Loading...
HomeMy WebLinkAbout030-2139-10-000 Wisconsin Departmentof Commerce PRIVATE SEWAGE SYSTEM County: S Safety and HuAing Division INSPECTION REPORT Sanitary Permit <, 463083 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID o: • j Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. C� Permit Holder's Name: City Village X Township Parcel Tax No: Miller, Sam I St. Joseph Townshi CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: a� I In p ' 1:f�)P4_ QJC = CS i 04.29.19. TANK INFORMATION U ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � )ZSo / Benchmark (0• ,�,� OU.O Dosing 1 y Alt. B 57, Zt, O I . W/ Aeration Bld ewer ZC q2. Holding St/Ht Inlet � 15. 1• g TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom r / Lt Dosing t, r � � r Header /Man. ' 162 Aeration Dist. Pipe Holdin Bot. System CID 0 . 00 Final Grade $ -3s� PUMP /SIPHON INFORMATION C• 3r Manufacturer Demand St Cover 7ELL-6P1 GPM �•Z� ����5 odel Number 53 10. ZZ TDH Lift Friction Loss System H Ft (a.F9 n. Pi -ro Forcemain Length 1 Dia. Dist. to well S Z 4 SOIL ABSORPTION SYSTEM p ENC Width I Length f No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM S 3 � /� SETBACK SYST EM TO t P/L BLDG WELL LAKE /STREAM LEACHING Ma facturer. Type INFORMATION Of CHAMBER OR O &L S ystem: t (0 p i — UNIT Model Number. 1 1.0 K DISTRIBUTION SYSTEM -f L� Header /Manifold U Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length 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 [] Yes No ] Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:()"[ (T /� Inspection #2: - --- T -- Location: 1163 56th Street Houlton, WI 54082 (SW 1/4 NE 1/4 4 T29N R19W) Park Hollow Lot 10 �1 / \ Parcel No: 04.29.19. 1.) Alt BM Description 2.) Bldg sewer length = b ( U - amount of cover� � I ���� y _•(rte 11� , Plan revision Required? [ •_! Yes No L Use other side for additional informati n. SBD -6710 (R.3/97) # _ e Date `���� Insepctors Signature Cert. No. DEL -17 -2004 03:49 PM A.C.E. Soil & Site Eval. 715 248 7764 P.01 Does Tank Information w#*r with W* and bo * Q *Am VW Elrohloal a per NEC 300 and "ww Comm 1626 WAC DMoonned � 4 In. min. Tank component Is Rop&* vented 4--- Ana, at" tocft Weser Concrete Manufacturer Forcanlak� dMrr+ehr Ca 2 In. 773.78 Gallons Volume 1 18.12 D alAnch A Weep hole or on& Dimension Inches Gallons A 26.48 428.94 C B 2.00 32.24 � (rt D 7.52 121.14 D 12,00 193.44 D Total 48.00 X73.76 ir ` Dose hrllc arevation rt 9• bedding u er tank Alarm Manuefacturer jLeveLArM Alarm Model Number I DLV - Pamp Manufacturer Zoeller Pump Model Number 153 Pump Must Denver � gpm at eft TDH Pmjeot: Miller Construction - Residential Dose Conventional Page 4 of 8 rri G7�h O SS s DEC -17 -2004 03:49 PM A.C.E. Soil & Site Eval. 715 248 7764 P.02 BB 53' BB" - z N N? y I �z_f 1 a rn_ (A I wRg r � A 5 m ± s t 3" 57" z 1 r. I I I •' � / v I I � • • � � J r D 0in m y T rn a z G C D N D Z Y C m 0 z m y z i7 "+ -r m Z -+ w o In A c) n 2 p z #rm r2r A v r.,p v o o o�v .o r,or-oz'�.'D N i l r� U n m D C7 AZT Dc $ " 5 ?