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HomeMy WebLinkAbout026-1025-10-300 sin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix :ty and BSiiiding Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 506109 0 GENERAL INFORMATION 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: Jents, Daniel & Sharron I Richmond, Town of 026- 1025 -10 -300 CST BM Elev: Insp. BM Elev: BM Description: '' (( Section /Town /Range /Map No: l �' 6 u"JO� N 03 S �iY - 07.30.18.97D TANK INFORMATION � DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic c Benchm rk � e 3 /2-3 //2-.3 /v6.0 Dosing soZ A_ It. �-- 6 / �p • Z 1 2,17 Aeration Bld r , 7 / V0 Holding St,/Mt Inlet S Ht Outlet Q . TANK SETBACK INFORMATION 6 TANK TO P /L WE BLDG. Vent to Air Intake ROAD Dt Inlet 7 C1 Septic C > 2 Dt Bottom Dosing HeaderiMan. 7 – Aeration -- Dist, Pipe 2• �Q.S L Holding Bot. System _ /3 a 9` Final Grade PUMP /SIPHON INFORMATION 1 x'1 d�5 t� /7D 8 0_ 2-- 10 2. 1 Manufacturer Demand S Cov er / rte_ �3 �� 2. •7 P Model Number - 7—, & .0 2, c/ Or, 7. 3e TD H Lift Friction Los System Head - — TDH Ft Forcemain gth Dia. Dist. to Well SOIL ABSORPTION SYSTEM 2 4 Z3 BED /TRENCH Width I Le th T D / No. Of Trenches PI IONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS - m SETBACK SYSTEM TO UUU P/L e JBLDG WELY LAKE /STREAM LEACHING Ma cure CHAMBER O 1 INFORMATION T S Yp f S ystem �/ > r� __ 1 / UNIT Model Number: DISTRIBUTION SYSTEM ✓S` ' Header/Man ifpld Distribution G Z L x Hole Size x Hole Spacing Vent to Air Int ke Pipe(s) (rd r q "7 . I. Length Dia Length ``�� O � Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only 0– iFA Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil <�,.. Yes No ,;i Yes No _ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:/ 1 Inspection #2: Location: 906 160th Avenue New Richm nd, WI 54017 (SW 1/4 SW 1/4 7 T ON R1$W) NA Lot 3 P6 Parcel No: 07.30.18.97D 1-" 1.) Alt BM Description = � � X 2.) Bldg sewer length = l/N, 4 4 - amount of cover = / U Y� `�-� X�G( �,��• ,Sfff1�C 11/�JS/ IOtM' ` ` - 0 Plan revision Required? Yes Use other side for additional information. Date 2sepct S Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County N V Iscons i n 201 W. Washington Ave., P.O. Box 7162 �j e Yh ,- � Madison, WI 53707 — 7162 Sanitary Permit Number (to be filled in by Co.) De artrnent of Commerce (608)266 -3151 5 � Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information yo nvide , may be used for secondary purposes Privacy Law, s 15.04(1 xm) Project Address (if different than mailing address) o I. Application Information — Please Print All Informatio - - - -- Property Owner's Name hi 4A, t Parse; ay Block # l Owts�'$ iling A &ress roperry Location 9 Q /l ff . ST. CROIX COUNTY y, Section City, State Ll Z,ip Code Phone Number "' (circle o T, N, 11. Type of Building (check all that apply) �1 or 2 Family Dwelling — Number of Bedrooms 2w; CSM Number ❑ Public /Commercial -- Describe Use ❑ State Owned — Describe Use ❑City_ [OVillage Vownship of , - o, ✓. III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. A1r'ew 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 i Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl XNon — Pressurized In- Ground ❑ Mound 2:24 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 ❑ Leaching Chamber ❑ Dri a 1 1 Gtavel -less Pie lain) V. Dispersal/Treatment Area Information: C A- Design Flow (gpd) Design Soil Application Rate( pdsf) Dispersa roposed System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New 1 Existing Tanks Ttutks Septic or Holding Tank a Aerobic Treatment Unit J �+ Dosing Chamber ��� -0 li l, C G V- 111. Responsibility Statement- I, the undersigned, ass respon sibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature PRS Number Business Phone Number _ 1 411. '114100 a-- 6tr�t>i :• r 1. 