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HomeMy WebLinkAbout020-1395-47-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building D~ision INSPECTION REPORT GENERAL INFORMATION' ~ (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Steinwa ner, Brian Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: 95 , t Z \~- _ I" (~ TANK INFORMATION TYPE MANUFACTURER ~ d~ n/~ CAPACITY ilGl ~ Septic `..); e~e.~.. ~ ] Zoe Dosing CO ~6~ HBLdtl0li F;~ 1 Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 1 l ~/- f ~' I ~~ 1 Dosing ~ ~ / 1 Y j Aeration Holding PUMP/SIPHON INFORMATION A~ ~/ Manufacturer ii errand r ~ Jl GPM j Model Number ~~ ~) TDH Lift ~lg Friction Loss o • 3~ System ad TDH Ft '7. ~ Forcemain Length ~ Dia. / ~ Dist. to Well A ~ Z ~ SOIL ABSORPTION SYSTEM County: St. Croix Sanitary Permit No: 463322 0 State Plan ID No: Parcel Tax No: 020-1395-47-000 Section/Town/Range/Map No: 25.29.19.2441 ELEVATION DATA STATION BS HI FS ELEV. Benchmark ~~ f~ ~ ~'Z Alt. BM nJ ~ ~~ , 1 Bldg. Sewer rz ~5 R i, zS St/Ht Inlet '~ • 1 dq U 1 St/Ht Outlet \ ~ Dtlnlet Dt Bottom L1,~ g / , ~o Header/Man. -3 9 3 , '"7 Dist. Pipe ~ ,~ ~ ~ ~ Bot. System ~ ~ Final Grad ~ ` , ' Z • ~ q St Cover ~J a ~ 9~ I ~~'~O ~•~ - .e3 s.~ ~'S - ~] 1~3 •S 7a~ / BED/TRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~~ (~~ -z i( ~ ~ ~ ~ SETBACK NF RMATION SYSTEM TO P/L ~ BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: ~y( I O Type Of System: ~ / C~ ~ / ~ ~ ~~ UNIT , Model Number: ~ J ~ J v~'~o ~ I~ISTRIBUTIDN SYSTEM 4 .1l_ ~~~ Header/Manifotd ~~ LL1 Distribution ~ Pipe(s) \\ \ \ x Hole ize x Hole` pacing ~ Vent to Air Intake ` Length Dia I~ Dia Spacing Length ~ C(lll CCIVFR ., o.~~~,.~e e.,~ro.,,~ n..i., ,.., nn.,~~.,.~ nr et_r~rarlo Cvefamc only Depth Over ~ Bed/Trench Center C Depth Over a Bed/Trench Edges \ xx Depth of Topsoil \ xx Seeded/Sodded Yes No xx Mulched Yes No J ` COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 738 Regal Ridg oad~Hudson, 154016 (NE 1/4 SW 1/4 25 T29N R19CW) Scenic Hills L,ot~47 Parcel No: 25.29.19.2441 1.) Alt BM Description = ~ J 1 ~ 6 J ~~ ` ~ ~J "`~ 2.) Bldg sewer length = 1 J `,~~ ~~.. ~ ~~~ ~ ~~ vIB ~~~ -amount of cover = i ( M. G V p(~r'dl i7 ~ T .. ~ __ _ _ _ 4 ~ ~ Use otheriside foruadditional information. o ~L_ ~4' i ~ `~'~-~ I I ~ ~-- ~~,~~ Date /~ Inse or's Si ture Cert. No. SBD-6710 (R.3/97) pv~ ~; /~'%,rN-'• ~~rtr~i ~,Q,~~ Q~ C V r ~ aJ~/e- ~, Safety and Btiildings Division O. p~t~ 62 P ton Ave Washin ' 201 W County ~ ! ~, 20 1~ 'T ~ . ., g . Madison, WI 53707 - `J Sanitary Permit Number (to be filled in by Co.) ~~~~~~~~ (608) 266-3151 ~-.~ 3~-~~ Department of Commerce O ' State Plan I.D. Number cation Sanitary Permit Appl In accord with Comm 83.21, Wis. Adm. Code, personal orma}~~ly ~ may be used for secondary purposes Privacy La , s15.®®dd~~ 11 roject Address (if different than mailing adds s) 1. Application Informati - lease Print All Information ~_ ~~ ~~J:i ~3 $ ~6 6~i ~ Property Owner's Na me S i . C~~OiX (;Cit;,~~;"`~t' a- ~~,~,~ ~l.J orFic~ Parcel N Lot N 'e{ B ~ - ~ ng Address aili Properly Owner's M Property Locatiai ~ Z,Cf 2 ~ ~© l ~ °V~'~~'") 0 (Z-S b~-~l~ ~ y,~'/a .Section City, State ~~ tJ ~ ~ Zip Code ~~O ~ ~ Phone NujmbQet• ,/•~ ~~/~ 7 (/' ~ `t / (circle one) T ~ N; R~E or~ d'hs II. Type of Building (check all that apply) ~• /tG~P/La. -Number of Bedrooms Dwellin 2 Famil 1 Subdivision Name CSM Num er g y or• / SG N~ G l LLS ^ Public/Co,runercial -Describe Use ^ State Owned -Describe Use S W Z Z .