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HomeMy WebLinkAbout020-1415-90-000Wisconsin 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 Sienna Cor Hudson Townshi CST BM Elev: Insp. BM Elev: BM Descriptio ~ ~3 , r' ~ _ ~ ,.- ~ ~~ 1 TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~~~ Dosing ~ (~ q ~ e~.•v~X ~ /Ft- ~~~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 5 i (A ~ l ~ ~ Dosing G l ~ ~l ~~ / ~ / ~ ~ 1 - Aeration Holding PUMP/SIPHON INFORMATION , ~~ Manufacturer ~ ~ and G Mod umber / lT~ TDH Lift Friction Loss Sys ad TDH Ft Forcemain ia. Dist. to well SOIL ABSORPTION SYSTEM County: St. CroIX Sanitary Permit No: 453254 0 State Plan ID No: Parcel Tax No: 020-1415-90-000 Section/Town/Range/Map No: 20.29.19.2627 ELEVATION DATA STATION BS HI FS ELEV. Bengt ~M Y V `~ j~i ~ r~~ a~ , Alt. BM F~,:~.A~ Z • Id9, ~ Bldg. Sewer St/Ht Inlet ~" ~~ /blv St/Ht Outlet Dt Inlet \ \ Dt Bottom Header/Man. ~ _ 3 g•BS ~ a~•5 Dist. Pipe Bot. System 5 9.8 0..3 /d ~ ~a . Final Grade ~"7. '~ ./e3 . ~ ~ St Cover 3 3 ~d ~ BED/TRENCH DIMENSIONS Width / Length ) ~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Di~ Liquid D th ~ ~ ~~ ~ ~e~ \ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturers-- INFORMATION CHAMBER OR ~ 1 jt Type Of ystem: / UNIT . -~/~ ~ Model Number: DISTRIBUTION SYSTEM Header/Manifolds ~ y Distribution Pipe(s) ~ x Hole e x Hole Spacing Ven Air Intake Length Dia~ Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over / xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center \ Bed/Trench Edges ®,~J Topsoil ~ Yes No ~ ":~ Yes ~',~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~/~/~ Inspection #2: / /_ Location: 425 Swift Cr Unknow (NE 1/4 SW 1/4 20 T29N R19W) The Glen Lot 33 Parcel o: 20.29.19.2627 FGJti~a~rv r ~~', a 5 ~ 1.) Alt BM Description = '~- V~y~a', ~-t~ • ~' ~•o ~--e~ ~'t C'. 2.) Bldg sewer length = ~~ ~ I / J j -amount of cover = ~$ ~r ~ ~S ~' ~I ~"~'~`"~~ L.~o 1 Plan revision Required? `" _I Yes Use other side for additional informati n. __~ "~ ~~ ' Date SBD-6710 (R.3l97) 6ati c~ ~~ ~~- _~,~ _~ 7. Cert. No. ~~ Safety and Buildings Division ~T~ Coumy y 'i i 2Qi W. Washington Ave., P.t~. Box 71b2 ~' C ~~~~~$~~ ~ Madison, wt 53707 -"]162 Samulry Permit Number (to be 811ed in by Co.) ~ (b08) 2bb•~ISI ~ Department of Commerce t.~c32 ~-r~ ~ ~ ~ _ ~, r Sanitary Permit Application r"b r State Plan I.I?. N In accoM with Comm 83.21, Wier. Adm. Code, personal information you provide may be Ilaed for secondary purposes Privacy Law, s15.1'td(1}(m) Protect Address (if different than mailing address) I. Application InPorination -Please PrUit API InPormatta ~W t~ G(, ~ 2.~,_,_ Property Owner's Na tna ~~ ~) ~ ZQO~ , Parcel N Lot X Hlock N ~ S~ `e Gc-. Gar ~~ Property Owner's M ailing Address ZQt~;lS1G iJlF~i~CE Property Location ~7 ~`lr ~ c~,~"~ -S'c~t~ ?'~~. ~,~ Section ?~ ~u ~ , , City, State i Zip Coda Phone Number ~`,v~c ,S :~`f3 x..5^..2 ~3.5 ' ,~~~.2 (circle o ) T %?9 N E o~ R~ II. Type oP Buihiding (check all first apply) ; _ ~ ~ ~ ~ (~ n _ - ' _ 1 or 2 Family Awaiiing - Number of Bedrooms ~t~ ~ ItrO~-~A~ Subdivision Name CSM Number ^ PubliclComrrtercial -Describe use ~ ~` ~ ^ State Owned -Describe Use ~ ^City L1Viltage (,Township of ~G~d~~lt,!/ III. Type oi' Parma: {Check only one Uvx on Ilne A, Complete llne B if applicable) pZp - I ^ ~fl - 8t3D ~ 2(oz ~ A' New System ~ ^ Replacement System g p y ^ TreatmendHoldin Tarilc Re la~:ement Oni ^ Other Modification to Existin S stem g y B. ^ Permit Renewal ^ Permit Revision ~J Charye of ^ Permit Transfer to Now List Previous Permit Number and Date Issued Before F.xplration ~ Plumber Owner IV. T oP P0WT5 5 stem: {Checlt all that a I ) Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soli ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Sittgle Pass Sand Pilfer , ^ Constructed Weiland ^ Pressurized In-Ground ^ Holding Tatu ^ Peat Fiitar ^ Aerobic Treatment Unir ^ Recirculating Sand Filter ^ Recircula ' S ntttadc Media Fiitar Leaciting Chamber ~1 Drip Litre ^ Gravel-less Pipe ^ Other (explain) '~'. Dis raaPJ'heatttietit Area Inforixiatlon: u.i . ~ y's _ ! Assign FIo ) Design Soil Application Rate(gpdsf) Dispersal Area Requirtd (sfj i Dispersal Area proposed (st) System Elevation AA ~i7fY i 7 ~ O s~ i ~,S 7 ~ l~J~e -3J~ VI. Tan Capacity in Total Number Manufacturer ~refab Site Steel ~ Fiber Plastic , Gallons Gallons of Units ~ Concrete Constructed i Glass New Existing ~ f TanYS Taakt ' Septic or Hotdtng Tank ~25`Q er ~j Aer~ic Trcat71lent Dais Doing Chamber ~ ~~o l w~ ~~~ F _ __.__ VII. ResponsibWty Statement- I, tht tindarsigned, assume rQSpo7zaibWty for Ilation of the POWTS shown an the aetached plans. Plumber's Na me (Print} Plumber's Si gnaturr MF !vIPRS Number Business Phono Number ~ :gym S fis~m~!'GY ~ ~ s~v~7~9~~ ~S= Ft's-~/~2 Plum 'a Addre ss (Street, City, Stott, Zip Coda) 1 d74 S~ ~. z{/..d s c.~ CJ . ~. G VIII, Count 1De tment Use Unl ApprovQd ^ Aisapproved Sanitary Permit Foe (includes Grrr.Indwater Aate Issued Issuin Agent Signature (No Stamps] Surcharge Fea) ~~ ,--- D! ~ i ~ ^ Ow 'ven Reason for Denial t IX. Conditio A val SYSTE 1 Septic tank, effluent filter and dispersal cell must all be serviced f maintain®d as per management plan provided by plumber. i 2. All setback requirements must be maintained as per applicable codefordinances. 1 Hr.d. ~ ...J.. _._ SRri-1~~t4iR !R m mai ~+.r.~.v Ir.wo Sw ww w.w.~ y.u~J +vr .ate syowu7 an papor 7103 3Cfi loan i1R x El llaibll 173 i1it+ ~Sccc.~G l ~ ~=Y~ ~ „ ~ ~ ov o ..~-- ~,,~rt.~,„ Q.Q~- . 1o s. 3 ~ ,~ ~Y S ~ `~,.cl.~~ ~~~'~ k o~ .~..~ ~~z ~ ~,~-e .~c~ Ta u~,i~ dim ~ ~.~d-l/ f ~.5~ ~ ~ l =Y//jam ~- -.-- .~-- S~{st.~,., ~.. ~os.3~ ,~ 3~$~ TR~.~~~' 44 c~:tiCk `~1~5 "' j'`~ ~~~,~ ~ ~ ~ .rti ~j ~ ~~ i p, !~ i ~ :~~ ~~(b i / ~ / ~ /~ / /J1 / apl~~ ~~~'~-----~~~~ ~~' ~a~~Pa' .5~~yl°`f Mr ~% Z- v Wisconsin Department of Commerce -SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8%i z 11 inches in size. Plan must include, but. not limited to: vertical and horizontal reference point (BM), direction. and percent slope, scale or dimemsions, north arrow, and locatioo-and distance to nearest road. Parcel I.D. P/ease. print all information. ,..,e,.- ~•-••: -""""°'°~ Reviewed y Personal informatron you {rrovide maybe used fw seconda~ m~'gya~r,law~ s. ~5fW (~(m))- ~ ; _ ~- 1092 page 1 of 3 Steel Sal Service St. Crobt pending Date t Sienna Corporation =` "' ~ °~ G~ti NE 1/4 SW 1/4 S 20 T 29 N R 19 W ~~~~ Property Owners Mailing Address Lot# B # Subd: Name or CSM# 4940 Viking Dr, Suite 608 ~;T C .' 33 ` na The Glen Gity State Zip Cade Phon Num ~._ . ~~-a~~~:i~ Village -Town Nearest Road GcE~j~u MN 55435 952-833 .tbt?'I Hudson .Carmichael Rd. Property Owner Prop L ion /' New Construction Use: /' Residential /Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public ~ commercial -Describe: Parent material Pitted outwash Flood plain elevation, if applicable na General comments and recanmendations: System elevation 105.35ft; trenches spaced and depth to code 3.50ft below grade ~~ ~~ ~ U'~ 'lam ~ ~ ,e v' ~'bCi-t/~L~ i Boring'# Boring /` 96 ; Pit Gr ound Surface elev. 108.85 ft. Depth to limiting factor in- Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Stn~cture Cons~tence Boundary Roots GPD/ftZ *Eff#1 *Eff#2 1 0-7 10yr3/3 none ~ sil 2msbk -mfr gw 1f .5 .8 2 7-15 10yr4l4 none sicl 2msbk mfr cs 1f .4 .6 3 15-24 7.5yr4/4 not5e Is osg mith- gw na .7 12 ~- 4 24-96 7.5yr4/6 r_< none ms ~ osg ml na na ~ 1.2 j l~ ~ ~/~ Boring # Boring 96 Pit Ground Surface elev. 108.85 ft. pepth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ttZ *Eff#1 ~ `Eff#2 1 0-9 10yr3/3 none - sil 2msbk mfr gw 1f .5 .8 2 9-23 10yr4/4 none sicl .2msbk mfr cs na .4 .6 ~, 3 i 23-96 ~ 7.Syr4/6 none ml osg ml - na na ~~ 1.2 ~.