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HomeMy WebLinkAbout020-1409-12-000"ommerce PRIVATE SEWAGE SYSTEM t ,,,~ INSPECTION REPORT SON (ATTACH TO PERMIT) .e may be used for secondary purposes [Privacy Law, 5.15.04 (1)(m)]. Inc. Insp. BM Elev: (~ ~ "1- !o RMATION City Village X Township Hudson Towr MANUFACTURER CAPACITY b ~ oc~ Holding TANK SETBACK INFORMATION TANK TO P/L ~.a5~' WELL ,1,J6~f BLDG. Vent to Air Intake ROAD Septic ~ (~ ~ ~ ~ ~f (/ ~ v (~L~1 ~'''~ GYt . Dosing ~,~, Qty Aeration Holding PUMP/SIPHON INFORMATION Manufacturer C'[ ~ `t-~ _/ _ !'it/J~ Demand GPM Model Number ~~ TDH Lift/ L~ , Fric~ ~ Loss Syst~e_m ~~~1 7 " TDH .~ ~,F 5 For emain 10' ~- Leng t 1 . ~ Dia 2 `' Dist. to Well N o,- ,~ y~ SbIL ABSORPTION SYSTEM ~ ~ ELEVATION DATA County: St. CrOiX Sanitary Permit No: 420724 0 State Plan ID No: Parcel Tax No: 020-1409-12-000 SectionlTown/Range/Map No: 24.29.19.2570 STATION BS HI FS ELEV. Benchmark ~ ~ ,~ ~ ~ 1 AIt.BM .I~I~ w 6 t/ /_2 lo,,/~ (~ "l s BI .Sewer ~n ~~ 7. ~ ~{- 3 S t Inlet S ~ Z .`lam S Ht Outlet /~ ~_ Dt Inl ~- ~~ Dt Bottom airy led- a `~ ,?. g °~ ~ 1 Header/Man i ~ i'1-HD /_ _ d fP C AS_ _/ Dist. Pipe .O Bot. System ( ~ ~ Z. Final Grade .~' Z ~~}}.// Q~ 7(O' ~OU St Cover ~. 9G-~ ~' BEDITRENCH DIMENSIONS Width 3 / r Length ~ ~ No. Of Trenches PIT DIMENSI S -~°'' No. Of Pit Inside Dia. Liquid Depth SETBACK SYSTEM TO P/ B G WELL LAKE/STREA LEACHING Manuf rer. /~ INFORMATION CHAMBER OR ~ .~-~'1 i ~T~.'f'b Typ Of System: V~ ~ _ ~/y ~ j ~ UNIT Model Number: DISTRIBUTION SYSTEM Steed !~~- ~,a rn~r h ~ e^ ~ ~Q/ Header/Manifold f IJ Distribution ~ Pipe(s) ~ ~ ~ ~~ ~S x Hole Size/~ x Hole Spacing / Vent to Air take ~ 1 Length Dia Length Dia_~_ paang / ~ V 5 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over j / Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ ~ ~ Bed/Trench Edges Topsoil ~ Yes j%] No i~ Yes ~. J No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 5 / ~ S//~d3 Inspection #2: / / Location: 829 Hidden Lake Rd Hudson"WI 54016 (SE 1/4 SE 1/4 24 T29N R19W),Boundary Ridge L t 12 Parcel No: 24.29.19.2570 1.) Alt BM Description =Wa.~-I-CY~'L • P'~' i ~ ~~ ~~ ~'!"1D SSIs`~h• /~ 2.) Bldg sewer length = ~j~ i s ,~/,i/ ~;~Qj~ ~nd~~'!/~'lf ~// Q~,~^ (•~~-~ -amount of cover = C,rot.L~~ a~' +`vt,f • st P ~ 3~'~` W "~^"1 ~~~' I'~ ~"I 3,~ ~'j~ ~~ ~ZCR~'~ -- - ~/ Plan revision Required? ', Yes No ~II'' ~I it ~ I~ Use other side for additional information. L __-- -_.