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HomeMy WebLinkAbout030-2013-95-000 r - Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 515176 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: Sand uist, John & Elsie I St. Joseph, Town of 030 - 2013 -95 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: IM I G 36.30.19.409A TANK INFORMAT ON ELEVATION DATA TYPE MANUFACTURER ' N CAPACITY STATION BS HI FS ELEV. Septic ? Benchmark > ItiJ Itc,S E' u AIt I; I L, 60 Bldg. Sewer O Holding St /Ht Inlet ``�� TANK SETBACK INFORMATION St/Ht Outlet $T O TANK TO P/L WELL BLDG. Vent to Air Intake ROAD (J D f) �+ D Septic 7 pwie"M W eA ; /4b OZ J >Ab We eA5 S. Z, Dosing ` 7 /bU/ 1 7 / Q i /66 i ✓ Header /Man. 1 9 ' .3 5A/ 35 Aeration Dist. Pipe 9� I s Holding Bot. System 9 Final Grade PUMP /SIPHON INFORMATION ' Re , 3 Manufacturer Demand St Cove GPM Model Number r 0, DH Lift Friction Loss System Head T Ft cemain th Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width ✓ Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. __ Liquid Depth DIMENSIONS 3 7( 3 ! %_ " SETBACK SYSTEM TO (J P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer— : %,4 ` INFORMATION CHAMBER OR Ir�� f c Type Of System: r UNIT Model Number: G a (PIP 1 6. 9 7 166 A ,,,-i DISTRIBUTION SYSTEM /P4 !— 1 5 L `AS Header /Manifold / Distribution x Hole Size x Hole Spacing Vent to Air Int Length Dia Dia / Length ` \_ ra �` 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 1 Bed/Trench Edges Topsoil \_ �, es No ;Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1281 80th Street Hudson, WI 54016 (NW 1/4 NW 1/4 36 T30N R19�W) metes & bounds Lot Parcel No: 36.30.19.409A 1.) Alt BM Description = 2.) Bldg sewer length = /'��� a nE r� - amount of cover = �j(,jT 1`/�. (J J Cp Jdil. - - - 3 - . Plan revision Required ❑Yes No G I I Use other side for additional mformatio 1 O J — Date Insepct is Signat a Cart. No. SBD -6710 (R.3/97) �j (A�'A k-0 comrnerce.wi.gov Safety and Buildings Division CamlY " Washington Ave., P. 0: 16; S d scon sin Madison, Wl 5 t Sanitary Permit Number (to he filled in by Co.) Department ofCcimmerce 51517 Sanitary Permit Application ,rare Tiansactigo umber 1 In accordance with s. Comm. 93.21(2), Wis, Adm. Code, submission of this form to the appropriate govcntmental AM unit is required plans to obtaining a sanitary permit. Note. AppAication fomx for state -owned POW FS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary ur ses in accordance with the Privac Law, s- 15.04�(nt}, Slats. lz<6 �,(J�44, f or m ation I. Ap licatio Information— Plea Print All in U ` (/✓ Property Ovmer's Name — -- — • ` Parcel p ,3 AN .4-1 S t ) e S aN� GU� S ()30- a(AI- 9S, o oh Property Owner's Mailing Add v" -'� . -'- L Property I- rx.uion D� / T li c unnUUUNI T 6 7 ► $_7QNt O FFIC E Govt. Lot _ City. State Lip CRde — Ph at e T r r1 W ' '/, Section NP 0�.1 �) S 1 Q( / (0 a4 S y+ ` (circle one) T -3 1L o N. R VQ _ - EofW I1. Type of Building (check all that apply) Lot p - 3 C I m'2 Family Dwelling Numlero(Qcslr i �nr.4 Subdivision Name — - _ Qlock tt U Public/commercial Describe Use City of _ ❑ State Owiwd - Dcscritx Use CSM Number — ❑ Village of _ — Town of S I Ill. Type of Permit. (Che k only one box online A. Complete line R if applicable) A. Pnewation m Replacement System ❑ Treatment /Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) list Previous Permit Number and Date Issued l ❑ Permil Revision ❑ Change of Ptuntber El Permit Transfer to New �/ C Owner / l 6 IV. Type of IPOWT S ystenUComponenUDeviee: (C all tha »hplY� bi:�4o Pressuri7je ht -Grou ❑ Pressurized ]n- (around ❑ At -Grade U Mound > 24 in. ofsuitablc soil U Mound < 24 iR 1 U Holding Tank U Other Dispersal Component {explain)__ _ ❑ Pretreatment Devicc (explain) V. Dispersal/Treatment Area lntorination: fhsign Floty (gpd) Design Soil Application) ate(gpdst) Dispersal Area Required J (ti.