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HomeMy WebLinkAbout020-1413-90-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORNFATIONf (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Glen Johnson Construction Hudson, Town of CST BM Elev: Insp. BM Elev: ! BM Description: n ~ ` ~ oo 1 G 'c7V J TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ]'..~--. 'e ZB: f zQv Dosing Go / ~ ~~ Holding TANK SETBACK INFORMATION TANK TO P/t o (~ WELL BLDG. Vent to Air Intake ROAD Septic 3D ~ y v~b ~ /Q ~ / 6 ~ - Dosing 30 / 7 50 ' /d / d ~ Aeration Holding PUMP/SIPHON INFORMATION ~ I , Manufacturer I Demand ~Q J C GPM Model Number ~ ~ ~ ~ 3~ TDH Lift Friction Loss System Head TDH t is . 7 ~ 3r ~~ l y~, z Forcemain Le t Dia. ~ ~ Dist. to well ~ Z 7 ~ SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 487919 ~j111~] State Plan ID No: Parcel Tax No: 020-1413-90-000 Section/Town/Range/Map No: 20.29.19.2607 STATION BS HI FS ELEV. Benchmark 5 , ~ /D 5 /~ Alt.. ~~~- Ca ~~ ~ ~Z, 3 `t (~. ~ Bldg. Sewer ~ ~~~ I ~G J St/Ht Inlet ~ 's ~ .7 ~3 . ~} SUHt Outlet ~ ~ Dt Inlet Dt Bottom ~ 1n - ~~ 1 Header/ an. ~' ~ y ia `6, to l j Dist. Pipe 5 ~ ~ q t' Bot. System /'~ / ~ , Final Grade ~ a~- ~ ,.~ ~~~ . ~ ~ 1 / ~ T ' ~P /~ , St Cov~ lt/~-- ~OJ ~ i'Z ' 3 q 1 ~r T- 7~ aS 87.95 ~ Z 7, ~ 9?. 2 ~ ~• ~ ~4~ Z BEDITRENCH DIMENSIONS Width / 3 Length I ~3, rp~ No. Of Trenches 3 ~ ~C~ j _ _ ~ - PIT DIMENSIONS ~ No. Of Pits Inside Dia. ~- Liquid Depth ~ SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: lrt,+~~.1~~ Type Of System: ~ G6v411~~~0~ Z ~ / ~ ~ + ~ ~ / / /~ /V 1 ~ UNIT Model Number: J~ r)ISTRIRl1T10N SYSTEM N r1.1. ai /Sf~S~-iS ~ ~fS d-~~as Header/Manifold+ Length ~ Dia +/ Distribution Length \ Dia \ Spacing x Hole Size x Hole Spacing \ Vent to AirQl~ke~~o t ~ ° u"'~ CAM COVIPR v D~n~~nrn Cvc4nmc Anly YY Mnuntl (lr Ot_Gradia $VStEmS (7r11V 4 ~ c~ ~+'vv~ Depth Over y Bedfrrench Center / / Depth Over Bedlrrench Edges ` xx Depth of Topsoil xx Seeded/Sodded - No Yes + xx Mulched I Yes f No "]~ Z ~ I COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /_ Location: 757 Martin Avenue Hud on, WI 54016 (NE 1/4 SW 1/4 20 T29N R19W) The Glen Lot 13 Parcel No: 20.29.19.2607 1.) Alt BM Description = w~ w.S o d ~~ 2.) Bldg sewer length = Z-7 ~ C~ Sciw.l`. - amount of cover = ~ ~ ~ 1 f~-e,t Use otherls de for additional information. No ~L ._~~ r~' . _ v ~~ I __ ____ __ -.. __._ ______ ..__- Date Insep is Sig re SBD-6710 (R.3/97) i -- -i -T --- . Cert. No. Safety and Buildi ision I County i ____..~_~.~ ~ 20i W 'Washi tOnAv ., P. ! .S~~I~'cr.i~,)(~ /~~~ ,v ~ y f q~l~r~ al Wl S ~(37~~ Permit Number tw be filled in b Co ) _ Department of Cor~er~ i ( 8) 2 3151 ~ T$7 .._. _ w. i., a State lan LD. Aumber-/ ~ --- _.. _--_---____.-~ Sanitary Permit Ap is o ' ~' zo _ ~ !n accord with Comm &3.~1, Wis. Adm. Carle, persu inf you $l'~r _ may be used for secondary purposes Privacy L ., s .(W ~~O~kCOUNT Proj ct Address (if differt;nt than mailing addrrssl ~I j I. Appllcatiort Information -Please Print All Itrforrnatirut, A-}~ ~' ~7 -~ Property Owner's Na me ______....__ _...._ ' P "" Lot * ock M i I ~ ~ ti.~/ ~~ ~9~~ J S Property Owner's M ailing Address 1'roporty Location i ~.__~ SL.. ~! ~ _ _ ,/~ ~~1 f City, State .-- '- -_--- ~ - tk,~k/ u,5eccion _.~jt~ Zip Cods Phone Number I/ G ~8G_ x Q~ (curie u ~ l ~~~~ ~ ~` .~Y N; R~E or~ II. Type of $uilding (check all that apply) __ _ _ _ _ _ I~2 or 2 Family Dwelling -Number of Bedrewms '~ ~ 6~' I ~m~ Subdivision Namz CS,14 Number --~-_ - -- ~ - ---- -- --- 1 E { ~~ PublieiCommercial -Describe Use ~_ _______..~ pv~~ ~~,~ ~ ~h ~ ~,~ p„J I L 1 Sttte Owned -Describe Use ~'~-- ~ i r - --• . ---.._____., ._.._...._~---------_.______._ _----_-___. .~... ~Ciry_OVillage~T'ownship o,~,/u ; ~III_ Type of Permit: (Check only one box on line A. Complete line B if appJitzable) _-~ ~ 7~ ~- ~~1~ ~,~ ~Qr~~ 67 i ' ~- Vew Svatem ~ I_! Re lacenaen ~ i ~ ~ ~ p t Systetn ~ T.t:au~tentrHulgtng Tank Reptactment Only ~'.'~ Other Modification to Existing System B. ~_1 Permit Renewal _ Permit kdvision ~~ Change of ~~ Permit Transfer to New I.tst Previous Permit Number and Date Issued -T-Tj Before Lrxpiration Plumber ~ Qwnet ~ y ~ ~ 9~ ~ -____ ___._ .L._- _ I iV. Tie of PUWTS System: (C'lteck all that a ly)~ ~~ ~~` __..._._._ p.L? _______..__~~._.___~..~ _ KNun -Pressurized In-Ground i_• Mound > 24 tn. of swtable soil Q Mound < za u,_ or suitable soil ~ At-Grady ^ Single Pass Sand fiilter ~ ~..-~ Constructed Wetland J Pressurized In-Growzd `Wl Holding TarJc ~Tl Peat Filter (<i Arrobic Treatment Unit r~ Recireutating Sand Fdtrr '•~ Racirculatitty Syntheric Media Filter ,t~}.,eaching Cho bey L~ Dri Line ^ Greval-teas Pi d_~ Ocher {explain) _ _- _ -- I`V~Dis ersal/Treatment Area_Infarmatton: _ ~ C ____ _ Design Flow (gpd) Design Soil .4ppiicatian iLtte(gpils ~ D persal Area Required (st) Dispersal Area Proposed (s ~ System Elevation - F ~ VI. 