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HomeMy WebLinkAbout020-1409-02-0004 0 ti ~ of H ey ... 0 N 00 N ~O d C ,y o~ '~ •~ N V •~ ~~ V •~ O `I~i v rn w ~ m v z °' w N H fn O ~Z~y ~ N y, T t O a' m V c m N a a M J V O W FN ice. CC .~ C~ ea ~+ O ~ 0 o ~ ~ O C o O' N y O N 2 at ~' ~ °- ad; c U d ~ Q ~ I 3 I O ~ I I y _ a9i ~ I E y ° m ~` 3 ~ I ~ 3 u iw-v ~ I O'O y O. "' C O ~ x p f0 0 V .~ '_ U d N ._ f0 > ~ L f0 ~ L L O L aL V ? ~ .3 nay ~ ~ I E Y ~ >.~ oc ~ I ~ f0 C y m C O aU + O . ~p y p ~ Z c p_M > w U c L oaoo._~ C O f0 ~ y ao E I I O~~~ p C C d 3 ~ °~' v'rnw.m I Q a ~ ~=~`o ~ ~ I ~ ~ I z I E r $ I a m I O ~ c U - ~ 0 m w o I ~ v C ~ -p I (,'' N C ~ 7 ~ N ~ m O N ~ c I d m ~ ~ I z ~ z w I ° z I c c I d N m ' N A ~ a co y m ~ c m ~ .o c g I ~ o oa ~ rn m ~ I , rr rr ~ O ~ o a~ ~ o I z ~aaa ~ ~, v y o o 'p ~ m I = O O ~ } -p N N ~ ~ ~ N N ~ O I J O O _ ~ 7 = 0 m ~ c a I c N '0 41 ~ y ~ _~ Q /~ C/~ ~ O ~ A I M ~ C E c ~ a ~ o c c a N N N N O Y O 7 C'1 C 3 N ^ y ~ ' ~_ ~ n y O mvo " o N m z =a ~ ~ I ~cn w ~€ I m a I a ~ ~ I f A V i Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ~~~O ~S,~ Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) 1 i Department of Commerce (608) 266-3151 ~ -/ Sanitary Permit Applicatlo ~ _ rate Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information o may be used for secondary purposes Privacy La rojext Address (if different than mailing address) ~ . [. Application Information -Please Print All Information ~ e j Property Owner's Name 1~ Parcel # t # Block # - ~~ U1X Ct~UNTY a Property Owner's Mailing Address ZONING Pr ope rty Loca tion - ~ ~ ~ ~, S ~ Section ~~ ~ ~' S i Zi C d e Number Ph ~ ' =~ -~ tate C ty, p o e on T N; R~ [ E o~ ~1 Type of Building (check all that apply) R . ._ - - . 1 or 2 Family Dwelling -Number of Bedrooms Subdivision Name CSM Number ^ Public/Commercial -Describe Use ^ State Owned -Describe Use ^City_^Villa a wnship of III. T ype of Permit: (Check only one box on line A. Complete line B ifapplicable) - Q ~ A' Jew System ^ Replacement System ^ TreatmenUHolding Tank Replacem nl ^ Other Modifi g ystetn B. ^ Permit Renewal ~( Permit Revision ^ Change of ^ Permit Transfer to Ne~v List Previous Permit Number and Date Issued Before Expiration ` Plumber Owner ~ /~ / 4 ~_ O~ (O ~ IV. T e of POWTS S stem: Check all-that a 1 ~tl ~.)Ypn -Pressurized In-Ground ^ Mound ? 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 Filter ^ Recirculating Synthetic Media Filter Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersaUTreatment Area Information: Desi gn Flow (gpd) Design Soil Application Rate(gpdsf) sal Area Required (sf) Disper Dispersal Area Proposed (sf) El e vation System / !~ l~ ` .~ Q 8J~7 ~d g / ~ l toy ~~ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tatilcs Septic or Holding Tank I~ / ,.~ ~OO ' , I ' .~ p ,- ~"~~ ` Aerobic Treahnent Unit - Dosing Chamber ~a -.~ O VII. Responsibility Statement- I, the undersigned, assume res onsibility for i stallation of the POWTS shown on the attached plans. Plum Nam (Print ~~t Plum Signs a PRS Number Business Phone Number - ~ ~a ~ ~s~ 7~s - a~ s~ ~ Plumber's Address (Street, City, State, Zip Code VIII. n /De artment Use Onl pproved ^ Disapproved Sanitary Permit Fee (includes Groundwat Surcharge Fee) ~ ~ Date Issued R Iss g Age Sign re ( mps) ^ Owner Given Reason for Denial ~~ . ~~ 0 IX. Conditions of Approval/Reasons for Disapproval ~ ~ ~ L / Affach complete plans (to the County only) for the system on paper not las tn>ad ar/c x If tncdea rn stxe SBD-6398 (R. O 1 /03) ~-~~. ~ N6- ~ t ISoo goo ~~ !`' ~(D !~ -~oc~ ~~os 8~. 