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HomeMy WebLinkAbout020-1404-06-000A Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM 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 Pearson, Kurth P. I Hudson, Town of CST BM Elev: Insp. BM Elev: BM Des tion: � 0r I r o0 � �� ° Vh � (z TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Vent to Air Intake ROAD Dosing R / 7 dl 1'-k 6, - b / _v Aeration '! Length Holding Dist. towel TANK SETBACK INFORMATION TANK TO P/L W "A WELL ./ BLDG. Vent to Air Intake ROAD Septic Friction oss System Head ! '! Length Dosing Dist. towel 1 vl� S e Aeration 6 S Ht Inlet P/L BLDG b3z Holding Ht Outl Manufact,wer- L, r INFORMATION MB ER 7 CH Typ f Syst • P11MP /SIPHON INFORMATION Manufacturer BS Demand GPM Model Number ELEV. TDH Lift Friction oss System Head T Ft Forcemain Length Dia. Dist. towel County: St. Croix Sanitary Permit No 499137 0 State Plan ID No No: 020 - 1 4 0 4 -06 -000 vlap No: 29.29.19.2538 STATION BS HI FS ELEV. Benchm I f�/ 7 Y5 Inside Dia. Liqui Depth 1W, b Alt. BM �— �Q Length �l Dia Bldg. Sewer 6 S Ht Inlet P/L BLDG b3z LAKE /STREAM Ht Outl Manufact,wer- L, r INFORMATION MB ER 7 CH Typ f Syst • Dt Inlet r " j f Dt Bottom Header /Man. Dist. Pipe M Bot. System W F inal Gra 0 - f B be St Cover f/)PR QiLo Z 7 ��s S 1 - 2 QnI1 ARCr1RPT10N n„s, Z/,/ /a,, __., —1n00%"d - An h4eklizy 64 C BED/TRENCH Width Le j No. Of Trench x Mulched PIT DIMENSIONS No. f Pits Inside Dia. Liqui Depth DIMENSIONS ( t' Length �l Dia SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM ACHIN FR Manufact,wer- L, r INFORMATION MB ER 7 CH Typ f Syst • r " j f Model Number: � ION UT SYSTEM der /M ifold Distribution q � x Hole Size x Hole Spa ii 1Pipe Cr111 r_rl \ /FR - 0---- c.,- E— r%,l — RA--i rlr et_(:rnriw SvstPms Only Depth Over Depth Over xx Depth of /Sod ded x Mulched Bed/Trench Center Spacing T7reded Topsoil Yes No 7 Yes No Lengt Dia / Length �l Dia Cr111 r_rl \ /FR - 0---- c.,- E— r%,l — RA--i rlr et_(:rnriw SvstPms Only Depth Over Depth Over xx Depth of /Sod ded x Mulched Bed/Trench Center Bed /Trench Edges T7reded Topsoil Yes No 7 Yes No COMMENTS: (include code discrepencies, persons present, etc.) Inspection #1:/ / Ul ° Inspection #2: Location: 421 JackE riv Hudson, WI / 5401 (NE 1/44 SW 1/4 29 T29N R1 9W) Walden - / Woods Lot 6 Parcel No: 29.29.19.2538 1.) Alt BM Description = I S� ' ea z" 2.) Bldg sewer length 30 3 - amount of cover Use other side for additional in Plan revision Required? Yes o formation. Date Insepctor's Sign ure Cert. No. SBD -6710 (R.3/97) 2 . vvt GvYy�/t� cing ent to Air Intake Attach complete plans (to the County only) for the system on paper not less than 51/2 x 11 inches in size nr' 7 )� SBD -6398 (R. 01/03) Safety and Buildings Division Box 7162 201 W. Washington Ave., County 1*is .O. Consin Madison, WI 5370 162 Sanitary Pe it Number (to be filled in by Co.) (608) 266 -3 De partment of Commerce 1 Sanitary Permit Application tate Plan D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide Project Address (if different than mailing address) may be used for secondary purposes Privacy Law, sI5.04(1)(m) 1. Application Information - PleasePrintAllInformation Property Owner's Name Parcel # Lot # Block # v u , a�\� �. I AUG i - � Property - Owner's Mailing Address Proper cati �G Cl�t: •l /� ST. CROIX :� -' 44, Section �Q C' State Zip Code P Number 3 ® � (circl °� T o2 Q N; R p E e orQ'�'/ II. Type of Building check all that apply) V �/ • t( S� Number 2 Family Dwelling - Number of Bedrooms r l l Subdivision Name CSM ❑ Public/Commercial - Describe Use Ij� zd ood S ❑City_ ❑Village Township of Pfd.