-- ~ ~~~ ,~~~~ g ,, tnwent ~~ = rsw 5> so < zza mg/L and TSS >30 < 150 mglL * Effluent #2 = BODS< 30 mg/L and TSS < 30 mg/L SST Name (Please Print) Signature: CST Number 3avid J. Steel -c Q~ 248956 4ddress Steel Soil Service ;Y'i-' Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, W 15401 9/5/2002 715-246-5085 Property Owner Sienna. Corporation parcel ID # pending Page 2 of 3 a Boring # Boring /` Pit Ground Surtace elev. 103.15 ' ff. depth to limiting factor 96 in. Soil Application Rate Horrzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= 1 0-4 1 Qyr3l3 2 4-1 10yr4/4 3 `! 12-96 :5yr4l6 ~,` /~ l3orino # Boring "Eff#1 "Eff#2 none .sic! .2msbk mfr gw 1 f ,5 .8 none sci 2msbk mfr cs na .4 .6 none ml' ~ osg ml na na ~ 1.2 . " Effluent #1 = BOD ~ 30 < 220 mg/Land 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 Borinct # ~ Boring -_ - ... .. ... _ . Page 3 of 3 STEEL'S SOIL SERVICE r David J. Steel 1564 Cty Rd GG CST-POWTSM Sienna Corporation New Riclunond, WI 54017 Lic. # 248956 NE1/4,SW1/4,S 20,T29,R19W (715) 246-6200 Town of Hudson, St. Croix Co. (715) 246-5085 The Glen tot 33 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.. Legend 1" = 40' • =Benchmark E1. LOO,OOFt Top of 1" steel pipe s =Alt Benchmark E1.101.SOFt Top of/2" pvc pipe a =Borings Boring Elevations B1 =108.85Ft B2 =108.85Ft B3 =103.15Ft B4 =OO.OOFt ~G--~/ 9 s-o2 rS~ ~~ ~-rrr'`t- ~gy~~" ~,~ ~a s~~P~- ~l iai s~~~ ~' ~ ~ S 6' .,, ~9~ zy , a, n~ e x,/05.3 S~t- f t. ~ a a . 15Ft- ~'~ , /o I, o ~~~- Br" so wf ~ l p v ~»~ i1c, Apr 'r I _ 1. _ _ : ' !! av _~,,< .' ," ° : ,~ ~~ 57- Il _ _ . " ,.. - . ~~a..~. \\1t j 1 ~ t. J 1'1'1 / ~^ ,. ! CI 1 - l~^" ` f ' ~.- _ 1 1 )) ;' `•• `\\"~ ~ ~ '=-.r+ ~ a-- 1 -_ - ~ ~ It `9' 1 .~ rQY~ ~I n' V V ~, . 1 - 1 ~ f •r ~ ~8 - 78 "65 ,~ , .. _ _ r, ,, r, __~ __ ~ _ ~ i .~ 1= ~• - ~ ~; _ „~ ' .~ _. ~ ! " ./ .. " _ ! ' ~ i . ' . .... ~~, .- ... 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I t " / ., { 1 1 1 '\' ,. / !r l i I1't . - ~~c. 1 *`- i 1 `, s w ~ ..~ .. ! f .t ~\ ` ~ it 1 It r .t • ' J ~ -• 1 ~' \\ ~'\\ 29" Ill-~~`"" 1 \_ ,\ 1 a ,~' r , / r ~li I ~; , 1:44 \ ~;.~ \ .t:. , ~r ~ .. i .1 1 \ \ \~ a L ! :~ I III i 1 ~tt 1 r.l tl f ~,_1 , -y;ii , 1 1 Ijl e t .t ~ f l1 i ~~ ~ ~ , rte!) f' 1 i,a _ ~ I ~II I ___'_ I 1 ~ 1~,J ,, f 1 ___ w///~~ W 1' r .I t i 1. 11 '~:t 1 I) I .. ' r fT N.. ff `1' -, ,1 / -- 1 ' ~_, ! N III ~'lt7 r _ ~~ 1'. ~ t l~ ? a 1 III I __ a '~ ~ =, ,1 ~ , t l I .l : 2~ ~, ;~. ~ , ' a -} . 1 l f , , , .' w ~'" C2 +IENi PIPE 12" ~ ., > ~5 ~ FRdM DdJR T ~ IN. ASJVa G.~ADE E FRESy AIR INTAKE W,~N~d~J pR FyNISHED ~RAx~E ,~ '~~~~ ...~,..,...~. ~'~ C I R T S Eke =,--...~~ ~.~" ~IN. r:~ K X -1 1 ~~ ' ~~ WATER r3~eify SEALS -' ~ _'~"` ~~~~RflV ~~, ~ 'Ip ~~ 1 `...i.,. ~3 ~~ ~ ~~1`G S,?t 1D i y~I4 --~...` FJMP LFF ELEV. rT, ~I C !~~ ~ __ _1 ~ ~ ~+~~r~~a~~~~ ,rux~~ioN ~t~~x t~i i~ C'~ND{JI~; ,; ~~ ,, GA5- ~ ' ' T1 GHT ~ '~ SEAL , ~, ~~"°2IC i DOSE "`hNK MANUF'ACT'~3RER: D05 £ ~" APFRuw'ED $EDD+NG L'~DER TA?~K SRECI F. CA2: C~v'5 ~... GAS.. d~ 6A.:~ . ~LAFcM MAt~,JFgC'IURER: -~~` MODEL N~11`S$ ER : L.i~C;.,,.,, .SWITCH TYPE: ~..... ~dZ~ ~... o. w..,. ~. MODE?. MJhCHER : ~"t~r~~' .., SWITCH TYPE: ~y ~- EQL SRED D i 3CHARGE R,AT ~ .~ .~ P:~ A ~ , n ""'~......n...~ti ~~~~ APPRO'J£D `SANNQL~ iOV,~ W ! pAD LOC K 8 WARNING ;.qg,~ ~ ,~ --» M . !~ . ~~ ~AiJK ~ ~ da2~RS ~tlti~ DM ~ ~~' ~YO~ P (P~ ~ 1 ! J SOL1a. SO2L CFF ` ~ a~ RI'~ER EXI T FLRMY T TED C;~L~ ~ ~ IF TANi~ ~ t'JANUFACT'J:~ER ~ ~ ~ A PPR O~,h ? ~ON~RETE FAD L 05 w V Ci~tJ,~'aE Y hC LUDSNG 2"LOSv'BA~CK: 1 ~Q~ GAL CAri~CZ«I ES; A • ~ .I,'vCHES r,r„~!t~GaAL. C ~ INCr1ES ~ ..~.