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HomeMy WebLinkAbout020-1414-50-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division -.. INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. permit Holder's Name: City Village X Township West Lake Builders Hudson Townshi SST BM Elev: Insp. BM Elev: BM Descri on: ~ / ' b ~ l) - ~ ~n 15 ~~ ~l~v ~ wa~-f TANK INFORMATION X aT3? _ p,L,,t~„J ELEVATION DATA TYPE MANUFACTURERSfK CAPACITY Septic ~~~~~ ^n A' J~~~ ~ /~~ Dosing //~~ I/~ /~ - a IV Aeration T ~ ~ p / m / L 7 Holding r Y~GJ - ~ riW.r --. TANK TBACK INFORMATION TANK TO ~P/L, j~ ~~ W~EI L BLDG. Vent to Air Intake ~- ROAD _ Se~ ~j ~ ~ Dosing Aeration Holding PUMP/SIPHON INFORMATION ~/~ 1~Q~~ ,Q~n-nf Manufacturer De and GPM Model Number TDH Lift Friction Los ead TDH Ft Forcemain Dia. Dist. to well SOIL ABSORPTION SYSTEM ~~r~nti~';,~/jA/ < BED/TRENCH Width ~ J. Length / No. OfTren es DIMENSIONS ~ 7 / _ ~l / INFORMATION TO county: St. Croix Sanitary Permit No: 429989 0 State Plan ID No: ~~ Parcel Tax No: ~7~,~ V ~"- ~ ~ .~ Se tionlTown/ ge/Map No: 20.29.19. `a7 STATION BS HI FS ELEV. Benchmark j (D (a~ y j 0 O- d Alt. BM ''rvcJ~/l~~ r s•- ~ Bldg. Sewer 2 ~ .I> fig`/ r'•~ ~- ( ~ St/Ht I let x.~_ 3.- ~G q~.a S t Outlet p ' a @ S= 0 Dt Inlet ~' Dt Bottom ~ Header/Man. G(,p S - • Z ` ~,. Dist. Pipe ~ DO 0 L q ~ .- / Bot. System '~i Final Grade / S ~ ~~ / St Cover 2 r,'~e . !0 98.9 PIT DIMENSIONS INo. Of Pits ~ air - h ~~' DISTRIBUTION SYSTEM ~ltr~ill/i.~~i>'.~ LEACHING Inside Dia. ManutaLtu~ri ~ +~~ Model ~fNumberb/er: ~ ~. an,ri .L ~, a.. Header/Manifold 9 ~/ it Len th Dia Distributi~~o~~n ~~ / Pipe9s)_~!r'! !~ p g t] ~ Len th Dia S acin x Hole Size ~_.' x Hole Spacing ~--- V t Air In ~/ SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade S{rstems Onlv Depth Over ~ ~ J Depth Over xx Depth of xx eeded/Sodded xx Mulch d Bed/Trench Center Imo" Bed/Trench Edges Topsoil ~ ;J Yes I I, No .Yes ' ~ No COMMENTS: (Include coc~ discrepencies, persons present, etc.) Inspection #1:~/n~/~/ ~ y Inspection #2:_ Location: 723 Martin Ave Hudson, WI 54016 (NW 1/4 SE 1/4 20 T29 19W) Th Glen Lot 19 '( Q Parcel No: I 1 J Alt BM Description = ST • f ~~ ,C/~~,~, ,,~ ~ ~1 ~7 /~/~ 2.) Bldg sewer length = 2 3'r /.- ~ QN'D ~ ~~~~~~~~ ~J~I"lnfrEfG(.,(~/Z - amount of cover = ~'g yi~. ~{~n,,,>•tdR,,h~_ Plan revision Required? ', Yes o , Use other side for additional information. ' "' 1 ~~ _ __ ~ - - - - SBD-6710 (R.3/97) Date Insepctor's Si ature / .1~ ~~ Cert. No. r~/ ~~ I ~ _ ~ ~Sairty and 13ui:diags Uiviswn County r~ ~ 20i w'. Washington Ave , P.O. Bax ;162 ~ ~ r ~ ~~0~~' ~~ Madison, WI 53707 - 71b2 5arutary Permit Number (to be filled in by Co.) De artment of Commerce ~ {608) 266-3151 ~,Z°~ q8' Sanitar ~'errn~lt A lieation state Plan I.D. Number Y PP ~ In accord with Comm 83.21, Wis, Adtn. Code, personal infortrtation you provide may be used for secondary purposes Privacy Law, x13.04(1){m) Project Address (if different than mailittE address) I. Application Infaurtinatfon -Please Print All I+ RECEIVED ~ x-23 MAC-T7N ~Q , Property Owner's Na the Parcel M Lot,Y Htock N ~s ~~ e .~~-,` /d e 8 2003 l~ Property Owtiar's M aUing Address Property Locatlon ~ ~~ ST. CROIX CFFICEY ~~, ~' ~ld,Secdon 24 City, fate ~ ~ one Number ' f ~~Go,~J Gr/. ~ .~~~i/DI6 ~ ~~~ (circle o > II. Type of Huilding {check all that, apply) T ,;~¢ Nt R~E o~ Q~l or 2 Patnily Dwelling -Number of Bedrooms 3 Subdivision Name CSM Number .. ^ Public/Cotnmercial -Describe Use `'~ ~ ~~~~ L~'ownshi of ~„_sc! ~ ^ State paned -Describe Use 2 r K . 