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N N O �J 7 fD ~ ti W CD O W CD O III O y Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479494 0 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: Hendricks, Edward I St. Joseph, Town of 030 - 1071 -10 -000 CST BM Elev: Insp. BM Elev: BM Descripti Section/Town /Range /Map No: 26.30.19.253K TANK INFORMATION ELEVATION DATA TYPE MANUFACTU CAPACITY STATION BS HI FS ELEV. A -1 cn Septic t r MM 6� N::�KCP-d �'O �� o Dosing .f Aeration Bldg. Sewer J2.24 ?cr.9o' Holding SUHtInlet 'Z•d 1 / TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ,� Z� Dt Bottom (� 8S. yl O To Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System 19.0 11 . Final Grade • PUMP /SIPHON INFORMATION o J Manufacturer �6,�� GP and ` St Cover ti Model Number � i � D S3 - 10•0 C12 . o TDH Lift • 4 Frictio� System Head TDtj Ft • , O •-- t Forcemain Length t ia. ist. to Wel ZO Z SOIL ABSORPTION SYSTEM oa>rt' RENCH Width / Length ( No. f Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DI 30 � SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING [Manu fac t rer: I INFORMATION CHAMBER OR Type Of System: / UNIT el u gr: O DISTRIBUTION SYSTEM • c ,�cr (, Header /Manifold Distribution �xH e Size x le Spacing Vent to Air Intake Length '�— Dia Length Dia Spacing O'h 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: C>Q r.31 11 12AP5 Inspection #2: 1 ? Location: 1382 Frog Pond Lane New Richmond, WI 54017 (Gov't Lot 4 26 T30N R1 9W) metes & bounds Lot Parcel No: 6.30.19.253K 1.) Alt BM Description = S •T• �� �� (✓{�� S KS 2.) Bldg sewer length = 64 s - amount of cover = ,� � 3) �� Plan revision Required? � I � Yes No Use other side for additional information. _ ._ �. �� � • i SBD -6710 (R.3/97) Date Insepctor's Sjg(iat(e _� (� "Oow ert. N , Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 �y i Madison, WI 53707 - 7162 ermit Number to be fi led in b Co. ) SCO�t�'IS //� Y Department of Commerce (608)266- �, 4 � .7 1 i Sanitary Permit Application State Pl I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you rovid r "i 005 maybe used for secondary purposes Privacy Law, sl5.04(1)(m) Project A dress (if different than mailin address) I pn � f 1. Application Information - Please Print All Information 6Y3 g �'-°� ONI F Property Owner's Name . arcel # Lot # Block # Property Owner's Mailing Address + Property Location +G � /a, City, State Zip Code Phone Number lt %a, Section 5 7 o/ (e - v - d/ s, (cicle or e) Z 53 T 0 N; R �O r Eor � II. Type of Building (check all that apply) �� a5 �1-m - 2 Family Dwelling - Number of Bedrooms _ I L _ ��I 7 ��M •� Subdivision Name CSM Number - ❑ Public /Commercial - Describe Use ❑State Owned - Describe Use at� ity_ ❑Village oTownship of fit. Type of Permit: (Check only one box on line A. Complete line B if applicable) k A. ❑ New System lacement System Y p y m ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System f 4 4 AALO Q B• d ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner e of POWTS System: Check all that a 1 Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ onstructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter )<A eaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) O�P V. Dispersal/Treatment Area Information: a I Design Flow (gpd) ;_ Design Soil Application Rate dsf) Dispersal Area Required (sf) Dispersal Area Pyo ed (sf) Syste levatio - 7 D E Z � 8 �VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing r Tanks Tanks peptic or Holding Tank . Aerobic Treatment Unit Y— o Dosing Chamber >e- C' VII, Responsibility Statement - I, the undersigned, assumerespon ility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' igna re MP/NfPRS Number Business Phone Number /Al rlQ - Plumber's Address treet, City, State, f ip Code) —4!F� S �� C d°Zl�G� �� VIII. ( tun CA Onl Approved ❑ =Pprove Sanitary Permit Fee 'ncludes Groundwater Date sued Issuin gent Signatur (N mps) Surcharge Fee) � q L ❑ O eason enial "�`-' v � 1 �J IX. Conditions of Approval/Reasons for Disapproval ad m 3 f J � e1�`t (� �o �Z �� SYSTEM OWNS: ) Uo •�1 +'e.+�aY 2 1 , t. 'Ssplil:.t * 4 Mlumt tl W WW ,(6 $ ' e-o, ee. t v� +b �� • 7 , +b / d epereal wt aN f� 2. � i M re�gWrom plasm pMvkled be by 1 /( d b• J 1 Z Sa ` 0 Y ble code / ordinances ., a •` — 15 � per appNca � � Z � � b 5 . � +� At ch m coplete plan (to the Cou ty )for the syste on aper no t less than 81/2 x 11 inches in size 7 5 aw ��� � IdJIC�L\ ►'�� C7� atCJa�`�' SBD -6398 (R. 01/03) CL AV, - IZ e � i "3"Wv M3T4I xis slNt snsuBM , Mnst ; t / J te' RA _R 1 i i A l l Q r�-r� a •w 8- +l.'