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HomeMy WebLinkAbout020-1418-00-000Wisconsin Department of Cos~n~erce „ 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: t BM Description: //1] ~ 11 ,f ~ g o3.~tS - - q g 1 0 . `E S - .e,e,aoa il I ~-Tl TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic c.~~-ems ~ Z d v Dosing /~ ~-' l.~I Y'ti'/ 1l a Aeration ~ ~_,! D~ ~ 1~r Holding TANK SETBACK INFORMATION TANK TO ~ P/L~ WELL BLDG. Vent to Air Intake ROAD Septic .y ~5 /- J ~ 3 ~ ~ Dosing ~ 2~-j Aeration .___ Holding r'" PUMP/SIPHON INFORMATION Model Number GPo ~~-~ TDH L~f~•p ~` Iction,Loss System Head T H Ft ~.tQO .~.~---- •.~.(pp Forcemain engt L f r d Dia. ' u Dist. to Well SOIL,ABSORPTION SYSTEM T g"1 ~ LL~...,.J~s DIMENSIONS SETBACK SYSTEM TO INFORMATION Tvoe Of Svsten DISTRIBUTION SYSTEM 7 `'' Z P/L BL G Z~ ( ~'3 NTo . P1 ELEVATION DATA County: St. CrOIX Sanitary Permit No: 430512 0 State Plan ID No: 1 --- Parcel Tax No: 020-1418-00-000 Sectionrrown/Range/Map No: 20.29.19.2648 STATION BS HI FS ELEV. Benchmark Aft. BM - ~>7 ~ Bldg. Sewer D~ ~` . ~ / ~ ~- ~t SbHt Inlet D. ~ St/HtlOu et / .h i S~ ~~ Dt Inlet ~d t.e> Dt Bottom ~ 1 ~ ~ 'T ~w O l2 - 3 ~ Header/Man. ,d ,Zp ~ ~ • ~3 I Dist. Pipe Q • 3 D q, ~ c~-- -d ~ 1 Bot. System Q •8 3 9~ .~ Final Grade - 3L St Cover ~-7 J >~P~j . (D O .!o ~ ~~e~~~ ~ tea.. 4st' Fil ~ lE:~° toV • tS / 0 3~ ~ No. Of Pits I Inside Dia. (Liquid Depth ./STREAM LEACHING fa ~ CHAMBER OR ~------ UNIT Mnrlal Nnmhar• . I( Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake It Pipe(s) Length Dia Leng Dia ng 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 Topsoil ~ ~~ Yes , ~ No Yes ! No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ /~/ ~ ~ Inspection #2: D~/ ~"" 1 ~ Location: 456 Wren~rcle Hudson,r~W_~I/~~_"54016 (NW //~NE 1/4 2y0~T29~N R_1"9pW~) The Glen Lot 54 ~ Parcel No: 20.29.19.2648 1.) Alt BM Description = 5T• ~Nr~c tA~f~~~' n~ lJ (~a~~]~.~' ~~G/s~nJ+-~C,~/rihP1/~~,"VL(S ~ v~ S~K!'(,,~.~ "'~~ ~~~-- 2.) Bldg sewer length = ~ r fa++,NOL ~'t'~y" ~ fit~+.s"~Zl.~ C~•'vi''i "~c~a~ ~t~ {- a..~- - amount of cover = ~ ~ r-~_~u.r'~/'~~~ .~ l~ N ~ ~ ~'-1-~ Gv~-c ~c, r t1~ {%l'~ ~ Go ~~~ Pfan rewslon Required? [] Yes No ~ • 0~ Use o~thepr~i"de for addi final info ati ~ ~ ~i _ ____ ___ `_________ ________~^~--.___ _ ___ ___ __~ ~t T -tP _ SBD-ti 17 0 (R~3/~~~(5~ . n ., /'~ ,D_~te{~ _ ` ~I/ns~epctor's Signature ~rA,, / Cert. No. (d~iQ "~ O (L.. w ~ cX`aM-+.++b4A! ~.~.s ('+'•a! SA.Q_SO{~ U1,~" (Ni"'~-- (.~/Y~ (®l't-~~~ _t _ g ~ Safety and BuUdings llivision 1 f~~~~~~~ Af~ ~%• Washiogton Ave., P.O. Box 7162 '~De~artmen~ t of Commerce /"`1 Madiso ( ~2 ED Sanitary Permit Applica ~~~r q~y In accord with Comm 83.2t. Wis. Adm. C;ode. persotur! infor anon y`ou prov~del 2003 pray be used for secondary purposes Privacy l.aw, sl ')4(1){tni ~"- ST. GROIX COUNTY ! r ~ __"---, _ County°._..... .