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HomeMy WebLinkAbout020-1395-50-000 ~ ° ~ o ° a ~" ~ ~ m ~ I a 4. ~ c I ~ ~ i I o I I N b O I ~ '~ U I ~ ~ ~ C '> ~ Y '~ Z ~ I li = 3 a I ~ a ~ ~ I I ~ i ~ ~ Z y ~ ~ ~ i. ~ V I Z .- ! d d ' I z a m N r a~i o I O Z N ~ ~ u ~ c ~ p o- N~ ~ I _ N Z a fA F r Q i ~ a C U O ~ O 'd ~ ~' m "' I N ~ .C ... ~ ~ O C ~ ~ 3 I ~ L Q O C O Y O C ,~ O O C c~ I Z o0 ~ 0 ~ Z O ~ H N r W d d ~ ~ O ~> N d ~ V 'c o O D d N N N N N L ~ ~ m O "~ ~ ~°n i I ~ ~ ~ o a i z ~~ww `~+J _ aaa ~, I ~~ a ~ ov~i v °'~~ I lA J U ~_ N N Z O ~ ~O M ~ N ENO N N ~ ~ ~ + ~ O •~ b a M ~ 00 N Q ~ Ql w ~ ~ m Q Z cn I C~ ~ c ~ « o !~ 00 O ~ N C C~ ~ ~v ~ N ~ ~ = a caOl 'a N O ~ N M ~/ W C ~~ Ql N U` y 7 N ~ ~ ~ N V ~~ w N C C~ ~ ~,' o N 2 U~ o Z C Y ~~ o ~ c ~ ~' I _ ~ I V ~ ~ r ~ d j ~ a I ~ o. l , `~i ~ a v '~ c ~: ~ A ~ n i o ~ a~ i c ti \0' /~ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety ~ nd Building 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: City Village X Township Carria a Homes Inc. Hudson Townshi CST BM Elev: ~~ -~ Insp. BM Elev: 9 •~o " BM Description: ~~(c-s TANK INFORMATION ~ ~(j,.o.~.Q,~.~,.r gZ wCrtQ,) TYPE MANUFACTURER CAPA ITY Septic W E\ C'CL ZS'C) Dosing ~-~S ~- fT'DD Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic t ~ 5'p , s ~-- Dosing ~~ ,,t L~ ~ ~ Sa Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Dem ~ GP odel Number S N t S`~Z-- DH Lift ~ Fricti n Loss System Head TD Ft '~ .30 -- .as Forcemain Length r Dia. ~~ Dist. to well ELEVATION DATA County: si. Croix Sanitary Permit No: 430698 0 State Plan ID No: Parcel Tax No: 020-1395-50-000 Section/Town/Range/Map No: 25.28.18.2444 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer ~ , ~.~ i SUHt Inlet ~~ p $~•Q~ SUHt e I Dt~~ Dt Bottom q }$ ~ 18~ $ \ ~~, oZ Header/Man. ~.5~ ~ 93~ zs Dist. Pipe Bot. System Final Grade ~ ~.. St over/~ q, 5 ~ ~~ ZZ / SOIL ABSORPTION SYSTEM / 14 )~1(an.~.h~ .~nouQ.L. N idth Length I No. O Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS t 3 S~-so i.0.. 2J SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: OD ~~L Type Of System: I / \ _~' UNIT tt Model Number: _ r `h ~ , ~ ~t' DISTRIBUTION SYSTEM' Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake ~` p / Lengt ~- Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depffi 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: DEG • ~3/, Inspection #2: ->'-~T'~~ Location: 735 Regal Ridge Circle Hudson, WI 54016 (NE 1/4 SW 1/4 25 T28N R18W Ic .18.2444 ~ 1.) Alt BM Description = ST~01'('~~ ~~ S~S~-. t 2.) Bldg sewer length = SD ' ~ ~ s 9 3, /1 - amount of cover = ~2 ~~+ • 7~ 4 ,~ , 5y.~ ~. _ ' S ~ 3) SYN. ;w,d ~ ~5t?. ~ ~ -~, ~ =~(°,~ `~•!. ~ - ~3 __ _, . - - -- , Plan revision Required? ' Yes No ~ ~ D~ ~ ~ ~ ~ ~~~ Use other side for additional information., ; __ --. ~,qD-6710 (R. /97) s ~~ r ^ ~~Da /~~ ,~L,Z lgse~ctor's naturt~ ~ No. 1• f•/1 /G~' It c~ q gt-a(QA, t `M" "'s~~rl1"1~ i d -c ---_. . Safety And Buildings Division t:awtty 201 W. Washington Ave., P.U. lktx 7(182 ST. CROIX __ _ i~ea nsin Matdistm, WI 53707 - 7()$2 Sanitary Permit Number (to be Palled in by Co.) l ~ryos~ 261-~sar; ~3d ~ ~ ~' Department of Commerce Sanitary Permit Application i s'~ Plan' I.D. Number I In acatrd with Ccnnmt 83.21. Wis. Adm. Code, personal ittfixntatinn yott provide may ~ a+~11br sKxi>ztdary purposes Privacy law, s! 5.04(k }(mj _. Jest Address {if differerA Utah malting addness,~ 35 REGAL RIDGE ~ t 2C-~> ~ Application Information - Please Priaat Ail Infttrmatiutt - Pn>tttrly ()water's lsratiw aral ' Lot # I)l~eek-#-- ~ 50 CARRIAGE HOMES XXI, INC. --- 1'rapetty Otiti~attx's Mailing Adck~ss Propary Loeffiiorr 12415 - 55TH ST. NO. NE SW ~~ sea;~~~ 25 St t T C i Ph N M _ a e City, p cx c one um r 2~ (9 r°1~°t~) LAKE ELMO MN 55042 651-439-2414 II. Type of Building (check a{l that apply i~l~rzFa,:,;IyD,R,ellm& _N,,,t~ni•~ bedrooms per submitted house plan st'"'~i~"~tlvaf"e cs~t~'"°'~ L I Pttbiier'L:omaxrcial - I)escrilYC Lae SCENIC HILLS ^ sc~tz D~~;txr_rsc -- ^Citv__^vinaKe (X4'r»mvltipot HUDSON iII. Type of Permit: (Check only sate boa on i~ A. Complrte line B if applicable} 2 0 _ 3c~~ _ ~~ ~-2_._ ~ - ~' l~ New System ----- I_~ Reglacxanent System ^ TreaUttertUllotdirtg Tank Reptaexn~! canly ~.~ Otlte~r Mvdif;catitm to Existing System ~. ^ PermiR Renewal ^ Permit Aevistun ^ Change of ^ Patrtit Trartd'er to New I~~ Previaas Permit Number and Date 7sstxvl I3eture Exp;ratien Plums (hvtut ~_ -- --- IV. T of P()W'I`S S tem. Check all that a i - 0'0 Ncm -Ptessutiaed 1a-Ground U ~.1~~nd % 24 ;n ol'suitable scsit I~ Moemd < 29 in. ofsuitabte soil ^ A3-Grade ^ gle Pass Sand ~Itcx CtMAttUCSBQ WetlattJ ^ Presstu'i'rcd In-CirOUrid l~ Ho~ing'F:ufk ^ Peal t'itttir 1.-.1 ner<etric 7~reatmeautlnit ^ Rracirwlalir~~ Sand Filler ^ K eciecutating synthetic l~ledis I: iher ~ F.eschirtg Chamber ^ Drip Line ^ Gravel-less tipe ^ 3e lain) 2 -TRENCHES W/ 14 V. Dis rsalPTarattmeaatArealnrttrtttatloan. OIFFu-~• A MBER -Zabel - A100 filter SDeaigu Flaw {gpdj thvign Suit A.ppticatio» Kate(gpdet) Dxpersal llrna Rtxlnire+t! (c1) A** +pxcetl (xt) ."yslem !slevatian 870.8_ 92.05 600 .7 57 VL 'C'ank Ixtf6 Capacity in Taal Numkxs _ ;44anufaeAtrer ~ Prefab Site stet! Filler PittstiC [aalio~ Clalfnrts nfiittirc ConaeAe tonslruci«i Glass New Extstugi Tanks Tarzl[s senri~~[tl~ia~~a~ x 1250 1 WIESER X .Aerobic Tnalmen4 LJni! T'"""s`'"~"''"r X 1000 1 WIESER X VII. Responsibility Statement- ], ttae artderslgttc~, asarrec res nai6iiit or iaats~9adkrs at'the M}vVfs if~o+vs an the rttacbed pMuts. Plumber's Nana (Print} Plum 'f YlLS ltiumbsx ttttvna'va Pt~rme Nru+atte~' TODD FEATHERSTON 242514 ___ ____. 715-381-1704 Plumber"s Address 1.StPCet, f`tty, StAtC, Bp ~a?(tC} P.O. BOX 467 HUDSON, WI 54016 V III. Cctan !De aetmeatt Use Oa ~ ,r ~,>,ppraved ~ U llisaptxtrved Sanitary Permit F"ee (in odes Groundwalcr S,u~t~ c Pei) Date I5s"tte+i I i erg Sigttat (No Stamps) I ^ t~u7 Given Reasan fur Iksnia! g Z ~ ~ ~ f _ -_ _._ _ IX. Conttitions of ApprovallReasonsPorDsapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. 1Uaci rlam (ts the Ceu®ty nay) tar thr system ao piper rat teas ttaaa tnrz z it :mss ~ sin ~~ / Brims ~~ ~~~ ~~~ •~~ .` ~~ A ~ ~ ~~~ ~ s~~ ~. ~I~l / 1FL /~, b Ta/o~~"~`c APE ~ 6~ at ~~. yP 9~ To +~ of z '"~+~ y°ioE ~- .8 / _.. 93.9a ~~ - yG-8a • 1 '~` '"~, N ~~~~~.. 