- nersal Area Propos . I) System Elevation `� S v -� _ G43 _ , H -4ySo -M 93.sa- t; .s� VI . Tank Info Capacity in I nlal N of _ — Manufacturcrel r r Gallons Gallons Units o v Net, Tanks Ex Tanks N V y o o g (i✓ / ° �Zs a m rn r, U O., Scpricor Hold ingTank — I_y�' -t ';I`y 7 f�: Dosing Chanrhtt � � V V V VII. Responsibility Statem t, the undersigned, assinne responsib for installation of the POWTS shown on the attached plans. Plumber's Name (Prim) Plum s Sign a -` _ MP /MPRS Number Qusiness Phone Number Plumber's Address (Sif cc[, City, Slate, Zip Code) ^ , u� b - -- duns oN l,J �s � S Vill Cunt /De artinen ) Use Only Apprraved Permit Fee Date stied Issuing t Signatur t0 C=Ze. Reason for Denis IX. Condiflldl l&MR ,Mihf IFReasons for Disapproval 1. Septic tank, effluent filter and dispersal cell must all be ser0ces / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as pe applicable code / ordinarms. Alf -.106 to complete plans to, rile system and subnul to life Connty only on paper loot less till" 8 112 x I I inches in size S13D -6398 (R 01/07) Valid (hru 01/09 ., o � a me s A N 4 t5 inn � u e �1ees� r G�Ge 4u go 0 �,. Sk s , N y S41; 6 New 8Vu g nl �l � �- �S Rv Piz IVI Tor wooi YY COrcW {12 fi�NC -r Yt3j Itv = 1ua �N4i 1 1�a�v►ti co f o ma 7Ba v. ie. m ees r LCx:a�'/on a 8 ut - S�, ac 1* a� 4uqov C) h N ? p N X $ VU El ea Tip ll� Woad •- - - - - - - - -- cercNea �cNCt lVp -b . 35U f' J j . r RECEIVED r 2. SOIL EVALUATION REPORT Page I of 3 Division of S a f e t y and B u i l d i n g s vi,v'�i y �'� N Y PLANNING & W� *"' Comm 85, Wrs. Adm. Code County C>+o ;X Co u h f Attach complete site plan on paper not less than 81 /2 x 11 inches in size. Plan must S� include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road.. O 3 0 -�? O /3 -75 - 000 Please print all information Reviewed b ! Date , Personal information you provide may be used for secondary purposes (Privacy law, s. 16.04 (1) (m)). 1�( Property Owner Owner�¢� Property Location .Ta Ai H 'f lx'J C Sati o� a ; s 'f Gove tvt 1UW 1/4 /VW 14 S Id T 30 N R t 9 C-W) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City State zip Code Phone Number ❑ City ❑ Village E,Town Nearest Road NC& I WX s +016 1 ( 715 ) -) 6 - sa "if IL J-0S..04 C. �t ❑ New Construction Use. Residential/ Number of bedrooms -S Code derived design flow rate i GPD XReplacement ❑ Public or commercial - Describe: Al A Parent material m I o e-tr ove q / a c , 0 t t; j � Flood Plain elevation if applicable Aj � r� ft. General coments ca: s !� S 7`e r+r a S l 2 lC C� D 7 w e c s? t o r, *1 4 c; y . 1 v e c or+a ty. e r / and recomrite ations: ,� : ;�` . "• a . -� 4 g- �t� t� � �i%j d '{' 3 t o "� �' . vx C �c°,y � e /o c v c y , �, r a � P d ct•^ q.` S/1'G � n �• »i�eh., ry 'f: 16 i ❑ Boring # Boring > / ® ft Z' ❑ q ' Pit Ground surface elev. tf . Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh: -Eff#1 - Efr#2 o!S" lv yl�3 /3 °� Ja � /5 - -�� /D �? �' °~ t. r� � ,�1: d .t � r L. ,;�° �? ai �. d" L3• � I� T Boring # C] Boring \ pit Ground surface elev. r�. ft. Depth to limiting factor ✓ 7 k in, Appl ication Rate Soil Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. / - Efr#1 - Ef W 0-/0 /o CL Ors ct . a ` Effluent #1 = BOD > 30 220 mg/L and T S > < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 nUL CST Name (Please Print) Signature CST Number / Address Date Evaluation Conducted Telephone Number .old � sy �� �'�, � �. � �� � � �i�r ail 540 s� 3, ��� � /s z �'�',�'`�� �` T — sh s� �•� ✓Oi�h 9 �e. r..i .� C J . VV 0 Property Owner � Y -Parcel ID # © � - aZ J° � Page Of ❑ Boring Boring # K�1 pit Ground surface elev. 7 7 7 ft. Depth to limiting factor / in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 I - Eff#2 1, 31 5 /1 2 4N a 0- S c 0-0 Of �J s a s Je l vP a- 7 / • 1S F—+1 Boring # ❑ Boring q ❑ Pit Ground surface elev. �• ft. Depth to limiting factor .`•'' / °� in. Soil 'cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell / Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 I - Ef1#2 0. CAV i r S S d e e l 15 l� Boring / Boring # Ground surface elev. 1 " 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 - 002 Effluent #1 = BOD, > 30 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 2648777. ssD -8330 X07100) . +�' � � ,..,,�,,,, il' ' ' , ,as l - 3 0�� c P �1 J �C 2 fi� � �vr ^�.