6•~ Q~ COMBINATION SEPTIC/DOSE CHAMBER TANK & PUMP SPECIFICATIONS PER COMM 84.25 CODE CHANGES 2/1/2004 Access Opening, not top of cover, must e~dend to a point na greater than 6" Bdow Finished Grade Cover vuith ~CA'rF~1 Lacking Device ~ X (typical) ~UII.UN~1~t' St:1N ~R- lNSU~ P-~ Min. 23" Access Opening Ouh:t C~ifluent Filter ~ Inlet Baffle s~ Access Opening, not top of cover, must e~dend at least 4" Above Finished Glade . ~'~/~~~~ pQ~~ ~~ fi fFinishedGrade IZaM/N~//~vm ~-- Min. Z3" Access Opening ~ r,~i~ if ~'p/c SL.~'~ ~i ~ .Union ~¢pe°YE~ ~/P~ 3 Pr I a~.~ oN`Ta soda So~~ SPECIFICATIONS TANK MFR: Ll,t~~-~ TANK SIZE: SEPTIC /0700 GAL. DOSE ~ GAL. ALARM MFR: ~Q.w~1~- MODEL # Switch type: PUMP MFR: MODEL #: /.. s'~'oS' SWITCH TYPE: l'~-~-.~ REQUIRED DISCHARGE RATE o~Z~GPM 3 ",Sand or q ru. "~ ~n~yunal~F~ c,~i~h c~ch~er 2•, ~vwer yLhan Pd~ps CamparFment SepticJPump Tank /~ ~ ~r A~ o n ~vfside GUa~~ DOSES PER DAY: DOSE VOLUME: ~~ GAL. (INCLUDES FLOWBACK & <20% OF DWF) CAPACITIES: A = ~~oZINCHES = l ~S~L. B = _2_INCHES =~_GAL. C = ~~~©INCHES = ad~ _GAL. D = ~ INCHES = fOJ~ GAL. PUMP & ALARM WIRING PER COMM 83.43(8)(e) VERTICAL DIFFERENCE BETWEEN PUMP OFF & DISTRIBUTION PIPE (LIFT) = fb 3 FT. MINIMUM NETWORK SUPPLY PRESSURE (DISTAL & NETWORK PRESSURE) _ + ~" FT. ~_FT. OF FORCEMAIN x /~ /t~ FT./100 FT. FRICTION FACTOR ...... _ + s ~/y' FT. TOTAL DYNAMIC HEAD (TDH) _ ~~ gI /FT. INTERNAL TANK DIMENSIONS: LENGTH ;WIDTH ;LIQUID DEPTH 3 MP/MPRS SIGNATURE: LICENSE NUMBER: ~?~~.~5 7 ~~ GOULDS PUMPS • Submersible Effluent Pump , ~~ EP04 & E PO 5 Series APPLICATIONS • Fully submerged in high ^ EP05 Impeller: Thermoplas- ^ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication and efficient improved performance, construction. • Effluent systems heat transfer. ^ Casing and Base: Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms manual operation. Auto- superior strength and corrosion • Heavy duty sump matic models include resistance. SA. Canadian Standards Assodation • Water transfer File # LR385a9 Mechanical Float Switch ^ Motor Housing: Cast iron ~~ • Dewatering assembled and preset at the for efficient heat transfer, Goulds Pumps is ISO 9001 Registered. factory. ~ strength, and durability. SPECIFICATIONS ^ Motor Cover: Thermop-astic • Solids handling capability: FEATURES cover with integral handle and '/<" maximum. ^ EP04 Impeller: Thermo Las- float switch attachment points. • Capacities: up to 60 GPM. tic semi-open design with p ^ Power Cable; Severe duty • Total heads: up to 31 feet, pump out vanes for mechanical rated oil and water.resistant. • Discharge size: 1'/z" NPT, seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) Intermittent. METERS FEET ---- • Fasteners: 300 series to stain ess steel • Capable of running 9 30 --- ~--SGPM --, dry without damage to ; - --....__. i s :____ .. __ _,. components. z s ~r 25 ° ~ -; Motor: W ,........._ ......... . ... _ ._ :.. _ . __ j x _ t-- _ ; • EP04 Single phase: 0.4 HP, ~ 6 zo 115 or 230 V, 60 Hz, 1550 a ~ ~-'-'-'-~~' __ _. RPM, built in overload with ,~. 5 automatic reset. ° ~ 5 .. . • EP05 Single phase: 0,5 HP, 0 4 - ~ ~ ~ EP05 ... 115 V or 230V, 60 Hz, 1550 ~ RPM, built in overload with 3 to automatic reset. - ......i ....... , 2 I _ ......... .......... EP04 ........,.. . .. • Power cord: 10 foot 5 standard length, 16/3 t ~ -----~ Z o ........ , .. ........ . SJTW with three prong ~ ~ - ~ ~ _ __ _ .._ grounding plug, Optional 20 0 0o i j foot length, 16/3 SJTW with '0 3o ao so GPM three prong grounding plug (standard on EP05). o z 4 6 s t o i z m~/n CAPACITY .. Goulds Pumps ® 2003 Goulds Pumps Effective July, 2003 838" ITT Industries I Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT P141D Page ~ of m acwroance wnn Comm oa, vvis. ram. ~.oae County ~' ~~~' Attach complete site plan on paper not less than 8 1/2 x i 1 inches in size Plan must ~ . inGude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. ~ ( d"~ , r~p1 Z~ ~ ' Y'v ~-r C percent slope, scale or dimensions, north arrow, and location and distance to nearest road. . 1 Piease pri igtor~ieR- -•--~----~-~-~ . Re ' ed b Date Personal information you provide may be u . a 4 d for llgr pur~dddt{/rrRracy La~. s. 15.04 (1) (m)). ~ Property Owner ~ Property Location + ;, ~ j_ ~i "~ ~~1~;~, ~ Govt. Lot ~ 1/4 ~ 1/4 S T N R ' E (or~ Property Owner's Mailing A ss s Lot # Block # Subd. Name or CSM# 9 t.~. ~ ~ . , o~ lid ~ City State ~, ^ City ^ Vllage I~Town .Nearest ', ~ New Construction Use: ~ Residential / Number of bedrooms _ ~ Code derived design flow rate (~~ ~ GPD ^ Replacement ^ Public oJr_commercial -Describe: _____ _ Parent material Q (~ Q~ ~ Flood Plain elevation if appligble ~/~~ ft. General comments ~Y~~~ N1 ~/'e U ~ ~~i~/ `~ and recommendations: Boring # ^ Boring Pit Ground surface elev. ~Zr C~ ft. Depth to limiting factor ~~ in. Soit ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Z -L / - S~ nib ~5' - , ~j Z~-Il$ - ~ ~ `- • ® [~ pit Ground surface elev. t~OZ~ d ft. Depth to limiting factor ~,~_ in. ~n~ # ^ ~~ Sofl ication Rate Horizon Depth Dominant Color Redox Description Texture Stnxxure Consistence Boundary Roots GP D/fr? in. MunseA Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eft#1 'Eff#2 4 ~ Z t7 ~ Sl ,,~ r r- ~'Y~ ~ V~ I J~ 1 L- D L -- ~ siG G ~-- ~ r io ~ ~L'G1 ~ M (, - r' EtflueM #1 = BODS > 30 < 7Z0 mgll and TSS >30 < 150 mglL 'Effluent #2 = BOD, < 30 mg/L and TSS < 30 mgll CST Name (Please Pnnt~ _ - tore 7 C:.=rUrrfber Ada ran vv~o~ . ~y /'-~~ ~%' ~ _-.. ~-S 3 3 a `~ Address ~ rJ to Evaluatwn Conducted Telephone Ntxnber x-11 ~ ~ ~" ~ ~ .~ rv`u.~~~, w I ~ SYo z S~ (~ - l ~ -d ~ 7/S- ~ -o~ ~ ~' Property Owner ~ mC-~ Parcel ID # _ f d-t' Z Page _~ of btu Pit Ground Surface elev. 6Z ft. Depth to limiting factor ~Z ~ in . ~I iption Rate Horizon Depth Dominant Cdor Redox Description Texture Stricture Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 `~ d ~~ 1~ ~ (r ~t~ G ~+ 4 Z 2- I - c, L ,md k. M ~ 3l - Z1 - S O yY~ ~ ~ - r ~ ~. a ^ Pit Ground surface elev. ft. Depth to limiting factor in # ° ~~ . Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fl= in. Munseq Qu. Sz. Cont Cdor Gr. Sz Sh. •Eff#1 I •Eff#2 ~~ # ^ Bonng - ^ Pit Ground surface elev. ft. Depth to Nrrrfing factor in. Sal iration Rate Horizon Depth Dominant Col Redox Description. Texture Stnx~ure Consistence Boundary Roots GP D/fP in. MunseA Qu. Sz. CoM. Color Gr. Sz Sh. •Eff#1 •Eff#2 • EffNcent #1 =BODE > 30 < 220 mglL and TSS >30 < 150 mglL • Effluent #2 =BODE < 30 mgJL 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. seas3wtR.broot PAGE ~ OF~ rT a ~~~ ~St~ LOT# ~--- T EGAL DFSCRIPTION~ ~-~ ~ ,~ y T ~ N R ~gTElorl' 'I r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERA. INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15,04 (1)(m)]. permit Holder's Name: City Village X Township Bast, Kernon Hudson Townshi SST BM Elev: Insp. BM Elev: BM Descriptio SANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic .~~ZQ.Qh. 1 ~6J Dosing / ~ J n~ Aeration (ti,~ QQ Holding. TANK SETBACK INFORMATION TANK TO P/L ~ T'S WELL BLDG. Vent to Air Intake ROAD Septic ~ / ~ I / ` / ~~ Dosing / Aeration Holdin PUMP/SIPHON INFORMATION Manufacturer ~ ~/ , . n Demand ~, , - , C~!J' 0 ~D U ~ GPM Model Number ~~ ,/ ~ ~~ TDH Lift ,,3~ Frictigp` Los Sy stemN ' d T ~ ~r Ft 1 Forcemain Leng~r Dia. /i Dist tro W~ ~~ county: St. Croix Sanitary Permit No: 430110 0 State Plan ID No: Parcel Tax No: 020-1409-02-000 SectionlTown/Range/Map No: 24.29.19.2560 STATION BS HI FS ELEV. Ben hmar ~~ ,' ~ 3 I Alt. BM `~. GSA (v. Bldg. Se~jer ` ,~_ /' ~~ St/Ht Inlet SUHt Outlet .~- ~~ Dt Inlet ~~ Dt Bottom Q ~ ~ I G I • d ~ v ,' S~ o Header/Man. ~QJ, t'0~~~ 9~. y Dist. Pipe ~p UG ~ ~ ~ q7- d ~ Bot. System } 7, ~~0 7 6 y Final Grade , u~e~}-si . Z 3. ~ f p~, d,, St Cov ~/ //-- • rP ~~O SOIL ABSORPTION SYSTEM _ 7 R l,tl/ / ~ ,r2P/1_'~'j ~-o.(~. _ BED/TRENCH DIMENSIONS Width ~ 3 Length ~"~ No. Of Tr ch s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth ~~ ,J SETBACK SYSTEM TO P/L BLDG WE L LAKE/STREAM LEACHING M apf28Tu~r: INFORMATION CHAMBER OR ~ 11~~ ~b1' ~]1T Ty Of System: / ~ UNIT Model Number: Z t ~lP~ T DISTRIBUTION SYSTEM Header/Mani~old it h Distribution ! ~ Pipe(s) ~/ x Hole Size _ x Hole Spacing ,.~-~- Vent it Intake / Lengt Dia Length~~ Dia Spacing ~ ~ /~ SOIL COVER x Pressure Systems Onfv xx Mound Or At-Grade Systems Only ~ d C~+ (,¢.ys ~ y~~yt Depth Over Bed/Trench Center ~i ~i~l Depth Over Bed/Trench Edges xx Depth of Topsoil xx Seeded/Sodded xx Mulched Yes f No ~ 1, Yes . J No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/_~F~~ Inspection #2: / / Location: 832 Hidden Lake Rd,Non, WI 54016 (SE 1/4 SE 1/4 24 T29N R19W) Boundary Ridge~LotA2 Parcel No: 24.29.19.2560 1 J Alt BM Description = r~~~~~l/ ~''~~/I.QfL- ~~ B~~ ~ ~s~ wi.X~`~` ~lj ~.f ~ 2.) Bldg sewer length = ~ ~ /~jyt,~ ~jl.J ~~~ - amount of cover = ~ ~ .S (~ (~ d ~ ~ / ,I - N ~ S6 ti ~ ~-t.S-~ -Cc~ l~' _~oLB-eJ~_'~~_~_ v _ _ °~Pl' Plan revision Required? i _ Yes [I No ~Q/' n ~~/~ 'I~-- _----- - - - -- ~- - - --1 , ~ `-~~ Use other side for additio inf m on. ((~(%1 ____II ~ ~ .]C Q~te ~ Insepctor' Signa ure Cert. o. SBD-6710 (R.3/97) ~ ~ / `~ - _, I [ ~ c e~ p ~ ~ c~ ~ 3~~~- VtPn[~.T ~ ~'Lt) ~ ~ ~ ~'i 1 / ,$/ ~~~ ~ ~~~. ~i$ ~ v~ ~~~~ h Safety and Buildings Division C~tY ~ ~ m ~ 201 W. Washington Ave., P.O. Box 7082 ~ ~~ is~Ons'~~ Madison, WI 53707 - 7082 (608) 261546 Sattitary txtrtit Number (to be filled in by Co.) ~? . De artment of Commerce , ~ l~~ Sanitary Permit Application State Plsn I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary Purposes Privacy w, s 15.04(1 xm) Project Address (if di fferent than mailing address) I. Application Information -Please Print All Informati ~ ° t4 ~.~,,°P' O Property Owner's Name ~ 4~~I,i~~ ~ ( Parcel # Lot # Block # ~ ) Property Owner's Mailing Address ~ ~ Property Location G `'%~a ~ ~~ ~` ~' ~ ~ ~'/ ~/ S i Ci tate Zi ., ., ect on p Code r ~ (~~ J ~~ // to ~~ -, L circle one) T ~N R~E or W II. Type of $uildiag (check all that apply) g 4,b ,,,,~ ; ~ Subdivision Name M b 1 or 2 Family Dwelling - Number of Bedrooms _ dM.S um er ^ PublicJCommercial -Describe Use ^ State Owned - Descn'be Use ^City ^Vi age wnship of IIL Type of Permit: (Check only one box on line A. Complete line B if applicable) O,t.O - -OL ~ CJtX~ e.Zs A. New S em yst ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B• ^ Pernit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T of POWTS S stem: Check all that a 1 v ~on -Pressurized In-Ground ^ Mound > 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 Filter ^ Recirculating Synthetic Media Filter Leaching Chamber ^ Drip Line ^ avel-less ipe ^ Other (explain) V. Dis ersaVTreatment Area Infor lion; k Design Flow (gpd) Design Soil A lion Rat Dis Area R ved (sf) ` Dispersal Area Proposed (s System Elevation / ~" ~ ' loOd ~, ~' ' ) oo VI. Tank Info Capaci Total Number Manufacturer Prefab Site ~cel 1 stic Gallons Gallons of Units Concrete Constntcted s New Existing Tacks Tucks Septic or Holding TuJc ~ Aerobic Treattneat Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for i tallatioa of the POWTS shown on the attached plans. PI t ~ Plumber' Si tore P PRS Nurt~ber Business Phone Number ,~ ,~~~r sera 3s ~ ~.