'Cattle Info Ca acity itt Total Number ~-' ~ p `~ Manufst:turt:r Pr b Site Sizel ~ Fiber ~ Plastic T Gallons Gallons of Units j Concrete Constructed ~ Glass ~ New ~jq~~ I ~ 7'anRs I Tanks h// zo1otJ~[,, Q~ l~j Fi J ~ ticptic or Hoidirg Tank ~ I J~U d - ~ T ~. Wr'•GS' B Y ~ ~ " Aerooic Treatment Umt ' ~ _ _ -r ~ ~~'~-- ~_ ^.~~_~ j ~ i Dosing Chamber i ..-..__ __ ...._._,. _,___-.~. ~ __- __ . _...- __-- -~ f _ VII. Responsibility Statement- 1, the urtdersi ed, assume resputtsibllity far h Uation of the POWT5 shown nn the attached plan.. ` ~~I Plumber's Na me (Print) ~~ Phtmtxr's Si gnature ~ P . FRS Number Businass Phony Number i Plumbzr's Ac±dre ss (Street, City, State, Zip Code} ~ - VIII. Count /De artment C`se Oul,~ _ k--. -_ .....~. _ . _.. ~ _.~ Approv;.c] i_3 sapprove TSanitary Permit Fee (includes Groettxlwater - ~ Dat iss Issuin eut Sign pu , u ~ Surcharge Fee) ~Dd ~ ~ J ~~ !)5.~ + J ne _ven Reaso oLCknial IBC. C'ond'utiaris of Approval%Rea-sons for }~isappro4al ~~ ~_ 8Y8TEM t)VIMER: 3) tiJe,.J 50,` ~ (P ~' /~7Y~. 1. t3aptfe tank, ettktxrtt fillet attd dlpatssl caM moat alt be st>!tvices / nt~ird ~.l ~~ ~ lbr~- ~ ,,,,rr~~QQ~~ ~~~ ~1C~J ~0 r-~Or..~- j ati par msrtapernent plan provided by pkrrnltN. / LT~--`7( ~u / ~ 2 AN salback ngtalrsments must be mairiWrtad l]] ~~ ^ .,^ 1~,_ D`t/1 as ~ appftcabls code / ortNttances. !.~- S~b ~~.- M.a.~ N G"~ -tiC~, ~C t. _. 11 / Attach complete pleas (to the County ocNy) far the system au paper t+ot iesa than Ei12 x -i inches is size ~~ ~w ~ `~ ~~ ~~ ~~ ~~ ~~ ~oas,.- ,S, ~~-~ s ~ ^~ r ~~~ ~~ , ~ h o d ~ ~ ~ c ~~ ~_ P i°~ -~-> __ ~i~e .,y ~a~,J~'ow CQ, sue'' ,2c~ 7~ l.3 7~ ~ .1~~ ,e ~/ .~a.~L-„so~/~/ ~_ ~~ ~. s ~, ~ ~ co r ~1, 4 o' , ~a a wlaaonsin Department of Commerce SOIL EVALUATION REPORT Dlvbion d Safety and Butidinge in accordance with Comm 85,1IVis. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County S include, but not dmited to: vertical and horizontal reference point (BM), dlredion and Parcel I.D. percent sbpe, scale or dimensions, north arrow, and location and distance to nearest road. QJ,p , Please print all Information. Revs by Personal fnronnatlon you provide nwy ba used ror seeondary purposes (Prlva¢y ~,~,. s. 15.010) (m)). _ _ - / J Page ~ of Dat ~ i~~~/s c~(f /~ Govt. Lot ~ 1/4 ,~~1/4 S /,~Q T ~4 N R E ~ Owner's Mailing Address Lot # Block # Subd Name or CSM# State p Code Phone Number ~ City ~ Village (Town Nearest Road `~ Scsn. 5t14 i'r1 ( r~ Sa /~ t Lc.' ~~ n Z /t ~''v Construction Use: ~ Residential / Number of bedrooms ^ Replacement Code derived design flow rate _ ~~~ Gi 4 GPD (^ Public or commercial - Describe: ___ Parent material _ !'~ y-4-t,,J a !~ FkxxJ Plain elevation if appUcable .(s•L~- ft. -~cornone: ~'yS~Pn~ el ~,~ ~ ~ ..S ` loo w (-..- ~ ~. 1-'~ r~ _ l Boring # t--l oonng Pit Ground surface elev. ~ ft. Depth to limitino fader ~ Horizon Depth Dominant Col R Sal in or M d edox Description • Texture Structure Consistence Boundary Roots GPI . usse (]u. Sz. Cont. Color Gr. Sz. Sh. 'EfHl1 l , /) r--~ ,- ~ ~~ # U rsonng Pit Ground surface elev. ~d fl. Depth to rm.Hnn t~.w,. ~? 3 'EH#2 Horimn Depth in Dominant Cokx Mussed Redox Description p Texture - Stnu:ture .... Consistence Boundary Roots Sod ication Rate GPD/It? . u. Sz. Cont. Color ~ ~(5~ Gr~.~~S\z. Sh. ~~' I~ '~ 'Eflfi'1 ~ ~ 'Eff#2 ~ . ~//~ ~~` / /. ` i J r ~/ ' Ef iYteri t #1 = 80D > 3A < ran ~„r,n s..,~ rcc ~~n ~ , e n ...... ..~ - -- - - - - - - - .+..... - w ~r~yc ana r a~ _ au n1g/L CST Nlente (Pisses print' ~,,,.--. °_ CST Number rW1S~, 1 °~ Date Evaluation Corxiuded Telephone Nu ber ~~ ~ .~lC-'c'am 1 ' i/1 ~ 5 ~Ul ~ ~U ' Z g' -CS ~l.s = 764 -C Z .~2 i Pr'opeftY Owner ~t rl-.So ~- Paroei ID # Page ~ of ~~ # LJ Boring ~- Pit Ground surface elev.1~,. ~ ft. Depth to limiting factor ~ in. ~ i~~ ~ th D minant D Redox Description Texture Structure Consistence Boundary Roots GPDlfP Horimn ep in. o Mansell t1u. Sz. Cont. Color Gr. Sz. Sh. •Efl#1 •E}f#2 ~ Q~ ~ ~~ Zm m ~ l t -' s~ ~' O v y - ~ ~` v-'~'r~ ~ S ~~ - ~ m ~ -- ^ ^ Pit Ground surface elev. tt. Depth to limping factor in. Soil ication Rate # ~ ~~ i th D Dominant Cdor Redox Description Texture Strud~ue Consistence Boundary Roots GP DRE zon Hor ep in. Mansell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eff#1 •Eff#2 Q ~~ # ^ Boring ' ^ Pit Ground surface elev. ft. Depth to limiting factor in. Sa'i icatron Rate Horizon Depth Dominant Redox Oesaiption. Texture Strutdure Consistence Boundary Roots GPD/ff in. Munsep Qu. Sz. Cont. Cdor Gr. Sz. Sh. •Eff#1 •Eff#2 • Effluent #1 = BODE > 30 < 220 mg-L and TSS >30 <_ 150 mgll • EfllueM #2 = BOD` 530 mglL and TSS , 30 mglL The Department of Commerce is as 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. awuxta~oot ply per ~~ ~ Parcel ID # Page . of „~ ~9 ~ ~,.] Boring Pit Ground surface elev. ~~ ~ ft. Depth to limiting factor ~~ Soli icetion Rate izon H th De Dominant Redox Description Texture Structure Consistence Boundary Roots GPDIft' or p M. MunseU Qu. Sz. ConL Color Gr. Sz. Sh. •Eff#1 •EtT#2 ~ a~ ,~- ~ : Zm m C f s ~` ~ , y -- ~c/ v-'~'>` c S i ^ ^ Boring ~# ^ Pit Ground surface elev. R Depth to limiting factor in. Soil iption Rate Horizon Depth Oominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/if in. Mansell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'E~~ ~~ Q Boring # ^ Boring ~ .. ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soq Rate Horizon Depth Dominant Redox Description. Texture Structure Consistence Boundary Roots GPD/fl° in. Munsep Qu. Sz. ConL Cdor Gr. Sz. Sh. •Eff#1 •Effll2 • Effluent M1 = BOD` > 30 < 2Z0 mgll. and TSS >30 < 150 mglL • Effluent fl2 = BODE _< 30 rtglL and TSS : 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or aced material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. seo.arelaioo> PAGE ~ OF~ NAME ~tjh rlSu •~`~ LOT# LEGAL DESCRIPTION '/a ~/a,S T ,N,R E(OR)W 1` SCALE: 1 ~~ = yQ BM i ELEVATION I~(S y Cg BM i DESCRIPTION ..~rjd..F.. pG,,•/•.~r ~~ BM 2 ELEVATION .-. BM 2 DESCRIPTION 1 SYSTEM ELEVATION/~ ~/ f_ ~ 1 ~tOw w'~ /Zsc~ SYSTEM TYPE ('Ull if~Zy~,77Jc:.naLl SIGNATURE ~j ~-~_~-~~--~~ DATE ~~- ~ ~' ~ .~^ .~ ~ 1 ~ _, r~ Sa Bui1~` ~ ~_-._-_ __.__.--._.._._,_..-.-~.~f+ CJl , ll' r rgton AvC., P.O. Hvx ` aunty - s'~ ~1!O /r X -.._ ~~~~~~~~ ~ adis tk'I S~?U7 - - 7152 f anitary Permit Number (to be filled in by t'u 1 Department of Commerce _~~ _ ~(,IJ" _. ~ _.T~ 0 ~ / ~ ~ _ ~_„~ ~ ~ unitary Pert~~t App >< off' cHOlx courv-rv wte Plattl.D. Number !n accard with Comm 83.2!,11r'is .4dm Code, personal m FFICE may be used for sewndary~ purposes Prrvacy Law, i15.t11(l)!m; Proje,:t Address t'rt"drftere a,t maihnP ;~dtiress} i j _.._ __ _ .___._ _---__.. _--------.-.~_ .__...._._ ~_.~__~ I. Applecation 1 armation -Please Print Ap Iaformation ~_ ~--- - --.._ ' ~ ~ ~ ~ ~r~N ASE. ' . . _ Property' +~wnet's Nam Bk,ck # Parczi # Lot N Property Jwner's Mailing A.d ss i Pt0 LpCatr ~` d d' ~ -6<- -~-^~ ~ ~ ~ /' ~~/~, ~~/, Section ~~ ,~ ~ l,lty ~ J~lklnt t'iUrilbCr } ~1~' COQC .. -._... i l4Drs~ ~ ___1_~v_~ ~ ~7 7 [' ~,7 N; R.~~~COr ~~ y) t II. Type of Building (check gll that I ~~___.__ ____._..__ , S ~1'or 2 Family Dweiirng -Number of Bedr s - ~ ~ l `Q PubliclCommercial -Describe Use Subdivision Nacre C5M Number _!.~~ ¢ ---.---~ - .-._ __. _..._...~____.._~.-_,._..____.___.-__ __._---- ~Q State f)wnrd - Ihs~rib+: Use- __.______. _.- ___-- -- i ~'Crty^ ^Viliage,~fawnsh:p or'~ ~~_- ' 1II. Type of Permit (Check only one box nn lin .Complete line B if licable) .___ . ~ - ~0`~p ~. Z(p0 } .4. I 'Vew cyseem ~ P Y - T P 7' i~ Re laccmeni S etem ruse,nenVtiotd,n nnl R~~ iaceniant OnI f g .. ~ C)thr'r Mtrdificanon ru Exis+in Sti-stem ~ I ,,-- Permit R~~rtewal ~ Q Permit Revision ~Q i'tw e of :? Permit Transfer u; New list Previous Permit Number and Irate Issued Befbrs: E:xpirarion ~ I Plumber ~ Uwner ~ 1 IV. TYpe oi' POWT5 S item: Check al! that Y lv ~~e~~~l~tti~-M ~ - ----____ z~ ~a~ c.eX~C inn -Pressuriz,E•d In-Grtwnd ^ 1Vi~und ? 24 is of suitable - ,I '..~ h9 < 24 in ni suitsl;le soil ^ At-tirade ^ Sittgte Prsss Sand Fitter Q '4. C'unsauc[ed Wcdand J Pressuriiad tn-btuund ~ tiul~i: Tank L Ynat r '~ Aerobic Traatmrnr I,Tnii ~ keel+culntina Sand Filtu Recirculating Synit±etic Ntc^d,a Flier eaching C,ham U Dnp_Ltnr ~ vet-less PiJx ~~. (xner texpfain) -_ ~ _ _,._. - ''~' ~~'^R °f~l Z' ' __ _ reatment Areit In[orni>ttton, ___ Y, Dis erllttilt Design Flow(gpdt Design Soi4 Applreation Rate(g ij i Dispersal Atea Required . 1 Dispersal At'ea Pr sac Syste Elevation I I ~/./D ! '~^ 7S ~Lla~,p~ l Fib S Pl i ~ Si ` ^ er tei a_st e lo '/Mt)er Manufacturer Prefab Caprceiry in Tot ~I~ S7. TAnk Info j t'oncrete Constructed Glass Lallans va ns ~ of Lnits w' 1 New F.xiatittt; ~ `I'"r 't'anks Tanks _ I .~._.___-__ ---- --- tiepriccrF! iagTank ~~,// aQ~l ~ ~- W Auobic Tiratrnent Unit ~ ! ( '~'" ~~~j~ r{L------- ~ ~ ~' ~ ./ f ~ ~ hosing Cfiamber r ~'I I. Res onsibiGty statement- I rt undersigned, a~nme responsibility for inst lion at tilt POWTS sbu~~a o e attyched Ions. mber's Name {Print) P}umtm's Signature P lu r RS Number usiness Phone Number ~f ~ E P~u mber's Address (Street, 4'iry, tr, Z,p c" ej ', ~ ~ lI. Coua !1}e artmen se Anl ` ---' ~~ Sanitary Permit Fee i dudes (iruurldwater hate issued ISSUIa ,Agent store Nc Stamps? I ;1i ~A provet'i ~ ~ ' ~ ~' . O~ p a ~ureharge Fee) _ ~ Q a Reason for Denial ~ _____ ~._- IX. Conditions Appro~' iReasel~~feri~tatt~Qvet \ SYSTE ER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / rrlaintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. AitacM soaaplek piarrt (to y onl3'7 1'ar the system ws piper hot tray chin 81/2 x I1 irubea in ai:e ~ ~' _.__ _ .~ ~:,~/T S1~D-b398 (4i. OI/G3) ~i . 0 v ~~~ s a ~i . of ~~ 3 ~, D ~v ,u r ~. h ~~,~ ~~ b~~ ~~ r o ~~,o ~~ ,~~ ~ ~ ~~ _ ~ K yycw~o~~~ ~ 1, ~~ ~S ~. `l5 b M -~ ~I~ _~ .