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HomeMy WebLinkAbout020-1430-50-000Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFC,>RMATION (ATTACH TO PERMIT) Personal infdrmation 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 EI v: Insp. EI~ BM Description: ~ n . c~.a. S 3 TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ J l~ /~ ( Dosing ~ ^ t l!~„~,~ !.~ Aeration Holding TANK~3ETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ l ~ s-r Dosing n ~ ~ ~ l 4 ~ ~ Z Aeration Holding PUMP/SIPHON INFORMATION _ . _.~- n~anuracrurer ~ _ n S odel Number ~(-;j,/`~~y.~!' ~`^ t l°' `~ H Lift ~ Frictio~ 044 System Head .~ ~ ~..-. Forcemain Length ~/ Dia. Z tt Dist. to Well SOIL~SORPTION SYSTEM ~ S1L .~..,/,,,~..,., O Ft ELEVATION DATA County. St. CroiX Sanitary Permit No: 430009 0 State Plan ID No: Parcel Tax No: Section/Town/Range/Map No 20.29.19. Z STATION BS HI FS ELEV. Benchmark ~83 30 1• Alt. B Bldg. Sewer $ ' t 9~ 31 St/Ht Inlet ~'~ 3. ~o' SUHt Outlet Dt Inlet DtBottom ~3•>75 ~_at Header/Man. ~ . ~5 ~ ~ •~C Dist. Pipe Bot. System •kra ~~~~ Final Grade ~.30 ~ ~/ over 3.80 ~ 3 RE C Width ~ Length No. O Tre ches PIT DI N IONS No. Of Pits Inside Dia. Liquid Depth DIME NS 3 ~ wces 3 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING M nu urer: INFORMATION CHAMBER OR ~ Type Of Syst ~ : 4 ~~ 1 ~ ~ ~ ~ `~ UNIT Model Number: ~n K ~ DISTRIBUTION SYSTEM ls~-Fe Rs...Q„ R.. a.4+~tJy~,~ ~,. Header/Manifold 1 ~ ~,,~, (,.~• Lengt S Dia ` Distribution Pipe(s) Length Spacing x Hole Size x Hole Spacing Vent to Air Intake y SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth cf xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil IL.= Yes [] No G ', Yes f` No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~ ~~ Location: 423 Wren Lane Hudson, WI 5_4P _116 (SE 1/4 NW 1/4 20 T29N 1 W) T e Glen of 89 1.) Alt BM Description = rj +T . t~~K~ Cd~>~/. ~~~ ~, j W~ ~ t~~ 2.) Bldg sewer length = ~ /u S, ~ ~~~ - amount,pf cover = ~Z'f~'a'tg' , ~ ~ a ~„~~L~p~ Q~, Plan revision R wired? Yes o ~ S ?,~U ~- Use other side for additional inforrpa ' ~ ~ ~ I l~/-w Date ~ SBD-6710 (R.3/97) ~ _L-. ~~ Inspection #2: TT P cel No: 20.29. 9. ~~~ vv Sys we. Z-'3 ii S Cert. No. ~~ ~~~ Safety and $uildings Division 201 W. Washington Ave., P.O. Box 7162 County ~ ~ GYO ! ` ~ ~~~~~~,~ Madison, WI 53?07 - 71b2 Sanitary Permit Number (to be filled in by Co.} ~ De artment of Commerce (b08) 266-3151 3ppd Sanitary Permit Application Stan Plan I.F. Number personal information you provide Code 21 Wis Adm ord with Comm 83 In c , . . , . a c may be used for secondary purposes Privacy Law, s15.()rt(1)(m) Project Address (if different than mailing address) , I I. Application Information -Please Print All Info RECEIVED ~ ~ 3 (,,,i fZE1~I L.Ar~I? ~ Property Owner's Na N, ~~ G ~ x ~ Parce] ~/ ~Lio'tdM Block ~ ~ ~ u Property Owner's M ailing Address ' Property Location ST. CROIX COUNTI ~~`~~ ~(Lr~. Q' C j~ ZONING OFFICE ~~ lk,~~,,4,Section ~ e Gyty, Sim i p Cod Z Phone Number _ ~ - + / S'o..