7 % .a /3" 5W Plumber's Address (Street, City, State, Zip Code) X '� o_ VIII ounty !De artrnent Use Only Approved Disappro Sanitary Permit Fee (includes Groundwater Date Issued Issuin gent Signatur o Surcharge Fee) y� C rGivenReason enial k{ �J� �� 3 ZZ' 07 IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 1. Sceptic tank, effluent rifter and dispersal cell must all be services / maintained as per management plan provided by plumber. 2. AN setback requirements must be mandakW as par applic" coda I ordkte im. Attach eomplete plans (to the County only) for the system on paper not less than 81/2 x I1 inches in size SBD -6398 (R. 01/03) �Y�1 L' �/ � L� �� L� � �"P✓Y . 0 �� � ��6s12 Gee �.0 ��4�- / G'if/1/JC�� /l r � I� Ls4 O d L r ti pp -fvA to s 3 1 4 u S -1 k� rays 141 f / Y Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County ' 1-6 �f 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. 2-4. 1 z:5 /d - 3bn Please print all Information. Re vie by Date Personal information you provide may be used for secondary purposes (Privacy Law s. 15.04 (1) (m)). .3 / 7A 7 Property Owner Property Location 6 e r6t (� /� oie or,a Govt. Lot J 6U 1/4 5ZV114 S - 7T 30 N R / k 0(or)o Property Owner's Mailing Address Lot Block # Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road ( 715 - ) Z y6 - 5.'73 4 r')-10' J 16 C) c ue ® New Construction Use: ® Residential / Number of bedrooms Code derived design flow rated GPD ❑ Replacement ❑ Public or commercial - aibp: Parent material /t N 0 2- �5 .? -7 P c n Flood Plain elevation ff appiigb ^ ° ft. General comments and recommendations: JUN ST CROIX l` ❑ Boring C/C/ cr j1, 20NMVGOFFICE a Boring # Ground surface elev. / r ft. Depth to limiting factor �/� n. / � - • \ motion Rate ® Pit Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary GPDM In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 I e -/6 10 A/ Zf / In Z- q 2c o.7 4.2 2 /D- Z Y /DYl j �/,� C S - Z .:2 2y So 7 SY� s/ �IJS 6S A7 6 - /-2 Y D - //0 7-57X 4' Pl f 01 A� -- W 7 a Boring # ❑ Boring ® Pit Ground surface elev. /, �-� ft. Depth to limiting factor 7 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I - Etf#2 1 0 -'Y lore , /PA �s /r� 1 / . 1-2 8 - 23 /o Yt yi NA C V- 5 7,5K 6 RA- Ps Gr OJ SZ 111 75 Gr DS JycL — — . r rl y 43 • Effluent #1 = BOD > 30 < 220 mglL and TSS >30 1150 mgA- • Effluent #2 = SOD _< 30 mg& and TSS 1 30 mg& C Number Add Date Evaluation Conducted Telephone Nunber ti e .S�D,� ��rtir /,v� 6 - /r/ - 0 7/,� =� y7 700 Co� Property Owner 6n'cd 1T(`e c kAOe Acr Parcel ID # Page of a Boring # ❑ Boring ® Pit Ground surface elev. �' /S 3 ft. Depth to limiting facto /O in. Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 7 —zz % AI S 7-) 5 Osf 67 l a Boring # O Boring ® pit Ground surface elev. S ft. Depth to limiting factor 7 ;'�� in. Soil — Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Z S Z �S 6 S GT OS9 Cw �� L 3 zY iro 7s rf P7 a Boring # Boring S © Pit Ground surface eleV. 7 /, ft. Depfh to limiting facto in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 / S^ � i / � � .7 r.2 Y 6 - /i6 75 % �� 1 0& M4 Effluent #1 = BOD, > 30 < 220 mg& and TSS >30 < 150 mglL ' Effluent #2 = BOD, 130 mg& and TSS 130 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. SBD4330 (RA=) 3 Property Owner Ge /G/) 1 1 ( c kh O - - )6rl Parcel ID # Page 2 of ® Pit Ground surface elev. &7' 7, / a ,V Boring ft. Depth to limiting facto /D in. Sal A pplication Rate Horizon Depth Dominant Color Redox Description Texture Str Consistence Boundary Roots GPDM In. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh. '0111 1 •Eff#2 /.2- 7 -22 o / Zz f 3 6 l 7 Y�/ R � b.S� /'7 C � / F o 7 ,2 N Being # 0 Boring ® pit Ground surface elev. �g S ft. Depth to limiting factor % //a in. Sod Application Rate Horizon Depth Dominant C Redox Description Texture Structure Consistence Boundary Roots GPD/fP In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Efl#1 •Eff#2 Z B=ZY 7s,P 6 SGT 059 L Cw /10 3 zy iro 7srXVV �� ,�, Of m� J � /o - z a Boring # 0 Boring © Pit Ground surface elev. ft. Depth to limiting factor ] /b In. Sod Application Rate Horizon Depth Donanard color Redox Description. Texture Structure Consistence Boundary Roots GPD/fl' In. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efr#1 'Eff#2 J 0 -0 y Z S / /V .- 41-2 G Ce r b - 7 /.Z y160 (S A L C 1,2 Effluent #1 = BAD > 30 < 220 mgll_ and TSS >30 150 mg& • Effluent IQ = 800 130 mglt_ and TSS < 30 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 forma lease contact the department at - 8777 t, p 608 - 266 -3151 or TTY 608 -264 P seo4330 (RAM) OWNER Page 3 of 3 Name Kl Brian Parnell Address l6,9e CST 231314 lye " rnon 7 Date A Benchmark 1 1 p 44:4 AOe) �� A Benchmark 2 T flee R 101-5 ❑ Soil Boring 1 - 1 ,- -i Suitable Area 1 40' Scale 7 4- 7 f 77 -4 11 �1 5�, 13 4ep V 0 A"-V ................ ---------- T 7-7 65;92926 KATHLEEi1 H. 1AL111 REGISTER OF DEEDS ST. CROIX CO. YI RECEIVED Fill AENO CERTIFIED SURVEY MA 08-0 `' °" Located in part of the Fractional Southwest Quarter of the Southwest Quarter and part of FEE 4 Quarter of the Northwest Quarter all in Section 7, Township o North, Range 18 West. T lchma�nd, 14.00 St. Croix County, Wisco Wi Prepared for and at the request ot• OaNER: > Gerald A. Klwddfowfrr is Section Corner Monument Rail ee tetra of Record New Richmond, w 54017 1.1 t' s 24' iron Pipe weighing 1,13 pounds per linear foot Drafted by. Ty R. Oodge • • • • ......Bulding Setback Line (100' from Right of Way) i' APPROVED ST, CROIX COUNTY i rcl 114 CORNER to SEC7tAV 7 -JO -7C p �nY Zanln9 snd Perte Cn.� fFOU+1v 1• eecw n1aE) AUG S 2001 If not i� reaXdett within 30 days of � UNPLATTED LANDS OF OWNEi�rO date approwal shall be iO ------ ----- ---- -- ---- muff � iN ' N6 MW521 530.12' 0.04 �- 21• 210.04' 210.04" x z � `G ro ct LOT 3 LOT 4 !> LOT 2 OTAL TOTAL AREA: Q r' . FT. 139.255 SO. FT. I v TOTAL AREA: 3.20 ACRES i r j 139,255 SO. FT. AREA EM R -O -W: AREA EXC. -O -W: 3.20 ACRES t32,324 SO, FT. 132,324 SO. F', 4 z AREA EXC. R - O - W: 3.04 ACRES 19 3.04 ACRES u $ 132.324 SO. FT. u a 3.04 ACRES -i l i ti o o � ;R I rn LO th N N p \ \\ w jfi I� I 4 ty - Na9M5'52'E•630.12' s _ -'`� •� 210.04_ jc� W 2100044' �i 2 _0 .04' ' 210.04' °. r 2 210.04' • N69VS'52'E 2069.55' w Sa9'05'52 630.12 i f � S OUTHNE S 7 CCRNER1' _ S89V5'52'W 2699.77'---- .. sec7pew 7 -JO- 18 SO417N LINE OF 7HE SW 114 SW H 114 CORNER (FOUND ALUMIN!!M UNPLATTED LANDS SECnav 7-JO--18 COUNTY MONUMENT) - -.- - - _ . _ _ _- _ ( FOUNO AL UM/NW C0111aV7y MONUMENT) N OTE: h o Township lows, rules shown ond regulakonsagi.e.rw subject minimum otus =6 access to Parcel. etc.). Before purchasing or developing any parcel, contact the St. Croix County Zoning Office and th ro date Tow d for advice. JOB 0 V4057SUJI Prepared by. ` °ap1Y13w1 ?Ualywr t� J 4 ", y1�So &N v i__— ______ ° N TH r+r { Phone No. (71 24 6-4319 fi DODGE •1 SCALE IN FE inch E . 