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HomeMy WebLinkAbout030-1097-30-200 o d :i c d o C C CD tD y ~ 3 3 ~ ~ `rS O 4 Go cn u) C) ? (o O oW N W N• (D (D L W Q 00 (D cr S CD 0 CD CD -4 O Q C O S W o CD o! 0 0 O) O N O o N F N pp N O O p S .7 w O O 'O v fn z ID a a~ co cn D m 0 a cc C c (D CL c 3 O CD N N _I I O N N ~ I C) CD 0 r, cn N W W C N rt C 3 N N• : 0 0 0 Z C 00 0 G O S S C C N Z 0 a ~ r3- U1tntA^ g D ~ T v 0 0 ( (D t'D y rn co c -0 _0 o ^ (o N (D CA Q Z c a D O j a c3 ° n m CD CD i m c W Z N CO) 0 p Z m N S N A z 7 N m W O r z 3 j A O f fn <p y Z m ~I W l =y a CD CD Cn O- o - N C CD Z a I N 7 C CD O CD O y I ~ v ~1 A O t0 ` CD m 7 CD O CD N o ~ ~ O KA O b N 7 I ° ~ oo w <n O ti CD v' r - ~r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: ' ~ 0 430566 0 GENERAL INFORMATION (ATTACH TO PERMIT) tate Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. g' = TnLu . Q Permit Holder's Name: City Village X Township Parcel Tax No' Blaiser, Joe St. Joseph Township CST BM Elev: Insp. BM Elev: BM Descri i n: Section/Town/Range/Map No: /00-0 A )b Rh'1 --,,v 32.30.19. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 154 / Uvb Benchmark a !D 3 toy-3 Dosing 10~ Alt. B O Z Aeration Bldg. Sewer Holding St/ t inlet S TANK SETBACK INFORMATION St/Ht Outlet TANK TO rP/L WELL BLDG. Ventto . take ROAD Dt Inlet G as~ A I 6-r -77 Septic \ Dt Bottom 01 r- ' l.S 17• eader/Man L, iA Dosing a-7 , Aeration Dist. Pipe 1 Z 2 `SZ ~S f Irb . S'~ p . Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St ov /rye +Zn GPM ! r Model Number a I ~ -`3 -7 S TDH Lift Friction Loss System Head TDH Ft s- 3. 3. Dist. fO~ e~ ~ f Forcemain Length ► W-2- - SOIL ABSORPTION SYSTEM 1 BED/TRENCH Width Len th No. Of Trenches PIT DIMENSIONS No. Of Pits I side Dia. Liquid Depth DIMENSIONS /•0 ( / SETBACK SYSTEM TO P/ BLDG W LAKE/STREAM LEACH G Man cturer: INFORMATION Ty Of System: C u R OR Mod umbe . Lkll*h ti DISTRIBUTION SY TEM Polo ed ihe- ID. rig.( 42M U Header/ManifoldN Distribution x Hole Size x Hole Sp cing j7e~ir Intake /r Pipe(s) S 5 ~3 Z r~ Length Dia Length Dia Spacing 4Z-/-A I SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xxx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 161nspection #2: /2 /O~_ Location: 1218 Rolling Hills Trail Hudson, WI 54016 (SW 1/4 SE 1/4 32 T30N R1 9W) NA Lot 2 Parcel No 32 .1 eta 1.) Alt BM Description =--for O Qlq 2.) Bldg sewer length = -amount of cover ~J A4w , 2r 1d03 Plan revision Required? ai Yes X No S li Use other side for additional information. L_ - SBD-6710 (R.3/97) Date Insepctor's S nature Cert. No. 1 Safety and Buildings Division Coun 201 W. Washington Ave., P.O. Box 7082 !rr 11 1seonsirn Madison, WI 53707 - 7082 Sanitary P it Number (to be filled in by Co.) Department of Commerce (608)261 6546 ~J~ S Sanitary Permit Application State Plan I.D. Num r In accord with Comm 93.2 1, Wis. Adm. Code, personal information you provide 1~ 2? / may be used for secondary purposes Privacy law, s I5.04(1)(m) Project Address (if different than mailing address) 1. Application Information - Please Print All Information - b- Property Owner's Name Parcel # -r Lot # lock # Property Owner's Mailing Address ) Pro#erty I J Location ~j City, State ip C e Phone Number G N; E W of