~,,,.....GAL. D z ,.,~„ i.YC h ES s GAL . ~...._. PUMP E A:.ARM ~':RI1vG AS ; ER ILF3R 16.23' 'SAC CRI'CAL DIFFERENCE BE. ~~+'~P Gs F° AND DISTF,7SU'^ MINIMUM NETWORK SUPPLY p~ESSLRE +IdN F~P~ , . , ~,....r FEET F ORCEMAIU x ~~ ~'~ FEE:' <d FT/1CL~ F:'. FEET FR=CT:ON FACTCiR . T~?AL D~'NAMIC MI.4D : ~`ErT '"'ERNAL DZMEi1' :l~N$ ~F p ~ a T }- ~ , ~ T LM. ..r4.rh . ~NED: , ,.- ? dE'~tr N.'.`fBEF.: v~ r ~ 4~i+ ~ W E ~G i ,y ~--~-.~.--- w n -,_ ^q~r. ,. , ..r.,,;,,,,~,,,,~.r~............ . 3871 EP05 APPLICATIONS Specifically designed for the following uses; • Effluent systems • Homes • Fanns • Heavy duty sump • Water transfer • Dewatering SPECIFICATIOiVVS • Solids handling capability: 3/w" maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: l `/~" NPT. • Mechanical seal; carbon- rotarylceramic-stationary, BUNA-N elastomers. • Temperature: 1a4°F ta0°C) continuous t40°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Singie phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. •EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. Power cord:l0 foot standard length, t 613 S1TOW with Ithr o~°o~l 20 grounding p u9. foot length 1613 S1TW with threeaa d an EPO )tng plug (scan • Fuily submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- matic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP041mpeller: Thermoplas- tic Semi-open design with pump out varies for mechanical seal protection. ^ EPOS Impeller. Thermoolas- ticenclosed design #or improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover: Thermoplastic cover with integral handle and float switch attachment points. ^ Power Cable: Severe dory rated oil and water resistant. METERS FEET : _ ,...__ .,. ,. .,...,.,..._.. 10 j... _. _. s v 0 ^ Bearings: Upperandlower heavy duty ball bearing construction. AGENCY LISTING ~' Canadian standards Assoda>jon (CSA listed model numbers end in "F" or "C".) Goulds Pumps is ISO 9007 Registered. _. _' -S GPW~ ....., rr . __ ..... zs .... __ ~ __ _ ~__ . EP05 _ ~' EP04 . _. ...,_ ._. GPM 40 50 10 _'~__12 m'/fi Goulds Pumps ITT Industries ® J~000 GOUtds Pumps £ffecuve fe6ruary. 20D0 e3•~+ ,._~. ~•...~~ " STANDARD CHAMBER Quick4 Standard Chamber SECTIt7N VIEW FRONT VIEW ~~r ri~~{a ~• ~Quisk4 Start~ard Chamb -'~'~ L ~~ ;i b SIDE VIEW Size (W x L x H) - -- 34° x 52" x 12" Effective Length _ qgr~ Invert Height ~~' ~" SIDE VIEW TOP VIEW Si2e(Wxt:xM) 34"x16"x12' Invert Height 8" or 1.25" fNF~LTRA OR SYSTEMS INC STANDARD LIMiT~D WAR~NT_Y (al re s.nlGUral ntuguty of ear G ~hamne,, enJ Ldale, wedyE and other ax rvny mmudactural by A~fiAralol {'Units'. when Inslaiia7 and operalrxi m a I a: hlieltl o7 do pr6go _urGtic system in acxA!T1i1nCe with Inliftralor's it slrue!iores, Is warrernHd to Iho original rxlrchaser ('Hukier) 8L}.Nnsf delectlva, n 64a1 a^.d W(Nknlan3hH) !Or Onn! yEar inpn }hA dai0 thaahe SOpIIC Darlllll 15 iS51/ed for lh9 Septic E:yS78m CORUNNrIg IFxr Un,Y.S FIrWKIed, hOW"?Ve5 Inat t a sepho pe mn w n:rt reyuved by applcaUto law.. the warranty x~riud vnli bapn ,yxm the ua:e Inal ,nstallaliay ~)f the septic 5/stem CommenC96, Tv ezrv t e is warrerM/ ryhls. lioa7ar n"rsf notify Inliitrattx n wrtiryd ai etc ..n~p<xale Hrmd,.P art rs '.r. rlld Sayuwcde, C.tmrraclicut wN;,m llfleen (157 tkiys ]I the aIcayHd dnroc . In1itl Alor will supply repiacHmBni U ur.; irx Urtil eetArmineJ try lr It area W Us arRred tW Gris Ltmaacf Wanauy. ~ni h eta ~ Sahil¢y spar:irtc 81ty excludes the urst of rarncvat arx4ur m,~ausuon Uf ir:a Units. flr {H[ ~.M.UTtD WAARnNTV i.NO R6MFDIES IN 31;d9HgW1i ~APH (al AF'1- F,XGLUStJt li1:HF ARE NO OTHER WARHANTirS Wfri-. HAS?r C7 rU f ~ IJNIT ' N ~IJLISJ!