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HomeMy WebLinkAbout020-1398-17-000 Wisconsin Depasment of Commerce PRIVATE SEWAGE SYSTEM Safety and Buil~ing 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: I City Village X Township I Bast, Kernon Hudson Township r _ „ 'A1 CST BM Elev: Insp. BM Elev: ~)6t~ /~D TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic /', W~~ ~ ~~ Dosing /~^_ /- - L v'''-~tJ`U Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ t l7'D 3 ~ f<o os' ~ ~ fi/lX~ Aeration Holding C PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number ~~ TDH Lift Friction Los ~ System Head TDH Ft I I •o~ . 7 ~' I~ •07 Forcemain Length ~~ 1 Dia. ,,r ~' Dist. to well 8 0 SOIL ABSORPTION SYSTEM county: St. Croix Sanitary Permit No: 420761 0 State Plan ID No: Parcel Tax No: 020-1398-17-400 SectioNTown/Range/Map No: 22.29.19.2477 ELEVATION DATA STATION BS HI FS ELEV. Benchmark I ~~ ~t71 ~ f 4 ~ ,rye ((JlJ Alt. BM Bldg. Sewer ~O.B' ~ ~~ }fit Inlet ~~~y~ ~~ t Outlet Dt Inlet Dt Bottom /-.~v g'a~na Header/Man. - >~Y ~ ~ 3 Dist. Pipe '. Z . 4 3 , ~~ Bot. System ?, p a•7~ Final Grade ~~/ ~ 8~ Cover 8'.3 g3.S i ~3 Cl `~~ ~b ~ ~ 3 ~ I .r ~~~ g.33 a3.~ ~P_I,uv,~~~ cpr~: "l I• -~9 BEDlTRENCH Width Length ~ , S No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3~ r~ ~• t3 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type O~S~ ~: ~~/ ~~/ ` UNIT Model Numbe ~ i ~'~ //. ~ DISTRIBUTION SYSTEM ~ ~.5~ HeaderlManifold r ~~ Distribution x Hole Size x Hole Spacing Vent to Air Intake . tr ~ Q( r U'~ Pipe(s) -r "'-~ ~ Length Dia Length Dia Spacing \O 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:,~_! ~t /_~ Inspection #2: 1 Location: 829 Ross Rd Hudson, WI 54016 (NW 1/4 SE 1/4 22 T129N R19W) PChe'as~ant Run 1st Lot 17 Parc I o,:L 22. 9.19.2477 1.) Alt BM Description = ~.~,~ Lb~~ ~% '~ r )~.~ "t'`~ ~~'~ ?/ ~`~S ~7~~p~d ~.~~~~p,'~~('.~rj il`Qt~(d' 2.) Bldg sewer length = ~1 r ~^ k C9/ti2t:L ~. ~4;~~i" '" - amount of cover = ~ i!"t [~ f1 ~J`p'~ ~~ ('~--~ ~t _/~,~,u,~ ,,~cdtkY.~-~U 5 ~ )~I ~wvwbt+ d~Sr~"~° Plan revision quired . ~ ~~~ Yes ~ o i I Use other side for additional information. ~ U ,~ 10~ 1^~.____ _ i I `~ Date Insepct s Signature Cert. No. SBD-6710 (R.3/97) ~~~~•IA~~IlT/l. ~'[ 'fJt!~'o Wei ~ (S', I,~~Q~ fA/~ ~ I~~Y~ >r/" Q.4w/.tA•~il ~, O'L.t, I•`'"" Safety and Bttildiags Division 201 W. Washingoon Ave., P.O. Box 7162 County isconsin . ~ ~~ - n~ Pew Nmnber (>o ~,~ m ~ ~., (~ 266-3151 U7 - [ ~ ~/ I S ~~ De art:ment of Commerce Oi Sanitary Permit Application s~ L'D~ - pe+aooal yon pet~vide Atha. Cade 21 wn; hi aonarid weh Comm sa , _ . . . may be resod fix seooudary ptttposes Prtvary Lsw, sl5.tk(lxm) Projoct Addt+ess Cf ditl'ertn[ Chao mailing address) I. ApQlicatioa iafornoatian -Please Print All information: ..~~ S 2 Property Owner's Na me Pa[td 0 Lot ! Block A ~/UB ~ l ~ --r'-.. Property Owner's M ailatg Address PAY Low ZN (tity, fate Zi{r e~ae Phone Nambar S e9t ~ ~t~6--- 7-~ (`~`~ E N R~ T ~ ply) e of (check all that a II Ty _ , - p . p be CAF-N ~tx 2 FamUy Dwdl6tg - Number of Bedrooms ~ r um SLbdivision Name .