----__ Sanitary Permit Numlrer (to be filled in by Co.) X30 ~ ~ Z State Ptah I.D. Number Project Address (if 3ifi rent than malting addres { Prop yte Owner's Na n ~~.` ----______ _. ~ ~~ (.l~ea~ L. I ~,~-L S~v~~ Lot As Black ,~ Property Owner's !y ailing Ad~iress ------ .-..-_ -~~G! ,/~ f/ Property location '~- City, State Zip Code --~ Phone Number - ~ = ~~+k,~~ ~•Section I IT, Type of Building (check alt that apply) ~ ~,"~~"- _ T ,~, N; R~lr ' ~. S ~1 or 2 Family Dwelting -~ Number of Bedrooms _____ __~ „_ _ _--_~-~. ~ Subdivision Name CSM Number PubliclCommerc t~ State Owned _ Dial -Describe itse ~-~ ~, ~~~, - ~~ -----t- -...._ __ -_____ escribe Use r K $~. Sp "" --- ----- ?~--- - --- ~ _.~_ ^City ^Village~Tocvnshipof d~ ill. Type of pertnIt: (Check only one box an line A. Complete line >~ if appiica e) p I ? ~ blew System ` ^ Rep!at:ement System ~~ 'i'reatmenUHoldirg Tank Rep!acen,ent Csnly C Otller 4lodittcauon ro Existing System ~ __ I S• ^ Permit Ret~wd! ~ ^ permit Revision ' l.~ Change of ~ ~ Pcrrais Transfer to New T T f- Ltst Prevwous Permit Number and Oars tssued~ ~' t3r}ore Ezptration I s Pfumher , t7wner + __ -. _ n, - _ Type of POYVTS 5 steer: (Check tttl that ~i j ---__ __._._ ---- _ ~~_~~~------~ ,.~(, Non -Pressurized ln-Ground ~ Mound > 24 in. of suitable soil r~' Mottrtd < 24 in of sustabte .'oil ^ At-Grade C_I Single Pass Satz! Filter _ r ~i `~. + ... t'onstructed Wetland ~~ Pressurized ln-Ground ~ i{olding Tank '.- Peat Filter (~~ Aerobic Treaunent Unit !7 Recirculating Sand Filter U Recirculating gynthetic Media Filter l,~ac _L'hamber ~1 lln Line ~J a !-less Pipe ~~ Other (exQlain) 4 V• Dis ersai/Treatment Area lnformatio f}--/~C • - ~-7~-~ ~~~~-_-~ ~Desi n Flow ' - - - - ~~-~ wS -~1 B tgpd7 Design 8oi1 Application (gpdsf) Disl~rsal ~vrea Require ls~ ~ Dispersal Area Paoposed (sf) S~T~yscem E;ovation I VI. Tank Int'a Ca aut i~ ~ --~ ~ ---- -~° ~-~ ~--- i p ' y n -r Tti~l "Number Ma.nxfactusCr -'~'.--~ t-':-- i 1 Prefab Site Sree! + htber Plastic i Gallons I Gallons of C.,nirs i Concrete ~ Constructed ) {Blass NewTiuing~ { I i i acpuc or Bolding Tank X _-_-_}J,2~d 1 nerobtc Treatment ~?uit __ ~ t.'asing Chamtx~r'^"- ~ V IC. Resyonsihtlfty Statement- I, the underslgrsed, assume re: ' Plumber's Na tn~ (Print) Plumber's Si gnature ~~ ~ ~._.~_/f_. ~G!%ll,'orlrt-,. ~~Ec yy6,~a/~G~I ~ ' Goa {~ utumber's Addta sY (Stfect, City, Stare, Zip Cods) _ r.~ d' '? ~' Ste. ~ ~' ~'~ f7°u o~~'„ ~ ~ `~.~'r r ------T ~~e .irllidy fur Uatiorr of the PtJ'4VTy showrr o_n the attached plans. 1\iP/ iPRS Number _rBusiness Phone Number ~_ ~~ ~~ri~ ~- _- ___--_ 1 ~~s--.~~d; -~.-~la~ Appiaved ~ C7 Disapproved Sanitary Permit Pee 5umharge Fee) ,.~,,,~___~_'-.