Loading...
HomeMy WebLinkAbout020-1395-63-000- _- - wisoonsln Department of Commerce PRIVATE SEWAGE SYSTEM l Safety and Building Division R 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 Bonfe Builders, Inc. Hudson Townshi CST B Elev Insp. BM Elev: BM Descri tion: ~ 9(0.3° ~ _ ~. ^~.' TANK INFORMATION ~~ TYPE MANUFACTURER CAPACITY Septic ~' ~ /~ _ ~1~-~ 2 Dosing Aeration Holding .,~ TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic > ~~ t ~~' O ~ ~~ Dosing _ Aeration Holding PUMP/SIPHON INFORMATION Manufact er ~ Demand ~!` GPM Model Num r ~!~ TDH Lift Friction Loss System Head T H Ft Forcema~~ Length Dia. Dist. to well ELEVATION DATA County: $t. CroiX Sanitary Permit No: 430371 0 State Plan ID No; ~. - Parcel Tax No: 020-1395-63-000 SectionlTown/Range/Map No: 25.29.19.2457 STATION BS HI FS ELEV. Benc mark 81 ~~ ~ ~ .9 ' . o AI BM _ Bldg. Sewer ~' •~~ ~ 9S: 3S SVHt Inlet A 7 SUHt Outlet -f ~ - Q ~ ~5,. ~ Dtlnletlnlet Dt Bottom Header/Man. l Dist. Pipe Bot. System 1 D ~ -~ ~ Final Grade ~ `.~ + ~~ , ?~~ d St Cover ~. ~ tm .2 / SOIL..ABSORPTION SYSTEM //~iC) [~ ~.n..~.I~.t /~v~e.~.. REN Width ~ Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIME ONS ~ 9 L ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING M uf tu~e~ ~ i (~ INFORMATION CHAMBER OR ~ ~ ~11.. ~!'~M~ Type Of Systemtl I ' So ~O 3 ~ , t ~ ( UNIT Model Numbe~ ~ ~~ DISTRIBUTION~~TEM Header/Man' old~ Distributi n x Hole Size x Hole Spacing Vent to Air Intake ~ ~ Length 'n' Dia Pi ength Dia Spacing "~ ~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil [] Yes [] No ~, j Yes ~ ~ No C 3 I~~NTS: (Includ de digcrepenFies, perso s pres ~c.) Inspe ion #1~~~-/-~~f Z~ Inspection #2: Location: 827 Highlander T rail Hudson, WI 5'401e6__(SW NW 1/4 25 T29N R19W) Scenic Hills Lot 63 Parcel No: 25.29.19.2457 ~/Zilv}- ~•~~/ at 1.) Alt BM Description = ~~ S: r• vN.e.wY~•~ ~/'. 2.) Bldg sewer length = 36 ~ -amount of cover = 36 ~%t'. Plan revision Required? ~ Yes ~ No Use c~hgr si a fo d ition~l information. - n ~ __ SBD- ~/~7) a ~dCca~rw ' J Sly:. - ~ I - ~~, ~- - - ~~ P~P~) Safety and Buildings Division i County s ~ 201 W. Washington Avc., P.O. Box 71 b2 ?` of 1 X.. ,s~O~~',~ Madison, WI 53707 - 7162 Sanitary Permit Number (to be fttied in by Ca.) De artment of Commerce (6os)266-3151 ~3~'3~-l Sanitary Permit Application State Plan LD. Number _ ^- _~ In accord with Comm 83.21, Wis. Adm. Code, personal information you p vide R ECEI may be used for secondary purposes Privacy Law siS 04(1)(m) t Adi ~s (if differe ili t th n m dd es ) , . n a ng a r a s I. Application Information -Please Print All Wormation S E P 1 5 2003 ~~~ ~~~~ ~^'~~ Propeny Owner's Na me parcel ~ L'ot ~ Block ~ OIX C ®..