- -40 • - mt' _f N C r m Z < N VIr��f� �m2do p,M�.. N r) rn z m I m r O rn A X ~ n 1. Ar51n1 °llr 'W n \ 17 = 0 D / r r U A D 2 p, .v D (A m I pt r y 0 U; O A nr '71 �• X ^r 2 N r5f m cs n� rn to m 'Ai M 4« N d p n 2 O Z s �mm m CD O D 0 N A U1 O m C ZZ =r C 0 v n 2 O C y m .,-% a m �_t O Z cm p (n N O m w v� D rn N n z o c rn rn o m n Z z rn rr*i W -( r� \ W1250/750 --MR \ WISER COnCAETE S CALE: 114 REV N0. pA1E. i DRAW BY;SWT _ E T \ SEPTIC MANUAL WS716 uS HWYtD, MAIDEN ROCK, WI 54150 DATE: JANUARY 200 REV, JAN. 2004 800 325 - 8456 PILE: W1250 750 -MR PUMP PERFORMANCE CURVE $ PUMP PERFORMANCE CURVE PUMP PERFORMANCE CURVE SUMP I EFFLUENT MODEL i f EFFLUENT MODELS S 318 112" & 3/4" SOLID PASSING CAPACITY 42 '° 318 ", 112" & 314" SOLIDS PASSING CAPACITY U ------ - 4 53155 191 MODEL 48 5A59 72 76 98 1371139 140/4140 151 152 1 153 13 Feet Meters Gal. Lhers Gal. Liters Gal. Liters Gal. Liters Gel, Liters Gel. Liters Gal I Liters I Gal I Liters Gal. Liters Gay. ?Liter 3 R 5 1.5 29 110 43 163 38 144 50 189 1 72 273 93 352 86 326 50 1 169 69 261 77 10 3.1 22 83 34 129 30 114 40 151 61 231 79 299 BO 703 45 170 81 231 70 ?69 1p 15 4 -6 10 38 19 72 14 53 30 114 45 170 64 242 73 276 38 144 53 201 3 1es 20 6.1 - - 17 64 25 95 36 136 68 250 29 110 44 167 52 - 9� 1 4186 25 7,6 -- - -- -- -- .. .. -- -- -- 8 30 59 223 16 61 34 129 _ ^ a2T -- 5> 30 9.1 -- .. .. .. .. .- .- .. .. - 49 185 :1 40 12.2 -. .. .. .. .- -. _- -_ .. .. .. 28 106 , 50 15,2 -- ._ -. .- .. .. -. .. .. -- -. -- .. .. .. 32 10 60 183 -- -- -- -- -- 100 80 24.4 .. .. _ .. .. .. .. .. _- .. .. .. .. 3 90 27.4 .. _7 - _ i � 100 30.5 _ -- -- _ - _- - - .. — T 110 33.5 -. .. _ .. .. .. .. .. .- -- 90 2 120 36.6 -- -- - -- - - - - •. 130 39.6 26 86 Shut -off Head. 18 ft. 5.5m 19.25 ft. 5.9m 18 fl. 5.5m 25 ft- 7.6m 23 ft. TO 26 fl. 7.9m 50 ft. 15 2rrl 30 ft. 91m 38 h 11 t 6m' 44 S. 3 =m 1 24 80 165 4165 75 0 22 161/4161 163/4163 165/4165 185/4185 18614186 188/4188 18914189 191 2 65 4163 Gel, Liters Gal. Liters Gal 7 Liters Gal- Liters Gal. Liters >- Gal. Liters Gal. L.1ers _ 100 379 61 231 61 231 58 220 145 _ 549 145 545 a5 _ 5 60 93 352 61 231 61 231 58 220 140 530 0 530 11 161 169 85 322 60 227 61 231 58 220 134 X 507 35 55- 4161 4189 79 299 59 223 60 227 58 220 128 484 131 4M - -- 1F{ 1au 70 265 57 216 59 223 -- -- 58 220 122 4 6 — 'S - � — 50 4140 62 735 55 206 56 220 85 322 58 220 116 7 1 - - 454 — Oaf 5 166 45 170 46 172 55 208 70 265 58 220 193 58 220 TD --t 394 109 1 < � - 4166 20 76 _ 33 125 50 189 51 9� 341 9 T— 4J 15 57 39 148 32 121 58 220 71 12 2 40 3 87 9 34 52 797 51 I 197 9 1 _ _ 152 153 10 38 45 170 26 8 35 31 117 _ 2�.j� 34 ^ '.29 - - 1 - 16 80 30 151 .. -. .. .. .. 4 15 r'_t. _ 85 g 4185 . _. - 25 5 . 66.171m 66 It20.1m 69 K.264m 73 it.223m 114 A. 347m 9 t1 -277m 110 fi.(33 37n ti 20 0099226 4 2 CAU710N Model 185(4185 should not be subjected 5- 46 2 7s 1 3 7 to less than 30 feet TDH. ss 139 NOTE: For Pump Performance on Model 112, Industrial col - GALLONS 10 20 30 2 40, 50 60 70 80 90 700 110 129 130 140 150 umn explosion proof pump, see FMO219. LITERS 3 BO 16 240 320 400 480 560 FLOW PER MINUTE 009922A SEWAGE AND M 264 66 26 8 2 0,42 , 2,4 — 4 , c 9 5 DEWATERING 5J z r'r + 7z _t tl 11 �J °] Y 96 - J6 �s tl 8 ]] t 50 f 9 19 �. S 0 OB 0 0 J �0 1b _ SB X 56 2 l� 6 0 1e b _ - 1I— - � C __. { _ 1 _ � Y . - -- -r - -.. .o ,. 0 w .. v - a Z 0 293. - . _ . PUMP PERFORMANCE CURVE SEWAGE MODELS 2" SOLIDS PASSING CAPACITY _ 21 -1 I - - - 264 � -97 14 ' 7�� Model 29374 should not be 28 4 subjected to less than 15 fe H. K 30 4G `0 50 70 90 90 1 C0 110 0 1YJ 1470 1`0 70 180 19 10 10, F,1 1 1 C 27' 210 ?2G 73; 4 �3, � 4c 7 2'� 009904ABLK FLOW PER MINUTE © Copyright 2003 Zoeller Co. All rights reserved. 