~~ o P~tic/Comtnercial -Describe Use ~ State Owned - Describe Use - _ - --- - ~i QViltage ~town4hip of = III. Type of Permit: (Check Daly otm ltoz on line A. Complete line B if applicable) A' ^ New System ^ Replacement System ^ TreaumarlHaldiog Talc Repbizement Ody ^ Othe Madifintion m Existing System B. ^ Permit Rtstowd f E i u B 'Revision ^ Chaage of Phnnbar - ^ Permh Traosfe tp New Owner LiCu~ Previt-us Permit Number and Dace Iswted 328 /0 3 ee e xp ra o° { 4a o ~ ( rv. Ty of Povv'rs : tCheek au that ~ ^ N~ -Preswrinod Io-GroaM Q Mooncl > 24 m. of suinble s~7 ^ Marod < ?a is of suitable sort ^ At-Grade ^ Siggk Pass Ssrd Filter ~ Consnvcted Wetland ^ Presstxiaed In-Ground ^ Hotdi~ Tack ^ Ppat F~~ ^ Aerobic Trratment Unit ^ Recirarlatiog Saud Filter ^ Recirculating Synthetic Media Filter ^ Leadmtg (umber ^ Liue ^ Gravd-less Pipe ^ Odrer' (explain) V. Area Iafoamaatioa: Design Flow (8Pd) ~ Sod ~ ~ ~ Area ~~ (~ Area ~P~ (~ sYsC /? ~ ~ , ~,S'~ ~' 3 r VI. Tank Info Capacity in Total Number n Manufacture ~ Prefab Site Sled Fiber Plastic Gallons a~f Uri ~ ' Concrete l7oasornclod Glass New ~~ ~ T Tads ~ Clfam6tr r-_ /E~ / VII. ReSpo~bilitJ Statmtent- >y the'riudarsrg~ed, asstmne -for button of the POWTS shown on the attached plans. Plumber's Na me (Print) Phm~e's Si ~ ~/MPRS N®be Business Pharr Nmnber ~ zi r~dd r- --p6~9 ,state, ) 2828$ McKenzie Rd. ` /' 4~ ~~~° VIII. ~j Y`l - - Sammry Permit Foe Cmclvdes Gmmdwat~ ' Dace Ismail Isstrmg S~ (No SmmPs) ^ Owner Given Reamn for Denial snteharge Fee) ~ ~ dc~ ~~ ~j -j 1 ~D 1X. Conditions of ApprovaUReasons for Disapproval ~ ~~n. n~ ~/ AttacL taoplae t~ fta ~~y ~ ~' ~ ~ as paper ant teas rem sirz x n t~ m nu i ~~ Fogerty PN~b+a6 - #221180 Wi 59801 (715? 635-9608 ~/2~~3 ~, p-t x b3 - ~~ ~ ,~ B z d ~/ 4'sy ~ .~~ 8 /r cvNc~rc f/s,~. ~ii~.t'it/G a~Ev : / ~ 2 = 9T 3 ` e.~ ~'~'Y: ~'!.: ~~78-p/.z ~' 3 . ` rya' ~•z ~~.~=t/-s8' /z.s~f7s--r c.~~- ciao r~~~ . ____-- ~y~,~JL !• 3 Fogerty Plumbi~~ rA~.F cc ,_„ ' #22180 28288 McKenzie Rd. p~~flp CHAMBER CROSS SEtT101J AAIG SPECIFICATIO~!S Spooner, WI 54$01 _ (715) 635-9609 __~._-,__. -- VEA1T CAP - ~ ~~°~-.!`~~~~"~ E M"t.I. yENT PIPC ~„/EATNERPROOF ~ APtFt,' O~~E ~~}(~~jj~~KIAI JUWCTIOAI 80X M'Ar~I~#OC`E~Cb'~VC'R fig' rR0^'- DQOA. ~ WIAIOOW OR FRCSH 12"MIU. ~ { 4 i "-. AIR IWTAKE 1 GRADE 1 y+~ylu_ r C©IJDUIT ~-- ~ ---------- 18"MIAs. ~a ------ ~ ~ PROVIDE I '"" - IAILET AIRTIGHT SEAL i `1) _ _~*~ ~t ( *l A LBT~/1 f~E,~~ ~i~ ~ ~ ~ I - / ~ - ~ 1 ~ ` At.ARM a ~'`'~ / / j i I *APPROVED ( i ~~~ • ~ JOII~ITS WITH- , i i - _ , - f;.lEV FT APPROVED PIPE - - __J - 3 ` D~~ PUKP -~~ OFF r D SOLID SOIL - 1 GO-ICRETE DIOCK - ~- RISER EXIT PERMITrEO C1AILy IF TAAlK MAWUFACTURER HAS SUCH APi~ROVAL SEPTIC F SPEGIFI•GATIOAlS DOSE ~ j/i~L~~ i~lUM6ER OF QOSES: ~ PER DAB TANKS MAIJUFACTURER: ~- -~ • TAAJK SIZE : S~ 6ALLOUS DOSE VOLUME ~~ It11CLUDIAIG 6ACKiLOW: ~~7• yZ GAl ALARM MAUUFACTURLR: ' '~ ~~~~~ MODCI 1.IUM8ER: ,iCtSt,~ --~Dl~ CAPACITIES: A= 37 ~/IUCH[S OR ~~~` SWITCH TYPE' ~l~R A g =_~_IWCNES OR .:LT.sa~YGAI PUMP MAWUFACTUR[R: _ ~jt~G!~ _ _ C =-L~.IUtHES OR .,~.L'L~GNL MODEL AIUMDER: ~..~ Ds..._.~..INCNES OR S%~~ GAL • SWITCFI T`JPE: /if~'.~/•~~ IUOTE: PUMP A1JD ALARM ARE'TC DE MIAlIMUM DISCHARGE RATE 3 Gp/+~ IAISTALLED OAt SEPpARATE C1iRlCcIITS VERTICAL DIFFEREAICE DET WiEU PUMIP OFF ARID DISTRIRsUT10~1 PIPE.. _.LL.~_ FEET j,!• ~'~7 -~ M1AlIMUM NETWORK SUPPI.~ P?RG~S~54tRE/.. .. .... ..~~~~ FEET • ~d FEET OF FORCE MAIM X ?~C..F/ioortFRlCT1o-J fAtTOR...