1. ,1 ` ••" ~.. ~` ~~ ~ .~ ~- .` a ~ ,~ 8~ ~ ~~a ~+~~ ~~~ ~~~ .~ ~~,~!' ~~ ~ e ~" ~~~ L BAZ ! ~~ ~!~vc ~iOE T/o~'..Z To s~ of z "'P~ ~o,,oE ,/8~.... 93.~a s8 a - yG . 8'a B~-9~-~0 ,~ 1 ~.~ ~ ~ ., a ~ ~ ~~ ~~ N -. a ~ ~. Wisconsin Department of Commerce - SOIL EVALUATION REPORT Page 1 of Divisidn of Safety and Buiktings In BCCOf48n0e YVIGI wmm tsa, wm. tram. was t Pl i i 11 i h ~~ s - c ro i' ze. nc es n s Attach complete site plan on paper not less than 8112 x an mus indude, but not limited to: vertic~i and horizontal reference percent slope, scale or dimensions, north arrow, and a and neared road. Parcel I.D. a ZO - 3 9 S ~ - ~ .__ , .Please print all i ~ n. .~ ~, 15 04 ~t by Date ~, ~ ( 1 /l ~ 2"o Q Personal iMorrnation you provide may be used far x. . ?) (m))• . ' ~ ~~ i ~ ° Property Owner - ~ Properly ~~ - ~ ~ ~ ; -~~ ~~~ ~? ~ : '=Lot ~/~ 1/4 ~W 1l4 S ZS T Z q N R E (or~ Property Owner's Mairng Address S7 ~H41A S of ~ --_' Bock # Subd. Name or CSMif ri i1NTY CJJ ~ Z ~ S-I~ i ~ ~ Wad ~-... ~ G ~ ~ . City State Zp Code Ph _ . . ^ Village (~ Town 4 Nearest Road ,. . ~Srt'i: I L w«..~-cr Vhi i~.. ESQ ~Z ( ~' ~`~!~_ _ ~ . s c ; n ~. ~q/ ® New Constructbn -Use: ® Resider-tial / Number of bedrooms _3 _ `l~ Code derived design flow rate ~Sd ~lo O O GPD ^ Replacement ^ Public or oommerc~al - Descxbe: Parent material Oyfca.JGt.B ~. Flood Plainelev~atiogiFappric~ble ~G ~/• O fl, General commerds S S ~ rvl e. (~. ~a f ~b n - qZ ~ ~ v~/. Co (J~/ L3 Z s: and recommendations: ~, (~ ~ 2.. .e.J 0. : d n - . ~'O• ~ ~y~ ^ Boring Bring # i;pi Pit Ground surface elev. q 3.9 O {t, Depth to limiting factor /~_, in. So~7 ' n Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/I~ , in. Munseq Qu. Sz. Corrt. Cobr Gr. Sz. Sh. •Eff#1 •Eff#2 S<2 ~ Z.s-3~ .c~'i ZZ - SS'- ~ Z ^ Boring ~ t 2 -f- c~.~r ~u~cr' Boring # ®Pit Ground surface elev. q ~' 8 o ft. Depth to limiting factor 1 / ~ in. sou Rate Horizon Depth Dominant Cob Redox Description Texture SWdure Consistence Boundary Raots GP D/tt? in. MunseA Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eft#1 •Eff#2 I -' /D 3/Lf - ~ LS m5 ~r c Ivy .~ /• Z ~-e s ~v~.J w Si ~- 4z •~ S~- q3 * Effluent #1 = BOA > 30 < 220 tnalL and TSS >30 < 1 50 mall • Effluent #2 = BOD . < 30 mglL and TSS < 30 mgll CST Name (Please Print) is ature CST Number' ~G~ ~~~~w~e.r ~ - ZS33~~ Addrnss ~ Date Evaluation Conducted Tele~orie Number 2113 8b~.~ .~n~e~~Gc!/ -~ZS ~'/-~/ -7l5 - 2Y7 4~~ Property Owner l~r kG ~ I Parcel ID # Page z ~_~. Boring # ~ ~~ ®Pit Ground surface elev: 9~' ~d ft Depth to limiting factor 71 ~ in. Soil lication Rate th D t Cobr i D Redox Description Texture Structure Consistence Boundary Roots GP D/fP Horizon ep in. nan om Munsell Qu. Sz. Cont Color Gr. Sz Sh: .~ "Eff#2 I a- . r ~ ~ L S lm m~i' GS ~v~ .~:~ 1.2 ~-q2-~ I ~---- 5~ 3 ^ Ong # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. ~~ lication Rate on Hori De th Dominant Color Redox Descxiption Texture Strucbune Consistence Boundary Roots GP D/fr? z p in. Munsell _ Qu. Sz Cont Cobr Gr. Sz Sh. `Et~i 'Efflf2 Boring # ^ Bonng ^ Pit Ground surface elev. ft. .Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Cobr Redox Description Texture Sfiudure Consistence Boundary Roots GP D/f~ in. Munsell Qu. Sz. Cont Cobr Gr. Sz. Sh. 'Eff#'I 'Efflf2 • Effluent #1 = GODS > 30 < 220 mglL and TSS >30 <_ 150 mglL * Effluent #2 = GODS < 30 mglL and. TSS _< 30 mg/1. 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 departmern at 608-266-3151 or TTY 608-264-8777. SBI)-8330 (807/00) PAGE 3 OF~_ NAME 14 Y" ~-~-~ L LOT# SO LEGAL DESCRIPTIONtiE `/.5w `/a Sz„sTa N Rlq E or SCALE: 1"= y ~ 1 BM I ELEVATION lQd • CJ BM 1 DESCRIPTION -~ p o~ Z"~ U~ P ,' P e BM 2 ELEVATION Gfl~ 9 +~ ~~~ Z S BM 2 DESCRIPTION~~O a ~. Z" o J ~ ~l ,_y c I x SYSTEM ELEVATION GZ. (n G - + ALTERNATE ELEVATION 90 • Ln U ~ CONTOUR ELEVATION yyS I ~ rr~ Z ~f ad `~ ~ ' ( "-~ Oo 0 ~i®~ _ N _~ ~_( ~ ~ ~ ~• -~ ~ ~-~•. W ~.. ~ 4 y . O ~b ~°~ ~i _p ~-z ~+• w.L~. 9~ Y• o POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 1 of 2 FILE INFORMATION OwnerCARR1AGE HOMES XXI INC. Permit # 2 DESIGN PARAMETERS Number of Bedrooms 4 ^ NA Number of Public Facility Units ^ NA Estimated flow laveragei al/day Design flow (peaks, (Estimated x 1.5) (~ gal/da Soil Application Rate .7 al/da /ft2 Starar~cd Influent/Effluent Quality onthly average• Fats, Oil & Grease (FOG) <_30 mg/L Biochemical Oxygen Demand IBODss 5220 mg/L ^ NA Total Suspended Solids (TSS) <_150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) <_30 mg/L Total Suspended Solids (TSSI 530 mg/L ^ NA Fecal Coliform (geometric mean) <_10° cfu/100m1 Maximum Effluent Particle Size Ys in die. ^ NA Other. ~A "Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity1250 al ^ NA Septic Tank Manufacturer WIESER ^ NA Effluent Filter ManufacturerZABEL ^ NA Effluent Filter Model ^ NA Pump Tank Capacity 1000 al ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer ZOELLER ^ NA Pump Model MODEL 98 ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: ~JA Dispersal Cell(s) ^ NA ~n-Ground {gravity) ^ In-Ground (pressurized) ^ At-Grade ^ Mound ^ Drip-Line ^ Other: Other: ,~A Other: .~ NA Other: ~NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tanklsl At least once every: ^ monthls) 3 ~ earls! ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third IY,1 of tank volume ^ NA Inspect dispersal cell(s) At least once every: 3 ^ ea~~sl s1 Y ^ NA Clean effluent fiher At least once ev ^ month(s) ^ NA Inspect pump, pump controls & alarm At least once every: 2 ^ month(s) 7 year(s) ^ NA Flush laterals and pressure test At least once every: ^ monthlsi ^ year(si ~f~~lA Other: At least once every: ^monthls) ^ year(s) ~NA Other: ANA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carcying 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 tankis) 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 IY,1 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of irf 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 _<12 months, shall be performed by a certified POWTS Maintainer. a A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Page 2 of 2 STIiiRT UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cellls-. 