-- __ _ ~l<~~~, __~ ~ ._~ Date Insepctor's Si ature Cert. No. "7-6710 (R.3/97) J /~i ~7~ I/ ~ ~n ~~~_ ~,k~~Q~ e`~~~~ Safety and Buildings Division City ~ ` m 201 W. Washington Ave., P.O. Box 7082 L ~ 5'CO~~I~ Madison, WI 53707 - 7082 Sanitary Permit Number (to be filled in by Co.) De artment of Commerce 08) 261-6546 " ! ~ ~ 7a ~{ ~ - o>J Sanitary Permit Application State Plan I.D. Number /~ In accord with Comm 83.21, Wis. Adm. Code, personal information you provide maybe used for secondary purposes Privacy Law, s15.04(Ixm) Project Address (i differ en t th an mailing address) I. Application Information-PleasePrintAlllnformation `^~~~V~I.at ~ ~ ~ ~~ ~ ~ ,1;,~.lJIJ/'" ~~ Propwty Owner's Name P 1 # Lo # Block # ~} ~I i L ~ I'1 1 d ~lY r_ J e /(/~ Property Owner's Mailing Address P , perry Location d uj ~ ~!~ - ~ z .~ 3 ~ sr. ch~oix e~,, v , ~ ZO ~ y. ~y. Section City, State Zip Code Phone u . , , , N ~~~ ~ ~~S- p!~ 8 ' U ! ~~ T ~N; R~E or W) ~ aJ 7~ II. T Building (check all that apply) Ah,(~ /~~i7/r'v"' or 2 Family Dwelling -Number of Bedrooms Subdivision Name M N ber , ^ Public/Commeroial - pescn~be Use ^ State Owned - Descn'be Use ^City ^Villag ip of III. T ype of Permit: (Check only one box on line A. Complete line B if applicable) - A' New S em yst ^ R Iacement S tem ep ys ^ Treatment/Holding 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 Plumber Owner ~ ~ ~ ~ ~ ~ 6 ~ / IV. of POWTS S stem: Check all that a 1 Non -Pressurized [n-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland pressurized [n-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Urit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal ea Required (sf) Dispersal Area Proposed (sf) Sys Elev tin / ~ ~~,75 ~s7 ~ 7Q ~ G VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank / ~ -... /~O© ~~ Aerobic Treatment Unit Dosing CMmber ~ ,_ Q p ,~ VII. Responsibility Statement- I; the unde igned, assume responsibility for to tallatlon of the POWTS shown oa the attached plans. PI 's Nam (Pont Plu 's Si tore PRS Number Business Phone Number ~D~ t~~ t~ 3 ~~s- a~g ~ G ~ ~ Plumber's Address (Street, City, S te, Zip C e ~~~, ~~~ II oun /De artment Use Onl Approved ^ Disapproved Sanitary Permit F (includ~roun ater Surcharge Fee) ~ Day sued ~ suing Agen ignature mps) ^ Owner Given Reason for Denial r ~~ / ~7 ~ IX.nCornditions of ApprovaVReasons for Disapproval ,~, - e '`~ii a GtN`~c- c ~`' e ~' ~~ - ~ - r 1`~ ~t ~ ~%L~~ ~ y /~~ C~t~ ~ ~ '~'1,.2 -~ ~ • -S /~incQ~e~ lrGt ~c C ~ ~" Q~Q~(l~Z~- ~ - ~ ~ ~~ZOY1,~ ~'` ~ ~ Attach complete pleas (to the Bounty only) fer the system os paper not less thaa alrz s 11 inclid is sin SBD-6398 (R. 08/02) ~~ ~~ 1 Q ~ ~ y ~ ~ ~ ~~ ~ ~ Q ~ ~ d0 ~ ~ ~ ~ `'} ~ c'' 1 ~' ~ S a .~ y ~~ ~`\ 1lJ ~ [ ^1 "' / _ \ `~ ~~~~-~ 1 e W W W PUMP CHAMBER CROSS SEC T IOIJ ANG SPECIFICaTIOnJS VEI~IT CAP `1~~C.I. VEAIT PIPE ~ 25~ FROM DOOR, WINDOW OR FRESH AIR IAITAKE WEATFIERPROOF JUIJCTIOh1 BOX 12"MIU. I I I I COIJDUIT ~-- rnr.,l cF APPROVED LOCKtA1G MAIJHOLE COVER GRADE 18"MIN. ~ INLET I * ELEV. FT. A 6 C D y" MIUJ. ~ 18" /"111J. 11~ I I j ~*~ I~~ I I (I I ALARM II I I Oti I V ~`~ \\~; PROVIDE I AIRTIGHT SEAL *APPROVED JOINTS WITH APPROVED PIPE 3' ONTO SOLID SOIL I I I I I I PUMP -~~~ COAICRETE pLOCK OFF - ~ I'r6~ g3,~, ~- RISER EXIT PERMITTED OIJLy IF TAtJK MAAIUFACTURE.R HAS SUGH APPROVAL SEPTIC E SPEGIFIGATIOAIS 005E ~ TAIJKS MAIJUFACTURER: ~ ~ IJUMBER OF DOSES: PER DAy TANK SIZE : ~~ GALL01J5 DOSE VOLUME h IAICLUDIAIG 6ACKFLOW~ ~ ~ GAIIONS ALARM MAIJUFAGTURER: w MODEL I.IUMBER: ~~ ~ ••~~// CAPACITIES: A=~S~IAICHES OR .J'~~~GALLOIJS SWITCH TYPE: g =_ ~INCHES OR ~ GALLOAJ~ PUMP MAIJUFACTURCR: f GALLOIJ`. ` C=IAICHES OR ~~ MODEL AIUMdER: // D=_~~INCHES OR ~!PGALLONS SWITCH TYPE: MOTE: PUMP A1J0 ALARM ARE TO pE MIAIIMUM DISCHARGE RA TALLED OIJ SEPARATE CIRCUITS S E ~~D GPM IN /n ~ VERTICAL DIFFEREAICE DETWEEAI PUMP OFF AIJD DISTRIBUT101J PIPE.. ~V FEE•T • MIIUIMUM AIETWORK SUPPLY PRESSUR E . ~ FEET • ~C~ FEET OF FORCE MAIiJ X Lj ~ T, / FRICTIO-J FACT ~F FE ___ / .~1 OR. ET ioo Fx = TOTAL Dy1JAMIG HEAD = ~' FEET IIJTERAIAL DIMEIJSIOIJC OF TAIJK: LEAIC~TH ;WIDTH ;LIQUID OEPTH .s~_ SIGIJED: LICEI~ISE AJUMBER: DATE: ~~ '' ~ ~ Goultls ~ .pmt ~ °~ b ~r~ <<~~`~ ~~~ Submersible E~iuent Pump C~ 3871 EP05 iAPPLICATIflNS ;;pettifu~ily desigced for the following uses: • Effluent systems _ • Homes . Fartris Heavy duty sump • Water transfer • pewatering (T•l SPECIFICATIONS Pump: EP04 • Solids handling capability: 3/~" maximum. • Capacities: up to 55 GPM. • Total heads: up to 24 feet. • Oisd~arge size:l'/z" NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BONA-N elastomers. • Tem~rature: 104°F (40°C) continuous 140°F (60°C) mtermitter~. • FdStenBrS: 300 Series stainless steel. • Capable of running dry without damage to components. Pump: EP05 • Solids handling capability: ~~ maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • D'~scharge sue:1'r~" NPT. • Mical seal: carbon- rotary/ceramic-stationary, BUNA N elastomers. • Temperature: i 04°F (40°C) continuous 140°f (60°C}intermittent a) o~eo<-cowna . ux. • fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 a 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • EP05 Single phase: 0.5 HP, i 15 V, 60 Hz,1550 RPM, . built in overload with automatic reset. • Power cord:l0 foot standard length,l6/3 SJTO with three prong grounding plug. Optional 20 foot length,16l3 S,i'IW with three prong grounding plug (standard on EP05). IrIETEFtS II FEJ tOF a W d 0 J F 3 • Fully submerged in high grade turbine o~ for lubrication and efficient heat transfer. Available far automatic and manual operation. Automatic modals inclode Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP04 impeller. Thermo- plastic Seml-open design with pump out vanes for mechankal seat protection. ^ EP05 impeller: Thermo- plastic enclosed design for improved performance. ^ Casing and base: Rugged thermoplastic design provides superior strength and corrosion. resistance. ^ Motar.Housing: Cast iron for eftidern heat transfer, strength, and durability. ~ Motor Cover: Thermoplas- tic Dover with integral handle and float switch attachment points. ^ power Cable: Severe duty rated alt and water resistant. ^ Bearings: Upper and cower heavy duty bait bearing construction. AGENCY LlfiiTlNls t~atatan stanclar~ds Assocf~lon {CSA listed model numbers end in "F"or °AC".) caPa~mr ,~ ~..