`• NJ IMPL ED NA iRA: 11L U MEC C tiANTF l3 U Y OR CI NF ~ CVH A PAR'TICIJIAIi faJkVaSE. tr.) lrl I ~ted W a tY I rl to ' u ' en, r yi .t th ~ltamt vstem r 8 uracJvsnr >ti 1 ne >trrpr Ilwr. bH61 alOr ITg Li,n tM Warranty dWs '". I t ,d to . ~.r it tN ,.x,ue prat, sruK, ar ~ i J u da nays . ntii:rarr~r ,r al nUf n a k f a perp311m. or ligwc.ale) dMneyH . nNue,r,p bss of :unh uon and y 1 I 4 hor ancr mafer'~5 overh ad cn915 a o her '.asses or azpenses r rune;} Jy s^,e Holder nr any IhIM pally, Spoci4coUy e~: I! dPd from Llm0.ecl Wanarrly GOV9ra(jn err Jertaye tC IFIH .nrl5 dUA tO Or(111ary wEar anU tHar, a11B d!h]n, dCGdP.n(, mISW^0, ABUSE Jr noglHCr OI Ii1F 1nItE: tnn Urt!s lktiny SUllieryad f^, VHhic;;a 1 attic O! Other ,G1ditM.X1a which arH not I,;AfYnlllfd t1y ihH inStalallOn Ir1AIrt1G['pn5; laNUrf' Irf maNttdul She mirlmUm gmlmd Coverg 50110'1h NI the Insialla,ipn OlsirlGlgn$; t^Rf ph'rOanlr30l 0T ihlpropex materials iN0 the system Clxttalning tr>z lJr;lts: (attars of rite C'rots yr rtes septk: system dua to unproper silmg or unpr;,per sing, excossivH wales usage, improper grease disposal. or inyxopsr operation; or 8rly otrrHr BvBnt nut causal tsy InAhralW, this Limped W&ranty uilall t~ Yoid it Iha hlol„or (ails to rnmp~y w~..;h al a~ Iha IHrms 5e1 lorih in Ihls Lirrri(ed Warra;ty menf arrtr m derv mall InfUtralvr fn raspc:nsible for any ioc_ x damage to fhe liddnc Irn i)ri!s, o any Hurd party rAvJitny from installation or enip~ y waducl IiaUrlily Jaims ni Holder a any If rd party Fr.- Ini ~.imdHd Warranty to apph Iha Uni!s mull Ue instailsd m accordance Wdh elf Sde wnUi(gns reQUirad by slate and focal codc5; all OlftOr apy;fcatx iaW~; and IMIIi gt0'3 -nstallalion y)g,rucibns, (dl l`r,+ rP.proGenlalivH 01 Initlralor has III atAl verity 10 ahanyc a egand [hl; L"wifaa Warranty Nc warranty arq)lies .O a[ry parlY othrir Illan the wgi- riAr HnIISP.r, '"~ ahovo represenl5 Ifre S!aluiard l,rmifnd Warranty olkvsd 6y 1 lilt alur. A . rod number of slaiHS Arx7 cOUr11ie6 hays ditto t w rranry reyuire- rnergs. Arty pucl awe <d Clnrls rw Id rxtr,r~i tniftratn s G rpUr a Haan twnars tr, Uld SaybronM:, ponrlx:fk»t, pn...- .u ~~t, r,ur..hase, to cblai,r a CvPY Ui thH aPplreahH warranlY, a,V shoWd eareWfly read That warranty pr,G to the pw-hose p} pls. • ~YSTL`-MS INC ~ Environmental t?rtsite Wastewater 5oluttons'" 5 Business Parka Road • P,O. Box 7fi8 Old Saybrook, CT 06475 8G0-577-7000 • FAX 860-577-7001 $00-221-443fi U.S. Patents: 4,759,661; 5,01 T,041; 5.156,4813; 5,336,017; 5,401,1 16; 5,401,459; 5,5f 1,903, 5,716,163; 5,588,778; 5,13$9,&{4 Canad+an Patents: 1,329,959; 2,0p4,584 Ciher patents penUinp. !nfittratof Egcaliz6r and SidaWinl]er are registered trademarks of Inftltrator Systems. inc.:ntiltrator is a reyisie-ed h'adem,ark in France. infiltrator Systems (+1C. is a registered rr aoemark in Mexico. Contour, Conlw,a Swivel Connection, Mir;roLeal:tting, PoiyTuti, SrtapLoek, ChamherSliac~r, r'rJSlLock, Qu!cicCut, t]u+CkPtay and Ouick4 are trademarks of lnfiltralor Systems Inc, L9 20(X3 Inridtrata Sys!ums Inc. Printed ',n U.S.A. AECres~'oP~r~A MuitiPort End Cap POWTS OWNER'S MANUAL & MANAGEMENT PLAN li.E 1NfrOPIMATiON Owner ~ O _ Permit ~ 2. S uCSKiN PARAMETERS Number et 8edraoms ~ p NA Number of PubBo Facility Units ®NA Estimsted lbw leverages ~~,d Design fbw Ipeakf, (Estimated x 1.6i of da ~/~ d Soil Applicatbrt Rate elide Standard IntiueltU£ffluent Quality al/da Jftz Monthly average i=ota, Oil ~ Grease (FOGS 530 mg/L Brocltemioal Oxygen Demand (BODes 5220 mg/L ^ NA Total &uapended fiotids {TSSi S1 b0 mglL Pretreated Effluent auaE'Ry Monthly average Biochemicsl Oxygen Darnand (BQD~) 530 mg/L Total Suspended Solids C7S51 s30 mg/L q iVA Feoal Colifonn (geometric means S10° afu/100rn1 Maximum Effluent Partials 81ze yi in die. ^ NA her: l7 NA 'values typical for donteatic wastewater and septic tank effluent. Page ~ of F Ssptio Tank Capacity ,2 () al ^ N~ Septic Tank Manufacturer p N~ Effluent Filter Manufacturer ~ ~ ~ p N~ Effhrlent litter Model ~0' d N~ Pump Tank Capacity ~ al D N~ Pump Tank Manufacturer rms. ~, ~ NA Pump Manufacturer ~,,,~/~ Q NA Pump Model - - O NA Pretreatmult Unit L7 NA d Band/C3ravel Filter ^ peat Fllter D Mecharticai Aeration ^ Wetland 0 Disinfection ^ Other: Qlsperes( CeiNa) ~ NA L7 tn-Grauntf (grav)ty1 ^ ln-Ground ipressurizeds Q At-Grade ^ Mound ^ Drip-Line ^ Other; Other: ^ NA 0t!»"' O NA Other: ^ NA Nuuarlt~aNCrl: ac+~oul.E 8srvice EwM gNyi~ Fraqusnoy lnsDect condhton of tanklai At least once every: 3 rr-o s s (Maximum S years) t7 NA Pump out contents of tanktat When combined sludge and scum equals one-third tYsf of tank voiurtTe i? NA lnspeot dispersal cell{ss At least once every: ~ ~~ a) tMatdmum 3 yaarst O NA Clean effluent fUter At )seat once every: ~ moMhlal Q NA tnepect pump, pump controls 8c alarm At least once awry: ,..~-- a month(sl O NA Plush laterals and pressure test At least once every: .- © oaNsi ss DNA , Other. At least once every: monthia? .-- ~ ts1 ^ NA Other: O NA MANVTENANCL ~fsTRUCrIONs tnspectiona of tanks and dispersal calla shall tae made by an individual parrying ens of the following iioenaes or oertificatlans: Master Plumber; Master plumber Ftestrieted Sewer; POWTS inspector; POWTS MainUlner; Septage Servicing Operator. Tank inspections must inolude a visual inspection of the tankisl to identity any missing or broker- hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to chock for any back up or pending of effluent on the ground surface. The dispersal oell(ss shall be visually inspected to cheek the effluent levels M the observation pipes and to check for any pending of effluent on the ground surface. The pending of etfluent on the ground surface may indicate a failing condition and requires the immediate noiffiaation of the least regulatory authority, When the combined aocumulatior~ of sludge and scum in any tank equals one-thad IYs) or more of the tank valums, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordanoe with chapter NR 113, Wiaaonain Administrative Code, Ali other services, Mcluding but not limited to the servicing of effluent (liters, mechanical or pressurized eomponenta, pretreatment units, and any servicing et intervals of 512 months, shall be parfarmed by a certified POWTS Maintainer. A service report sha!3 be provided to the bcs! regulatory authority withM 10 days of completion of any service event Page ot~ START UP AND OPERATION For new conatructlon, prior to use of the POW75 check iro~tment tankis} for,the presence of painting products or other chemicals that may impede the treatment process andlar damage the dispersal celilsi. If high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prio- to use. System start up shall not occur when soil canditians ars frozen at the infiltrative surface. During power outages pump tanks may flit above normal highwatec levels. When power is restored the excess wastewater wilt be discharged to the dispersal ceillsl in one large dose, overfeeding the califs! and may result in the backup or surface discharge of affluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator pricy to restoring power to the effluent pump or contact a Plumber ar POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. do not drive fir park vehicles aver tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down abpe of any mound or at-grade sail absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the cite of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental flans; diapers; disinfectants; fat' foundation drain (sump pumps water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the foiicwing steps shall be taken to insure that the system is properly and safety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • Ait piping to tanks and pits shalt be discannected and the abandoned pipe openings sealed. • The contents of alt tanks and pits shall be removed and property disposed of by a Septaga Servicing 4parator. e After pumping, al! tanks and pits shalt b® excavated and removed or their covers removed and the void space #iiled