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HomeMy WebLinkAbout020-1414-20-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division ~ INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes fFrivacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township West Lake Builders Hudson, Town of CST BM Elev: Insp. BM Elev: BM Des ription: 1:76~TO+n~ ` ~ ~ ~~ n. ~ aF i e~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic :~ / Aeration Holding TANK SETBACK INFORMATION TANK TO P/L J WELL BLDG. Vent to Air Intake ROAD Septic I ~ ~ ~~/ i ~~ / Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift fiction Loss Syste ead H Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM ELEVATION DADA County: St. CroiX Sanitary Permit No: 463339 0 State Plan ID No: Parcel Tax No: 020-1414-20-000 Section/Town/Range/Map No: 20.29.19.2610 STATION BS HI FS ELEV. Be m,,jjrk 't~_ ,/~ ~art'ow.. d+' Sid/ ,f 'F.~ ~ ~ / Alt. BM~1~ Bldg. Sewer ~' Zg ~,~ $ L St/Ht Inlet ~ `7 ~~ St/Ht Outlet /~ `a ~L, r / T Dt Inlet ~ ~ Dt Bottom ~ ~ Header/Man. /O ,~ Q ~ , 1 Dist. Pipe ~~ ~ Q e~ ~~ 2 J Bot. System ~ ~ ~ Final Grade / Z . .3 St Cover r~ ~ $ „r ~ z BED/TRENCH DIMENSIONS Width / ~ Length, ~~~p No. Of Trenches ~ ` / PIT DIMENSIONS ~ No. Of Pits \ Inside Dia Liquid Depth SETBACK SYSTEM TO P/L BL G WELL LAKE/STREAM LEACHING Manufacturer .~.T- /ly f ATI N CHAMBER OR ~L.~^~ l INFORM O Type Of System: C o t ~ ~ ~ J ~ UNIT Model Number Q ~; ~Jc. ~ 1'IISTR16l1TInN SYSTEM ~..:.LA_ C ZZ + Z 3 = ~,c5 ar-dSZ Header/Manifold // Length_~ Dia Distribut'~Qn Pipe(s) \ ~ Length Dia ~ Spacing x Hole Size \~ x Hole Spacing ~ Vent to Air nta~ 3 ~~ SOIL COVER x Pressure Svstems Only xx Mound Or At-Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded/So ded xx Mulched Bed/Trench Center >? / _ `J , `p Bed/Trench Edges Topsoil ` Yes ' No ' Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Location: 743 Martin Avenue~}H~udson, WI 5401 (NE 1/4 SW 1/4 20 T29N R19W) The Glen of 16 1.) Alt BM Description = ~D ""~ b~ ~~~~ ~ ~,~:,n.S ~ S 2.) Bldg sewer length = i ,~. -amount of cover = ~~ ~ ~1 Y ~' ~S~- ~S ~ns~la,~ _ _ - __- Plan revision Required? ~'J Yes o ~ ~ Use other side for additional information." I _~ ~~~ ~~ ___ Date Insepctor' ignatur~ SBD-6710 (R.3/97) ~ ,~ Inspection #2: / / Parcel No: 20.29.19.2610 ~3 ~ ~ 1 ~~ lG~_ ~~_%T/,~ Cert. No. ~ ~ ! -~-- Safety and Buildings Division /~0~~~~ ~1 W. Washington Ave., P.O. Box 7162 Madison, WI 33707 - 7162 Department of Commerce (608) 266-313 t Sanitar Permit A * - -° ~ In accord with Comm 83.21, Wis. Adm. Code, ppllea 1.10 ~ ~; ~ ~ ( .. t ormatio you provide tnay be used for secotxlary purposes P ~15.OTt( ' I. Application Information - Please Prim A!1 Information Property Owner's Na me ~' _i ~ U~ ~ { " `~ ` ' n es7' ec,' e y PropertyROwner/'s Mailing Address ~~ f~d'~C 7G~, }' City, State Zi Code P Phone Number II. Type of Building (check all that apply) p~ ~" S wt.; ga.l or 2 Family Dwelling -Number of Bedrooms y ^ PublicJCommercial -Describe Use , -T" ~ ~ State Owned -Describe Lisa I .7 r" ~i ` X Sanitary Permit Number (to be filled in by ~~333 Plan I.D. Ntrmber Yroje(ct Address (if different than mailing address) w ~ ~`f3 rufl~t-J~r /~v~. Part 1 aY Lot N Block At l~ Property Location ,~~ 'k,sU~ u,S~tion .. 