~;.; , . . . -~~ r~we ~v, ~~s n~e~~ 0 2 a e s. ~0 12 mom S~ I.4-taoc~ ~(C.~ P•~ . ~ Sanitaty P it Application safety & Buildings Div. In accord with Comm 83.2 t. Wis. Adm. Code `~ 201 W. Washington seonsin See reverse side for instructions for completing this application PO Buy Department of Commerce Personal information you provide may be used for secondary purposes Madison. WI 5371)'•" (Privacy Law, s. IS.04(I)(m)j (Submit completed loan w county :; Matt u~~n Attach com lete Ians (to the count co onl )for the s stem, on a er not less than 8•I/2 x I I inches in size C'o n o State Sari ary Permit N tuber O Check il'revision to previous application ~~ zo ~2 . State Plan I. D. Number 1. A lication Information -Please Print all Information Progeny Owner Name LOCat10n: L ~ ropeny Location as7 d L. Propene Owner's Mailing Address LL,, t ~I/4`J~I/4, S~7Ta l,N, W (or 3~- ~~~~ ~ MA `3 of Number Block Numb '~~..1.(.C.J~r COUNTY' Cin, State Zip C ~ ~ a ~/~,,// t / /~ Phone NumberZONING OFFI bdivtston Name or CSM Number 11 Typ of Building: (check one) o~~ c~,ti,,~ ~, ~' I or 2 Family Dwelling - No. of Bedrooms:~ O City _ O Public/Commercial (describe use): O O Village ~ n o ~ State owned _ ~ -_ 1 I _ (!1 ~I ~ w __ ~ ( ~~J~' ~ Type of Permit: (Check only one x on line A. Check box on line B if applicable) , Nearest Road A) I. fc~New System 2. O Replacement 3. ^ Replacement of 4. O Addition to Parcel Tax Number(s) S stem Tank Onl Existin S stem B) ~/ dab •- O ! o~ ~~~~ Permit Number O A Sanita Permit was reviousl issued Date Issued i 1V. Type of POWT System: (Check all that apply) ,$1 Non•pressurized ln•ground D Mound ~~ O Sand Filter • O,Pressurized In•ground O Holding Tank O Constructed Wetland O Single Pass O At•grade , t S O Aerobic Treatment Unit O Recirculating ~- 3 n ~'~-xD -~-~.~ ee.Q~ O Drip Line CJe"~ D Other: V Dis ersal/Treatment Area Information: - X I D 3/ ~ F ~r . , esign low (gpd) 2. DispersalArea 3. Disp sal Area 4. Soil Application 5. Percolation Rate Required Proposed Rate (Gals./day/sq. ft.) (Min./inch) ~ ~d 6. System Elevation 7 Final Grade 9 ~/ -- / qd, ~J " EI vauon 85 ? o ~-- VI Tank Capacity in Total ;Y of Man ctur ref ~ a _ 9 a Information Gallons ons Tanks a Steel t er• Plast,~ ~~ New Existing glass Tanks Tanks trusted VII Responsibility Statement ~ 1, the undcrsi ned, assume res onsibilit fo nstallation of the POWT own the attached Ians. Plumber's Name (print) Plumber's igna ure (no P PRS No. Business Phone Number Plumber's A dress (Street, City, State, Zip Cgdeh r~Q~O 3S ~ ~~S' l6 b~ / VI11 County/Department Use Only O Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Approved O Owner Given Initial Adverse Surcharge F Issuing A cnt Signature (No stamps) Determin n ~ ~ r~Jr IX. Conditions o pprova /Reasons for Disapproval: SyS~eM.. • S rµ.