~ .a Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buitdings in accordance with Comm 85, W is-Adm. Code Attach complete she plan on paperrwt less than 8%: x 11 incites in size- Plan-must County include, but not limited to: vertical and horizontal reference pant (BM}, direction and percent sbpe, scale or dimemsions, north arrow, and location-and distance to rt~rest mad. Parcel I.D. Please prn-taH infomratian, ~,,,..~•~ Personal information you provide maybe used for secondary pu (m)}. ~~ ~~~ 1160 Page 1 of 3 Steel Soil Service St_ Croa pending Date ;~~.; , 1 z3 ~u Sienna Corporation ,~ ~~C. NE 1/4 SW 1/4 S ZO T 29 N R 14 W Property owners Mailing Address "~4-~ Lot # BI # Subd. Name or CSM# 494o-VikingE?r, Su~e60~8 ,, ~~- 4~ ~~ The~len City State Zip Code Phone 1 ~L~ j 3 ~ ~ Village ~ Town Nearest Road t;~rit~ MN 55435 ~15zp~ Hudson Carmichael Rd. / New Cons#nfctiat Dce' ~ Residential / Numt~ of bedrooms 4 Code derived design flow rate 600 GPD Repl~ernent Public or commercial -Describe: Parent material Pitted outwash Elood lain livable p elevation, APP na Generaicomareats o and recorrimendatioris : ~ System elevation 95-70ft,. trenches spaced and depth to code 4-75ft bebw grade ~ 33 . ~' ~.N,~e~., 3 /~~ surd-~ w +l~-!.~ 1 Boring # Borg ~, Pit Grand surtace elev. 100.45 ft. Depth to limiting factor ~ in- Sod Applicatron Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 *Eff#1 *Eff#2 1 0-11 10yr3/3 none sil 2msbk mfr gw 1 f .5 .8 2 11-18 10yr4/4 none scl 2msbk mfr gw na .4 ~- _6 3 18-24- 7-5yr4f6 Wane- tits osg mF es na .7 1.2 4 24-3 7Syr4/4 none cos osg_ mvfr cs na J 1.6 5 39-96 7.5yr4/6 none ms osg ml na na .7 1.2 3 ~ -_ 5-`7 `' ~~) Su-rya-c~_ -~- gys~l-~/mot 3 ~ ~- qs. ~o 5~- 3 Bonng # Bormg 96 / Pft Ground surface elev. 100.45 ft. De¢th to limiting factor in. ~ Aeon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz *Eff#1 *Eff#2 1 0-10 10yr3/3 none sil 2msbk mfr gw 1f .5 .8 2 10-18 10yr4/4 Wane scl 2mstrk mfr cs na -4 -6 - 3 1~ 7.5yr4/4 none cos osg mvfr cs na 7 1.6 4 33-9fi 7.5yr4/6 none. ms osg ml na na -7 1.2 3~- ~~ a~ ~~~ ~Su.r~-c~--~~'3`, * Effluent #1 = BOD ~> 30 < 220 ma/L and TSS >30 < 150 ma/L * Effluent #2 = BOD < 3o mat and TSS < 3D mat 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 9116/2002 715-246-5085 prey Ow,r,~ Sienna Corporation Parcel ID # Pending Page 2 of 3 Boring # 1 Btxmg 94 45 ft th to lim De itin factor 120 i / Pit Ground Surtace elev. . - p g n. Sod Applu:ation Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/it2 *Eff#1 *Eft#2 1 0-12 10yr3/3 none sil 2msbk mfr gw 1f .5 .8 2 12-24 10yr4/4 none sicl 2msbk mfr di 1vf -4 .6 S Z 1Qyr4/6 none sir cf ~ Zmsbk mfr di na .4 .6 4 5-120 7:5yr4/4 none cos osg° rrnrfr rra na ~ 1.6 ~~ . ~-7 S~/5 7 `~--~ I ~ 7 N l~n. Gbs Hor~io[L#3-has noncor-tiguous. moftlina- Boring # 'Boring - .. .-- - - * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS <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 Boring # ' Bonng - -- -.- - . Page 3 of 3 STEEL'S SOIL SERVICE N David J. Steel 1564 Cty Rd GG CST-POWTSM Sienna Corporation New Richmond, WI 54017 Lic. # 248956 NE1/4,SW1/4,S 2o,T29,R19w (715) 246-6200 Town of Hudson, St. Croix Co. (715) 246-5085 The Glen lot # 13 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 soil test was conducted. n ~ec,.QnG~ /~410~~ ~ ~Pf~yc6jPa~~~g~~~t`l.~fs~'~- ToPaf I(i uc ~~~.~. '~ = air ~S ~ LL i3~rr`/! ~~21/~rAAf 82= /so. s~.s~~- 63- ~~ 4'l-. H. yjis L. g6 ~F--~ `~ 6- av •,~~~yr tom.. 72' (h'~!'I ~7 ~~// o ~(6~ B- 23 r -~t,SoK1~. iCo~ h.i~ Go~2r ~ ~ ~zgg r3 ~~ ~~~ ~3M ~' IV I I _ -_--- 1 I ---' ~~ I i - _ ~~ 1 ,-- ,, ; ...:- -,r .. _ .: -_ .-- ~~r: _. -i.:::.- 1 _ I ~ ~ _ CCcc '`-~ ~.7V v .. .. '. _ ,.f /~ a•. -`i ~/~~.' - ( +r •'~ t ` 417• '. _. ~ .~L ~ a _ __~_~'. i _ 1 r 1 ~~_ ~ ~~~ ~~.~~_ lea ~_~ .... , .r . \ - 1 _~ ~ / .t-_.. 1 - ; -' // fir- - ,. 1, Y ` ~~~ i , w.Z `i. ; 1 ~•r^_-~r ~. .~''J'i e e ; i'82 -,, 1 ,~ ~ ~~ 1. y. ;~ `i`i -/•~~~_ Ali ~ _~ +• 1 `~ / J' ~~• ` ~ l 111 `~/ .\~ I `W'' 11 .-'\ t \ L 1 i 1 pA/. ~ //. ~~w~ _.. ~ ' _ ~ it oY ._ . _ 'p!`" 1 r .. `^-- r _.>` - - ._ _.~ . . _' - - - ~ - ------ 1 _ -- - • - -- Y 1 t / : . 1 iI -1 ^ ~`` ` • ~' NJ .1lF 1. r __ ill. t. ~J ! ~ i 1 _` _.. -~- `• _ _ 1 ~ 1 tli :;~ ~/ + r/ 1"`i :` 4 - i - -- ,345 \ i ~+ It~~ : i _ ~~ - ~ ~-- -, i r ' ~ ~.e°` •' ~ .i • ~ .. ~ , ~ . i .'•?t• 1 _' _ 344: • ~• le t ; t ,. _ _ • - A '' .7 1 r• .NF~ ' L f i. Y 1 1 ~ i ~ Q 1/ ~ \_ 4 :; 1.,~ . .-; .._ -,ter -dj.~`~ C r 1: ~ ~~ ` i-~•~~. • ~` ~ -- _.. ,._ -... -' d i i{r1 .. ILL '- ' •. : ~ c ~'{~- _ 39 1 ` '~ _ _ ~~ ~ - .. .+~7 _-- ~`~-. _ _ ~ ~ / ~ , i it i` ~`' LTA r~..~ .mss i iJy _ --- 1J .~. - „ >•. \\ \ l 1' "' +- } : lr:: / r ~ ' ~ tl ' ~ 1i ii i ; i, e`•; rl 1 .. ~ _/.1 _ < L 1 'L __ r \ rl, 1 ~~ '.L`t: i4+1'~i w..l •i i 1 t ..id.l 1 _ A~jYf .