- ... L•i .. y t „ i , + , C , , « 99 +r i✓ � P t 9 .............. ...�+ ...., ,.jV 62 ;KP RM �; ... -.w� . .ate.... - :��, r,..dY.....�,_ � � °. �,. �✓ �*"' �. S V � r i J �ib ,e ;`7 . fa6r'1:• / °'ZyGr r "� dxp e�r 7' '` : ' t 0) 'A Wi C,� µin o Jai fir+ A ?` rvISCumr = ueparwrientorinaum, SOIL AND SITE. EVALUATION REPORT Page 1 of s Labor and Human Relations Division of safety a Bulklnp in accord with ILHR 83.05, Wis. Adm. Code »��....�. COUNTY Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (13Mt), direction and %,of slops, scale or PARCEL I.D. I dimensioned,' north arrow, and. location and distance to nearest road. 030- 1107 -1100 APPLICANT INFORMATION.- PLEASIE PRINT ALL INFORMATION REVfEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Ed & Lori Hendricks GOVT. LOTH 114 NE va,S 2617 30 ,N.R 19 fc (or . W PROPERTY OWNERS MAILING ADDRESS LOT a>t BLOCK 8 SUBD. NAME OR CSM N 2 na na 1382 Frog Pound Rd. CITY, STATE ZIP CODE PHONE NUMBER ❑CITY OVILLAGE [MOWN NEAREST ROAD Hudsqn, WI. 54016 (715 381 -8187 St. joseph Frog Eqnd Rd. ([ New Construction Use I if Residential / Number of bedrooms 3 [ [ Addition to existing building jxJ Replacement [ I Public or cornmerc ial describe Code derived daily flow 450 gpd Recommended design loading rate .7 bed, gpolttt .8 trench, Absorption area required 643 bed, ft 563 trench, S ?Maximum design loading rate _, .7 tied, gpdtft .8 trench, gpdgt Recommended infhitration stuface elevations) Area A= 93.93 -8 =92.87 ft (as referred to site plan benchmark) Additional design / site considerations area of B-3 backfilled to code Parent material lake terrace . Flood plain elevation, if applicable na ft S - Suitable for system CONVENTIONAL MOUND iN- GROuND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK tt - UnsUltable for s stem OS ❑ U 0 S @ U i7C S o u 0 1 1 ®U 5C] $❑ U 0 S ® U SOIL DESCRIPTION REPORT Boring # fH Depth Dominant Color Mottles Texture Structure Consistence Boanfty Roots GPR /ft in. Munsell Qu, Sz, Cont. Color Gr, Sz. Sh, Bed Trench 0 -31 10yr2 /2 none fill material cs 2f np np 2 31 -35 10yr3 /3 none sil lcsbk mfr gw if .2 .3 Ground 3 35-46 10yr4 /4 none scl lcsbk mfr gw na .2 .3 elev. 9 6.7 n, 4 46 -84 7.5yr4/6 none ms Osg ml na na .7 ;.8 Depth to limiting factor +84 Remarks: Boring* 1 0 -18 10yr3/3 . none 1 lcabk mfr cs 2c 14 .5 2 : 2 18-48 10yr4 /4 none sicl Icsbk. mfr gw lc .2 .3 3 48 -84 7.5yr4/6 none ms Osg mvfr 04S na .7 .8 Ground L` :_ 97. OQ 7� 7 �s --� v�-� c� 5 m.� y� iti �i 16 Depth to limiting +g 4" Remark CST Name:-- Ptoase Print G L. Steel Phone: 715 -246-6200 Address: 1554 2 e. New Richmsd& WI 5 17 Signature: Date: 4 -10 -99 CST Number: m02298. PROPERTYBWNER Ed HendrickB SOIL DESCRIPTION REPORT P+ Rf PARMI.D.0 030 - 1107 -1100 — Boring # F2' Depth Dominant Color Mottles Texture Sere Consist�noe ggxidary Roots GPDIft in. Munsell tau. Sz. Cwt. Color Texture Sz. Sh. Bed` 0-17 10yr3 /3 none 1 lcsbk, mfr gw 2c .4 .5 3 17 -38 10yr4 /4 nonce Biel lcsbk mfr gw im .2 .3 Ground 3 38 -62 10yr5/4 none sil lcsbk mfr gw na .2 .3 ems 4 62 -10 7.5yr4/4 none ms 0Bg mvfr na na .7 :.8 99..L ft. Depth to kung factor +1 2" Remarks: Boring # 1 0 - 10yr3 /3 nme 1 lmsbk mfr gw 2f .4 .5 4 2 9 -22 10yr4 /4 none sicl lcsbk mfr gw if .2 .3 3 22 -34 7.5yr4/4 none sl lcsbk mfr gw na .4 .5 Ground elev. 4 34-96 7.5yr4/6 none ms Osg ml na na .7 .8 97�i- ft. Depth Ip brUng Lj facto +a�w Remarks: Boring # 13i Gmudd elev. ft Depth to limiting facts Remarks: 80fing # 13.1 Ground ft Depth lind5ng facts STEEL'S SOIL SERVICE Gary L. Sted Ed & Lori Hendricks 1554 200th Ave. CSTM r{W-OMk S26- 730N -RI9W New Richmond, Wi 54017 MPRSW -3254 town of St. Joseph (715) 246 -6 N. 1 "=40' Hsi.= top of concrete walk by front door el. 100.00' Alt. EM.= bottom of house siding C el. 99.50' Ar 141. 30 ZE .a. bp s Gary L. Steel 4-10-0 Wiscoffsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # 07 C6 - 6 00 dimensioned, north arrow, and location and distance to nearest road. 030 - rTV7 — M-T� " APPLICANT INFORMATION- PLEASE PRINT IN i4`fib . REVIEWED BY DATE PROPERTY OWNER: ti` !;Y .