�a /r �, ° V �,� �t p si `f'e �.7 ;� `:� 0 1- �' td L^ .St• ,S�:c S� � Fawn — ..a ;*: �,��: �.: T 0 w d ,a n' S h - h i V - 1 0 � � i I as K E Y .Sc d C't)ett.p7 - ;on_s P-ia7ed� r �,°' r +e, • s p •����W `a"38.3�� c Ta s r �� o } Soil Absorption System Cross Section �---- ft 4" Schedule 40 Final Grade PVC Vent Pipe With Vent Cap , ft Lo TX�wL� Leaching ` Chamber �a $p ft L T►u.�1, System Elevation 3' ft S ft Nwyl,'�hti�l, g3-,YO gy.su Soil Absorption System Plan View � Q ft f { ft Leaching Trench 1 Chambers 4" Dia. Trench 2 Header Vent Or Observation Pipe Leaching Chamber Specifications Manufacturer And Model _ TES � r' *on. - Q41 � (,k. �( EISA Rating . U sq ft per chamber Soil Application Rate t (, gpd /sq ft l S V gpd Design Flow - . Soil Application Rate d EISA = _l 3 _. Chambers 3 akrows of 15" chambers each. U Page of r '/ ST. C ROIX COUNTY tiEPTIC TANK MAINTENANCE n GREEMEW Ai-1a OWNERSHIP C ERTir iC;A,'TION FORM 0"Wner/BUyer -- --u � N 4 S i lk Mailing Address_ Propert -f A ;U: ens S p p er ' (''verification tequired Planning &Zoning Department for new co-nstructisn.) - Katy / ;fate P .'A'P . X 15 C ,. farce! !derttif cahor Ntiitjt�er LEGA:. DESCRIPTION Property LaCat ©a1 N W !4 , N s /a , S EC � T 3 N R 1 Q W, Town o Subdivision _. Certifier}! Survey Map d , Volume _ -- , Page # larraanty Deed # , VGliiiue Page e # 30 Spec (souse ycs 110 Lot Imes identifiable yes no SYSTEM MAENTENAINCE AND OWNER CERTIFICATI±L�N !mpraper use arA imintenance of your septic system could result in its premature failure to handle wastes. Proper t'.... ! =--e consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pun—,— What you ; put into tl:e eyst"r: ca aaE:ec - t tht function of the septic tank as a treatment stage in the waste disposal sycle Owner maintenance rest ns:s ;; , are specified in Korrim, 63.52(!) and in Chapter 12 - St. Croix Cntnr� SAnitaer}• Ordinance. "fie pmp:.rty or-set agaees to submit to St. Croix County Planning & Zoning Department a certification forts, signed by the ovmrr and b; a nsaster plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on- site - wastewater disposal systcim is in proper operating condition and/or (2) after inspection and pumping (if neceswy), the septic tank is less this, 113 full of sludge. the undersigned have read t it ments and agree to maintain the private sewage ditpood systew vr.*-1he ataasdanh Set fortis, herein, as Bet by the ce and the Dcpartracm of Natmaat Resmirc4R, $irate of �Y :ac onan;. Crrtss ca : :aa stating tha�at yruur septic system ilia hied mulct be Completed and returned to the St Crom CourA Plan:�ir bemn;�iatn mp . �. & ,� Zonlsg'DepartMent witis:a, 30 days of the tkee yahl ; on date. V vc certify that all statesuents on this fora►ttm ftt to the best of my /our knowledge, Iiwe am/are the of the 4 xomrty ueseribeai above. by vitae of a wanMh► ie ded in Registe: of Deeds Office. No bar cdro . c `q-rA; S. NATUP*E OF APPL DATE * rlisy ifitfolaitle►tiolf that is ttvsrepresetstetl ito>)i1t in age sanitary permit being revoked by the Pluming & Zaaing Department. • "' 4` Inciude with this appiicaahon a record :va - sty daeti &+tm the Register of Deeds Office and a copy of the cerkified survey map if reference is made in the warrsaty dead. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the SO.h*l 4 z I S 1 C Spl�, ll �IGuiSj residence located at: NW Sec. T (� N, R��W , Town of S St. Croix County, Wisconsin. Upon inspection, I certify that 4 1 have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced S • � � Did flow back occur from absorption system? Yes No line. J (if no, skip next Approximate volume or length of time: ,Capacity: (boo gallons minutes Construction: Pre Vab Concrete V Steel Manufacturer (if known): other Age of Tank (if known): N N - (Signa A • v 3 ` r r. (Name) Please Print (Title) M3 RS aaa U� (License Number) (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition,.I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis, Adm. Code (except for inspection opening over outlet baffle) . Name � C�iCr Signature MPJ MPRS Zia ()l FILE NOfORMATiON f'OWTS AN OWNER'S P 11 MANAGEMENT PL ►'np9 fit weer SYSTEM SPECIFICATIONS _- - �pN . ��►) f Septic Tank Capacity ( � u el D NA Sep lic Tank 1Viflnionctitr9r __._..,_� — DESIGN PARAMETERS s� El NA [ Design umber of Bed[ Fffloonl Ffiter Mant1(actfffef Dams ANA '- U NA Effluent Filter Model umber of Public Facility Units - 11 NA ❑ NA ( Urr,lr Tank r'al► -4cit.y - timated flow (average) NA Pun, ► _gat /day 1 lank Manufacturer flow ipeakl. !Estimated _ . _- _ NA gallday Pumit Marndaf -hr►er il Application Rate '7 NA 1 andard fniluent /Effluent Quality - -_ - _`-_ - - MN 9y/lt rump Model NA Fats nil Monthly average" Pretrentrr►ent hrtit & (71$a39 Ir0f31 -- 8 lncltflrnical Ux O frfg /l. iJ Satl(l/riravol f iitn► NA VAmf [)ernanrl iRC)t1,1 �7,?t) rfrt7A 1 J NA t.J f'nat FNrpr _ -_ Total_ Suspended Solids fTSS) 5t5O ntg /l t ► Mnr hnnlr:nl n n , nrinr, i l Wrtttartd Pfetre9ted Eflluent Cltrality Ll bl.^,ffff"Wkm -- --- - - - - -- -- - -- - - - -- - - -- _...._....._ (J (Aber: MnntldV AvAtagn _. IlinCh"mlral Oxygrt„ Dema I) iSir�rs: , l Collt,) tt3DD 530 mglL ❑ NA Total Suspended Solids (TSS) Fecal Colilo►rr, (goo r r+rnunrl (pravi ►Y► f :1 to (;rorrnti (pressurized) s30 mg /L tl NA ometric mean i 1 M r;rndr, 1 5f U" r,(tr /10Urn1 i l Mnuf)d Effluent Particie Size — __ . -.. lJ p ne - Cl Other: Max Drip li — __ - -- t rn diA. f 1 NA f )thnr - ' !t — i: _ .. _... ❑ NA 1:1 NA t)fhnr- -- "Valres typical for domeeth- wnst"..tnr and SRr,tic tnnt nipua„ } __ _ �O NA (fthr±r MAINTENANCE SCHEDULE _ ❑ NA service Event inspect condition of tanktsl Service f=requency -'"-- - At least one" eve y: rnonthts) Pump out contents of tankist - - Q earls) (Maximum 3 years) DNA — -- - When combined sludge and scum ue(s one -thhd (yi of tank volum Inspect dispersal c eq eipsi ____— __. -- At Iflast nnrrt weary: ^� ❑ ntonth {s) 0 NA Clean effluent filter - __.._. oC vast (MaxllnU 3 yearn) O NA gVer : _ At least on en rtv9ty: ❑ nrontltlsl _- inspect p ump __._. - ....... _ ......._ R Punt a Ontrols & Aiatft► __ 1'earfs) O NA __._.__ At least ottce evflry: u monthls► "`- - --- Flush laterals and pressure test A year(s) At t NA oast once eV"ry: '- - O ntonUtis) u yeasts) NA 5thsr: ------ .._-- -____: At least once every: 4 ►nontliisJ - _ - -` NA AINTENANCE INSTRUCTIONS NA Inspections of tanks And disparate cells shell be trade by .aft individual carrying one of the f Master Plumber; Nester plumber Restricted nspections must include a_visual inspection of the tenkis► to identify any, P or broke off owing licensee or era tlf(cation k Sewer- �WTS inspector; POW or Maintainer, Septage Servicing Operator. Tank neasure the volume of combined sludge and sctt►rt and to check for any back up or pendi ng a tt@' ld e ff l ue nt t on the gr ound racks a the dispersal cet((s) shelf be visually inspected to >I effluent on the ground surface. The ponding, of effluent on the g rou nd surface ma check the effluent levels in the observation pipes and to che for any plmdin mmediate notification of the local regulatory authority. 9 e y indicate a ( siting condition and requires the Vhen the combined accumulation of sludge and scum in an isc nts of the ta shad be recn"Id b Y tank razor one -third (Y or more of the tank volume, the entire r. Vlsconsin Adminietretive Code. y a Septage Servicing Operator rtnr! rlicn.....d r.vaorr _ & f fit arrorrian ...j.