%~ ~G s-~ ~ Plumber's Address (Street, City, State, Zip Code) / / ~ ~ • ~ 1`icr"~~ s Q O V ~~ II. Coon /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Surchar F ) Date Issued sui Agent Signature o Stamps) ^ Owner Given Reason for Denial ge ce ~ ~- ~/ZS/; ~ IX. Conditions of ApprovaUReasons for Disap~y~va~l '' nn~ ~ ~--TV'etA,t.Qnlrl~ rw~.t,a~ ~ ~~nt .~' ~.ti..f~ 3 ~-~f0 a b~.~t~ a.~e..~tq C,ls+vaaw, ~ ~ o.a ~ ^ I - V+A ~I". Mttach complete pica: (to the Ceenty only) for the system oa paper set hxs thaw 8]/Z :1! caches is sift ~S r SBD-6398 (R. 08/02) r l ~O . I ~+ l~~ N ,~ p ~~ f~ 3y 1- /°° ~ ~~ r r' -_ ~ ~° ~ 1 ~~ = 3~ 9 a l T 3 : g~, sa 2~~ ~-~ ~~,ao .. to ~~.- ~~ ~ v {~~ ~ ~~~ 1 ~~-a ~30~ ~~a -,~ ~~ ~~~~o ^. ®' ~- ~~ ~~ ~ t 1 T~a q 3,so ~ ~3 aao3s~ ,~=3 ~ 9o?.SO r ~ - ~~~ r ~ ~~ 39 ~~~Or>a ~~ . ~ . ~~o _ a . ~ ~ ya /3~ ~~ .~~~ r~ 93 ~ ~a- T-3 _ g~,sa ~. -~. ti o ~~,, l ,~ ~~~, ~` p~ 1 ~~3-a l /`_-30 ~~-a ~'~'~ ~,~. ~~ ~ ~~~ ~~ ~ ~~ ~~ ~ C~ ~t1 T~a q 3, s~ ~ `~3 aao 3S7 r ~~ 9o~..SO r Ndt• ~~ T '~ 0~ f~Pld~(J ~ . 3 5 ASS '~ /y/4'J a /2 plq-T /~L~~trQl f~U~r- 'Msconsin bepartmenl of Commerce SOIL EVALUATION REPORT page ~ of 3 -Ivislon of Safely and Buildings ' in accordance with Comm 85, Wls. Adm. Code ' County 57;' CR Ol }~ Allarh complete stir, plan on papr±r not less Than p Ill x 11 Inches In size. Plan mull hrciude, but not Iindlyd to: vertlral and horizontal reference point (BM), direction and parcel Lb. OZQ • /Q~ 9 • /~ • /~ percent slope, scale or dimensions, north arrow, and location and distance Io nearest road. Please nrlnt ail -nforn>Iaflon, rte ewed b~ ~ D Je ~ ~> ~ZSo hnrsonal inrornratlon yotr provide may he used for secondary proposes (r'rivacy law, s. 15.01 trl (mtl Properly Owne- f KEIpNoil! I3~yT ,' D`NA~~ ^~ pY location Cc ~/ E Govi. l.ol SL t!4 ~ 1/4 S Z T T ~9 N R ~~ ~ (or) W Properly Owner's Mailing Address col p Block # Stlbd. Name or~8(M# ~` y f;IIY Slate Z-p Code Phone um er - [] Cily [~ Village g] Town Nearest Road ffv~so ~ cv,. syo~lP , ~s ff vf~soN ~ r~Aa~~~s ~ ~l . New Construction Use: (~ Residenliai !Number of bedrooms 3'~ Code derived design Qow rate y~(~ -' ~p6C7 GpO (_) ReplaEemenl ^ rubllc or commercial -Describe: Parent material _ /Q~'S f) D~ ,$/4,L,~Q y Rood Plain eievallon if applicable /V (I. General comments ~~L-~/4 r~ t`- and recommendations: jf~a.~ • TEST i9'~P~`~' sv~•T,g/3/~ ~~' ~'.v /.~ f/~ov.~~ Co'vaE.~'r~o.~A c._ haw r-s . I Boring M t~-1 Bo-!ng G4 /b ~ C~ ^w n.. r2.f..•..a w...fwww wlw.. 7a • f~ l -.. ~,..~ ....... ..........y .~~.... - .... I lorizon Ueplh Uomina-rl Color liedox Uescrlplion texture SUuctvre Consistence Boundary Roots Soil Application Rale GPD/It' . In, Munsell Qu. Sz. Cont. Cola Gr. Sz. Sh. 'Eff#t 'Eft#2 / D•~z IDy~Zj3 G. 2~SbK n~fie w 3 f S . 8 /.t •3~ /a Yk' Y ~ ------- SiL she •~.~ie ~ / ~ 5 f 8 3 _ ~~ /Dye s/ ----... SL 2 Sb,~ ~s . S . 9 Boring # Cl Boring y8 so > ~ y 1X1 hll (imund SurtarA alav h nw.,u, rw u...urw.. rww~w. ~_ fo-tzon bepfh borninanl Color rtedox bescrlpllon texture Structure Consistence Boundary Roots son nppac 6p aaon mate D/11' In. Munsell qu. Sz. Cont. Cola Gr. Sz. Sh. 'Eff#1 'Eft#2 / D • $ io y ??'3 _ ~ I f ;s,bx ~t die w ,3 • . ~ . z ~ ~ a y ic. Z S ,~ ~ fie / f , s . 