� ERTY LOCATION Z Ed & Lori Hendricks �,'' ' /', Fs r, ";7 G- LOTNW 114 NE 1/4,S 26T 30 ,N,R 19 fC (or) W PROPERTY OWNER':S MAILING ADDRESS J LOT BLOCK # SUBD. NA M # 220 randview Dr. 1 -- ( �,., na a na 1382 rog Pond Rd. CITY, STATE ZIP CODE `_, � NE NU [:]CITY ❑VILLAGE []TOWN NEAREST ROAD Hudson, WI. 54016 38 l;t. Joseph Frog Pond Rd. [ J New Construction Use[ :4 Residential/ N bf.bedrooms 3 ' [ J Addition to existing building Ix1 Replacement (]Public or commerce Code derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Recommended infiltration surface elevation(s) Area A= 93.93 -B =92.87 ft (as referred to site plan benchmark) Additional design / site considerations area of B-3 backfilled to code Parent material lake terrace Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem El S 1:1 U El 6O U 0 S El EIS ®U ® S ❑ U [Is ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh . Bed Trench 1 0 -31 10yr2/2 none fill material cs 2f np np 10 r3 3 g 1 -35 2 3 none sil lcsbk mfr w if .2 .3 Ground 3 35 10yr4/4 none scl lcsbk mfr 9W na .2 .3 9 6.7 ft. 4 146-84 7.5yr4/6 none ms Osg ml na na 1 .7 .8 Depth to limiting factor +84 ^` 4 Remarks: Boring # 1 0 -18 10yr3 /3 none 1 lcabk mfr cs 2c .4 .5 2 < 2 18 -48 10yr4 /4 none sicl lcsbk mfr gw lc .2 .3 3 48 -84 7.5yr4/6 none ms Osg mvfr na na .7 .8 Ground elev. 97.O Depth to limiting factor + a Pn Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200 e. New RichmeAd, WI 5 017 Signature: Date: 4 -10 -99 CST Number: m02298 a— 4'Q�� e PROPERTY OWNER Ed Hendricks SOIL DESCRIPTION REPORT Page? "'%3 PARCEL I.D. # 030 - 1107 -1100 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourb3y Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -17 10yr3 /3 none 1 lcsbk mfr gw 2c .4 .5 3 2 17 -38 10yr4 /4 none sicl lcsbk mfr gw lm .2 .3 Ground 3 138-62 10yr5 /4 none sil lcsbk mfr gw na .2 .3 elev. 4 62-102 7.5yr4/4 none ms Osg mvfr na na .7 .8 9 9 — L ft. Depth to limiting factor +10 2" Remarks: Boring # 1 0 -9 10yr3 /3 none 1 lmsbk mfr gw 2f .4 .5 4 2 9 -22 10yr4 /4 none sicl lcsbk mfr gw if .2 .3 3 22 -34 7.5yr4/4 none sl lcsbk mfr gw na .4 .5 Ground elev. 4 34 -96 7.5yr4/6 none ms Osg ml na na .7 .8 9 ft. — Depth to — limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: i SBD- 8330(8.05/92) PROPER.TYOWNER Ed Hendricks SOIL DESCRIPTION REPORT Paget of 3 s PARCEL I.D.# 030 -1107 -1100 f Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmer& 0 -17 10yr3/3 none 1 lcsbk mfr gw 2c .4 .5 2 17 -38 10yr4 /4 none sicl lcsbk mfr gw lm .2 .3 Ground 3 38 -62 10yr5 /4 none sil lcsbk mfr gw na .2 .3 elev. 9 4 62 -10 7.5yr4/4 none ms Osg mvfr na na .7 .8 9 _ i ft. Depth to limiting factor +10 2" Remarks: Boring # 1 0 -9 10yr3 /3 none 1 lmsbk mfr gw 2f 1.4 .5 '} 4 2 9 -22 10yr4/4 none sicl lcsbk mfr gw if .2 .3 3 22 -34 7.5yr4/4 none s1 lcsbk mfr gw na .4 .5 Ground elev. 4 34 -96 7.5yr4/6 none ms Osg ml na na .7 .8 9 7.6 ft. Depth to fimiting factor Remarks: Boring # Ground elev. ft. Depth to fimiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) r ` STEEL'S SOIL SERVICE Gary L. Steel Ed & Lori Hendricks 1554 200th Ave. CSTM2298 NW4NE4 S26- T30N -R19W New Richmond, WI 54017 MPRSW -3254 town of St. Joseph (715) 246 -6200 N 1 =40' BM.= top of concrete walk by front door C el. 100.00' Alt. BM.= bottom of house siding C el. '99.50 V , 30, ,3 4 s Gary L. Steel 4 -10 -99 J 5 4 Private On -Site Wastewater Treatment System ( POWTS) Index & Title Sheet Owner: 4- lm,.. /' 1 1�r�t•��, � �S Project Name and System Type: �,i Location: Street Address tq 'AV 6v Azc S d k z 3©.. Legal Description S i eeD k Township /County Contents: Page 1: Sanitary Permit Application Page 2: Plot Plan Page 3: Soil Test Page 4: Plans Page 5: Septic Tank Maintenance Agreement Page 6: Warranty Deed Page 7: POWTS Owner's Manual Management Plan Page 8: POWTS Owner's Manual Management Plan Page 9: POWTS Owner's Manual Management Plan Page 10: Certified Survey Mgp Page 11: Copy of House Plans Attachments: Plumber/Designer: Mike Rogers Signed: Credential Number: 225094 Date: 5 S ART UP For new construction, prior to use of the POWTS check treatment tank(s) 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 tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water - saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable /fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. Valves Valves shall be operated in the following manner: �-ATarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back -up of sewage into the dwelling or surfacing. INFECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). 0%.*tic Tanks Component Tank inspections must include a visual inspection of the tank 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 backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one -third (1/3) 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 NRI 13, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. tfi2jhL Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of the filter. Any service needs or repairs shall be promptly taken care of -mound Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Page of I ` ❑ Mound, At- Grade, In- Ground Pressure The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. 