& _. - - ART UP AN OPERATION p e" -- of OF new construction, prior to use of the POWTS check treatment tankla) for the presence of painting products or other dmwnkW* UK may Impede the treatment process and /or damage the dispersal callial. If high concentrations are detected have the contents f the tankfai removed by a eeptage servicing operator prior to use. ystem start up shall not occur when soil conditions are frozen at the Infiltrative surface. ur(ng power outages pump tanks may fill above normal hiphwater levels. When power is restored the excess wastewater will be ischarged to the dispersal cellisl in one large dose, overloading the cellls) and may result In the backup or surface discharge of ' Ifl cent. Yo avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring ower to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to istore normal levels within the pump tank. o not drive or park vehicles over tanks and dispersal calls. Do not drive or park over, or otherwise disturb or compact, the area Within 16 feet down slope of any mound or at -grade soil absorption area. Wuctlon or elimination of the following from the wastewater stream may Improve the performance and prolong the We of the OWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental foss; diapers; disinfectants; fat; a undation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; most scraps; medications; oil; sintng products; pesticides. sanitary napkins; tampons; and water softener brine. ANDONMENT Ihon the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is roperly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • Al piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. fl 640 llIRlil fift•trt ill saWts 4"a ANf w4wil fA 4dlwi *A6 w„w wAiitiiold 011111/flit iii iris Y 0 iiO41 OP441idilk • 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. 4IMdENCY PLAN the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant tphlcament system: Ja,,,A suitable replacement area has been evaluated and.may be utilized for the location of a replacement soil absorption`:` ' system. The replacement arse should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot Ines and wells. Fallurs to protect the replacement area wNl result in the need for a now soil and site evaluation to establish a suitable replacement area. Replacement systems Mist 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. Cl The eke h as' not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soll 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 tallied POWTS. ; Mound and at - grade soli ebsorpawn be reconstructed in place following removal oflthp, blotnat at the Infiltrative surface. Reconstruction” ystMn must comply with the rules In effect at that ' <WARNMG> > µ itE''TIC. PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT. WTER A SEPTIC. PUMP OR OTHER TREATMENT TANK _UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY. W-11 ULT OR IMPOSSIBLE. »�-• w DDITiONAL COMMENTS �`:1 ` S`�t ?: �' 1st r ` �i 's.�1tG.i► � /:: !- •� OWTS iNSTALI.gi POWTS MAINTAINER Name J 1 � 1�6M 1�-� Q (L - . Name h. i- 41141., .. . ; Phone S' Phone . 1 0 U` a ,�► �.I to s Bpi" f= L RYA THO �I lj.fsa 6 csi , l r., �EPTAOE SERVICING OPERATOR (PUMPER) LOA REGULATO U R1TY Name , .t:, ,�►�r Name CTtU� - Ir�:...1 Phone O ;�, Phone 'hJe I ART UP AND OPERATION Page _ J of or new construction, prior to use of the POWTS cheek treatment tanklal for the Ikesence of painting products or other chemicals IN may Impede the treatment process and /or damage the dispersal ceOfsl• If high concentrations are detected have the contents t the tankla► removed by a septage servicing operator prior to use. ystem start up shall not occur when soil conditions are frozen at the infiltrative surface. urIng power outages pump tanks may fig above normal highwater levels. When power is restored the excess wastewater wig be / ischwged to the dispersal ceNlsf in one large dose, overload ►ng the colds) and may result in the backup or surface discharge of ` lfluent. Ya avoid this situation have the' contents of the pump tank removed by a Septage Servicing Operator prior to restoring ower to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to Peters normal levels within the pump tank. o not drive or park vehicles over tanks and dispersal calls. Do not drive or park over, or otherwise disturb or compact, the well 4thin 16 feet down slope of any mound or at -grade soil absorption area. leduction or elimination of the following from the wastewater stream may Improve the performance and