[f t° Vic, OF UNTY ICE ~3 Property Owner's ailing Address ----~ ; - __ Pro adan ~' G .sr. c 1~ / :~. ~~/ Scction ~ i4 Ci S i, , ry, tate Zip Code Phone Number ~ '~ m ~ ~°~ ~~ ~- _ ~ / (circle o e) ~W T ~ N R~~ E ; o II. Type oP Building (check al! that apply) ~ ~ vwi s ~ S. , ~ ~ Subdivision Name CSM Nttmber j+31,1 or 2 Family Dwelling - Nttmber of Bedrooms ___ ~ ^ Public/Commercial -Describe Use ~ C. ~ s G ~: ~`$~ ^ State Owned -Describe Use t~2) ~ ~ ~( ~~ - S~ S - ^Ciry ^Village'Township of~q III. Type of Permit: (Check only one box on line A. Complete line B if applicable} p2o- I2 ~S_ (~~, _ 0~ , 24~5~ ~ A' ~ New System ^ Replacement System ^ TreatmenVHolding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Ntunber and Date Issued Before Expiration PIutnber Owner 1V. T e of POWTS S stem: (Check all that a 1) aE -~t?D Non -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 Sautd Filter ^ Recirculatin Synthetic Media Filter Leaching Chamber Dri Line ^ Gravel-less Pie ^ Other (ex lain) V. Dis ersal/Treatment Area Information: C ha ~ • b c' ~ Design Flow (gpd) Design Soil Appilcation Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation ~'a ~ ~ ~~1? ~ 9r, ~° VI. Tank Info Capacity in Total Number Manufacturer Prefah Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing ` Tanks TaNca Septic or Holding Tank l~~ ~ ,~~~ ~ ~ L, X. Aerobic Treatment Un1t Dosing Chamber ~~ i GS~Y OC VII: Responsibility Statement- I, the undersigned, asstune responsibility for allatlon of the POWTS shown on the attached pleas. Plumber's Ha the (Print) Flumber's Sig re PRS Number Business Phone Number • ,u s~ti U ~. ale. ~ ~ ~^~ ~~ ~cr ?~sr.~8 ~--,~io21 Plu m ber's Addre ss (Street, City, State, Zip Code) l ) /' ~ t VIII. Count /De tment Use Onl Approved ^ Disapproved Sanitary Permit Fee (i ncludes Groundwater Date Issued Is ui Agent Signature (No Stamps) ^ Owner Given Reason for Denial Surcharge Fee) _ 2.~ "~~ , 2 ~3 IX. Conditions of Approval/Reasons Por Disapproval ~~~~, L SYSTEM OWNER: 3~ a ~ U ~Q ~ S~~Q 5 ~-lz 1 Septic tank, effluent biter and , ~ ~ ~ ~~,~Q £ ~,~,~ _ ~~~ ~ " - _`_' dispersal cell must all be serviced /maintained - ~ _ _ ~-~~------- as per management plan provided by plumber. ~~~ S 2. All setback requirements must be maintained as per applicable code/ordinances. SBD-6398 {R. 01103) ntwco complete plans (ta the Cauaty oaly) for the system oa paper not less than 91/2 x 11 Inches >n else -~f,; ~,v~ ~6r~s S4 cv ~~ ~~// ~i~a~.vv~ ri~~.s"e,.~ v.Scc~~ /'=mod ~ .~ ,dfr~~ / ~f/G /d0. O ~~~ 1~~~ 9~- ~S` -- 2 ._._-- ,~~ , . -~ ~. ~t% ~ ~~s ~ ~~ ~ ~ ~~ z a~'C ~osoa,(jorS ~ "td( `~/ .~ ~n pr jr.e~~ ~ ~ 5 e , n ~~~ ~ ~ ~~ ~~ r~~ ~h ,-- f i.2S~/~Dd's~"~°t c ~W, `~l'~ 20 b ti c ~ ~6d C~p~ iP ~'m ~8'; ~~ v ~ 6 ~~~ ,sue e.~/i G t1'~'!~~ ~c'tZJ.!/ D ~ ~i~s'®,f/ ~iScc ~ ~ / ' ~= ~O r .: ~f~j / ~G j~0. O ,~3~i.~- l~~G 9~'- ~, -- ~ ._._--- -v~~t% ~ I ~~~ ~ ~~~ ~ ~~~ ~~sa/~odsat'r, ~ ~~,1~~ 20~~~ ,~t60 a ~~ ~~.,,~,y~~-s T ~t-® ,~ - . B~ I ,~.~ w d~ ~---- r~~ ~~'~ , - ;~ _.-=--r" i ,~~ , . ~ ~ ~' Wisconsin Department of CArnrrreroe ~ ` SOIL EVALUATION REPORT page 1 of Division of Safety and Buildings • in accordance with Comm 85, Wis. Adm. Code ~~ ~ +. C two c' Attach complete site plan on paper not less than 81/2 x 11 irx~res in s¢e. Plan must inducts, but not I'urnited fo: vertical and Horizontal refererroe direction and p~e1 I.D. • t ZC~ ' (3 ~ ~- ~ ~ ~ ~'~ d roa . percent slope, scale or dimensions, north arrow, and ~ neares ~'-`-'°' ` ; ,~,\ eviewed by Date .Please print all i Parsonai infortnaUon you provide mar be used rar rpoaea , s. 15:04 ~) (m)).. ~ 6 .