Building (check all that apply) /~~1_ 10 or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number ❑ Public/Commercial - Describe U I ❑City ❑Villa wnship. J DS ❑ State Owned - Describe Use 00 : Z f~ ILL Type Permit: (Check only one box on line A. Complete line B if applicable) A. ew System ❑ Replacement System ❑ Tresunent/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New Last Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that apply) ❑ Non -Pressurized In-Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soi t-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 ❑ Drip Lane ❑ Gravel-less Pipe ❑ Other (explain) / V. Dispersal/Treatment Area Information: ~ Area Proposed (sfj S teen Elevation D!og Flow (gpd) Design Soil Application Rate(gpdsf) Dis l ArA~ aR uired (sfj Di sal - , - Number ,.I Manufacturer Prefab site Steel Fiber Plastic A OD VL Tank Info Capacity in Total Gallons Gallons of Units W / Concrete Constructed Glass New Existing L'V I 1 11 -I Tanks Tanks Septic or Holding Talc Aerobic Treatment Unit Dosing Chamber VII. Responsibility Stateme t- 1, the undersigne me responsibility for installation of the POWTS shown on the attached plans. Plt's Name (Print) Plumber's MuU Business Phone Num/ n b Y ) ~ ~ l Plumba's Ad~ress~ (Strcet~ rty, State, p C6de) VIII. ooun/D art~rtment Use Only Approved ❑ Disapproved Sanitary Permit Fee t cludes Groundwater Date Issue4 /1 Issuing Agent i ture S ps) UP/ Surcharge Fee) 2 ~0 / 2 3 ❑ Owner Given Reason for Denial ---LLLPPP ~J IX. Conditions of Approval/Reasons for Disapproval l0 -zt 6 3) SYSTEM OWN ep Ic tank, effluent filter and C-S dispersal cell must all be serviced / maintained U _ as per mana em n rovided by plumber. 4 07V-h,P/? C92,,C.Pi.~/~ 2. A se ac requirements mus as r applicable code/ordinances. Attach complete plans (to the County only) for the system on paper not less than 91/2:11 Inches In size SBD-6398 (R. 08/02) PLOT PLAN PROJECT Joe Bl.aiser ADDRESS 1220 Rollina Hills Trail Hudson Wi 54016 SW 1/4 SE 1/4S 32 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 9/29/03 BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of 1/2" Pipe ASSUME ELEVATION 100' Filter Zabel A-100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 100.2 Scale - 1/419 - 10, 544' Property Line Tank is t e perly bedd nd vided Well is to meet all ock n covers setbacks found in h V."' _ cQ Comm. 8I~ hi n ,I ! `y N Pro 3 Area 15' below system is Bedroom to remain undisturbed House 0 B-4 Slope B-2 p ~~~Ni B- B.M. 0 m 99' (1~ 100.2' K ° ge Alt. B.M. r 100, m 101, Grading is to be done 102' B -5 B - 3 to divert run-off away from Syste 150' 600' Property Line Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601-1831 TDD (608) 264-8777 \*i.4consin www•commerc .wis i www.wisconsonsin.gov .gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary October 21, 2003 CUST ID No.226900 ATTN: POWTS Inspector SHAUN R BIRD ✓ ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 _ff CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/21/2005 Identification Numbers Transaction ID No. 928487 SITE: Site ID No. 666490 Joe Blaiser Please refer to both identification numbers, Rolling Hills Trail above, in all correspondence with the agency. Town of Saint Joseph St