prolong the He of the OWTS :. antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfootants; felt oundathm drain (Sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; most scraps; medications; oil; s{nthtg products: pesticides; sanitary napkins; tampons; and water softener brine. ANDONMENT Then the POWTS falls and /or is permanently taken out of service the following steps shell be taken to insure that the system is roperiy 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. $40 if ilia 1100 ti o Ilia wkwii 0 wmi. *46 wN wil hAsili dikilishil 04 Ili w 000WA16 "iifiNi srp0441I • After pumping, all tanks and pits shall be excavated end removed or their covers removed and the void space filled with soil, gravel or another Inert solid material. 81TNIIOENCY PLAN the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant splacem system: D.,,.A suitable replacement area has been evaluated and .may be utilized for the location of a replacement soil abwrptbn` ;° system. The replacement woe should be protected from disturbance and compaction and should not beInIldngsd tgion by required setbacks from existing and proposed structure, lot Ones and wells. Fallure to protect the rep{aownent arse will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems "met comply with the rules In *(fact at that time. 17 A suitable replacement area is not available due to setback and /or soil limitations. Barring advances M POWTS technology a holding tank may be Installed as a last resort to replace the failed POWTS. 13 The site has' not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a Boll and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a hoklktp tank, may be installed as a lest resort to replace ths•failed POWTS. ® Mound and at - grade evil abavrptio �si} ,be reconstructed M place following removal oN"1M bktmet at the Infiltrative surface. Reconstruction ,4 must oomply with the rules M effect at that•, ►►•. F < WARNING » ,, :... :... 10I'TIC, PUMP AND OTHER TREATMENT T¢NKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. 00 NOT ENTER A SEPTIC. PUMP OR OTHER TREATMENT TAMK _UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RE=SCUE OF A . MASON FROM M INTERIOR OF A TANK MAY LT OR IMPOSSiBLE. � *� DptTfONAt. COMMENTS s3-� �¢ +fF} :. . !(� et!!e >- .Er; ?ii l`,N�: ;:• ` '4 ', r�. ' OWTS INSTAU.ER sdi 4iver�fy±i .sr POWTS MAINTAINER .• +�: Nettle Name nit p- 11111,• U` Phone S' 1 +.,_i Phone .ysi+ 0, r fiP'T'AGE SERVICING OPERATOR (PUMPER{ ''`' ''f+ LOCAL REGULATORY AUTHORITY Name S n ,i�ertt`t ► � . k; Name CYLC,� x- 13aN,� 1 4' rr o;r... s,,. p Phone O ,:. .. F'...: Phone ., "e ms -•.n -! = dx7! =d t= °_: -_ :_ ._� w'� s ^= e� nwlw!r��i! 1�r1L1n = =d 11 SA M s,. M! _ . 4 . No. 8.1. Warranty Deed — Common Form (STATE OF WISCONSIN) ^' See. 286.16, Wis. Statutes. Form No. 1 P: bl. =bed by Eau Cluire Book k Stationery Co. 27b670 This Indenture, Made this day of March , A. D., 19 64. between EDWARD G. WHITMAN Land LAVERNE D. WHITMAN, his wife, part ies of the first part, and JOHN ROBERT SANDQUIST and ELSIE MARIE SANDQUIST, husband and wife, as joint tenants, part ies of the second part Witntooettj: That the said parties of the 'first part, for and in consideration of the sum of ONE NO /100ths DOLLARS ($1.00) - ---- to them in hand paid by the said part ies of the second part, the receipt whereof is hereby confessed and acknowledged, have given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by these presents do give, grant, bargain, sell, remise, release, alien, convey and confirm unto the said part ies of the second part, the i]heirs and assigns forever, the following described real estate, situated in the county of St. Croix and State of Wisconsin, to -wit: I� The Northwest Quarter (NW 4) of the Northwest Quarter (NWT) of Section Thirty -six (36), Township Thirty (30), Range Nineteen (19), containing Forty (40) acres, more or less. t i f ' I i k Cogttotr with all and singular the hereditaments and appurtenances thereunto belonging or in anywise appertaining; and all