~ ProPer~Y Owner _ oa ,- ~ 4<: ;~` - ~° J~A p~~ . ~r ~ - ~ ~ . Govt; Lnt 5 w 1/4 ,I/ul 1!4 S ZST 2 ~' N R /`~ E Property Owner's Mai~ig Address a~ ~~ S r ~ , ,~ of # . _~ Block # Subd. Name or CSMi/ ~~ ~ ~~ S e City State ZP Code Ph «- ,~~;~. ^ Ydlage [~ Town Nearest Road . _ ~S~ii:Ilw«.•I--~r YYt~. fSo~z. ( '~1~9~--.zxl~ v ~,,.; .E,~~.- ed ® New Construction Use: ® Residential / Number of bedrooms - ~{ Code derived design flow rate ~Sd l (o O O GPD ^ Replacement ^ Public or commercial -Describe: Parent material OU fraJGc..S (.~ Flood Plain elevation if applicable /o Z 7 . a ft General comments s s ~..~ yyL L l e. J 0.f • b /~ - 9/. Sv ~ and recommendations: ~ ~ ~ ~ © ~p+ Pit Ground surface elev. ~ • 3 ~ R Depth to limiting factor ~ in. ~d~ # I^~1 ~g Sod ic~tion Rate Horizon Depth Dominant Color Redox Desgiption Texture Stricture Consistence Boundary Roots GP D/ltr . in. MunseO Gtu. Sz. Cont Color Gr. Sz Sh. •Eff#1 •Eff#2 I b-LZ i ~~3 ~' Sil 2.rno.bk ~' C I v-~ . 5 ~ ~ Z IZ -'+2 I D `t ~'-1 Slc] 2 rr m-~r ~ 5 - . ~( , (A 3 42-112 1 ~ `t>`lv ~_ p m l _ ~ . -1 /. Z S ~~ ',, ~ ~ ~- C ~s~s ~~• -' ~i ~ Baring # ^ Boring ® Pit Ground surface elev. X15 • `nO R Depth to Igniting fader ~~ g in. Sod ~~ Horizon Depth Dominant Cobr Redox Desa~tion Texture SWdure Consistence Boundary Roots GP DVIi? in. Mansell Du. Sz. Cont Cobr Gr. Sz Sh. - 'Eff#'1 •Eff#2 ( b- I b I r 3/3 -`' " 5 i~ Z rrLO.L~ I m~r- c s I ~~' ~ S •. 8 Z lU-!!o . ~ ~ Si~.I sbl cs - . ~{ 3 I -!D ~d ~~ - m5 Os ~ 1 - - ~ ~ ! . Z. "Effluent #1 = BOD_ > 30 < 220 ma/L and TSS >30 < 1 50 mNL ' Effluent #2 = BOD. < 30 mgll. and TSS < 30 mgA. CST Name (Please Print) Signature CST Number e.r' ~^ - 253309 Address Date Evaluation Conducted Telephone Number Property Owner f!1.r~~ I~ ParcellD# Page Z of~_ Boring # ^ Bow ®Pit Ground surface elev: q3.5 ° ft. Depth to limiting facts' ~ ~ 2 in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f~ in. Mansell Qu. Sz. Cunt Colo[ Gr. Sz. Sh: "Efl#1 *Eff#2 ~ 6-lZ 3 siI Zmcbk m~'r LS I~~ ,5' ,g 2 -~-tb ~ - _ l 2rn I ,n -, G~ _ _ y l~ ~ y0 11 2 I ~ r `~/(o ~ ~ m S ~ , .~ ~ .- -. ~~ ` 1.2 s lw~ s ~ ~ S .. _ bz . _. . . „~, s, ~/ ~ ~ , ~, ~~ # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. ~~ ic~tion ~~ Horizon De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f~ p in. Mansell Qu. Sz. Cont Cobr Gr. Sz. Sh. 'Eff#1 "Eff#2 Bonn9 # ^ Bonng ^ Pit Ground surface elev. ft. .Depth to limning factor in. Sai lication Rate Horizon Depth Dominant Cob ~ Redox Desaiption Texture Structure Consistence Boundary Roots GPD/f~ in. MunseU Qu. Sz. Coat Cobr Gr. Sz. Sh. 'Eff#'I 'Eff#2 " Effluent #1 = BODE > 30 _< 220 mgll_ and TSS >30 _< 150 mg/L Effluent #2 =GODS < 30 mglL and. TSS < ~ 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. SBp-8330 (R.07/DO) . . . • r ~, ~ n r. - , ~.J ~ ; r`~y ~! ,,. ~~ I ~1 f r,, h. ~''"~'` ~~_ ~ j y~y~a ~ y,_ ~ 1 _. -: ., ~ ~-' 1 Y d ~; $mt .r f3 ~~I ewG~^,~,(k5 ./ ~~ ~ ~m~ ~ ~ 3a~ 5-~-~~~.-_ . ~' l bUr ~~ . "~` ,~yy~ ~j VJ ~ ~~ ° ~ w~•l~ 6~ ~~ ~s ~~b~ '"~° 0'`~ ~~~U~ ~~ ~~ ~~ 31 ~~ ~' a ~~ L. ~• ~ oz~. 0 SIGNATURE ~ ~~ ~ DATE - G • O/ ,~ I ~ PAGE ~ OF_~ NAME 14 Y` K-e-~ ~ LOT#(9 3 LEGAL DESCRIPTION'/o A1W/4,SZSTZ9,N R !