✓ ❑ State Owned - Describe Use III. Type of Permit: (Check only one box on line A. Complete line B if applicable) Zp — YW . 06 -- O M C. 2 A. New system ❑ Replacement System p y ❑ Treatment/Holding Tank Replacement Only g p Y ❑ Other Modification to Existing System g Y B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl kNon - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Ching Chamber ❑ Drip Line vel -1 s Pipe Othe[ (expl O ) V. Dispersal/Treatment Area Information: ✓ ` Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sO Dispersal Area Pr System &vation 3. S -,-0 s✓„4 .7- q� 4d6) - ;7 _/ VI. Tank Info Capacity in Gallons Total Gallons Number of Units Manufacturer — /0D�) J P Concrete Site Constructed Steel Fiber Glass Plastic New Existing Tanks Tanks _ Septic or Holding Tank 1/ /\ G`/ Aerobic Treatment Unit Dosing Chamber A! $`GQ ' . e VII. Responsibility Statement I, the undersigned, assume responsibility for inst llation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature Number Business Phone Number s' ai S "0" & lrr � 1 WMPRS m��?2 7 Plumber's Address (Street, City, State, Zip Code) t IS�213 -Go d ( VIII. County/Department Use Onl I Approved El D' pprove Sanitary Permit Fee includes Groundwater Date Issued Bsui Age Signature (N S a ps) Surcharge Fee) ❑ i n Re ason fo Denial IX. Conditions Approv al 3) S 1 t 5 S J �C•tM SYSTEM OWNER: -- 1 Septt't fenk, effluent filter and Co dispersal cell must all be serviced f tvtehAssi tied - as per management plan provided by plu a,� 2. All setback requirements must be maintained , "r as per applicable code /ordinances. `7� Attach complete plans (to the County only) for the system on paper not less than 51/2 x 11 inches in size nr' 7 )� SBD -6398 (R. 01/03) Th , D � . m o 4 �1 So y3 Q fj w a� x a �' 02- Th �e� Ysd-y � ° � � �/�ld �.� Ld a a �s ���� V� c � � �• \� ��� °� n �. ���� �� 3 3� m _� �I s�� � o ��% u y�� a �° L o � � �� a� M� � �� �� a� _� � �;�� � cam! p� ��. � �I � 7��G � /���'�� .- Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County I q4 S° 14yP Hudson WI 54016 715 - 760 -1149 Hudson Redox Description Texture Structure Consistence Boundary Roots GPD It New Construction Use: le Residential / Number of bedrooms 4 dasign 1 D Replacement � Public or commercial - Describe: sl EE ds Parent material Glacial outwash jFk)od Q if apgii¢le Q a General comments 7 -20 tj �� !! WIT none and recommendations: Install 2 trenches using high capacity infiltrator chambers. . = 9 . aw 2fm,lc 0.5 0.8 3 20 -25 7.5yr4/6 F] Bonrng # 2j Boring 0 sg dl jg Pit Ground Surface elev. 100.56 ft. Depth to limiting factor > 9301 .. - I Si Ott' .Apji nation Ra 1' l) -9- °/ 1471 Page 1 of 5 A.C.E. Sal & Site Evaluations Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must St. Cron include, but not limited to: vertical and horizontal reference pant (BM), direction and per( I. D. percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. 