Croix County SW1/4, SE1/4, S32, T30N, R19W FOR: Description: Proposed Three Bedroom At-grade System Object Type: POWT System Regulated Object ID No.: 925043 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "At-grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems" SBD-10570-P (R.6/99) and the "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST- SAS (01/81)". • Limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is require ccess o e i ter for cleaning must be provided -perASoiyff o uct approva con itions. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. C, 12(x. 11~► A SHAUN R BIRD Page 2 10/21/03 Owner Responsibilities: • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Gerard M. Swim Balance Due $ 0.00 POWTS Plan Reviewer - Integrated Services (608)-789-7892, Mon. - Fri. 7:30 am to 4:15 pm jswim@commerce.state.wi.us WSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 RECEIVED OCT -12003 Cover Page SAFETY & BLDGS DIV. Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 9/29/03 Owner: Joe Blaiser Location: SW 1/4SE 1/4 S32 T30 N,R18 W Lot 2 Rolling Hills Trail St. Joseph System type: At-Grade Manuals Used: At-Grade Component Manual version 1.0 SBD 10570-P (R.6/99) SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST- SAS (01/81) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve W SAFETY AN) UILDINGS OF COMMERCE 7-9. Maintance and Contigency plan llIVIS'" OF 10-12 Soil test SEE CORRES NDENCE Shaun Bird Signature License number 226900 PLOT PLAN PROJECt Joe Blaiser , ADDRESS 1220 Rollino Hills Trail Hudson Wi 54016 SW 1/4 SE 1/4s 32 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 9/29/03 BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of 1/2" Pipe ASSUME ELEVATION 100 Filter Zabel A-100 ❑ BOREHOLE (DWELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 100.2 Scale - 1/499 - 10' 544' Property Line Tank is t e operly bedd nd vided A Well is to meet all wit ockd n covers o setbacks found in ' h ap oved Comm. 83 arnin labels I N Pro 3 0?. Area 15' below system is Bedroom to remain undisturbed House 9% Slope B-2 B.M. " B-4 B_ 0 m 99, 100.2' Alt. B.M. 100, 101, Grading is to be done 102' B- 5 B-3 to divert run-off away from Syste 150' 600' Property Line L sr PVC F0fkLLMRIW > 5~ ~TuRN- UPS " T ...1` t-- oisrAv?-jiTlort L^TrL AAt A ~srw151L1 -6 £D Oa* Y :`4AT'" WELL - o 5, l/6 B { l/6B I/2 B AFt. L 1<2 F{. CELL o f (L Z /Z AGGot€.&aTE VII " R. AtPRcVEb SYhJTREnL Fabric Distribution Lateral 11 .STABICIILb Observation------ti..` o "Soil Cover Well / t2 ~2,i `7 VIP- (p0~ •Z ~l.QwtEt~ LpYE2 ' > 5' A >5 °lo SL Flan Viers and Cross Section of Wisconsin At-grade Unit With a .Single Absorption Area on a Sloping Site SiGrjwruom LILE r4SE#~ Page Of Distribution Pipe Detail for Lateral Metwork AC C@ TURN-uP (ratn4out) PVC Force Main PVC Distribution Pipe _ P * Last Hole Should Be Next To TURN- ~P P Ft. Hole Diameter Inch X oQ~ Inches Lateral Diameter o Inch(es) Force Main Diameter Inches Y ~ inches # Of Holes/Pipe Invert Elevation Of Laterals /TB Ft. Signed: License Number: Date: • CROSS SECTIaN AND SPECIFICATIONS SEPTIC TANK PUMP CiiAMBER WEATHERPROOF L412 CI VENT PIPE 12" MIN. ABOVE GRADE JUNCTION BOX MANHOLEDCOVER >2gt FROM D44R, WINDOW OR WITH CONDUIT W/ PADLOCX 5 