~(E (or~ SCALE: 1"= y~ , BM I ELEVATION .v BM 1 DESCRII'TION~p o-~ ~ ~~u~ ~, pe BM 2 ELEVATION ~' $• ~-~ a~S v 13v~ BM 2 DESCRIPTION ~o p v-~ ~ ~~ ~ d L O P ~ SYSTEM ELEVATION ~l/ .S O ALTERNATE ELEVATION g ~• ~ ~ CONTOUR ELEVATION 43. So - 9G • S ~ .~.-. - ~~ e•z5 ~~=~-~ /, . `z-~: q~. So p ~,mor`~ ~ ~ 5 ~ .Z ~ Q,f• 5~ ~, q y. ~o ~ ~'`~k ~/3. Sb ~ cam' .3 ~ ~ ~~,h1~~~'~ ~ ~~ ~~ . __ - ... - ~;~% 3 A C / ,~ ~- R~ o~ C .,.1 ~ Po E~ X' / P 1037. Iii ~ ~ 1038. 7 ~~ ~ ~ X C1~ 1 .4 ' ~ / ~` X 'fl 1036.$ X ~~ X - ' ~~\ ~,-- t 0 ~ 104 ~ A 9 ~/\ ~, ~. ' t 037.3. 103 ,~~ 11) . ~ X 033. ' / 1'044.2 ~ 1 / ~ Q ~ ~ / i X Z. J . 04.4 10 5~ l ~ ~\ X / X X J ~1 8.0 1043.7 ~ ~ 1 5.4 036.9 Q v 14~ • 2,19 ~• ~ X 1038.4 I ~ .09 ~ 0 --" ,~ . . ~ ~ , . u~ ~ ~ ~~ ~` _~ 0 ~ 1 ~ J E - ~._-.-~''~ t . 6~ i X \~ ~~ ~~ ~ 1026.1 020 , 0 ~ H.W.L~ 1027.25.6 I 11024.8 X O ~~ v `` ~ -~ ~., ~. o~~~ ,~ ~, / I, ZONED -RESIDENTI .~-~ ,, L . __~ _,- ._ ,~ :~~: ~. r ~~. ,~-~ =~= . ~~ z,7, ~\ % ~ y ~ 1024 ,'~~ /~ ' ;~ ~~~9~A~C X. ~'~ 0 ,, 0275 8.6 H.M~ ,?~~ 1 +.. + .t`..,~Y ~, G : `~ ;" ;' :. !i . ": ~ C. R ~. ~ : ~ ~ 1. ~ 1 i C' :~ .~'1. ~ / ~ ? '' T ` ,.A ,.' T " M' y - ~s~ 4x v~N~ PIPE ~2" MAN. ABOvc G:~ADE s wEAi'~?SRARDaf Z ~ +' FROM DOOR, WiNDQW OR J:;NG2ION 8CX APPR041£D FRE5H AIR INTAKE WITH CONDUIT `~ANHOiE CG'~f£R FaNISHED GRAZE Wl PADLOCK 6 4" CI RISER ---~~ WARNING LABEL _ff~ ~" MiJr . ie ~ j `', .'~ Li T ~ ~ ' ~ --~ ~' ,...J i ~ . WATER TIGHT SEALS GAS. ; ; ' ' n --r ,- ``yt ~y~y A +iEA2r ~ }1 ~QTNTSrWT'~~ 'IPS 3' , ~ g ~ LM lI~P~VEO A CPS S4l.I D, SO I t, ~OI~ FUMP OFF ES.EV. ,,,,.„~,F'T. ~ C ' ' ~ I "~'""" OFi ~ ~ ~'~' RI`SER EXIfi ~~ ~} ~ ` PERMI T ~'ED uNL~ IF TANK ~1ANUFACT'JRER ~" APPROVED BEDDING lI1DER TANK ~~ ~ APpRQVA? ~ON~RETE FAD SEPTIC f DOSE TANK MANi~FACT'JRER TANX Ss DES: SEr~'xC ~~-d ~ GAL. rasr VCidJME II~C;;JD.r,NG DOSE 4c~ G~.L;. FLOwBACK: 1..~9.~.._ Gr1L. ,~,_,S ~EC I F I CA1'I Cfv' S lN~~t°'~rY N'JI:BER DOSES PER DAY: ~_ - AI~A,RM MANUFACTURER: ~~~ Jam` M4D£L NUMBER: 3WITC~I TYPE: ~r PUMP MAN~.rFACTURER : ~~` MODE;, NUMBER SWITCIi TYPE CAi'.9CZTIES: A ~ I;vC:?E5 ~ ,w~ , ....~..,GA1.. 8 = ...,.~,. INCHES = ,,,,,~,... G.Ai . C r .,~.,,, INCHES ~ .j,~ ...~.GA?~. p = ,,.~~„ INCHES :.1~~.....~Gp.L . EiEQJiRED DISCHARGE RAT ^,P:S P'JMF ~ ALARM 1~'IRiNG AS rER ILHit 28.23' WAC VERTICAL DIFFERENCE BE. GFf AND DrSTF.IBUTIOhr PIPE ~~ I"EE:' * MT~tIML-M NETWORK SUPPLY PAE55URE F£EI ~ „„~d,,,~„ FEET FORCEMAIN X,_;,r<0 FT/1O0 f T. fR:CT:pN FACTOR PEES" TOTAL DYNAMIC BEAU ~ r ET.T :.tT£RNAL DIME;iSIs~NS 4F r^LMF T~tlrt;: LE:~'C3iy ---~--- ~ WIDTh "" T TER ~"~'` ,_,_..,..,,,~, D .. ~ % y~" ~ y LICENSE hMBzP.: ~~'S9„ d~„_ CA:'£; :~ ,1~$ r*'~ ~,,~ r1 ~ ,,,j ~.. 4: i ~: v .w Submersible Effluent Rump ~A~~~ 3871 E~~ ~r /""' ~ ~or1~1! ~~~~ • • Deal ~MBAIl~At~ •~~ I~ndlinQ 1t~Y~ tim~dmum. • M~~a1ti: Win: 141E IOIfN111CiN1 9151~-•N ela~ntm, f 1~3~~''Cr COIWAU01is 144' ~10°C~ ~~ • FasaCSrr, X00 a~~ . d~iy~to oaapon~. r ~ ~8oi1tM~ a capa~llt~r. • p~~dtiN: ~A tc 60 t~PMI. • ~ headaV up ~ si fart ~~: r~ ~. ial~F 10~' ooa~nuoa 14G"F.