with soil, gravel or another inert solid material. GONTINt;3ENCY PLAN If the POWTS faits and cannot be repaired the following measures have been, or must ba taken, to provide a code carnpliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soli absorption h Id b rotected from disturbance and compaction and should not be infringed upon by ~~A system. The repfaoelnent area s ou e p required setbacks from existing and proposed structure, tot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the raise in effect at that time. O A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS tsohnology a holding tank may be installed as a last resort to replace the failed POWTS. p < <WARNINt3> > SEPTIC. PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL l3ASSE& ANDIOR iNSUFfiIGIF.NT OXYl3EN. Df3 NOT ENTER A BEPTIC, PUMP OR QTHER TREATMENT TANK UNDER ANY CIRCUM8TANCE8. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OP A TANK MAY t3E QIFFICULT OR IMPOSSIBLE. ADDiT10NAt COMME.~ITS --- POWT'S INBTALLER Name CJ~~y~~~~u ~~, r C~tY~ Phase ~ C „ ~. ~ ~~ POWTS MAINTAINER Name Phase SEPTAt3E SERVtCiNa OPERATOR {PUMPERI IOCAL REODU4TORY AUTHORITY Name Name ~_ t`~(K Chu-111 ~N/uG~ Phone Phase (~. This document was drafted in compliance with chapter Comm 83.221211b}tll6di&(fi and 83.54(11, f~l d~ (31, Wisconsin Admtnlstrative Code. Mound and at-grade soil absorption systems may be reconstructed in place fallowing removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rubs in effect at that time. 8T CROiUC COL1~ . _ _ _ . - _ _ _ _ sF..~~c Twrnc c8 Ad~NT OWd~PBFt,;HjP C,"f3R'TL'FrCXTTON FORM tAvuaBuycr _ .J J ~'~t.1,q ~' ,C ~'~ ~4 -n' c, r~ M~oiliug Address ,~, a Vi K_~ ~ ~ ~ .SV t ~ (o Propt,rty Address ~.;~.~ _ Sol ~ `~~ G.~ ~''r+..~ (Yerificatiaa required from i'4nansi DopacQmicut fat asw Ciry/Stato MU~.S'oiJ ~..t/ ~ E'arcci idat,tificadoa Numbor L~GAI. ~.S 1'ropes-ty r.ocatioa ~~.~ ~ ~., sec. _~.O . T 2~ N-t~,'W, Town of MUUSr~ ieJt Subdi~.sia~a ~~~ ~: l_~~~~__._ _. .~ ~, Lot # ~. __--- Ccrtifrexl Sun+ry Map # Volumt: ____~_,_„~„~,,,, Page # _ ~_~-- '4Varrctnty Decd ~! ~ Co ~D • . 0. Q , __rt__ . Vvtume 1 ~ ~t „_,_, Page !! _ i ~ - spec ~t~ ~i y~ ^ no L.ot L:~cs id~i.$able ~ yes ^ as `f 3 S . SYSTEM MAINT'ENAi~ICE izapt~apet usa sad maiakasaae of your ~epdc rystrsa tat-1d molt i[t ies pt!cmartrrct~ 4ilute to hatulZaw~sstes. ~xmsintwaar~c ~s3:a of »~g out [b,e trpoic tsar e~aty tbc~c yeses or raoeer, it ozedod by . li6tasrd puxopar. orbit yov ytit into ors our tffeet ~ l~tncdatc of t~'e~e traJc ss a a~camna~at ttege is tbz .rsate ditpottl ~ 'Cbe p[opezty o.vaa sgsrez W cabatic tas St t~ois Deps[tmeec s cet~ifscabCa fotm, s~o0 by thc% avvna aad by s ~Crphrmbe~, ja-rroeymaa piuctrber, tt~ic~odp[3uaber oe s ticenied P~ ~ t2sft (fl) ttre tm-~tte rvatiStRrata di+p~v ry~ is {er ptapet opc-rti~ag cos+~ditioa wd/o[ (7) otter twsp sad pu,mFia,r {it_neoeearY). du ~eytie task ~t 1~a[s tban t~ f+nll of tlod~a pres. the rrrrdo[~ci~sed bsve cad the arb~avs ir.~yiranartls sg~ee to >arsatain tht pdvsts eewsgc disP°ael try~as evith tb. eernduds +[ei facto, hccz-y a: sec by cbc Depaatnneat of Cearme iad the ,7epacitc~at of Nzatet:etl Rsaoucces, Bcste of Wigeosin. Cse~ft;r+abaa catic~ s>sr teptfc rystaa bocn saes' be c~omq[ictu! and retut4ed to tine St t~ouc Cot~ty Zoning Ot'bee rrid~ 30 ds~f ehc~eyt4sr q~indaLe. y~~-~ DA t3 t:«,~fy tlsar su : ats o ~ tocm an anre to d><: best of fay (aur)laaowicdgo~ I (wig am (are) the o*~al of yen a~ibor s waccaat7 deed r.cnrdcd is Aegutes of Descds OfSre. Ilny iafbrtast7_u (~cfw aus•rtpa.!teored rnsy rccult in tht ttoitaryyctmitlwia6 revc+kedby thc?vsriag Doprr~-~ •••s•• •• Ipclude rricb this epplie.tlna: a wr[stwty dsa! ~ the AeaictKOt Dceda o9~ce a copy of the :,eraSad cucvty mtP if ttitcxv~'~ it tide is t1u tv~taaNy deed TC1AL F, O ! 