FRESH AIR INTAKE f WARNING LABEL 4" HIM- riNiSHED GRADE K, y' C.z. a ERWt+~~ _ r.a. tgutAllf- 28" III. fltb ' INLET GAS- 1 ED =z ~AppRQ11 WATER TIGHT SEALS ~ TIGHT j A gEAL ; NM JOINTS IQ PE ItTER AppROM __L_ ; 31 $ ' = O SOLID SOIL APPROVED PIPE 3' C f t OFF (o SMID = o FT. " SOiL PUMP 0 £LEV { D BEDDING UNDER TANK 3 ~ APPROVED 1titCRETE PAD SPECIFICATIONS gEpTIC / DOSE NUMBER DOSES DAY = TANK MANUFACTURER: DosE vOujM£ INCLUDING - GAL. FLOWBACK: ~ 7. , GAL K SIZES: SEPTIC GAL. TAN GAL DOSE . NCHES = CAPACITIES: A ~ = 3 6 GAL. RM MANUT'ACWRER: g .2 INCHES _ ALA MODEL NUMBER- _)__.AL. SWITCH TYPE: CJ C ..$~INCHES MA1itJFACTUR£R= _ ~ IItCIiES =r GAL ^ D PUMP . MODEL N- UMBER 16.23 WAC swITCK TYPE: PM pump S ALARM WIRI TaG AS PER I LHR FEET PIPE REQUIRED DISCHARGE RP►TE 11 . ' ~.;.~-FEE? DIFFERENCE BETWEEN pUt°IP OFF AND DISTRIBUTION FEET VERTICAL DIFFER PRE FICTION FACTOR + M;NlrUM NETWORK SUPPLY ~ ~ FT/ 1Q fl . FT. HEAD F££T FORC£MAZN X - TOTAL DYNAMIC -FEET IDTHDIAMETER LENGTH TANK= INTERNAL DIMENSIONS OF PUMP LIQ's3ID DAT£ = LICENSE NITMBER SIGNED: .t&S • i.)il;i ~iti\n."c1i:, ^[AQ/'i..rlrnia!`( • ^Ft_liEl~T rr .q Hl,!lY C~i!~ylF Lh!Jl r, l i J I 52 erl 40 t tit 1 i rT r- I f 20 < 34 129 j -42 };ice I ; 2 5 717: 1 30 Q q 4. i -i 44 r, i , ~ I 1 0 I 600 100 4! LV~S I ! 2 a 5;'"2+ -ra U ?7~ 1^i; U FLOW J rR !CUTE j - i CONSULT FACTORY FOR SPECIAL APPLICATIONS _ • i Timed dosing panels available. as • EleCtriCal alternators, for duplex systaas, are available and supplied with en alarm. • 'Variable level control switches are available for controlling singie phase s systems. j--__- - - • Double piggyback variable level float switches are available for variable v'1 ong and short cycle controls. ! !eve! long' - Sealed Qwik-Box available for outdoor installations. See Rvil420. ; - • Over 130°F. (5401^.) special quotation required. i 2, 1521153 Series !i I 1521153 MODELS control Selecton Y F. i_y_~.~ ' Model -et l Vohs-Ph Mode uolex Non 2 or 3 rJ152 1 tt5 1 , J included I 2orl -a q I Auto i~nt52! 115 1 - tl~ I 2or3 i ' E152 230 1 I Non 4-3 j 3Ei52 230 1 Aulo 43 Included i 2or3 i 2oi 3 SELECTION GUIDE 3 back variable !evel float N BtNs15 Its t t Non Auto ' ° 10 Included o, s 1 I : 20r 3 1. Single piggyback variable level f:ca switch or double piggy e 15230 t Non 5.3 - 230 1 polo h -i tr,cwaed 2 or 3 switch. Refer to Fr•90477. i 2- Sae F%/l07 i2 for correct model o Elect rical. A!tainater E-Pak. A CAUTION r~ Al! ins tattation of controls, protection devices and wiring should be done by a qualified 3- Variable Ieve1 contro! switch I0- -La5 used as a control aLUVatOr, SDcCIfV duplex (1 licensed to lationitian. All electrical and safety codes should be followed including the most or (4) float system. A recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESER1fE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pulnIp. MAIL TO: P-0. 30X 11,347 - C Louisville, KY 40256.0347 ,biamowtows ot- . y SHIP 70: 3549 Cane Run Road £Dr LouSville, KY 40241.1961 ~.LtU/'Y~✓i1PS NL'f ~~~J (502) 773-2731 • 1 (&CO,I 92p-PUMP Z FAX;Sii2)77; x624 htrA-/fwww zoeller. coin r. rn-•.rrinht 2000 Zoeller Co A!! rights resented Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ~ of 3 Division of Safety and Buildings 4~ in accordance with C m 8 ~ A . 