~../=Lq.Lq- FEET ~ _ TOTAL. Oyf,JAMIC HEAD = Lt• r.L FEET IIMCq~I~~ 1'1~MCfIC~A~I[ f1c T~fIK' 1 CAIf 7N •WIf1T4! .'I IAl11D nEPTH _.- ` ~~ Discharge size 1'/: NPT_="' Solids: ~: ma~dmum Motor - Single, phase:.115V Materials of Construction Brass/thermop~siic Features and Benefits •Top suction eliminates impeller clogging. • Corrosion resistant construction. • Float actuated switch. METEIIS FEET Ci ~, s ~ = 5 ,s ~. a Y 3 10 0 a 5 1 oa MDDEL DVP03 o s +o ,S so 2s 3o as .o us.urM 0 2 a s s to~4r carncm METERS FEET 10 MDDEL: 3871 9 30 a zs e za s 5 4 15 EP05 0 ~ 3 10 2 mot 5 7 ° ~_ io zo as ~o so usea~ 0 2 4 8 8 TO 12 m~Ar CAPJ1CfTY Pump Specifications Features and Benefits '/~ and'/: HP • EPtkl impeller- semi-open design Up to 60 GPM with pump out vanes to protect Maximum head to 32' mechanical seal. Discharge size 1'/f NPT • EP05 impeller -enclosed design Solids:'/: maximum for improved performance. Motor • Rugged glass-filled thermoplastic All motors feature baA casrng and base design provides bearing construction. superior strength and corrosion Single phase:liSV resistance• Materials of Construction • Cast iron motor housing for Cast iron efficient heat transfer strength, Thermoplastic and durability. Stainless steel • Corrosion resistant threaded stainless steel shaft. • Available for automatic and manual operation. • CSA listed models available. 9, Ail Models are designed for continuous operation and feature stainless steel hardware. Safety ~md Dirisiaa t7avtT _ . 201 W. W Are., P_Q Rox 7r1~2 _ ~ De rfineM of Commerce 1 _ _. ~Ill~Ty ~~1C8tiDII sa.o~r Permit m zo~ora ~ Ao.rru at.21, vlfis. Ad.. bode. pe~sowl ldareataio>t ~. P~ ~ D Cbeelt if 18eir8io. '7~a D ~"~o ( . be ased for Iaw. s L A,ppik~ae ~ - Pb~se PrTrt AS bia~matiat sat P!m tu. NerWer A l~ '1 ~" ' / ~ ~ o,~raar's Na aue ~„~~ ~' . T -k~ ~'m ~f 1 u h s --i --~to, `~ ~~wd~ ~ ~Z~f7~7 ST. CROIX COUNTY' 9I 1i- T N R may, Sme Tap Oude Pbo~e O F F I C E Number Blod~ 1~bv man Name C5l[ Number Bl` ~ ! ~" 7 ~ /~ ~ b ~i ~ •~1 •.~ ~ ~SYnsr , ~ D(34 1 a' 2 ~Y Dweller Nmdrcr of Bedtoosa O -near'6e tke L a strte owaed ~vt~ .r.~r~~T~e~-reams / xea~e~c ~o.d _ . s ' . ~ a-/ 6T7~'~-- lII. 'lypt:.f P~~ oab aae boot a.liae A. is tar i.rec.at ~) (r7w.pl de iltae s, ~' app6cablt~} A. i 20 ~ s~rstem >Irpboeme~rof 6D Adt'itio. a >~ ~- aue B• ' o~ ~'sad#rp Ptrmir Pteriuusljr isrwed Permir Nwnber ~ DMe wed Iv. l~pfef POWT SJSI~ +~eck a9 float appl,~. I+~`, ~4 fcc:~ a~j h y ~Yt ~1iy~~ Y ~ ' / W~4ot ~15 Noa -~SUrieed L-(~amd 21 O I~upd - _ 47 0 Sam Pikr 90 O (]omaoc~ed 4412 ~~ oC .ems 2a o a m-c~or~u si o 1 ~c ,s o s~ r~ si o nap z.~ .,~~ i ~~~ ~ G~ a~rn ~ . 45 ~ At-Grade 46 DAaabic lltaaaac t~ir 49 ~ Raeiradapws 30 DOYKr ,~.+~ ~ ` v. Area Lafarmat iou: nesi~t low (~- n; ~ ~ A~ Sd >!eraoetaad>tat s~ ~ t~.t cir~de P''npasnd f~ ~ tom? ~_ / ~. j l . ~ Y s'v ~ 3 ~c S ' s'/ p.~-4- 3. ~ s- z - 7 e- Z 9y. d 9q• ~ . 3 s . VI. Tapk Lafo aP~4- ~ Tad Number lfaeofa~oarer Pre4b Sipe steel ~ Plastic C-iaYaas Galiaas of Tanks , ~ ~ Uoou~ae C7o~neted Ghss ~ ~/6 ` 1L t-~iWL ~ -r~~ , s~e°' m - • e~ s ~ va. 5--1. We rrriarsi~ei, asa~a: t~lrtiua dttie PU'iY'!S z~aaa the ailb~at PLtt~s. FDgeTE~/~Phi bim~11~ ae Petk "ASS N~ber ii~eus Pl~oae Nmu6er z~// ~/ ~i~ ~7y~-3~'~ Pkmber's ~ , ~ ~ ~•• . wt 54~UI - c~~ GSF- a.~-sre6 vYa. ~ ~/ ~ ApP~'mred ~ I~1id MMase ~ ~ nrrte tea 3/ b! n --"T 2 a tJ ~ IX. Goaelltiela of ApptnsraUR far n '1 ~ fi r~/~,,..