots GP D/ft2 in. Munsell (1u. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0-10 10yr3/1 none I 2msbk mfr cs 2c .5 .8 2 10-39 7.5yr4/4 none sl 2msbk mfr gw 1 c .5 .9 3 39-120 7.5yr4/4 none cos osg mvfr na na .7 1.6 i u ~~ o / 3~" ~~<3 (00 s ~ 3~ * Effluent #1 = BODS> 30 <_ 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS <30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number David J. Steel ~ 248956 Address Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 12/15/2003 715-246-5085 ~~. i rrd2 2u~, /a -~D ~~~ Property Owner Httdson Rod, Gun & Archery Club Parcel ID # 020-1038-90-000 Page 2 of 3 Boring # ~ Boring U'' Pit Ground Surface elev. 97.20 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-6 10yr3/1 none I 2msbk mfr cs 2c .5 .8 2 6-29 7.5yr4/4 none sl 2msbk mfr cs 1 c .5 .9 3 29-39 7.5yr4/4 none Is osg mvfr gw na .7 1.2 4 39-120 7.5yr4/6 none cos osg ml na na .7 1.6 ^ Boring # J Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # ~ Boring _~ Pit Ground Surface elev. fl. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh, *Eff#1 *Eff#2 * Effluent #1 = BOD S> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 =BOOS < 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 608-264-8777. r s .~ r STEEL'S SOIL SERVICE INC. David J. Steel CST-POWYS Hudson Rod, Gun And Archery Club Page 3 of 3 1564 Cty Rd GG New Richmond,WI 54017 Bus.(715) 246-6200 Fax (715) 246-9372 Legend 1" = 40' • =Benchmark Ele. 100.00ft Top of 3/4"PVC Pipe • =Alt Benchmazk Ele. 100.00ft Top of 3/4" PVC Pipe ^ =Borings Boring Elevations B 1 = 99.20ft B2 = 99.20ft B3 = 97.20ft B4 = OO.OOft -~-~`-~ ~~ ~ ~~., (I T~~ o~~'~~,N 1`~~JcG y • -. HOLDING TANK SERVICING CONTRACT ~{u~- ~~ ~~ ~oilA.~ _~ Holding Tank wner(s Names This contract is made between the "ITZ.i and ~Pumper's Name We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal descriptions:) ---------------------------------------------- 1. The owner agrees to file a copy of this contract with the local goven~unental unit that has signed the pumping agreement required in Comm 83.52(1)(c)1. Wis. Adm. Code and the approved Holding Tank Component Manual. This agreement will also be filed with the St. Croix County Zoning Department. 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. The pumper agrees to submit to the local governmental unit that has signed the pumping agreement and to the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; ~. 'i he name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volume in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with local vernmental unit and the ounty named above within ten (10) business days from he date of change t s servic c tr t ~ ~ 'p ~ ~.~'l ~ ~94D UIU9~- Owner(s) Name(s) (Print) Owner's Signature(s) Subscribed and sworn to me on this date: 3-2-0~- Today's Date .e !Yl o. Pumper's Name ~~~ ~_ Pumper's Signatur Public Pumper's Registration Number Commission Expiration 715-549-5965 p•1 Rpr 15 04 09:56p Shawn Carlson •-~- rulitRTY PLUMBING 1?156355286 '" - p . 1 ST CROIX COUNTY " .SEPTIC TAI~IC M~NTENANCE AGREEMENT . AND O~SH1P CERTIFICATION FORM - . Owner/~uy~ ,! i2o ~ Property Add ~-~ _ (Venteanon ~~°d t~ Plammg 1kPubnent fornew oonttten:fiott . C;tylStato Parcel Icierstificetion Number ~~ -~» ti fi- ~m_/ LEG D N -- --. _ Prolxri3' Location ~ y., .~, y,, Sec. ~ ~ - 7 z - --.~-1~'R !.~_~'. Town of ~Eyc,r_ p~,rJ Subdivision ~ _____... Lot # =-"r Certified Strevey Map # ? `!b /~C'e~s "'~'' ~ . Volume Page # Warraniq Deed # l~'~ 3 ~p . '- --~_,__ =Volume z2~ page # _~'~ Spec house p yrs Ii~rro Lot lines idetilti#"lable tE'yes !] no -1M~~TENA~Nr~$ ~A°Per~snd~ Hof _ ?"