~` Lt/1.~-d ~ ~~- ^City_^V illage Township of 0 Z III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A• New System ^ Replacement System ^ Treamierit/1-Iolding Tank Replacement Only ^ Other Modification to Existing Sysrem B. ^ Permit Renewal- ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Nutnber and Date Issued Before Expiration Plwnber Owner 1V. T e of POWTS S stem: (Check all that a 1) • Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Consu•ucted Wetland ^ Pressurized hrGround ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filler ^ Recirculating Synthetic Media Pilter Leaching Chamber ^ Drip Li ^ Gravel-less Pipe explain) V. Dis ersal/Treatment Area Information. y -' Design Flow (gpd) - Design Soil Application Rate(gpdsf) ~ Dispersal Area Required (sf) Dispers ~ osed s f System Elevation ® ~o ~ a 8S8 c~ $~ VI. Tartk Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Pl stic Gallons Gallons of Units Concrete Consdvcted Glass New Existing Tails Ta,ilcs Septic or !•lolding Ta,ilc ~ ~~ , I l (/V Aerobic Treaunent Unit - d •7 ~ Dosing Chamber x VII. Responsibility Staternent- I, the uudersigried, assume responsibllity For u[stallation of the POWTS shown on the attached plans. Plumber's Na me (Print) / Plumber's Si gnature MP/.AfiPRSNumber ` Business Phone Number abr.- ~f6 ~ Z ~ 6 ~ ~ ~ ~~s zz~ s~~u Plumber's Adldre ss (Street, City State, Z' ode) G /~ /, ' // f ji~b7Z. `~--K W ~ ~~! VIII ount /De artment Use Onl Approvt;d ^ Disapproved ^ Owner Given Reason for Denial Sanitary Permit Fee (includes Groundwater Surcharge Fee) 3(,~,, ~ Date Issued / a' da D Issuing A t Si atu ( o Stat s) LY. Conditions of Approval/Reasons for Disapproval 3 ~ ~~ R SYSTEM OWNE : 1 Septic tan cT, elf ul enI'filter and ~.~J~~~®~y~iy~,~~ ~ ~L p~yi,~ - .,t~ e ~ ~~~~~f- ~y~~. ` dispersal cell must all be serviced / mamtalned ~~ / ~~ as per management plan provided by p{umber. ,1'" Qh.~a~ ~1-e~ utremen s mus a main atn 2 ff' ~ ~~~ L ~ ~ . o O (rfic. j~t.-. ,tt-l/ " as per applicable code/ordinances- %S 0'h ~ Pr~Cr'~y~ U / rn~' I ~ Attach cnm nlafn nlnoc n,. ~t.., r' ......... .......i v,... n..... ~ J ----••~ ----+' .-....--~~.~.•~ ~.• yyyy~~. ••~}-.=tea .,.+.., oa... n as aucnes w size O SBD-6398 (R. 01/03) ~~'L6K/////',Q~1~'~~n." ~ -~ ~ ~ ~~b ~ ~ _ _ i`'= ~o' N.,r• SE ~~rne~ ~ ~~ ~d~J ~~ ~ ~~ Bm ~ /tS~ v a ovt t~ `~ ut~x,C~~ ~~-- Ada-1~,~ ~- ?; ~~$ ~~- ~~ _ _, ~ ~~. :\ ~ ~ \ ~~~ A C b ~\ ~ 6 I 95 t ~\ f ~X ~~~ .gs~~ 95 .1 X X 957.3 ~ ,_~ . • ~ , \' S' 4 ;:~~~ / ' ~ ~• g ®63.4 ./ X ~ , • _ ~ 96 6 , , . ~. _.. ,. _ _ ~ ~ ~.; `~. \ `"'~ C~~'. 4 3 ~~ ~©Se """ ..- i ~~ r ~_ . w 63.5 ~ ~'~~=,.:`,~ .~. ~ r .~ ~ j ,r. a F 6 ~~~~ 5 ~ _ . . ~ , , ~` 9 5` G~Q~. 4 ~ ` 1 ~j ~J 1 ~ jr3~" H: y 1; V f ,~ ~ '~i ,~ 967.4 ~ ~ - ~ a ~+ , ~+. ~~" - ~ ~_ Q' __ ( '~ g;~'2 ; ~ ti ; i _ } ~ ~ i / r .• ~ ~~ 9 71 ~ ~ ~ - ~._ 7 ~~ `~ ~ ,~ ' ~ ~~ r ~ ~ „ ~~. ~ r ~ ; ti ,~7, _~ t i 1, ± ~ . ' ' ~ t ~- ~ t ~ ~ ~ :~ ~ , i ~ ~ ~ ;~ I it ,. ~ ~- ._. _ __ A ,~ _.