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HomeMy WebLinkAbout030-2127-60-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 53085 -� 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: Balfanz, Steven I St. Joseph Township 030 -212 -60 -000 CST BM Elev: t Insp. BM Elev: BM Description Section/Town /Range /Map No S 5� j yX Z .� 25.30.20.1040 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark t r Dosing nn Alt. BM Aeration Bldg. Sewer /, S 94. 10 Holding St /Ht Inlet — SUHt Outlet TANKS TBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic i �� Dt Bottom L1, �S SS C ,o oc-- t Dosing t t t I t I Z t Header /Man. I Z 3 20 r Aeration Dist. Pipe ,Z � n Z0 r Holding Bot. System I / Final Grade 1 PUMP /SIPHON INFORMATION �` J Manufacturer Demand St Cov r4 � � J t 4 (p. 0 Gl7 60 G l -- � ' GPM o Model Number 7 e2 �� •fi �` S S t V... 0, 1 TDH Friction Loss t System Head TDH Ft e� J 2-SO I I t -5z 1 Force * iT%tn ' Length / Dia. tt Dist. to Well \ SOIL A ORPTION SYSTEM ) JS REN Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 SETBACK SYSTEM TO 1O P/ /L JBLDG IWELL LAKE /STREAM LEACHING Manufactu INFORMATION CHAMBER OR Type Of b System: r SS t \ r � UNIT Model Numb Cer �n �1� J DISTRIBUTION Hea er /Manifgld �'• t Distribution �xHole Size x Hole Spacing Vent to Air Intake C w (� / Pipe(s ` Len th Dia [ Length is Spacing / ab 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 ,I Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1 11 6i _ZCV Inspection #2: — ' 7 - ' — ` Location: 1364 Birch Park Circle Hudson, WI 54016 (E 1/2 SW 1/4 25 T30N R20W) Birch Park Lot 36 Parcel No: 2 1.) Alt BM Description = ST�DT ►n.ws. c 2.) Bldg sewer length= - amount of cover = 2� +• 1 lv� Plan revision Required? Yes No Use other side for additional information. s ��\ ^-� Date t _� i �J�"�- — _ - _ _ Insepctor's Signature Cert. No. SBD -6710 (R.3197) r Safety and Buildings Division Cody n � m 201 W. Washington Ave., P.O. Box 7162 N IviiMadison, WI 53707 - 7162 Sanitary Permit Number (to be f din by Co4- sconsin (608) 266 -3151 Department of Commerce Sanitary Permit Application :. State Plan I.D. Number In accord with Comm 83.21, Wis. Aden. Code, pesaeual information you provide may be used for secondary purposes Privacy Law, sl5.04(i)(m) Project Ad&mff Address ' different tan mailing address) . 1. Application Information - Please Print Ail Information r ° " E E Vr - X27- 4o - oon -lobo Property Owner's Name 1 # Lot # Block # ST54 l Aq ti < f 3� . 16 Property Owner's Mailing Address P operty Location y., Section 4 city fate Zip code F& S � -4 M - 41 - r y T .,�:. V� 155 / 2 7 � (cir le one) H. � N. 1 or 1� of Builds (check all that apply) n'Pe B uildi ng ( PP c��' 2 Family Dwelling - Number of Bedrooms Subdivision . Name CSM Number ❑ Public/Commercial - Describe Use L ❑State Owned - Describe Use 51 ❑City ❑Viilage�) ownslmip of ,7 42 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ew System ❑ Replacement System ❑ Tmatment/Holding Tank Replacement Only ❑ Odier Modification to Existing System B. ❑ Permit Renewal mit Revision Change of ❑ Permit Transfer to New list Previous Permit Numb�er / and Date Issued er Before Expiration O �" lumber Owner i S' 7 Z o IV. Type of POWTS Syl vw. Check all that a $(Nom - Pressurized la- Ground ❑ Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized ln-Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating S c Maria Fiber Drip ❑ 1 -less Pi ❑ Other ( lain) 1 �• L V. Dispers&Vrmtment Area luf6runiflon; M7 Y Design Flow (gpd) Design Soil Application Rate(AxM Dispersal Area Required (s0 Dispersal Area Proposed (sf) System Elution 0 t'7 ✓ 6'f3 % VI. Tank Info Capacity in Total Number Manufacturer Pfefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tacks Tanks septic o Uowkkgqmnk— /too 00 / F Aerobic Trcatmcnt Unit Dosing Chamber Q 1f V11. Responsibility Statement- 1, the ands ass sibility for installation of the POWTS shown on the attached plans PI s Name (Print) PI Si MP/MPRS Number Business Phone Number 1404V 2�- Ao3t447, s -- -u KK amber's Address (Street, City, State, ,5&b V r VIII nn /De partment Use Only ved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Iss ' t S! Odture Surcharge Fee) y Z 4 ❑ Owner Given Reason for Denial IX. Conditions of ApprovaUReasons for Disapprov ou -i-,) add Attach esmrpitte plat. (to the Coarty only) for the system era papa mot Is" that 91 n 111 loebea in sin SBD -6398 (R. 01/03) 08/19/2004 11:04 FAX 7152352592 T L SINZ PLUMBING INC Q001 T.L. Sint Plumbing In a `Ilse' a� E5609 708th Avenue Phone: (715) 235 -2644 Menomonie, WI 54751 Fax: (715) 235 FAX TRANSiVQ1'TAL Date: �' �9'D� No. of Pages: (including covet) To: /X �4 ZIYl. Attn: From: Subject: ` I , Message: a L�•ord. AvAe wd res od Signature: 08/19/2004 11:05 FAX 7152352592 T L SINZ PLUMBING INC lih002 A Z 4 .gad o� o F— z s W LO z�z' g @_ ir ne r Aff W � �'Ft s0 H U ■ � r �`zi s ..t r W w mr ! 