~ ~ + Ili L. / t1 -` 1 f: .. lei i' _ ~~• \`\ ~ r~.. ~~~ ~~ :~ ~ ~ 111l ~S•~ \`1.i ti ~).Il.ltl'~-11~~ i 1 --.. .' ` `/ ylr ~ ... , 1'.1 ~;r ~'~ - it s .. ..,1,,11:-:. ;:' ,\ .. •` . .,•. 1 Ir..'• ''r+' $ f . 1 j , , i 1 .' '' a 11 . i - 4....i \. ~ / . .. w +.. S?"PTIC '~RNK S PU:~iF' CH~aMBDR CRS a ~F4T~ON P.~iD S~'ECIFIC!`~.TIO:~'S =+" CI VEIJT PIPE 12" MIN. ABJVE GRADE ~ ~fEATN~RPROOF ? 25' FROM DOOR, W NDOW OR JUNCTION 8OX APPRGVED FRESH AIR INTAKE-- --- WITH CGNDUIT MANHCLE CaVFR ~ 'r1/ PADLOCK FTNISHE~J GRADE WARNING LABEL., 4" CI RISER "`_""'t -~ -~,.~---,~. ~+ tt MIN . 18 " 4M I N . 6 " MAX . ... ... ~ ~ ; "".--~~3 ~~ ,~ .. .~ N LE `I' ' ~ ....~..~...' ~~ k'ATER TIGHT SEALS a GA$' ~ TIGHT i `~ ~APPROYEO A SEAL ' JOINTS WITH tPPR4VED -•-~-~ ~ ALM APPROVED PIPE 'IPE 3' ~ ~ GN 3' ONTO INTO St~LID ~ ' SOLID SOIL. COI L P ~ UMP OFF ELE J , F T . ---~--- ~ ~ OFF ~~` R.~ SER EXIT T D PERMITTED 01JLY If TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEI?DING UND ER TANK CONCRETE PAD SPECIFXCATIONS SEPTIC / DOSE TANK MANUFACTURER: ~ ~~.,~,~~ ANK SIDES: SEPTIC 1~~'a GAL. ____..r. DOSE $ ec~_ GAL. A;~ARM MANUFACTURER: ~~~~~'.~-R.~ MODEL NUMBER: 'Q t~V SWITCH TYPE: M~0.~ PUMP MANUFACTURER: ~,~u~,,\ MaDEL NUMBER : f~ c~ ~ SWITCH TYPE: rY1e~C NUMBER DOSES PER DAY: ~` DOS£ YOLUME INGLUDiNG ~ ~ 9 F LOWBAC K : GA'. . CAPACITIES: A = ~_ INCHES = ~I~ GAL. 8 ~ ~ INCHES ~ ~~ GAL. C = ~ INCHES = ~a$ GAL• D = ~j INCr~ES = ~ ~,b SAL. REQUIRED DISCHARGE RATE ~ ~ GPM PUMP ~ ALARM WIRING AS PER ILHR 14.23 WAC ',r ERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . lo~.. FEET + MINIMUM NETW©RK SUPPLY PRESSURE . 2.S FEET + ~~~ FEET FORCEMAIN X ~®FT/lOQ FT. FRICTION FACTOR -~~~4-FEET TOTAL DYNAMIC 'riEAD = FEET INTERNAL DiMEN *_ONS OF PUMP TANK: LENGTH ~- WIDTH r-•~' DIAMETER t~z~ux~ 1'STA"' ~ ~ " ~ i Cr,~L pee I ~' S I G Iv'ED : -,~,,.z,~'',.r---• . _ L S C E N S E NtS M B£R : ~e~.~, Q CI U DATE c- 1/88 ~GOULDS PUMPS EPQ5 irppeller: Thermop~as- tic ert+ciaseddesign for lmprawed p~ormance. 3871 EPOS J1PPLtCATIONs SpeclF~cally designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • 5alids handling capability: 3I4" maximum. • Capacities: up to b0 GPM. • Total heads: up to 31 feet. • Discharge size: 1'/~° NPT. • Mechanitai seal: carbon- rotary/ceramic-stationary, 6UNA-N elastomers. • Temperature: 144°F (40°C) continuous 14O°F {60°C) interrrtitteni. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components, Motor: • EPO4 Single phase: 0,4 HP, 115 or 230 V, 60 tiz, 1550 RPM, built in overload whh automatic reset. • EPOS Singgle phase: 0.5 HP, 115 V, b0 Hz,1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length,16/3 SJTOW with three prong grounding plug. Optional 20 foot length, 1 G/3 SITw with three prong grounding plug (standard on EPOS). aD ZI)O(1 Goulds rh,mps Effective February, 200Q 83871 • Fully submerged In high grade turbine pit io_r lubrication and e#Icient hex transfer. Available for atttant~tk pnd manual operatlf;tp. Auto- metic models intlirde Mechaaical Floelt Svrtc assembifsd and pr+ss~t at tiie factory. fEATURES ^ EP44 Impeller;. TtfermQplas- tlc kmi-open design whh pump out vanes fo: rllechanisal seal protection. METEp3 FEET to 9 8 s 8 s~- a r~ Casing end ease: Rugged d>4ntfap sSic design provides superior strength and corrosion r~ittence: M~rr Housing' Cast iron for. eiflcienf heat transfer, strength, and durability. >>r Cover: Thermoplasifc t v~ith lrtegrai handle and fiat swlti:h `att~hment points. ~ IbWmr Gabler Severe duty ra/Lkd D~ and water rQSistant. a Bearings: Upper and lower heavy duty bai! bearing construction. AGENCY LI5TING ~• Clwdf~ stpaard:,~sowtion (CSR listed model numbers end in "F" or "~".1 c•ofdds Pumps is 150 Soot Registered. _... ,.. .... , . Submersible Effluent Pump z.s a __....~ 0 z 4 5 8 ttP t t m'Jh CAPACi7Y Goulds Pumps ITTlndustries ~~ STANDARD CHAMBER Quick4 'Standard Chamber Multipart End Cap FRONT VIEW (E'FFEGTIVE LENfxTH) -~ ,--~ r, C-~~~ 1r~;?_~ ,~ ~ slaE vIEW 1~ ~~ ~ s ~~ Jr r^ `~ ~ ' l L~~~ 1_ 4 ~~~ C_~.__.__-i_..__ ~ !~ SfaE VIEW Quick4 S1an[fard Chamber°Nominal Specifycatiors ~ ;~; Size {W x Lx y) ''34 x 52 x 12" Effective Length 48" invert yeight g^ y~ILT~TQ~ SYSTEMS. IJyC STAN~IAR~~,1~}TED WA~tgAIVT~r TOP VIEW -'~ ~, ~r Mult~~nri end C'a~ Nai~~tia1'S e~t3catiois ~ ~~ . ` l . ~ ~ _T ' Siie (ti1i xa x ;~j' ' _ _' _ 34" x'16"x 12" Invert Heighf ~ ~ B" or 1.25" fa Thc ln•Glu!al l1c J , of rich chamttor, 61d pla!e, wadga and nU',ei arxoss _n ru:.tN ~ured Oy Ir Idlraror !'i;e wile^'a•Slckrlrl a, id tl<x):aldd ul v lea. hllold of tr nos' a xiptir. sysem in accordance w,lh ktfUralorb insWc I -u, .5 war ~an,.nA to is t :+Igu,al pwcnaster i canr>• rg~ir,vf d9'NOllve !na er'^rls and w~ rn x ytip 4, ,yrp year loom Uw date chat Ure 53p1$ prxmil is sdGwid h r II'y 9Gy);r0 syslam cGraainng ttra l1RNG; uruwdld, hownzer, Ihat ~ sr-W±ic part t 5 -t recn~"cd hY appiVCabte law. the wanar»y Jxulori vn- hagin uie r !ha tlale Ihnf rslnllaltorr Uf ate sap'K. s si srrr i:a'nnxx,ces. Toe , r Isu -IS tva r t 11 v n s. Hoidsr n"+sl n I ry Lrfilhatnr ~ r dn} st .6 %orpc"ale Heerhf _r ftn: in CJ J Saylxnuk C'onnaca+cut wi.,r at Wlwxl j t (.