the estate, right, title, interest, claim, or demand whatsoever, of the said par# -es of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises and their hereditaments and appurtenances. So 10abe anb to 1?o1b, the said premises as above described with the hereditaments and appurtenances, unto the said part ies df the second part, and to their heirs and assigns FOREVER. A.nb the ftib Edward G. Whitman and Laverne D. Whitman, his wife, for themselves, theirheirs, executors and administrators, do covenant, grant, bargain and agree to and with the said part i of the second part, their heirs and assigns, that at the time of the ensealing and delivery of these presents they were well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all encumbrances whatever, i and that the above bargained premises in the quiet and peaceable possession of the said part ie8 of the VUL ,7 PA GC Y . VOL 402 PAGEr304 second part, their heirs and assigns, against all and every whole or an person or persons, lawfully claiming the y part thereof, they will forever WARRANT and DEFEND. ,3 n it itntOfl WDU90t, the said part i.es of the firs part ha ve6ereunto set their hands and seal. this day of March .A. D., 19 64 . Signed and Sealed in ' Presence of (2 . . !l. Edward G. Whitman ..... ......a. .... ....... ... ..t.. ... ... . ....... .. ...........»... ..... �� .:...�7..5..„ ...::............. .. .(Seal T.aVPrne D Wh ltman ) » ............_......._......»............_ .. ................._........... »» .....»...................(Seal) �......... » ......... ............................... .................. ... .... ......................... _.. ......... .......... ............. ...... ».... »_......_ Seal ........ ........ ........... . /?......11.x... ». ......... .» ........ ».County. ss. Personally came before me, this day of - Ma rch the above -named EDWARD G. WHITMAN and LAVERNE; D. WHITMAN, his w ife, '1964 , to me known to be the persons who executed the foregoing instrument,,and knowledged the same. ........ .............. ✓•!••r� _ .•w.- .....« ... h B. W: 6:11TE{» Notary Put lic, laas4La �` `J a �� MY Commission - Expire § marm N otary Public, ....._... ».._... ». "I *'W scorlwn My commission expires '+ 419 Drafts LE Drafted y....X . ............ » :.. EICBERG For ,Neumeier Fhenbercer Eekb '1 Attorneys at Law, Stillwater, Minnesota no4 (ees•witne a$es and s and State e'rentees. witness" provides that all instrument$ to be recorded shall have plainly printed or tyyewritten thereon the names of the wanton ry•.) = t [ • 'go w � ' qu Q' v i ti b M�nl y i� I .o. s q ra cc ho �•y�� i F i 1�-j .y q) \ Y V' x 1 Q, tEE w O. W V t U C `, : ry E t r. cdi t) r4 _Pj i Wisconsin Department of Health and Social Services Plb. #67 3/70 r Division of Health , SEPTIC TANK PERMIT APPLICATION TYPE or USE BLACK INK A. BIER OF PROPERTY Name Address (Street, City, Zip Code) /jam .., c ^-•''3 LC�"y•'L�-=- .1 .. , r L B. LOCATION OF 'PROPERTY WN EgE SYST',�i WILL BE CONSTRUCTED ALTERED O EXTENDED COUNTY Check One: CITY VILLAGE LEGAL DESCRIPTION TOWNSHIP C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? ( NO ��. Z PERMIT NUMBER D. SEPTIC TANK CAPACITY / % i Gallons NEW INSTALLATION [ - -- REPLACEMENT ADDITION MATERIALS: Prefab Concrete ^ "J Poured in Place Steel Other NM9ER OF TANKS TO BE INSTALLED: E. TYPE OF OCCUPANCY Cheek One: One or Two Family Residence &'- -- - commercial Industrial other Specify) Number of Persons to be Accommodated Number of Bedrooms F. APPLIANCES, ETC: Food Waste Grinder YES /E NO Automatic Clothes Washer 4- YES NO Dishwasher YES / / NO Automatio Potato Peeler YES / -NO Other (Specify) G. MASTER PLUMBER ?FAKING // INSTALLATION Names "I Address: ! f � �� /.