~ ~ +,. IJ ~`~c ~ (circle ) ' ~E T ~ ~ N; R k all that a l ) h f B ildi ( II T „ ec pp y o~ ~ c ype o ng . u ~ CSM Number Subdivision Name ~2 ar 2 Family DweElittg -Number of Bedrooms ~ ~~ ~ ~ l -Describe Use i ^ P bli lC ~ "' " ' ' ommerc a u c t ~~ S ~ '' ' ' ' ' 3 ~2 ^Village~fownship of i ,,,/ ^City r • iC o ^ State Owned -Describe Use ~ _ III. Type of Permit: (Check anly one box on line A. Complete line B if applicable) ' A' .New System ~ ^ Replacement System ^ TreatmendHolding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ~ ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration i i Plumber Owner IV. T of POWTS System: (Check all that a 1 > ~ ~ C- ~ Non -Pressurized In-Ground ^ Mouad ~ 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Fiicer ^ Recirculat' S nthedc Media Filter chin tuber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. erseUTreatment Area Information: ~' ~ ' T'~ Tess' i Deitign Flaw (gpd) Design Soil Application Rate(gpds Dispersal Area Re u' (s~ Dispersal Area Pr_opased (sf? System Elevation ~~d ~ ~ ~'S~ 1 ~- VI. Tank dnfo Capacity in Total Number Manufacturer Prefab Site Stee( Fiber Gl Plastic Gallons Gallons of Units Concrete Constructed ass New Existing Tacks Tanks Septic or Holding Tank ~ d ~ • e ~,Y ~ Aerobic Treatment UNt I Dosing Chamber ~~ ~ ~ ~; '~C ~,, VII.'Itesponsibility Statement- 1, the'tlntierstgned, assume responsibility for tion of the POWTS shown on the attached lens. Plumber's Na me (Print) Plumber's Si gnature MP! PRS Number I Business Phone Number Plumber's Addre ss (Street, City, State, Zip Code) ~~ E ~G ~ ..lJ 6C/ / J~ GY 4~ VIII. Count !De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued lss ' gent 5ignahue No Stamps} ^ Owner Given Reason for Denial Surcharge Fee) Z.Z~ rt' IX. Conditi~~oeen~Ds of Approval/Reasons fo Disapproval tt ~.~ ye~utl~ ~ lrwa~ b2 tM ------- 1 ~- ~~~ wttaCa Complete place (t0 tpe Cetmry aoty) ror tae system on paper nor rasa wau oa~o a ,+ ,,,~~~a ~,~ a...s SBD-b398 (R. 01/03) ~~ E' ~ t°_ l~l~ ~Tc ~ s ~ ~ y /if ~ ~i~ e.,v ~~ a1,~J cf /~ ~a~f S'~t,.cL__ ~ CEO ~-a ! ";. yp ~,~i~/ ~~ae lop ° / B/~!_/~G~ EGG l©0 0 r ,~ 3 ot.s ~ ~ `~~ !a ~ ~~v s~ G !Ji t`7l ,6~t ~ ~lQ J „ tW"~ I ~~ ~ ~~ ~p~ ~ ~ ~b C~~ ~ + ~ k v ~ ~/r12 ~ (~ ~ ~~ • ~~ i e ,~% I Y l~ ~~ ,. f. I / ~Ii C d ~-8 ` ~ ^ 4/Q r ~ ~~~ , ~~GG lD4 ~ - loss ~ Wisconsin Department of Commerce SE)1~ EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel Soil Service A#tach complete site plan on paper not tessthan8l: x 11 inches in size, Ptah-must C ounty St. Crooc include, but not lanited to: vertical and horizontal reference point {13M}, direction and percen4 sbpe, scale ordimemsions, north arrow, and location and distance to nearest road. Parcel I.D. pertdtrtg Please print all infomration. M... ~, ['ersooal ~tarrr+atisrrr ~ pra,ddernay be useEt i' tl'+~+, s.1;~ tW (t) (m)). By Date ~'`ll'Zg 3 Property Ov¢ner c, ~ "~" " ~~" ~ Property Location Sienna Corporation Govt. Lot ~€ 114 NW-114 S 20 T 29 N R 19 W Property Owner's Mailing Address- ' ~~ ;t '..! s G i [. L~ # Block # Subd. Name or CSM# 4940 Viking Dr, Suite 608 ~ 89 na The Glen City State Zip ode ~trorr~.Nuhiber ! J City ; Village Town Nearest Road ~~i ~/li, MN 5 3 " ~~ ~'~.