6 1 7 Safety and Buildings Division County �-- G IP J * i sconsin 201 W. Washington Ave., P.O. Box 7162 Madison, WI 53707 - 7162 Sanitary Permit Number (to b filled i by Co.) 4 (608) 266 -3151 De artment of Commerce State Ian I.D. Number Sanitary Permit Application 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, a 15.040 xm) 1. Application Information - Please Print All Information 1 Parcel # Lot # Block Property Owner's Name - # Property Owner's Mailing Address property Location o J ' Section City, State Zip Code �( Circle W � �f + T --+. N: _ . of Building (check all that apply) i division Name E IM F ❑ I or 2 Family Dwelling - Number of Bedrooms ❑ PubliclCommercial - Describe Use l C! ❑ S to Owned - Descrje Us� . 3X`1 3 . ) 5 C - I to ❑City_❑VillageRTownshipof 3t6 1� ,� 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ANew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System List Previous Permit Number and Date Issued B. [] Permit Renewal C1 Permit Revision ❑ Change of [I Permit Transfer to New Before Expiration Plumber Owner IV. Type of POWTS System: Check all that a Z ❑ Non -Pressurized ❑ Motnd> 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetla _ Pressurized In- Ground Holding Tank 11 Peat Filter 11 Aerobic Treatment Unit [I Recirculating Sand Filter ❑ l __X ...__...._�._ Recirculating Synthetic Media Filter hing Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑Other (explain) V. DispersalflFreatment Area Informati on: . o r =, Di s p ersa l (sf) System Elevation Design Flow (gpd) Design Soil Application Rate(gpdsf) persa Area Required (sf) Dispersal Area Proposed � 5 3?10 e733 ' 7Y. oa ef Site Steel Fiber Plastic VI. Tank Info Capacity in Total Number Manufacturer Gallons Gallons of Units Concrete Constructed Glass New I Existing Tanks Ta Septic or Holding Tank Aerobic Treatment Unit2 Dosing Chamber 2 a O ' 1 VII. Responsibility Statement - i, the of 1 1,11 assume responsibility for installation of the POWTS shown on the attached plans Plumber's Name (Print) Plumber's Signature I MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Cod -ro it ILCP 1 111. unt /De artment Use Onl Sanitary Permit Fee Sincludes Groundwater Date sued uin Signa (No ) pproved ❑ Disapproved Surcharge Fce) O , L!� Q ❑ Owner Given Reason for Denial ���!### --- ` IX. Conditions of A proval /Reasons for Disapproval Arisen eompkte plans (to the County oaty) for the system on paper not less than SM a 11 inches in size SBD -6398 (R. 01/03) Safety and Buildings Division . County - -- Alf 201 W. Washington Ave., P.O. Box 7162 C,Q,O 19 ISCOnsin Madison, Wl 53707-7162 Sanitary Permit Number (to be filled w by C i Department of Commerce (608)266 -3151 Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.2 1, Wis. Aden Code,-personal information you provide may be used for secondary purposes Privacy Law, s15.04(lxm) Dwiect Address (if different than mail VV /G3 1 s Ti 7 1. Application Information - PleasePrint AllInfo matto yt - 1 ,,,rE. { Properly Owner's Name f Parcel N Lot q Blame P operty Owner's Mailing Address .,5 y Pr V � ! ? ection City, State W r Syol �� le 11' Ty Building (check all that apply) T o w Vub sion N C'31v1 t`�frt�t ' I or 2 F welling - Number of Bedrooms ❑ Public)Cotrw - Descn..,, se � ❑ u ed -De Us 3' X .