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 other 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: CMLA 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 protect the replacement area will result in the need for a new soil 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. ❑ 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. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ 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 CONTIAN 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 Phone 1/ Phone S EPTAG E SERVICING OPERATOR (Pumper) LOCAL REGULATORY AUTHORITY Name Agency Phone Phone K:IWPDATA1EH\POWTS OWNER'S MANUAL.doc Page of Chamber SAS SYSTEM ELEVATION AND SIZING CALCULATIONS Below Grade Soil Absorption Systems Hendricks l Owner's Name 9/21/05 Review Date n Y or N Highly Pretreated Effluent 3 ft Suitable Soil Below System 12 in Chamber /Unit Height 8 ft Maximum Bury Depth 3 Ezflow EZ1203HP & EZ102H 450 gpd Estimated Daily Peak Flow 0.70 gpd /ft In -situ Wastewater Infiltration Rate 642.86 W Chamber /Unit Area 50.00 EISA ft / Unit 13 # of Chambers /Units 92.80 ft Proposed SAS Elevation 26.50 Bottom Area ft` / Unit Soil Surface Acceptable Finished Grade EL 4 (ft) Boring Grade Limitation SAS Elevation (ft) System Minimum Maximum Number Elevation (ft) Depth (in) Lowest Highest Elevation? 94.80 101.80 1 96.70 84 92.70 95.70 Yes 2 97.09 120 90.09 96.09 Yes 3 99.10 102 93.60 98.10 No 4 97.60 96 92.60 96.60 Yes 1. Depth of suitable soil required below the infiltrative surface for treatment. 2. Total height of chamber in inches. 3. Maximum bury depth as per manufacturer's recommendations. 4. Based on chosen system elevation, and chamber height. Top of chamber is finished grade may be required to meet minimum or maximum code standards. Version 4.0 04/03) TDH Calculations TOTAL DYNAMIC HEAD CALCULATIONS Gravity or Pressure Dosed Systems Hendricks Owner's Name 9/21/05 Review Date X X Gravity Dosed, or gpd Design Wastewater Flow X Pressure Dosed ft Total Combined Lateral Length Y or N n Forcemain Drainback in Lateral Diameter Must use 4 in, pipe with gravity dosed 9 25 ft Forcemain Length in Forcemain Diameter gpm System Flow Rate ft Minimum Design Head 5.00 ft Vertical Lift 0.01 ft Forcemain Friction Loss 5.01 Ift Total Dynamic Head 0.64 ft/sec Forcemain Effluent Velocity Forcemain velocity problem Choose Pump That Discharges At Least: 25.00 Igpm at 5.01 feet TDH M 0.00 gal Maximum Dose 0.0 gal 5x Lateral Void Volume gal Forcemain Drainback 0.00 gal Forcemain Drainback gal Maximum Dose Volume 0.0 gal Minimum Dose Volume Version 4.1 ( 07/03) / ��!! // SECTION: 2.20.010 ,,114L/TY FNZ-E /9,�� FM0493 _/3 'A � 0404 \_ Product information presented J / -- ✓� , —� Supersedes here reflects conditions at time - k of publication. Consult fac - 1103 tory regarding discrepancies or ■ inconsistencies. MAIL TO: P0. BOX 16347 • Louisville, KY 40256 -0347 visit our web site: SHIP TO: 3649 Cane Run Road • Louisville, KY 40211 -1961 http : / /Www .zoeller,com (502) 778 -2731 • 1 (800) 928 -PUMP • FAX (502) 774 -3624 Non Clogging vortex impeller. 53 - 57 Cast Iron Series Float operated, submersible (NEMA 6) 2 -pole mechanical 55 - 59 Bronze Series switch & variable level long cycle systems available. UL Listed 3 -wire cord plug; 9 ft. standard for automatic, 15 ft. standard for nonautomatic. (For Pump Prefix Identification see News & Views 0052) Corrosion resistant powder coated epoxy finish. No sheet metal parts to rust or corrode. Stainless steel screws, switch arm, guard and handle. °� L No screens to clog. �TYm g SUBMERSIBLE PUMP Watertight neoprene "On ring between motor and pump u housing. te L ( SUMP) " 2 FOR Solid buoyant polypropylene float. Tes ted to UL ( ) s CRAFt� Motor - 60 Hz, 1550 RPM, oil- filled, hermetically sealed, Standard UL778. O automatic reset thermal overload protected. IP EFFLUENT (SEPTIC TANK SYSTEMS) SSPIIA Upper and lower sleeve bearings running in bath of oil. MEMBER Entire unit pressure tested after assembly. PASSES ' /2" SOLIDS Carbon ertified io CSA n and ceramic shaft seal. p Standard C22.2 No. I08. 