~ti-°~~~~~~"' ~~ Hudson Carmichael Rd. New Construction Use: ~!! Residential /Number of bedrooms 4 Code derived design flow rate 600 GPD ._ Replacement Public or commercial =Describe: Parent material- Pttted outwash Flood plain elevation, if applicable na General comments and reccxnmendations: System elevation 1fl1.15ft, trenches spaced- and depth to code 3.5flft bekmrflrade a# _ ' ~~ _ _ _ ~ _ _ __ ~ Pit Ground Surtace elev. 104.75 ft. Depth to in. limiting factor Soil Application Rate Horizon. [)epth Dominant Golor Redox Description. Texture. Structure Gonsistense Botxrdary Roots. GPDI~ 'Eff#1 "Eff#2 1 {}-1fl lflyr'3/3 noire. sil 2msbk mfr gw 1# .5 .$ 2 10-26 10yr414 none sicl 2msbk mfr gw na .4 .6 3 ~-32 7.5yr4/4 none Is osg mvfr gw na .7 12 4 32-96 7:5yr4/6 none- ms osg mi na na :7 9.2 ~ dol. ISl Boring # ' ~ Boring ' i i !`; Pk Ground Surrace elev. 104.75 ft. Depth to limiting factor ~ in- Sod Application Rate Hrxizon Depth Dominant Gobi Redox Description. Texture Stricture Consistence Boundary Roots GPD/ltz 'Etfi#1 "EtY#2 1 fl-12 1flyr3/2 stone sil 2msbk mfr gw 2f .5- .8 2 12-31 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 31 ~6 7.5yr4/6 none ms osg ml na na .7 1.2 `f3.2 ~.q.Z ' Efrtuent #1 _ t3C3D ~ 34 ~ z20 frrg!l_ and. TSS >3f3 < ? 50 mg/L ' E#fluent #2 = Bc~Ds < 3(t mg/L and. TSS ~ 30 mgLL CST Name(Pl~se Print) Signature: CST Number David J. Steel / ~ 248956 Address Steel Sail Service ` ~ Date Evaluation Conducted Telephohe Number 1564 CR GG, New Richmond, W t 54017 9/3/2002 715-246=5085 . Pcoperiy Owner ~ie[trt~ CAr~pr~ti 1 ~ I i3oring ~ Boring ~~ Pit 1 0-9 2 9-16 3 16-23 4 236 10yr3/3 10yr~4/4 7.5yr4f4 7.5yr4/6- - P-arr,~-#G-# f?~p~?3 Ground ~~ ~. 101.85 ft. Depth to limiting faotor 96 in. Redox Description Texture Structure Ca~sistence Boundary Root: none sil 2msbk m#c gw 1 f none scf 2msbk mfr gw 1f none sl 2msbk mfr cs na none ms osg ml na ~ na Boring # Boring tape 2 of 3 Sal Application Rate GPD/ftY 'Eff#1 *Etf#2 .5 .8 .4 .6 .5 .9 .7 1.2 * Effluent #9 = BOD ~ 30 <220 mg/L and TSS >30 < 950 mg/L_ * E~uent ~ . $OD < 30 cragCt_ TSS- <_,30 ~/~ - -- - - b T'l~e Department of Commerce is an equ~1 opportunity service provider and employer. if you need. assistance to access services or i3ocing # .Boring 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 SEI/4,NW1/4,S 20,T29,R19W (715) 246-6200 Town of Hudson, St. Croix Co. (? 15} 246-5.085 The Glen lot 89 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 estahlished at the time the soil test was conducted. Legend 1" = 40' Benchmark EL 100.00Ft op of 1/2"pvc pipe ~o --Alt Benchmark EL 100:00Ft op of 1/2" pvc pipe a =Borings Boring Elevations Bl =104.75Ft B2 =104.75Ft B3 =101~85Ft B4 =00.OOFt 3 ~ 3~ ~~., o~,j~~' ~~,lo3,to~~ si, ~ol,4ti~~'' ~ S d- 3°a , S/e~ to aQ ~ ~y, ,6, ~ ~o~ 3S' 32' y6r lµ ~~~ q_ 3_aZ /01,3' Sa ~~-~ 1.-oj- ~,; ~ r . _. _____-- ---~" _ ,- _~ ~.: ,. 1- - ,f a :~ n -- ;/ .. ~, Y df. .--~'! is ~ . c ~~ ~A ~ 'ry'r ~ ~ - - f ~ L ~ - I - - - _: _. , nr ~..._ ;.. _ ; ~ /~~ r ~` I / r -^~. ~. ~• 417, ~ :~ ~ .'. • - '~~'' _ '/ t ~ _ ~ ~' `, ~ ,, 158 ~ - sr. ~ . ._ .. _ I . . ,, + w - •~ - " \ 4 as i ,, i _ ~ I `•0. ,.. `:r,. t `.:. pp ~. I W 1 ~~ r OV / ~., r a i / , r ` ~ 2 .-_ ~1 i. ..~ r ~ ~ 1 , r .- ... _ 193 t t . `~~ 79~ 77 r , '~. r" ~~ ~ , .- 1 , 1 ; { ` ` ~. I 4 .345 - J .. - ~ ..