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HomeMy WebLinkAbout026-1133-13-000 0 : r ° , , ; 3 % �� E : 7 m , ! 3 i/ § $ 2 [ ) E § B a E E 3 � @ m ) ' //( mA P f § CL , g � ■ : E 2 G § m 6 ' -4 3 0 E � ID © E @ v > E %) \ E 3 § = $/§ of § CL 2 \ j3 R / CL R ƒ # k @� § ( n E r Z cn / 2 2 ■ ty "*A. � a i Z z 0 0 CL @ k k k 0 \§ @ ■zl ƒ [ c 7 v v % < , , gd ■ �. r g ; -a! f k ( 3 . .. o CL \I \ e � \ / g = o e / / § g § * m 2 }_ k_ k z } I > w ■ o m 3 1 ■- 0 - § ■ a CL R \ 0 § @ 00 C4 $ / = ®0> CD EiCD CL 0 0 CD E7 �_�a)_ � 7$93 Z R 0 M =r aC = a n% . CD � �E K /£C ■ « \k C D � FF/ }�/ ! / = °g CL ■ ; � \ -0 �k C, j 2 0cn0 3.0 e E ° T §ql$i\ k CD F g O 0 2 0 ° t Ei (/ B - « E m 0 — _ « ' % - \ M 7 - a CD co / ° ^ C e Cl } ( :3 / o \ § ( 7 { 8 E @v [ %$ > f © E (a co e to ƒ 0 ) 7 4 m # k R CL CD k / \ K n r CO) m \ / & . [ T -0 -0 i j f } 0 0 0 = : 5 2 r , n f ` ca m � 2 § , ƒ 0 ( ° R 2 \ (D M N) �..�0 E § CL � 7 rr \i 5 E ƒ 0 —, k \ CL \ \) \ 4 k B wl m ° N E � z 2 k/ -4 (0) � o � o � ■ n § i /G� 2 / � E § z k § 2 £ E j 2 =L0> CD EiCD CL , 0 0 C Q j $@\§ E ƒ 7$§M< E f$ %2i �gf@ �q/ k 7E= K ; \k � ]/{ C 3 F' 7 Ekf % /erg k 0 Q t C, � 2 f Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division I& Sanitary Permit No: 430589 0 1 INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Halle Builders Inc. I Richmond Township 026 - 1133 -13 -000 CST BM Elev: Insp. BM Elev: BM Descriptio : Section/Town /Range/Map No: 0 6 ' J / O() . U �0 tTd>'�. 51 # 'L 06.30.18.926 TANK INFORMATION VATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / y � ,l Benchmark 3. 2 - 0. Dosing (J V Alt. BM w TI S7 '/E,4-' /a �.Y6 Aeration Bldg. Sewer 3D 3 +� Holding St/ it Inlet / o qj) TANK SETBACK INFORMATION S t Outlet 25, S '77• TANK TO P/ WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic r W - Dt Bottom Dosing Header /Man. 7 S Aeration Dist. Pipe - /. s - 7.3/ Holding Bot. System Final Grad \ PUMP /SIPHON INFORMATION &47 W S 3,S - P7 Manufacturer Demand St Cover / 7r� p ,6 GPM � — 3 /,6 21 Model Nu er TDH Lift tion Loss System Head TD Ft Force main Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM (02 9` /D /-- S- BED/TRENCH Width Length o. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 1 ; r SETBACK SYSTEM TO P/L BLDG WE LAKE /STREAM LEACHING M ectu 9F: INFORMATION Ty e Of System: y CHAMBER OR ✓ O�J c- �� I O r UNIT Model Number: DISTRIBUTION SYSTEM T/}A,r 1 44 �] /0-- Header/ anifold Distribution ( x Hole Size x Hole Spacing Vntak e Pipe(s i) _ N ) 9 5 �— ' Lengt Dia Length 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 Bed/Trench Center Bed/Trench Edges Topsoil _1 Yes No Yes No COMMENTS Include code discre encies, persons present, etc.) Inspection #1: 4 / Inspection #2: Location ��� h o in s17 ic 1 I 54017 (SW 1/4 SW 1/4 6 30N R18W) nt�gt 13 ' Parcel No: 06.30.18.926 1.) Alt BM Description = ST , C�ir — .�l � e y � 2.) Bldg sewer length = .Z s� ° �lJ�•gl T -Cw— - amount of cover Plan revision Required? r 00140 Use other side for additional information. J— SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. I � � .5 Z a� ��=���� � � �� �� h. .� �/ �- �� ,�� �' °/�� . � 111, �.r�" ..��� ✓��'� °� ,/ "�H f J` Y N`E � �qF ^ "� ' ,p �,W�' " d� {Jfs 6 �� ��YF�„u� ld� � r ! �.. ,� �G !f sb - 27 Iva tue-d E7. Wisconsth Depatimenf of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 86, Wis. Adm. Code (;' nty Attach complete alto.,plan on paper not less than 8 1/2 x 11 Inches In size. Plan must Include, but not lirrilted to.