1 n SUMP Jq Maximum temperature for effluent or 1 /z NPT DISCHARGE ANDSEwAGE . dewatering -130 °F (54 °C). AUTOMATIC PUMP MFRS ASSN. `�. Passes 1 /2" inch spherical solids. MODEL 1'/2' NPT Discharge. I! On point -7'/4' - Off point -3 ". ) Major width -10 3/32 ". . Height -10 1/16 ". r _ MODEL 55 'E= Cast iron switch case, motor & Bronze switch case, motor & pump housing. pump housing. Glass- filled polypropylene Glass- filled polypropylene base. base. Engineered, glass - filled, plastic VORTEX TYPE Engineered, glass - filled, plastic impeller with metal insert. IMPELLER impeller with metal insert. Stainless steel guard & handle. Stainless steel guard & handle. Bearing - lower & upper oil fed Bearing - lower & upper oil fed bronze. cast iron. ki(ODEL 59 I L L 5 % All bronze construction. All cast iron construction. Stainless steel guard & handle. Stainless steel guard & handle. Bearing - lower & upper oil fed Bearing - lower & upper oil fed bronze, cast iron. Bronze impeller Cast i ron impellek W1 0 D E L S ARC:: dal s� tl Y SUBIVIERSIB .I1' POWDER BN MODEL COATED Watertight - dust tight. Permanently oiled bearings. ABLE L.•� E 4 �,ON Cp Automatic or Nonautomatic .;uelw� "53- 57 " -.3 HP, 115V or 230V "55 - 59" - .3 HP, 115V or 230V Note: The sizing of effluent systems normally requires variable level BE53/BE57 & BN53/BN57 available packaged float(s) controls and properly sized basins to achieve required with Piggyback Variable Level Float Switch pumping cycles or dosing timers with nonautomatic pumps. © Copyright 2004 Zoeller Co. All rights reserved. L w TOTAL DYNAMIC HEAD /FLOW ,� LU LU U_ PUMP PERFORMANCE CURVE PER MINUTE MODELS 53/55/57/59 EFFLUENT AND DEWATERING 6 20 - MODEL 53/55/57/59 y Feet Meters Gal. Liters 15 5 1 1.5 43 163 -c 4 10 3. 0 34 129 10 15 4.6 19 72 009897 Shut -off Head: 19.25 ft.(5.9m) 2 5 3 718 — i 63M6 �— 45/8 1 112 -11 tit NPT 0 10 20 30 40 50 -� 3 718 GA LL O NS LITERS _ 1 0 80 160 FLOW PER MINUTE ' Variable level float switches available. - — Variable level long cycle systems available. , i Available with special cord lengths of 15', 25', 35 and 50'. Alarm systems available. 161/16 ! Duplex systems available. 33/32 Single Seal — _ Control Selection , Listi_n 1 !_. Mod I Volts Phase Mode Amps7 Simplex D uplex CS_A UL 1. Integral float operated mechanical switch, no external control required. iv153155 & M57I 115 - Auto 9.7 j 1 Y Y 2. Single piggyback variable level float switch or double piggyback variable level N53/55&N57159 115 1 _Non 9.7 _ 2 3 or 4 & 5 Y Y oaf switch Refer t FM0477 — - — -- — fl a er o BN53 115_ 1 Auto 9 7 _ ! _ i Y Y BN57_ 1 1 Auto 9.7 �- pl _ Y 3. Mechanical alternator °M -Pak" 10 -0072 or 10 -0075. BE 57 230 ` 1 A 4.8 y y 4. See FM0712 for correct model of Electrical Alternator. r 1)53/55 & G 7/59 _ 32 0_ Aut 4 .8 1 Y Y_ 5. Variable level control switch 10 -0225 used as a control activator, with Electrical E53/55 & E57/59 X 230 1 1 1 No x_4.8 2 1 3 or 4 & 5 Y Y Alternator (3) or (4) float system. Single piggyback switch included. O CAUTION For information on additional Zoeller products referto catalog on Piggyback Variable Level Float Switches, FNJ0477; ;r- iwu01i 4 controls r, 2 1'11011 devices Und wiring should be done by Electrical Alternator, FM0486; Mechanical Alternator, FM0495; Sump /Sewage Basins, FM0487; and Single Phase r.:: a ;, ai ai ai 'Aiy codes should be fullowe. "'L;' Simplex Pump Control /Alarm Systems, FM0732. 1'cot ;-! io -„ _Ic: u ' Code (dct) aid the Occupation 11 Gc&ty Jrr ... i For unusual conditions a reserve safety factor is engineered into the design of ever Zoeller um 9 Y . p P MAIL TO: P.O. BOX 16347 Z 17� Louisville, KY 40256 -0347 Manufacturers of.. � SHIP T0: 3649 Cane Run Road ® 1 (50 2I778-2731 Louisville, KY 40211 -1961 KMZITYPMURS 9 pNCE lff7g . 1 (800) 928 -PUMP Q http: / /www.zoelier.com PUMP �O FAX (502) 774 -3624 © Copyright 2004 Zoeller Co. All rights reserved. w TOTAL DYNAMIC HEAD /FLOW 2i w PUMP PERFORMANCE CURVE PER MINUTE MODELS 53/55/57/59 EFFLUENTAND DEWATERING r 0 6 20 MODEL 53/55/57/59 s Feet Meters Gal. Liters 15 5 1.5 43 163 0 4 10 3.0 34 129 0 10 15 4.6 19 72 2 009897 Shut -off Head: 19.25 ft.(5.9m) 5 f 3 718 Y _ _4 6 3116 5/8 11/2 -111i2 NPT o � 10 20 30 `40 50 ® 3 718 GALLONS LITERS 0 80 160 T } FLOW PER MINUTE 4 I �. �,4RF0AL APPLICAI I, Variable level float switches available. Variable level long cycle systems available. Available with special cord lengths of 15', 25', 35' and 50'. Alarm systems available. 10 v1s I ; I i Duplex systems available. I' I 33 /32 I Sin le Seal Control Selection Li s tin s :i_f v I J)< <z? TIDE t Model i Volts Phase Mode Amps Sim lex Du lex CSA UL 1. Integral float operated mechanical switch, no external control required. M 5315 5 & M& M 9 115 1 Auto 9.7 1 Y Y ! 2. Single piggyback variable level float switch or double piggyback variable level I_ _N 5A N57/ _115 1_ Non 9.7 1 2 3 or 4 & 5 Y _ Y float switch. Refer to FM0477. BN 5 + -r 3 115 5 I, 1 Auto 9 . 