2 ~J (circle v T ~ N: R~-E or~ Subdivision Name CSM Number /AL ~~/~L-i/ ^City_r]Village~Township of ~ ,s~~ ~• type of Yermlt: (Check only one box an Itne A. Complete line B if applicable} i New System ^ Replacemer System ^ TreatmendHolding Taal; Replacement Only ^ Orher Modifecation to Existing System i B• Q Permit Renewal ^ Permit Revision !, Chan a of Q Lisc Previi~us Permit Number and Date Issued g Permir Transfer ro New ' Before Expiration Plumber Owner IV. '1' of POWTS System: (Check all that a I ) Non -Pressurized in-Ground J Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Sipgle Pass Sand Filter I ^ Constructed Wetl d ^ an Pressurized It,-Ground ^ Holding Tank ^ Peat Filter ^ Aetobic Treatment Unit ^ Recirculating Sand Fitter i ~i~ Recirculating Synthetic Media Fil ter Leachin C ber ^ Drip Linc ^ Graval-I s Pt ^ ther (rx ain} ~ ~'• I1is tsallTreatment Area Information: Qu , •o ~ Z Design Ftow tgpd) Design Soil Application Rat 0 i rsaJ Area pe Po y tem Elevation 1 spe Required (sf} Dis rsal Area Pro ~~ i b VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Gallons Gallant ~ of Units Plastic ~~~ ~ _ i ~ onerete Constructed Glass New Existing -~ Tanks Tantcs Septii or Holding Tank --- ~~,~ _ ~~ ~s~ Y Aerobic Treatttxnt tJttit Dosing Chamber ~6~ ~ , erg ~• Vll. Responsibttlty Statement- I, the undersigned, asstttne responsibility for tlon of the POWTS shown on the attached plans ' . i Plumber s Na me (Print) Plumber's Si gttature i PRS Number Business Phone Number s•s 3 ill Plumber s Addre ss (Street, City, State, 2tp Code) VIII. Count /De rtment Use Onl Approved ^ Ai app ved Sanitary Permit Fec (includes Groundwater Date Issued Surcharge Fee) I•suin gent Signature do Stamps} ^ Owne the for Denial r~ r~A..atft~..n .. A... IT '~- G ~~~ SYSTEM OAR ~~ ~~~ .... 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. Attach complete plans (to We County only) [or the system on paper oot less then 8112 x I1 inches in SBD-6398 {R. 01/03) .S~d~~ /~='S'4' ~~ ~ x~f~~. P~./ ~~ ~ 0 ~ g~~ ~? ,1~ :~ N '~ '~ M o~ ~j g~S ` ~./j `t- 1 ~~ L ~~ J 'l~i_ Ys ~ o T1~ T/ ~ .~~~: -; ~,o , G ~~ :~ _~ ~ N ' ~" '~ M o~ ~~S _ ~ `t- ~~ ~ * '~ J V J ' 2 Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety acrd Buildings in accordance with Comm 85, W is. Adm: Code attach canplete site plan. on paper not less than 8%: x 11 inches in s¢e. Plan must ~~ include, but not limited to: vertical and- horizontal reference point (BI4t), direction and percent slope, scale or dimemsiorrs, north amwv, and fosationand distance to nearest read. Parcel l.D. Please prmtall irefomi!atiaR Re Personal informatron you provide maybe used for serxmdary purposes (Privacy Law, s. 15.04 (1) (m)). ~"`",~~ Property Ovmer Property Location 1163 page 1 of 3 Steel Soil. Service St. Cron Date .._. ~/Z Sienna Corporation ~ m°°°`°'°°aka ~~~ E 1/4 SW 114 S 20 T 29 N R 19 W operty Owner's Mailing Address i ~ ±° Pr ~oE~ ° 'BtScIC # Subd. Name ~ CSM# 4940 Viking. Dr, Suke 608 16 na The Glen City State Zip Gode Phone Num ~; Vil ~ Town Nearest Road ~Y.~'°l~ ,.: MN 55435452-Ff~s-~- a8~ Hudson Carmichael Rd. V~NewConshuction Uce-' Resid~tial/Numberof rooms'_~~~ 4'`'~-~-1" designfkruvrate 600 GPD _ ' Replacement _;! Public or commercial -Describe: Parent material Pitted outwash Flood plain elevation, rf applicable na General comments p and recommendations:) System e~vation 103.65ft, trenches spaced and depth to code 3.75ft below grade c~ ^ Boring # Boring 105 /. Pit Ground Surface elev. 107.40 ft. in. pepth to limiting factor Sod application Rate Horizon Depth Dominant Color Redox Description Texture Stnrcture Consistence Boundary Roots GPD/ftz *Eff#1 *Eff#2 1 0-8 10yr3/4 none sil 2msbk mfr gw 2c .5 .8 2 8-24 1Oyr4/4 none sict 2msbk mfr cs 1f .4 .6 3 241 7.5yr4/4 none cos osg mvfr cs na .7 1.6 4 41-84 7.5yr4/6 none ms osg ml gw na .7, 1.2 5 84-105 7.5yr414 none cos osg mvFr na na .7 1.6 ,~~-t~ 8~ ~, _ o~ --lo loci. Boring # Ong Pit