--_ -,,~ / ~ ~9~~~ j ' ~~ ~,: ~ X J~ -•~ ~ i r - I .a ~ ~, ' .. ~. f f r-`. a8, 8 y 1 / ~ - r ~ .-~. ~ y _._. ~.. _.. ,. -- _ ~- ~~ i. / ` ... _ -- ~ r _ ~~, .. _ ~~ -_.-`._,_.~-:-~r-v,-4-:-ram-;; ~ `--~.x'-- -`.~1/s~t~_>`:,`;~-1:-..~~~ - ,_ r _-v~~~~`z~'~~i-"s/~~: ~~_~- 1 y _ -~-,.~,~.~-. „- ~ . , z. ~e~ ~~R ~~ ~~ ~~ : a7 = ~ ~ f 5 d~ ~~.~ c~ 'f /ur~rtfi. ~r SE ~fn~~/ -~~~- ovt/~ ~ C,(J~4~1- ¢~ ~t C%(~C~-GEC- CC~jjQ:lirt.-S-7-' '. LOYi~/ ~ba' Y1~Qit~ _ ,~ ~ Combination Sept,~.c~Tank and PL1MF CHAMBER CKOSS SECTIOtJ AAJD SPECIFICATIONS ' . •VEUT CAP. ~ WCATHER PROOF . ' - Ju-~CTIOU 80X . ti~C.I. VENT PIPC ~ ,APPROVED LOCKIf.IG ~ jQ' FROM DOOR. MAIJHOLE COYER Wt~ ~ _ wAR1Jl>,J4. LABEL. ti+`~sP~tlpt`1 S'tPE +!lAIpOW OR FRCSH S coup~~r w ~ PnR.T1 s tYi" r-frp ~ ALK I Al TA K ~ t . .. bii j,~4JC ~. ~ _ j I {,K MU~~. ~ ~~O T ~ ,I I ( ~~ -- j ~ -- la'n-N. INLET APPROVED JoluT W(C.I. PIPEaRC'W i . ~° ~,~; ~\., _. ; ' ~ 1 +-~ PROVIDE i •;'„~ AIRTIGHT SEAL I .~ I a ~~~~ ( Tank construction I I shall comply with 'I ILH;~ 1;3.15 and 33.20 >s I, ~ ~l . Pur~P-~, __~ ~. ~~^^~~ p C0IJCRETE ~. ~ ~ L V ~ ~ B~OG1( ~r.' Mlu. ~. IC'M111. ~(~ V ~~ (I ~ APPROVED .101~1T: I ( W/C. T. PIPE~P~c II (~ ( ALARM ' 1, ou 1 OFF 3" APF'fcT~: ~• RISER EXIT PERl11TfED 01JLy IF TAIJK MANUFACTURCR HAS SUCH APPROVAL BFpOING SEPTIC r: SPEGIFICATIQf..-S DOSE T.~.1.IK MA~IUFACTURCR.: ~~~~ ~~~~~~ AJUMdER OF DOSES: PER DAy TA1•IK :,IZC: ~~ GA LOWS DOSE VO , L LUME /~ ALJIRH hlA>JUFACTURI`R: S~S~~'~.,~CO SL(~~.~ ~ ~- IAICLU0IAJG 6ACKrLOw: GALL01~$ MODEL 1.1UM6ER: ~~L Nw p CAPACITIES: A-~ <~ g UJCHCS 0R GAL Z SWITCH T~PC: ~''l~Z-~.1~ / g = Z IIJCHES OR _L~ GAL O~1S PUMP MANUFACTURER: ~•LL~~-S C;~IUCHES OR ~z C,ALLO-JS MODEL NUMBER: __ /h~'~D _,~ ~,~ 3 b D~ IhtCHES OR Z ~ GALLOIJS SWITCH TYPE: ~~'~C~ NOTE: PUMP AUp ALARl1 ARC TO bL M11,1lMUM DISCHARGE ~RATE~GPM IN STALLEO OtJ SEPARATE CIRCUITS // ~~, VERTICAL DIFFERENCE DETWCE-J Puh1P OFF Au0..01STRIBUTI0IJ PIPC.. _L_L~~ f EET + MlulhtUM I.IETWORK SUPPLY PRESSURE , ; . , , , , ~ FEET ' + ~~ FEET OF FORCE fM11J X ~F~ FRICTIOrv FALTOR ~ P p f>: .. EST __... TOTAL OyUAMIG HE:Ap ~ ~ `J ,FEET As per manufacturer t ~ gal/in. _~~ l Printed in U.Q.A. ~~p~~ ~ Q~~~y 5'~~ww~6rN~ y=Quick4 STANDARD DHAMBER 52" Quick4 Standard Chamber aa" (EFFECTIVE LENGTH) e ~ - ~ ~ ~ ~~ ~ ~_~ ~s ~~ ~~ ~g ~~ ~~ ~~ 34" SIDE VIEW SECTION VIEW ~ ~~ 0 MultiPort End Cap R O 16" 12" 34" SIDE VIEW TOP VIEW FRONT VIEW ~}i r', Quick4 Standard Chamber Nominal Specifications MultiPort End Cap Nominal Specifications SIZt, IW.x~L~x H)~_, ~ ~34 x 52" x 12" Size (W,: L x Hl 3g" x 16'.x_12" Effective~.Length ~ ~ ' _ 98' Imtelt Height ~ ~ 8 of 1 25 Invert Height 1 8" - t ,t 1 INFILTRATOR SYSTEMS. INC. STANDARD LIMITED WARRANTY (a) The structural integnry of each dtamber, end plate, wedge and other accessory manufactured by Infiltrator ("Urtits'~, when installed and operated In a Ieachfield of an onslte septa system in accordance with Infittratw's instructions, is warranted to the original purchaser ('HOlder'~ against defective materials and workmanship for one year from the date that the septic permit is issued for the