` ., ~ ~ , r ... ;' , y - - ` ~ ~-.... f t t -. r ~ _ ~. ~ ~ f ~ .; . ~ '- ~ ~ _ rr of 7 ~ a I ~... - » r 1 - ' ~ r a ~ f.. to r+1 _ ~ _ X44' a ~, {tiS; at` ~'~'-;mr~ ~ a 4 ~• t If ~ (. to rr 3 t _- 96 ; ~.'°,.?- _ "~ q?~ ~~ 5+; ; I a fr 1 r'. ~-.1`f ~ ~ i\ ~ _ t tr~A _+f I I I I' ~~ _ \ ' to ~f +~ .. ` . :. t , a ~. f a _y~ f t ;-4 A \ . f, :• ,,; ,;~ 'aa rr ,~ ; =' :, `: `. _ ,, . ~, -. ]` , . `. _ .. a ~ e"' ~ . ..' ~ _. . 7.. ~ ~.., + r r r ~` f , + to + r r ' 23S r/. 11 ~ ,/ .. `.. ~ ..` A i r i r :' '~~--, as i ~ft ~, a, r .aa + -_~..i- .. 9'! r \ r f ~t f / at a a. t _ i r 1 1 I :7 ,. ~-• \ ! - ,r ti r. 1 ., J / i :aal t ; ff.tt ~ i ; t .,: ., ~ ,' _ ,~ ~ f ~.. T s r to I+ L:f, .il a , r , '., 4 r t `a ~r t f i r _. -... . - .. ~' i i \. ... 5 I. L •. r r- _\ 33 a ~, , , ~t i~ f~. ~\•-5- + r', .~.. '.ft 'k i r,. rr r. t t 1 r r f +~ + 1 1 . ` Ye , t _ -. 1 ~ (' , e r ; a t- ~ `M ~ j.l U . ~ 1 . L _ .. .. 11 ' - I I m i i r - ~: i. t ... ~ t f: t r ;I f-I ,i - 1 5 ~ ~• 1 ;: ~ ; ` .. ~~ r.; ` f~ , . r ~ y F t' a ~~I' s_r r 1 \ / ;. t ,1 + _ .~ ~ a ~~ 1 . r , ,, ~,, ,~ 14,t~ ,, ., a, t r _ ; ,. ~ ' ~ i,, .~ ,,~7 .1,.1 t- - SEPTIC TA.:~K € c'L3MP GHAMBEF~ Ck~SS ,~;CTION Ar~~J SP£CZFiCATTGIvS ~+" CI VENT PIPE 12" MIN. ABOVE GRADE ~ > 25' FROM DOOR, WINDOW OR FRESH AIA INTAKE FINISHED GRADE ~„ CI RISER ----~ 18" iN. 6" MAX. [NLET 1 ~~ ~ ATER TIGHT SEALS -PPROVED 'IPE 3' INTO SQI. I D TOIL PUMP OFF ELEV . FT . WEA~'HERPR40F JUNCTION 80X WITH CONDUIT `y~ ~•~ _ ,' , ~, i ~ Gas- - T+GHT ~ -~ SEAL ' LM ' ON ~ , ~ ~ ~ DOFF APPROVED MANHOLE COVER W / PADLOCK & WARNING LABEL _...4" MIN. ~~ /APPROVED JOINT5 WITH APPROVED PIPE 3' bNTO SO3.I0 SOIL ~~ RISER EXIT PERMITTED ONLY i F TANK MANUFACTURER HAS APPROVAL A 8 C _"~'"' D 3" APPROV ED BEDDING UNDER TANK SPECIFICATIONS SEPTIC / DOSE NUMBER DO5E TANK MANUFACTURER: ,~J~~~ TANK SIZES : SEPTIC ~aS ~ __ GAL . DOSE VOLUME DOSE ~ 6AL. ALARM MANUFACTURER: ~~v~_~ .~ MODEL NUMBER; ~~ v SWITCH TYPE: y}ierc PUMP MANUFACTURER : Gnu/ ______ MODEL NUMBER : ~' SWITCH TYPE: REQUIRED DISCHARGE RATE ~(~1, GPM CONCRETE PAD S ? ER DAX INCLUDING F LOWBACIC : 1_,_,~~~ GAL . CAPACiTIE'S: A = __a_. SNCHES = ~~GAL. 9 ~ 2 INCHES =GAL. ____.. C = ~_ INCHES = lG„_,_8 GAL. D _~.,. INCHES = ,,,fe?_.~____GA L . PUMP ~ ALARM WIRING AS PER ILHR 16.23' WAC VERTICAL nIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE 1•? FEET + MSNTMUM NETWORK SUPPLY PRESSURE FEET + (~ Q FEET PORCEMAiN X ;1.60 £T/ I0 0 FT . FRICTION FACTOR /~~ FEET ---~-'- '~"'"- T.OTAL DYNAMIC HEAD = f~ FEET .INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ~- ~ ; WIDTH - r„_; DIAMETER ~,,,_,,, LIQUID ~~__ 3~___--. ~f~?~./~D~y ~ ~; SIGNED: ~~~/•' ~ f~~, - _ LICENSE NUMBER: ,~??79Q0` DATE: .~ ~ 03 1/8f~ C~~ ~~ lAlPt~lCAT!!