•7S" E NES .�D City_ ❑VillagelTotwship of TD3 4 �� . ill. Type of Permit: ( ck only one box on line A. Complete line B U applicable) A. New System placement System ❑ Treatment/Holding Tank Replacement y ❑ Other Modification to Existing System - 8 • Cl Perm t Renewal ❑ P vision ❑ Cbange of ❑ Permit er to Now List Previous Permit Number and Date lsiucd Before Expiration Plumber Owner I I V. Type of POWCS System: Check all t o 1 _ , XNon - Pressurized In- Ground ❑ Mound > 24 f suitable soil 11 Mound tss f suitable soil 1) At -Grade ❑ Single Pass Sand Filter U Constructed Welland ❑ Pressurized In-Ground ❑ ding Tank ❑ Peat Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leachin this ❑ Drip Line Pi ❑ Other (explain) V. Dis ersalrrreatmentArea Information: :e -04 5'ra• _ Design Flow (gpd) Design Soil Application RatoZpdsf) at Required (sl) Dispersal Area Proposed (sn System Elevatiou Go - -- I VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Gallons Gallons of Units Concrete Coastructed Glasi New Existing Tankx Tanks S.-rix or HuUng Tank Z.� �a •s �,: ruble Tmaimcm Unit Caing Chamber GA..10 v'll. Responslbill Statement- 4 the undersignedf. unit responslbWty for lnstalLdon o POWYS shown on the attached plans. Plumber's Namz (Print) Plumber's S' tun MP/MPRS N.044 Business Pbone Number Plumber's Address (Street, City, State, Zip Code) FILL Court Te artment Use Only _ Approved ❑ roved Sanitary P ertnit Fee includes Groundwater Date Issu , Is wing gent Signature (N S za i; Surcharge Fee) wnerGiven on al 2 - 5 1X. Conditions of ApprovaU sans for Disapproval K SYSTEM OWNER: 3) N� t Burl - 1 Septic tank, a ent filter and C�A� dispersal cel ust all be serviced / maintained as per man ement plan provided by plumber. — o 2. All setbac equirements must be maintained as per ap icable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than a1 /2 1 It luches in site SBD -6398 (R. 01/03) ✓R. �~S� Qtr-�� ^\ i rs �- ¢ f ' ar,L Lv 2 +b..1 K3 1 00 R I r_ r<l-a iw J r e -3'k 4z.7S'Tiaucl..s �•`�� C /OD.0 /s -L3;o D: C4jsyad.4m.cL.Trt,ac,L. Q - T T Wti .77' �i C; Op l . S W sTo.w. Q G. Ak4k '�yY3l a.s Xt'y' a , uAl y -13e� Ller ld d (�j /2Sh co'4 L ST' w 2 +b�.1 i9 J o0 rte A � 1 31 1� 3' WA- - T, -',P � - / = /O d. oa /S- i3 ; o D : q4os wa dc. c.L.Trtac L, "r a . `T'Z31'►1 '1'eP e' L 6 S 77 '2 RECEIVES i 1756 Wiscor►sin Department ofCom JAN 1 6 2004SOI� EVALUATION REPORT Page 1 of 3 Damon of Safety and BuildinW. in accordance with Orrim 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations ST. RO'X "' U�� i`. i County Attach complete site plan paper X1 mdles i size. Plan must St. Croix include, but not limited to: M), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. Pending from 030 - 1014 -50-000 Please print all information. R iewed By Date Personal information you provide may be used for %=dary prrposes (Privacy Law, s. 15.04 (1) (m)). 