020 - 1083- 30 -000, ID #29.29.19.3340 Please print all information. - -- B Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). , 'Z S Property Owner Properly Location Midwest Const. & Developme Of Hudson„ INC. Govt. Lot NE 1/4 SW 1l4 S 29 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# P.O. Box 932 _ 6 1 1 Plat Of Walden Woods City State Zip Code Phone Number "I City _ j Village 0 Town Nearest Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fly *Eff#1 *Eff#2 1 0 -17 1Oyr3 /2 none sl 2f ds cs 2fmc 0.5 0.9 2 7 -20 1Oyr5 /4 none sil 2msbk ds aw 2fm,lc 0.5 0.8 3 20 -25 7.5yr4/6 none Is 0 sg dl cw if 0.7 1.2 4 25 -55 10yr5 /4 none gr. s Osg dl gs - 0.7 1.2 5 55-9 1Oyr6/4 none s Osg dl - - 0.7 1.2 9S. -7 S Horizons #2 & 4 contain IVIproximately 15% gravel & cobbles. F Boring # � Boring Jim Pit Ground Surface elev. 100.09 ft. Rate App >92" in. Soil lication Depth to limiting factor Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW *Eff#1 *Eff#2 1 0 -8 1Oyr3/2 none sl 2f ds cs 2fmc 0.5 0.9 2 8 -24 1Oyr4/4 none sil 2msbk dsh aw 3fm,2c 0.5 0.8 3 24 -35 5yr4 /6 none gr. Is 0 sg dl cw 1fm 0.7 1.2 4 35-49 1Oyr5 /4 none gr. s Osg dl gs if 0.7 1.2 5 49-92 1Oyr514 none s Osg dl - - 0.7 1.2 -- Horizon 'n approximately 5 °k gravel &cobbles. * Effluent #1 = BOD ? 30 < 220 mg/L and TSS > <150 mg/L = BOD -s mg/L and TSS < mg/L CST Norte (Please Print) Sign CST Number James K. Thompson �� �"— 3602 Address A.C.E. Sal & Site Evaluations D e Evaluation Conducted Telephone Number 340 Paulson Lake lane. Osceola. W154020 9/15/01 715- 248 -7767 pfoperty owner Midwest Const. & Development parcel ID # 02 - 1083 -30 -000 I D# Page __ 3 of 5_ F # � Pit Ground Surface elev. 101.2$ ft. Depth to limiting factor >96" in. Sod Application Rate Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots GPD/fF -_ *Eff#1 *Eff#2 1 0 -11 1Oyr3/3 none sil 2fsbk ds cs 2fmc 0.5 0.8 2 11 - 25 1Oyr4/4 none sit 2msbk ds aw 2fm,1c 0.5 0.8 3 25-40 7.5yr4/6 none Is 0 sg dl cw if 0.7 1.2 4 40 -76 1Oyr5/4 none gr s Osg d l gs - 0.7 1.2 5 76 -96 1Oyr6/4 none s Osg dl - - 0.7 1.2 72 Ln Horizons # 3 & 4 contain approximately 5% gravel & cobbles. Horizon #2 contains approximately 10% gravel & cobbles. E 1] Boring � # 1[A Pit Ground Surface elev. 101.88 ft. Depth to limiting factor >99" in. Soil Application Rate Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots 2 *Eff#1 *Eff#2 1 0 -12 1Oyr3/2 none sl 2fsbk nvfr - - 0.5 0.9 2 12 -21 1Oyr5/4 none sil 2msbk mfr - - 0.5 0.8 3 21 -27 7.5yr4/6 none Is 0 sg ml - - 0.7 1.2 4 27-62 1Oyr5/4 none gr. s 0 sg dl - - 0.7 1.2 5 62 -99 1Oyr6/4 none s 0 sg dl - - 0.7 1.2 Horizons # 3 & 4 contain approximately 5% gravel & cobbles. L ---- 8] Boring # Boring Pit Ground Surface elev. _ 101.63 ft. Depth to limiting factor >98" in. Soil Application Rate Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0 -9 1Oyr3/2 none sl 2fsbk ds cs 2fmc 0.5 0.9 2 9 -19 1Oyr4/4 none sil 2msbk dsh aw 3fm,2c 0.5 0.8 3 19 -34 5yr4/6 none gr. Is 0 sg dl cw 1 f 0.7 1.2 4 34 -58 1 none gr. s Osg dl gs if 0.7 1.2 5 58 -98 1Oyr5/4 none s Osg dl - - 0.7 1.2 Horizons # 3 & 4 contain approximately 