8 • g /o --- n~~2. S o, s .7 ~. ~:~ • errn..___ . L. i, ~•••~~••• ~• • - ~~~s - ~~ _ cw mgrs anv r ss ~~u c ~5u mgrt_ ' Emuent f!2 - BOb~ < 30 mg/L and TSS < 30 mg11. CSi Name (Please Print Signalur CST Number 'Ro,BER7" ~//6RiCtiT 2243?S Address Dale Evaluation Conducted Telephone Number ' ht g Associates ~ f~a ~/.r • 3~CO ' ~l g 5 Private Sewage onsu 655 O'Nail Rd. Hudson, Wis. 54018 ~. S,o~~~ t3~5r ~.~,,~ s 3~ ~ K . /3~-sT , rroperly Owrrer r r ago . ~o~~ •to -. ~~ Z 3 a cel Ib a U poring a U Boring ~•~ 3~ Gage rn Ground surface elev ~ > ~ of , . _ rl. Ueplh to limiting raclor In, 1lrnizon bepih M Uonrlnani Color Redox Uescripiion Muns ll 7exlure • Slruclure Consistence Bounda Roots ~ Soll llpplicalion Rale GPDiflt • t o -i e Qu. Sz. Coral. Color iorR 3 -- t Gr. Sz. Sh• Zfs h~ 'Ettai 'Erra2 ~~ w 3 F • s , g ,~ ~o ~ st SiL 2 f ~, a,i ____ S . ~' - - -- °F~ Boring ~ u Boring 33.x/6 q_~ U f'il Ground surface elev. rlorhon Ueplh bominanl Color Redox Uescriplion In• Munsell qu. Sz. Cont. Color ~~ rl. beplh to Iirniling laclor ln. Soil /lppilcalion Rale 7exlure Slnrcture Consistence 9oUndary Roots GPO/Il' Gr. Sz. Sh. 'Errai ~ 'ERa2 r Borin '~ ,. U Boring!! r~~ 9 LJ rll Ground surface elev. H. Uepih Io tlmlling raclor in. ~` {iorizon beplh Uominanl Color Redox Uesaip0on 7exlure Slruclure Conslslence Bounda Roots Soil AppOcalhxr Rele ln• Munsep ry GPD/llt Qu. St. Coral. Color Gr. Sz. Sh. 'E%at ~ 'EIri~2 N ' Ellluenl ill = BpUs > 30 < 220 mgll_ and TSS >30 < 150 mg/t_ ' Erlluenl p2 _ 9QU < 30 m • _ g/L and TSS < 30 mgll. 'the 1)eparlnrenf of Crnnrnerce is an equal opportunity service provider end employer. If you need assistance to access services or need material in an l+lfernate formal, please contact the department ai G08-2G6-315) or 7TY G08-2G4-8777. SIth.R7)n rR F/Mq ~~ ~D ~0 l ~ `~ ~ ~ ,~ ~~oY Yr v ~~ ~r ~ ~' , o ~~ o ~ o~ •~ - ,C3~,Ic~~e A~'TS ~, a - ~,~~ vie ~ ~~ ; ~P~,.,.Qs M ~ ,, 10 ~ ~- c ~._„ , ~'4~30~ 4 ~~, 3~, o ~ /y . ~ ~ f~- P' s o ~~ qo ---- o ---_ ~fl ~~ . J /! 1 ~- POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of 2 FILE INFORMATION Owner Permit # L~30 / 1 ~ DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Uniis ^ NA Estimated flow leverage) gal/da Design flow (peak), (Estimated x 1.5) ~~ al/da Soil Application Rate ~ S al/day/ftz Standard Influent/Effluent Quality Monthly average" Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand IBOD51 5220 mg/L ^ NA Total Suspended Solids (TSSI 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD5) <_30 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Coliform (geometric mean) 510` cfu/100m1 Maximum Effluent Particle Size Ye in die. ^ NA Other: ^ NA "Values typical for domestic wastewater and septic tank effluent. ^aeuuTCr-rerurrc erucnru ~ SYSTEM SPECIFICATIONS Septic Tank Capacity al ^ NA Septic Tank Manufacturer ^ NA Effluent Filter Manufacturer z c ^ NA Effluent Filter Model ~ - p a ^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer ^ NA Pump Model ~ ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ^ NA Dispersal Cell(s) In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA Service Event Service Frequency Inspect condition of tankls- At least once every: ^ ear sj s) (Maxirnum 3 years) ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third (Y31 of tank volume ^ NA Inspect dispersal cell(s) At least once every: ~ ~ yeas sj s- (Maximum 3 years) ^ NA Clean effluent filter At least once every: ^ month(s) .