1 ~ ~~ 5 .. f ^City_^'Village p ~"~~ i Ili. Type or 1Perrnlt: {Grieck only one box oa ltne A. Cotppiete line 8 if applicable) A' Now System ' ' ^ Replacement System ^ TreatmentlHolding Tonk Replacement Oniy ^ Asher Modification to Existitl~ System $. l7 Permit Renew ~ 1?ertnit Raviaion ~ Change of ^ Permit Transfer to New Lisc Previous Permit Nuns er and Date Issued Before Expiratlon Plumixr + Owner ~~ ~(~ p~ /KdtN 16, ~ ~ I Non -Pressurized tn-Ground ^ Mound > 24 is of suitable soil ^ Mound < 24 in. of snitabla soil ^ At•Gradu ^ Single Peas Sand Filter { ^ Constructed Wetland ^ Pressurized 1n-Ground Q Flolding 7anlt ^ Feat Filter ^ Aorobic Treatment Unit ^ Recirculating Satx1 Filter 4 ^ Recircuwa ' rtthetic Media Filter ^ Leachin Cho ^ Dri Line ^ Gravel-less Pie ^ Other tax lain) Y. Dix zeatxuent Area Information: ~ G ~t ,es^s d'7` Design Plow (gpd) Design Soil Application ltate()(pdsf7 Dis sal Area Required {st) Dispersal Area Pro ystem Elevation VI. Tank Info Capacity in Total Number Manufacturer Pre ab Site Steel F(ber J PIBStiC i Gallons Gallons of Utvts Concreu Conatrucud Glass New Existktg I Tanks Tatti.G Septic or Holdin8 atilt (,3p D' 'C GY Aerobic Troatrrrera Unlt Doaitr8 Chamber , G Sa l~..tse,~ YII."Res iWiit Statement- I, th! ttnderai ed, t~:vtune respon+lbility for atlatton of the POW'CS shown on the attached pleas, Plumber's Nit me (Print) Plumber's Si gnatu a 1MPRS Number Business Phnne Number l Plumber's Addro as (Street, Ctty, State, Zip Code) ~~ ~~ jd?d s'~ ~ ~'"~~ ~~so ,c/ G•~ t ~S~D' % ~•rc~/s'-off Q~ Approved ^ Disapproved ~ Sanitary Permit Foe includes G,~undwater (Data Issued { Iss ' g Agent Sign tre No Stamps) SurcharSe Fee) i 4 + ^ Owner Given Reason for Denial ~'~~ I 2 ®~ ~ !_ IX. Condidons of Appraval/Reaaons for Disapproval t EM OW ERS ~ ~ CA.~ i2~.t~ S ~~ SYS 1 Septic tank, effluent filter and dispersal cell must all q~,serviced ! millr~l~ as per management plan provided by plumber. ., ~,- ~o~t,o~4 rP~tuirementS must be maintained as per applicable codelo~f«e plans (to the County only) for the systom on paper not lots thou 81/2 x 11 inches in alie 58D-~3~8 (R. Oi~o3} :~~~ ~a~-2 .~~, ~~~/ale ~S y~ ~y s~~ ~.7G P'.?~fiP/9' .Z o T/9 fie,~~~,ev ~cidsar~ s~-e, U~ `S~ ~o.~ ,t3f~~~~m~ s,%/ ~oa~ ~' 'U ~L~ l~ ,~~/ ~OimY' s!%~ /QOM v 'U f SOIL EVALUATION REPORT Page o of . y w'~ nsui ~,~~,, ~ ~~„~ Division of Safety and Bufld"mgs in accordance with Comm 85, Wis. Adm. Code Coup ~~ A,~~ ~mpiele site ptan ~ paper not leas than 8112 x 11 inches M direction andt t 6mi6ed to: vertical and horizontal rafierence Po&! ( )• t b d d tercel lD. no u u e, in and location and distance to nearest road. rth arrow i . ons, no percent sbpe. scale or dimens Please prlni: al! fnformatlon. b~ ~ Pasoasr inrormalion you provrde maybe wed rot eeoaMary purposes IP l 5.04 E1) (m))• ' ProperiyOwner Uv ~ ~~~ ~ petty Loption ovL Lot ,i(f 114 ~ ~ 114 S ZO T z N R E (o W e Properly Owners g Address Lot # Block # Subd. Name or CSM# Cky State Zip Coda Phone Number ^ City ^ Yrllage ;Town Nearest Road Sam w( SKI/ ( 3 f"-~~~ ~u o to GQ ® New Construd'non Use: ~ Residential / Number of bedrooms Code derived design flow rate GPD (~ Replacement ^ PubYc or c~mmetdai -Describe: p Fbo(~' Piicab ~ ~ ~ s j ~ ~ Parent material ,r^SLSIS~-~_ General comments and recommendations: ~ (' CjO• °~ LOS' ~r S 9• ~ qU G 2 8 2003 ST. CROIX COUNTY Boring # U Boring Pit Ground surface elev. _~~ fl. Depth to limiting factor _ ~ 7 O in. c~ lion Rate ots R GP DIfE= Horizon Z Depth in. Za_ Dominant Color Mansell o /y Redox pescxiption t]u. Sz. Cont. Cobr - Texture SJ~/ SWcture Gr. Sz. Sh. Z~ns / Consistence ~-~~ Boundary e o _ 'Eff#1 ~ 'Eff#2 .6 Z-1 ~a ~ ~ os 1 - -- a-- f ~- py,a ~ (-1 _ n Boring ov~my rr ~ i (X/ ft. Depth to limiting faCmf - ~' / in. Pit Ground surface elev. __._ Horizon Depth Domb>ant Cobr Redox Description Texture Structure Consistence Boundary Roots in. MunseN Qu. Sz Cont. Color Gr. Sz. Sh. o _ ~ S . ~. ,~ ~ l v-~ Shc ~n Rate GPD/ttZ 'Eff#1 'Etf#2 ~ z 0- t / - S1c~ Zm / 1M~r L .. , ~ _~ , ~ S a5 r~ 1 ~ ~- l~ Z o ~lG ' EflluerN ftl = BOD > 30 < 220 rngll erld TSt3 >30 ~ 7.1U Ingl4 cuw~rn w~c - wv .: •••, •••y-.