°trsYstemcotddie~t:nits " can aBeet of 4ie septic tasd< aas ~~ ~t ~• ded irk a fia~~~p~~ ~ ~ a~moe duposAl systan, 57-. masterp]umbgp,~~ °~ ~ b mbodt io St. Ckobc ~ a . ~y°aoptwvl!a~restricted ea~i5eativa t is iti priop~} aii~or(aj "alters ~ d fat {I) ~~ yvowaer grid by , LurS, ffie .sde>~y~ >~ .eaa the ~B Ctfn°~'b the tank is ass than 1/3, set rotllt, ~, as set 6y tie Degartmeot and awe m ~ ~~ • y,oe,. ~.erx aaa ie neptta,eot of 1`Iaaual spa l system ~ritit the staadads d d:~ ~e`°°",~eaea~.amme saw ocwa, ce_~ Gn°t ~]` ~ O~aa 'this 30 o~ • ~ i 4' c cERTrF[c ~ ~~ I (.e atl stata»ents un ttris - 6Y victise of a fona aye hn't to the best of m7 (~ I®owkdge, I (we) am (are) the : of ~tY deed s~morded i>t Register of Deeds Office. " owoe~{ S[GNA1ZJgg '~' LICANT ~ . C#- as~a~~ D My iafornlatiai tint is ate-nptesaatedrgay restt8 in the , _ •~ Include ~~ P 6eittg revoked by We Zoning 13epa~ent sws. ~. with ~ stPptiafioa: a atatuped wa~taaty deed flora the ~8~ ~ D~ of~ee _~ . a Dopy or the - ~~ if refaenoe is made is the wutaary deed vot . 0028 ~~ , Sf~ ~ _.. _._._... ___ WAltunnl'1'Y~jaL" .___. ___-_.___. .__._. 5'1'A'1'!!, UI• W1aVSj}y~j~(-- . U~j111 No. 1 lJUMBER „i/ ~ ~7~ ~ ~ / ~ , /~ / ~ ~ Received for Reaord ..... t~B t . ~ D ~7 - .. ............__._....._ ................_......_.. TO._......_......_.....___.......---.. ..-_.._.... -- ... j~ I ~j ~~"~~~/~/........ ~i t./tj0 ...._... /.7 .A. D., 9.u~_ Ii ~ I I ._.......,~-~'!~-~,.C-~~~...VGA.~.._...._._.~....._........_ --~--- -..._..._.[~~Z~.:-.. --- _. -...-.Register of Deeds. ~~ This I _...-- ..._.... ... -.... _...._ ._ ............. ....... .................. .. .'--- . .........._----. of the 11iat Dart. and ' rdd~/,G~ ......... .. - ~ - ~ -- -.... .....~ ........ ....... ..F.Q<~!'hfirl- .... ...... ,~ pthe second part. WITNESSETH, t the ea1~a~ ...pf the first yart, for and 1n Donald inn of the sum of.__._........--_- ...:...................................._................................._._ Cd _............ .... ............... ...... .............5.4.:C...:. ... .. ollars ....................._.....----....._........._............................................................._._......................................_...D , to..._ ......... ... .._.....................in hand paid, by the satfl part~.._of the second part, the receipt whereof is he~re"by' 'confessed and aclmowledged, ha.e4/ given, granted, bargained, sold, zemisod, released, allened, veyed anll co}}n~~firmed, and by t1/~ese presents dora,~ve, grant, bargain, sell, famine, release, alien, convey and confirm unto the said part..- .....of the second part,~!l~~C4c~aaraQSal~s and assigns forever, the following deaarlbed Real Estate, eituatefl in the County of St. Oroiz, and 6tate y~Wisconsln, to-wlt: ~, ` -- - - - - ,_ _ TOGETHER, with all and singular, the hereditaments anA appurtenances thereunto belonging, or 1n anywise apDertatning; and all the estate, right, title, Interest, claim or demanfl whatsoever, o! the sai8 Dart. of the first part, either fa law or equity, either in possession or expectancy of, Ia and to the above bargained Dremises, and their Heredltamente and tutenanaes... • ~ •~ TO HAVE AND TO HOLD the said premises as above described, with the Heredltamenta and Appurtenances, unto the said patt.~_...of the second part. and to..~ ~ .. .. .......be$s an ass F REVER. , AND THE SAID- ..... ... .,..e%r.~~~~fr-l,~iJ~ ........... ... .........._.. .... !!r!.:.'.-d__-----~---•-~--------~-_---....__._.-------------- ~_~'~~'~ ..........._._..-- ................... ....._........---................._.._....---_...._..............__....__.......__._...._r.....---_..___..................._._...._..._....._..__._......_._.._............_........_.._._._-._._.... for.._......- .............-.......... .........._................___.........:.....-._...._.17eire, ~zeoutors and adminlatratore, do~oovenant, grant. bargain and agree to and with Lhe said part_~of the second part,,,(i!~' ............. _ ...-•..._._......_..... ~~Nrtand asel8ne, that at thotlme of the ensealing and deIIverp of these presents..__ ............. R.,e"r.'!.!`..".`~_~_.~..A,ar...._......................-..._.................._.._...,..