- vertical and horizontal reference point (BM), direction and Flarcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. C Z (0 Pliense print all hiformation. Reviewed by Date P You Provide may be used for secondary purposes (PrivacyLaw. s. 15.u4 (1) (m)j- Property Lo cation 114U, 1/4 S ' E(o Property 0 .. G0 IL/ J R o wners Address Lot # Block # ubd. Nam r M# 2101-01ji— MoneRNM69"r NIT tale 0 city MI ag, a Town Near t Road k - Q11 s .. 2 7 -New Construction Use: 0 Residential Number of bedrooms 0906 derived di slqn flow rate GPD Replacement ❑ Publi or commercial - Describe: Parent material Flood Plain elevation [I' applicable General comments and recommendations: ' Borin g Boring # </ pit Ground surface elev. IA / Depth to limiting fact or In. $0 8ppiloation Rate Horizon Depth Dominant Color Redox Description Texture Structure Qnsistence Boundary Roots I I.I., GP= In. Munsel) Clu. SZ. Cont. Color Gr. Sz. Sh. %W1 "Eff#2 7 7- Boring Cr Pit Ground surface elev. Depth to limiting fac or In sggl . Appl. 1:19mn Ra te Hocizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G In. Munsell RU,,8z....Cont. 2 Ior Gr. SIX. Sh. * Eff#i *Eff#2 ak YA w. C ks'w &rx e-i its Q4 Z. I i1wi * Effluent . #1 SOD. SOD 00 rrqt� d TS M S, CST I�Wina (Pl4ase Print) §,lon4w, CS'Mumber 22 e l , Add Date EvaluallZ Conducted Tellephon; Numtmr Ake t� Sivdot Property Owner -A- Parcel lb # _ . e . _ rage �: � of Boring # Boring, l� � Q /� ❑ pit around surface slev. _.s Zt. 6 _.. ft. Depth to limping factor — $nA A tcatton Rate Horizon Depth Dominant Color Redox Den)rIptlon Texture Struoture Consistence Boundary Roots glr D/T In Munsell Qu 9z. Coy it. or . Sh. _j Boring # ❑ Boring ❑ pit Ground surfaceelev.� _ ft. Depth to tlmltinl1 factor._ _ In. goi! Ilcedon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence boundary Roo ts GPD/W In. Munsell Qu. Sz, Co rsi. Color Car. Sz, h, "bff#1 'Eff#2 Boring # r❑r°� Boring 0 E] Pit Ground surface slay, _, -� . ft. Depth to limiting factor - In. Solf Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary_ Roots If? In. Munsell Qu. Sz. Cont. Color Cdr. Sz. Sh. 1 vv * Effluent #1 = BOD, s 30 S 220 rrglt, and TEW >30 160 mg/L " Etftl'ent #2 = BOD, W 30 rng/L and TSS 130 mg1L The Department of Commerce is an equal oppoxiuility service provider and -am- pleyer. If you need assistance to access services or need material in an ajt0rn8,te .format, please contact .th *aftrnent at .t i08- 266 -3151 or TTY 608-264 ssn.s�wcx;�art . e x Alo Agr' NP ov (A_ Ell r ` Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7082 6 Madison, WI 53707 - 7082 Sanitary Permit Number (to be fill in by Co.) ,s'COnS,n - Dep artment of Commerce (608) 261 -6546 ,36 ST y Sanitary Permit Application State Platt I.11° rber In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Caw, &I5.04(I)(m) Project G, s (if different than nulling address) I. Application Information - Please Print All Information t - 7 Q 1 q 1Y T' ST Proper w er's Name ]� Parcel # = 96 3 Block # l 04 -1133 -13 - Go a Property Owner's Mailing Address Property Location 1//3 ia, / City, State Zip Cade Phone Number v,. Y., Section �O Sy / 7 �iraZ14- G t13 Ay {circlegi�) T N; li / E ofi1i� IL Type of Building (check all that apply) GA4 � _d+or 2 Family Dwelling - Number of Bedrooms Subdivision Na r� CSM Number 11 Public /Commercial - Describe Use { (/ []State Owned -Describe Use 1 JS C ❑City ❑ !lag