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 cellls) 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 ar 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; dente{ 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 tfie 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 fast resort to replace the failed POWTS. ^ The sitie has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ 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 ~~ Phone ~ ~- ?d- y POWTS MAINTAINER Name FEATHERST Phone 715-381-1704 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name PINKY'S Name ST. CROIX COUNTY Phone 651-436-5788 Phone 715-386-4680 This document was drafted in compliance with chapter Comm 83.2212)Ibllt-(d)&It) and 83.5411), 12) & 13), Wisconsin Administrative Code. S'I' C1i~?I X CO t~'N'I'1' SEP~'iC TANK h4AiNTENA.'~ICE AGP.EEI4IEN'i' AI~iD OW;v'EI;SNii' CERTii~ICATiON i'OR.'v1 Owncr/F3uyer Carriage Homes XXI, Inc. t~iailing Address 1 241 5 _`reet North, Property Address ~7 ~ 5 /P~~,/~L ~~~GE ion required from Planaing Dcparimcnt for new S mo, MN 55042 CitylSt3te wi s cons i n paz~ Iderti~ication Ntunbec ~ Ozo - 134 S ~ ~ - ,2 ~,FGAL nESCRIPTIl3N - See Attached Legal on Deed Property Locatioa ~/E '/,, ~ L'~ t/t, Sec. ~5 . T~N-R_ ~,~V~Tov,~n of ~~d..SO/1/ ~. Subdivision Scenic Hills. Lot # ~ . CCi'flrt:d StiiYCy I4~a~ ~ __- _ -_____ ___~- . ~'`OItTII1C _PA~C ~_- _ ~_ ~ar't~anty Deed # 6 4 8 6 0 4 Volume `~ ~ Z Page # 2' (~ . Spx hawse ^ yes ®no L.ot Imes idcntxfiable ~7 yes ^ no SYSTEM MALN';"~NAI~ICE . Ia~xaper asc tad M, *„s••,,a*+~ of your sep*sc ~ could zcsalt im its pizmatu~fail~e to handle wxstcs. Proper mamteuaacc caasis~ of pumpiag out the optic tam every thru years or sooner, if near by a Sioeasal pumper. What you put into the system can tffxt the fiiaction of the septic taalc as t trcataseat stage in flee wute d~OSaI system. 'I1se pmap~xty aWncr agzees to suhtnit to St Croix 2:oning Degartmestt: ccrtificatioa foua, sigrnCd by tl~.e o~eacr. and by t n~sterpl~ber,jotrmeyt>zaaptumaet;nsuidedp t ar:liccas.-dg~vaifyiagthat(1)t5~on-site ~zstcwatcrdisposzlrysttm is in proper operating eonditioa and/or (2) a_Fter iaspoctioa and ~ittg (if necessary), tse scptictank is Icss than 1/3 full of siudgc. Uwe, the uadasigaed h:vc read the cbove rcquirnments wad amt to traintain the privata sewage disposal system with the staadatds set forts, hetGia, ss set by t3~.e ~ of CommaCC wad the L)cpartaneat of 2~'aturai Rcsouzres, Smote of Wisconsin. Ccrtif cation stating that yoar optic sysLcra has been taaiataiacd must be cocaplrxcd wad rctnrued to the St. Croix County Zoning Office within 30 days of the~tFite~'7~ ezpaatioa tc. LLB.--- ~~ _ ~/ f ~ ChtATURE OF AP DATE OWI~IER CERTIT?ICAT74N I (arc) certi.Fy that all statcmcn's on this form arr. true to ttze hest of n±y (oi:,~) L~owledge. 1 (wc) am (rr~) the owner(s) of the property a4~ove, by virtue of a waranty decd rxozdcd in ~Rcgister of f.?reds Office. ~: ~ D~ SI OF APPL.IC.l~h'T DATE ssei ss ~Y inf'o:mc+ion that Ls nz:s-r; i~t~,.s~tad ray rcri!t is the san3ta.-y pcrcnit txi :S tcvo)<td try eie Zeaiag Dcpa.