2 Z Property Owner Property Location Sam Miller Govt. Lot SW 1/4 NE 1/4 S 4 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# P.O. Box 151 10 Park Hollow City State Zip Code Phone Number City Village ✓ Town Nearest Road Hudson WI 1 54016 1 (715) 386 -2769 St.Joseph I River Road ✓ New Construction Use: ✓ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install two trenches at elev. 94.00' using 28 leaching chambers. Boring # Boring U ✓ Pit Ground Surface elev. 98.42 ft. > 1 06 „ in. Soil ' Depth to lim ing factor Application Rate AL- � Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 `Eff#2 1 0 -10 10yr3/3 none sil 2fcr mvfr as 2fmc 0.5 0.8 ( 2 10 -23 10yr5/4 none sil 2fsbk mvfr cs 2f,1mc 0.5 0.8 to 3 23-36 7.5yr4/6 none gr Is 0 sg ml cw 1fm 0.7 1.2 4 36 -54 10yr4/6 none s & gr 0 sg dl cw if of 0.7 1.2 '} $q o 5 54 -90 10yr5/6 none s 0 sg dl gs - 0.7 1.2 6 90-106 10yr6/4 none s 0 sg dl - - 0.7 1.2 F2 ] Boring # Boring ✓ Pit Ground Surface elev. 98.39 ft. Depth to limiting factor >1 10" 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 1 0 -8 10yr3/3 none sil 2fcr mvfr as 2fmc 0.5 0.8 .6 2 8 -23 10yr5 /4 none sil 2fsbk mvfr cs 2fm,1 c 0.5 0.8 (o 3 23 -32 10yr4/6 none gr Is 0 sg ml cw 2f of 0.7 1.2 , b 1 4 32-48 10yr4/6 none s & gr 0 sg dl cw if of 0.7 1.2 5 48 -85 10yr5/6 none s 0 sg dl gs - 0.7 1.2 6 85 -110 10yr6/4 none s 0 sg dl - - 0.7 1.2 } Effluent #1 = BOD 5 > 30 < 220 mg/( and TSS >30 < 1 mg/L fflyefit #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signatu : CST Number James K. Thompson •s— 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, la, WI 54020 11/13/2003 715 - 248 -7767 Property Owner, Sam Miller Parcel ID # Pe nding from 030 - 1014 -50 -000 _ Page 2 of 3 3] Boring # Boring ✓ Pit Ground Surface elev. 98.12 ft. Depth to limiting factor >113" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -8 10yr3/3 none sil 2fcr mvfr as 2f,1 m 0.5 0.8 2 8 -25 10yr5/4 none sil 2fsbk mvfr cs 1fm 0.5 0.8 3 25 -35 7.5yr4/6 none gr Is 0 sg ml cW 1fm 0.7 1.2 4 35 -50 10yr4/6 none s & gr 0 sg dl cw - 0.7 1.2 5 50-86 10yr5/6 none s 0 sg dl gs - 0.7 1.2 S. — 6 86 -113 10yr6/4 none s 0 sg dl - - 0.7 1.2 ❑Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAV in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP 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 S_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. / 4otIO /� /at o{ / /low � � I Pro pos e_ cl Tow A 2p Proposed dr,✓fwllly ■ 83 �PtS�N Brea Co,- c /ace,",,,f f $ ■ ■ 62 C o o p art c,w 97. o' p, Ass itm a / ekw /00- 00 ILL . 7;,o o4" /oi Q. �Jci; = /o 8. i s �o p, 303 • r Bi oD iff use r • • i �.,. � �.... .�..— 1.x...1. �... �...... �. � � HW En d Universal End Cap Chamber 11" Stan• 14" High 16" High Available Siz Dimensions dard Capacity Capacity i'• r .'.`!'•ail r ,��,��I ,r r.:� {• � •'�. � • y ,SJ.•CQ �. - _�� • * r `I�l �`, �' � r `f ♦'- F�:.t C ''�� \`, � »1..`'.1*r11t41: / r G ., l • 1 isv l� � }}. ti0. Y t � L t L r t' '! J • l�'V b lk � i ° :te�: lG'� 1. r. it � • ,�' • r r .ir'��I{ },� � �` y�.' �i.'•wa� ?�,''rl•.:.Yi��.�•;:{'• .. �i:ru..(i�' /�u��.y.