~~ ~rt~ . , ~ ~ ~~Ai s amble 0! NfminD c4~wil~t ~tma~e to aomar Naar; ~~ s~a~'~o »~~o' Ro pMct i rblt! w}th ~f>~Wrp15 Q p~N,~, 1i~V, bdi~ r with ~ M~~rC~~~d:'E01aQt ~~tdlr+d Du~1h, i8/3 8J~fd W~h thne ~ ~jf4t11~~1ra Igrrpth,161~ SJT1N tt+rlt rortQ grounding glue ;aterd 4n ), ~,~ ,o 0 f ndi t ~1bi-~i~ Or ~~ ~~~~~ hat tf~~K. A~artitsbi~ for s~O~ ad monk oparilore. ~ae~ lint flat~eb aaunbl~l uu1 pHNM1 it 1UI iNOlor-~. ~~~ ~ ~4 ~M#oba: t'tternno- plaiic 8amhaprn dalpn ~~~~~~ m+a+hanlt~i:Nl eroledia+~. p~iast~ic ~~leait d ~marovld perfomuarrce, ~ ub ~ Ruffed thernl~c daipn pr4vidln ap~or etnn~+ and c~1roNOd~ rreista~ce, ~ r ~Iln~; Gat iron atr0i1Q~1~ 1~ dtNabW1Y~ Y mow' tie and f~ta~~a~ct'+t p ~~f~ ~ ~~ lower ~~~on. L~I1'~'INO r~AC~ ~ umbers 4 ~ ~ Al~fi F~ E_ ~• m . J f= A Q. Y A ~' ~ ~~~ m eK PN O u' s T~jij ~ a ~ X r_ m •~ . _~ ~~ ~ i~ i~ • Q m • N m . ~ ~ ~ a ~ ~ m . ~ ~ N.O x ~ N s` ~ ~ ~ u ~ ~ ~ a ~ s* „0 3 ~ ~~ ~a N ~ ~~ ~ z i ~~ ~a ~~ ~ w ~ ~ M ~' - m o . 0 c m O M ~ ~~ N H a ~Y ~ 3 N 1 a`t J ~r ~~ 3 a :~ y~ r;, ~~ r' ~= ~ ~ ~ .~e tD O tv ~ ~ n ~ ~ A' .-. CD = ~± r~ T \V S X '' ~ ~ g X _ 2 ~ ~ ~~ a n cn =a ~ c~ ..~ > >' ~ m ~ w ~ tWV ~ ~` - ~ ~ 1 ~ °= 1 • • ~ • -~ -, ^2p~r ~ ~co~ ~cQ c © ~ J // am~ \I ~ :r m~ ` - ~ ~m ~w~~~~ n ~ a~~c,~ a-o~ Q-~ m ~o~cn-• r~•<o a~' ~ a ~ ,:~ m o = ~ :~ o t~'y m o ~' ~ N ~ ~ ~~ _ ~~~ ~ Q3 ~ ~ J J ~ 3 °' ' ~^_?. c ^sn-~ ~<-:m ~Dw cQ ~ ~ __. ~ ~' .. . m c~ N a 4 t T~AGE=.._~ OF -S ~/' ~ ~ ..J ~1711 .i ~ ~~I ~ ~ i~il . O ~ „~~~ ~ ,,~~wwG ~ a m n ~~~ u pp ~i- ~I~ ~~ 4d Invert i 1'-}i ~~ W c~' owner ~ ~,;.~ Permit * 3 ~ ..........~ swswuo~reQ~t P~WTS OWNER'S MANUAL & MANAGEMENT PLAN VCiRi1~ re+~wnr.. ~w y p NA Number of 6adroama Number of Pubac Facility Unite ,~ p NA C-stimated flow tweragel ~~;` Gilds Design flow tpeakl, (l=.atimated x 1.6i ~LJ ® al/da Soil Apptioatbn Rate Gilds /ft' Standard Mfluent/Effluent ouafaty Monthly average' Fats, Oil rk Grease iFOGI 530 mg/i. Bioohsmbai Oxygen Demand IBOi),i 5220 mglL p NA Total Suspended Solids iTSSI 5160 mg/L Pretreated teffkaent f~uagty Monthly average 8ioohembai Oxygen Demand tisoo,~ s~30 rrw/~ Total Suapanded L~ialide iTSSi S30 mg/L 0 NA Feoai Coliform Igeamstdo mean) S10` afu/100m1 Maximum Efftuettt Partbte Sire ~ in die. ^ NA other: v NA •t/alues typical for dornsstb wastewater and septic tank effkaent. Page Ot ••,.•.. - ------ -- SerMta Ewnt inspect statdttiort of tsnktat - At least once every: ServiG FrerW~Y o UM ~ y„n} ,3 oat i p NA C1 NA Pump out contents of tanklsl When combined dodge and scum equals otoe-third tYsl of tank vaiume monthtal tMa~dtra+m 9 Yeeraf n NA Impact disperssi celitei At least once every: ,~ ta! mon el p NA lean affluent fgter At least anae wary: f, t.~ ! VA inspect pump. pump controls i4 alarm At lest once every: arl monthlsi ~ZpNA Flesh latarab and preaure test At bast one wary: r-` Q earis- e? mon fiIA I ~~ ~ Oslo: At least once ovary: t ~ p QUA MAINTENANCE {NSTRiJCTIONffi Inspeotiona of tanks and dispersal cells sriali be made by an individual carrying one of the followi.g 1}ng ppe~torca Tans Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector: missMg or~broken hardwares, identify any asks or leaks &tepection• moat include a visusi inspection of the tankis) to