7 - ---- Y Y 3. Mechanical alternator "M -Pak" 10 -0072 or 10 -0075. BN 115 1 Auto 9.7 - - -- N Y _ BE53I57 2 Auto 4.8 I — 4. See FM0712 for correct model of Electrical Alternator. ` _ � 1 - - - -- Y Y D53/55 & D57159 230 1 2 Auto 4.8 1 __ Y y 5. Variable level control switch 10 - 0225 used as a control activator, with Electrical E5 3155 & E57/59 i 230 _ 1 Non 4.8 2 3 cr 4 & 5 Y Y Alternator (3) or (4) float system. Single piggyback switch included. D CAUTION Foi information on additional Zoeller products referto catalog on Piggyback Variable Level FloatSwitches, FM0477; ;a 1 wsmiiaiiun of cuntrois, protection devices and wiring shouid be durie by Electrical Alternator, FM0486; Mechanical Alternator, FM0495; Sump /Sewage Basins, FM0487; and Single Phase lit; u d clucia r r n r -,il pct icrd and safety codes should be followLE) wL i; Simplex Pump Control /Alarm Systems, FM0732. 'W' scent i! Idunal 'cle ric CodL (I IEC) and the Occupational SaMiy and For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. BOX 16347 Louisville, KY 40256 -0347 Manufacturers of.. 0 SHIP T0: 3649 Cane Run Road Louisville, KY 40211 -1961 Q16VTY SIADF lff& ® p 1 (50 2)778-2731 • 1 (800) 928 -PUMP http: / /www.zoeller.com l VMP �O FAX (502) 774 -3624 © Copyright 2004 Zoeller Co- All rights reserved. r —�' — '#- '1 c-a T �g��' iwt�ws nu��aau N�neona aarwveum m�'i tau jhuumvmvx astvazMOas A IOILLNO3 siNZMUOada AMMDad MM SSYR 'ad • SHOAHAWnS X NOISM Oxv KM am S313rdGNM IHO'i V 43 � S�IIrJNH MII F "a (.1.1 . ri. a gy p` Ilion ,d s s a LL � 4i t d is.r .1. F'S^ ZO. b\ I 1 / / WEH _ . .(,°k � ti' k° ' \ l k '� / 1 � J ffi - � S Q N W 3 •bae acs• � Vi i. - � ! �! i ! � / o, % r� mwc0 s? W 40 f ce p O I p @ a r ieo i 1I WOO M I E., C _ s m � o. w. ac' A _ ,rs Iii •� �a ZV d - 41 4z 5 J � • 8 �Q- eV• / c \, � ('�, 1 � 40 d li J p , s / IN 'LE. q Wware soouua'LX3S nAINUO dSYMOMMzaeusa000sma euoe�: yas V899 96L SLL xej 9LL9 WRd accre►z�►t �wua wao's�uoaBB,xenM L40V91M `PUDARM — N �Pltl / `IIl!J681uf ` ll� se)Old„ D S*WPUG"W11 PM ps oil ff E = g al l a ����' O n �a � � $ g n n Z 2 o• .21 ! ! 2�� $ 4 a 8SS S a g 3 �i' $I - g $ S 8 a �w gds its �°�s {p „gS �� SS gt 9 1 7 cF Wwg • Bn�Y� _�'� � � £g•fl TS i$t�bi5 �a le i - —as SEa - z a 8 g s Sew ps+°EZ$ •q € - o �.�aieiv •e g .er S gi� S 1 � 8 .ME • -! T Q: p�s • v : J��i'•. _ a i CO L =''Qc p a I (1 6 co f A �j / 0 0 r Parcel #: 030 - 1071' -10 -000 02/10/2005 03:14 PM PAGE 1 O F 1 Alt. Parcel #: 26.30.19.253K 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): = Current Owner " HENDRICKS, EDWARD M & LORI L EDWARD M & LORI L HENDRICKS 1286 89TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): • = Primary Type Dist # Description tT SC 3962 NEW RICHMOND J SP 8040 BASS LAKE REHAB DIST SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 26 T30N R19W PRT GL 4 COM 1948 FT W Block/Condo Bldg: OF NE COR, TH S 352 FT, S 43DEG E 484 FT, TH S 50DEG E 264 FT TO POB TH S Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 50DEG E 122 FT, S 40DEG W 130 FT TO 26- 30N -19W SHORE LK, NWLY ON LK TO PT S 40DEG W OF POB TH NELY 155 FT TO POB Notes: Parcel History: Date Doc # Vol /Page Type 04/21/1999 601719 1420/464 WD 04/21/1999 601718 1420/461 QC 2004 SUMMARY Bill #: Fair Market Value: Assess ith: 5328 193,600 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 141,400 49,100 190,500 NO Totals for 2004: General Property 0.000 141,400 49,100 190,500 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 73,900 39,200 113,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount 040 -OTHER ASSM'T SPECIAL ASSESSMENT 441.63 Special Assessments Special Charges Delinquent Charges Total 441.63 0.00 0.00 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer d a r �d Loy i Hcrdrfcks Mailing Address Bq / Property Address Bg2 IbM Ln (Verification re4mifed from Planning & Zoning Department for new construction.) City /State N !' o o _)j j Parcel Identification Number c� te - 3Q • 2.S3 < 036- 16 7 /- /6 -a LEGAL DESCRIPTION Q Property Location /, , NE 1/4 ,Sec., T 3() N R ( "1 W, Town of ��p _ . Subdivision , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (,n I I q , Volume 4 , Page # 1 64 Spec house yes no Lot lines identifiable Pye no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification staring that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the threUear expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 13 � G 4 / 12-1 SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) VOL 1420MGE464 STATE BAR OF WISCONSIN FORM 1 — 1982 6 ©1719 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS DOCUMENT NO. ST CROIX CO., WI RECEIVED FOR RECORD This Deed, made between Kevin Bottineau 