150 feat 1 Fax No. (715) 246 - -3830 F S -2434 ? BEARINGS ARE REFERENCED TO THE SOUTH LINE OF THE P.O. Sox 325 CLEAR LAKE,* SW 1/4 OF SECTION 7, TOWNSHIP 30 N. RANCE 18 W. New Richmond. W 54017 ri vii 5" WHICH hS ASSUMED TO BEAR S89'05'52'W. of S Sheet 1 `�•'••......• s C.' ���rrkG itih ;N�t ; V01.15 Page 4145 POWTS OWNER'$ MANUAL & MANAGEMENT PLAN Page - of FILE INFORMATION l -�(�' �� �' 3 SYSTEM SPECIFICATIONS Owner Tank Capacity al 13 NA Permit # ^--- ao" �- l J�q,rl'o.r�, J Septic Tank Manufacturer O NA DESIGN PARAMETERS Effluent F ilter Manufacturer �d„bt�� Q NA all Number of Bedrooms D NA Effluent Fil ter M Q NA N of Public Facility : Y Units Q NA Pump Tank Capacity g Q gal ❑ NA Estimated flow (averages) O gsy da Pump Tank M 1,z ❑ NA D esign fl (pe (Estim x 1.5) d (� a1/ rsI Pump fx O U. 0 Manufacturer O NA - Soil Ap plication H _ elide ,lftt Pump Model W4 Ci NA Standard Influerit/ Effluent Qualty Monthly average' Pretreatment Unit 0 NA Fats, Oil & Grease (FOG) 530 mg /L Q Sand /Gravel Filter 0 Peat Filter Biochemical Oxygen Demand (SOD.) ! s220 mg1L O NA 0 Mechanical Aeration Q Wetland Tota Suspended Solids (TSS) 5160 mg /L _ Ci Dis infect i on © Ot her: Pretreated Effluent Quality Monthly average Oispersel Ce(lis) ~� O NA Biochemical Oxygen Demand (SOD,,) s30 mg /L 0 In.-Ground (gravity) 0 In- Ground ipressurized) Total Suspended Solids (TSB) s30 mg /L CI NA ❑ At -Grade 0 Mound Fecal Cvliform (geom etric mean) s10" cfutlOQml M Drip-Line 0 Other: Maximum Effl Particle S iz e Ye in dip. 0 NA Other: 0 NA Q NA Other` ❑ NA "`laf ,es typical for damestie. wastewater and septic tank effluent. Other: � � C] NA MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank(si At least once ever month al y' � �!I ye ars) (Maximum 3 years) C] NA Purnp out contents of tank(s) When combined slud and scum equals one -third Q) of tank volume 0 NA Inspect dispersal call(&) At least once ever 13 months) -�� -- _ y X yearls) (Maximum 3 years) ❑ NA Clean effluent filter 1 At ieast once everyt / 13 month(s) -M NA At ea_Y r(°) n month(s) Inspect pump pump controls & alarm -- A C1 year) :) least once every: �---.. - O NA _ _ _ Flush laterals and pressure test f At l east onc every: ._ _ mh D NA s) ~- _ e ont Q years) _ Qther � � At latest once every -- ❑ month(s) ❑ NA Other: ❑ year(a) ❑ NA 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 'Insp 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 vombined sludge and scum and to check for any beck up or ponding of effluent on the ground surface. The dispersal ce "Hs) shall be visually inspected to check the affluent 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 (Y or more o+ 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, %sconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretrt,atment un'ts, 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. aoo� enatgiis�wwi�d u�suoaslM 10 v 1Z) '(thrGles DUO l►) tuwo, Jeideya yl!m oluelldwaa,ui pez)eip sem luawnaop sWl L 98°►h - °�SS� - S/G euo4d euayd 2 VAM N - GPWON AllllOHlnv 1561vineau '1Vo01 Itedwnd) b101VIGdO EM131A!!3S 3DV1d3S _ __ - ---- eu M E N — l E'— $ �� — ,5 I L auo4 @ �� � mod! � ewe si3N1V1 11 W V311VISNI S1MOd SIN3WW03 ivNdlllaav 31919$0dWI !10 impoId,dlO 38 AVW )INVI V d0 NOWUN) 3H1 Mid NOSRi3d V dO mows '11t1m AVW H1VM '93ONVIewhoj!)0 ANiV MONA MNV-L 1N3Vy1V31d1 U3H10 110 dlNfld '311d3S V 1i31N3 ION OO 'N30AXO