identify any maasuee the volume of combined sludge and ocum and to check for any beak up or pondinp of effluent on the ground surfacE the diaparsal osllis) shall be viwaify inspected toy a~~usnt on the Around eurtace ma~diaate a faiinp card ion andaequres th of effluent on the ground surface. The ponding immediate notiHcatbn of the local regulatory authority. When the combined accumulation of stodge and scum in any tank equals one•third tYa1 or more of the tank volume, the entir contents of the tank ahaN be removed by a 8eptage Servicing Operator end di:posed of in accordance with ahaptar Nfi 11: Wisoonein Administrative Code. retreatmei All other services, including but not limited to the servicing of effluent filters, mechanical or prossurizsd components, p units, and any serving at ~tsrvais of 512 months, shall be psrformad by a certified POWTS Maintainer. A ~rvioe report shall bo provided to the local regulatory authority within 10 days at campletior- of any :ervios event. Page _....~ of __..,..._ START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankisi for the preae++ce of painting products or other chemicals• that may impede the treatment process andlor damage the dispersal celllsl. If high concentrations are detected have the contents of the tankls} removed by a aeptage servicing operator' prior t8 use. , ,- Systars~ mtart up shall not occur when sail conditions era frozen at the infiltrative surface. ~ ~ ~' `' .~ During power outages pump tanks may fill above normal hi8hwatar levels. When power is restored the excess wastewater will be discharged to the dispersal ceiNs) in ono large dose, overloading the collie) and may resu#t in the backup or surface discharge of affluent. To avoid this situation have the contents of the Rump tank removed by a $eptage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump eontrala to restore normai levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. po not drive or park over, or otherwise disturb or compact, the area within f 5 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 performanoe and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; dagreasera; dontal floss; diapers; disinfectants; fat; foundation drain Isump 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 PQWTS fails andlor 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 Gamm 83.33, Wisconsin Administrative Code: • All piping to tanks and pica shah be disconnected and the abandoned pipe openings sealed. e The contents of all tanks and pits shall be removed and properly disposed of icy a Septage Servicing Operator, • After pumping, sli tanks and pits ahai{ be excavated and removed or their covers removed and the void apace fitted with Boil, gravel or another inert solid material, CfJNTINGENCY PLAN If the l'OWTS faits and cannot be repaired the following measures have been, or•muat be taken, to provide a Dods compliant replacement system: {~ A auitabie replacement area has been evaluated and may be utilized far 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 reauit in the need far a now soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. O A auitabie a ~o d~ tank may Ibe inst t edl eels last resort to 8epiacs the tailredl~POWT3 $ Barnng advances in POWTS technology ng she ~~ p tank Q Mound and at-grade soil absorption f such s stemsbmust ccomply withitheiru!