ek ip of III. Type of Permit: (Check only one box on line A. Complete line B If applicable) A ' ew System ❑Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B• ❑ Permit ermit Revision Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued ❑ Before Expiration Plumber Owner IV. ' nEpe of POWTS S stem: Check all that a I a 16- 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 ❑ tmg S dP' r ❑ Recirculating Synthetic Media Filter ❑ Leachin Chamber ❑ rip Line ❑ Gravel - less Pipe ❑ Other (explain) 02 V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Sail Application Ra dsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total I Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing rank: ranks ptic rHoldingTank BUD Aerobic Treatment Unit Dosing Cbamber VII. Responsibility Statement - the undersigned, assume responsibility for instaAatio f the POWTS shown on the attached plans. Plumber's Name (Print) Plu a gnatur Si PR mbar Business Phone Number F`717/9 ; 7 zZ /�/7/ GG 37 P lumber's Address (Streets City, State, Zip Code) S / e/b S T �rnP� G✓r S"Yeo VIII,Xountyl De artment Use Onl Approved Disapproved Sanitary Permit Fee (includes Groundwater Date sued ssuing Agon Sign re tamps) Surcharge Fee) �j� �Q L wner Given Reason for Denial J U r ✓ / �7 (� IX. Conditions of Approval for Disapproval -- 7,0 J" r' h��'7/J 44 Attach tompkte plans (to the County only) for the systew oft paper not less than 111/2 x 11 takes In do SBD -6398 (R. 08/02) Jai G n Z ' eeA NP Z C�X�'� Alm O IV Q' r r ` U Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of- Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County � /. Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. o Z (o — ,33 — /S — '0 0 O Please print all information. R e Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). / Q Property,Owrjer Property Location 11 Govt. Lot S dt/ 1/45l✓ 1/4 S 6 T JO N R �� E (orff Property Owner's Mailing Address Lot # I Block # Subd. Name pr CSM# / / 3 City State zip Code Phone Number ❑ City V Ilag Town Neare Road 0/7 ( %> u2 -bP �/ SS ST Ef Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate yif 6 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable ft. General comments and recommendations: (/ E] Boring IT Boring # R pit Ground surface elev. ,7 ' / ft. Depth to limiting factor �s� in. Sa'I Applicatiort Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. •Efr#1 •Eff#2 Z -,R 7,5 e p%/ y ? ��/ SL �s�,C A 2 q Z Ae Ca S Z. G Boring # El Boring Ll Pit Ground surface elev. 91 ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •042 I 31 2- SL 2M M' 9e r 2Ai sd Afe el 4,�' a;Z/� lir Effluent #1 = BOD > 30 220 mg/L and TSS > .< 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST New (Phase Print) Signatur CST Number I l i 22lv7/ Address Date Evaluation Conducted Telephone Number ?2 / Sl0 S I A-61 Lv _L`' ao y /3•Q 7/22(09 -�6.�� r Property Owner L —_ Parcel ID # Page Z of Boring # ❑ Boring �j 3 ❑ pit Ground surface elev. / 8 i / lea ft. Depth to limiting factor ^ in. Soil — Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eft#1 'Eff#2 A T619 S ' a Boring# Boring C] C] Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 i a Ong # ❑ Boring Ground surface elev. ft. Depth to limiting factor in. El Pit Sal Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Efl#2 I I ' Effluent #1 = BOD > 30 1220 mg1L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 130 mglt. and TSS < 30 mg1L I