septic system containing the Units; provided, however, that if a septic permit is no[ required by applicable law, the warranty period will begin upon the date that installation of the septic system cwnmences. To exercise its warranty rights, Holdw must notify Infiltrator in wilting at its Corporate Headquarters in Old Saybrook, Connecticut within fifteen (15) - • . days of the alleged defect. Infiltrator will supply replacement Units for Units detennirred by Infiltrator to be covered by this Limned Warranty. Infiltretor5 liability specifically excludes the cost of removal and/or installation of the Untts. O (b) THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE IXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT SYSTEMS ~ N C TO THE UNITS, INCLUDING NO IMPLIED WARRANTES OF MERCHANTABILfTY OR FITNESS FOR A PATTTICULAR PURPOSE. (c) This Limited Warranty shall be void if any part of the chamber system is manufactured by anyone other than Infiltrator. The Limited Wananry does not extend to incidental, consequential, special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, including loss of Environmental Onsite Wastewater Solutions"' production and profits, labor and materials, overhead costs, or other losses or expenses incurred by the Holder or any third parry. Specificaly excluded from Umited Warranty coverage are damage to the Units oue to ordinary wear and tear, alteration, accident, misuse, abuse or neglect of the Units; the Units being subjected to vehicle Vaffx: or other condttions which are not permitted by the installaton instructions; failure to maintain the 6 Business Park Road • P.O. Box 768 minimum ground covers set forth in the installation instructions; the placement of improper materials into the system containing the Units; failure of Old Saybrook, CT 06475 the Unds w the septic system due to improper stting or improper sizing, excessive water usage, improper grease disposal, or improper operation; or War oa ryr event not caused by Infittretw. ThIS Limited Warranty shall be void if the Holder fails to compy wkh all of the terms set forth in this Limited g60-577-07000 • ~FfAX 860-577-7001 Further, in no evert shall Inflllratw be responsible for any loss or damage to the Holder, the Units, or any third party resulting from installation or ship- 800-221 -4436 ment, or from any protluw liability daims of Holdw or any third party For this Limited Wananry to appy, the Untts must be installed in accordance with all stte conditions required by state and beat codes; all other applicable laws; and Infiltretor's installation Instruwlons. (tl) No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any party other than the odgi- nal Holder. The above represents the Standard Limited Warranty offered by Infiltrator." A limitetl number of states and counties have different wananry r~quire- ments. Any purchaser of Units should contact Infiltrator's Corporate Headquarters m Old Saybrook, Connecticut, prior to such purchase, to obtain a copy of the applicable warranty, and should carefuly read that warranty prior to the purohase of Units. U.S. Patents: 4,759,661; 5,017,041; 5,156,488; 5,336,017; 5,401,116; 5,401,459; 5,511,903; 5,716,163; 