~"Owner Given Reason fur Lenin! i IX. Can~tions of AppravaUifteasons far Disapproval ~' SYSTEM OWNER: i Septic tank, effluent Nlter and dispersal cell must all be serviced !maintained as per management plan provided by pl- u b 2. All setback requirements must be maintained as per applicable code/ordinances. ours urounawatar Date Issue 25D ---- ----- ~ . GYM Signature (t~q,StampS) ~ n ~•~~ ~~~np,ete grans {w the County only) rot the sysietn on paper not test; than !l~ x l l incites in she SBD-639$ (R. 01 /03) S~ ~.~,Ja Gor,~ ~'~~" Sal ~is~ ~y,C~.~ ~~~,~/ ~r~itd..~~o..c/ ~c a~ -~ l ~= ~Q _._. din ~- ~~,~,e, y'~; ~ 5 `~st~. ~~~ v= q 4 •~ S ~ , ~~~~ ) ~~ ~~' y _-. ~ /~'~ k° X33 ----_ ~` ~ , ,f~ ~ s ~ ~8 ~ r~ ~ ~ ~dT< ~ ~~~' ~~~s~ ~--~ ~--- a ~~ ~~ v _~ o. ~"~ ~~`~~~ ~" C( 2~~ ~ ' ~`1 o~~r,6'I~ ~'a~ ~~'" DX ~"' s'~° ~ ~~~ ~~~~ 3 ~,n P~ C® T~~~ iJ °~,~.ow'~ ~~ ,l s ri ~~ ~ t ~ o~ ~y ~U,o .~"~' f Gad"~,,S ~ofi Lo ~-- ~s- ~~ ~ ~~~ Y ~~8 ~~~~~ ~dr'`~ ~~ ~~ ~ ~f~s~ ~ ; ~L e ~~ J ,~ Sc a~ ~ ~~ ,~ yQ , ~~~ ~~~~ add, -~ 5~sr~-~~~ ~ = q4-~s ~~ 2'~ ~ " ~, <rh ~~ r ' Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach compete site plan on paper not less than 8%: z 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and parcel i.D. perrant slope, scale or dimemsions, north arrow, and location and distance to nearest road. Please print all Information. I Personal information you provide mey be used for secondary purposes (Privac (m)). ~ Property Owner _-~ Prope Location goo 9~ 1133 Page 1 of 3 Steel Sal Service St. Croix pending Date Sienna Corporation Govt. L NW 1/4 NE 1/4 S 20 T 29 N R 19 W Property Owner's Mailing Address ~ ,~ D ~ ; C i~ot # Block # Subd. Name or CSM# 4940 Vilking Dr. Suite 608 ~ ~= i• '~ ` 54 na The Glen city C~~YIa state zip Cod Phone Num_b~,, , ,,. ; ~ty ~ visage ~ Town Nearest Road . - .~ ~ MN 55435 9~~0~'~~"~'` Hudson Dorwin Rd. ( L {Boring # Bering 96 ~~ JJ If Pit Ground Surface elev. 103.45 ft. Depth to limiting f~tor in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Raots GPDlft2 *Eff#1 'Eff#2 1 0-10 10yr3/3 none sil 2msbk mfr gw 1f .5 .8 2 10-24 10yr4/4 none --- sicl 2msbk mfr cs 1f .4 .6 .~ 3 4-44 7.5yr4/4 none Is osg mvfr cs na ~ 1.2 4 44-9 7.5yr4/6 none ms osg ml na na ~ 1.2 ~~ y ~p U ~, tmuenr;F~r = rsw ~ su < z[u mgn_ and r SS >so < 1SO mg/L ` Effluent #2 = BODS< 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number David J. Steel v 248956 4ddress Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 9/12/2002 715-246-5085 ;r, New Construction Use: tY Residential / Number of bedrooms 4 Code derived design #knnr rate 600 GPD Replacement Public or commercial -Describe: Parent material Pitted outWash Flood plain elevation, if applicable na General comments L;Lt2[h uu~u.c~- r5 o h and recommendations: System elevation 99.95ft, trenches spaced and depth to code 3.50ft to grade ~`s / ~/ Z - ~o f Sew.