Ground Surface elem. 107.40 ft. Depth to limiting factor 105 in. Soo Applicatron Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKtz "Eff#1 *Eff#2 1 0-9 10yr3/3 none sil 2msbk mfr cs 2f .5 .8 2 9-19 10yr4/4 none sic) 2msbk mfr gw na .4 .6 3 19-31 t0yr4/4 none scl 2msbk mfr cs na .4 .6 4 31-105 7.5yr4/4 none cos osg mvFr na na ~ 1.6 ~S ~i,o~ , tnruenr ~~ = rjw 5> su < clu mgi~ and 155 >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name {Ple~e Print) Signature: CST Number David J. Steel ,I (~G~~ 248956 Address Steej Soil Service ~J/ Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 9/16/2002 715-246-5085 pr~{y pymar Sienna Corporation •, 1 Big # Boring /: Pit Horizon Depth Danirrant Gr>{or 1 0-1D ?Oyr4/4 2 10-105 r--- ~~~ 7.5y4t4 Parcel ID # Pending Ground Surface elev. 101.60 g. Deptn to limiting factor Redox Description Texture Structure Consistence none scl Zmsbk mfr none ~~ osg mi Page 2 of 3 105 in. ~ Application Rate wndary Roots C-,PDltt~ *Eff#1 *Eff#2 cs 2f .4 .6 nor nor ~ 1.6 /~~G~ (~ ~,.,._ ~ZZ ~ -~ ~ S ~~ 5 ys-~~ -°~'U' W l ADO /~ ~`~ ~~~ ^ Boring # !Baring Pit Ground Surface elev. ft. Deptn to Cmding factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stnrcture Gor>s~tence Boundary Roots GPD/ftz *Eff#1 *Eff#2 Rnrinndf Boring * Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODE <30 mglL and TSS <~0 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services ar ~, - `~ - ~° 'a `. . ~ ., ~ .~ ~ ~ ; ' ~ , +~ .. ~ s . ~ . te ... . , S ~ ~ \~ ~ ~ {70 \ 1 a 1. ~' v\ ~ ~ 1 ~ ..~ Page 3 of 3 STEEL'S SOIL. SERVICE David J. Steel 1564 Cty Rd GG CST-POWTSM Sienna Corporation New Richmond, WI 54017 Lic. # 248956 NEU4,SW1/4,S 20,T29,R19W (715) 246-6200 Town of Hudson, St. Croix Co. (715) 246-5085 The Glen lot # 16 This soil evaluation was. conducted. to safisfy a zoning. requirement, it may or may not be suitable for N 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. ~ . ~o~~- ~ ~~t~~ ,fit = /3a ~~~ngs ~/ . /D7~'S!~ fr d2= ia7~ ya~h ~3 ~ /o/. G ot-F ~,6-ate •- ~ .• .ti 21 1 r DJ t 1 ~ 1 1 \ ~ I l -' / f • .- , f ~- ~ ~, "•,.x208 ! YT ;~_ - ; .. • ~ . '~ .' •~ 1 . ` : ~ -J~tT-I- ~. s. J~ / ter-' i. .r _ • -~ ~ .. ~. ~. . ~8 1 1 - `• . _ ~ 1 J !. ... tom/' '. 1 . .. ~ w i . 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I I ~ 1. . ~. :J J(..V ~ ~" i 1 1ENi ~FPE 12°' MIN. A80VE GRADE $ 2:25' ~'Rt~M~ DOUR ~ WSIvAOW- pR' a~Ai'N.FR~R00~' FRESH ATR iN~,{!CE JL'NCilOh' S ;X AFpR{3l~D WITH Cy~tDL'IT `~.'JF~OiE GaV~R FiNIcH£~ GRADE W/ PADLOCK ~ ~''' CI RISER -~-~•~~ ~' ,.. WARNING :.,ABEL '.."""~' ~f'trL~~' ~ _ ~ ~ ~ ~:~ ., ~~ _, ti ~ ~~ ~ ~ p r ? t r ' i WAMwI~ rZ~~T ~GiAyy ~ ~ GA 3• 1 I + .`.~' A SEAL ~ + ' ' PROYE~ ~p~Rfl~1E~J `'"! ,~,~,,,,, ~ ~ Jt?INTS ~tStM 'IPE ~' ~ 8 r --4~A~.M ~ App~YE~ PCF~ ~~~~ ~ c ~f ~ so~.ia sOtt i RJMF CFl" ELEV . FT. ~ ~ `~ ~ _~ I ~* r -~-,-w ~1'.~.." -~"C~` r r ; RISER EX. T 4 f pERMYTTE~ ONLY ' ~ IF TANi~ MANUFACTURER 3" A~FRO~%ED 8£S7AING iJtiDER TANit ~S APPR4VAt ~;~PSIC r' DOSE i `ANK MANUFACT'~TRER: ~.;1vK Si2ES: SEi~"IC DOaE SPECIF.t.CAT a`CN5 -~'t.~..,,., GAL . dv Ga. L, , ', ',L.4nu MAl~~1FACTURER: ~"~" MOREL N'JMBER~ ,~ _u_`""' SWITCNf TYPL: r.... i?~tr~ ~' '~ MANUFACI~~,'RER MODEL NUMBER SWITCH TYPE; ~~U IREA DISCHARGE R.AT(` .. Gp;; ~ou~R4T~ ~A~ htiMBER uOSES ?E.R DAY: _._ 1,~~ ~OSC VCs.~1:~E SNCL~JD_NG FLp~vBACK: `~~ GA;~ . 9 " ,,,., ~ S tiCHE S ~. ,,,,~,,.