~.~"~ ~. sGI"" a w+.e /Ca~++~±~/ a~" /~~' (o o ~ ~ta~t- '(~ Ce.~sc~/, `~ i~S1V-~ 5 5~•. ~.~.c~+*~; ~2. 0 • ~ct~ I`K ` a,..J~l - ~~ b,~,2a,~-sr~-_.~.6~•~~c, ..F.Y ~. .b~~1 sees- see ~.-/~~t `'~ j "'~~" k.~-36 ~ t~~'~ue.,~'-~`t.~ - ~t~Qo~,O ~in~t~`~+e~~ ~ per ~vta.~wt~e~tc~ S,oec.c'~icrzS 1 ~. 1 n _~ ~1 ~ ~ Z , O -~ ~~~~ ~~ ~ ~. ~ ~ O ~~ ~~ ~ ~ ~} Z ~. c~ ~ ~ p q ~ s ~ q, ' ; T- ~ ~ ~~ ,~ ~~ .. ' ~1 ` 'b ~ - \ ~ = ~' to ~~ 1~ 1~ ~0 O v P O a W ~ ~ v rn W ~~ co s ~ O `~~ ~~ ~~~~ ~~ ~ ~ .~. ~ ~ ~ ~ ~ ~ ~ s ~' 4' - ~~;T-. R, ~, > ~ y ~, ~: U~ ~ ~ °, ,~~ ~ \~ ~~ ~~ ~ ~ ~~ - ~ w ~~ -~ ~ 1c o ~ ~1 P ~ ~ Q W ~ ~ ~ ~~ a ~ ~6t' ~~ T . a~ ~tP/'Ro ~ . 3 5 A~+.es r MA-~ d /~ ~i~-T /~~,tr~~ ~ ~ i 'Msconsirt Department of Commerce , SOIL EVALUATION REPORT page ~ of 3 gvislon oI Safely and t3ulldings ' to accordance with Comm 85, Wis. Adm. Code County 57; CI~ Ol ~... /Mach conrplele site pl;+n rnr paper not less Ihan 8 1/2 x I i Inches In size. plan mtrsl Include, but not IlmNed to: verilcat and horh_onla) reference point (HM), direclton and parcel LD. 02Q ~ /Q~p 9 • ~~ • ~~ percent slope, scale or dimensions, norUr arrow, and ioa~lion and distance Io nearest road. h/ease prln[ alt lnforntatlon, Reviewed by bale r'e±t50118r rllrfNmOr~0i1 yOV nrOVr(tB 1t7Ay r7(! USC(r rOI SCCOntr01Y rf111r705e3 (PIIvACY LAW, s. 15.04 (1) (m)). pfOnerty ()WirP.r ~ ' KE1pNoN j3f}5j" ,' DfNA ~ ~S p/INDy locatCion ~J a o Govt. Lol S~ 1 /4 ~ 1/4 S 2 T T Z 7 N R ~/ ~ (or) W property Owner's Marling address Lol p Block p Subd. Name or~66Mlf ~~ 9y 8 ~~¢ /3/~'Qtr~ ~ • JuL 2 2 2002 12.. " j,3ovvD~rRY JPi~~E- (;Ity Stale Zip C e phone Number []City [_J Village ~ Town Nearest Road l~v~So,J Lc71. 5yo S~~ Eau ~v~SoN l3AA~~NDS ~ ~ - New Conslructlon Use: ~ Residential I Number or nedrooms 3- y Code derived design Iiow rate y~d - t~ISD GpD ~_ ~ ReMaCemenl [, public or commercial - besc-Ibe: f arrant material lO~ 5 ~(,~ ~i4rVQy Flood plain etevatlon it applicable /V /1. General corrnnenls ~V ~'"~J/1-~f _ - and recommendailons: ~!s^~ ~91P~~-- T~ST~ svi TtF'~~~-- ~~ /9,v ~.vy /c~ov~~ ~o~,~~T,o.~~-~ a©~ ~--5 . goring * ~ Roring q C ~ i ~ J / ~ ~~ ~ Pit Ground surface elev. , rt. Depth to pmiting factor (n. Soil Appllcalion Rate lorizon beplh Dominant Color Redox Uescdpl{on texture Structure Consistence Boundary Roots GPD/fl' . in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etll11 'Effl12 z -2 /d S/G /fs~! ~fi' w /~ ~.. .3 3 ~ 7•sy~y ~ 1~~ ds~ c -s . ~' q Boring # ~ Hor{ng > 2 ~ Mr Ground sur-aen nine. ~ ~ ~~ n ne.,rr. r., u..,nr.... r....r... ~~ ~.. (lorizon beptlr Uomhranl Color Redox Uescripllon texlOre Structure Consistence Boundary Roots aorr nppnc 6p aaon rare Ult1' In. Munsell Qu. Si. Cont. Color Gr. Sz. Sh. 