-rnrnt. «'' •:. « " Iadude wft'~ this rppEicxtion: a s;z*;~ped waeranty deed from ti'~c Rester of Deeds of:'iec a campy of tixe certified ri-vey asp if r`ferencers n-.s3c in the warrnrry derv a2 t35 40 130 38 125 120 36 n5 34 IIo 32 105 30 95 2e 90 26 B5 24 ~ 1 f 75 4 22 7 ~ 6s le 60 55 I6 SO 14 45 t2 40 HEAD/CAPACITY CURVE .AD CAPACITY CURVE EFFLUENT MODELS MODEL 42 4g 53,55, yg 137 139 140 161, 16 57 59 4140 4161 41 191 ON Model 185/ 8 hould not be subjected to 1n 30 feet TDH. For Head C on Model 112, Industrial expbsion q o i ump, see FM0219. 4 10 2 5 98 IO~p •6p~10 160 240 320 ~ FLOW PER MINUTE (1' .~,~ ~~ ~a, W 4 HE AD C CITY CURVE SEW E MODELS 2a 75 1100EL 261 168 267 169 z7o zaz ze. 192 z93 z94 1% 22 7O Fr. s Izt'rLns 1.s rx 90 tms. 311 rx 128 t72s. 481 rx. 128 t]KS 181 07L 128 ems 48 12 su. 70 1193. x1 rx 81 t19s. 4 cu. 284 tms. 192 ]KS 1 cu. 193 tia5. 41 6LL 94 t1iS. 4 G,IL 295 tiRS. 4 132 500 tYl 492 190 661 7w -- -- 1% 741 111 a10 2O 6r3 10 15 10 4.6 60 n.3 n7 85 ~ 50 3J7 I% 89 50 337 189 B9 SO 337 101 362 93 360 lsa 599 124 let 885 19B 7S3 8 6G 20 u b 6.1 7.8 9.1 10 39 10 38 10 189 38 77 56 19 191 112 110 6J 33 5 2J8 125 19 133 1% ]6 43 511 101 188 Ifa 1% 91 ]3 56 409 3{4 284 212 1 % 81 w] 109 165 150 I]6 1 623 588 s15 1N 16B IS• 6% 876 583 55 w So 12.1 fs2 10 b 4B 182 21 459 356 iw 113 5J0 135 16 60 1aa zm es >J7 50 7o zla IJ 19 5q y23 14 45 LOC K WIVE: 1 8' 11 .5' 21 .5' 11 .5' 29 ' 26 ' J S' 4 2' S 0' 6 2' 2J 7 e7 5' /2 40 35 10 30 293 O CAUTION Model 293/4293 6 2s , a293 should not be subjected to less than zsza26 270 427 15 feet TDH 6 20 0 . 15 009904a 4 10 266 ,267 2 , 268 5 26 4 292, 28 4, 294, 295, 4292 428 4 4294 2g5 GAL N 10 20 30 p 2 U_ 3 2 0 a O U.S. LO S 40 50 fi0 70 80 90 t00 110 120 730 140 150 160 170 180 190 200 210 220 230 LRE 0 80 160 240 320 400 480 560 640 720 800 880 FLOW PER MINUTE ® Copyright 1999 Zoeller Co. All rights reserved. 5 12!09'p3 TLIE 15:03 FA% 715 386 4688 ST CRX Cd Z4NING ~ Opl ~ar+ ,. ~~ PL1Nl~ CHAMt;~R CRASS SEC+10+.1 At~.1G ~PECIFICA"rIQ~~S M"C. I. v~AJ7 PIP[ ? 25' FRDr1 DOOR, w~unOw aR FRE$H AiR 11JTAICE IB"!rl f fit. IA,+LET * A La ELEtl. - FT, C 0 ~TVEA]T [AP we,arHE+~Prtoo .luuerleau aox~ +2"M I U. GRADE *APPRDYED JOINTS WITH APPROVED PIPE 3' QNTO SOLID SOIL t GOUDU+T ti'-= P1xov~DE AIRTIt;MT 5£A,L, Pt+MP ~ cD+acRET>< atac-t AiPRpVEO LOCKIAiG MAIJHOa_f' t'4VEK y~ Mt1.1. I6" 1`11AI. _._~____.~__1 ~ III 1 ~~I I 111 I I ~ ~ I ALARM I II ~ + I ~ Ob1 l ~ t _~ ~.! OFF R1SER E1t+T pCRMIlFCp OAll.y IF TAWK 1`1ANL+FACTi,IR>}-K HAS SLIGFI APPROVAL SEPric E SPEC,If` iCAl"SOl~JS D°s£ ~ WIESER 'T~A1lKS MA-JUFACTURi"R: I-JW~-@ER OF DOSES: 4 PER DAy TAAJK SfZE: 1000 GALI_oAJS DOSE VDf_uMt ALARM M+l-sUFACTUttiLk: ZABEL iNCLUDIrtJG DAGIClrLOW: 482 feAt~olJf MODfwL LlUM6tR: 1 OO CAPACITIES: A= 22 1lJCgES OR -._ . ~ GALLDNS SWITCH TyP[: WEIGHTS I H ~ 2 tASLHfS oR GALLO-JS ~- puMp MAASLIFAGTUREft; LLER G-_ 5.O4t1,?LHES OR r,ALtOU: ~ MOO$l AJLjA46ER: 98 D o 7 SlaCH£S DR ~~_ GALLOkiE 1 SWITCH TYPE: WE1~7HT SWITCH UOTe: PL4M'P A+,lD ALARM ARE TO ec MlA1+MUM D15CHARGE KIATE 15 - 30 GPM IN57ALLEp Dtf SEQAAATfi CIRCUITS VERTICAL D+FFE1[EA1CF D>tT WfiEAJ Pl1MP OFF RAID 61g71i[IbUT14E! PIPE., .~= F!<ET ~- MIA1ft~UM kIETWORK SUPP4.'