•t r ~.. y I I re aile.,h} 1 irK,?. rn(IYalo- will Supt'IS• rotAacamenl IJn a Iw Vn0.- dotarmined r Y Udra ak.' Su b0 coWrcro iYY II nS Un,itod t54;rrarlly Int Ud a s Il,fbn,l; prr;rt,rn;ry a wdes Uw w>t G1 +srnoo-al arkUrx insta(lali+xt of iha l;nili- ill r' I /il:_,f ttRHr;ANiY ~ NJ Rt:ML-;itL~ IN SUHPARAGRANi- la; AHE EXCLUSivi~, "ri'!?J7E .AI ~ N:) CGlhfn 'fJAr?RA1difE:. 1M1'iTH HE ~:PECf P~ -•rr rifv. fi, ~.N.;L~D1NG NO eN?UEC WAHftANTIEB OF MEnCHAh TAl31Ll'h~ (1Fi FIT IF S~ rGFa Nr>si1 U:OL9H PUfiFJt~F. rr 1 rr_ Lln tiler: W ra r ~ V, ill lx vGic it arty- Dori or tl ra chzn'•ner system s :r:,,udnrturnY I: ~r,Yrt:v~ nttMr ltWr. UNdIr:NO+. nr3 Llrr rl+xl WonantY Uaes .xn txtr nd ie Inc tlunta~ 'G'+erxlUP.ntal. spoctial cr mdirep damagas. IntiNrotrx ,hnli tic[ oa LabYd IOr pr!nal[iss dr IiquFdalad rf,3n:aga;, Srclutlirtg loss ci ~,,r,.+!r",!ion arc profits, rbor and m:ttE+rir:!e, cv,afieid costs, w other b55es or eKpensas inu.nei try If,p Hufclyr or nrry Ihird oar€y. SrxCiiir;aliy +?~ '.'Ie a lroin L r, Inc 1~;enantY G'+er:age :A'P, can~aga :o the Unts dtrB IC orUirrary w9ar rinU U3a!, al!orali~Y,, dp!;i:kua, mi~ya, aG1:~.;: Gr nuy12U o! 1hp „tits; llw Urnls txring sublaetad In veiues trAR'~c ur older ccnd@ior>s ~Mtich are nog fu±mfitte.~d dY 1'ra •I'tSWllation urstr~tlcns failure to mainialn the m r n+ y~ound ovary sM fo tr 11 She ins!alYatron Inaiructbns ltw ptacenurf n! improna~ ma~sriais into the sYStem cw,)a;nmg tha snits: iaau.-e of the U u,s of the sec ;c vsirnr x t_ r^ixr•per c,t",g or '~ntr'ropur sizntt7, axre.ss+ve waral us ya, rn.pr<V:gr 9"~ dlsporal. cr+rnpraprr t;p5ration; or any n!nar oven! tic. t a ~serd .iv I rtil al;;r. This Laniler;'Nananry rt!a11 Ge void i• ete Hddw 81. to a,rrpy with aU m the ter.7is z~ fcrth it irus Linvled Vranmlry F,. rll e n K- av H J i I M.lrlral ~r ~ rertxrnslt+tu lur eny kas er don loge to the Holder, rho U ,IS, a F.ry third party r~.ullnd ;rcirl ~ua rtl;nn ar,yy;p. rrodnt Yr ~nm any prodl.rn iApuly claims el r;aiaer w 2ny third party for Ihls Umilad N ananly W arapiy, IM Urvts nu1Sd be InsiaNed It anardimraa wfh bl site r:U:'1dile)cs rt ,lul:Bd by 51a:b a",d ip:al .;CtleS: all GI!N7r drpilG4i3' ie'.3WS'. and IlliihrnlOr$ Nt4i@IIildOri igt'U;:11oRS. (, f) N.y rapn;&anlat v-.: r rnrl;laiw has ho autiV~+lY lu cnanga ar exfe+,ci ihrs LlrnllrxJ 'Na 'ro iiy N~'Narrlt,lY al`di[*z IG anY F.a+1'y GtYrer 1'ua++ita wgi- nal hlu4Jer. T`n atxWe rCVry,Wnls tlu! S;antlard Lmilarf Wd:ranl!y operexi by IplillrffiGr. A Im I .;i nnmbar rt( slate; n t i rAUnlies I+a,re dtlferenl v manly rayuue- ment„ Any putdtasrx of Uri{s six>uid uon(act Inlrltlalor's Corpornln HGaarulrlers in OI1 ury+arouk• C'onnoclicn, prior to suUr purcYnse, rxr obtain a cr,,py o1 the appkrable ~wanalxY, amt shw+d eareluryy read that warranty pow io tf•,a purchase of Units. CU SYSTEMS I NC E'nvironmentat tlnsite Wastewater Solutions`" 6 Business Park Road • P.O. Box 768 Old Saybrook, CT 064'5 860-577-700U • FA:d 860-577-7001 8Q0-221-436 JS Patens 4'S/6 1;5.Ot/J~1 r,,;5E,488;5;33b017;5,401,1?Fi;5,4t;1,45t1,5,5f190J;5J1b163 c:.bElB,i?B,.,G39,844 ('anaUiar Patent i S?9,959 2.004.. Ili4 t7ther pale .is psrldn;J. inldU~d of Lgcalaer anc SoeW nl let u~ reptistered iredF'marks or Infliralor SyStey.IS Inc. rnritratdr is a re4}isterecl lrN. tt9T+,ark nT France, IntGtrater Systems inc. 'u a r. yiyte+ed GaUernaK.n M.;xieo. Ca,lour, Contour ;:,vivei Connexion, MicroLUUC'~~ir9, Poly O.dl, .:rtupLvck C,tauLerSpacec PosiLo,~i., GuiCkCrd. (ltackPlay RFfrctE[r pgPEA .., ~. f . ,. r.. ~ ~. r, r... r.. .. n.n. r. ~,r +~I"..nr-,. r„m.n,,,.~ rn.. ,F'.• "?r .r, ] 1•.rJr.~rnr G,cramc L-,r /rrnlurl in , C D .-,nr ~ n...., ,n .. StGfION VIEW FILE iNFOi~uu-,~„ ~, Owner Permit ~ i / 7 0 ~ ®E$IGN RARAMI:TERS Number of Bedrooms ~ f ~ ~{, Number of Public Facility t)rrits, A Estimated flow daverage} ~' ~ Design flow (peak), !Estimated x 1.5} ('Cam allda Sol( Application lute ai~dtst. /ft' Standard inflvent/Effialent C2uality Monthly avar~giw*' Fats. Oi! 6 Grease dFOGi S30 mg/I, 8}ochemioal Oxygen Demand IBODB) 5220 rnglL, a NA Total 8uapended &ollde ETS$) 51 BC mg/i. F~retreated Effluent Quality Monthly auerage BiOChsmical Oxygen Demand {$dDs) s34 mg/~, Total Suspended Sods {TSS) S30 m~/{. DNA . Fecal Coliform {geometric mean) S10' ofu/1 Q~mi Maximum Effluent Particle Size Kin dia. Q NA a+uu: ANA "Vetoes typkal for danlastic wastewater xr7d soptic tank affiuaarn. &168T8M SPEC1fICAT1ON8 PaWTS OWNE~'& 11I~~NUA-~. & MANAGEMENT Wi.A1V L v ~~~ of &ARtfo Tank Capacity ,2 ~ a5 DNA S±~ptc Tank Manufacturer ~~ DNA Efflpsnt Filter Manufacturer ~~ 6 ~' ~ DNA ~#tN~lnt Filter Model d(l a NA Pump Tank Capsoity ~' a! Q NA Putttp Tank Manufacturer ~ ~~r,. ~, ^ NA Purr~~ Manufacturer ~,~. ~ / DNA Pump Model ~ i3 NA Prvtrpatment Unit ~~ind/d3ravel Filter p fylaahanieal Aeration Q i~sinfeotion D Peat Fllter G Wetland D Other; 0 NA tliep~lrsal Ce(i(a) Q i~s•~raund dgravity) Q (At•Cireds q prip•Line O NA D !ra-Ground dpressurizedl ^ Mound ^ t7ther: ~' DNA -~ ~ NA Qithar; DNA luaaTCnlANClr ecl~ 8srvbe Eararat 8arvloe Frequenoy inspect eondit'wrl of tanlcds) At leist onc• .every; ~ _ ~ ~ s e dMaximum 3 years) ^ NA Pump out eontenu of tanWe) ~ Whoa ocambtraed a>:N.idge Brad scum equals arae~third iY,) of tank volume ©NA Inspect dispersal ceftdsi At (spit oraae ~rpry: mom(s) tM+ludmum 8 yeah) ,~ e~{il DNA Clean effluent fiber At ieas><t ~taaa query: l morit~-tai ~ nisi morlttlda) 0 NA inspect pump, pump controls 8r alarm At isast onq>t every: ,,._._ R ear{ei _ DNA !=lush latorats arsd pressure test At lea;t onoe every: ~-- nror~ ds) ^ ear(B) ^ NA ~~: At Iealat once every: ,_,_. manthds! O years) _ __ p NA (hher: a NA MAINTiENANCE li4STRUCTIONS lnspectiaata of tanks anal dlsperaa! Celts shall be rxarde by an individual carrying one of cite following liaenaes or oertificatlons: Masher Plumber; Master Plumber itestricted Sewer; POVV'T3 Inspector; PC)WTS Maintainer, Septage Servicing (Zperatar. Tank inapectiorss moat include a visual tnspectian or the taniN~ll tg identify any missing or broken hardware, identN'Y any oraoics or Isaics, ressure the volumaa of combined sludge and Baum and to ahsak far airy knack up ar ponding of effluent on the ground surface. She diapersa! tali{s} shall be visually inspected to check the sffivnt levrls in the observation pipes and to check far any ponding of effluent oat the ground surface. The ponding of effluent Qn the grour>!d surface tray indicate a falling co(wiition and requires the immediate notification of the local regulatory authority. WhQn chs combined accurr+ulatlon of sludge and scum in any tank rq+taie one-third {Y~) or more of the tank volume, the entire canients;ct the tank shah be removed by a Septags Servicing Operator end disposed of in acaordanoa with chacpter NR 113, Wiaoonein Adminlatrathre Code. Al! other services, inciudin~ but not limited to the rianrieting ~of effluent fUtere, mechan}tai or prsssurrxed components, pretreatment units, and any ssrvicklg st iratervats of s7 2 manthi, shall be p~rfam+ed by a certified POWTS Maintainer, A service report else!! be provided to the focal repuletary authority witha3 1Q days of cc-mptetion of any service event. Page ~f . v &TART UP AND OPERATION For new construction, prior to use of the PQWTS otteck treatment tank(s) far flee presence of painting products or other chemicals that may impede the treatment process and/or damage th4 dl9pel'aal aelitq). if high concentrations are detected have the contents of the tanktsi removed by a saptage sarvioing operatpr prlrar to use. System start up shall not occur wizen soil conditions arts frtrxeit at the inf'sltrativa surface. During power outages pump tanks may fill above norms! ftiphWatar I®vats. When power is restored the excess wastewater will bs discharged to the dispersal ceN(s) in one large dot!! ayarl~ading the aeit(si and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tir-~k removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumbs{ or PQi~VTS ~llelntsiner to assist in manually operating the pump controls tfi restore normal {evels within the pumR tank. '~ l3o not drive or park vehicles over tanKa and dispersal .coils. Qo net drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grads sot! absorption ar+sa. Reduction or elimination of the toHawing from the wastewater stream may improve the performance and prolong the life of the PQWTS. antibiotics; baby wipes; cigarette buttrl; goridorna eottan sv~aba; degraasara; dental floss; diapers; disinfectants; fat; foundation drain (sump pumpl water; fruit and vegetaple peelings; gasoline; grease; herbicides; meat scraps; medic$tions; oil; palming products; pesticides; sanitary napkins, tampons; and water soften4r brine, ABANDONMENT When the PQWTS fails and/or is permanently taken out 4t earvice the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapiar Comm 133.33. Wisconsin Administrative Code: Mound and at-grade sail absorption systems meY be reconstructed in place foflowtng removal of the b~omat at the infiltrative surface. Reconstructiana of such $ystema must comply with the ruins in affect at that time. e All piping to tanks and pits shall be disconrlacted and the abandoned pipe openings sealed. • The contents of a!4 tanks and pits shad be removesi and properly disposed of by a Septage Servicing Operator. • Alter pumping, aN tanks and pits shall be excavated and removed or their covers removed and the void specs filled with soli, gravel or another inert solid material, CDNTiNaF.lNCY PLAN If the PQWTS falls and cannot be repaired the foitowinp meeaures have