5% gravel & cobbles. * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD 4i mg/L and TSS <30 mg/L 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. Property Owner Midwest Const. & D evelopment_ , PSI ID # 020 - 1083 -30 -000, ID# Page _ Z _ of 5 le, 4 31 Boring # Boring jo Pit Ground Surface elev. 100.37 ft. Depth to limiting factor >91" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots CPDIft� _ 'Eff#1 *Eff#2 1 0 -10 1Oyr3/3 none sil 2fsb ds a 2fmc 0.5 0.8 2 10 -27 1 Oyr4 /4 none sil 2msbk ds aw 2fm,1 c 0.5 0.8 3 27 -39 7.5yr4/6 none Is 0 sg dl cw If 0.7 1.2 4 39 -73 1 Oyr5 /4 none gr s Osg dl gs - 0.7 1.2 5 73 -91 1 Oyr6 /4 none s -- - - -- - - - - -- - - - -- - 0.7 - 1.2 - -- - -- -- - -S -- - - Osg - - Horizon #2 contains approximately 10% gravel & cobbles. F Boring 4� # jo Pit Ground Surface elev. - 97.14 ft. Depth to limiting factor >90" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots SPDhE- *Eff#1 *Eff#2 1 0-8 1Oyr3/2 none sl 2fsbk ds cs 2fmc 0.5 0.9 2 8 -29 1Oyr4/4 none sil 2msbk dsh aw 3fm,2c 0.5 0.8 3 29-41 5yr4 /6 none gr. Is 0 sg dl cw 1fm 0.7 1.2 4 41-69 1Oyr5/4 none s Osg dl gs 1f 0.7 1.2 5 69 -90 1Oyr5/4 none s Osg dl - - 0.7 1.2 Horizon # 3 contains approximately 5 gravel & cobbles. F51 Boring # Boring Pit Ground Surface elev. 96.84 ft. Depth to limiting factor >90" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots SPDhE- *Eff#1 *Eff#2 1 0-8 1Oyr3/3 none sl 2fsbk ds es 2fmc 0.5 0.9 2 8 -29 1Oyr4/4 none sil 2msbk dsh aw 2fm,lc 0.5 0.8 3 29-41 7.5yr4/6 none gr. Is 0 sg dl cw 1 f 0.7 1.2 4 41-69 1Oyr5/4 none srs Osg cil gs 1f 0.7 1.2 5 69 -90 1Oyr6/4 none s Osg dl - - 0.7 1.2 Horizon # 3 contains approximately 5 gravel & cobbles. * Effluent #1= BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < mg/L and TSS <30 mg1L 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. SOIL AND SITE EVALUATION 1471 Page 41 of 5 PROPERTY OWNER: Midwest Const. & Developme Of Hudson„ INC. PARCEL I.D.# 020 - 1083- 30 -000, ID#29.29.19.334 A.C. Soil & Site Evaluations REPORT MEMO Soil evaluation completed for plat review purposes and prior to clearing or lot monumentation. Results indicate that the soils at this location are suitable for a conventional septic system. Additional soil evaluation and clarification of system location /design may be required prior to POWTS design and sanitary permit acquisition. key f "` /y 7 ( ■ Sci / e rriz /u a-6 oo ) 0 / ^ 4 4 • 5o %/e dQ /uc.��br hQ nd Sec..� J� - C/aiX b2. • A -e 1 6 Zed p'nc, AsSu.►acd /eNo. CV, . a fig- t, 0� / /oi.o' 5 1 �c k ea v l cl W;t p ecd Pi s Cc.�C - S4e. 2 1 Ie P 0 3 8s' 9 e0/ oo.o 99.0` 97 o /� c/o 11'S 1 1 , i s r� 3� a aW R� � Lcyr 7 2AW ACM 0 17A 90. Fr) VA f(" Hf F_TF' I Y `7 it L;3 E- I I I C!l h r r r r' r' r VEG WE" I a a �;", klON 9OUVM L&M OF OHOM ACKNnM, w' oi LIP v4 T I � �EiD t Lcr8 4 &4= vacm Ia. rr.) -e 0 ? 0 / .. - L.*r 4 * 2 2" 90. Fr.) 0 . �• w� SEPT TANK & PUM CHAMBER CR AS S SE CTION AND SPECIFICATIONS ." 4" Cl VENT PIPE 12" MIN. ABOVE GRADE ? 