�. jc� ° 11 C " ' lo POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner S IIA AA A C I l Septic Tank Capacity I Z S c3 al ❑ NA Permit JI Septic Tank Manufacturer 463 �$.3 P ' g ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Z 6 " L ❑ NA Number of Bedrooms t ❑ NA Effluent Filter Model A _ a p ❑ NA Number of Public Facility Units 5NA Pump Tank Capacity al (CIA Estimated flow (average) :5'0 g al/day Pump Tank Manufacturer KNA Design flow (peak), (Estimated x 1.5) D O g al/day Pump Manufacturer ONA Soil Application Rate D, - 7 gal/day/ft' Pump Model (& NA Standard Influent /Effluent Quality Monthly average• Pretreatment Unit Cg<NA Fats, Oil & Grease (FOG) 530 mg /L O Sand /Gravel Filter O Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L In- Ground (gravity) O In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA O At -Grade O Mound Fecal Coliform (geometric mean) 510' 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 SCHEDUL Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA X,y 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: O month(s) (Maximum 3 years) ❑ NA 2; year(g) Clean effluent filter At least once every: / - 2 O month(s) fir ear(s) ❑ NA Inspect pump, pump controls &alarm At least once every: ❑ month(s) ❑ year(s) ❑ NA Flush laterals and pressure test At least once every:. ❑ month(s) ❑ NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ 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 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 cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority, When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and dispo$ed 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, 4 r S UP AND OPERATION Page o! Qew construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals ,gat may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents 'of the tank(sl 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 cell(s) 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 repl;� ent system: suitable replacement area has been evaluated and may be utilized for the location of system. The replacement area should be protected from disturbance and compaction and should not be ringed upon absorp required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. O 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. ik � T alua �-0NS`??Z(JG?Z� O Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the nfiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT.TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name POWTS MAINTAINER �c..�QfUL� -C..C_ Name A, ' ` Phone / 1 � , GY c q 6 0 tO J / 12 Phone / 2 - S) k I L- SEPTAGE SERVICING OPERATOR (PUMPER) Name LOCAL REGULATORY AUTHORITY 5 Name Phone ( 2D�/� . Phone —1 /S— 3 & ,/- !o This document was draped in compliance with Chapter Comm 83 .22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. I ST CROIX COUNTY SEPTIC TANK MAIN'T'ENANCE AGREEMENT " AND OWNERSHIP CERTIFICATION FORM Owner/Buyer /W (j_ LQ- ' Mailing Address 4"15^ Property Address l I ( P 3 (Verification required from Planning Department for new construction) City/state./y., 6(s o .T Z4, Parcel Identification Number ` LEGAL DESCRIPTION Property Location S LJ '/4, E '/ Sec. q . T ?- N -R_Lto Town of Subdivision H o LL 4 t.y . Lot # Certified Survey Map # (O 3 : , Volume Page # Warranty Deed # - 71 , J( 2 - `� 9 , Volume 2 Z . Page # ©d 3 Spec house 0 yes ❑ no Lot lines identifiable Xyes ❑ no SYSTEM MAINTENANCE 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. 