04-21 -1999 8:30 PM a /k/a Keven Bottineau YARRANTY DEER EXEMPT 1 Grantor, Y �Y FEE: and _Edward M. Hendricks and Lori L Hendricks, l husband and wife p pt FEE: 840.40 RECORDING FEE: 10.00 PAGES: 1 Grantee, Witnesseth, Thu the said Gtantm, for a valuable =WdqdaL conveys to Grantee the following described teal estate in S t . C r o l x THIS SPACE RESERVED FOR REC DATA County State of Wisconsin: NAME AND RETURN ADDRESS Commencing 1948 feet West of the Northeast Heywood $ Cari, S.C. 1 corner of Section 26, Township 30 North, Ra ge P.O. Box 125 19 West; thence South 3�2 feet; thence S 43$30' Hudson, WI 54016 E 484 feet; thence S 50 E 264 feet to the place of beginning; thence S 50 East 122 feet;thence S 40 W 130 feet, more or less to the shore of Bass Lake; thence Northwesterly along the shore non in7l - of Bass Lake to a point which is S. 40 W 1S5 feetPAR °E`IOENT'F'oAT'°NNUMBErt more or less, from the point of beginning; thence N 40 E 155 feet, more of less, to the place of beginning,-together with an easement 33 feet wide for travel over and across a parcel of land located in NW 1/4 of NE 1/4 of Section 26- 30 -19, Town of St. Joseph,.the Westerly line of said easement being described as follows: Beginning at East corner of a parcel recorded in. 11 463 11 , pgge 489 in the Register of Deeds office of St. Croix County, thence N 50 00' W a distance of 396.0 feet; thence Northerly to a point on South side of public highway, said point being two rods South and 1738 feet West of Northeast corner of said Section. This i s homestead (IS) ((isnodj� P .ro Perry Together v �evin ginf u lII88U duamena and appurtenances thereunto belonging; And 1 � warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except and will warrant and defend the same. Dated this 4a day of April 19 9 9 (SEAL) _' L 2u'c.-1 (SEAL) KEVIN BOTTINEAU (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signatures) Kevin Bot State of Wisconsin, a /k /a Keven Bottineau �. County. authent4Md,his o f Ap r i 1 19 9 personally came before the this day of the above named TITLE: F NSIN of au . Stats.) to the (mown to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY H eywood $ Cari,S`.C.by Samuel R. Ca 9nd T.nrnct St FLnAenn w T S 11 6 Notary Public, County,Wis. (Signatures may be authenticated or acknowledged. Bah are not My commission is permanent. (if not, state expiration date: necessary) 19 ) ' Namrs of pttaau sigNng in My npKky shouid by typed a primed below I kir $"tum. WARRANTY DEED STATE BAR OF WISCONSIN Wboonsn LnW Blank Co., Inc. Form No. 1- 1982 Marraugt", yyy POWTS OWNER'S MANUAL MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner e Septic Tank Capacity p� gal ❑ NA Permit # Septic Tank Manufacturer .es�— ❑ NA DESIGN PARAIVYETERS Effluent Filter Manufacturer [0- NA Number of Bedrooms 100gpd/bedroom ❑ NA Effluent Filter Model . ��n ❑ NA Number of Commercial Units NA Pump Tank Capacity , gal ❑ NA Estimated flow (average)* 6_, gal/day Pump Tank Manufacturer I e 5 4! � ❑ NA Design flow. (peak), estimated x 1.5* pgal/day Pump Manufacturer e4— ❑ NA Soil Application Rate g aUda Y fe Pump Model ❑ NA Influent/Effluent ali Pretreatment Unit Qu ty FA Monthly Average ** ❑ NA Fats. Oil &Grease (FOG) [I Sand/Gravel Filter ❑Peat Filter Biochemical Oxygen Demand (BODs) < 30 mg/L El Mechanical Aeration ❑Wetland Total Suspended Solids (TSS) < 220 mg/L ❑ Disinfection ❑ Other: < 250 mg/L Manufacturer: Model: Cell(s) Pretreated Effluent Quality ❑ Monthly Average * ** Dispersal Biochemical Oxygen Demand (13 40k- g r ound (gravity) ❑ In- ground (pressurized) S 30 mg/L ❑ At -grade ❑ Mound Total Suspended Solids (TSS) Fecal Coliform (geometric means 5 30 mg/L ❑ Drip -line ❑ Other: <10 cfu/100m1 ❑ Leaching Chamber Manufacturer & —Z Maximum Effluent Particle Size 1/8 inch diameter Model E Zia v 3 W P Approval Stipulation *Wastewater Flow Verification on and calculations: Soil Application Rate " 7 gp d/ft a Area Req. ft� (Other than bedroom based) Absorption Area Credit per unit _ _ 5 f12 Minimum Number of Chambers 1 3 ❑ Aggregate Design Flow/Loading Rate= min * * Values typical for domestic (non - commercial wastewater Materials: all materials must comply with WI Adm. Code and septic tank effluent. CON M84 and be installed per manufacturers specifications ** *Values typical for pretreated wastewater. and approval letters. DESIGN CRITERIA "Wisconsin At -grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.al.1990) ❑ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 ❑ . "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6 ❑ "Design of Conventional Soil Absorption Trenches