4 VED C Attach complete site plan on paper not less than 8 1/2 x 11 in es in size. Plan must nty~("_ ~X include, but not limited to: vertical and horizontal reference poi it (BM) ~I ~d t rcel I.D. - 0 30 - 10'7 -1 percent slope, scale or dimensions, north arrow, and location nd dist c~ to n~eTas~rti3 U Please print all information. 51. C;, !k e7;Z~a Date Personal information you provide may be used for secondary purpose Privacvi;ls MS 0.d (1j (tel. 1 1Zt Q 3 T -YWI Property Owner Property Locatio, Jc~~ Govt. LotJLL) 1/45114 S3,~ T N R E (o W Property Owner's Mailing Address Lot # Block # Subd Name or CSM# City State - Zip a Phone Number ❑ City ❑ Village Z Town Nearest Road New Construction Use esidential / Number of bedrooms Code derived design flow rate 2~;' GPD ❑ Replacement ~/i' ~I ❑ Public or commeraai - D e: Parent matedal4/4' 61/,gee . Flood Plain elevation if applicable ft. General comments and recommendations: s1 ✓V~%~ /Ci Boring # ❑ Boring pit Ground surface el5w/ V-1 ft. Depth to limiting factor /7- u in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 /Z 3 "~-l s Ao--),4 A114 3- U Boring # apit Boring Ground surface elev. ft. Depth to limiting factor _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 p~) 3 0 3!Z' - S 9 Z 3' s 1-cJ 1 ~ . S 3 l ~ O rr'l N i ~vl ~ • ~1 Effluent #1 = BOD > 30 1220 mg/L and TSS >30 < 1 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) lure CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715-246-4516 Property Owner _ Parcel ID # Page of Boring Boring # 1-31 f Pit Ground surface elev. ` ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 0 -i Z U ,fez- r~ r- ' s- J Boring # Boring F-41 YF Pit Ground surface ele ~L J ft. Depth to limiting factor ~ in. r Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 o,~ C D,' G - .U o © El Boring Boring # Ground surface elev. ~ft. Depth to limiting factor ,/~~in. Pit Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 -/Z o 3/t- s es- . Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 mg/_ ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (8.6/00) f r Soil Test Plot Plan Project Name Joe Blaiser Sha Address 1220 Rolling Hills Trail Hudson Wi 54016 CS M #226900 Lot 2 Subdivision Date 9/29/03 SW 1 /4 SE 1/4S 32 T 30 N/R19 W Township St. Joseph Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1/2" pipe System Elevation 100.2' *HRpSame as Benchmark Alt. BM Top of 1/2" Pipe @ 101.1' Scale = 1/411 = 10' 544' Property Line J3 0 0 css 2 N Pro 3 Bedroom , House 9% Slope B-2 0 B-4 B-1 B.M. 0 CD 99, K Alt. B.M. r 100, 101' 13 102' B-5 B-3 15 0' 600' Property Line Maintenance and Contingency Plan for a At-grade System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Dose Chamber is to be pumped at the same time as the septic tank. 3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 4. Once every 3 years the mound is to be inspected via the inspections pipes in the at- grade. The laterals are to be inspected via the cleanouts. 5. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 6. Pump and electrical components are to be checked at the time of the pumping. 7. Owner agrees to leave the area 15' below at-grade undisturbed. 