LN3)3IdjnSNI dOiGNV S3SSVD 1V14131 NIV1NO3 AM SNNVl 1N3W1V3rd1 WH10 ONV dWMI '31.Ld3S < < DNINUVM > > awil lew 1E loage u! saini 941 y }Inn Aldwoo lonw VW04rAs vans ;u suo - ow l-ins an ;u! a4i le MUOi 0 41 ;o leno BUIMOpo; soeld ui po orulouoael 8q Aeu.J swaisAs uo13diosge Ilos apex -le pue punol ' I Mdd P611e; 044 eoe lde J of 3Josai lsel e s agel q Asw Nuel BufR104 P alggtlene s! 00je luawaoeldvi ou ;I •98A lusi.418oeidsi algeilr s a 910001 of pacwo ;Jad aq uollenlena t ails pug POS a Slh10d e y i ;a einila; uodn •ease luOWebelda 01ge1169 s & pivap! of petenl9na ua iou s9 al►s 941 ❑0 'S1MOd Aellei 941 e091dei at} 1x0003 3991 a ap palleisul aq Aew 4usl Bulploy a A6olouyoel 1 S.; n,�Od u! saouenpe BulJJeg suollellw,y PS JdIpue tloegi69 bl anp 8 1g 8 1!RAe lou si eeie 3uewooeldeJ algellns b U ' 3814119 409;1e u semi 041 4l!m Aldwoo isnur swalsAs luawou •eeie luo o1g93lns a y bi Uop e njena 0118 put pot M eu a JO; peo eyi ul llnsei I1!M eaJe luauieopidea ayl 10910id of einlled •sll0m pug toull 1 'tJn ;3x1340 p9 sodoid pug Bu14 wa; slosgles pa imbei A4 uodn paSulJ ;w aq IOU P0 pug uoliaedwoa put 4004MIGFp Lubi} po ;5eloid aq p1no4s eeie luawsoaldeJ 0 41 •welsAs uolldiosge 1!09 tu€ veneldai a ;o uolleool 01 41 AN pezlpin aq Am pus p93sn1ena ueeq seq eeie 3uawa3eldeJ algei!ns V iueydwoo apoo a epinoitl 01 'u9jei aq Ism Jo 'ueeq 0ngy sm�n9o•w QulMa11o; e wa4sAB luewoo9ldaa yl pailedeJ eq 3ouuea pue sll9; S1MOd 9 41 it NVId A3N3DNUNO3 lz nn pall►; coeds peon ay3 pue penowaJ sianao he 4 JO le u93ew P1109 VOW Je yloue Jo ISABA 'Ilos 4 penowes pue polgngoxe eq 119140 slid pug s4uei lie 'Buldwnd i9jjV • JoistadQ fiulolnJOg 96eideg a Aq ;a pasads,p Aliodoid Pug lsahowOJ eq lle4s sild pue sluel (le io siueluoo 942 • - peleas sbuluado adld paucpuvge 041 Pug p aq 11840 si!d pue SKuei of Buldid IIb • : enl3eJls1u1wpV ulsuoao(M 'Mgg wwOO A$de4o 41!m eauelldwoo u pauopuega A1a1 ; )i St welshs at 1943 asnsui of uetl63 eq 13 sdels BulM 9 A,te es pug AlJOdoJC4 0110; 44 gols ;o ;no ua�lei A1luauewJad $! Jo/pue spe; SIMOd 041 uQgM 1N3WNOONVGV 19u,Jq J O U0 4 08 MOM pug -tuodwgi ;sulildeu Ampues :sep!asad :sianpoid Bu pquled '1!0 ;sunllewlpauJ 'sdejos iedw 'sap!alglay :aseaJ6 !au1)o Il) ;ai$ulload 9lgeiRAan pee i1nJ; 'Je4gM (dwnd dwns, uleip uollepunol '1P; `si�,JOtae;u1spp :siadelP :0001; Isluep .sJase®JBep !egems u4Z306 tsulopucn ;sllnq 933•JeHlo :sed m A e eyi }a GA 043 Bunloid pue 40uewio;.rad eyi enaduq Xrw Wggiisl aglewal8enn e 4 i w0J a1 q q 's0llolgliu¢ :S1.MOd i3ulMO 0 ll f 4i !0 uolieu!wlla JO u0140npou `eeJ9 "10JO940 Jim apoz -ie Jo punoeu Aue ;o adols u tae; g l u!43lti� Me ayl 'zoedwocJ io gJn3s!p aslmie1430 Jo 'Jena 4Jed jO enlap 1bu c0 'sll 1psiadslp pug s�luel Zeno salod died 1 0; 9 iou o1J 01 s10Jzu03 dwnr4 ®y, Bu Allenuew ul lslsse bl JO I 9 w 'llUei dwnd eyi u141!M 810n01 lewiou eJOiseJ tS F�uuoisei of loud JoleJedO BulalnJeg a8elde e A I l W S1M0al 10 Jegwn a 3DeW JO dnd lu"WO eyi 01 Jamod 0 JOIs 0 S q p®AOU10J tlug; dwrld nyl P sluaiuoo eyl en94 Uolienils S1144 Prone o,L ' ;uanilia y e,p aoe ;Jrig Jo drijoeq eyi u! llnsei Aew put (*)I19b 941 OUIPsopano 'aeop a 6191 &UO u! ( IesJadalp s41 of PsSJgyoaip gq !I!m Jezennemm ssa0xa eyi peJOls•J s! JaMOd uayM •slpAaj J04OM4014 lewJOU enog9 lll; Aew siluel dtund seBeino mm od 8upnrj 'aoe ;ins 8A13eJ3411 1 9333 3Q u"64 sJt suOlilpuoo 1! U04M i n000 iou )legs do 1Je1S we iBAS slusluoa 041 0nP4 pa100iep aJ9 sl0npoid �ulluled suolipJ;,UaaUO0 g a5 tq od61 �id iO3eJedo BulolAM e891das a Aq penaweJ (sl3lue18y ; ;p s)0alwaya Jayio J 