® year(s) ^ NA Inspect pump, pump controls & alarm At least once every: ^ month(s) ^ year(s) ^ NA Flush laterals and pressure test At least once every: ^ month(s) ^ yearls- ^ NA Other: At least once every: ^ month(s) ^yearls) ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankls) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. 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 (Y31 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized 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 ~ of 2 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products of other chemicals that may impede the treatment process and/or damage the dispersal cell(sl. If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. ' System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cellls) in one large dose, overloading the celllsl 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 patkbver, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; 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 shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall 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 POWTS fails and cannot be repaired the following measures have been, or: must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be 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 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 effect 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 installed as a last resort to replace the failed POWTS. ~~ T alua ' a o ing~ank be ' e ate '~fZp{.j181T~ ~OIQ-1~/>~/ L'ONS`77ZC1~?LD ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT 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 DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name P ! V ~-A~'~ Phone ~ Z(o Q, (' ~9~ POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name s-T', t~' l d ZD~II ~ Phone "7/S- 3~(0- !O (~ This document was drafted in compliance with chapter Comm 83.2212)Ib1i1)Id)&If) and 83.5411), 12) & (31, Wisconsin Administrative Code. ST CROIX C~~ A~$~~ SBP'TIC TANK iVti OWNERSHIP CBRTIFICATION FORM Owner/Buya Niailiag Address property Address C'itylState ~i~~v~/ ~ !fir Parcel Identification Number LEGAL DESC1t1PTION ~ ~ ~G~ ~/~, ~~ t/s, Sec. ~, T._._._.1.N ~L! -1-w~ Town of property Location `vim Lot # ~ Subdivision ~~ "~- .Volume ~-~~ # Cer(3Sed Survey Map # 0 7 ~ ~©~ _~ Volume t Page # Warranty Deed # es O no Lot lines identifiablei-a yes CJ ao Spec house ~g~+'M liRAIN'rENA.NCE could result is its pce~~ ~~ to handle wastes. propermaw use acrd matatenaareof your septic system sooner, if needed by a licxased Pampcr What You pat zuto ~ eonaists ~pymping out the septic tank every threeyears ran affect Hie function of the acetic tank as a treatment stage in the wade " a cerpSication form, signed by ~°~°,~ The pmpcrty owner agrees to subanit to S't. Croix Zoning Dept , that (1) the oa-site wasbcwa dtsposd p jo~yrnaaplumbe~ testrictodPlamber or a hcenaodp~PeT verrfyiag ,~ tic tank is less than 1/3 full of st~dge- eondit:on andlar (Z) after inspoction and pumping (if necessary), ~P is is proper operating with the stcwdards T~ ~ wed have read tine above regairemends to maintain ~ private sewage disposal troa and agree nt of Natural R~esonrces, State of Wisronsia- ~~` . set foci, heroes ~ set by the Department of Commerce and the 1Dct to the St Croix County Zoning Coca within 30 stating that your septic system has betas maintained must be comp days of the tbs+~ Y irntioa date. ~f / D DATE SIt3bTA APPLICANT OWNER ~RTIFICAI'ION our knowledge. I (we) am (are) the owner(s) of I (wc) certify that all statements oa this form are true to the best of my ( ) above, by virtue of a warranty deed recorded m Register of