8. The owner agrees to save this plan. 9. Trees, shrubs, and other similiar vegitation are not be planted on system. The system is not be driven over. 10. Effluent Quality is not to excede the requirements found in Comm. 83 Contingency Plan 1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if needed, then bypass pump float and try pump with out float. If this works, float is bad, replace float. If pump still does not work, check power at the pump with a electrical device such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is power, then pump is bad and needs to be replaced by a plumber. 2. If at-grade fails, determine cause of failure, test another area or remove pipe and sewer rock, retill soil, install new mound system. 3. Replace any other failing components as needed. Important Phone Numbers Plumber: Shaun Bird 715-246-4516 Pumper: Tom Mondor 715-246-5148 St. Croix County Zoning 715-386-4680 MENT PLAN Page ` of t pp\I1fTS OWNER'S MANUAL SMS EM SPECIFICATIONS FILE INFORMATION Septic Tank Capacity at ❑ NA Owner j O B f Septic Tank Manufacturer ❑ NA Permit Effluent Fitter Manufacturer ❑ NA DESIGN PARAMETERS NA Effluent Fitter Model ❑ NA Number of Sedroorns ANA Pump Tank Capacity al ❑ NA Number of Commercial Units Pump Tank Manufacturer ❑ NA aUda ❑ NA Estimated now (average) Pump. Manufacturer Design flow (Peak). (Estimated x 1-5) .T U aVd Sv~ ❑ NA J~ al/da /ft2 Pump Model A Sol APPfica~ Rate Pretreatment Unit Monthly average` sand/Gravel Filter ❑ Peat Fitter Influent/Effluent Quality (FOG) S30 mg/L c3 Mechanical Aeration Wetiand Fats,. Oil & Grease ( 220 mg/L Q Other Biodhemical Oxygen Demand (BODs) Disinfection Total Suspended Solids (-rSS) 5150 m L Manufacturer Pretreated Effluent Quality Monthly average" Dispersal Cell(s) ❑ In-ground (pressurized) 530 mg/1- [I In-ground (grav~Y) C1 Mound At-grade B errti,at Oxygen Demand (BODs) 530 Total Suspended Solids (TSS) m ❑ Dri ine ❑ Other. (geometric; mean) s10' cf u/100m[ Fecal COliforrn (g values typical for domestic (non-commercial) wastewater and YB inch diameter Maximum Effluent Particle Size septic tank effluent Values typical for pretreated wastewater- MAINTENANCE SCHEDULE Service Frequency Service Event ❑ months ,Year(s) (Maximum 3 yrs.) At least once every Inspect condition of tank(s) equals one-third (Y,) of tank volume When combined sludge and scum o ea s Maximum 3 yrs.) Pump out contents of tank(s) At feast once every ~ ❑ months Y ( Inspect dispersal cell(s) ❑ months year(s) At feast once every Clean effluent filter S At Least once every ❑ months°ar(s) O NA Inspect Pump, pump controls Li, alarm At least once every _S ❑ month year(s) o NA Flush laterals and pressure test At least once every ❑ months (7 year(s) Other a s ❑ NA ❑ months L1 year' ) At least once every r. ottre MAINTENANCE INSTRUCTIONS one of the following licenses or Inspections of tanks and dispersal cells shall be made by an individual carrying inspector POWTS Maintainer, Septage certifications: Master Plumber Master Plumber Restricted Sewer, POWTS ) to identify any missing or broken back up any Servicing Operator- Tank inspections must include a visual inspection of the tank(s to check the effluent levels hardware. identify any cracks or leaks, measure thddispersal cell(s) shall belvisua y inspp~ed and check t to check