! PRESSURE ~ ~ ~ ~ ~ 2.5 FEET + ~_ FEE7 pF 1:ORGE MAIL! X•74 FT,,// ~y• 92 /pp~FRlliTt6F.1 F/-CTDI~---- FEET -"' ">`07'Al. QyA1AMIC N£AD ~' ~EET 98" ILITER-.fAs.., D StOtifs~ o TAA.iK: i..E+.IGTH ;w10TH $O_.,,,`_.;L-QLE+D flEPTi-i 36" ,._ strytitE°' LICEAlSE ut3nBER:242514 2-19-2004 DATE; 2 ~ SYSTEM CROSS SECTION MAN HOLE GRADE i INSPECTION PIPE E' ZABEL FILTER ~ 1 1250 GAL. ~, ,_,_,__,,..,87.50, _ SYSTEM ELEV. 92.0 5 _„_,_,,,,_ O 87.50 ~ 1000 .,., ~ O ~ ~' NE '/s SW '/s,S 25 T 28 j~l,R 1 1LE (.~)T 50 g(„~ $U8 SCENIC HILLS Cfl V~3IL~~~~~ ~`- ~' I, DOCUMENT NQ. it t ~ ~, R'ARRANTY DERO 2 BTAT; OF W18CANBIN-FOAM B • y VQI. ~~~"-~L ~' TRiR [-ACE RLEERVED FOR R[CORDINO DATA 'THIS INDENTURE, Made b .RICfiARD N• PEARSON and JEAN M. PEARSON hus ........................................._................... ..................L. _. band and ife ......... gtantor.s.~ of..._St..CiO1X ..................................................Coonty.,•Wisconsin,• hpreb conveys and warFants to..._~~??AGE HOMES XXI, INC., a ,~ Minn~sota corporatlon, ...................._........................................... , ........................ . . _.. _ asli~ing£oii.._.._......._ ...................................................~pn~{~ ~}t rantee........ of:. • County, or the sum of On.~_pQllar.„~nd_ no1100__j~l; 00),_and. other good.,and.valuatile,,,f~RETORN ro La+n.~cl Tif Iti CP!?.~ }S1~X~~ loo .............. .. .. ......................._ ._„_•,..fS1i339513 l~jL'C- Sr I/t-~ lrtl(r 17c.~. .................... Sf 1L•L. the following tract of land in_.__St.....CL:oi?c..._,_...,_ )l.~E •~~ l'F~ I J / +oN m~/ Wisconsin: .Ali,..CI;..kile,_1Vo;t17w~~,~_.Qyart<ek.,, jNy.JJo~._a11d,.,~Iorth half (N~) of the Southweest ~ r// z Quarter (~;) of Section R~denty-Five (25j, Township Ztventy-Nine (29) North, Range Nineteen (I9) West, St. Croix County, Wisconsin, except Lot One of Certified Survey Map filed June 29, 1994, recorded in Voltame 10, Page 2762, St. Croix County Register of Deeds, as Document No. 518444. See Attached Exhibit A Parcel Identification Number This is not homestead property la Witness Whereof the said grantor. s.. haVe...... hereunto set.........their hands... and seals.... this ............ ..............._......_... day of...... aY......................................., A. D., Y(r(.2QQ1 BtANffiD AND aHALED IN PREBSNCE O[' ._. .....~~, .......................(SEAL) M••.. 50T ............. .......................(SEAL) ' ..............................................................................................(5EAL) g~pta Smo~te of >~Fh ,,,,,,._WashingtOn .... runty. Personally came before me, this.?~:'~`.. day of.. ~.`..~? ............. . RICHARD N A. D., i'~..2,Q01 the above named ..............._.._....~.....E~RSON and JEAN M. PEARSON, husband and wife, to me known to be the persons.... who executed the foregoing instrument and acknowledged the same. 1 _ ...................... TNIB IN87RUMENT A~ D AFT BY Richard J. Ga~rLe~, ~~2869 ~, : J=A,~Y.lNOUNTAIN 880 Sibley Memorial Hwy., #114 NSEALT Nota[yPublic,. ~' NQTARYPUBUC-MINNESOTA Count ,Wis. S'IE""~"`' ' "" ~ ~` "'"" Se 3 ~ °-1736 ~ ~ My Camm. fixplres Jan. 31, 2005 y ; ~ . Afy corttmission (eht ' ..._._ .................._........_...._.`._........................ ~ (Section 39.31 (1 j d the wiNamin Stalutea provides that all InatmmeMS to be recorded aball have plainly printed or typewrittrn thereon ± the nano of the ~raoton, arantea, ritneua and rwbq. Sation 59.51} simiLdy requite that the name or the perm vrho, or aovem- I mental aarncy whah, dotted Guth imttumenq shall le printed, typcantten, Namped ar vrritten ehertm in t le[iLl< meaner.) WARRANTY DEED STATE OF WISCONSIN wlscon[tn Lo[wl Biank AOmD[D7 I`ORllt No. ! lrliwaukse, Wls, (Job 98R 11 1 . ~ _, ~M1 ~ ~,~ 1 ~ ~~ ~`d. ~~ ~fttf ~~, ~~ ~ ~"~4 j€~ `' ` ~ 1 k~ ~ fi. ` r ~'?~~ ~ t, :~? `° _ , =~,~ `~ ~ °-~ ....~. z s ~ a ~ ~ `-"`-.. .. ~s~' ._ ,.,. ... f r , ' < * ~ ~ ~. v ~F~ ., w a ~ a F + ~~ ~~ FF ~- E ~ i P`. I t // ,. 17- ct 8- U a 4- 0- .~ . :r0 H(<AI) CAPACITY CURVE MouE~ i 52/ ~ 53 40 1JJ I _.... 30 ,~,, ~ _ .. 2U -- -.. lU 20 GAU.UNJ _ Littk$ 0 80 : , I - i 40 GO 80 100 tso zao ago FLOW PEA ~tINUT[ CONSULT FACTORY FOR SPECIAL APPLICATfONS • Ttmed dosatg panels available. • Electrical ahernators, for duplex systQms, are available tend supplied with en alarm. • Variable level corrttoi switches are available for controiGrtg tdngle phase sYstems• • Double pg9Ybadc variable level float switches are avaNabte for variable level kxtg and short cycle controls. • Sealed Qwik-Box available fix vtlbdoor InstadaGons. See FM1420. • Over 130"F. {54°C.) special gtlotatlon regWred. 1571153 Series 7flti Gltet~.~ll~~ Loon Medd Yoltt-Fh tJodt • f Dypltoc , 1 ;;s 1 -~. e.s 1 ~ ~Ma aNt52 11~.__ 1 9.6 ~ i~~~~ ~ Inok,dad 2ar3 Etb2 230 t NCtt 4.] 1 ? a~ BEtti2 230 1 flub 4~ _ InM,ded 2 a 3 ~~~ N1J3 116 1 Non 1 2a 3 BNt57 t 15 i AWa 10.6 , inck,dod 7 a a Et53 230 1 Mon _ li.3 1 2 a3 9E t53 _ 230 1 Auld ~,;~ Ir~'lu~t~l _ _ ; __ 2 or 3 O CA J1M nsWltaon of convds, protec0oa davlcat toil tr~riny •tlouk k done q a ryuermee iktntW f1ae17iClaa. Ab altctrKW arttl 7ftkty oodea should ba rollorwd Includlne ela coal rsctnt Nation[: pKVle Codt (UEC) and tha Ocoupatienal tiartty and Ntakh Aqi (OSHAj. 1. Sir>Qle p'Ig4ytxlclt veriaWu Y,vel flue[ twltdt or doude pippybedc varuttq lawl float switch. Relu to FM0477. 1- gee PM0712 Tor wrrect model oT Electrical Alternator E-Rek. 3. Variable Level control switch 10.0225 used as a control activator, spodiy tluproz t3) or (4) float trystem. RESERVE POWERED DESIGN Fvr unusual conditions a reserve safety factor is engit'teered into the design of every Zoeller pump. ~ O ht W ~w'w'M'.JOaM~r. oom • PU/t?P !O. © CoPyripht 2000 Zoeller Co. IUl ripttts reserved. _Or,4 valve: 3i?.A rl. (' 1.6rn) ~ "..C~ t t ~ Li! n i .... ._.. ot.ca a • .• : .- ~- .t ; /32 r v, j ~. I - r ( ~ 'll r ~'; ...~ ~l ~~ - ~ ., i~ ~~ ~ .. 1 Y 1 ~` ~ ~ ~.. SELEt:7fON l?UiDP I(AIL TO: P.0 6QVr 1WS7 La,nstWit, KY X0236.0347 9H(P T0: 364a Civ Ru, Rwcl Laukvlrs,XY 102t1.1A6r 16021 T1W7>•3f • t {80r)11 D?I-PUTAP FAX {6tT1J 776392< MamAadu'cvt or. . ~vurr PuLCCS S,vcF /9.99 • Ili 1tl U`•b1WIC Hf4:iCAPA,^.IIY •'~ ~ GIt1V,,TE Fr.CI l~irlr.,x i:ul. titerc~- :;r,! l ilc•s n 1.5 57 261 %% 5!31 I i' 3.1 5' Y31 !;; ~~'~ Iti 1.°i ~t3 701 ~ ;,' 2~, it. G.1 4A tr' ... ~? 19% .7;: /.b S~ 12b• 47 ' :act 3~ 3.' 2 `rt! .3.i ' 7~i ~~ a~g