~ ~Sl~desipnedla'the • ~ . • tlvmae Fad • ~ .per fir' fEP0~1 + Solids handing cilllty; 'I4 msadmum. p fiap~ldes: up try 55 Gi'M. • Tcdal heads: up ~ 2A tAet~ • pfrge ~a: tVP" 3~PT, • fNechar~icai aeai: carbcrn- rota ~cwarnlast~y, auN`~-~ elaatGmers. • Teml3~raturo; 1i}4•F 4C°'C} t,~ntinuGtts 14Q'~ ~500°C~ interrr~ttent. ~ ~A$t8AeC8; 300 Belies steirtiee$ steel, • dYYi~~art~t}t~t48t1181QB tQ '~'~tyMr~r 1_~{r~rf • Salffls herldling Capability: ~~'rna~cimum. + Capaoit~s: up to 60 GPM, • Tatai heads: up to 31 feet. . • Gtschurge ei~ i'~" NPT. + fllfeohtlrriaal seal: c~arhon- /t~6rart-1C~3lott8ry, etsatomers. • '~~~l5~dttUCtre 14C~ ~80°Gj int8t'itl~8nt. c~) O t~ ~OIdd4 Pub, r-w. • Fastesters: 3U0 series mess ~eei~ • ~ of Nnning dry ~QUk damage tG CamAalerts, I~Ot: E'PQ4 SIr~~ base: 0.4 HP, i 15 or V, 60 Hz, 1550 RPRA, built in overload with automatlC reset. • EP03 8lnpie Phase: 0.3 HP, ~ 15 v, 60 fit, ~ ~~a FPM, built in overload with • Power contoat etsn~bErd length, X6/3 SJTG with three prom r~round!ng plug. Optional 20 foot ler>~pp,1fi/3 SJT1N with startdtsrd on EPg5);nQ plug N~'r'E14g , FEET iQF O4 S ~ ,-~ ,; ~.:a ,.; U i ,: 5ubmbrs~ble Ef~~u®n# Pump EP~4~ E~~5 iruily submerged In high grade turbine all !or tttbrroet-on and ettlder+t heat traneter. A~vaii>lbie for aa~tnatla and mar~al oprtra~a. Aataaattlo m~ela it~ltrde Idedtaniael float 8wltob eeeambled acrd prat at tha hstair. i:~aru~t~ ~ ~A4 impeller: Thermo- plc Semi~opett design with p~~rnp Gut voce tat' mechanical seal protedlcn. ^ EPCS Irryteiler: Thermo m~pro r~ at. for • Caei~ and fl~ant: Rugged thermaplashc din provides superior strongtn and C~4T061Jn• reSiSl'a'ICB. • l~otar l~eit,~; Cast iron tar ~aient htlat trarreter, s~en~th, ehd durability. ttlla~r`Cowr: Therrnapfas- dc c~verwlth integral handle and liaatawi~h atrm+rnt ^ Aower Cable: Severe du~r raked oi< and tn~r nrsistan't ^ Be: ~ppef atN1 IOW~f heavy d~ty batl beari~ cons#ruct(an. NB~CY Sli ppaa~ae aeao~auan (C5A i rrtodei numbers encl lt? "F"ar "AC`.y - } ----( ---- ~ ~ I _. ~..._...-.i 6~ i 1 i ~ ~ i c ~ , e ~ ~ i ~_i 6 !~ °° ~ 0 AO 0 o d 12 m'M a: ~' POVUTS DW ER'S MANUAL & MANAGEMENT PLAN Pe$o of ~ I~~~- Go RP . sysrr~n sP~ci~lcATloNs ~ owner •~ .~, e...c.-~ ~~ ~t~-~C. -e i QEBK~! PARAAAt'.'1'F.RS Number of Bedrooms ~ d NA Number of Pubtle FaoflitY Unite O NA Estimated lbw leverage? ! r}'d atJda resign flow {Peak!, (Estimated x 1.51 GL~ ~ aUda SoN Application Rate allda Jft' 5tandan! lnffuent/Effluent t1,ua#ty Monthly average' Fate, Oii 8: areas {FOG! S30 mgfl. >3ioohembal Oxygen Demand (BOD`! 520 mglL O NA Total Suspended 8oNds ITSSI S1 !i~ moll. Pretreated tftiuent Guallty Manthiy average Bioohsrrlioal Oxygen taemand {BOOa! sc30 mg/1 Total Suspended Solids i'fSSI S30 mg/l O NA Feaal Caliform !geometric mean) S10` Gfu/i08rn1 Maximum ii:fflueM Patriots Sfze ya In dia. DNA hsr: O NA 'Valves typkral far dornertic wastewster and septic tsnk efflusrrt. Septic Tank Capacity ,2 d al DNA Septic Tank Manufacturer ~ , DNA Effluent Flltw Manufacturer ~ ~ ~ Cl NA Effktult Plater Model ~' d NA Purrs Tank Capaolty Q' el O NA Pump Tank !wlanufaatunr r ~,y. 0 NA Pump Manufacturer ,~.*,~ / 0 NA Pump Model ~ O NA Prstroatment Unit 0 Sand/Gravel Filter 4 Mechankat Aeration D Disinfection t:] peat Flter O Wetland O Other: 0 NA aiapanal c.ut:! ~tn-Ground tgravityi D Ai-Grade D arip•Line o NA ID !n-Ground ipressurized} O Mound C7 Other: O NA DNA 0 NA MAINTItbitAPlCE 6CFIBDtJi.E Bayles Event SeNiae Frequency inspect conditiat of tanktst At least once every: 3 s {Max>»wm 3 Years? ors O NA Pump out oontents of tankts! What combined stodge and scum equate one-tht<d (X~) of tank volume DNA inspeot dispsrssl call{s) At least once every; ~ ~~ jai (M~dmum S Yearo1 O NA Clean effluent fgter At tenet onoe every: ~ ls! sl !