•••••• • _- . -- •--~•- ~ e - CST Number CST (P Pri>y , .. z ~,/ ,~`` Address Date Evaluation Conducted Teleptxx~e N er a, ~v Property Owner ~ ~ -~7~ ~- ~ e Part:el ID # t3oring Page z of Boring # I ~ I [' Horizon Depth in. ~-~=- ft. Depth 1p 4miting f ~ Pit Gad surface eiev- Dominant Cobr Redox Descriptbn Texture Structrtre Du. Sz. Cant Cobr Gr. Sz. Sh. MunseB aC1Dr --~ in. Consistenoe Boundary Roots SoB lion Rate GPD((F `t~1 ~f~2 ri ~ ~ a- 6 g~ ~~'~( ~ ~' Zm.s~~ r L t ~ tG~ Z B d. (e - ~ a S ~ ~ ~ u Boring Boring # ft, Depth to 1')miting factor in. ^ Pit Ground surface elev. Soii lion Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GPDffF in. MunseN ~u. Sz, Cont Cobr Gr. Sz. Sh. 'Eti#1 'Etf#2 [] Boring Boring # Ground surface elev. R Depth to limiting factor in. ^ Pit Soi lion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft? in. MunseO Qu. Sz. Cont Color Gr. Sz. Sh. `Eff#1 `Eff#2 ` EtBuent #1 = BODS > 30 < 220 mglL and TSS >30 <_ 150 mglL ` Effluent ff2 = BODS < 30 mglL and 7SS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. lfyou need assistance to access services or raced material in an alternate format, please contact the department at 608-266-3I5] or 7TY 608-264-8777. SBD•63701R.OT/00) w ' ~ ~ . e ~! ~a ~ 3 ~-~ 3 ~+; , gir. ( -40o e-~ door s ~/( ioe ~ 5~~-ern .~lw -k~ ~d,od G6W~,- ~O'„Q ,~(_ ~ S-f--~ ZS~~o9 3, 0 a vo ~(~ ~~ ~ ~ -/~ ~ ~ 3 nt;~ ~~~ Safety and Buildings Di isinn County ~ S~G 201 W. Washington Ave., P.O. Box 7162 ' n I~p ~ ~ = ~ Madison, WI 53707 - 7162 ,~~~ns~ Sanitary Permit Number (to be filled in by Co.) i Re artment of Commerce (~8) 266-3151 ~a,q 9(Q~ Sanitary Peru Applleat~on State Plan I.D. Number personal information you provide Wis. Adm. Code in accord with Cornet 83.21 , , may be used foc secondary purposes Privacy Law, s15.04(1)(m} Project Address (if different than mailing address} I. Application Information -Please Print All i~ at1~ECEl ~ 2 Mfl~Trnl ~~~u[[ Property Owner's Na me 1 5 2003 Parcel >i!1 Lot M Biock !f ~"1esT' Z~.~~ ~ °~ ,e ,~ s NiAY /~ Property Owner's M ailing Address ST. CROIX COUNTY' Property Location ~ ~d3 ZONING OFFICE „~ 1 ~~~ =~~~don 2~ ~ City, State Zip Code Fhone Number •- ~- 6L ~ ~y~/~ ~gG' -Y~'~f~' 2~ tcircte ) 1~E ot~ T N; R Type of BulldinE {check al! that ly) f -~ ~ II , . 3 ~~ troS~cQ91~(.C ~1 or 2 Family Dwelling - Ntunber of Bedroo Subdivision Name C5M Number ^ Public/Commercial -Describe Use e,,. ~ ~ ~ • ~ ~ ~`~~ .. ^ State Owned -Describe Use ~ CL!J' 0.' rr~~ ^City_^Village ,t~tt'ownship of .5' Z. Bests • III. Type of Permit: (Check only one box on ' A. Complete line B if applicable) a A' ',New System ~ ' ^ Replaccmcnt System Treatntent/Holding Tank Replacem my ^ er odification to Exist' S m H. ^ Permit Renewal ^ Petvttit Revision ^ ange of ^ Permit T nsftr to New Lts a us t rand Date Issued Before P.xplratfon Plum r Owner T feet: (Check all that a l) 2 X - S ~- Non -Pressurized In-Grow ^ Mound > 24 in. of suitable so ^ Md < 24 in. of suitable soil ^ At-Grado ^ SinPlo Pass Sand Filter Constructed Wetland ^ Pressurized - oldin$ T Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filtea Leaching Chamber ^ D ' ine ^ Gravel-less Pipe ^ Other (explain) V, reatment Area Infor ~.~ •~ Design Flow (gpd} Design Soil Application Rate(gpdsf) Disper Ar Required (sf) Dispersal Area Proposed (sf) Syste r n ~_ ~'0 . ? 