• > / f, c° /• , . . K. �L:ro n e Number: � j l lip Signature of Applicant: - i f ll- !!P RSW A/ , f Addresss H. (To be Completed by Issuing Agent) Date of Application / - -? r �� Fee Paid Permit Issued (date -� "� / ( ) Permit Number / �• � � �f Agent (Name) Fort Town, Village, City; - County, - etc. (Specify) Note: The application cannot be considered for filing until all of the above questions are answered and the fee paid. Agents will forward application, the fee of $1.OU for each septic tanK and the third copy of the permit (canary) to the Division of Health. Checks and money orders should be made payable to the Division of Health. Do not write in space below - FOR DEPARTMENT USE ONLY I. DATE RECEIVID % -� ACCEPTED BY '- RETURNED (Initials) ) � ) -- (Date) See Corres. FEE RECEIVED VALID. No. r '! / PEAMIT N0. ' (Y es or No REVIEWED BY APPROVED•. _ DATE (Initials) jYex or No COMPLETE OTHER SIDE r SEPTIC TANS PERMIT N0. R S P 0 R T O N S O I L P t R C 0 L A T I 0 N ? E S T AND SOIL BORINGS TO DIVISION OF HEALTH - ZNG S C C PLLHB E TI�Zi E P.O.Box 309, Madison, Wis. 53701 Pursuant to H 62.20, Wis. Admin MAY 14 1't, strativs Cods <`iI 1 ' rivislor, PZRC0LATI0N STS? 0 °`T ^r 6 EAL Fu i Test Depth Character of Soil Hours Water Test Time Drop in or Level Inch_ es Minutes Number Inches Thickness in Inches Since Hole in Hole Interval Second to Next to Last To Fall 1st Vatted Overni ht in Minuton Last Period Last Period Period Onse Inch Example P - 0 36 Top Soil 10 Clay 26 25 Yes or No 30 1 2 1 2 _ . Y2 60 l � J r f r / RECORD DATA FROM MINIMUM OF 3 TEST HOLES Compute size of absorption "a in accord with H 62.20 Wis. Administrative Code. S 0 1 L B O R I N G S - Minimum 36 Below reposed Abso tlon System Boring Total Depth Depth to Ground Water Depth to Bedrock Number Inches Observed I Estimated Observed Estimated Character of Soil with Thickness in Inohea Example B - 0 72 72 Black To2 Soil 12 CIM L8 Sand 18 ^• Gravel 24 2 RECORD DATA FROM MINIMUM OF 3 BORE HOLE i t YPE OF OCCUPANCY: - 2 y} RESIDENCE# Number of Bedrooms OTHER (Specify) / u" )4 L— Number of Persons -- POO WASTE GRINDER: Yes No �! r Dishwashers Yes No m / Automatic Clothes Washers Yes o FFWENT DISPOSAL SYSTEM: NEW EXTENSION ADDITION REPLACEMENT Tile Size No.Lin.Feet Trench Width Depth Number of Lines i Seepage Beds Length 2.5 f Width / o Depth y j Tile Size � No. Lines Seepage Pits Inside Diameter Liquid Depth i I, the undersigned, hereby certify that the percolation tests reported on this form were made by me or under my super- vision in accord with the procedures and method specified in Chapter H 62.20 (13), Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. NAME J lC. � Y/ ,, 0f / :' ! // 5 TITLE Type or Print i REGISTRATION NO. / or MASTER PLUMBER LICENSE NO. ADDRESS /�. >/. /% C' ( - 7 Z `DATE `7` S� - 7/ SIGNATURE 0 § 3c M n d' � k g 7� r ¢ ) . T n 1 _ \ _ @ � 2 s z= 7 z c 2$ w o $ E & m o E ; : • = cp �& - 7 ( ƒ / / k CL � ] �� _ § � j } � CD % / / \ e = ( E , % § § a z � ��� E e o CL O. 2 i E o o § o - @, ®; 2 \ J . � ® #: \ \ Z' 2 E C E � 0. 2 T V T 2 E. 7 000 $ / o l Ep (a CA ■i' , �� c V �� X ; R © n ; � 2 / 7 � A � Z , � z } 0 § 7 [ ƒ 7 CD � CD � c � \ CD \ y 7 (6 _ - Co z - \ CL 9 g ■ 2 m 0 k / \ o z R z % ECc± je § xna � E\f % CL =m � / $ g E = A � t $ % C) § k 2 770 \ � % \ i a . � # Parcel #: 030 - 2013 -95 -000 12/11/2006 10:21 AM PAGE 1 OF 1 ' Alt. Parcel M 36.30.19.409A 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): 0 = Current Owner, C = Current Co -Owner JOHN R & ELSIE M SANDQUIST 0 - SANDQUIST, JOHN R & ELSIE M 1281 80TH ST HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1281 80TH ST SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 19.890 Plat: N/A -NOT AVAILABLE SEC 36 T30N R19W NW NW EXC N 663.5 FT Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 36- 30N -19W Notes: Parcel History: Date Doc # Vol /Page Type 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 169577 Use Value Assessment Valuations: Last Changed: 05/31/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.890 74,200 150,000 224,200 NO AGRICULTURAL G4 17.000 2,500 0 2,500 NO Totals for 2006: General Property 19.890 76,700 150,000 226,700 Woodland 0.000 0 0 Totals for 2005: General Property 19.890 76,700 150,000 226,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 112 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00