'Etl!!1 •Elf!!Z •s R ~. s o, s c -- . ~ ~, i. 9 "~ . I ~ `~ • tro..__ ~~~ ~ ~ r• _ ~ ~~ ~- ~ ~~ ~ ~<~ ~ 3 3 ~ _ -...~~...... - ~~~s - ~~ _ «v Illy/~ anv r as eau c you mgrt_ ' Elnueni A2 - BOUT < 30 mg/L and tS'S < 30 tngJl. CS1 Name (please print Signature CST Number ~'o,gE/pT' J1.1/6RietiT" ~~~'- le!,(,~j 2435 PrlvatA Sewage cone 655 O`Neil Rd. Hudson, Wis. 54018 /3 - 3-~oZ. ~is• 38~ •885 ry Lo ~'` ~ Z 3~ ono . ~o~~ •io - /~ Z 3 (r ro~rier~l~y Owner _ parcel Ib ~ U Rrning N U Boring ,. Page of ~, hii Ground surface elev. ~~ - ~~ fl, beplh to smi{Ine farrrx ~7a r.. ftoring ~ rUt goring __-_J LI hit Ground surfar:e t!lev. 11, Florizon Uepih Uominanf Color Redox Uescripffon Texture M• MunseA qu. Sz. Cont. Coior Borin • Boring !! ru-~ 9 U pit Ground surface elev. ff, ~~ ~ {Ior{ton bepfh f)om-nanl Color Redox Uescripllon ~• MunseO qu. St. Cont, Color Oeplh to Nmiling laclor In, Texture Siruclure Consislen Boundary Roofs Gr. S ,. ' ' ; 'Ett!!1 ~ 'Effp2 ' Ef0uenl gt = BOb~ > 30 < 220 mglL and tSS >30 < 150 mg/t_ • Emuenl if2 _ BODs < 30 mg/~ and TSS < 30 mg/L 'l he beparlnrenl of Commerce is an egaal rrpporlunity service provider end employer. If you need assistance to access services or need material in an Alternate format, please contact Ilre department at G08-2GG-3151 or'I7Y G08-2G4-8777. Sph_R/10 (R RMnr beplh to Iimliing laclor In. 5oi1 Appflcaiion Rale Slrrrcfure Conslslence Boundary Roots GPD/ll' Gr. Sz. Sh. 'Eltpt ~ •Etl!!2 -~ 1 d ,, ~~ ~ ~~ ~, ~~ ~~ ,, ~1 ~~ ~ A a ~ - o -ts ~_ _~ ~ .~ Q ---~ 0 . ~ 1- v~ O V`~ • N d_ ~ --, .. ~, ti 0 ,~ ° , .~~ v ~ 0 ,1 ,- :. p f. .~~~ ~ /n ~ 0° TT ~ a,/°o ~ ~~. ° ~m p Y ~ y_~ ~ 0 ~V 1 I f 0 ~I POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFOR149ATION Ownsr C ~ ~~¢ N Permit # zl~ ~2 DESIGN PARAMETERS Number of Bedrooms L ^ NA Number of Public Facility Units ~NA Estimated flow (average) d ~ al/day Design flow Ipeakl, (Estimated x 1.5) ~ ~0 al/day Soil Application Rate t al/da /ft~ Standard Influent/Effluent Quality Monthly average" Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BOD51 5220 mg/L ^ NA Total Suspended Solids ITSSI <_150 mg/L Pretreated Effluent Qual"rty Monthly average Biochemical Oxygen Demand (BOD5) <_30 mg/L Total Suspended Solids (TSS) <_30 mg/L ^ NA Fecal Coliform (geometric mean) 510° ctu/100m1 Maximum Effluent Particle Size YB in dia. ^ NA Other: ^ NA "Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity ~ a S'~j al ^ NA Septic Tank Manufacturer '' ^ NA Effluent Hlter Manufacturer ^ NA Effluent Filter Model - ~ ^ NA Pump Tank Capacity al ®NA Pump Tank Manufacturer @ NA Pump Manufacturer 0 NA Pump Model Pa NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ~'NA Dispersal Cellls) ~In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA .Other: ^ NA uw~urcwrw~~ne enucn~u e ~^~.