and Beds ". R.J. Otis — ASAE Publications 5 -77 and "Design Manual — Onsite Wastewater Treatment and Disposal Systems". stems .EPA 625/1-80-012 P Y October 1980 ❑ SBD — 10570 —P (8.6/99) "At -Grade Component Manual Using Pressure Distribution" ❑ SBD — 10567 P (8.6/99) "In Ground Absorption Component Manual" ❑ SBD — 10705 —P (N.01101) "In Ground Soil Absorption Component Manual" Version 2.0 ❑ SBD — 10628 —P (N.6/99) "Recirculating Sand Filter System Component Manual" ❑ SBD — 10656 —P (N.6199) "Split Bed Recirculating Sand Filter System Component Manual" ❑ SBD - 10572 P (8..6/99) "Mound Component Manual" ❑ SBD - 10691 —P (N.01/01) "Mound Component Manual" Version 2.0 ❑ SBD - 10595 —P (8.6/99) "Single Pass Saud Filter Component Manual" ❑ SBD - 10657—P (8.6/99) "Drip -line Effluent Disposal Component Manual" SBD - 10573 P (R 6/99) "Pressure Distribution Component Manual" ❑ SBD - 10706 —P (N.01 /01) "Pressure Distribution Component Manual" Version 2.0 ❑ Drip -line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months years) (Maximum 3 yrs.) Pump out contents oftank(s) When combined sludge and scum equals one -third (1/3) of tank volume Inspect dispersal cells) At least once every ❑ months (®'yeaz(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ months,: s ar(s) Inspect pump, pump controls & alarm At least once every ❑ months Ckyear(s) ❑ NA Flush laterals and pressure test At least once every ❑ months &year(s) ❑ NA Valves At least once every [3 months ❑ year(s) tI"A Other: At least once every ❑ months ❑ year(s) (ANA Page of :i CJ 5 0 21 - 1 1 SoJ I Sevice Inc. 715-684-3449 p. I LL SOIL AND SITE EVALUATION REPORT p I a, Labor f4ur"an Piwailons gairfai of salow & 13wkhw in accord wilt ILHF3 B&C6, Wis. Adm. Code Atach cofriplete site plan on Fmper not lose titian 8 112 x I inches in size. Plan must include, but St. Croix net limited-to vertical and hoftoatai refers point (EIM), dir6don and %vl slope, scale of PARCEL I.D. d �� mensioned.'north affaw. and kxatian and distance to newest road. 0.30-1107-1100 APPLICANT JNFORUATION-PL EASE PRINT ALL INFORMATION FIEVCWED By OA7E PROPERTY OWNER: PROPERTY ILOCA'710N Ed & 'Lori Hendricks GOVT LOTNW V4 NE 1,14.S 26T 30 NA 1.��) i-(0* PROPEM OWNER'S MAILING ADDABS LOT • � �LflGK It I St 18 D. NAME04CSMS I. iew Dr -- na M 1382 E22 . PCind Rd. HP — CODE — OPOWS — tUMBER - OCrfY OVIUAGE Or NEAREST ROAD wa. 54016 (713 381-8187 1 JoSegh I L Fr CKt ZMd R4 Now Corsbrudon Uw 1 -1 Rwidenflal I NurMw of beorwre 3 Revawwt I ) Public or MWerCa Code fttv0d* 00w_450 bpd Recornmrowl desVIoWing rate .7 bad 9pae- _tad, Abnoon am r"ked _§43_ bed, 0 _=_, trench, 9 Ma4inumdaWgnleading rate .1_ bed, gpdfit? .8Lbrench,gpd1 Ama .A -B! .. 7 ft (a referred to sft plan benchmark) A(dWW de son /s Cmderatim a= gf El,-3 bW jai i-i,ed to _Code Pwent mate W lakke texraoe lipoicat)le eta Sufi" Spin IN-GROU HOLDING TAM u: unsuitable lot sysium io ki S o sit) SOIL OESCRIPTION REPORT i 13cring Horizon Dopm Commant Color hVi4owmess Texture Structure Consislencv Ebxd3y F;oois in. Munseil Qu. sz- Carts. wor Car, Sz, Sh. 1 0-31 10yr2/2 none 1111 maCeri4i CS 2f n P I IV 2 31-35 10yr3/3 11CRe sil 1c--a* I fs qv If i v 2 � .3 3 35-46 iOyr4/4 none SCI lcabx mfr SW M 96.7 ft 4 46-84 7.5yr4/6 none MS Oag M1 xia nay +84 ---------- Remarks: 1 0-18 10yr3/3 none 1 abk wfr CS 2c. i t A C 2 2 18-48 10yr4/4 110rie sic. ILsbk mfr gv 2 .3 3 48-84 7.5yr4/6 -aone MS 06 9 r na 1.7 '.8 '00 V-5 Remarks: M Name:-Plusc Print Ca M L. Steel Fhane� 715-246-6200 I AeArmv 15U ?(V*h.-wUTP NO&W 2 ii-hnTAArl WT N&I'l 7 J 54 0 2 _. I I P S t e 0 i 0 e I rl C 715 P.? , *u*iwr , f omER Karldrirjts SOIL DESCRIPTION REPORT Paget YAM Lo, 030-1 1.07-1100 kping Horizon Depth •Dominant Coior Motses Texture Strumure co aw"day Roots G P it 1 in. Munselt cxj, Sz. C(V* Cdw Gr SZ. 'Sh. 1 0-1.7 lqy none 'L lcebk laft gw 2C .4 s.bk lwr qw r 2 1�_3b loy ZA/A noruc- sic! I c 1M .2 3 38--62 layrs/4 sib. lc*bk mf. r 9w naj .2 3 4 62-101 7.5yr4/4 1 AS ();3g mvfr na na .7 .3 t I th l_Q2 0-9 U yr 2f 1 .4 . 5 bone- ihsbk mf r gw I 4 2 9-22 .10yrA nme sicli lcobk lufx if .2 3 22-34 7. Syr4/4 n0he 81 l ,mbk r1cr na .4 rev, 4 34-96 7.5yr4/6 nco-e Ma OS 9 f Ml Ila r1a - 7 4_ ; MI-Mb, Mvid ft Remarks: . . . . . . . . . . . . . Vtit to i "'Wr - 1 1-,? -- E84 - 2 3 E." Cj _ Stee I —, Sc- S�� -,e I ric. 15 p " STIEEL'S SOIL SERVICE 1564 2001h Ave. ,tI,r'V L Steel 'Ed & Lori Hendrick-- New fiichmond, WI 54017 NW � S26-VON-R19W (71S) 246-6&"') JAPRSW-,1254 town of St &*eph ;v,.= t of concrete walk by fmut door 61 JM-00' j Ut. EM.= b of house siding 0 el. 99-50' tz Y �- Gary L. 3"1 4-10�99