The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altemate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. seo•uw (RA=) I 'r/ -� she f AI)o 14 P NF c,- ge, ---1� P ►1�a w��� o - D o �I r 19 i G 1 `44. RECEIVED DE 4 3 2003 Safety and Buildings Division County � ST. CUOIX COUN Y 2 W. Washington Ave., P.O. Box 7082 5 T OFFIC Madison, WI 53707 - 7082 Sanitary Permit Number (to be filled in by Co.) De artment Of Commerce (608) 261 -6546 O Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, sl5.04(1)(m) Project Address (if different than mailing address) I. Application Information - Please Print All Information ' - 701 q (, T. Property Owner' Name � � _ Parcel k Lot # `BleolE�i -. Property Owner's Mailing Address I `rr op-�errty Locat ion l 3 y ' Yti `�.. Section Ci ,State f Zip Code Phone Nutmbeer �r W I c� / �� S 7 {p O � 3 TSD N; R � a � or li ire or�g) II. Type of Building (check all that apply) ap [i¢t S .w 4 ( Subdivision N e CSM Number ❑ l or 2 Family Dwelling - Number of Bedrooms ❑ Public/Commercial - Describe Use ❑ State Owned - Describe Use ry ❑Yil wnship o' III. Type of Permit: (Check only one box on line A. Complete line B If applicable) � _ _ of g. A. �Tlew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision Change of Permit Transfer to New List Previous Permit Number and Date Issued ❑ Before Expiration Plumber Owner IV. T e of POWTS S stern: Check all that ap ! J<Non - Pressurized hr- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Weiland ❑ Pressurized In- Ground ❑ Holdirg Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Latching Chamber ❑ Drip Line ❑ Gravel - less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdso Dispersal Area Required (sf) Dispersal Area Proposed (s0 System Elevation //Z0 .7 g v 9 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass Now Existing Tanks 'ranks i JA Se or Holding Tank A0 0 Aerobic Treatment Unit Dosing Chamber VII Responsibility Statement- 1, the undersigned, assume responsibility for installs ' f the POWTS shown on the attached plans. Plumber's Name (Print) Signature MP P umber Business Phone Number om.,, zz iy7/ Plumber's Address (Stre ity, State, Zip Code) VIII. Coun /De artment Use Onl 14 Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued [ss ' g Agent Signature No Stamps) Surcharge Fee) El Given Reason for Denial � — 0 24 GW 3 M Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 3) (MCL r.rlTeK ` t� 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. Attach complete plans (to the County only) for the system on pa nut teas 1 ai z It tnc4ol In she ..UV�v SBD -6398 (R 0$/02) G�k Sw SwS ( 30 NR8 IiJ S� LoT� 13 a��Z e • hol ���. Qi� I oo_' Q.2 oa v .4 /00 Ll (od A" th. or M C yy ' '14A /o T Al n '22 1517/ Sir S cis ( T 30 NV8'W SlJI A'j Lj xor I n' (04 AV) lorz ,o0 7 4 C il �I� r bo yy ' r 'Wisconsin Department of�Commerce SOIL EVAWATION R ORT Page of 3 Division of Safety and Buildings � ..� ' ' � in accordance with Comfn t35 Wis tdrn,& 0, [' �^ � ty / Q Attach complete site plan on paper not less than 8 1/2 x 11 inq size. Pi include, but not limited to: vertical and horizontal reference poiht; *), �r and t? I LD. percent slope, scale or dimensions, north arrow, and location nd- oistarlh '1¢ n4)rgst r ' - V1 Please print all information. �. -'i, v cs+x ev{ w by Date Personal information ou provide may be used for Y P Y secondary Purposes rivd� La ' g► Aa . 