4~3 ~"~'3 ~'y. a 2 Vi. Tank Info Capacity in Total Number ufacturer Prefab ~ ite Steel r Plastic Gallons Gallons of U ' Concrete Cons Glass raw latistlag 1 Tacks Talcs Septic or NoldinE Tank ODd ~'e.S~ Y' Aerobic Treatment Unit Dosing Chamber ~~" ) ( L//- VII:' Responsibility Statement- I, this tmd ed, easunae responsibility Por tion of the POWTS shown on the attached lens. Plumber's Na me (Print) Plum is Si gna c MP PRS Number Business Phone Number C111~~~ sc:FtG~~r.s!!rG'// ~ ~ 2a~~~~ 7 s-,~~G-3l~l Plumber's Addre ss (Street, City, State, Z' Code) ~- ~ e~~ ~ ' ~o , VIII. Count /1>e artment Use Onl Approved ; . ^ Disapproved Sanitary Permit Fee (includes Groundwater Surcharge Fee) ~ - O- Date Issued ~ r • Issuing Agent Signature o Stamps) ^ Owner Given Reason for Denial ~ 5 ~„ „ [ l _ ~ r t IX. Conditions of ApprovaUReasonslor I>isa prove] I__ ~ ~r ~ ~` ~ ~~r ..S D h.c~.tT ~, I~- S ~ .~~ ~ a~ , MS~ S i~ - ~ cSt,UWA.~ ~ t;+~t t "'t ",~ ~ ©• ~ ( /~~ Z S~ ~~2 S ~c ( f 7 / ~ ---®-~ ` - ~n1~ 0~-. ~~~~ b -~ . Attach tompkte plans (to the County only) for the system on paper not less than 81R x li tncnes rn uze SBD-639$ (R. 01{03) /~r~~~Pac loa, ~~~, ~ ~pU~ ~~' ~d ~ ~_ l~iO~Q 9 ~P4 /, f~i~ ~~ac l oa, ° ~~~, ~ ~p~~ ~~' ~d ®- ~ ,Z 1158 Wisconsin DepartmentafiCammerc~ SQtL EVALiJATIQN REPQRT p~ 1 ~ 3 Division of Safety and Buildings ~ aceordancewith Comm 85 Wis Adrr+ Code Steel Soil Service Attach complete sde plan on paper not less than 8%: x 11 inches in size. Plan must County St. Croor include, but rrof limitertto: vertical and trorizantaF reference point f~T. directiorrarxi petrenLslope, scale. or dimemsions, north arrow,. and location and dbstance tQ nearest Parcel I.D. e Please pegrtt alF lnfof~rtrttioR. ~, ~.'"~ ~=-~,1~ p ,~ g ~ ~° B Date ~ersonalinfomrafion you provide may 6e usedfwsecnrrctarY pu lFmr~(r s ~t5 0~(tJ.(m)7. ~ jy~ ~ ~ Z't~ ~ 3 Property Ouvner P~°.. ion Sienna Corporation.. ~`~~ clrivt_Zot N1N 1/4 SE 114 S 20 T ~ N R 19 W P owner's ' " Address ` ` ~ ; ' ~~#ock # Subd: Name. ~ CSM# roperty tlAa~ng t. 4940 Viking Dr, Sine 608 5 19)r "`~~''~ The Glen ~~~ City State Z~r Code. Phone Num ~'; City.. Village Town Nearest Road ~c,~r%Itf. ~ .55435 9gz-~S- z~o~ Hudson Cachael-Rd. New Catstntctiat tJse: i/ Residential / Numherof bectroorns 4 Code derived design flaw rate 600 GPD Replacement Public or aornmerciaL - Describe: Parent material Pitted outwash Flood plain elevatiat, fi applic~le na General comments and recanmendations: .system Elevation ; trene s spaced and depth to code 4:58ft below grade ~ i1~- ~ L2QSr ~ ~-a i ~ 3'g C'~ilvr, r Siorle / Vz%rs i`n s 7 1 goring # _ Ba~;r,g l J C~, n ~s ~ 2 / Pit Ground - Surface elev. 98.80 ft. in. pepth to limiting factor Sod Application Rate Horizon ..Depth Dominant Color Redox Description ..Texture Structure ..Consistence.. Boundary Roots, GPD/ftz *Eff#1 *Eff#2 1 0-S 10yr37Z none s7 Zms6k mfr cs 'k~ _5, .8. 2 9-22 1Oyr4/4 none sieE Zmsbk mfr gw na .4 .6 3 22-43 40yr4l4 none sct Zmsbk ' mfr cs na .4 .6 4 43-96 7.5yr4/6 none ms osg ml na na ~ 1.2 ~6~~~ti Q Bonrtg # - Bonng Pit Ground Surface elev. 98.80 fl. .Depth to limiting factor ~ in• Sod Application Rate Horizon .Depth Dominant Color Redox. Description Texture Stnseture Cor>sisfence Boundary Roots. GPDfftz *Eff#1 *Eff#2 1 0-28 10yr3/Z none StT Zmsbk mfr cs 1c .5 .8 2 28-36 10yr4/4 none sicl Zmsbk mfr gw 1f .4 .6 3 36-52 10yt4E4 none sl Zmsbk ~. cs na .5 .9 4 52-96 ' 7.5yr4/6 none ms osg ml na its ~ 1:2 - tnruerrr~r = rsvu53 sv<rcvmgrr_ arra rs~ >su <Tavmgrt_ "EmrrerrT#2= BDL7$<3IImg1L and TSS < 30 mg/L CST Name (Pl~se Print} Signature: CST Number Qavid J _ Steel (~ `/~ 248956 I~~l/ ~ Address Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 540 9l17/20Q2 715-Z46-5085 prp~,~ Sienna Corporation Q Borrng # :Boring /" Pit t Q to toyrar3 2 10-~ 1 1 tlyr4t4 3 21-9 7.5yr4lfi Jo, l~= 3~ `/~Z ~, Page 2 of 3 Soil Application Rate toots GPD/ftz *Eff#1 *Eff#2 1 c .5 .8 1f .4 .6 na _7 ~' 1.2 Boring # ` ~~ * Effluent #1 = BOD 3El < ~} , and TS S >3F} < 15f} , * s' _ tom- _ mg~L Effluent#2 = BOQ~<3t) mglL and TSS < 3p mg/L Tl3e Department