~ 1~ ~ ~--~-~~Gv~`~° ~;sit.~i.!-t oC.~ ~...Q.w --~rn•.~ ~,~v rc//C~,~a,~ ~~u73 ~ ~ P.Q2 ~rw,+-,. ~ 3•S~ , ~~.v"nryt~ ~/12~~"~~r''"` ~vw73" ~ .~ a-u-c ~~`.~~`.~Y~ ~~.~~ ~" `ma-n2~~~~f'"""'"" f/ _ - Atcma oop.pkte puns (to tee comet, earl mr aKS~m m ~.oc ~n ago aul x u u~ t. ~e (~ ~2dc~-,. ~.~ ~- 3 6P-, ,Qan•~ ~~~i%~rua~a- ~~ vvi~~` ~ .~ f , ~=-~ -1 / r{ v ~ ;~ ~ c ~ q ~ 3 M ~ \ ~ E~ ~~rn ti°. ~` ~ a. V ~ ~ o d.~x~c~ ~ ~ `i ~ ce ~ ~ 3 ,I~l N oa. D N p_v ~ $ ~ ~ ~ 0. ~ ~ ~• V v ~ N N V ~ ~ ~ ~` ~ ~ ~ ~' ~' ~ H t7 p ti r ~ ~ u ~ ~ ~ - _ ~y x H ~ M '~ ~ 4 \ 0 1 T. ~ ~ ~ .per / '~ ,I f ~ ~ ~L ~f ~ - ~ I ~ ~ !~ ~ ~ . ,I ~ 1, o ~ ~ ~~~ i ~ ~ ~ 1 r ` ~ f ~ ~ ~ / 1 i ~ep.~ sass 0 w~ ~ ~ ~ ~~ T ~ i ~ o \ „~ % I. . ~~ v ° / ~ -- h 1 a ~l -~ ~~ .. 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C ~~N,O~ (~ pp ~D ~' COQ ~ C~ ~-t O ^fD M ~' ry~~ n O I~ ~~~„~ l1 ~.a n ~ ~ ~ 4 c~ ~ ~ 0 0 a~ Y e ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~'~K.~i~ t~-~s7' Mailing Address ,r'Y~ !~-~te~~ ~t~ /fir! s~./ Lv ~,Q1,~ Property Address City/State ~~ j /toss /'~ /J ~ ~~se~_ cry- (Verification required from Planning Department for new Parcel Identification Number ~'Zo -...~ 79 ~- i 7- off' LEGAL DESCRIPTION 2~f~ Properly Location ~ %., ~'/., Sec. ~z .. T?.~_N-R,1~.W, Town of 1,1~.~~~ Subdivision ~fi~~,~ff.~ii-'T /~/ f S-r _ - .Lot # .~,Z_. Certified Survey Map # Volume ~- ..Page # Warranty Deed # G 2 7 S' / ~ ,Volume I S 3 / .Page # y' ~ 3 Spec house ^ yes C~'no Lot lines identifiable Oyes ^ no SXSTEM MAINTENANCE Improper nse 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 masttr Plumber+ journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system is is 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 Deparhnent of Commerce and the Department of Natural Resources, State of Wisconsin. Certification :-tating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days o~' the three year expiration te. j~ ~_ ~Lsf.-t.~ .._ ,~ .~~~~ SIGMA OF APPLI ANT 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 rty descn'bed hove, lam, virtue of a warranty deed recorded in Register of Deeds Office. ,y" vC~ l 1 SIGNATURE OF APP ICANT DATE «***** Any information that is mis-represented may result is 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 survey map if reference is made in the warranty deed . . F14E ~lFOt~ulAnoN Owner ~ _ DESIGN PARAMETERS Number of Bedrooms 3 DNA Number of Public Facility Units ~NA Estimated fbw (average) aUda Design fbw (peak!. (Estimated x 1.5) Sd aUday Soil Application Rate _ al/day/ft2 Standard 1nNuent/Effluent f2uality Monthly average" Fats, Oil & Grease (FOG) 530 mg/l. Biochemical Oxygen Demand IBODs! 5220 mg/L ~ NA Total Suspended Sol'Ids (TSS) 5150 mg/L Pretreated Effluent O.uality Monchty average &ochemical Oxygen Demand (BODE) 530 mg/L Total Suspended Solids (TSS! 530 mg/L ~NA Fecal Goliforrn (geometric mean) 510` cfu1100m1 Maximum Effluent Particle Size Y8 in dia. ^ NA Other: ^ NA *Val~s typical for domestic wa~sltewater aril septic tank effluent. ..- ! I (/ I"' /I ~/S~ /~ nn nom.....,, ,t J /i~-l'.Y. POWTS OWNER'S MANUAL. & MANAGEMENT PLAN Sv_ST~ SP~lCAT10NS Page ,~ of ~-~ 'Septic Tank Capacity ~ ~ A Septic Tank Manufacturer ~ ^ NA Effluent Fitter Manufacturer Z ~-L ~ NA Effluent Filter Model _ ~ d NA O Pump Tank Capacity al .