- lr.P~a~~y 6~-~ - '_-~-(~ ~. Q Boring # Boring ' 96 / Pit Ground Surtace elev. 103.45 ft. Depth to limiting factor in• Sot Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz *ETf#1 "Eff#2 1 0-10 10yr3/3 none sl 2msbk mvfr cs 1 f .4 .6 - s 2 10-17 7.5yr4/4 none Is osg mvfr cs na ~ .7 1.2 3 17-96 7.5yr4/6 none ms osg ml na na ~ 12 i ys3~ „ ~~ ~ ~ sys~ ~ ~ q~. ~ " ,, ~S=6o~9~ `-f ~8 t ~, ~e~ Page 3 of 3 STEEL'S SAIL SERVICE David J. Steel 1564 Cty Rd GG CST-POWTSM Sienna Corporation New Richmond, WI 54017 Lic. # 248956 NWl/4,IVE1/4,S 2o,T29,R19w (715) 246-6200 Town of Hudson, St. Croix. Co. (715) 246-5085 The Glen lot 54 This sail evaluation way eondu€ted ttt satisfy- a zoning reQuirement, it may or may not be suita6k for your nse. The location of the test may or may not be as shown as permanent lot lines were not established at the time the soii<test- was ¢ondueted. Legend 1" = 40' • = Benehtnarlc El. 1OO.pOFt Top of /"5{e~Lpipe • =Alt Benchmark E1.98.'~SFt Top of ~ "S}e~lpipe o =Borings B s BI =103.45Ft B2 =103.45Ft 3 =10(185Ft B4 =00:OOFt i~~ x~ ~, \_ Property Owner Sienna Corporation Parcel ID # pending Page 2 of 3 Boring # ' ~"~ 100 85 Depth to ft limiting factor 96 i Pit Ground Surtace elev. . . n. ~ Applicat~n Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 *Eff#1 *Eff#2 1 0-15 10yr3/3 none sil 2msbk mfr cs 2f .5 .9 2 15-25 7.5yr4/4 none Is osg mutt gw na .7 1.2 3 25-57 7.5yr4/4 none cos osg mutt gw na .7 1.6 4 57-96 7.Syr4/6 none ms osg ml na na .7 1.2 ~- `~ (o . ?..cal Borna # < Boring - - * Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or Boring # Boring 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 NWl/4,NE1/4,S 20,T29,R19w (715) 246-6200 Town. of Hudson, St: Croix. Go. (715} 24b-5085 The Glen lot 54 This soil evaluation-waseonducted to-satisfy a Bening requirement,-it may or may not be suit~bk 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 El. 100:pOFt Top of /",s {,[pipe . =Alt Benchmark E1.98.75Ft Top of,,"~festpipe o =Borings Boring Elevations BY =f 03.45Ft B2 =103.45Ft 133 =l OQ:85Ft B4 =OO:OE?Ft ~d/, ,fb~r . , ' ~ ~ s~L~~' _ _ _ _ _ -- ~,, ,,-- j ,- ~ ip p ~~ /~ ~ .U ~~ -' ~ - S4~` ~ I p II •,. ~ y `` , _ ~ I' _ , , _ 1 '53 ,,,: ;~,, 56 ~i ~ L!~ a II _. r _ . _ tir \ II II .. ~ ., ~- .. • .^ - 5!`... _~ ~w•/.. . / t i /wJJ~ _. : \ 0 , ~~ • 1 • - ~ ~. .. . ,. . ;, a • : , ~ , -; '. ~ 57: it ~ I I , ~ Arv. / i• t / { _ .~ , -. \ 1 ~. - ..~w c ~Q 58 ~ ` l t , ~ r t ' L.' `. ~• 2 ,~ ~ .. ~~ 9 w' • • ! a! / , \ ' a ~ ' 1 ' ` .P , ti F p~'` ' _ - ~ ~ 83 -81;1 ., - \~ _ ; ~ 1 .. 1 ,' i , 1 a tl 1 ` t ~r r 8or~ r _. . f :. , f ~, i, t .•. . , , .. /. r w w_-- ... _. •~: , .: _yt~.- ~. 6 ... ~. . - / Y . ..... _ ... _ . '~ti~a..-..-sue- +`___a-~.._+. ! ,. a ~ : - '~ ~ .. -.. .' - ` i 't 1 t ~ : i ' t 238 J ` / r, ~~-, ~ ,/ ~ t , V ~:~ ~w t !~. J "f r7 ~ 1 g ~'y 1. r ., a~0 t ~ LC5 ~. N i r w ...~ 1 `.. -. ~w ~.r • a0 „~ - -~ -._. .J n. ~~\ -. FI ~ 1 ~ _ ,~ a R .~Kw is s w~ ~ \ :t t • t 1• , . ~ _.- , _ w r i s3 r E w~ •• F r,-. t '. al ~`O yri_ n e s ", ` ' • , }r ,' > ;Y'2 n ..... .a . Fa < ... t ~} . - 31 67z. n __ ._ i ' , . , w~ , ~ \ ~• ~ '~ .. • `. ~; \ l _ ... - - '.