of Cornmerce is an egaa.l opportunity service provider and employer. tf you need assistance to access services or ..Parcel ID # Pending Ground Surtace elev. 93•~ ft. Depth to lim#ing faet~ g6 m. Redox Description Texture Structure Consistence Boundary ..none sil 2msbk mfr cs none sci 2msbk mfr cs none /mom ~ osg ml rta I ~ ~ Page 3 of 3 .Boring # ~~ ~,} Pit Ground Surfaces elev. ft. Depth to (smiting factor in. Sod Application Rate Horizon Depth- DaminantColor Redox flescriptiorr Texture .Structure Consistence .Boundary Roots GPD/fP *Eff#1 *Eff#2 • .. ~ ~ _ , ,1 ..\TJ ~. y-r~ 21~ t t ~~ 't ~ J ' J i l ~ ~- ~~ '~ • \ _ .. t _, ," , . :. i e t ~ls- .: 7 '• ~ ~ Y I WW .. ~ ~ " ~ 7 .. ._ {-~- ~ I ~ , • a __` . ~ ... { ~ .~ ~•• .~ I ~ lg 11 m '. 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Jf..l ; - \,` t,; ;:.° -~ v'. , ~ - .rt. 1„ 1 ~ / ~r- -~.~'•, 4 t li -;: 5; -.t ~.~.111 I-„ `"h: 1 .~t... :R .~ i r I , I .., .~. / ,,. \. .;:, ---- . - .. ,1 .. , ~ .. .. r , ,, _. , : , . - ~ , ~. 1, \ : I IN - 1. ri. i iii , sv, `n /. '.1. SJy~ J ~ •. , r n J 1~/ 7 1' , ./ \•. /. ' , ~ t'" ' it ~ `- JJ ~~ J A > ~1 ,~ cX'~ ; - -~-.- : ( ' tl J ~_T ~ ~ ~ \ t~~ i ~ ~ ( ~ 271 - J r / ,~~ t r ~,~t i 1 I i{i j - Il /~ ~ j 21.1E ". ~. '': i i ~ ~ 1 , l i ~~~~~.- ~f J / I I'1 i/ Ott{ I,• 1'' I I -1-.;.~-..~-~ ~ ili i ii! . 1t. ~ 1.. r Cn~"~ T(~~T1V14J CRC 5 5 ~ ~;: i' i C ti r~._.~ J r ~. i F~ ~.+ SEPT7C TANK ~ PUMF CH~.Mn%R 4+~ CY VENT PIPE 1.2" MIN. ABOVE GRADE ~ 25' ~'RflM DOOR, WINDOW OR FRESH AIR INTAKE FINISHED GRADE ~„ CI RISER ^- ~,~" IN. 5" MAX. NLET ~ ~ f I _ _- ~- WATER Tia riT S FA;..S ~ -~-' 1 ._!._.. PPRdVED I ~ B IPE 3' ~ ~~ N70 'Sf~LIp ~~ 4YL PUMP Or F ELEV , ~ T • 1cD 1~EATIiERPR~3~lF JUNCTION BOX 4~'ITH CONDUIT .,.~ ~~ i , GAS- i s ~, TIGHTS cEAL 3" APPROVED BEDDING L'NDER TANK BpECIFICATIONS SEPTIC 1 DOSE TANK. i~.gNUFACTURER : , ~ ~~.~~~ TANK Ste: SE~PTiC ~d GAL. DOSE ~~ GAL. ALARM MAIvn.;FA~:TURER: / P~~.~st,c~~+ °""""~ MODEL NUMH£R : ~a s• z~ SWITCH TYPE: J~~ rc.. PUMP MANUFACTURER: C>~~,~~' MODEL NUMBER : ~,~/ o =~' ..,~., SWTTCH TYPE: /~~'s"G REQUIRED pISCHARGE RATE _ GPM APPROVED MANHOLE COVER W / PADLOCK ~ WARNING LAHEL ____ i} " M T Tv . ~ .e `~ i ~IAPPROVEfl JOIh'T5 WITH ALM APPROVED PIPE 3' ONTO ON ~ SOLID SOIL ~ OF£ ~'~` RISER EXIT PERMITTED ONLY TF TANK MANUFACTURER HAS APPROVAL CONCREx'D PAD NUMBER DOSES PER DAY: ~.~...--- DOSE VOLUME INCLU?~ING GAL, F LOWBAC K : .1~ CAPACITxES: A = ~ INCHES =~~~ GAL. g 2 INCHES = 3~2 GAL. GAL . C ~ $ INCHES GAL. D = ~ YNCH£S = ,~~~ PUMP ~ A?~ARM WIRING AS PER ILHR 16.23' WAL VERTICAL IJ It PERENGE BETWEEN PUMP GFF AND DI STRI HUTI GN PSP£ • . ; + MINIMUM NETWORK SUPPLY PRESSL°~RE ' ~ FEET FORCEMAIN X ,:1.G0FTe"? CO FTOTAL+DYNAMICAHEAD . -. _..~' _..-w-- FEET _~' FEET ~~2 FEET „y FEET T .~ INTERNAL pIMENSTONS 4F P~JMP TANK: LEI3GTH ; WIDTH____^__; DlAME~E _,_,~_ LIt~UID is 1 r~ ~~ n~/~~x1 ~ rr ~~GNED: ,,~:..~-- ~_.._...~____ LICENSE 1~'UrtBER: .2~?~''~r'd DATE: _~ 3~ --~--- l/88 ~. 1/~ 4 Goulds ~~bm~r~6bl~ ~-~~1~~~~ ~um~ Tj1 aJ 3V~~ EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ^ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. systems l dry without damage to heat transfer. ^ Motor Cover: Thermoplas- •Ho mes ;,omponen~ts Motor Available for automatic and tic cover with integral handle • Farms • Heavy duty sump : • EP04 Single phase: 0.4 HP, manual operation. Automatic and float switch attachment Points. • Water transfer __ 115 or 230 V, 60 Hz, 1550 RPM built in overload with models include Mechanical Float Switch assembled and ^ Power Cable: Severe duty • Dewatering , automatic reset. preset at the factory. rated oil and water resistant. SPECIFICATIONS •EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, FEATURES ^ Bearings: Upper and lower heavy duty ball