4Bfy it 'f ))1 I p y; 089wep Jo/pue s89oaid 1uewlgeJl 8141 epedwi AeuJ 1sy1 10 ;o aou0said 014; Jn; 19)4Ue3 weW0104 40040 S1MOd 941 ;o eon of Joud 'uotionJlsuoO Mau JOA tc — 96993 NOI1Vki3d0 ONIV d11 Lllklis START UP AND OPERATION Page For now construction, prior to use of the POWTS cheek painting products or other chem n treat tank( ®) for the presence of p • that may impede the treatment process and /or dam�g the diepersat G enial, If high concentrations are detected have the contents of the tank(s) removed by a sapless servicsng operator prior iq use. System start up shall not occur when soil conditions are frozen at the Infiltrative surface. During power outages pump tanks may fill above nortna ! hlghv►ster levels. W ed to W hen g h dispersal Power is rest er p sal ce!!(al in one large dace, ov rloedi np the cell {z) and may result in he backup or surface discharge dst;char of effluent. To avoid this situation have the contents of the pUthR teak removed by a 3eptage Servicing Q er Power to the effluent pump or contact a Plumber or F'OiNTS Maintainer to assist ' g p aloe prior to restoring restore normal levels within the pump tank, in manually operating the pump controls to Do not drive or park vehicles over tanks and diaper &al calls, Do not drive or park over, or otherwise disturb or �- , within 1 b feet down absorption area slope of any mound or at -grade soil absor ' ompac., the area . Reduction ar elimination of the following from the wastewater 8#eem may Improve the performances and a POW7S: antibiotics; baby wipes; cigarette butts; Qpndome; cotton stilr8bs; degreasers; dental floss; diapers; lg the .efe of the foundation drain !sump pump) water; fruit and vegetable Poo a; gelsolir1el grease; herbicides; meat sra s dis fat; painting products: pesticides; sanitary napkins; tampons; and water softener brine, p edicatians; oil; ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the s stem C omm y 3s Properly and safely abandoned in compliance with chap C n�rfn $3.33, Wisconsin Administrative Coda; • All piping to tanks and pits shah be disconnected and the a b andoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Ope; dtor. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled w1th soil, graval or another inert solid material CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following momsures have been, Of must be taken, to provide a code compliant replacement system; 0 A suitable replacement area has been evaluated and may be utilized for the location of a replacernont• 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 iinas 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. 0 A suitable replacement p nt area is not available due to setback anti /or soil limitations. Barring advances in l'O:'•J;S technology a holding tank may be installed as a last resort to replace the failed POWTS. The site as not en evaluates! to identify a suitable to lapernent area. Upon failure of the POWTS a soil and site ation be Pa evalu ormed to locate a suitable repleCefttent Brea. If no repl acement may b tells s a last resort to replace the failed POVVTS; p acement area is available a holding tank C] Mound and at -grade soil absorption systems may be reconstructed in place following removal of the hiomat at the infiltrative surface. Reconstructions of such systems must gamely with the rules in effect at that ti < waRNINa > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAiN LETHAL GASSES AND ±OR INSUFFICIENT OXYGEN, DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNbER ANDY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE. OF A PERSON FROM THE INTERIOR OF A TANK MAY BE (DIFFICULT OR IMP08518LE. ADDITIONAL COMMENTS POWTS INSTALLER WT MA INTAINER Name Phone / S .. g ".