„,~GAL . .: C; ~ INCilES s =.....GAS,. D ,~,~,,,, i ~tC H E S s„ j~.G A ?. . ~ RUMP f, ALAxM WIRihG ~,S : ER zLHe't 16.23' W~,~ yRTI~CAL YJiF'FEREAtC£ 8E~ n NIN::~UM lVETWORX SUPpLy' PRE CF F AND ..ISTP,. Bt1TI QN FiPE 1.,~ f'CET ~_..... FEET FORCF:MAIN X ~ ~'d gT/1~0 ~~'~, ~FR.C ~ C ~~4 ~ . ~~~ ~`LE7' 7 c~N FA Tt3. +~C":qL DYNAMIC MEAD = FE^~ ''~"'"ERNAi: D2M~:~'Slptia t~F p ~ ~ '* ~,~hED: Yi ... "/ • • , a ~"~ti.r.r .' ~GOULDS PUMPS • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. 3O~ 1 EP05 APPLICATitJNS Specifically designed for the following uses: • EfFluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: ;/." maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • bischarge size: 1'!z" NPT. • Mechanical seal: carbon- rotarykeramic-stationary, BUNA-N eiastomers. • Temperature: 104°F (40~ continuous 140°F {60gC) 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 Singgle phase: 0,5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power card: l0 foot standard length,l6/3 S1TOW with three prong grounding plug. Optional 20 foot length, t6I3 SSTW with three prong grounding plug (standard on EP05). ®2000 Goulds Pumps Effective February, 2000 83871 Available for automatic and manual operation. Auto- matic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller. Thermoplas- tic Semi-open design with pump out vanes for mechanical seal protection. Submersible Effluent Pump ~i ^ EP05 impeller: Thermoplas- tic endased design for improved performance. ^ Casing and Base: Rugged thermoplast'sc design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor lover: Thermoplastic 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 ~,' Canadian standards Assotiation {CSA listed model numbers end in "F" or "C"J fiordds Pumps is 150 90ot ttegistered. METERS FEET .. ... __ .,..,, _ _ _ . ... f ! 10 , ua x 0 0 GPM 6 B 10 12 m~/h CAPACITY Goulds Pumps ITT lnclustries ,,y,, . = uick 4~m STANDARD CHAMBER ~uick4 Standard Chamber MuitiPort End Cap FRONT VIEW ~L~ 11 - t4 ~ ~ ~' --~ y-~-, ~ ~, rti l ~ s I,, fl E~ , _~.~,. i____~_y_._r_ SIDE VIEW SIDE VIEW TOP VIEW hamber P~ominaf SpecihGat4o€~s ~' F ~t Mult~Fot .End Cap Qu~ck4 Standard ~C ~omirlal Specifications , ~ Size(WxLxH) 34 x52"x12" SizelWxLxH) 34"x16"x72" Effective Length ~ _ 48" Invert Height 8" or 1.25" Invert Height 8" INFILTRA R SY-STEMS INC. SIANOARD-_.~i 1ty~ED WARRI~V~Y (al Jhe suuaWral mtegrily or ear n t3ramhar, anA plate, +voUgo 3 ~d other acce5spry manufaetuBd by IrA'Jirarur ('Volts"1. w1u7n installed dnd a(xTralr~d in a Iprghfield vt n orrvila s..ptic sy5larri in aacrrdacca with Inlilb.nar s instrucbate, is warranted [r ttvz onglr~al purc:hasr:r ("Hinder'? against dafeotive n?Ier diS anG wur'xntanship is uno yrar Irum the dale tl>at L•te seuC~: peroi! is issued f•~~ 'he :u;plr;. system r vTlaudn3 ltw IJrt!s; provrtletl.. hovrrrver, mat 'J s `.xplrc: pe,mif rs rx>t raqu"ad by apprCekile law, the W8Yt3hly period wAl bagJ1 u{k1n Iho care Ihal rnst;diatinn or Shp saptk: s{stem commerrct5. 7o e.umrsa fls warranty digs. tdokia nwst noHty kd7Aralur rn wntn!; at its CvrpCrate Hea<i,rrarters ht Dk9 Sat'brordr. OcrtrarraiodA nn4tin M!een (15) ay- ct lire dlkg ~ nefa7 InuBralr~r will WCtply r.;p4uement U'nis for f)nrys detemuned by Inr14rai+N to h¢i tNPaYCK7 by thl5 Limned WarrtkNy tilt ~Lx`s Ylalb ny s{x"9tlcaAy axc~:des the Gust of remove arKVor rosin WUOn rd the l,tnit5. N) THE LMiTED NiARHAN'.Y MJO REMECIICS IN $LIRPARAGRAPH tai AHE E'XCLLISM~ 11iEA(= aRF Nrl OIHEP WAR~AME:3 WTiH RESPECT Tip -'HE I.INtr$, iN(;Ll1UiN , NO IMPLIED WAFWANTIES OF MEACN~WTA41LnV C?R FITNES~> FCili A PAgT'ICUl,4R PURPCI'iE. Ic4 Aa.S Limited VJarranly' strap oa vt>Id it Early part d Ina ihambar system Vs manufach"rxl Uy anyone Mher t; ran I. °dtmior. The Lirtntr~7 Warrargv daps nU! oxtGnd to irci<Senlal. censequanlral, spxla! a indrrEx;l