~..well seized of the premises above described. es of a good, sure. perfect. absolute and indefeasible estate of lnheritanoe 1n the law, 1n fee simple, eWd that~the same. are free and clear from all lnaumbranoes whatever,___..__...__._._ ................._ and that the above bargatnefl premises, fn the quiet and peaceable possession of the sat8 Dart_.~_o2 the second Part ~~~--~/i k~~ .... .......................................~Lelee and assigns, against all and every Damon or Persona Lwtully olatmlag a whole or 677y Dart thereof,_..,,6~........__.___..... w1ll forever WARRANT AND DEFEND. // IN W SS WHEREOF, the said Part._. __of the first part ha.lY:.hexeunto aet._......._.. ._..._..:._~7and_._.and aeaL.....thLa..-1~.. _ .,~,1.._..._ day of... A. ~ 19.-0..~.(.o '' :-. ~/~/ /~ / '. ... v,. ed and Sealed 1n Presence of -~ ,i ...__........---......._.._.._ .................---..............._..._....._..._.._.....__...~SEAL .... ___ ..........................._....__........._.._.........._..._..._....-------......._......__(SEAh .~ STATE OF WISGONSIN St. Oro1x COUnty. '7 ? ~~ Personally came be xe me, tht _ ................:. ~ / . ~ ..........__.._day oi._._..... ....... .... .............`..:....__..:......_..._:._....._, A. D.,19SL_~', the above named. ... .. ...........~ ...---............. ._ ....... ..............._._~ ...................C 1~~.................---.....:.....:.........:...........__........._ ~ to me known to be the persan_._._who executed the foregoing instrument and aolmowledged the same. //!], _ / Notary Publlc__.........__. ......./..Cr2.-4-f~~._._Oouaty, Wla .. ~'~~/~ nfy Oommlaston exp ._ "~ _~_~_ __ r rt M .i!__2580P 037 St. Croix County Hofdfng Tank Agreement fate Plan Transaction Number - ~U,nSditJ ~c~.C~w~ 4~zc-~~.~' Gwf3) I~JrC . Name - (Owner) Typed or printed being duly sworn ,states, under- oath, that: 1. He/she is the owner/part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume 22 Page ___~_~ Document Number I~~~PPZ~~3~~~~~~O,~S,~~t.~~Croix County Register of Deeds Office: A parcel c;r€iaiiiiwTe~the,1~J~'f. of t6 ~t %. of Section ($ T.~ N - R ,~~,_ W, Town of ~tA2'S ot..! , St, Croix County, Wisconsin, being duly described as follows (include lot no. turd subdivision/CSM or detailed legal description): Agrwment Date• ~ ~ ~y 7 6 3 7 1 KATHLEEN H. MALSH REGISTER OF DEEDS ST, CROIIC GO. , MI RECEIVED FOR RECORD 05/25/2004 08s30AM HOLDING TANK AGREEMENT EXEMPT • REC FEE : 11.00 TRAMS FEE: COPY FEfi CC FfiE: PAGES: 1 Name and Ratu~q Address ( f/v??sc'~N 7Co"~.Gv~ 4ARCtf ~Y mo'/o. Box 4s3 >^f u-a S cam, LL9/ Sit ai ~ OZD -l639~3Q,_Oo~ Parcel Identlfit:atlon Number (PIN) We acknowledge that appllcaUOn Is being made for the InsteUaUon of (a) holding tank(s) on the above described property or that corrtlnusd use of the exlatlng nremiaz: »~~ n... tr.e: z .;o!_~ .tar.:: bs ',nnL^,:I:::::::: t:.~ :.c,:,:,,ry C.: Sire yii:~:::SN ui proper wnrainment of swage. AlaO. the property canrat now be served by a municipal sewer,. or any other type pf prtVate onsite wastewater treatment system as permitted under Ch. Comm 83. Wis. Adm. Code, or Ch. 148, Wis. Stets. As an Inducement to the county to Issue a sanitary permit for ttte above-clezcribed propa~ ty. we age ea to do the failowlnp: 1 . Owner agrees to conform to all appUcable regWrements of Ch. Comm 83, Wls. Adm. Code rotating to hblding tanks. If the ovmer falls to have the holding tank properly servtoad In response to orders issued by the governmental un{t of the Department of Commerce to prevent or abate a human health hazard as described in s. 254.68, Stets., the governmental unit (Town) may enter upon tits property and service the tank or cause to have the tank to bs serviced and charge the owner by ptadnp the dtarges on the. tax bill as a spade/ assessment for ttrrrent services rendered. The charges w1U bs assessed as preat:ribed by s. 68.0703, 3tats. 2. The owner agrees, pursuant to s. Comm 83.54 (2), and Comm 