25' FROM DOOR, WINDOW OR FRESH AIR INTAKE -�-�- -----� FINISHED GRADE 4" CI RISER --� 1B" IN. 5" MAX. INLET WATER TIGHT SEALS ,PPROVED 'IPE 3' )NTO SOLID ;OIL PUMP OFF ELEV . FT. WEATHERPROOF JUNCTION SOX APPROVED WITH CONDUIT MANHOLE COVER Wf PADLOCK E ---- -- WARNING LABEL h "� —��� -- 4 MIN. IGHT' APPROVED A SEAL Y JOINTS W :TH —f-- , �ALM APPROVED PIPE . ON T SOLID SOIL C i --- OFF *6 RISER EXIT D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: W�a.se_c< TANK SIZES: SEPTIC ) GAL. �.... DOSE R GAL• ALARM MANUFACTURER: .�.ve��w'ci MODEL NUMBER: d�.V SWITCH TYPE: PUMP MAN'LlFACTURER : MODEL NUMBER: SWITCH TYPE: REQUIRED DISCHARGE RATE L AO GPM NUMBER DOSES PER DAY: DOSE VOLUME INCLUDING FLOWBACK: l54 GAL. CAPACITIES: A = Q, INCHES = LI b a ­ GAL• B = 2 INCHES = L GAL C = $ INCHES - _GAL. D = b INCHES = _ _k4 GAL. PUMP i; ALARM WIRING AS PER ILHR 16.23 WAc VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE I� FEET + MiNIM'JM NETWORK SUPPLY PRESSURE . �2.5 FEET + O FEET FORCEMAIN X �. O FT /I00 FT. FRICTION FACTOR . . FEET TOTAL DYNAMIC HEAD = 1 INTERNAL DIMENSIONS OF PUMP TANK: LENGTH -- ; WIDTH DIAMETER .---• LIQUID DEFT R 32 /! J 0 GA I . P e. 2 �ICNLD: LICENSE NUMBER A a 9 9 n DATE: 1/86 r(RGOULDS PUMPS Submersible Effluent PUMP 3871 EP05 APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: 1 /4N maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1 1 /2" NPT. • Mechanical seal: carbon - rotary/ceramic - stationary, BUNA -N elastomers. • Temperature: 104 (40"C) continuous 140OF (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EPO4 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length, 1613 SJTOW with three prong grounding plug. Optional 20 foot length, 1613 SJTW with three prong grounding plug (standard on EP05). ® 2000 Goulds Pumps Effective February, 2000 83871 • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- matic models Include Mechanical Float Switch assembled and preset at the factory. FEATURES ■ EPO4 Impeller: Thermoplas- tic Semi -open design with pump out vanes for mechanical seal protection. ■ EP05 Impeller: Thermoplas- tic enclosed design for improved performance. ■ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ■ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ■ Motor Cover. Thermoplastic cover with integral handle and float switch attachment points. ■ Power Cable: Severe duty rated oil and water resistant. METERS FEET : _....._. 10 a r u a 0 0 9 8 7 6 5 3 2 30 2s ■ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING 41 ' Canadian standards Auodadon (CSA listed model numbers end in "F" or "C".) Goulds Pumps is I50 9001 Registered. ►(.—s Gan ! ... . 0 00 10 20 30 40 50 GPM 0 2 4 - - 6 8 10 12 MI /h cAPaclrr Goulds Pumps <& ITT Industries Quick4 Standard Chamber Mult!Port End Cap SIDE VIEW SIDE VIEW TOP VIEW Size (W x L X H)" X 1W X IT Invert Height Effective Length 8" or 1.25" hivert Height INELLMmo-n-S-MEMS, INC. STANgARD_LIMI ED WAELMIly Owl 01-0-1 A 0.-1 u h-,b,.. 1-41 plate. -kp -4 by it Jlar t 0 ofaYMOrl 0 .".-W Ot y.,pyncw wif IrJ Irwlp - n 1 -Irl.--1 1. 1! 1-1 ". "Aw, dow.-W. 