Camages, I~n^k^l_lrala, shall not ba liable rnr p.:n:aNi[+s w lfqulCefdct narnayes mniuJutg tws of prcxtiCGm alld profits, IdtlOr and rrratpr'rals, overhead r:n5S5, Or Olhar N~ D a oxpen5as nCUrtarl by tP+e Hok:or Or ar.y IhiR1 p8ri)•, tif)ECkIIGANy r'xiludeCl tYOm Lkm'ted'v4arranly COrel'age ar9 damage to U,a Urals duE to Oldl!tar/ wp;lr and Iber, alleralAn, dCGider'll, m(strse, abuse Or flegwcl i( the Units: the Vrn!s being srb;ncied to va7Ws vaflir, cr other wrditiens adtich are cm pwmit!ed by the instatlalvx; ir~s'ructions, lailura to rtaintain tl>0 minimum grnrt?d oovers soV harpy in Iho instellaliar instructrorrs; the plan?manl of impoper matd'iah nV, the a}~slrxri cbntainkrg We UNLS; lailure of 'I-.e Ungs or the Septic 5y5tam due to imprrl>z- SNrng o< improper sizing, ea;.assiv& waver usage, irrprgyr gr^.asa disposal, or imprcy:er r>taeration; a any clher rnrenl not Caused by intUiratpr. !his L~mged Warranty ^atlall h0 YUid ^ tYk» F:~~iUU!'ails 10 a7mpy wile at'~ pt the terrtS Srsl tUrth In IYlis LI(nged Wananty. ~,uthw, ~n ro a>.e»i shall InGllrabr be resrrnnr;ibla for ant' bsa or odrage to the Ho47er. ;ne Urtils, Ur any tnrrd party My.rN ng trorn inslalknfirxl Or SI',ip- mwrt, ar trorn any prodruA fabimy clams of Holder nr any Irnrd pang, For mis [ imged Wananty w appN. the l buts msl Era irx5t:.lled m arawrMnce with an dte c:rviiliCas required by slate and iM2l codas. ad other IIVP~ic-tide law:;: and ln(ihrator ~ n?stailetlon atsrnlo6rios. 11? fL rc.;:~nr' - rtivn ci Lrl'll -.;tor has Ina aulMwgy to ^h:"ry!~ er ,r~;,a.d Iris Liu itM Wa+r,,:~~ty 'vo w.arrarNy aPDb0. lc ony OanY otr:c•~ than the orUi~ nal tickler. Tre ao:va represargs Uxt Standrrd Unyteni Warrant/ ;rllered by InIilUMOr, A ignituJ m;mher d states and counlras haw anerarn warranty requile- muats. Mty purchaser of Urdu stti~iid cdrltac! latiliratnr's G>rpxJrato HeacL;uanars n Old SaYUnAk, C:umaclicut, pros to SUCK pJrchase, to oohlin d copy of the applrcab:e wanargy, aril shvulri rdrafuify rsad lrral warranty prior to the pua.hasa of LMits. ~ ' ~ ~ SYS~'-EMS f N C Erwironmer-tar onsrte wastewater Sorutrons'" 6 Business Park Road • P.O. Sox 768 Old Saybrook, CT 06475 860-577-7000•FAX 860-577-7001 800-221-4436 U ~ Palms 4 755 66;; 5 OS 7,044; c 156,488; 5,336.017; 5 40 116 5.401,db0' S.511.90J; 5,716.163, 5,588.778; 5,8:19,844 /+~ Gana.liar~, Patent 1 3i9 459 2,0?4 564 Ott>el patents p(-rnorng. (`', jay mfiuralor Equalizer and SdeWinder are registered tiacemarks at rnhlFralor S•ys[ems Ins, {ntilb2ta is a registered tradonsvk in France. Infiltrator Syslerns Inc. .. -.. ~.. __ .,. _ .~...,....., r n:..,.r ... , r.:,,,, a,.r„r ,n C..~..I .-..k ^namh...Cnr.ar Pncrl ,rtr (1..~,-kr.,l (lr rir4PLv RECYCIEO PAPER _, tiE(:I IViV VIt~N POWTS OWNER'$ MANUAL. & MANAGEMENT PLAN Page of Ft1,E INFORMATION Owner -~- LAIL(= t~t_ID~R-S Permit ~ 6 3 3 3 pEStQN i'AIiJ1ME~'ERS Number of Bedrooms t{ C7 NA Number of Public Facility Unite ~NA Estimated flow Leverage} 'T~' al/da peaign flow (peak}; (l:atimated x t .b} ~~ ~ ~/da Soil Application Rate elide /ft~ Standard lntluet-t/Effluent 4uality Monthly average" Fats, Oil ~ Grease (FOCt1 S30 mgfL BiochemiaaL Oxygen pemand iBOt75) 5224 mgiL la NA Total Suspended Solids ITSSI Sl ~ mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (80Ds} s30 mg/L Total Suspended Solids LTSSI S30 mQ/L ^ NA Feaal Coliform tgeometric mean) 510 cfu1t00mi Maximum Effluent Partials Size Ya in ilia. ^ NA Other: ^ NA "Values typioai far domestic wastewater end septic tank effluent. .. ,~ .. SY$TEM $PECIFiCATION$ ~ - $gpt}c Tank Capaaity ,? d al ^ NA Septic Tank Manufacturer ^ NA Effluent Filter Manufacturer ~ ~' ,~ ^ NA Effluent Filter Model S~ ^ NA Pump Tank Capacity (J al ^ NA Pump Tsnk Manufacturer ~r6'S ~, d NA Pump Manufacturer ~,,~,~~ C3 NA Pump Model Pretreatment Unit ^ Sand/(3ravei Filter A Mechanical Aeration ^ DWnfection O Peat Fitter ^ Wetland ^ Other: ,P3~NA Dlsp~rsal Csffta} ~(tn•Ground Lgravity} O At•Grade ^ Orip-Line O NA Q fn-Ground {pressurized) ^ Mound l7 Other: Other: ^ NA Other: ^ NA qth~: DNA MAIINTBAIAMGE LiCHiEDtJiS liilerlllCe Event Service frsquartoy inspect condition of tsnkLa} At !seat once ovary: 3 a e (Maximum 3 years? ^ NA Pump out aontenU of tankts} When combtned skidge and scum equals one-third LY,) of tank volume ^ NA lnspeat diapered aeilLai At least once very: 3 ear ale! tam 3 ysaa? p NA Clean affluent falter At lease onoe every: ( month ei tai ^ NA Inspect pump, pump controls & alarm Ac !seat once every: .-- monthLai ^ ai ^ NA Plush Istarals and pressure test At iesst once every: ~- • ^ man {s} ^ al ^ NA ' At !seat once ovary: ^ mon~La} ^ NA ~~~ O NA MAMiTENANCE ~lBTRUCTIONS Ir-speatione of tanks end dispersal cells shell be made by an individual parrying one of the following licenses or osrtifications Maatar Pkrmber; Master Plumber flastricted Sewer; POWTS Inspector; POWTS Mainiainar; Septage Servicing Operator. Tani inspattiona r»uat inaiude s viauai inspection of the tsnkta} to identify any rr9iasing or broken hardware, identify any cracks or !asks measure the volume of conbined sludge and scum and to cheok for any back up of ponding of affluent on the ground surface Tha diaperaal ceU(s} shall be vhually inspected to check the affluent levels in the observation pipes and to check for any pondinl of effluent on the ground surface. The pond~g of affluent on the ground surface may indicate a failing condition and requires th+ immediate notification of the IoCal regulatory authority. When the combined accumulation of sludge and scum err any tank equals one-third tY,l or mare of the tank volume, the entir+ Contents of the tank shall ba removed by a Septage &arvicing Operator and disposed of in accardanoe with chapter NR 113 Vtlisoonain Adminiatrativa Code. All other serviaea, lnclud'+ng but not iimiled to the servicing of effluent filters, mechanical or pressurized gomponants, pratreatmerr units, and any servicing at intervals of S12 months, steal! be parfarmed by a certif'ad POWTS MaintaMer. A service report shall be provided to the local regulatory authority within 10 days of canpietbn of sny service avant. •apo~ anils,xs~u{utp~ ursuoas~/N 'tg) ~p (Z) 'tx}b9'£8 Pue t3}RtP)t4}iq)tt)ZL'ti8 wwo~,exdeya yl{M iallspdul~ W i~us1R i~M w•wn~ ~l `~ ~ 1 ' O~ 's 7 •uoyd jy / (~•~cvi,e j ~(/ ~7 ' 1 eu~w awe{ ww~~ ~uw~y 1LLItJt7tilnv Aay1v a Ewa w.fv , euo4d ~N a3NIVJ.NIVW 81MOd ~ •uQyd ~N __ !aadwnd! ao.~vasao oar~lna~s 3ovw~s x"~~' " ~ - ./ ~ auoyd ,.f8~a ~...~ Ya.'f/~.'~ eu~teN aS'1'Y1/1SN1 S1MOd S1N3WW00 iVN0111GGV '9"191SSOdW! !!O lln~iddl0 S9 1lVW )1Nt/1 d d0 a01a31N! 3H1 Woad NOt3a3d v ~o an~ssa 'llnssa ~vw N1V'Sa '830M-1Swn~a}o ANV a~taNn ~Nt-1 1N9wlvsal a~Hlo ao dwnd 'aud3B d a~.N~ lON Oa 'N3DAX0 lN3j;01ddt13Nl a0lQNb s3ssdo ibH1~i NM1N0~ AVW S?1NV11N3W1V~2l1 a3H10 aN ~ <O ~ M>s> StM(}d u! s®auenpe BU!118~ 'S1MOd Pol!s~ •yi •osjdoJ o; iJOSe~ isej a se p•(teisu{ •q ~eew ~jusi bwpjoy s At3o{ouyoai •suolisilW!