~.... ~...-...vim ..v^ .~.+...... Service Event Service Frequency Inspect condition of tankls) At least once every: ~ ^monthlsl (Maximum 3 years) earlsl ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third. IY3) of tank volume ^ NA Inspect dispersal cell(s) At least once every: t~ ,N year( )Is) (Maximum 3 years) ^ NA Clean effluent filter At least once every: ^ month(s) earls) ^ NA y ^ monthlsl .p NA Inspect pump, pump controls & alarm At least once every: ^yearls) Hush laterals and pressure test At least once every: ' ^monthlsl ^yearls) ,~ NA Other: At least once every: ^monthlsl ^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 IY31 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 of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of'painting products or ofher chemicals that may impede the treatment process and/or damage the dispersal celllsl. If high concentrations are detected have the contents of the tankls) 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 celllsl in one large dose, overloading the cellls) 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. 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 util'IZed 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. ~~ ^ The site has ^^t h°°^ °v~lt~at°" •^ *'~' •« L.1 _ ..~.,__~___ ~ ~--- t..:6.rn nF the P{)WT~ a coif and site ~~~., e....~....•..... ~ ~... _~_ _~ ,____ _61.. nnh^°mant ar°a If n ronl^---. ~---- 1 hl° 1i^Idm~ tank ^ 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 U„TG-lAre~ LL1µtg-lil N(~ Name /,( ~ ,. ~ ~ Phone I '7 /~ - l I_ ~ .. / ~i 1 ~' POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name ,. S ~ ~,~-.cR Phone ~ .- B - a This document was drafted in compliance with chapter Comm 83.22121(b11111d1&Ifl and 83.54111, 121 & 131, Wisconsin Admir>istrative Code. ST N~AN~ GRH,$MB~1T SgpTIC TANK AND OWNERSHIP CBRT~~`TION FORM OvvnerB~ 9.~ ~rs~~e ~~~ ,~ prpparty Address (v~ca~on s~ Planning Dot far nea consa-.------ ~~ ~ Parcel IdenlificatiOn Number (aty/State . T p~At OE~S[`~-~TION ~ ~ ~f 1/., Sec. ~ T~N ~-~--`-w' Town of pmp~y Location Jr ~ y., ~ .Lot # /Z- Subdivision _ ..~--- ,page # ~~ -~- ,Volume CetrEiSed Sutrttey Map # ~ 3 s ~ page # a~ n~a # ~ 1 / 1 _ volwne Warranty D no Spec gouse~eS ^ no Lot lines identlfiable~es SYS'~M MAIN' ~NA~ Y >zc couldresultin its Pr~°alioensod P ~ ~ ~,e systom ~~~ ~ of oursep - sooner, if by coat of pining Dirt ~a saptic t ~~-~ ~,gc in tho waste d~P°saI syste~- canaffectthe fnadio~n of the sepii a motion form, by tl~e owner ~ ~ a The grope~Y °~ agCees to submit to b"t. Ca+oix Zoning ~verlfying that ~I) the on-site ~ ~p~eymanplnmbeti restrictedplnmber or a licensed ). ~ ~Phc tank is hss than 1!3 hill of sludgy is