'I aaa w 0 IM A", xaL pw,jw , ­j t,,, jl� 'ci 11 'Yttt 10OR UIIKS; Led thee me w n A - i, , 1td b� APok -Orift IFw, the arwtty p-m -I u bO,, tr, 61' AMT, mw., ',I 0 the aik d JD? k0l'A") W.4 aumtly,6k4&.W't U 0 " U Velln"l) try to texwrod by 0194 UMIJJ Wan8irN. """ "tWy sWIt"w a10UIK the CW1 Of Mnr,,�,J W(I/Cj InitWiallon ()Ill* UnII.S. �6 , Thr. [_"ITEC, WAFOM AN* AEMEDIR; IN SIIHPARAC .I!4 ts) AFF FAGLij;iivC Itil 44 APW NC, OA& WIARANTX$ Writ FCSKCT N�;LUO)ft', N,-)V.bLj1iD WM OF VE1C.WNIAE1LI.r`t` Oil FITNIZr 11 pa Tae LW,.rIed Warranty ("& "6 IrAlOct 08111i4jp,; hrldhatcll snil� not be IndA. 4 r, (I OF QuIcateiblagm induurg k or, rc JWtIM anti G cI t lAct e ! wArwIli, OMWO f or Other otrqc°or C rlCwws by ova HAdw 0,L ally wird i 1114cl M-ol, clAW26* are ugrrla�fi TO ft ull'till rit') io <OrrJinyy wear ­,I r ear. rrjr,"$1,r', _"H* 1 i. misum. atkw or ;414(1 of tP,!t'. w.,g .J oh.. I Or %w -fl, ws -A" wo 144 palmitim 6, It'. 1 libl'.0016. W&A.I. rniil,,ta:b it. 9-l"O ,C- ae( fo,11, :n the outaraiar the P.-N 0 ale-i :"it, It'. SYA- w talolhq lim Lhw.% (i !,- of 15 1,. -t., - ,yt-,.j,- 4. hlploph Ir,ivlg IX -tro., .."a, --o t-1. '-r(alpt 9',laee cOlsOxAbi. Q "M" 1crarel-1 'r-I - 14.( by Inier"w, This Lxbirad W-" w'A be wo 11 any ja-A0, .0 "A c 411 ( Other %l1AG4:)ie!j14: Wd hhw;11(Y1 iwallawh inolrws" lutholoy le) CM0 or welkf IM x111100 wa va.lj. No wamcliy 419AM to any pitty Other 111w IN mgr -V066111, IN �ila !,-d L,rr,,61 ftw,.r"' 'dwt l Uy A O.'a h A&u, t. O h l , e Lei ; I SYSTEMS INC E"wkimmmi &K% wntewsw soukm' G Business Park Road - P.O. Box 758 Old Saybrook, CT 06475 8(30-577-7000 - FAX 860-677-7001 800-221-4436 �ol Eq,-wzer arid SiGIENVIAduf ala mijisteved Jtjdtir(IaTKs of jiqI1tr-_jt,)r Sy%:On,s 1r, is a rtgstoniod ttad0mf)tk n Franco, hfdtra',V $ygefria jnC, � a (, n Wx Ck,nlo,,c Contour 5`,mvO Connet;1 ori, Mw- Pu!vluli, FiwpLock. � ftteftacer Pct;iLock Culckckli. Gljl,-WIA� OfECIOCLeDPAPEO nw STANDARD OHAugm SECTION VIEW FRONT VIEW 'WTS OWNIR'$ MANUAL & MANAGEMENT PLAN Page of Septic Tank Capacity I Z + a l O N ffilpttc tank Manufacturer Number of Bedrooms 47" q NA Number of Public Facility Units, 14�► Estimated flow (avers") PudM Tank Capacity D*&ign Now (peak), (Estimated x 1.5) al 0 W Pump Tank Manufacturer r S . � Sol( Application Rate Pump Manufacturer Standard Influent/Effluent Quality Ud lftt Monthly auef#�ii# Fats, Oil & Grease (FOG) 530 mg /,L Sloohemicsi Oxygen Demand MOD,) x220 mg /L O NA Total Suspended Solids (TSS) 5150 mg /L Pratrested Effluent Quality Monthly average Slochemical Oxygen Demand (600 930 mg /L Total Suspended Solids (TSS) s30 mglL P NA Foos( COliform Igsometric mean) S10 cfu /l00mi Maximum Effluent Particle Size K In die. 0 NA Other: l I NA N 1 , erGround (gravity) 0 In- Ground (pressurized) liftent Filter Manufacturer *, n Ni Pf #hwt Filter Model 0 N PudM Tank Capacity Service Frequency al 0 W Pump Tank Manufacturer r S . � 0 Ni Pump Manufacturer �� / p NA Pump Model Inspect dispersal celi(s) 0 NA Ntrestment Unit 0 NA NA P SerW/Gravei Filter ❑ Pest Filter 0 NA Q Mechanical Aeration 0 Wetland . month(s) q serf&} Cl Disinfection ❑ Other: At least *no' every; Diaper" cents) A O TA N 1 , erGround (gravity) 0 In- Ground (pressurized) 0 t.