( I!os Jo/pue ~{aRgias of enp o!gepane iou s{ Be1S iuauJaasjdaJ a{gs~ns t/ p •ewli isy; 1e iao}~a w sajnl ayi yilM A{dwoo isnw swais~ts iuauJeas{day •enJS iuvwaoe{dal v{geuns a 4s{{geisa of uo{isnisna oils pus {!os Mau s ao; paau 91{3 w i{nsa,- a{(M eBJe iuawaas(daJ eyl iaaio~d of aan{!s~ 's{{aM pus saury ibj 'eJnionJls posodmd pus Ou{is{xa uso,y s~asgi•s peJ{nbaJ Aq uodn pet3ulJ;u{ eq iou plnoys pus vonasdu:oa pus eouegJnis!p uaaJ; peioaioJd eq plnoys ¢ase iueweos{doJ ayl •waisAs uotidJflsge {toe lUAW8Q8{d81 E ;O uOllit30{ ayi ao; I~zH!in aq ~Sgw pus paienjene asap s8y eels 3uvWa0etdel a{gei{ns y :weisAs iueuJeos-daJ xue!!dwoa epoo a ®p!noJd o1 'ua~(si eq isnw Jo 'u•aq sney s•mseauJ dwMO{{o; ayi peJ~de3 eq iouusa pus s{!e; S1MOd ®~ -1 NVId AON~aNI1N00 '{$!1838"~U p{j03 iJaUi Jay30Ue JO jaA419 '{{os yi(M pa};{; seeds p(on ayi pus penouJal s,Janoo Jjeyi ~o panowa~ pue peisnsoxa eR !lays sild pue s~{uei pe 't3u{duJnd jai;d • ~JOieaodp Bu!a!n.~ag aBeideg s Aq ;o posods!p ~t{JadoJd pus penowaJ sq ({eye si(d pue sx(uei {{e ;o siveluoa eye, • •pojses sf3u{uedo ad{d pauopusge ayi pue peiaauuoasrp aq (ieys si{d pue s~us~ ox 8u{d{d Ild • :apo~ an{is.~is{u{ttJpy u{suoaslM `££'£8 uJwo~ ~aidsya yilM aauer~iwoa ut pauopuege tire;es pus MJedo~d s( wsisAS ayi ieyi eJnsw ai ue~jei vq ,jays sdais 6UIM0{{O; ayi oa!nJas ;o ino ua~jei ~tjiueueuJJad s! lotpue slls~ S.{.MOd 843 u~lM 1N3WNOONti~9d •au(Jq Jauaisos Je3eM pue :suodwQx :su!>ideu RJex!uss :sap{atxsad :si~npoJd t3uliu{ad :f(o :suo(iea!paw :sdsJas 3eBUJ ;sep!a(gJay :asesl8 :suposs8 :stiw(sad s{geisban pus x!ru; :JaxeM {dwnd duJns) u!sJp uo!iepuno; :ie; :sxuciaA;u!s!p :sJede!p :sso(; {e3uAp :sJ®ssal8ep :sgeMS uolxoa :suJOpuoo :sxinq auaJeB{a :tad{M Ageq :satlorq{;ue :S1MOd ayi }9 a;lt ayi 6u4tOJd pU6 zausuJJO}18d ayl anO1dW! ABIU Wee:as 1diBMSiSBM Byi WOJ; t3uIM0({O; ayx ;0 uOlieU1W!{e Jo UOl;anped •eeJS uojidJOSge {{os apeJ~-is Jo punouJ ~cus ;o edojs unnop iea; g t u!yi+N+ eels ayi 'xasdwoa Jo gJnisjp assM/8yia ~o "Jeno ~ja8d Jo en!Jp iou oQ •sj{aa {ssJeds{p pus s~{usi Jeno ea)a{yen {Jed Jo an!Jp iou oU •~{usx duJnd ayi u!yuM sjensj !ewJOU aJOisa~J ax sjoJiuoo dwnd ayi 8u{ieJado Aj{enusw u! is{see of Jau{eiutew S1MOd Jo Jaqu~n{d a iaeiuoo Jo duJnd iuen{;;e ayi of Jannad Bu(JUiS9J 03 JO(Jd JOl~JOdQ SusAiN•$ et3QidBg a Aq penowsJ ~uei dwnd ayx ;o swaiuoa ayi aney v0!xenx!s s!t!i pions o•j, •iuantya }o a6Jeyas~p eas;Jns Jo dn~aaq ayi u! xln$aJ ti•w pue ta){{sa eyx l3utpeojJeno '•aop al3Je{ ouo ut is}qao (esJgdstp oyi ai paeJ~ayos(p eq I{!M 18xBMaxBBM ssaaxe ayi peJOisaJ s! JaMOd ueyM •stans( Ja3eMy~!4 jgus,ou anoge (t{; Asw s~uei duJnd S•Ba3tlo JOMOd ButJna •eae;Jns en{isu{(;u! •yi xe uezoa; ae suo(i(puoa (!as uayM Jnaao iou ((eye do xJeis uwlsAg •esn of Jo{Jd JoisJedo @wo!nJas aDeidas s Aq p•nauJ•1 {s{~{uai ayi;o siuaiuoa $yi aney peiaa;ep rile suwienueouoo yBty ;{ ' js}Ilea jtzsJadt;p ayi a6swsp lotpue sseooJd iuawieBJi ey; epedw{ slew ieyi s!eo!uJaya 1$yxo Jo sionpoJd t3upu!ed;o aauasaJd syx Jo; {sy~jut'i lususisaJi ~la•ua S1MOd ayi;o esn of Joud 'uo(ionJisuoo Mau Job Nol.~e-a~ao aNV an lae.~s o tl~ +o eBQd '$W13 3eyl is laa}}a t/6 88{tu ayi 1{i1M A{dWOO ilnW sW83slt8 yonS;O SuOliatl,FiSUODa~ •aas;Jns anl3ei11+3u! aux la xsu-o(q $yi ,<o {enowrtJ ~u!nno{jo} aoeid u{ poioruisuooo~ eq Jtew swais~ts uo{~dJOSge {{os rapel6-is pus punoW awncr~IIuyer ~ Mailitt~ Addrr.~ss Property Addr s _. City/State Gam/' Parcel Identification Number ©2 ©- l`~/5~ - 2 0 -~~ ~- 2~~°~ LEGAL Dk~SCXtIEk'TTQN Property Location /vim '/,, ~~'/~, Scc. 20 , T?'~ N-R ~~ 1~V, Town of ~~~s v>-t Subdivision ~~`''.~„~, c~ rn ~ r' ~?'l~ ~ _ _ _, Lot # C~_._. Certified Suwey Niiap # ~_,., Volume ~- , paB~ # Warranty Ueed # ...