in proper opt ~tton andlor (2) after °n ~ PnmPmg C s e sy~nwi8'the tl~ ~ have read the above r ~ a~ tO f N ttaal Rem cf~OO~°O~ wi8~in 3~ ~+ of Commerce and the D Zoning that your sePticbsY~~t~ ~ co~~tcd and ~ ~e St. Groix County days of the Year ~ dam' 3^ / / / jl"~ DATE ~ TURB OF pPPLSCAN"r pW____NE^R C_C +LRRTX'F'I ATIO our lanowledge. I (we) am (am) the ownez(s) of I (we) certify that all statemeats on this form are tine to them gaifstmer of Deeds Offsce• ~ descxibed abov virtue of a warranty deed r~tded ~/ ~~ ~3 DATE TURK OF APPLICANT yG1~ revoked by the Zoning Dept ****** •*s**s pny information that is mis-r~Seat~~Y result is the sanitary Pmt • licstion: a stamped wa~Y docd fry ~ if rof his ~na+do ~ Y decd ** Include with this PP a SPY of t1m ~ su~Y >~ • ~ 'J.215yP 201 II STATE BAR OF WISCONSIN FORM 2 - 1982 I WARRANTY DEED DOCUMENT NO. Kernon,,7 Bast and Donalda J Speer-Bast conveys and warrants to McCabe _Homes IriC. _ the following described real estate in St . Cr0].X County, State of Wisconsin: Lot 12 Plat of Boundary R_idae, in the of Hudson, St. Croix County, Wisconsin. 7 1 1 1 4 3 KATHLEEN H. i1ALSH REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 02!26/2003 8.•pp q~ EXERT lk REC FEE: 11.00 TRANS FEE: 224.70 COPY FEE: CERT COPY FEE: PAGES: 1 THIS SPACE RESERVED FOR RECORDING DATA NAME ANO RETURN ADDRESS Mr. Thomas McCabe '~I 935 Osprey Blvd. Bayport, MN 55003 020-1409-12-000 PARCEL IDENTIFICATION NUMBER This i c nr~•f- homestead property. (ts) X~- Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this 25th day of Febru ~1/'Q!C''~C~ ~r~cT~ e ° " %~~c,.c~--' (SEAL) • Donalda J Speer-Bast S"1 • (SEAL) (SEAL) Da ° Q o ~3(~3~ ~~o~- CARD ,I i I -~-- ~n d04 3 C~~GvI OfiJ -------------- ~IOOL~~39P~o~lsa ~~ P \ ~ TO THE =D- '"~ LOT1 '~~ 94,8 2 SQ. FT. SEE NOTE B: ~ ~. BENCHMARK p ~STIIyC, ,.......... ,. RNF SEE NOTE A SPECIAL DEEP CASING ~~ WW ~~ ~~ ~r a Oq'sT/~ S ~~°~ ~ ~'F `Sg4,sr, ~~' S8•F2r4 ~ '~~ tis WELL REQUIREMENT. ~ H.W.L = ~- - ~~ 1049.40 ~4 4 MINIMUM BUILDING / ~ N LOT 2 ~~' ELEVATION = 1051.40 ~ / '~• 2.03 ACRES ! ~ / i ^o. 88,265 SQ. FT. ~~ / i $ •. SEE NOTE A SPECIAL DEEP CASING ,,~`~",~~~~ / 11 , •' WELL REQUIREMENT. ~ ~ ~~~ i. i ~ i' • ~ ~ /'? i~ LOT 3 2.02 ACRES 88,127 SQ. FT. NOTEA: :CWL DEEP CASING LL REQUIREMENT. 89°03'17'VN 364.71' LOT 4 2.01 ACRES 87,544 SQ. FT. NOTE A _CIAL DEEP CASING LL REQUIREMENT. .' i f ----'-- j • I j 1 .. ,~ ~~ ~~ ~. rte" \ ~ •. ~~ .A ~, '. LOT 11 ~ ~ O ~ '. 2.01 ACRES ~ 87,420 50. Ff. .. ~ \ ~ ~ .. ~~ ~ ~~ ,.~ / '~ 10 ~.-~-- LOT 12 I ~ ~ . . 2. CRES ' ~ ~ a7,s27 sQ. ~. I ~ ~ SEE NOTE A ~ ~ SPECIAL DEEP CASING /' ~• WELL REQUIREMENT. z~' 1 S86°13'32'E 314.52' s ~~ ~. ~ 00 ~ '. '~ SEE NOTE A ~~ SPECIAL DEEP CASING Z WELL REQUIREMENT ~~. SEA MG]PC OO ~i1~1f \, \ ~ ~ ~~~ \ ~ ' ~~ \ _\ d04 9 C~~~t10[~1 - ---- - 1~I0~ ~a pC~o 9 ~ chi