~ ,r !~-~i4 Pump Tank Manufacturer ~( NA Pump Manufacttuer NA Pump Model ,~.hIA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ D'ISinfectiwl D Peat Fitter ^ Wetland ^ Other. Q NA Dispersal Cells! In-Ground l ra ' ^ At-Grade ^ Grip-Line Q NA ^ In-Ground (Pressurized) ^ Mound O Other. Other: ~ NA Other. ^ NA Other. DNA MAITII CIYAI~IIiC .1l.flCVVLG W ' w `~ / ~ Service Event ~Oe Frequency Inspect condition of tank(st At least once every: ^ month(s) (Ma~ntm 3 years) ~ Is) O NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y9) of tank volume ^ NA Inspect dispersal cellls) At least once every: 3 ~ month(sl (Maxbrxum 3 years) year(s) O NA C~ effluent fitter At least once every: ~ month(s! Z- years! O NA ^ month(s) ~ gf1A Inspect pump, pump controls & alarm At least once every: p yearls! ' ^ month(s) Q NA Rush laterals and pressure test At least once every: ^ year; (s! Ocher: ^ month(s) ~ Np At least once every: ^ ye~ls) Other; ~,NA MDdNTENANCE INSTRUCTIONS lnspectlons of tanks and dispersal cells shall be made by an individual carrying one of ale following Gc~'rses or certif'ICatlonS: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined stodge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cellist shall be visually inspected to check the effluent levels in the observatwn pipes and to check for any pond'mg of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY,) 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 fikers, mechanical or pressurized components, 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. Page Z--of Z .. iaHT UP AND OPERATION For new construction, pr~r to use of the POWTS check treatment tankls) for the presence of painting products w other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concer-trations are detected have the contents of the tank{s1 removed by a septage servicing operator prior to use. System start up shalt not occur when soil condiiians are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater wiU be discharged to the dispersa{ cell(s) in one large dose, overloading 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 Servicing Operator prior to restoring power to the effluent 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 soil absorption area. Redaction 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; dual floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fn,it 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 following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shat! be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shat) be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the P S fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant r - _ ` system: ~" A itable replacement area has been evaluated 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 ~ alfnn9ed upon by required setbacks from existing and proposed structure, lot 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 rules in affect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be instaNed as a Last resort to replace the faded POWTS. The site has not been a suitab{e replacement area. Upon oil and site area is available a holding tank may be installed as a last resort to replace t~failed PUVV'F~: ^ 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> > SEPTK:, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAI. GASSES ANDlOR INSUFRCIENT OXYGEN. DO NOT =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 DIFFlCULT OR IMPOSSIBLE. SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY -may Name Name ~j j , ~,12p (X Cp.t~lJll ti t 1 Phone Phone ~(~ -~ ~ '" This document was drafted in compliarx~ with chapter Comm 83,22{21{bl{7-(d!