• \ 5~ Ia_ ,-.fit ;. .. . , _. _ ~ .. , ,, , \ . . • ,. w ~ i \. i r '. . .. rs 1 .~ .. \ ~ 1 i - .~ - \ _.. 39 _ ,i.. ., - ,~ t ,. .. ~ . ~~ =- ------ r t 9 ' - wI X11 ~ „w .'. \ - a\\a 1' .tl v~~ ~.. ~, w . ~• ' ~j 1 ~ '. , ,. t ~ \ ' F c ~' T43 ~ ~ , ..~ 38 -' 332 t I ryQi r r :~ r!-,``LII t a a' \ t 1 r1•.:' X 1 1-_ '-e \ r , i / i (/\~ ~ ,r- 'i. 4 r r.~, r I I a 1 , f . ' i ! r „ I I' , . I 1 ~ ,• ~ -rn .• ,, r ~. , 1-~ -1 1 `j \t -- r ~ 11 1 .. a _ I 1. 15 i I t. ~ `~b ,, ,a ~ ~ ~ r ~ t t __J~ I ,~~ ~ t t F t ~ 1 /.,' If~ ,. ,a , . ' \ \ r '~~~~ ~~ 1 ~I~t . , Fa\ 1 aat aa. aa\ ,af~F" a\ - 1 i ' 1 1 f.1 p I 1 ' ~ (I ~ 1 i~~ 1 I/ 1 1 3 1 /~ ' , i _~ 5 s;~ A •~ ~ ~gg ~X N •N ~^ ~~ 4 ~~ ~ ~ ~ ~ `= ~a •. ~~ N i N_ p~ JR j % a ~~ ~~ • • ~' ~ ~ ~~ ~~ ~p .~c~i o~ ~~ N ~y ~~ ~: ~$ i~ ~tr . ~$ ~z g• 'i ~' ~e ~r ~~ s E 3 i c _ --- r p '~ D r m 5 H m .~~. A Oi ~ ~ e . ~ U? b p w ~ ~ m ~ O 3 a _. fA U7 ~. O ~. ~ ~ ~ x x (~ x V to CJt X W -+ w ~ • ~ ~ -G i^r. ,/~ 2 ~ ~ ~ 1 W ~ ~ n ~ ~ ~ g ~~ :~ ~ ~, ~ a~ a c m~ ~~~a~ o to ~° -~ ° n, o cis ,~'~~wm ~~ o°',o~ e~ ~ d , N ~ o ~ ~ ~~, ~,~, ~~~~ n ~a~~ .~ a3~ v' ~~~~~ ~ ~ N C~ ~ _~ ~. A ~ ~ o ~,=:~ ~~~' ~~~~ ~• c~ m N a a i Envert 11'--•~ r ~, s b n ~ ~N ~ ~" ~~~ ' ~ ~~ ,~ a 0. ~ ~n ~~ rt ~~ ~~l ~~ qd 4 W C T• •J '~ - .. ,,,,; t ~~ ~~ GOU LDS PUMPS ~~~~lll ~'~ lei) li~~~ !~! ~~~~ ~: Submersible Effluent Pump ~~ 3871 EP05 APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: 3/a"maximum. • Capaaties: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: l'/~' NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) 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 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: l 0 foot standard length,16/3 S1TOW with three prong grounding plug. Optional 20 foot length, 16/3 SJTW with three prong grounding plug (standard on EP05). • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- maticmodels 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. MtItKS htt 10~ ^ EP05 Impeller: Thermoplas- ticenclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for effiaent heat transfer, strength, and durability. ^ Motor Cover: Thermoplastic cover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upperand lower heavy duty ball bearing construction. AGENCY LISTING ~' Canadi~ standanls Assodation (CSA listed model numbers end in "F" or "C".) Goulds Pumps is LSO 9001 Registered. 0 x u_ ~d z 0 a 0 10 12 m3/h cAPaarr Goulds Pumps ITT Industries ®2000 Goulds Pumps Effective February, 2000 83871 •~°, cz v~xs asps ~2~~ r:rN, AsavE ~RA~D ~ ~ ?~ - FROM DOUR, WI~yDp~t CR +~EAl'HERAROaF FRESH"AIR iN•TAKE JL'hCZ'ION 8aX ApPROvEA ~~~~"'~ '~IxH CONDUIT `SA.'~t~4LE CG'J E F+NIS#iED GRADE W/ PADLOCK ~ ~" CI RISER ---~~ ~ WARNING LA.B£t, t ~~ `~ ~ ~ ~ fi ~ i ~ •, .h'LET --lv '~ r--,~ ~ , WA.ER TIGHT SEALS ` ~ `" GA - 4 ' _.s_.. ~ T ~ ~ APROY£D ~FPROYErs A SEAL JOINTS WITH ~i¢~ ~ ~ ~ $ -~A.;M ~ ~ APpf;pYEO P CPS ,p,(, C ~ SOLtO, SOi~, P~3MP vFF 1~LEV. ,_,,,,,,,F7, -..