&ads O Mound 4 Rrlp -Lin* 0 Other: O NA C1 NA vou" W101001 for ownum wastewater and septic tank sff luerrt, C NA MAINTENANCE SCiFIEOULE Soln iae Event Service Frequency Inspect condition of tank(&) At less( once every: mont s (Maxknum 3 years) 0 NA Pump out contents of tankfsl When combined sludge and scum squids one -third IV of tank volume 0 NA Inspect dispersal celi(s) At lent once !very; 5:1 ftx1f ullrl 3 years) 0 NA Clean effluent fiker At least gnae every: � © h s) si 0 NA Inspect pump, pump controls b alarm At least once every; . month(s) q serf&} A Flush laterals and pressure test At least *no' every; , ' 0 month(s) A Other: At leant once eywy: ._ _ months) ❑ earls) Y;DNA Other: NA MAINTENANCE WSTRLICTIONS Inspections of tanks and dispersal calls shall be mods by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sower; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tenklal to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum rill to chock for any back up or ponding of effluent on the ground surface. The dispersal ce(i(s) shall be visually inspected to chock the offluent 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 sown In any tank equals one-third f Ys) or more of the tank volume, the entire contents of the tank shell be removed by a Septag• Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. Aft other services, including but not limit to the servicing of eff luent filt ers, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be perfe rt+ W by a certified POWTS Maintainer. A service report shall be provided to the local regulatory ei;#Wky within 10 days of com pletion of any service event. •apoC) en!l u16U099 '!e1 $ 1z1 'I l WE9 PUS 1I1+91pyd lttq IME'99 WWOO jelde4O 43lM "Us11dulOa w pousjp M wsumOOP B ' OM 'S Ow4d e U04 d rl 1 9lv1(��+� �V AV> 'V(N D •-15 ewes! 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CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer Mailing Address Property Address EL (Verification equired from Planning & Zoning Department for new construction.) City /Stat v , ,- , \A Parcel Identification Number 02Q - 0`f - D6 - Oz>� 2 57 8) LEGAL DESCRIPTION Property Location &,r_ '/ , 5A) % , Sec. W Q , T o2 9 N R / Q W, Town of Subdivision A a- /de Lot # to . Certified Survey Map # �' , Volume , Page,# Warranty Deed # 3 , Volume , Page # Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION /(3 Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system 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. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Num .er of bedrooms SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) ®s W/ . . SUR ABOVE V -8 t/2" 0 !�/ l (2) 2 x a o n x . n � 03 U} . oc n� .b k S 4 •q �G � O i I . i� ao 1- I u- 0 a I LINEN { C.T (2) 1 3/4' x II 1/8' DROP 9 -4' G D CLG PET FLOOR lb'= 113/4" ZIAL SELE CTIONS AND CONSTRUCTION PROCE CONFORM TO THE 'STANDARD OF THE INDUS TEGORY 1 CUSTOM FABRICATED SINGLE FA -ANCES OF SIMI SIZE 4 QUALITY. ALL •RUCTION WORK SHALL CONFORM TO ALL !D CABLE CODES, ORDINANCES, AND COVENANT; H U }, Q u" r n l!! A - N OF STRUCTURAL LIA51LITY. Fitw 4'INUIRINO HAS NOT MUN Doe TO THIS W OR Mil PRIOR TO CONSTRUCTION AND /OR SIGNINGS OF A CONSTR I. STRUCTURAL �INURM K*? ON COMPLiT1liD ALL Gi CALCULATIONS NNCOGG ARY POR SIZING OP STMJCTURAL 18 THE ROPONSIBILITY OP THE Ojok A LIMAW BTRUC SHALL SIM AND Dl NGN ALL POOTINW, PO 40ATION I- Al I NPORCING RSDAR, NAN*Wth, POINT LOADS, 4 1RDW@S, MA STRUCTURAL 104INM R SHALL ALSO REYIpW CM i pi Tui (8). ROR I"% OP THIS PROUI CT, THl11 ARCHITECT HAS h