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, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in g condition and/or () after inspe and ro o 2 mg (if necessary), the septic tank is less than 1/3 full of sludge. P um P P Pe r operating 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 Zoning Office within 30 days of the three year expiration date. oy ATURE O-r7SPLICANT 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. TJ ILCL O'I h�jATIJRE' AP LICANT DATE • • • • • • 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 '1 2214 P 003 718249 KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM I - 1998 REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., WI Document Number RECEIVED FOR RECORD This Deed, made between James E. Ebbe, an adult single man and 04-/21/2003 03:00PM Thomas A. Ebbe, as custodian of Theodore A. Ebbe, a minor, under the Wisconsin Uniform Transfers to Minors Act —� WARRANTY DEED EXEAPT # Grantor, and Sam E. Miller TRANS FE E: 1 0 050 COPY FEE: CC FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (The "Property "): Recording Area Name and Return Address Sam E. Miller P. O. Box 151 Hudson, W1 54016 L The SW 1/4 of the NE 1/4 of Section 4, Township 29 North, Range 19 West, St. 030. 1014 -50 -000 Croix County, Wisconsin Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Together with all appurtenant rights, title and interests, Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except continuing easements and restrictions of record, if any. Dated this 17th day of April 2003 ames E. Ebbe . Thomas A. Ebbe custodian for Theodore A. Ebbe AUTHENTICAT yY Pl! "lt tiijf. ACKNOWLEDGMENT ` =DPP e ��C i fflj f STATE OF WISCONSIN ) Signature(s) e� ', ) ss. St. C roix County. ) OE Personally came before me this 17th day of r — authenticated this day of i, P % April, 2003 the above named J James E. Ebbe and Thomas A. Ebbe �' VY �1 -A � TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me k own to be the persons o executed the foregoing inst t d ac ow ge t i authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY William J. Radosevich, Attorney at Law 502 Second Street, Hudson, WI 54016 Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are not My Commission i rmanent. (If not, state expiration date: necessary.) 'Names ofpersons signing in any capacity should be typed or printed blow their signatures WARRANTY DEED STATa aAR Of WISCONSIN FORM N.. 1 - I"" INFORMATION PROFESSIONALS COMPANY FOND OU LAC, WI 600.655•:0:1 50 ;69 ......... .... — 749.40'— LOT 8 : W 130, 700 sq. ft. - ; 00 ;, LOT 9 3.00 acres : t°• 131, 006 sq. ft. .o 3.01 acre o s z s .,Jolnt Drlvewoy L.B.O.= 884.5 1 t F` Easement 3 N. rz) c £o o sem 9 en e t )T4 I )8 sq. ft. -- + acres . 296 04 1 + , N ��•Q5 /.• fro ss. • 160.23 1 1 \ •• - + 60.27 �'+ 5.54 ^, `s a ' • - • - M :► I I �n = Orolnoge B7AX ap • • S` i :I N o ��`� : E t '� • o 63 - S78o o ' + N ao � + N � CN to 1 + I ' I 1 O / LOT I O 130, 772 sq. ft. N N 65 + 3.00 acres /�• g4 ; L. B.0.= 881.5' ON �'� � g �; y� mo w. 66 b •- • �i R � � - c,6 J',,. 3' •N7 46 ' 'y `�'•• LOT 1! - /(v 7T� �.� 131, 306 sq. ft. / �' F`• : 3.01 acres • ,� N. IKEA . � D rainage • i. ` Easement h LOT !2 131, 457 sq. ft. 3.02 acres n s si y , W69 t • � � a $ � k 0 \ � e o 0 k a § C A [ '0 . m R o z o I { f 3 )7% . � # « 2 � a L E § ° z z' 0 { « / IL m « \ \ B B k 2 $ ) ° 2§= N c m�© ' Q � S. E + \ 3 E 5 } R \ _ CL o o a k § } e § k k i � £ 7 a a a � ; .;t § 2 j v _0 8 ° z � 0 _ 0 § � % \ k / � § § n 44 a / ¢0 / o{ K / CO 2 41 \ o ) / k � J � C — Z "CL \ r &� aka§ c 0 a ;0 3 0