~.-~ ~ w`"'Ori ~ ? `~~ RISER EX*T D ~ PERMITTED O~ti„~.' ~. ' ~ IF TANK !rlAKi~FACT'~R~R. 3" APPROVED BEDDING UtiDER TANK •~ S APFRQVAL SEPTIC r DOSE TAtiK MANUFACTURER. TANS; SIZES: S£P;'zC DOSE PECIF`ICATi~:e'VS fa.'~ ~.~.r Y „~~,.`s'd ....... GAL . ~4v ,~ CAI,. ALAr~M A1AtVtJFACTGRER: ~~L~~~ ~~'"~` MODEL NUMSEA: .~l?t u SWITCH TYPE: ~,.~ .._.. P,~,? MANUF'AC'TURER ; MODEL NUMBER: SWITCkJ TYPE t ~EQJ IREA Di SCHARGE R,AT~ ~p G w~h'~R£TE PA'J NU!'4dER DOSES ?ER DAY: ~ d~~ DOSE V C ,UME 31~'C ;~UDrNG Fi,Q~iBACK: !ter GAL.. CAPAwI?I ES: A : .~._ j:~G:?E5 ~ .. CAI.. .~. 8 ; _,,,,,,, x I4'CHES tt ~~ ~A;~ , `~ ~ PUMP ,~. A:,~ARM WIRING AS : ER Zi~F3R I6.23~ t~~a~ JERT:CAL ~;~'FERE,YCE SE^~."W.E,~ij_.~-~.MP OFF ANI~.~`.?"STP,T HiJ i 14N PIPE ~ MINIMUM NETWORK SUPPLY PRESSURE . ~ ~,~,,, FEET f QRCS'MAiN X 7 ~p £T/i~4 F;~, FRYCT:c~N FACTOR T•OT.~,I~ DYNAMIC HEAD :;tTERNAL DIMEA'SIQ;~`S QF FL'M? :A,tS}:: LENG,y LIC~UID ~""' ~ DTH,~ 0 /,s4 F"k"~T • FEET • ~ ? FEET N ..,~ rr E;,: ~~~ Pt7WTS C?WNER'S MANUAL & MANAGEMENT PLAN Page __ of FILE lNtrQRMA'liCyN Ownor Permit # ~ ~ Z t~8lQN PAt3AMETERS Number of Bedrooms ~ p Nq Number of public Facility Unite ~ NA Estimated lbw t+wersga) ~'8d al/da peaign flow !peak), tEatimated x 1.5} ~~ ~, elide SoN Appiicatbn Rata elide /ftx Standard influentlEffiuent Quality Monthly average" Pats, Oi{ & Grease tPOG) S30 mg/L Biochemical Oxygen Remand tBODs) 5220 mg/L ^ NA Total Suspended Salida tTSSI 5150 mg/i.. Pretreated Effluent t3uaiity Monthly average Biochemical Oxygen Demand tt3O134i 530 mg/L Tote{ Suspended Solids tTSSI sat) mg/L G NA Fecal Co)iform tgaometric mean) S10" cfuflObr7til Maximum Effklent Partkte Size Ya in die. ^ NA ~f'e" ~ DNA `Values typical far domestic wastewater and septic tank effluent. SYSTEM $PEClFlCATlONS Septic Tank Cspaoity 2 pT al DNA Septic Tank Manufacturer ~~ ~ DNA Effluent Filter Manufacturer ~ .~ O NA IeNluent Filter Model d~' d NA Pump Tank Capacity Q'd' al d NA Pump Tank Manufacturer ~~BS v'si ^ NA Pump Manufacturer ~,,..4/ O NA Pump Modal ~ ^ NA Pretreatment Unit O Sand/Grave! Fllter ^ Mschankal Aeratbn O Disinfection t7 Peal Palter ^ Wetland Q Other. 0 NA Dispersal Cents} O ln-t'srdund tgravityi ©At-Grade D Drip•Line DNA Q !n-C;round (ptessurized) O Mound ^ Other; Oar; O NA ~" DNA ~ Ehherc 0 NA tYfAlAi'TirNA1~CE SC~OtilE $ervikle Evsrtt Service Frequency inspect candkbn of tank(s) At least once Avery: 3 ear a) s trdiax>~ittm 3 years? ^ NA Pump out Contents of tanktsi When combined sludge and scum equals one-third tXd) of tank volume DNA inspect disperaa! ceilts) ~ At least once every: ~ ~~ jtsj tMaxfrrwem 9 Yvana! [7 NA Clean affluent fiber At least onoe every: 1. ~~ sl ;~' ®ariei O NA Inspect pump, pump controls ~ alarm At least ones every: ..