82.40(3xe), Wis. Adm. Coda, •to-hays a•water meter Installed in ttw structure. The water mater shall be ktatalled by a plumber authorized by the Department of Commerce to itiakit such instagaUons, with said inetatlatton compiytng with State regulations and manufacturers spedflcatlons. The dvmer agrees to ~bp flnaadally reaponslWs for-the pun:haw, Installation, maintenance, and repeU of the water molar, and agrees to allow the governmental unit or the Department of Commerce to enter the above-described property on a regular basis to road and/or inspect the water m®tar. 3. Owner agrees to pay all changes and costs incurred by the governmental unit Or county for InspecUOn, pumping, hauling, tX otherwise servidng and maMtatninp the holding tank in such a manner sa to prevent or abate any human health herald caused by the hoding tank. The governmental unl! shall notify the owner of any costs which shall be'paid by the owner within thirty (30) days from the date of notlce. In the event the owner does not pay the coats witMn thirty (30) days, the owner spedOcally egress that all the Deets and dtaryes may be placed on the tax roll ss a spade/ assessment for the abatement of a human health hazard, and the tax shall be collected es provided by taw. 4. Ths owner, agrees to contract with a person who la licensed under Ch. NR 173, Wls. Adm. Code, to have the ttokling tank saMced and to file a wpy of the contract with the governmental unit, The owner further agrees to file a Dopy of any changes to tits servlq contract, or a copy of a new ssMco contract, with the govemmsntal uMt within ten (10) bustMSS days from the data of diarige to the seMce centred. 5. The owner agrees to contract with a parson Ucansed under Ch. NR 113, Wia. Adm. Code, who shall submit to the county on s semiannual bests a report detalUng the servidrtg of ttta holding tank. Tha governmental unit or county may enter upon the properly to Investlgate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank is not being properly maintalrted. 8. This agreamont will remain In eHsct only until the county offtce responsible for the ropulaUon of private onsite wastewater trsstment systems certifies that the property is served by either a munldpsl sewer or a private ortalts wastewater treatment system that complies with Ch. Comm 83, Wis. Adm. Coda. In additlon, this agreement may be cancelled by executing end recording said certltlcatkxt with reference to this agreamont in such manner which will permit the existence of the certificatlon to be determined by reference to the property. ~. This agreement shall be binding upon the owner, the halts of the owner, and assignees of the owner. Tha owner shall submit this agreement to the register of deeds, and the agreement shall be recorded by the register of deeds In a manner which wilt psnnit the existence of the agreement to be determined by reference to the property where the holding tank Is installed. Owner(s) Nart~(s) - lease Print /~ '~~/ f'U f't. ~L.C~~~/~ Subscrtbed and swum to before ma op thl4idattl, •--, .., '•- • •+' +Vi1 .. a C-7"r1;Q1~S~Y f-V' uvsoN 'Roves 6u~v ~+/s r~~u ; , ,,... .... > . No zed Owner's gna refs Nota Public f _ _ r .~-• ...{ti, ~~ i' l ~ Governmental Unit Offidai Name, Title -Please Print M Commission Expir~>4~ '-, - . ~~~'; ' .•. •- . ~- /' 3/ - 2GaS" !e . ar, „ Governmental Unit Oftldal Signature Drafted by: rareonai mrormauon you proves may oe usao for seconcary purposes trnvacy ~v s. i 5.va(t)(m)1 "THIS PAGE IS PART OF TliiS t.EOAL DOCUMENT - DO NOT REMOVE^ Th/s /nlarmation musf be completed by submltter. document Ntle. name d return address. and Q((1((!1 requ/redJ. Other /nfornwUOn such as fire granting dausas, /saga! description, etc. may be placed on this lust pegs of the document or may be pNrced on addlNoneJ papas of the dOCUmen(: Mot9: Usa W this Dover neon adds one Hasa to your document end S2 DO to the nscord/na ree_ Wlscensln SYatutar- b9.617 .:$