Deeds Office. the properly descre / ~ ~, DATE STGNA F APPLICANT «««««« Any information that is mis-mpresentod may rosult is the sanitary peraut being revokad by the Zoning Does' ««««:« •« licatlon: a stamped wancsaty deed from the Register of Deeds oSxx Indnde with this app a SPY of the rectified anrveY a>ap if'roference ~ made ~ the vvaaantY decd (~/~CatlOn T'OQIiR~ uvua rra'++."'6 ~-r------ %~ ST~CTE BAR OF WISCONSIN FOAM"3 -4400 WARRANTY DEED Document Number ' This Deed, made between David A. Larson and Lee Ann Larson husband and wife Grantor, and xernon J. Bast, andDonalda J. S-pger-Bast, husband Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in st. Croix County, State of Wisconsin (the "Property") (if more space is needed, please attach addendum): That Part of EhSE1s Sec/ 24-T29N-19W described as follows: Lot 3 of Certified Survey Map recorded in vol. 11 of Certified Survey Maps, page 3151 as Doc. No. 548751. Together with all appurtenant rights, title and interests. 6 8 0 0 1 KATHLEEN H. WALSH REGISTER OF DEEUS ST. CRUIX GU., MI kECEIVED FUk kECUkD 05-03-2002 8:25 AM ,;aaauuly ;,Ei:c kEC FEE: 11.00 TRANS FEE: 1312.50 COPY FEE: CERT CUPY FEE: PAGES: 1 Recording Area Name end Retum Address ~F~ ~- 020-1069-10-100 Parcel Identification Number (PIN) This is homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Roadways, Easements, and Restrictions of Record. Dated this 1st day of _ May 2002 AUTHENTICATION Signature(s) * David A/./jL7arson ~ r • a Ann Larson ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. ~ St Croix County. ) Personally came before me this 1st day of Mav 2002 the above named vid L o nd Loe Ann rson TITLE: MEMBER STATE BAR OF WIS (If not, authorized by §706.06, Wis. Stats.) THIS tNSTRUMENT WAS DRAFTED BY Michael H Forecki Attorney to me known to be the person s who executed the fore o' ins ~nt . t ~~~ ledged the same. ~ s t Xnv A rll Notify Public, State of Wisconsin My Commission is permanent. (If not, state expiration date (Si natures ma be authenticated or acknowled ed. Both are no[ necess uv°"°"-'~~ ~ -" - 'Names of persons signing in uny capacity must be typed or printed below their signature. WARRANTY UEED STATE BAR OF WISCONSIN FORf11 No. 1-2000 ttomey Michael H Forecki 1830 Brackett Ave, Eau Claire Wf 54701.4627 T604G612.ZFX Phone: (715) 835-3029 Fax: (715) 835-4112 Michael H. Forecki Prwlucetl wish LPFwm ^' Dy RE FwmsNq, LLC 180Y5 FiaeM Mrs Roa4 Gaeon Tawnahip, Mirl,pan 48035. (800) 383-9905 ~D PRELMMINARY PLAT' QF: B~UI~C~I~-RY ~"1O.0~'~~ ~ LOCATED tN PART OF THE Nfg1l4 OF THE~E~?/4 AND IN PAP °~'~' ~asa¢ Ri9W. TOWN OR HUDfffON, ST. CROO( CONNTY. WlSCON91 RECORDED f N VOLUME 11, PAGE 9'f f31 At' THE ffiT. CROIX ~~ `e -------.---------------...-~ •6bF1APE6ET12s 3-STOiuONEOMt ~` i ~ ; ESE'CA 112 iW. -1dfa.~2 -.~ ~/ bBNp+lAiwi a ~ ~ ~~ ~ ~~ ~•e~a0 ' ~.=~~~///rte/ ~ / / ~ ~x ~aeo x x e o 1 ~~aer.~ x .~ .: ...:' ~aes.~ x ~ o ~ ~ 3 .Y ~, J ~~~ 1•,x' !~.~ i ti e ~ 2 ~~ ' ~ tOT x i : x ~ Z.OZ ~ ~ ~ A ( ~ 1066.4 fM0.6 x x •°~' ~ '•~x ~ 311.52 i ~ • x ~.~ ~ ~a~a x ._ , .; ios~.z x, i L i ~6s ZAt AIG ~ (Z.O ACf i t ~ ~ f GG7{JIY ~ T f~LA~ V~"i ~aV IwIDA~tY LOCATED IN PART Ot= THE NE1l4 OF THE SE714 AND IN PART •R19W, TOWN OF HUDSON, ST. CRODC COUNTY, VVigCONS1At; ~ RECORDED i_N VOI.VME 11. PA~iE 3161 AT T~iE 8T. CROD~ ~ E~1/c4~ OO~R ` ~, ' t ~ ~ ~ ~_ ~ ~ ~~ ~ ~~~~~w ~ 1 O _ ` ~~ ~ ~ 1 , ,` `~ ~ ~ I 11 ~ ~~ ~ ` .rte ~~ T ~.~.~ ••N `` ..... .. ' ~ 9EEN07[A: ~~ .~' ~ '~ ! ~ . ~TIp1~IM1IO •~• 1 / ~ `•I J i i~ ~/ ~~ '~ f~ ~i ~. ,~ i.OT 9 ~ J ~ / j' ~r:,,.,,,.r LOT iZ / ~~ ~~.. ~ j - l s~c~-oe~rrwsuc+ ~ / ~~or~~" ~~ t