eeuent on the or ponding of effluent on the ground surface. The round surface. The ponding o authority. in the observation pipes and to check for any Pe ndin 9 of effluent on the g the local regul3tO ground surface may indicate a failing condition and requires the immediate notification or more f the tank volume, th NR When the combined accumulation of byd a scum in Septage any tank Servicing equals Operator one- and third disposed of in accordance with entire contents of the tank shall be removed 113, Wisconsin Administrative Code- components, pretfeatfinent components, and any pressurized POWTS comp doomed by a certified pon Maintainer. The servicing of effluent filters, mechanical or leti on of any service eventPOWTS other maintenance or monitoring at intervals of 12ratomonths rity within 0 days of comp A Service report shad be provided to the local reg ry auutho products or outer STARTUP AND OPERATION Scheclc treatment tank(s) for the presence of painting tions are For new construction, prior to use of the PO ooccess and/or damage the dispersal cell(s). rior If a $ep concentra to high use. chemicals that may impede the treatment p to a servicing operator p detected have the contents of the tank( s) t~°-V~ 9 Page -of -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 Dell(s) in one large dose, overloading the ce!i(s) and may result in the backup or surface discharge of efffpent To avoid this situation have the contents of the pump tank removed by a Septage Servicing operator prw.t6 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 ompact, the area within 15 feet dawn 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 AM; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; drsrtfedartts; W foundatfon 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. ABANDONOMENT When the POWTS fails and/or is permanently. taken out of service the following steps shall Ixe taken to insure that the system is property and. safety 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 another inert solid material CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: O A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to 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 thol chnology a holding tank. may be Installed as a last resort to replace the failed POWTS. h site s no been eva o ide a ble reps cement area. Upon failure it and te u o~ to e sui ble pi me a a. re cement area is available a tan ay~I s a t resort to rep ce the i PO S. ound and at-grade soil absorption systems may be reconstructed in place following removal of the btomat at e infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. SEPTIC PUMP AND OTHER DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT 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 ~t I Name C_ 13 0- Phone j, z 111~ Phone c - l a SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORf(Y Name Agency 12 Phone 1,21-r- 2>66- 6 r Phone j,d This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agendes. This document meets the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)&(t) and 83.54(1). (2) d (3). Wisconsin AdminIstradve Code. Use of this document does not guarantee the performance of the POWfS. rMW (2101) r ~ ST CROIX COUNTY SEPTIC TANK MAINTSQANCE AMEEMENT AND OWNERSHIP CER,TMICATION FORM Addreee , Z M Prapaty Addrase (Veriliddon required flooari "maws t for now coasaucd atY Parcel Ideidfication Number Property Loc WCW.