�� oS.l Pho - SEPTAGE SERVICING OPERATOR {PUMPER) LOCAL REgULATORY AUTHORITY Name _ .: N sine c Phone Phonq 7/S - 3 SI, - 5►68 Th s document was drafted in compliance with chapter Comm, 83.2212)(b)l l itd) &(() and 63.54 121 & 43l, Wisconsin Alt- ninistrav cooe. I Myl 4 SEPTIC TANK 8 PUMP CriAyBER Q 9Sa SECTION AND SP 4" Cl VENT PIPE 12" MIN. ABOVE GRAI?£ WEATHERPROOF ? 25 FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE �'+► WITH CONDUIT MANHOLE COVER W1 PADLOCK FINISHED GRADE CI RISER WARNING LABEL 4" MIN. 18" 'MSN. 6" MAX. „* • r ""LET g WATER TIGHT SEALS GAS' TIGHT + PPROVED A SEAL JOINTS WITH PPROVEO --— ;' LM APPROVED PIPE ;lPE 3' $ ON 3' ONTO )NTO SOLID ' SOLID SOIL ' PUMP OFF ELEV . FT. - --- OFF RISER EXI D PERMITTED ONLY F TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING U NDER TANK CONCRETE PAD SPECIFIGAIONS Sr?TT_C / DOSE 47 TANK MANUFACTURER: l�L�.��.�, t4UMBgR DOSES PER DAY. :ANK SIZES SEPTIC �'�.S�i GAL. DOSE VOUJME INCLUDING DOSE GAL. FLOWBACK:� GAL. i-ARM MANUFACTURER: $. _ CAPACITIES: A = ;I INCHES ( I6 GAL MBER: . - MOREL NU �,i..V B = � INCHES = q a•- GAL. SWITCH TYPE: '�y�l�c _ aa PUMP MANUFACTURER: G C 2 b INCHES = GAL. MODEL NUMBER: V to O SWITCH TYPE: mzRC D = INCHES = -lA GAL. REQUIRED DISCHARGE RATE 4 0 GPM PUMP & ALARM WIRING AS PER ILHR 16,23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE IQ FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . 2.5 FEET + -- (Z FEET FORCEMAIN X .`O FT /100 FT. FRICTION FACTOR . FEET TOTAL DYNAMIC HEAD = FEET 'tiTERNAL DIMENSIONS OF PUMP 'TANK: LENGTH - , - ; WIDTH --- DIAMETER LIQUID DTPTN a --- ---- -- i3 B • eQ / Cr,4L Pee 1 i T ! . DATE G r hED: �.r- -- L _ lr.�.�� -- c � T C ENS E NL M i ER .�� _��____ — 1188 [6]GOULDS PUMPS Submersible Effluent Pump 3871 EPO4 EPOS APPLICATIONS • Fully submerged in high ■ EPOS Impeller: Thermoplas- ■ Bearings: Upper and lower Sp ecifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing p g lubrication and efficient improved performance. construction. following uses: heat transfer. ■ Casing and Base. Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion • Farms manual operation. Auto- resistance. " standards nSSSOaauon • Heavy duty sump math models include • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, In "F" or "C ".) facto ry strength, and durability. SP ECIFICATIONS ■ Motor Cover: Thermoplastic Goulds Pw+>ps k ISO soot Regiswed• FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. 3 14 " maximum. ■ EPO4 Impeller: Thermoplas- i Power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant. • Total heads: up to 31 feet pump out vanes for mechanical • Discharge size: 1'h" NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA -N elastomers. • Temperature: 104°F (40°C) continuous METERS T, 140OF 60`17 intermittent. 10 • Fasteners: 300 series stainless steel, g 39 - - ---- -. ,� _ _ 5 G , Capable of running dry without damage to e components. 2 --``- Motor: • EPO4 Single phase: 0.4 HP, 6 20~ _. -- 115 or 230 V, 60 Hz, 1550 RPM, built in overload with o Is automatic reset < 4r L'P05 • EP05 Single phase: 0.5 HP, c 115 V, 60 Hz, 1550 RPM, 3 10.. built in overload with }. EpQq automatic reset. z • Power cord: 10 foot s .... _ standard length, 1613 r S JTOW Optional ° °0 1' _. 