-- morttthtst O arls> O NA r;iush laterals etsf pressure test At least Inca every: '""` rrwnthtal p yearts) DNA otMr: At least once every: ._..- O monthtel p ants) ^ NA Other: Q NA lVI+4lN7ENANCE tNSTRUCTiONS tnspecticna of tanks and dispersal cells shah be made by an individual carrying one of the following licensee or certifications: Master Plumber, Master Plumber FiestriMted Sewer; POWTS inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspactione must include a visaed inspecticrr of the tankieJ to identify any rnissdng or broken hardware. identffy any cracks or leaks, measure the volume of combined sludge and scurry and to check for any back up or ponddnQ of effluent on the {around surface. The dispersal oel6tsi shall ba visually inspected to check the effluent }avels in ~e observation pipes and to check far arty ponding of effluent on the ground surface. ')'hha pond'ing of affluent an the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accur~wlation of sludge and Scum in any tank equals one-third tY,) or more of the tank volume, the entire contents of the tank shelf be removed by a Septage Servicing Operator and disposed of in accordance witi~ chapter NR 113, Wisconsin Adtnlnirtrative Code. Ati other services, including but nor iirnited to the servicing of effluent ftltera, machan°tcad cr prsseu-ized campononts, pretreatment units, and any ssrvb~g s2 intsrvala of s12 mcnths, shall ba perlormsd by a certified POWTS Maintainer. 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AID O'WN8~t8PIIt' C~''~'iG'~~ 'Ft3RM ti et' ~! ~JlllJla C.o tE' ~d ~'"n O ~ ~ ~.~ ~ Ow~B Y p rJ /"'~ Vt r ~ ~- Su c~ 1v~6 ~i1ia~ ,r'-ddross q,ddress `7~~1 ~~" e ~ ' ~'~~ ~ ~ ~~ uierd tra~m- Plaesp~t D0p"`~ee fas ~ eeasttetctloo~ . Zb `f'~ • ~~ ~t/LtiSorJ ltl~ Pascal Ydaahfica~`aa Number O2 qty ~Z,GAL brSC~''_~.L ~ N ~ ~~ ~ 20 T Z~ H.~`~~+ Soa-n cf Nut~-S 'Pcrop~Y 4a ~ ~'' L`1.:= l`' Sac. ,,,..,_,a .--~--~ Jry Subdiviszaa pn~ # ~. voi~-c ,~---~. C.crtified Sunray Map # ~ p~ga ~ r 3 Deed * _ ~0 ~P ~~0 - ~ Volursae Wam~-~' ~ O no Lot un~s ido~~le ~ ~'~ ^ t-a Spa ~wu~ ~ Y ~^ nne~iileue ~~~ S~'~rq'_.__~• b~~~ ~ QE yov~ ~e ~yttau erould ie~t is its ptam~ fp ha~dk~'~syt~s~ ~ m ~ ono' to if arpdod by a licensed P~Pie'~'. off pnmpiaB ~ ~ ~ ~ a ~~ ~~e~tbc.+sste dirP~ ~• b a csrl o,~t ~ Sian o'f ` ~ ~. ~ by ~ owner ~d Y The gtvp~artyr owa~c agseas fa t~b~ to 9c Gtoi~ tsrai~ ~irtdtylt~lbd (1) ~ a~~'or'atisdtispes*1 iyooam lussber~ adplum6a or a litaosed ~ txdc i~ lei t6sa 113 t~ of ~ludS;- a~~plmmLrr. jatutaeyaisnP aad gumpiaL Cd aec~t7r)- ~° ir. io ptq+~ agaatia$ eoed~tioa ~ad/ot (Z) alien tasQe~+ao Leda llte~ tbs ~~ .~,.~i,,.,.., b`~ ~ ~il~tC iC1y~ Oil CVO 1CLt~ ~ •~ "'`t'"""~O~ ~~~' Ott 0~ ~' f/we, dte,~detaip,~e~d t of Co ~ ~ °,~b~ ~e~ Yypiu~ Of~''hthin 3a ea ~ beeo~a. ss sct by tb'e D~opottttua _ to +be St. ~• Cary M~ ~t~ ~ ~ ~~ . _ ., ~ DAB v ~~ of )VVl~tF',~ ,RTI~+'XC O ~o~ted~e. i (aej am dare) tho atWnoK Y ) ccttify tbat ilY ars a this faun erc true to t'k~ beat of mY ~~ ei~sen abov a .