~ NA inspect pump, pump contro#s ~ alarm At least once every --- monthtsl Q ^l DNA flush laterals and pressure reef At least once every: r-- ~OniQns'a! DNA At feast once Query: ..~ mostthtsl O ts! 0 htA her: Q NA MASIITBNAN6~ INSTttUCTlONB inepeations of tanks and diaparsal sells shall he made by an individual oarryinq one of the following Ilaensee or oertificattons Masts Pkrmber; Master Plumber Ratric~ted Sewer POWTS inspector: POWTS Maintainer, Septage Servicing Operator. Tani k-spectlona moat Inotude a viauat inapsction of the tankts! to identify sny missing or broken hareiwaro, identify any craoka or leaks measuro the volume of oombined sludge and scum and to check for any took up or pondIng of effluent on the ground surface The dbpereal eellla! shall be vtsuaity inspected to chock the efflusrst Ievela is the observation pipes and to cheek for any pondinl of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a feilMg condition sad roquirea the immedieete aotificattan of the toast roguiatory authority. When the combined eocumulation of sludge and scum in any tank equals one-third fYe! ar moro of the tank volume, the entire contents of the tank shall be removed by s Septag• Servicing Operator and dtapased of in aceordanoe with chapter NR 113 Wisconsin Adtniniatrative Code. Atf other eervbes, lnoiuding but not iirnited to the servking of effluent filters, mechanical er prossurizsd componems, pretreatrnen units, sad any servicing at intervals of sti 2 months, shall be performed by a certtf'tsd POWT$ Maintainer. A aerobe repots shalt ba provided to the local regulatory authority within 10 days of completion at any service event. Page _._..~ o~ _~.. START IJP AND OPERATION For new construction, prior to use of the POWTS check treatrne~t tankisi~ for the presence of painting products,or other chemicals that may Impede the treatment process andlor damage the dispersal celflal. !f high concentrations are detected have the contents of the tanklsi removed by a ssptaga servicing operator prior to usa. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Oaring power outages pump tanks may fAl above normal highwater lanais. When power is restored the excess wastewater will be discharged to the dispersal cell{s! in one large dose, overloadtng the ceilfsi and may result in the backup or surface discharge of effluent. 7o avoid thin situation have the contents of the pump tank removed by a Saptage Servicing Operator prior to restoring power to the affluent pump ar contact a Plumber or POWT& Maintainer to assist in manueliy operating the pump controls to restore normal levels within the pump tank. Qq not drive ar park vehicles aver tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, :he area within 18 feat down slope of any mound of at-grade soil absorption area. Reduetian ar elimination of the foNowing from the wastewater stream may improve the performance and prolong rho life of the POW'I'S: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental fMas; diapers; disinfectants; fats foundation drain {sump pump) water; fruit and vegetable