1' 04 3 Property Owner Property Loc L(,��`�� �� ��� �� C �0 1/4,SVJ 1/4 S T 30 N R } E (o w Pr perty Own is Mailing Address C� .4< Lo lock # Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village [K Town N arest Road New Construction Use-;K Residential / Number of bedrooms 1 2 Code derived design flow rate GPD ❑ Replacement ❑ Public _ } orco ercial - Describe: Parent material q'ctct 4� Qi Flood Plain elevation if applicable ft. General comments M0.y X S�� a — Co *7 C VS r c '^ Ff�}'P�a+00"`s J and recommendations: `''\ S � :5 : T ' 1 > 9io, r 6'4 c �.: � " 3 > 9 �►Fo + r e ar , T, 7, 4 l❑ Boring # F1 Boring I W Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 0- )olp � SL arfr mF 0 av` It 'k c 3 y 3�- �, y --- s The soil test report for lot 3 was discovered to be inaccurate during the septic inspection on Nov 2, 2001. The soil horizon reported as single grain ❑ Boring loamy sand was actually massive loamy sand with Boring # ® Pit Ground surface elev. f D �. YY ft. occasional pockets of sandy loam. Therefore the Horizon Depth Dominant Color Redox Description Textu loading rate must be .5/1 and not .7/1.2. If thi in. Munsell Qu. Sz. Cont. Color error is discovered on any other lot, additional borings /soil investigations will need to be performed for the rest of the subdivision. The plumber should I q Ne'T make note of the potential for error and prepare for 3 11 14 L the possibility of increasing the size of the drainfield. * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 _< 150 mg /L CST Name (Please Print) Sign to I�on1nq S- a r� �Zlkk' Address of a a00 0 10 0 �Ya 1, Property Owner La Kes 1'!3 "tnC Parcel ID # Page of F 3 1 Boring Boring # Pit Ground surface elev. /C ft. Depth to limiting factor ) in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 o -►o to 3 S L aF&R C\S yy) ' r-\ r, r M - - 1 ►a V3 Z- �, . z4, 3`� as % Cad, N1 Boring # ❑ Boring Pit Ground surface elev. g 7 `� ft. Depth to limiting factor I aQ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 / 0 -g 3 a SL aFUR F aS a ,S ,9 0� 8 -a - 1,5 9 He st- M FR IC LE.1 I F S .9 3 al -3f 15 4 1q --- SL dFS NF P, N W E -S .9 31 -yy 7.518 41 -.. _. S - s M L CW .'7 t.a y�l -mu 7, 5 R s y S O -S wt L --- --- J I. ❑ Bring Boring # Ground surface elev. ft. Depth to limiting factor in. El Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 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. SBD -8330 (R.07 /00) L,A —key 4- l : i)5 `�,c.. paw_ 3 3 5w`l4 5w'1��� 5��. �� T 3or►�, ��g Bonn p+ �, st�� k- yU r ort � I of ! r c.1 i o '% 40 • ° '`> s . s 9 3O, 13 go fJ v d �w �. 8 m 1 I po, w POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner . ' u i Septic Tank Capacity 7T a l ❑ NA Permit # O Septic Tank Manufactur r b'8ry ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model A op ❑ NA Number of Public Facility Units PrNA Pump Tank Capacity al A Estimated flow (average) 320 g al/day Pump Tank Manufacturer A Design flow (peak), (Estimated x 1.5) g al/day Pump Manufacturer "A Soil Application Rate gal/day/ft'. Pump Model "A Standard Influent/Effluent Quality Monthly average* Pretreatment Unit A Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg / ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L YrAn- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) :91W cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other. ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ yeast j(s) (Maximum 3 years) 13 NA Clean effluent filter At least once every: _ ❑ month(s) ❑ NA jff year(s) Inspect pump, pump controls & alarm At least once eve ❑ month(s) year(s) Ins A P P P every: ❑ year(sl ❑ month(s) PNA Flush laterals and pressure test At least once every: ❑ year(s) Other: ❑ month(s) MNA At least once every: ❑ year(s) Other. PNA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) 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 cells) 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 (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of 2 START 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 cell(s). 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 cell(s) in one large dose, overloading the cellls) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or-must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be 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 prote a replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply w the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. A ( T Iv aluaY a o Ong tank b - e ai �RDf 11877�1� �i /J�b✓ (�' NS"T72c1�Ttvn ❑ 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 POWTS MAINTAINER Name ert- tj) Name Phone Z_& & 7 j Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S G ( 20AI " Phone Phone 3W40- fo (7 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. ST tCl OIX COUNTY SEPTIC ';'ANK. MAINTI?NANCE AGREEMENT AND OWb ERSHIP CER111 FORM Mailing Address Propetly Address .,. _..... -� - (Verification requircd frou i Planning L'Ioparai - tiont for new constn�etiora)„_�_ _ City /Slate &,14 UZE Parcel Identification trltunbar &Q6 1 2 4Z(o L EG AL DLSCRIPTI N Propm - y Location. $G ? /�,�4v_' /,, Sz C. (o . T, 0 _.N - R,�j? W, Town of�>�__ Subdivision Cereled Survey Map # — .. Volume - �..____ _�. Page # Warranty Teed # Volume _ -__ --- Page # _- L--� Spec house 0 yes Z no Lot lines identifiable U yes 0 no SYSTE 1VLAlTI`I`EN1` -N improper use and mainttsanceof your se.l pc sys could result in its premature failure # o band] wastes. Properzrux consists of pwxtping out the septic tank every tko 'e years or sooner, if tieedod by a licensed pumper. Wixat you rut into the system call affect the function of the Qsptie tank as a tre,i went stage in tx��� w,�ste disposal s The property owzter of rees to subunit to Ste c)roix Zoning Div rtment a Caftification fo= signed by the owner and by a rtrasterpluznl�er, jrnlmeymanplt: ibex, restrictedpl. i beror a licetuedtsuunpe+rverifying that(1) the an "te wgstewaterdisposat system is in proper operating cond.i.tiian and/or (2) after it ! eetiort attd pumplag (if necessary), the septic tank is less than 111 hill of sl"ge• t/w the und have read the above require I ntnts and agree tea ) the private seurage tlis.posal systern with t>ao st;artdards a ,. set forth.. hereirx, as set by the Uapartmetxt Of CoM t P Ond *e Lretaartmont afNatural Resou eR, Stato of Wisconsin, ,et K;rcatiorr stslti at your septic system has been marsxtainei I mist bt complel ed at el ttwrned to tl� C St. tobA county Zoning Offic'. With n 30 s of a three year a I (ion date. / l� E I O I ATM OF APPLICAW DATE C JUBCATION (�Ve) ceTbfy t hat all stn nnents on this a irm are tmd to die best of my (our) k owled86, I (we) am (are) the owzer(s) of he t tZ)pert described abov b virtue fa wam ity deed recorde +l iax Rtgister of needs Office r 03 . — C ANT DATE Of APPLICANT Ajay Information that is mis- representcd a ay result in the sanitary permit being revoked by the