9 9 plug. pt 0 20 30 40 50 GPM foot length, 1613 SJTW with 1 three prong grounding plug a 2 4 6 s 10 12 ^ mlih (standard on EP05). CAPACITY G oulds P umps Q 2000 Goulds Nmps 4/`J ITT Industries Effective February. 2000 838'71 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer AA, S A-'v ti ati IT & s Mailing Address Z S � G / 54 ig' , ti C E - �'`. �d u-� /�'`�' �' S'/ � 9 0& Property Address k X X X � 6 d (Verification required from Planning Department for new construction) City /State Ac/j 6cy- �,,t..o y�A � ) / Parcel Identification Number 6 2 — /o 2- S -�U -3a LEGAL DESCRIPTION Properly Location Stn/ V,, ` /., Sec. 7 . T Zr N -R W, Town of eiG)4-4'h0 tiJ1) N . 3 Subdivision Lot # _ - Certified Survey Map # fns . Volume /s , .Page # Warranty Deed # 3 & 9s . Volume Z 3 s's— . Page # 2 Spec house ❑ yesA no Lot lines identifiable# yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof your septic system could result in its pretature 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal 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. Uwe, 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 Zoning Office within 30 days of the three year expiration date. 12Y /6 7 SIGNA OF DATE OWNER CERTIFICATION 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. Z / l D7 SIGNA , DATE «s * « «* Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.""" «« Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed w 2385 PA .,% 214 3 6 9 x 9 STATE BAR OF WISCONSIN FORM 2 - 1999 KAT REG H. IT OF D EM 1)ot:umeru Number REl3ISTR BEDS ST. CRGIX Co., YI This Deed, made between Rolling_Hil Datrv. Inc. RECEIVED FOR RECORD Grantor, and 06/22/2403 09:40AN Daniel . Jents and lsannon C Jents hus band and wife. WARRANTY DEED Grantee. ANTY i1 _ Grantor, for a valuable consideration, conveys and warrants to Grantee EIEW the following described real estate in St. Croix County, State of Wisconsin REC FEES I.I. (if more space is needed, please attach addendum): TRAITS FEE- 165.88 COPY FEET Lot 3, Certified Survey Map Volume 15, Page 4145, filed as Document CC FEE: No. 652926, located in part of the fractional Southwest Quarter of the PAGES: I Southwest Quarter and part of the Northeast Quarter of the Northwest Quarter all in Section 7, Township 30 North, Range 18 West, Town of Richmond, St. Croix County, Wisconsin. Recording Aria p Name and Return ,�tkdk4 RN TO : / Burnet Title 7550 France Ave. S. First Floor Edina. MN 55435 _o2tb- 1o25 -10 -300 Parcel identification Number (PIN) This is homestead property (is) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any Dated this day of Ag nst 2003 Rolling Is Dai y Inc. '_ .______ __. • By: Rita Kieckhoefer, Tr urer AUTHENTICATION ACKNOWLEDGMENT Signature(s) RoI9ng_HiI1s Dairq, Inc., by Rita Kieckhoefer, STATE OF } Treasurer ) ss. County ) authenticated this Sl _ day of Au, plat _ - _ , 2003 Personally came before me this day of - -- - the above named • Kristlna Ogland TITLE: MEMBER STATE BAR OF WISCONSIN ( not, _ to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY � !tprnq _ !S � r Istkw Hudson, WI Notary Public, State of - -- - — My Commission is permanent. (If not, state expiration date: (Signature may be authenticated or acknowledged. Both are not necessary.) ' Narnes of persons signing in any capacity must be typed or printed below their signature. infonnauon Professionals Co., Fond du Lac, wl STATE BAR OF WISCONSIN SM655 -11121 WARRANTY DEED FORM No. 2 .199! i r .. _..,.� , +4;- Al rY 4 r. � ... - ?� of d9r+� # ; � I•r �' �= i a �� � - r 3 4 — n I 1. g ro t i 44 rx r, y, In