bearing Pump: EP04 built in overload with ^ EP04 Impeller: Thermo- construction. s Solids handling capability: " automatic reset. plastic Semi-open design s/a maximum. • Power cord: l0 foot with pump out vanes for AGENCY LISTING -- • Capacities: up to 55 GPM. -~' standard length,16/3 SJTO mechanical seal protection. SP• Canadian Standards Association • Total heads: up to 24 feet. with three prong grounding • Discharge size: l'/z"NPT. plug. Optional 20 foot ^EP05 Impeller: Thermo- plastic enclosed design for (CSA listed model numbers • Mechanical seal: carbon- rotary/ceramic-stationary, length,16/3 SJTW with three prong grounding plug improved performance. end in "F" or "AC".) BUNA-N elastomers. (standard on EP05). ^ Casing and Base: Rugged • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Pump: EP05 • Solids handling capability: 3/4"maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size:l'/z"NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: . 104°F (40°C) continuous 140°F (60°C) intermittent. r. ©1995 Goulds Pumps, Inc., thermoplastic design provides superior strength and corrosion resistance. METERS FEET 10 9 30 8 25 o ~ a w. x U 6 20 5 v 15 .~ 4 0 ~' 3 10 2 5 1 0 Ol 0 2 4 6 8 10 12 m~lh CAPACITY Effective May. 1995 POWTS OWNER`S MANUAL & MANAGEMENT PLAN F14E INFORMATION Owner ~~ ~ ,; -~ ~~~ ` ~ Permit # y~ ~ g DESIGN PARAMETERS Number of Bedrooms 3 ^ NA Number of Public Facility Units NA Estimated flow (average) ~f S'O al/da Design flow {peak), {Estimated x 1.5) ~Q al/da Soil Application Rate al/da /ft' Standard lnfluant/Effluent Quality Monthly average' Fats, Oi! & Grease {FOG) 530 mg/L Biochemical Oxygen Demand (BODs} 5220 mg/L ^ NA Total Suspended Solids {TSS) 5160 mg/L Pretreated Effluent attality Monthly average 13iochemioal Oxygen Demand {BODs! S30 mg/L Total Suspended Solids {TSS) 530 mg/L ^ NA Facet Colifomn tgeometrtc mean) S10° cfu/100m1 Maximum Effluent Particle Size Ye in dia. ^ NA Other: ^ NA "Values typical for domestic wastewater end septic tank effluent. cvrTPrur lCPECEFICATIONS Page __~,_ of vSeptic Tank Capacity Q'~Q al DNA Septic Tank Manufacturer l' ~ ~, O NA Effluent Filter Manufacturer 6 ^ NA Effluent Filter Model ~Q ~/'O ^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer soy ^ NA Pump Manufacturer ~dp ^ NA Pump Model ~ ^ NA Pretreatment Unit ^ Sand/Gravel Filter O Mechanical Aeration D Disinfection ^ Peat Filter ^ Wetland O Other: ^ NA Dispersal Cell{s) ~.In-Ground {gravity! ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground {pressurized! ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: DNA MAiNTanwnuC st:nnuu~ Service Event Service Frequoncy Inspect condition of rankle! At least once every: mont s! (Maximum 3 years} ~ ear(s) ^ NA pump out contents of tank{s! When combined sludge and scum equals one-third {Ys! of tank volume ^ NA Inspect dispersal ce~l(s} At least once every: ~ ~ earl ~{$) tMaximum 3 years) ^ NA month(s) ^ NA Clean effluent filter At least once every: ~ ear{s} monifi(s) ^ NA Inspect pump, pump controls & alarm At least once every: *- ear(s) ' ^ month(s) ^- ~T. NA Flush laterals and pressure test At least once every: p Darts) Other: At least once every: CI month(s) ^ earls) i~NA Other. A MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the fallowing licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspectlone must include a visual inspection of the tanks) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume o4 combined sludge and scum and to check for any back up or pondMg of effluent on the ground surface, The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. Tho ponding of effluent on the ground surface may indicate a failing condition and requires the immedia#e notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third {Y3! or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized pomponents, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Pape ~of ,_ START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell{s}. If high concentrations are detected have the contents of the tankla) removed by a septage servicing operator prior to use. System start up shall not occur when soil cond{lions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater lave{s. When power is restored the excess wastewater will be discharged to the dispersal ca1){sl in one large dose, avertoading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Serv)cing Operator prior to restoring power to the a#ffuent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soli absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump! water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; ail; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned 1n compliance with chapter Comm 83.33, Wisconsin Administrative Code: • Alt piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of ail tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. ~ After pumping, all tanks and pits shall be excavated and removed or theft covers removed and the void space filled with sail, gravel or another inert solid material. CONTINGENCY PLAN if the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: ®A suitable replacement area has been evaluated and may be util'~zed for the location of a replacement soil absorption system. The replacement area should be Protected from disturbance and compaction and should not be infringed upon by required setbacks from existing, and proposed stnscture, Ict lines and wells. Failure to protect the replacement area will result in tfie need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. D A suitable replaaement area is nat available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. site A p sit tank ~ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING > > SEPTIC. PUMP ANO OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAlNTA1NER Name L/~ ~lr. ~ ~c ss-~ ,,. r. c? L~ Name Phone 7 ~ _ ~ _ ~ „z Phone SEPTAGE SEAVlCINQ OPERATOR (PUMPER} LOCAL REGULATORY AUTHORITY Name Name ~ }~ N /~ Phone Phone S. ~(O . (Q ~O Thin document was drafted in compliance with chapter Comm 83.2212}ib)(1)ldt&{fl and 83.5411), l21 & 13), Wisconsin Adminlatrative Code. l ~.I1~I~1 C~LT~T i Y i SkPTIC TANK MAINTLNANCI/ AGREEMENT' AND .. ; oWN1;P:51~.IQ CFRTIFiCATION FORM. Ow~ner/}3uyer Wss~" ~.k.e.. 13u."/~ er~.~. Zk~- - .__ Mailing Addrt~ss ___~~ ~• 70 1-,~~~ mar/. ~ -s4'c/G --- Properly Address 7~ (Verification requited from planning Department for new construct CilylState _- ,~~o Parcel identification Number _ LEGAL I)k~SC);t.i.}''~'IOi'~1 Property Location ~W '/,, ~~ '/., 5cc. ~, T ~g N-R ~V, Tolvn of __ .._ Subdivision 'T ~~ ~ o~ ~i4ips~r~,,.....,.. ,Lot # 1 9 ___. Certified Survey lti><ap # ~, Volume Fagz # _ __ Warranty Ueed # _,~„~~ •~ .,~~ . _ _-, Volume , 1:'age # ^ _ ~.,,~ Spec house .Oyes U no Lot litaes identifiable byes ^ no S~'ST~'.Ni Iti1At1VTENAI~'C~ Improper use and maintenance of your septic system could resu}tin its premature failure to handle wastes. Propel tT1.alrltenagce consists of purupi,ng out the septic tank every three years or sooner, if needed by a licensed pumper. What yott put into the systetrt eau affect the firnction of the septic tank as a treatment stage in Q;e waste disposal system. The property o:vnec agrees to submit to St. Croix Zoning Departrnent a certification form, signed by the awrer anti by a ruasterplerznber, jourueynnan plumber, restrictedplumberor a licensed pumper verifying that (1) the on-site v~~aste~vaterdisposat system is ib proper pperating condition arid;'oC (2) after izaspectioa acid pumping (if neCfSSazy), the septic tonic is less than 113 full of s1T~dge. Uwe, the undersignzd have read the above requirements and agree to mauntaitt the private se4vage disposal system with t11e stanti3rds set forth, herein, as set by the Department of Corturterce at,d the Department of Nahual Resources, State of Wisconsin. Gertificatioa stating that your septic system has been maintained must be competed and returned to the St. Croix Gounty Zoning Office within 30 days of the three year expiration date'. _1~ ' } ~ PF/~ T' - ~ ~ar.