RouHn TD By THE OUINER TO PROYIDE STRUCTURA,I. DbISICN Aw TO STRUCTURE WITHIN THIS ARCHITBOTU IS ASSUP4ED TO SUPPORT DESIGN INTENT ONLY AND THM CPT. OFFIT G.T. S I 04 � J 0 8' -b" 8 A10 6 A10 MI. II iIl b'-0 1/2" 02 If 1/8" LVL HEADER U_.2575P 113 STATE BAR OF WISCONSIN FORM I - 2000 WARRANTY DEED Document Number This Deed made between Renton. Inc., a corporation existing under the laws of the State of Wisconsin Grantor, an Kurth P. Pearson and Mary Gallagher- Pearson Grantee. cantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property ") (if more space is needed, please attach addendum): Lot b, at of Walden Woods in the Town of Hudson, St. Croix County, Wisconsin. 763QD fa g KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO -, WI RECEIVED FOR RECORD 05/19/2004 09:00AK WARRANTY DEED EXEMPT I REC FEE: 11.00 TRANS FEE: 405.00 COPY FEE: CC FEE: PAGES: 1 Name and Return Address Scenic Title and Abstract. Inc 220 Locust Street Hudson, W1 54016 :02ZaS Together with all appurtenant rights, title and interests. 20- 1083 -10 -000: 20- 1083 -50 -00.0 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 easements, covenants, conditions, restrictions and reservations or record. Dated this 30th day of April 2003 *Jeffre4 J. arr res' ent "�St: en E�Bou �eqre /Treasurer AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) authenticated this day of ) ss. St. Croix County ) Personally came before me this 30th day of April 2003, _ * the above named Jeffrey J. Warren and Stephen E. Bout to me TITLE: MEMBER STATE BAR OF WISOMSIN ' ^ " " " " " `']down to be the person f� who executed the foregoing instrument and (If not, authorized by § &kIWj$."jsWC ged th me. Notary Public THIS INSTRUMENT WA Dl$}' Bartholomew Law Office, S.C. ' ° * rian Scott Eckholm 220 Locust Street, PO Box 27 Notary Public, State of Wisconsin Hudson, Wisconsin, 54016 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) September 11 th , 2005.) *Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1 - 2000 k . I I I � QI u V V to to ( 0 I- - - - -- ��I I oo I w 1 os.7a� w c�a�a � Q0004aoa / / / / (S89`58DM N8 9 °87' 448.39 MONUMENTED SOUTH LINE OF GHERTY'S ADDITION. — 1181.b8' -- LOT 7 2.696 ACRES (117,428 SQ. FT.) H.W.L. = 808.0 r LOT 8 2.925 ACRES ' \ (127,401 SQ. FT.) \.F.F.E. - 810 BENCH MARK: TOP OF V IRON PIPE, ELEVATION 845.66 BENCH MARK: TOP OF 1' �i IRON PIPE, ELEVATION $ 825.00 203 .01' LOT E -, (109,293 SO. FT.) 2 OT S N (105,990 SO. FT.) M co / G O B moo• C �l �P✓ • y,�� .1�� . Z ' •LOT4 2.279 ACRES (99,283 SO. FT.) \ M.F.F.E. • 810 \, —I— c I �� v j � I I rA 0 68 0 I / 40 H.W.L. = 808.0 I 30' DF 16 FC 7D K m I oz I ° m I w * m m ZMI 0� r Om l cc"nm n0 vz �m I� 0- zm mpm NZ roM N� I o cn Q �I n — — -� m N O o 0 aV N O IN N 0 q N S � i V V ^ ti I� CA) V ly N LOT 7 2.696 ACRES (117,428 SQ. FT.) H.W.L. = 808.0 r LOT 8 2.925 ACRES ' \ (127,401 SQ. FT.) \.F.F.E. - 810 BENCH MARK: TOP OF V IRON PIPE, ELEVATION 845.66 BENCH MARK: TOP OF 1' �i IRON PIPE, ELEVATION $ 825.00 203 .01' LOT E -, (109,293 SO. FT.) 2 OT S N (105,990 SO. FT.) M co / G O B moo• C �l �P✓ • y,�� .1�� . Z ' •LOT4 2.279 ACRES (99,283 SO. FT.) \ M.F.F.E. • 810 \, —I— c I �� v j � I I rA 0 68 0 I / 40 H.W.L. = 808.0 I 30' DF 16 FC