•s;nlleff et at th t tlime.~e biamat at the infiltrative surtace. Reconatructiona o Y <WARNINO> > SEPTIC. PUMP AND OTHER TREATMENT TANKS MAY CONTAIN ~C RCUMSTANCESO! DEATH MAY RESUL;Yt3RESCUE OF A ENTER A SEPTIC, PUMP OR QTHER TREATMENT TANK UNOEFI ANY PER80N FROM THE INTERIOR OF A TANK MAY BE DIFFICt1tT OR IMPOSSIBLE. Af)DITIONAL COMMENT8 ~~ INSTALLER P01NT8 MAINTAMIER Name Name ~a`~~r~dc ~.~~, s. Q3~ Phone Phone SEPT'AGE SERVICING OPERATOR iPl7MPERl LOCAL REGU TORY AUTHQRfTY Name Nsme ~r - CQ.e Ce~u F~ ~- i Phone Phone ~-(~ • 3 ~, . ~O _ m 83.22121(blliltdl&{fl and 83.5411), {2l 813t, Wisconsin Adminstrative Gods. ith cha er Com d in cons Rance w pt This document was drafts A FROM Sct,umaker Plumbing FAX NO. 7153863121 Aug. 08 2002 07:14AM P2 ST C120LY COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Bayer _~ c~. tn~-2__ {-~, a ~.~.-e.~ ~A r S ~ h c., Mailing Address 2s~o 8"3 l,~ oro~ ~vur `~ M~ ~~'~ Z~ Property Addr~ ~a'~l ~-! ` 1 Ka Q ~- -r-,r (verification required m Platuung Depattmeat for new City/State T'3.~ ~~ +~ , ~ C Parcel Identifcation Number I~GAL D)~SCRIPTION Property Loealian S t'`~ %,, N ~^' '/., Sec. Z s T Z`~ N-R ~ ~l W, Town of ~ u ~ S o v~ Subdivision SGetn ~ ~ ~ : ~,~ S Lot # ~ 3 Certtf"ied Survey Map # Volume , ..Page # Warratnty Deed # ~ Q' ~, Volume _ ,Page # Spec hot:se ~I yes ^ no I.ot lines idanti&able ~ yes ^ no ~..M MAINTENANCE Impropear use and maiatenanceof your septic system could result in its premature failure to handle wastes. Proper maiataaance consists of pumping out the septic tank every tone years yr sooner, if seeded by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage is ~ waste disposal system. The property owner agrees to submit to St. CroiX Zoning DepartrYUent a certification form, signed by the owner sad by a masterphanber, joumeymap phunber, restrictedplutnber or a Iiceasedpumper verifying that (I) the oa-site waetewaterdisposal system is ~ Pr'oPeT ~ condition and/or (2) si3er inspection and pumping (if tLecessary), the septic tank is less than lJ3 ~ of sludge. I/we, the undersigned have read the about rc-gnircmcats and agree to maintain the private sCwage disposal systua with the stand2rds sat forth, herein, as set by the Department of Commerce and the Deparament of Natural Resources, Stare of Wisconsin. Certification stating that your septic system has bees mailnaiaed must be completed and returned to the St Croix County Zoning Office within 30 days of the three year expiration dace. ~. Sr `,i~~,o3 S A OF APP NT DATE OWNER CERTIRICA,TYON I (we) certify that all statements on this form arc true to the best of my (our) knowledge. i (we) am (are) the owner(s) of the p,+operiy described above, by virtue of a wamnty deed recorded in Register of Deeds Office. ~~ X03 S OF APPI: CANT pA~ •"««" Any information that is tnis~represeated tray result in the sanitary permit being revoked by the Zoning Deparm~-ent. `•s*'• *' Include with this