>klfi and 83.5M11, {21 & {3l, Wisconsin Administrative Code. SDOOner w~ ae~r-~ (715) 635- 1 POWTS {NSTALLER POWTS MAI N Name l ~~~ v Name Q~.~ Phone S-_ -' ?~~ Phone ~ - 4 - Q if~isconsin [)epariment of Commerce SOIL EVALUATION REPORT Page ~ of 3 Division of,Saf~ty and Buildings ,~, a~~„~..,~,,,,,,,u„ W...w. ~.,,~ ~..,,.~ Crd~ er not less than 8112 x 11 inches in siz lan on a Attach let site om Plan r+ p p p c p e . `' E I indude, bet not firmed to: vertical and horizontal reference point (BM). arcel t ~ ~ Z G - ~ 3 ~ ~ "' ~ ~ - aljD percent slope. scale or dimensrons, north arroa-, and location and dicta. to nearest road. Please print all information. ,~ U N 0 3 Date Persona( intorrnation you provide may be used for secondary Purposes (Priva~Y . s. 15.04 (1) (mp. ~ - ~ ~ ~ ~ Q 3 ~Y Owner FICE "~" Govt Lot ~: w 1/4 1/4 S Z ZT Z N R E (or U Property Owner's Mailing Address ~ ~ ~ Lot # ~ Block # S .Name or CSM# . Lca a e c I h un Nu mber P Trp Code t at City S e ^ City [j village :Town N t Road ~~ ~~ ly ^-7 -- ~ 2 ( ~j New Construction t1se: (~ Residential / Number of bedrooms 3 - Code derived design flow rate ~ GPD ^ Replacement ^ PubGc or commercxai - Desalbe: Parent material G~ ~ ~ In Flood Plain ele app ~ ft General comments SyS~~m ~(~ t/• ~s, ~ o - /~,~0 .~ /Yi.s •f~rW~^-~ ~ p3 and recommendations: _ b CST. B3 ~ ~ 3.0' -~ ~~~ D, ~ L~ tzrX~.x-1 ~ Sha,~.ozv f~~ O,S~i° ~? I Boring # ^ Boring ~ pit Ground surface elev. ~9. G ~J ft. Depth to lirruting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence .Boundary Roots GPD/ftz in. Munsep Qu. Sz Cunt Cobr Gr. Sz Sh. 'Eff#1 'Eff#2 I ~ -12 ( 2 .~. S (` 1 2rrx~bk mfr' ~ S 1 ~-~ . 5 . ~' ~z ~42 1p y I ~ ~r ~ . 5 . ~~ a Q ~~ # ®pi~~ Ground surface elev. ~ ft Depth to limiting tailor ~ ~ V in. Sall Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl2 in. Munse4! Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I b-45 (a~ 3)2 --~ 5~1 r ~ S I v~ . 5 . g 3 -1~ ~~ - Ds i - -` . -7 / Z S-O . T/~ b~Y 7~ o - Z v R7 ~' ' Eftiuent #1 = BODS > 30 < 220 mglL and TSS >30 < 150 mglL ` Effluent #2 = BODS < 3Q mgtL and TSS < 30 mgttr Date Evaluation Conducted--- Telephone Number ~ ~ . t~'fYI~~R-~ 1 525__ ~^ ~U ~D 2 ~7/5)2`~7-'BUD 8' ~.. Property Owner ~~~~ Parcel ID # /C> ~ /~ A, Page Z' of Boring # ~ Boring , ~'(~ ft. Ground surface elev. Depth tD ~mmi'tng facts' ~ in. Soil Application Rate Ftorizon Depth Dominant Color Redox Descx>p1'ion in. MunseU (2rr. Sz. Cont Cobr I p- lZ~ 2 2 - ry Texture S; 5,1 Structure Consistence Bourxlary Gr. Sz Sh. 2 m-~c- c S 2mab r~r ~S Roots GPD/ftz .~ ~ l v~ , 5 ~ ~ . g D i~ ~~ Bonng # Q Boring ^ Pit Ground surface elev. ft Depth to limiting factor in. Sail icatio~ Rate dox pescxiption R Texture Sfrur~(rre Consistence Boundary Roots GPD/ftz Horizon Depth in. Dominant Odor Mansell e Qu. Sz. Copt Color Gr. Sz. Sh. 