peelings; gasatine; grease; harblcIdes; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ASANDONMi~NT When the POWT5 fails andlor is permanently taken out of service the following steps shall be taken to insure that the system is properly and safoly abandoned to compliance with chapter Camm 83.33, Wisconsin Administratlve Code: • Ail piping to tanks and pits shell be disconnected and the abandoned pips openings sealed. e The contents of ail tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. e After pumpMg, al! tanks and pits ahail be excavated and removed or chair cows removed and the void space filled with soli, gravel or another inert solid material. CONTINGENCY PLAN if the POWTS fails and cannot be repaired the following measuros have bean, or.rtuat ba taken, to provide a Dods compliam replacement system: O A suitable roplacement area has been evaiuatad and may be utilized 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 atrueture, tot lines and wens. Failure to pretest the replacement area wil result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems muss comply with the rulos in effect at that time. D A suitable replacement area is not available due to setback andlor aai! iimttations.. Barring advances in POW7~ taahnoiagy a holding tank may be Installed as a last resort to replace the failed POWTS. ~~ D d < <WARNIN4> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN i.>TNAL GASSES ANDfOR INSUFFICIENT OXYGEN. DO N0~ ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RE6CUE OF J PERSON FROM THE INTERIOR OF A TANK MAY BE DiFIRCULT OR IMPOSSIBLE. ALiDITIONAL COMMENTS ' POWTS WSTALLER Name r ~J'/. ~~t yp•~ ~/~ Y~ Phone ~ r 3- _ ~ ,~ ~ ~ POWTS MAINTAINf"R Name Phone SEP7AtiE BERVICINO OPERATOR IPUMPERi LOCAL REGULATORY AUTHORITY Name Name r_______._ Phone Phone This document was drafted in compiisnce with chapter Carnrn 83.2212ttbl{t1(dl&{fl end 83-54(11, (21 & (3i, Wisconsin Adrninlstrattve Code. Mound and at-grade soil absorption systems may be reconstructed in place fallowing remavai of the biomat at tn+ infiltrative surface. Recansuuetiona of such aystoms must comply with the raise in affect at that time. ST CROIX COUN'T'Y SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~ ~°> ~ ~ ~ .~ Mailing Address o~ ~/~ ~w Y L /, ~~ ~' -ct r v ~ ~Lc ~~a.~ ~ ~'• Property Address ,~.~ (Verification City/State LEGAL DESCRIPTION ~>r,e from Planning Department for new Parcel Identification Number Property Location S~ '/~,i~ '/., Sec..2 d , T~~N-R_~,W, Town of G~u~.~'~ Subdivision ~~ ~ ~~r/~ r°.~ ,Lot # ~. Certified Survey Map # -- ,Volume ~ ,Page # Warranty Deed # ~ ,Volume ~~ ~ ,Page # ~O S ~ C nr1v,4~RP 1 Spec house ^ yes j~no -7,Ot lines identifiable J~yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposalsyctem is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year e irari date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, virtue of a warranty deed recorded in Register of Deeds Office. ~ / Z~/,~ . SIGNATURE OF APPLICANT DATE «««s«« Any information that is mis-rcpresented'tnay result in the sanitary permit being revoked by the Zoning Department. «««««. «• Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified sttrvcy map if reference is made in the warranty decd _ ' ~~~ ! STATE BAR OF WISCONSIN FORM 1 - 1998 WARRANTY DEED 666050 Y.ATHLEEN H. WALSH y~,' 7J~ f c sDocumern N mpe oA 1 kEGISTEk OF DEEDS r U .