2050 5~~6 ~ G99A6E, KA7t;LEER H. ttALSH S7AT@ BAR OP WISCONIiN FORM : • 1491 REGISTER OF Dt:Ei~ $T, CRQIlf CO.. MI AocumentNutaber WpRRA1\"TY DEED RECEIVED Fi7R itt~GORD 1:,~asiaoaz iepaeAti '!lids peed, trade between John Gies asd Pearl Gies, hssabautd wd wife, Grantor, and t~enaa Cortaoration, a cotporAtion under the laws of EfEIWT $ Miauetota, Grantee. F s ~~. C)rsuttor, for z valuablt cotuideratiotl conveys w C3rantce the pg t .8 followin8 described real estate iu We Cotuuy of St. Croix, State of Wiacatuia: Y Y p~ t : a 8®e Exhibit A, attached hereto FrddrtMrou ~ Oyreu, P.A. {(100 lalabury Cwlor 200loutb Slattb sdradt A4tnadapotal, MN Sf/00 Fared! Idar~tlfkatux, Nutnbar (PlN) 02p.1848.J0.000 Thta (u) (ia cos) homestead property. The parcel shown on this document is beNtq added to the parcel ehawn on the document recorded M Volume 1707, Page 1113, tlocumant Number 8i3t30f10, deeaibed ate a patrcel at land Iocatad: to create on parcel, and this traneection In thereby exempt from Chapter t8 of the 8T. CROiX COIfNTY LAND U9E Rf:CiULATI0N8 pursuant b 8ealon 18.06 (Ax3). ToSether with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in lea simple attd Yree and clear of encturibreacea except: restrictions, cavetlanta, conditions and easetslents of record, if anY• Datotl this day of 1Vavttmher, 2002. r AUTtSEMCICAT70N $ianature(o} alWrantiC4Wd this ,~,,. day of , ,_.,_ TITLE: MEMBER STATE SAR t3F WlSCt]NS1N (Ir na, cutiwrized hy$70ti.06, Wis. Saa:) TMIS INSTRUMENT WAS DRAFTED BY Fretirikaon & Byron, p.A. GSMM} 44U0 Pitisbury Grater 200 South Sixth Street Miar-oapolia, MN 55402 632-492-7000 26$2096 (Sltnaanad mxy b aWhdnticatdd or ecknowldadd. 8om are aot rtecnrary.3 •rlWOdi dppfa0ao rIjM1M$ in any eapaeY:y taaUd de rypod o, prtauo aowW tibir ceanaara ~ , 0 os Pearl S3iet ACItNOW1.EDGMEN7' STATE OF WiSCON6IN ~~ COSJNTY OF ST. CROIX ) Personally catttn before ma thin a,Qr'1ti • day or November, 2002, the above named Jahn Gks and Pearl Diet. huchand and wlfer to me itrlown to be the person who axdcuted the foreSoGlr instrument and acltnowtt>dger tku rune, ~Notar} Public, State of , i,~+t My ,CCmmia on is per (If rwr~ care expiration data: y~~ } Michelle Bank Nola Pubflo Stara t Hein wAalwN'r9 tgt0 6TA'tti eAa OP W16Nt.Ytn't lrORat ~o• i • taN fond Oo Ua WiCOntln 8e4rDa.rCJ3 lnlor.+gGOn Gref0~Y0n~a CenlpanY -~ - ~ - ~. ' `- 1„ / • ~ s~ ~~' ~ yr ~+ ~ ~~• -~. a '~ ~~ ~ •~ ` ~ ~ti 1 ~ ~a r ~~ ~~~ ~•~ i '~ '~. ' . 1 I I I ~~ ~~ ~~ ,F. °~~ ry~ • _ ~ I ~ ~ '~7 `~V I ~~ ~~ ~ ~ `~-~ ~-, ~.- '~ ~ ~i ~ v ~ ~ '' ~ ~ ~ ~ # ~ ~ ~ ~, ~ ~a I ~ `tir ~\ i ~~ 4531 S.f. ~ ~ J r ~ ~~~~ ~ ~N ~ ~~~ I ~~~ !, /y I / ~ f`" •. '~. Hb DWELI.INC Ft,.QQR EL.~YAT}ONS ~,tyW ~54.~ ~'~'~e'~ ~~r.s~~ ~ u~uT~i E~SE~ / ~ !o ~ +o~ _~ n~~ rop s~ ~...~' ~v~noN •~ a3a.a,~ r ~~ ;ss~s s 1 ~t,os4 ~ N4 DWELUN4 ~'L.OOR ~L~Y~tTK)MS ,~ ~~ga -I ~ ~~m ~.. yy I _L _ _ R - - ~ t~s~ ~ .>:,~ St ~~ E ~~ $ ~ m x ~~a ~ . `. v ~. ~\ ~\ 1 'L~.f[YII W1~ Ol m11LLA' WLLai lG ]M1 N1W110 L>-1M LG d ODIOYId ]YY lOIAI.A z ~T nay ~~ . . 9 133N5 33S ay , ~ '~~ « `~•~• 11 ~I . ay 1 ~ a ` ^ 11 '~ 1 1 1 i ay i i i a^y j -~i~ jj ~ 1 ~ 1 ~ ~ 1 1 1 1 n '~ ~ ~ )~; `~`` ` 9F ` ` `111, 11 11 ~ I I !. Y . f ,ttt ~~ ~. . ` 1 1 11 \ y, 1 1 1 1 1 14 I I 1 I I 1 J ~ 4 ro o ~~~. 111 ___-1 ~__ ___-_---~ ~_ -__-_- ~~~~ '` --~'~~~ ~ AVENUE '~~ ; ~ ;:- ~ a . j ~ , ., , .: ...• --^---------------~ R I --' I ~ ~ 1 1 1 1 ~~~ w~ 4 \) / ® / ~ l l 1 1 1 1 1 1 I I I I .' .' / / , 1 1 SI 11 ~'~ ' / y / ' 11 ~ m N~~ _ ~ N i ' ~~ 1 '~', / ~' ~. ' y NRx lltjl 1 11 111 1 I I 1 I~ I . y, i ~ ~ A r ' / A' 1 1 1 1 1 gg ~~C I I ~ / ~%' ~ ,t % 11 Y~~ i j ~r ` ~ 1.. -~ ~~ s ~/' i~/4 s~ ~~ ~z~ ~pa ap ay a ~~ ;~j ~ ~ ~~§~ ~~ ~ ~k4 o•ao ~~ ~~ K r ay I '1 ~~~ ~ 1 1 d 1~~ ~ ~ :cnl.L___-~ ::i LL'l9ft M.-l.9£.ooN f.u ocu ..srscwb ~ONb'l a311dldN(1 NOSOf1H ~0 AliO 9a u :/~is aw b I ~/~ ]. su n sn nv. - '~7iT A~3G-rSilNC`7 x ~~-