'Eff#i 'Etf#2 ^ Boring # ~ ~~ ^ Pit Ground surface elev. ft Depth to Gmitirrg factor in. Soil Appligtron Rate t{orfzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftZ in. Munseq Qu. Sz. Cont Color Gr. Sz. Sh. 'Etf#1 'Eff#2 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mglL ' Effluent #2 = BODS < 30 mglL and TSS <30 mglL The Department of Commerce is an equal opportunity service provider and employer_ If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBIY8330 (R07/00) *t t PAGE 3 OF 3 NAME ~c~5 ~ TOT# ~ 7 LEGAL DESCRIPTION,Uc-<I ~~C i4 FS ZZ T Z~f ,N,$, IQ E(or~ SCALE: 1"= L1O BM 1 ELEVATION /CUr ~ ~ ~ BM 1 DESCRIPTION ~ P ° ~ ~~ Sfecl ~c2~ P G ~ ~ }~ , ~, ~ BM 2 ELEVATION ~ S,(U ~ BM 2 DESCRIPTION ~~D~ o-~%I ~.~ I Qo ~ ~ ~ 1-~~~ SYSTEM ELEVATION ~ ~ , y ~ ALTERNATE ELEVATION ~~/ ~ O U CONTOUR. ELEVATION gg8o ~. q~ , 6 0 N -eC . Z Z t ~ I ..-- -#-- l 5~ (1 0 'YQ/a` \ ~ ----_ SIGNATURE ~,~ G ~ DATE .3 ,ZU ^ O ' ~ ~ PAGE 3 OF~ NAME +~ c~ 5 ~ LOT# 17 T 7 T T)FS('R IPTION W %~C 14 ,S Z Z T Z ~t ,~,~ IQ Eror~ SCALE: 1"= CIO ` BM 1 ELEVATION /C~ - ~ ~ BM 1 DESCRIPTION ~ P ° -~ y~ S+e~~ ~~. t ~' >~ ; ~~ BM 2 ELEVATION ~ S,/t~ ~ BM 2 DESCRIPTION ~ po-~% ,~.cc.l ~o ~ ~ ~ ~ l~~'~ {. SYSTEM ELEVATION y ~' . y ° ALTERNATE ELEVATION 9~/ - 0 v CONTOUR ELEVATION Q~80 d- 9~,6 ~ ~r'~~ ~ ~ ~i ~Y~ ~~ ~ ~~ ~~~~ ~ti~ ~~~ 1 l ~~ 0 ~~~,~ ~ i i ~- ~~~ ~ o ~p~rs~ ,,i fX) , ~~` , ~~ ~~ ~~~ ~, ~~ ~ ~; a~ o~'~"~' ~ ~ ~~y ~. ~ ~ \ ~ -eC . Z Z ____ -~- r i ~~ ~'~ X04 ~, QMt ~~, ~~ti a~ ,o~ q~6~~° SIGNATURE \ ~~~ ~~---~ DATE .3 ,w ~ ~ ~~ / ~ i - `~ SEMEN T ~ \ ~ _ r' i ~, -- ,- I ~ ~ - ~ / _ ~ ;. ~Io1tNt~U1Jl t3U~LI~1~Gi i ~` -~/,~ ~x c~ ~ ,~ ~ ` ~ ,~.X ~ ~~ ~ //~ ~ ~i i % f~' ELEVNTImN 9 .~ ~ ~ ~ .. ~ t.~ ./ ~ i ~i ~ ..~ .- 9 ~.~ 1 I ~ I 1 I { i 1• ~-` ~ ~ ~~~ ,- ~~~ ~(i! ~ ter. j 11 ; t 1~ 1,%' \• ~ 1 ~ ~H.M~L 08.0 \ ~ ~ ,/~ ~ i I J _~ ~ ~ \ ~ ~ 89a.s % . 1 ~ ~ _ ~.___~,~ ~o.9X \ •`, ti 5'--~24~` CM 'O ~,07~ 1 ;;,,- ._ _ -.r --~ .~•. ~ ,~ : ~&iCf ( ` dR WA~L PQIf~Tt ~' ~ __ FENCE ~. . _.._ ,~ ~: '` ~ ` x ~ X 'a -•~~".Y' .~ 1:'070-' . _ . .; _ . ., ~ ,, - x / ~,~' , BUt~,DiNG ~ \ \ :. • \-- ~• ~\ • '~ . • ~~ 904.5 / \ \ 1 PRA MIN 6 ~ 1~ .: ,~ ~ ~ ~. ! ' , ~ ~ , /~ A~ " ~p'00 ~ ; ~-TIb1N . ~\ ~ SILT ~~~~~ ~ \ ©~` ~.~~ ~. ~ ~, . `- _ • ~~ i~~~ ~ ~9 Z.~~,T ~ ~~ 9pj5.5 '- " \ ~~ '~. ~ ` ..rte r ~ ~.~•~ i`f~'~ !• -.-. r I ~ .~ r-- ~~.~ -~ ~ ' ~ 93 . 5, i X . ~ x - __ - ~.~"I~Ci 930.6 - ~- '' i ~ ~ .. 932.6 ~ ~ ,.r -~ ~ 93 . t ~ -~ 1 / 934.9 .~ '' X X .~ ~, .^..- .~.. ~. ~ J X" ~. ...~. __ ( \ .:936.5. ~ d. 'tQ' \ \ I _ 6 ~ Q~ .. ~I `.X f /{ i ~ ~ ~ 9.37.8 ~ 1 ~. ~ s, _ ~ , ~ - i "~ 4 • ~~~~ ~ 93719 `"9 tt 1 933.9 Z 0~ \ i ..... / i x `\ ~ _ ~ ^' ~ .936 2" ~ ~ ~ ~ i ~~ ~, ,., X 934. ~ / ~ _ .~_y. 53 ~ P`5~ ~{~3 `~ ]~~,~,, STATE BAR~~R~ 627510 (ifi i NLEEN N. 4lAL5H WARRANTY DEED sT~TC~oix~coDEEui Document Number This Deed, [trade between Marie A. Shimon, a siasle person, r~cEl~r FUR rrrcorse aa-Oi'--EaifO 3:00 PM 1NIRRiINTY BEE6 EXE!