5,588,778; 5,839,844 Canadian Patents: 1,329,959; 2,004,564 Other patents pending. Infiltrator, Equalizer and Sidewinder are registered trademarks of Infiltrator Systems Inc. Infiltrator is a registered trademark in France. Infiltrator Systems Inc. is a registered trademark in Mexico. Contour, Contour Swivel Connection, MicroLeaching, PolyTuff, SnapLock, ChamberSpacer, PosiLock, QuickCut, QuickPlay RECYCLED PAPER and Quick4 are trademarks of Infiltrator Systems Inc. ®2003 Infiltrator Systems Inc. Printed in U.S.A. Q011203HP-0 Wiaconsin~Departrrtertt of Commerce SOIL EVALUATION REPORT Qvision of Safely and Buildings Page r ~~ m atxxxaance wmr ~ornm oa, vv~. nam. was Pl n m st i Q 81/2 l ~ f. c ro ~' ess than Attach complete site plan on paper not a u n s e. x inducts, but not limited to: vertical and horimntal ~nt Redion and t Parcel I.D. OZD " %3 ? S- ' ~ 7 - ~(~ percent slope, scale or dimensions, north arrow neared road. , and din P/BeS@ pli~ft ~ ~ f~- ~ R by Date [[((~~ ~~~[l~cY ~. s: "1 (~) (m)) . Personal information you provide may be used ~ dary P C,(,(/y~„ ` / of ~ ~ Properti Owner - rn t l~9d 2 ~ P rty Location - ~'^ . . ?~~~ (oo t.l_ot F 1/45(,01/4 S Z$ T Z ~ N R /~ E(or)® Property owners Mai~-g address ~. , co Nry Block # subs. Name or CSMIf CO ~ Z. O s-~ i ~ ~ wa. ` .~_ , tlt9lc~FFiCE S e City State Zip Code . `Number .City ^ Ylllage [,~ Town Nearest Road _ _ ~S7 i I L wa..~r rh v~ . ~ S'o ~Z. ( ,~~ .. ~ ,' ®New Construction Use: ® Residential / Number of bedrooms _3 " 5'~ Code dernred design flow rate ~S~ ~~ O O GPD ^ Replacement ^ Public or commercial - Descnbe: Parent material ~Ufc.+JGi.S (~ Fbod Plain elevation iFappficable ~/~' R General comments S S ~ rv~. e, l e Jaf.b n - and recommendations: ~ l.-,~ e, i •e.,~ a ~-: o >~ - . ~~ U v a Boring # i~~i Boring Bpi Pit Ground surface elev. • ~ ~ ft Depth to limiting factor ~ i n in. Sdi ication Rate Horizon Depth Dominant Cob Redox Descaiption Texture Structure Consistence Boundary Roots GP D/fF in. Mansell Qu. Sz. Cont Color Gr. Sz Sh. *Eti#1 •Ett`if2 ~ e- 8 I x313 --~ i t Zrre -~ ~ s 1 v ~- - 5 - S Z ~-4 I~ ~t 3 5i ~l Z k ,~•~r ~ - , 5 . B ~ - ~ ~, ~~ ~,. ~ Gt~xL~o ~, ~C s~% ~~ # ^ ~~ .. ®Pit Ground surface elev. ~Z. ~y ft. Depth to limiting factor ~_ in. Sod ~~ Hor¢on Depth Dominant Cobr Redox Description Texture Stntc~ure Consistence Boundary Roots GP D/f~ in. MunseA Qu. Sz. Cont Color Gr. Sz. Sh. - 'Eff#1 *Eff#2 t 6-mot l r ~3 5iI I`. .m c l~~ ~S •S z ~_~. ~.~ ~ ~~ ~ Z ~ ~ ~ _ 8 3 k I ~ ~ y~ n-~S ~ ml _ .~ 1• Z ~, .- / ,e~~~c~ ~ s • Effluent #1 = BOD_ > 30 < 220 ma/L and TSS >30 < 1 50 mall. * Eftiuent #2 = BOD. < 30 rrtglL and TSS < 30 mglL CST Name (Please Print) S~' a'nature CST Nuntier -!~clGVV~ ~~-~.~w~-ke.r o~ /~~ 2~33c~g address Date Evaluation Conducted Telephone Number 2113 Bbd ~•. Svmerse+, (x~l S`-lo z~ C9 -~-d~ `7 t5 -Z`><7- ~/~$ Property owner f!1-r k~ ~ Parcel ID # Page z of _ 3 Boring # U Boring ~ ~ ~ ® Pit Ground surface elev. ~ ~- ~ 0 ft. DaP~ ~ limiting ~~'._....l.i -~ - in• Soil ication Rabe th D ant Color i D Redox Description Texture Structure Consistence Boundary Roots GP Dlfi~ Horizon ep in. om n Munsell Qu. Sz. Cont Color Gr. Sz Sh: "E~'I "Eff#2 o-g s, l 2,~nab ~rr~r ~ ~ ~ -~ ~, ; $ 2 ~~ rye 5^ 2 c5 ~ a' ~. - ~' ^ ~ri),)g # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon th De Dominant Color Redox Descriptbn Texture Structure Consistence Boundary Roots GP D/f>? p in. Munsell Qu. Sz. Cont Cobr Gr. Sz. Sh. 