application: a stamped warranty deed from the Register of Deeds of#"icc a copy of the certified survey map if reference is made in the warranty deed `~ 'J 2203P 526 716990 ' KATHLEEN H. MALSH STATE BAR OF WISCONSIN FORM 1 - 1998 REGISTER OF DEEDS ST. CROIK CO. , MI WARRANTY DEED Doa~mmtNumber RECEIVED FOR RECORD 020-1395-63-000 04/11/2003 03:30PM Pa~cd Wemitication Numbs (PIN) MARRANTY DEED EXEIPT #i 'PHIS DEED, made nrea XXI Inc., a Minnesota corporation, Grantor, onf e Homebuil c,, Grantee. REC FEE: 13.00 _ Grantor, for a valuab tde7ation, conveys to Grantee the following TRANS FEE: 242.70 COPY FEE: described real estate is St. Croix County, State of Wisconsin (the CC FEE: "Property': PAGES: 2 SEE ATTACHED EXHIBIT A "Phi d s _tea property. Together with all appurtenant rights, title and interests. R°°°'d'°8'+"°° Grantor warrants that the title to the Property is good, indefeasible in Name and Return Address: fee simple and fi'ee and clear of encumbrances except Land fiide Inc ~f/ Dated this 10th day of March 2003. 1900 Silver Lake Road , New Bri ton, MN 55112 X217 94 Carnage mes }IX I In c. w ~ ,( ~ ~ ,o ,~.T_ /~//~/~ y/ (SEAT.) e+~ /,/~G! (SEAL) +Kellei St. Martin, Vice President (SI.AI,) (SEAL) • + AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF MINNESOTA }SS. WASHINGTON COUNTY. authenticated this 10th day of March, 2003 Kellei St Martin, vice president of Carriage Homes XXI, Inc. a corporation under the laws of Minnesota on behalf of the corporation, personally came before me this 10th day of March, + 2003. TITLE: MEMBER STATE BAR OF WISCONSIN (H~~ authorized by § 706.06, Wis. Stars) THIS INSTRUMENT WAS DRAFTED BY Greg Booth 1900 Silver Lake Rd New Brighton Mn 55112 (Signatures maybe authenticated or acknowledged. Both are not tux:essaryJ •Na~s of paaom signing in any csrwcity must be typed or printed bebw tluir signatura + N cy J. entz Notary Public, State of Minnesota My commission u permanent. (If not, state expiration dau: January 31, 2005 gZ NHfv(:Y ~. LENTL E NOTARY PUBLIC-MINNESOTA f !!! 444~~~ • uv C,omm. Exdrea Jan. 31,2006 ~;.www~a iw~~r..,;. ,..1:..:...... .. ~~ NANCY J. LENTZ NOTARY PUBLIC-MINNESOTA r My Comm. Exprea Jan. 31.2005 ~ g i c ~ ~. ~ ~~ ~ =, ~ ~ ~ ° ..• ~ ~ ~ ~ ~ -~ \ ~, . ~ w • ~ ~ ~ / / _ ' 92,093 SQ Ff \ • ~ ~ 2.114 ACRES 1 ~ C'~ ~~ ~ ~ y . . C7 'i N 0 w y!~- .i I I S~go~,4 ' I ~,:3q s.ss, ~"E 282.4T I I ~8~, '73.?3 ~E ~ N • I I \ 22 ~ G I • I ~ ~ 9 .`~-`~~, • {4 I I ~ ~ I 2.186 ACRES '~ ~ Q S i i I ( ~~ 1 ~ :H , ~ I • • _ I "E 39829' 18 ~ i N I • ~` ~ ~ ~ ~ - ~ 88 947 S C ~ 024.0 ~, ~ n I _~ , Q FT ` / ~ ~ 2.042 ACRES ~~ 1.52 ~ w I H.W.L.= 1027.0 ~ "E 289.21' v ~ I ~ + 'z \ O ~ j r ~ • ~ I ~ o Z p- $ I ' ~ y H•WL.= 1027.7 r 9 `9i a ~F ------ ~+~~ i lti- r ~ ~ -.~` ~~ ~ 9~ t~`'~' ' sz'~ c ' 20' DRAINAGE . I E ' ~J ss,41s sQ F r ~ ~ ~ MENT 10 EACH . SID I 2.259 ACRES ~ E OF LOT LINE • ~ 5 I I : ~ ~ ~ ~ ~~cQ SQ FT I / +CRES I I N87°OT56'E 468.08' ~ i ~ $ I ~ ~ ~~ 65 ~~ ~ $ ~ ~ `' • ~ ~ . 93,959 SQ FT I 'E ' I I 2.157 ACRES ~ 295.80 I ~'~~ • I- ~ i I ~ . ~ 120,091 SQ FT ( • 1q.ss'. zo ~'~'06"E 250 ' 2.757 ACRES 00 ~ ~ •• ' i /~ V ~ h ~ 444.26 ~~'O6'F 639.26 ~ ~ / ~ rry