~T Y and Kertaua J Bsst and Douatd>e J: Speer-Bust, husbttnd Grantor t~RT COPC FEE: ~ ~ , and wile. ER FEE: 846.00 T6AliSE ' R:'.CORDTN6 FEE: ' 14.00 1tR6E5: 3 Grantee. Grantor, for a valuable consideration, conveys to Grat-tee the following described real estate in St. Croix C~ty+ State of Wisconsin (if more space is needed, please attach addendum): Recording Area Name and RNA UGLAND (See Attached Exhibit "A") ZilZr Estreen & Ogland F.O. Box 359 [iadson, WI 54016 ozaios9-go-ooo Pucsl IdeMificMiott Nutabu (Plld) This is not hmoeskad property pQ (is ~q Exceptions to warranties: Easements, rt~trit'tiotts and rights-of-way of record, if soy. tl~^ Zppp Dated this ~d day of July . ~rA - ,n ~f~ ,~/ - ~ Ma 'e A. Shenoa r t AUTHENTICATION Signature(s) Marie A. Shimoo, t single perseo, ti ~~ ti~'~day of July 2~ A wr, i. ACKNOVYL~OGMENT STATE OF WISCONSIN ) )~ County ) Fersonally came before me this day of the above named a,Ktysnes ata .o _ - :,~ g,Sr'('A7E BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing 7~. rw"~ _.,~--- instrument and acknowledged the same. autho ' § 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristian Ogland Notary Fuhlic, State of Wisconsin Hudson, W 16 _____ My Commission is permanent. (if not, state expiration dal (Signatures may be authetaicated or acknowledged. Both aro not ttecesstay J + _ ed or nted below their signature. " ~°"'a"r` ~°""~' F~8f10 66 2t~ ~ Names otpetsons signing in any capacity must be typ STATE BAR OF WISCONSIN WARRANTY DEED FORMNo.2-[999 rY .. . y~~ 1531oA~~ 435 Exhibit "A" - Page 2 feet along the arc of a 427.00 foot radius curve concave Northerly chose long chord bears South 69 degrees 05 minutes 43 seconds West 369.38 feet; thence South 89 degrees 43 minutes 25 seconds Yiest 546.65 feet to the end of said reference Tine. RBE'SRSNCB LINE NDMHBR 2 Cocmieacing at the Bast Quarter corner of said Section 22; thence North 0 degrees 02 minutes 57 seconds East along the,•East line of the Northeast Quarter n distance of 40.00 feet; thence North 89 degrees 57 miai~tes 16 seconds West 750.D0 feet; thence Westerly 136.81 feet along the arc of a 872.17 foot radius curve concave Southerly echoes long chord bears Sy~uth 85 degrees 42 minutes S7 seeds West 136.67 feet to the point of beginning of the fallovriag described reference Line: Thence North_Z69,97 feet; thence Northwesterly 350.77 feet along a 400.00 foot radius curve concave Southwesterly whose long chord bears North 20 degrees 05 minutes SO eec:onds 'Pleat 343.62 feet; thence North 40 degrees it minutes 41 seconds West 70.00 feet; thence Northwesterly 158.48 feet along a 227.00 foot radius curve concave Northeaatarly wtiosa long chord bears North 20 degrees it minutes 38 seconds West 155.28 feet) thence North 0 degrees 11 minutes 41 seconds West 500.06 feet to the said of said reference line. All is St, Croix County, Wisconsin M[~Pf~(Q~D -,~D~ OO M~-1Mn C~©_ o ~ OO 4~lGG°~~~ NOi'Og'34"W 1259.19' ~, za6.9g 536.a2' 1 227. ~ 167.96' ~1 / ~ 1 J f~,~ 1 1 sss.~r f ! 91 ~-'L1 '`' ~-~ 1 1 i 3~dN 1 O m 1 ~ o o i o 1 ~ a" i ~ z~ _ m~ - 1 ~ 1 jv O ~ tl ~ ~ 'r z a~ 1~ ~"I"i v : v' n N ;~- ~ 3 1~ m D m ~ v m AD ~ ~~ ~~ j i w~v ~N ~ of m w_ zav pm I ~ ~~ "' m~ ~ p S ~ a' ' ~ _ ~p _ - m -"1l7i NN•! Z - 1 ~ m in ~ I ~ c i ~,,jo, - : _-_- ~ R1 ~ 1 ,_ _ ~~ c ~\ _ ... ~ ~, ~ 33' i ,vas _ , -' ~.Z~E D`...p ~ ~1 1~ /.ice N .__. ~ ~ ~Z~£ ,~`V .~' I~ ~ / ~ ~ ({ .JJ ~ ... O ? i • ~ / ~ / NQt°06'41"W 174.79' v . / ' ' ' .• ® •-- -- - _~~` 31.24' • ~ ~i N .. ~ ~` (71 . / _ ~.~.'.. ... •~ N C~ •~ ~ /•~~ ~ ~ _ p ~ Z ~ ~ ~ ~ / ~ ~ Q N ~ ~ ~ / ~ ~. ~ ~ ~ ~ ld~ m ~_ m~ ~ ~ mz / ~ Y ~. ~' , aC ~N j w ~ ~~ ~D i ~i ~ C pm II C ON / ~ ~~ Nv ~ oz ' it ~ f yZ g~ f 'cam '~'sr ~ ~ ~`^J ~a ,~ ~~~ ~~ ~6