'Eff#'I "Eft a Boring # ^ Bonng ^ Pit Ground surface elev. ~R .Depth to limiting factor in. Sal licatbn Rate Horizon Depth Dominant Cob Redox Description Texture Structure Consistence Boundary Roots GP Difi? in. Munsell Qu. Sz. Cont Cobr Gr. Sz. Sh. •Eff#1 'Eff#2 " Efiluent #1 =-GODS > 30 < 720 mg/L and TSS >30 <_ 150 mglL ' Effluent #2 = GODS < 30 mglL and. TSS _< 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need as§istance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R07/00) Property Owner A.r ~G ~ ~, Parcel b # z of--~_ ®~~# o . ® Pit Ground surface slay: q ~• ~ 0 ft. Depth m Emoting facbr i t 5 in. ~ ~ Horizon Depth Dominant Colo Redox Desc~tion Texture SUuchxe Consistence Boundary Roots GPD/ti? in. Munsell Qu. Sz. ~ Cont. Color Gr. Sz. Sh: *~ ~ I ~-g Si ~ Z.fYiG.b YY~ L ~ ~i ~ :* . Z '3l, i'y~ 5~1 c5 - f s ~ ~~ # ~.~n9 ^ Pit Ground surface elev. ~ft. Depth to Igniting factor 7 ~ in. ~ Rate Horizon th De Dominant Cobr Redox Description Texture SWr~ure Consistence Boundary Roots GP D/ff p in. Mansell . ~ Qu. Sz. Cont. Cobr Gr. Sz. Sh. *E~ *Eff#2 o-,z ~o ;~ 3 3 -- ; I 7~.b~c - .Z ~ r-3 ~~ 3Z-9 ~a ~.~ 3 ^ 5 Bonng # ~'6~9 I ~ `~ ft. r .Depth ~iimiting factor ~ ~~ in. ~ ~~ ~ ~ J ^ Pit Ground surface elev. Sod Rate Horizon Depth Dormant Redox Desaiption Texture Strudrme Consistence Boundary Roofs GP D/ff in. Munsefl Qu. Sz. Cont Cobr Gr. Sz. Sh. *E~1 * a~,Z ,a~~ 3 5, 1 b ~ ~ 2~3Z D ~~ _- ~ T v ~ 8S~ /5 * Effluent #1 =- BODs > 30 < 220 nx3/L and TSS >30 < 150 mglL * E t #2 = 30 mg1L and TSS <_ 30 mgll. The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or nced material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. ssc-uw~o~roo~ PAGE ~ OF~ NAME 1~ r 1~-e- I I LOT# ~ ~ LEGAL DESCRIPTION,UE '/ay.~t/a,~,~f zq',N,R Iq E (or~ 1 pox SCALE: 1"= ~ ~ iS ~~ !'y ~-~~ ~ ~~~" ~ S BM I ELEVATION /CEO • D ~~o ~,,~,c~'~~~~i' BM I DESCRIPTIONr-G ~ l ; r. (~ "wood Pos i- BM 2 ELEVATION 9S. / Z BM 2 DESCRIPTION~h o- ~ ~ ~~ •~ Py ~ ~ ~ •P c SYSTEM ELEVATION g`T• ~O ALTERNATE ELEVATION 8 ~• ~ U CONTOUR ELE NATION Q 3 . e~ y `(~{. o d 7S' pr~utwa.( ece Se wWV~'~' e„~ ~ 5~~ ~~t ~-U ~haP-e- 0 ~'1~ a ~~ t 2 U° a Z~~3 .~ 39a ~. s~" e-~ S~ ~ 9, ~5` ~~__-,~ 0 0 . a-3 ~~ •f 6~-~-- -f° syr~ (~-~-Ul ST CROIX COUNTY SEPTIC TANK MAINTEIi~tANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM QwnerBuyer ~~ ~1.~.~J d~ ~ ~~^l ~/' ~ ~/~ytc/~ ~b ~/C.~'Z Mailing Address j~ ~ 7 (o'a c,p ~^f 4A'~~ ~? n ~fuf~~•/ dive ~~~/~ Property Address ~ 3 (Verification required from Rla7nning Department~tfr new City/State ~(~l,lsn. ~,~ Parcel Identification Number 7 D (3 °l.~ ~7 ~ ~ LEGAL DESCRIPTION Property Location /~~ '/a,~_ '/4, Sec. , T N-R l ~ W, Town of ~Cl1,Sd.