been, or_must be taken, to provide a code compliant replacement system: ~( A suitable replacement aroa has been evtllu,pted bpd mey be utilized tar the location of a replacement soil absorption system. The replacement area should be protected from di>iturbance and compaction and should not tae infringed upon by required setbacks from existing and proposed structure, let litres >tnd wells. Failure to protect the replacement area will result in the Head #or a Haw soil and site ousluation to eatablith a suitable replacement area. ftaptacement syatemF must comply wlxh the rules in effect at that time. ' D A suitable replacement area is not avvllaGle d,ue to 8etbaok amdlor soil limitations. Barring advances in PQWTS techno.lopy a holdin® tank may be installed e!s a iaR+t resort to replace the failed PQWTS. site ~~ © T sit ., tank e d < <'WARNlNO> > SEPTIC, PUMP AND OTHER TREATMENT TANK$ Al~AY trQN'~A1N LBTHA~ GASSES ANDIOR INSIJFFIClENT OXYGEN. OO Nt)T ENTER A SEPTIC, PUMP OR OTHER TRFJ1TMi13N'T 7AI~NK UFID~R~ ~Y C11aCUMSTANCE8. DEAT'I'i MAY RESULT. RESCUE OF A PERSON FROM THt: INTERIOR OF A TANK MAY t3E pIFIFl~i~1.T OR I~IpOtiSIBLE. ADDITIONAL. COMMENTS POWT$ MISTALL,ER Lao S MAINTAINER Name :~~~r•u ~...~ oh~C>?3^ Phone ? ~ . ~ _ ,~ „Z Nrnne Phpne SEPTAGE SERVICINl3~ OPLeRATDA IPUMPERI L L Ef3ULATORY AUTHORITY Name Name CQAfx. Co~.l~ ~oN i-~ Phone T Phone S, ~o . ~~ This doeumtnt wit drafted in compliance with chapter G:amn~ r~3.2~12i(bl(li(di&tfl tnd 83.54111, 121 ir< l3i, Wisconsin Admtnlstraiive Code. ST CROIX COUNTY _ ° " SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer + (~ ~hrYl ~~C~1 i~d.. Mailing Address ~~ WZ Property Address v~ (Verification required from Planning Department for new construction) City/State 1~,(~.~ (~~~ parcel Identification Number D20- 1'fl3 -90- e~C 2(,0~) LEGAL DESCRIPTION Froperty Location ~ '!<, ~~ '/a, Sec. ~, T~N-R~W, Town of ~{~~; Subdivision e~.~ ~~ ,Lot # ~ Certified Survey Mag # Volume - ,Page # Warranty Deed # %~/ /7,~ ,Volume ,~?`7~G ,Page # ~O Spec house ^ yes ~ no Lot lines identifiable /yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper, What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than I!3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Cert~cation stating that your septic system has been maintained trust be completed and returned to the St. Croix County Zoning Office within 30 _day~s of th^e three ye~ar,e~xpiMration date. , SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. *«**** "`"` Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survoy map if reference is made in the warranty deed U 27?6P 209 Document No. II STATE BAR OF WISCONSIN FORM 2 - 1982 WARRANTY DEED SIENNA CORPORATION, a Minnesota corporation, conveys and warrants to GLEN J_ OHNSON CONSTRUCTION, INC, a Minnesota corporation, the fol of wing described real estate in St. Croix County, State of Wisconsin. 79 1 1 '7 Es HATHLEEH H. MALSH REGISTER OF DEEDS 5T. CROIR CO. , MI RECEIVED FOR RECORD 04/04/2005 10:30AM NARRAHTY DEED EXEMPT REC FEE: 11.00 TRANS FEE: 420.00 COPY FEE: CC FEE: PAGES: 1 \~ Retum to: Sienna Corporation Suite 608 4940 Viking Drive Minneapolis, MN 55435-5318 Tax Parcel No: 020-1413-90-000 Lot 13 lock ~, Plat of The Glen in the Town of Hudson, St. Croix oun isconsin This is not homestead property. Exceptions to Warranties: Easements, reservations, and restrictions of record. Dated this ~) day of ~ ~--~~ ~~ , 2005_ AUTHENTICATION Signature(s) (SEAL) SIENNA CORPORATION, mnesota corporation (SEAL) Marsha A. Pierce Assistant Secretary authenticated this day of 20_ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06 Wis. Stats.) This instrument was drafted by: Sienna Corporation ACKNOWLEDGMENT STATE OF MINNESOTA } }ss. Hennepin County } Personally came before me this 3 1 sT day of Y~ua~-~~ , 2005, the above named Marsha A. Pierce, the Assistant Secretary of Sienna Corporation, a Minnesota corporation, on behalf of the corporation, to me known to be the person who executed the foregoing instr~,~ment and acknowledge the same. Catherine M. Thornhill, Notary public 4940 Viking Drive, Suite 608 Notary Public of Hennepin County, Minnesota. Edina, MN 55435 My Commission expires January 31, 2010 Signatures may be authenticated or acknowledged. Both are not ~_.~,e~!~~~s~ ~tt,Tytpp~LL necessary. i!O?AIRYPl1BliC-MINNESOTA f>~b ComNsfbn Fier Jen.31, 2010 ` Names of persons signing in any capacity should be typed or printed below their signatures. • •- // ~' `-~ ,,.. ..' .r `. ~ it ,t{JJ•~ JIJ/ ~ ~ ~ \ \ ~ `.. ,~ `, •.. ~Y~~ -.. ~ ~•~JlIIIlI,'jJJJ: I 1 ~ ~~ ~ i i ~~ ~ ~ I I : Il i~1 I ;, ,. .... ,r. ~,,, ...., ~,~, ~ ~" .,,,. , r. ... ._. ,,. .... ~...~r„ -r.,,, 'r' . ~;:~.r///.jam ~.. ~ I/ /~.~G ~ ~, ~ ~ .... ~ .... I • ., 1 J .~.. '~ ..., ;. ~ ..r y ~,.. ~' "` ~- / . r J, i / ~ / ~ "- .~ ~.~, r. ^ {- Q .., °' ! 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