~ ~ c~.C ~,~1e.C D,ATI; SIGNAT t I~ OI A. lc,~,~s O`~'NF.R CFRTIFIC,'ATIU~I I (eve) certify that all statements on this foan art true to the best of my (eti.r) knowledge. the property described above, by ~•irtue oC a ~~•arranty deed rccorcied tr, Register of L)aecis Office. ~ _ ~~ r ~rtis~ ~a~~ SIGNATURE Or APPLIGA ~~~ ~~ ~~, (~lp1.crs~ I (wet am (arc) the rn4•ner(s) of Si9',i DAT> `*'""* Any information that is mss-represented may result in the sanitary permit being revoked by the. 7-oni,tg Department. """+ •" Include «•lth this application: a stamped aananty deed frost: the Register o.f Llee~is office a copy. of the certified survey Rtap i£ reference is n1at~C 1i1 t11C Warranty def(1 952 835 7008 P.01i01 ~ MAY-09-2003 14 ~ 40 SIENNA CO ~P i v ~ ~ ~ ~ ~ 1 6 2 3 CZi Document No. STATE BAR OF WISCONSIN FORM 2 -1982 WARRAN'CY PEED SIENNA CORPORATION, a Minnesota corporation, conveys and warrants to WEST LAKE BUILDERS, INC., a Wisconsin corporation, the following described real estate in t. Croix County, State of Wisconsin. KATHLEEN H. WAL5H `~ r/ ~ REGISTER DF DEEDS 5T. CROIK CO. , till RECEIVED FDR RECQRD 04/07/2003 09:50AK WARRANTY DEED EXEMRT # REC FEE• 11.00 TRANS FEE: 298.50 COPY FEE: CC FBB: PAGES: 1 Return to; Sienna Corporation Suite 608 4940 Viking Drive Minneapolis, MN 55435-5318 L Tax Parcel No: Part of PID #': 20-1048-30-000 Lot 19 lock 1, Plat of The Glen, in the Hudson, St. Croix oun , isconsin This is not homestead property. Exceptions to Warranties: Easements, reservations, and restrictions of record. Dated this ~\ day of 'Cr`cv..r ~ , 2003. AUTHENTICATION Signature(s) (SEAL) SIENNA CORPORATIO Minnesota corporation B ti^ ''~ ~ ~ (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 4940 Viking Drive, Suite 608 Edina, MN 55435 ACKNOWLEDGMENT STATE OF MINNESOTA } }ss. Hennepin County } Personally came before me this 1~ t~ day of 2003, the above named Marsha A. Piero ,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 instrument and acknowlef~e the same. Catherine M. Thornhill, A~lotary public Notary Public of Hennepin County, Minnesota. My Commission expires January 31, 2005 _____ SEE SHEET 8 ~ "W° ~ `n __ ---- ---- Z Uz c V 4 WJ~~ Z ~ H ~ W i W~~ Q W ~ Z m d QNN O N ~~..1I ~ 3 ~ W ~'~i 2 1 O ~ a N ~ N DRAWING DATE: OCTOE ~ m W N Q REVISED: DECEM 0 50 100 150 ~• N Scale 1" = 50' WATER ELEVATIONS: _ _ _ _ DATE OF SURVEY 817.8' - - - - - - - APPROXIMATE LOW WATER ELEVATION: 817.8' _ _ _ _ _. _ ,_ _ _ _ _ 100 YEAR FLOOD ELEVATION: 825.20' , ELEVATIONS REFERENCED TO U.S.G. S. (NAND 29) TOP NUT HYDRANT AT NORTH SIDE OF CARMICHAEL ' 1175 EAST OF BURL OAK CURVE. ELEVATION=878.40 ~ 3 BENCHMARK in ~.----TOP STEEL PIPE n o ° S84'1505"W 130.12' ELEVATION = 828.27 I o ~ I OUTLOT 5 ^ I PARK AND OPEN SPACE HOMEOWNERS' ASSOCIATION I 708822 S.F. I (16.272 AC.) ~ BLOCK 2 - - - I ELE~ ° " -' - ° NO DWELLING I - - - -' " - FLOOR ELEVAl10NS I BELOW 827.0 I '14"E 221.69 ' 04 N82 I .~ N ~ I ~ m 19 I N i 46043 S.F. 3 I ;~ I (1.057 AC.) I N I ~' ' \ I ~ I I z I NO DWELL . ~ ~ FLOOR ELf i 20' BELOW 82 \ ~/ \ to \ / \ 1 \ \ 3 20 I I \ \ I IN 52082 S.F. \ \ I I a (1.196 AC.) \ ~2a I I °z \ \ ~ ~ I I see \ \ a I I \ _ \ ~ 18 \ So, i \ ~ ~ ~ 51564 S.F. ~i0 \ \ ~~ ~~ (1.184 AC.) \ \ ~ e A ~ i 83 \ ~ \ ~ _ _ -N -- ~ _ ._ \ --- ~ ^ ~_--