~/ Subdivision SG ~ ~l G ~l ~L~ ,Lot # ~. Certified Survey Map # Volume ,Page # Warranty Deed # ~ ~ ~ ©~ ,Volume ~ 7Z ~ ,Page # ~ d Spec house ~ yes (;~l no Lot lines identifiable Q yes O no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenanc consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the syster 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1} the on-site wastewaterdisposal syster is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standarc set forth, herein, as set by the Department of Commerce and the Deparhnent of Natural Resources, State of Wisconsin. Cert~catio stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 3 d o ee year expi lion date. L / /'~ / a,5~ ' SIGNATURE OF APPLI ANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. the pro dec~cribed abov by virtue of a warranty deed recorded in Register of Deeds Office. SIGNA OF APPLICANT I (we) am (are) the owner(s) c Z. /!7/oS DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. *****' ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey man if reference is made in the warranty deed Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanitary Permit Number 3 a..- Number of Bedrooms Desi n Flow -Peak (gpd) Estimated Flow -Average (gpd) Septic Tank Capacity (al) Z Soil Absorption Component Size (ft2) Type of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean ry years Soil Absorption Component Inspect once every 3 years ~~~ Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stets. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Gode (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filterll be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from ifis enclosure. If the ` Management Plan for a Septic Tank and Soil Absorption Component Plantings ofdeep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flaw. ~(~~cL^ Ct~~ 2 3 ' ~ ~~ ~~Zy P s~~ 784~Qa4 STATE BAR OF WISCONSIN FORM 1 - 2000 WARRANTY DEED THIS DEED, made between Carriage Homes XXI, Inc., a Minnesota Corporation Grantor, and Brian J. Steinwagner and Penny L. Steinwagner husband and wife, survivorship marital property Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property"): SEE ATTACHED EXHIBIT A KATfILEEK FI. NALSI{ REGISTER OF DEEDS ST. GROIK CO., MfI RECEIVED FOR RECORD 01 /03/:2005 10:00AN MIARRANTY DEED EXEi~T # REC FEE : 13.00 TRANS FEfi: 33?. 50 COPY FEE: CC FEE PAGES: 2 Recording Area Name and Return Address: Land Title Inc 1900 Silver Lake Raod Suite 200 Ne Brighton Mn 55122 t~ Z 3A S LZL Together with all appurtenant rights, title and interests. 20-1395-47-000 Parcel Identification Number (PIN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Dated this 21st day of December 2004. Carrie omes XXI, Inc. r ~/ . * ellei St. Martin, Vice President AUTHENTICATION Signature(s) authenticated this 21st day of December, 2004 TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY STATE OF Minnesota ) WASHINGTON COUNTY. ) ss. Personally came before me this 21st day of December 2004 the above named Kellei St. Martin, Vice President of Carriage Homes XXI, Inc. A Minnesota Corpo 'on to me known to be the s) who executed ~}e fo insttument and acknowed the same. (\ 1 Notary Publlic, State of Minnesota My commission is permanent. (If not, state expiration date: Larry Mountan Attorney 1900 Silver Lake Road Suite 200 ~ 3~It>s ~i (~ ~n_ New Brigihton Mn 55112 (Signatures may be authenticated or acknowledged. Both are not necessary.) (~! ANC' J. I..ENTZ :Names of persons signing in any capacity must be typed or printed below their signature .