Zoning 1)epartment. Include with this application- a stamped warn irity deed from the Register of .Deeds office a copy of the v rtified survmy inap if reference is made io the warm ty deed LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF RICHMOND COMPUTER NUMBER 026 - 1133 -13 -000 Parcel Number 6.30.18.926 OWNER NAME: First Last HALLE BUILDERS INC PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment 1709 91ST ST SECTION 6 TOWN 30N RANGE 18W %160 SW 1 /440 SW Line Description Line Description TOTAL ACREAGE 2.670 PLAT PINE VALLEY ADD'N 1/17 026/01 LOT13 BLK 01 SEC 6 T30N R18W PT SW SW 15 02 PINE VALLEY ADD'N LOT 13 16 03 2.670AC 17 04 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit 0 iJ 19 15 P 9 8 4 68253'5 STATE BAR OF WISCONSIN FORM 2.1999 KATHLEEN H. VALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., III This Deed, made between Hillvale Development Limited, a RECEIVED FOR RECORD Minnesota Limited LiabilityPartnershi 06_25_2002 8t38 AN 11ARWKTY NEED EAEIPT t 17 Grantor, and Halle Builders, Inc. REC FEEL 11.00 TRANS FEE: COPY FEE: CERT COPY FEE: Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Name and Return Address Lots 2, 4 l3 14 and 15, Pine Vall ey Addit St. Croix County, Wisconsin. SaGS" New ahlsaaad, VA 54017 This deed is given in fulfillment of that certain Land Contract between the parties hereto dated July 30, 2001, recorded August 7, 2001, in Vol. 1694, Page 568, as Doc. No. 653155. Pc 0 26- 1020- Parcel Identification Number (PIN) This is not homestead property. DO (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this 2 day of November 2001 Hillvale Development Limited • g Richard Neiso AUTHENTICATION ACKNOWLEDGME Signature(s) STATE OF WISCONSIN ; P` ASSA J. ( t1� _ County * NpT41?Y ct` authenticated this day of Personally came before m IDA ;rte d f November - . 2 P the a e Hillvale Development Limited, a Min i Partnership, by Richard Nelson ISC TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attoroe Kristian O land Notary 1) blic, Stag of Wisconsin Hudson, 1 My Commission is permanent. (If not, state expiration date: J �.,,� (Signatures maybe authenticated or acknowledged. Both are tat necessary.) ��.il� ' /.1 '2 l t�3 .) • d or pri nted below their sig nature. inrormenon PnxemWwN; eaepenr. Fad a Lea WI Names of persons signing in any capacity must be type pri g 000655-20¢1 WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2.1999 s 1 fy tr y y t Ap cc C.. ` kp 12 +� ,. P'IK'E- 989,07-, AX `- --- - - - - -- --- ----- - - -- - -- -- - - - - -- - --- s *ug %E. rc.S7 - - - - -_- ' A L N earrwrrNn7rvae atmeR: - 1 " PINE VALLEY ADDITION p - azt Y +na At[ gNSp9[Mf R ' tAN+ACF IEt3011 Q, 4 R KAR a[E WIt0 INCUted m roam o) th. S& 114 of the SP t/I u nd pact of the SW 114 of na«e. fes i R d- 1 the SW 11I f 5 t+o 6. MON. R1d11, Tpwn o) Richmond. SY CYps: 'e'o'• //\ C.,.nty. r r�P' 1 14 f ::4'3 E. '+"°" _ ,i t w.:.r rl Q5 ...... .. y r t h. A a �. '.. `,\ I _ .��! fv � w �y �* 4• '3.ti � H, \.. 4�� .....j... i . _... a Y: ", i . c i � f21D AVFMR! �! �,. -. � •. � wrt, .e x Ieeslt a < e a ' • Zr n n m '. i •$xxT. J.lt... a� _. .. .... App � � � Ib Y V «• m,�rw w r rw• evMr'n i i hF ..... ... ... r . . . . ti iUL S t I ....were..... __ .., .. /..._ _ .. .. ... ........ _ ... ... p. . I ... �. ... ..or _. .. .. .... .. ..... _ ..m ...... ... .. .. _ ----- ... .. delt .tR er )htar t'pYPIN! 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