~ N--W, Town of $itiiatan - - - - Lot # C ft"gy Mitip # . volume Page ~ S-1 - wanru ity oad k - 30 7 ?i . volume `J ~ PaEe ~ Spec ire, 0 yw/-t no Lot lines idaatifiablexy 2MAM ~mps+opee tla and oaf your aept4a ~ eyoald rasnlt is ~ perematnRe t~lm+e to beniew~astaa. leoprc coodan of pampieg ant eiss aeptla "vk aver dM yeans or soexoa, if needed by a ]seemed pwgapar. Witt►t yott pat ;boo 6e 4"Im can arm des "ad" of drat sap& as a tMtnseae stage in aw waste &Vow systems. Vo peaparty await apnes w =%Wx to ft C.mix Zaniag Depmu aat a aftifift" dorm, alp W by the eemsr and by it mttoetpbmf~R~~pou~yau~aP2w°abesr meacio0adplwnber ore lsosasadpa+aspa•verfifyL~ ttut(1) t50 veMSsbe ~waiet' n in p"w op=ftl am&" antler (Z) aftw inspeodDa and p=Vbg (if necesm7). die septa hole Is lea den W PA of slttr. the *s tmdeWpod Lave road the abave requn+er watts and agree tQ maintain the private saw%p disposal eyeeaat vvtdt the epindesds set fs, Lasob as set by &c Daft of Commerce and do Dgm=e t of Watwd Reso tem 9ntte of Wleoonela. moo statsag 1~ aaptle bas beea mahasiaesd un -1 be completed and n*vn~ed so tine St. OU& Cou9► ZeaS of&A wldiin 30 6VA dtys on date. 'R1RE CANT DATE Q3y+iS.S SETDFICA I (wo) Certify that au sa maoaa ca mss form arse mn to Ow best of any (ow) leaowle 46- i (aro) am (a+ra3 dw owneKa? of the dos a by vtrwe of a wwwty deed recorded in Register of Deeds Of&& 0Z DDA~T~,E •MR«f« t being v*W by go 20,11a 0"""l- Any infouUtivn the! is a~i dana reaarlt is the saaitaty gara+isr Iadade with ibis application; a sta nVad wamwty dead from the Aegis "r of Dew eyffke a cagy of tlta Gatti lead survey map if reference is matte is the warrxaty etaetd z ONtl9'INIM4 m BATH2 eS; f fl0 a s y~ . - 9A St At T A T, Le m m o ~ INSS'o1 N o O STp• FFE7 N jr ~~a 7tw J:. NY. •J:J4~ f,.:s•.~ e 'Yi:L• ` ~ T m ? ~ u N~ z pA0 a  E'd AumaNo 11Had als:so ED TO 400 w r 746671 VOL 18 AGE 4651 KATACEEA H. Mwzw- REGISTER OF DEEDS RECEIVEDxFOR. WORD $ 11/14/2003 02:15PH S y CERTIFIED SURVEY MAP sOO'34WV 5291.90' ? REC FEE : 13.00 c m o y'o COPY FEE: 3.00 O c NORTH•SOUTH 1/4 LINE A A PAGES: 2 o ~ a 00°34'52'E 389.87' $ -A zx a~ *j m y [?q; m 4902.03 cv mcV1rZ ~ pvDfm3 1 rtD r d ,--J Z(mncl) a? rn $ "UM c nc 111 3~E a~~~~~~o RA g 11 6D 9Q5 o ma 111 Smm a m~ W + g ;y my p ; Z 25 i~ mNRMa ul 111 mm usi gz w .1 n C m m 3c Ica 2 R E Q w; og m 5 m DC \~~a am c W _~t~~ o m ~t~o°Jo r \~-I Cr z m 8o89O \U\` mz v z $'v \Qo „c1 All C, 0 z To z u, \ PROVED o o AI N Z t~ r Y COUNTY i N 8~y7 a ~LIc_J = v nfin7Zaigmepq*xr'n.40 Om> Z 1E Oc ° NOV 14 2011 rn 21 coo w ?a0~ n N °s Q y al~f.".°.f M= W w:IM 30 d..9 i o 'y ■ &IIIIIIIIIIIIWaval m r fi N rz~ ~p mM wo W*1 slrM be~ m m v Z g m p c$A Pm ywi5a+1" a \ c-1C p -n Ompv Pg~i'~ 0 - * c' z 'n A Wo _ g t~?m E; Poo T. 1 Z~~ n g ZZ04 O m3V 3a M~ _gP lg y L O ycr D a exs`' -n 00 Zg Z ® 1~~ 6'pA,~o6 ax m Fn Fm BEARINGS ARE REFERENCED TO THE SOUTH LINE OF THE SE11/4 OF SECTION 14 32, ASSUMED TO BEAR S89-43'53-E 27 `S 0 o0` Fn zF) 111 IN `,!ra '~0 z Gig < DER \ o n 0 O \ Wiz 91 m O - r n im SHEET 1 OF 2 SHEETS c Vol 18 Page 4651