> V1tJ 5T. CFOIX CO., WI kECEIVED FOk kECOkD This Deed, made between Bane Corporation, a Minnesota corporation 12'21-2001 3:14 PM - - I IHikkAHTY DEED 'I ----- _. Grantor, L' and Sienna Cor at n M'n r ',; EXEMPT Y CERT COPY FEE: -- COPY FEE: -~ TRANSFER fEE: 9863.40 - __ 1.00 ~IHG FEE: PA _ -_ 4 G ~- -, Grantee. Grantor, for a valuable consideration, conveys io Grantee the following ' ': described real estate in St. Croix _ ~ County. State of Wisconsin ; (the "Property"): wc;~nUng .:ray See Attached Exhibit A --. Name and Return Address (~ni~r~t.E %~~ '! 5'1Gb 5 me+~rci Ur ~ ~ ~i.Li-1~ ~nl I~l i vi n e ~o~>n k ~., UI (~ 553' -- _ _ - __ o 20-1048-30-000 Parcel Identification Number (PIN) This 19 not homestead property. (is) (is not) - 20-1048-60-000 20-1048-90-000 20-1049-90-000 20-1050-00-000 20-1050-80-000 20-1052-20-000 !~ 20-1052-70-000 .. ~I Together with all appurtenant rights, title and interests. i' Grantor warrants that the title to the Property is good, indefeazible In fee simple and free and clear of encumbrances except See Attached Exhibit B. Dated this 20th day of December 2001 Bane rporation (SEAL) (SEAL) by ~ Joh M. Nassef Its C 'ef Executive Offic (SEAL) (SEAL) AUTHENTICATION Signature(s) . i authenticated this day of , a TITLE: MEMBER STATE BAR OF WISCONSIN (I(not, authorized by §706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Lockridge Grindal Law Firm 10-Q.~las _ Minneapolis, MN 55401 ACKNOWLEDGMENT Minnesota State ofirtdtsLrorrs?rt- SS. k' `~~'` ~~ County. Personally came before me thts 2 c,\t ~ day of December 2001 ,the above named John M. Nasseff, Chief Executive Officer of Bane Corporation, a Minnesota corporation to me known to be f{te pens "1~,, who executed the foregoing instrument and a~1^~n~ 'same. w HARRY E. CiALLAHEFt ~~~ ~ M1'Ct>•I4f9S10lf E7DIRES t+tf•TaOg 1 a ~ ~_ NolatgPublic, State of Wisconsin commission is permanent. (If not, state expiration date' (Signatures may be authenticated or acknowledged. Both are not JanusrY 31 , 200_ ) ' necessary) •-- Names of prrsorss signing In any capacity must be typed or primed below lbeir signature. ' WARRANTY DEED STATE BAR OF WISCONSIN wisconsi~ Legel 6iana Co., inc. -~ FORM No. 1 - 1996 Mawawte.. Wis. 33' ~~ Z N " " U ~- ~ ~ ~ o o I °' ~~ J I m ~ I~ ~ 1 `' s I: I I I _~ _- » 221 36' - - _- -" .~ N~V `~ "_ '" ~ 510'00'12 E- - - - -1 ~ _- ~___ ~- __ __----' 1 1 II 1 O+ , N t I O I 1 11 _-_- ~, - - ~ I t ~ °~ 1 i 1 ~I N I r `~ I 1~ 1 1 1 ~~ I Q I- r , \ ~ obi g r`~ `~ v N 33 33 \~~~, J i N ~ ~. \ \ `~ I ^~'~. ~ ~.,,, ~~ 100' I "00 ~ s I O~ \ '~ • ~. \ ~~~ ~~ I ~ '~ ~ ~~, I 3 ~ ~ ~~ I r ~ `~` \ ~ > ~.~ ~ ` `, - ~ to 5p. . _ ~, ~~ ~ ~ ~ ~ ~ ~~r ~~ / ~ \ ``` / ~~~, g • ~1~/ / / ~ ~ `~ ~ N10'364p3»W ~ / ~ \ i~ ~ ~ - ~ ~~S ~ \ , `` .~ ```-~ S'10•3 083»E ~' ~ U ,/~ ~ NN N N M N ~ v / ~^~~ "' ,_ / ~ ~, ~ i ,es i~ qn~ / ~ ry~ / 4. / v ~ ~~ I ~ ZIl I i ' - I +~ I I i I 100' I I I I~ Its 1~ N I I L~~I~ ~ +I CJ ~ ~~. ~~ . _ ~I ~-~JrI ~ `I -rl _~- ~ ~~ ~ _- s 71 s -I <I CI )I 50'