~. ~ rvOTPRt' Pl!5l.', ~-~J~INNES•~~TA ~";'' ndy Gomm ~',~ires Jan 31.2005 hrorw WARRANTY DEED STATE BAR OF ~ SIN FORM No. I-2000 ACKNOWLEDGMENT s _-. .~; ~~2y P 609 EXHIBIT A Lot 47, in Plat of Scenic Hills, located in the Town of Hudson, St. Croix County, Wisconsin. ~-+ N d 0 ;. ~~ S s ~~ ~- f ~ r ~~ I ,~ (, S •• _ .: ~~ ~ -- \, ~ ~. ,~ ~~ ~: `~ ~ ~ ~ . ~ ~~ ~ l,. .~ ,.~ ~~ J w r T. 1~ ~r i ~ APR-12-2005 16 28 FERGUSON ENT HUDSON ~~ GOULDS PUMPS PE ..~ •. ~: ~~~. ~..: ~~ SPECIFICATIONS `~.... Pump -General; • Discharge: 1'f~" IVPT • Temperature: 104°F (40°~ maximum, continuous when fully submerged. • Solids handling: ~/~" maximum sphere. • Automatic models include a float suvitch. • Manual models available. • Pumping range: see perFomiance Chart or curve. PE31 Pump: • Maximum capacity: 53 GPM • Maximum head: 25' TDH PE41 Pump: • Maximum capacity: 61 GPM • Maximum head: 29' TDH PE51 Pump: • Maximum capadty: 70 GPM • Maximum head: 37' TDH 715 386 6144 P.01 Submersible Effluent Pump ~,. MOTOR Generdf: • Single phase • 60 Hertz • 115 and 230 volts • Buih-in thermal overbad pro- tection witll automatic reset. • Class B insulation. • Oil-filed design. • High strength carbon steel shaft, PE31 Motor. • .33 HP, 3000 RPM • 115 volts • Shaded pole design PE41 Motor. • .40 HP, 3400 RPM • 115 and 230 volts • PSC design PE51 Motor. • .50 HP, 3400 RPM • 115 and 230 volts • PSC design APPLICATIONS Spedally designed for the following uses: • Mound Systems • Effluent/Dosing Systems • low Pressure Pipe Systems • Basement Draining • Heavy Duty Sump/ Dewatering METERS FEET r 40 r 10 ~. a° i u 0 0 F- 0~ PE51~ ' I~ I ~ 1 11 '" i I MODErs: PE31, PFA1, PE51 35 I I~~ I ' ~ I I I ~ .I ~. ~I . ~ f HP:.33• .ao, .so ' r ~ ! -- 2 GPM I 30 ••Pf`4•i I~--•.'_ I..i• I ~ I ~ j~l ~~ I l i I I' ~ ~ I I r l~ 25 e~~ .:..: I I I r ~ I V I I I, i ~ ~ _ • ! ! ,r I I ~ ~ ' I' I I i'~ I I ' 1 .7.. ~ I I I ~. ~ I ~' '~ ' I i iii ! I ~ '1- .i jr" I^ - I~ I ~ r ; ~ 1~ ~ ~ •i ..,, 15 ;;, .-1... I' 1. 1. r I I ~~ I I, ~ I i I . ' it ~ ~ , ~ ~ "' 10 ~lr r ~~I ~ I ~~ ~~1~ II. ~~ ~• _ ~ ~ ~ ~ i~ i ~ I• I I r .I ! ! I.I.i. 5 I I I I ,..1.~ ~' ' ~ I ,~ ' ' l I. ~ i ~ i' i I ~ i' ~ I I I I ^~~ ~ ~~ I I• O l l ^I I ~ r i ~ ! I ~ ..I. .I I ~ ~ I~ I! ~ 0 10 20 30 40 50 60 70 GPM 80 , U 5 10 15 m3/h ; ceverrTv ® 2004 nT Water Technology, rn~. Effective June, 2004 ~E3 T/41 FEATURES ^ Corrosion resistant construction. ^ Cast iron body. ^ Thermoplastic impeller and cover, ^ Upper sleeve and lower heavy duty ball bearing construction. ^ Motor is permanently lubricated for extended service life. ^ Powered for continuous operation. ^ A!I ratings are within the working limits of the motor. ^ Quick disconnect power cord, 20' standard length, heavy duty 16/3 SJTW with i 15 or 230 volt grounding plug. ^ Complete unit is heavy duty, portable and compact, ^ Mechanical seal is carbon, ceramic, BUNA and stainless Sleet. ^ Stainless steel fasteners. AGENCY usrINGS ~~v C US Tested to UL 778 and CSA 222108 Standards ~ ~ standards Jlssociatrort Eik,~lR365a9 Gourds pumµs is ISO 9001 Reg'rner~, Goulds Pumps 4~Y 1TT Industries