__^ ~Ss~~ , Volume Z}S~ ,Page # ^,~~ „~~ Spec house yes U no ~ ~ Lot lines-identifiable yes ^ no SYST)~,M IVIAiN~.,ENAl~'CE IntproQer use and maintenance of your septic system cooed result in its premature failure to handle wastes. Propel m.atntenatsce consists of puruping out the septic tank every three years or sooner, if needed by a licensed puprtper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The properky o:vn,ec ae=ees to submit to St. Croix Zoning Department a certification form, signed by the owner at~d by a rttasterphunber, jouruey7nan plumber, restrietedpluutber or alicensed pumper verifyins that (1) the on-site wastewaterdisposal system is iat proper operating condition and;'or (z) after inspectioa and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Ua=e, the undersigned have read the above requirements and agree to mauntaiaa the privata sewage disposal system v+ith the st~nd~rcis set fortix, herein, as set by the Department of Commerce and the Department of Nahtral Resources, State of Wisconsin. Cer~fication stating that your septic system has been maintained must be completed and returned to the St. Croix Counry Zoning Office within 30 days of the three year expiration date. siG~~ ~°~p~°`~ ~~ ~ laA~rt; (]~YNF.R CFRTIFIC'ATION I (we) certify that all statements on this form ate true to the best of my (our) knowledge. the ropcrt desetib'd abp , by ~•trt a of a ~~~arranty deed rccorned it Register of Deecis C~Cfice. SIGNAT[ f~ °I• APPLICANT I (~=e) atu (are) the o~•~E~~(s) of 2«in as- t)ATl • *' •'~* Any information that is mis-represented may result in the sanitary perntit bcinr revoked by the 7.orting Departnte.nt. •""* ST (:i201X COUh'Tl' SEPTIC TANK MAINTENANCE AGR~EMEN~' AND QVI~1EliS~-lIQ CER'TIFiCA1'I01'~ FORM {Verification requited from plann~Departme.nt for new •" Include ~~~ilh this application: a stamped warranty deed fruit; the Fegister o.f I)eeda office a copy of the certified survey map if reference is made in flee warranty deed ,~, .~ U 275? P 317 Document No. (I STATE BAR OF WISCONSIN FORM 2 - 1982 WARRANTY DEED SIENNA CORPORATION, a Minnesota corporation, conveys and warrants to WEST LAKE BUILDERS, INC., a Wisconsin corporation, the following described real estate in St. Croix County, State of Wisconsin. ACKNOWLEDGMENT WARRANTY DEED EREI~'T # REC FEE: 11.0@ TRANS FEE: 306. @0 COPY FEE: CC FEE: PAGES: 1 1~ Return to: Sienna orporation Suite 60 4940 Vikin rive Minneapolis, MN 55435-5318 NE4V Br'~tG'c~r,~ 112 FILE NO. ~..,.~.1~.`'1 Tax Parcel No: 020-1414-20-000 Lot 16, Block 1, Plat of The Glen, in the Town of Hudson, St. Croix County, Wisconsin This is not homestead property. Exceptions to Warranties: Easements, reservations, and restrictions of record. Dated this 25 day of FEBRIaARY , 20~?. AUTHENTICATION Signature(s) (SEAL) SIENNA CORPORATION, a Minnesota corporation By ~~~~~ D ~~~ (SEAL) Marsha A. Pierce Assistant Secretary authenticated this day of 20_ I I I LC. IVICIVI6C1'[ J I H I C 6/iR VC VVIJIrVIVJIIV (If not, authorized by § 706.06 Wis. Stats.) STATE OF MINNESOTA Hennepin County 788567 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO. , WI RECEIVED FOR RECORD 03/02/2005 09:30AM } }ss. } Personally came before me this 25th day of rEBRUARY , 20 05, 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 inst ment and acknowledge the s me ~~~~ vn I I i f I I I I I i I I y~. i f ~t n~ ~' ~ .) k i E L__- 5 j _ ~ I I I I I I I ~ ~ ~__ r___. i i I I I I E I ~~ I L ;-' - ~ ~ ~ --~' . ...1 ~~'•ti~ ; 1 ~ •~ ~ 1 ~~. pS4i S.F, (1.860 111A) b w N ' ses~'1a'~ ~11lA' ~5 ~ slfM• s.F. ' (t.3M AC.} N BLOCK 1 i 16 (1.141 nc.) I ,. - ,~ ~~~ ~~ ~~ ~~~ ~. 1w ow¢wr+c nooa ~v~r etl.ow es~.o 19 ~60~3 S.F. ~~ ~~` ~^ ~ ~~ ..~'~ ~ ~ \ ' J \ \ ~ ~ ~ ~~ ~ ~ ~ ~J ~ i~ ~~ \°~ ~• ~ \ ~ 18 ~ ~ / --°-. ~ 51564 S.F. ~ ~ ~ / ~ `~j \