~-arrattty doed rototdsd is AuSi~' °f Qe~ ~• ~ tI D!-T'B ~ j) raemedt ~,rsrs Aay f~atorcna6oa is tnis.~nspwseated msy rrsvu is tlLe tstdtary pcznait bofng rev~ofamd by the ZoaiaB eP .. ~r.ww s. tieatlo~s: a sued wartsaty decd final tbC ~8~$ df Dew o~ Ltetude .vith Wis app s eaP!- ~ the eatCiScd ~ri-ey ~P iCtdet'~ ii t~ is the ~nry decd TOTAL P.02 S'tATG 8AR OF WISCUVS!N FORM i - :998 WARRANTY DYED E't.F+Ey08t0 ' /~`] KATHLEEN H. WAL9H aoaumK„ NWnOtr ynr ~ 7,y a PAGI 61 ~ ~rOISTEk QF' DEEDS :' .. .. _ ,aT. CKOIX CQ., WI Thin Deed, math between Banet Cors+otat'ton. BECEIBED FOR 9ECAR6 __.a Minns~eota aoraaration '"' 3Z-21-2VY03 3:1C PA -r.~. _ _ -----~------'-- _ ' and ^_~ln~Coracararton- a M7 ---.~--•. Grantor. ~T Y ~ riAL811ta c,-erno~ati~.~..~_._ 1 I'pp1' FEES "" ~- .----._.--- TAAIiFEIttfEE: 9A63.1(t ._-~. ~" °".~-'--,-----'----...- _ k~a~l DING FEf: 17.00 ---..^....._......._..,~ Ci rARIOr. (Of a vatuaDh GORSldortifon, described rwl tttab to S t; • Csot% _ Grantee. t 4 COnWy~a t0 Grantee the r0$Owing (the "Property'}; Y Sate of Wiacansin 9Ea ALtatshed Exhibit A ~+e: ri Wn a rroa rael .. ~ sk^wend~Ae3urnAdd :. .. . Lr niikr~st~ ~ ~~ '- 5~~ 5 me.}~r~ Ur' + ~. ~Si-+.i~. ~fC3~ ... ... . .. 2o-l04b-so-oao © ~ Prim IdMliapatlOn frytnDar ~ "~'~'~! Thk ig nat . homestead property {!s) (k na) 20-1048-68000 20•!04$-90-ODO 20-1069-90-000 zaloso-aaooo zo-loss-ea-aoo io-loss-ao-ooo -- so-lost-7o-ooo logather µ~ith ail appurronant rtghu, tula and intrersU. hvtantor warrAnts that the tti3e to the Property 1s goon, trxlefessible In to alm plt and free and clear of encumbrsncra txctpt Sss Attached Exhibit B. ;I Dated :hts 20th _„ day of Dees~„__~~_, _2DtJ1 Bane r oratiots ~ jj'''~' by _ I ~ [ I{ J,/ _...._ (SEAi~ ARIA' Boa 14, Nasre -. Its C of Ex~~cytive Offic {5EAL1 AUTHENTICATION Ssgnature(s) au,henncated thla dey of ?!TLF. h1EhiBEft STATE 8AR OF WISCONSIN (if ,~oL authartutd by 8706.06. Wls. Stats.} (SEAL) ,, ~~ ~~~ ACKNOWI,BDGMENT Miattsaota Seats of itYfrrCtrlAtt- } ss. _ k,. ,.......~ _ County~ J PerWnally came Defora me Ih,s a\t day cf Dacolnber John M. ylaass!£ Chta~~~utive Office of Bane Coraoration, a Miansaota cor oration '--- me known lp yc die to / Pt~;~ %~.~ who eat:cuted the foregoing instrument and adtrt~wl~ifoJrl,.'"....,a tH;$ ~N87RUM[:N7 Wqa DRAFT 3?0 BY ~~ ~ ~~~MMM Lac&rit# a Grindal Law Firm '~'~ ~ .~, - f~~e'tiAIJ.AFfQR Minneapo2ia~-~NA S~4p1 /~''N,!~~yr9'~'D1tc,SateofWtxcon>tin ~~0°°tf°°e'D ($;Q1ktl~.;rts may be•aut}lenueated or acknowledged Both an not 3aauaryas3~ is permanrnt, (If not, state exptratlon date: nn.rssary) ~~ ., ' h',rne, of ;»rswis up:irq to any tspaeu Muss Ds t ... - ..... ~ ~ ~ ...... Y YPed o: pNnsrJ bNaW char uaa~uut ..... ... .. WAkRANtt DEtD S7AT8 8Ap OF M~I5t:avS2N RORef Na 3 - 19111 +~'"twnan ~spY Olane Ct., Me. ~turee. ins. ~~~ ~~~~~~ .~