'war` - .c� SaC�.�f �• = 8 Q LL �! z _ . �.. .vr S r �i i Z ' m > D z W W o ZO ca o z J W W IL co) H m � W 0 0 Z z �J z .?� :co O w x u_ a cl) a Q `W z w O ,� (, ` Z O t-�- U) LU LLJ Z v o U 42 M LY ~ cb � H o W U. J � u- LLJ Q uJ o W m O w --� Z �� � va t -� o ui z > O a. M ca y POWTS OWNER'S MANUAL 8z MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner l e ?.- Septic Tank Capacity / gal ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer p l ❑ NA Number of Bedrooms i0 NA. Effluent Filter Model fit f NA Number of Commercial Units ,2 Pump Tank Capacity gal ❑ NA Estimated flow (average) gal /day Pump Tank Manufacturer, ❑ NA Design flow (peak), (Estimated x 1.5) D gal /day Pump Manufacturer+ ,! ❑ NA or Soil Application Rate 7 P gal/day /ft' Pump Model ❑ NA Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil 8z Grease (FOG) s30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) x220 mg/L ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) s150 mg /L 0 Disinfection ❑Other: Manufacturer Pretreated Effluent Quality ❑ NA Monthly average* * Dispersal Cell(s) Biochemical Oxygen Demand (BODs) S30 mg /L R'In- ground (gravity) ❑ In ground (pressurized) Total Suspended Solids (TSS) :530 mg/L ❑ At - grade ❑ Mound Fecal Coliform (geometric mean) s10' cfu /100ml ❑ Drip ❑ Other: Maximum Effluent Particle Size inch diameter * Values typical for domestic (non - commercial) wastewater and septic tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every /v 3 ❑ months years) (Maximum 3 yrs. ) Pump out contents of tank(s) When combined sludge and scum equals one -third (A) of tank volume Inspect dispersal cell(s) At least once every p/o ❑ months J?P'year(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ months Ayear(s) 4V, iO AVee�cs-1 Inspect pump, pump controls 8Z.-alarm At least once every ap/* 3 ❑ months years) ❑ NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) NA Other At least once every ❑ months ❑ year(s) NA Other: At least once every ❑ months ❑ year(s) NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector, POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels In the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may Indicate a failing condition and requires the Immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (A) 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, and,any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION 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 Pa¢e of System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above nonnal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) In one large dose, overloading the cell(s) and may result in - the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by. a Septage Servicing Operator. prior. to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers;. disinfectants; fat; foundation drain (sump pump) water; fruit and;vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; palndne products: pesticides; sanitary napkins; tampons; and water softener brine. ABANDONEMENT When the POWTS fails and /or Is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with 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 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; 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. ck and/or soil limitations. Barring advances in POWTS technology D A suitable replacement area is not available due to setba 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 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. 0 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 CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER -ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name 1L• %1AI&I pG.d<'b'" /Nc.� Name Phone '?t.S% SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Agency 5/ 0/� o � /.v Phone ? /,� 3 & � Phone _ FROM CERTIFIED SOIL TESTING FAX NO. 715 233 03913 Jun. 14 2002 05:52RM P3 W F AT4 E IZ Pi?w;: L egn4Cs GOVBR JLNrYtot� 8th 1r1,RWW� Du�ciC Ptar�wKt}Ci --� eosg 4 PYG Soh l Ii'JJf %if!' 4�0 GIPG. 3 1 Sc1, 0 t++D1STuRBEF �, 24" Z -S7. II 4" 40 y4 ViKTi /44" 9'. CET 3DINTa BA,FFL.E i AL w j 3 PIM - a Z., ri6CTlpt►i.S °"}� {\ ei�+r,�, V'+ • t \ 1 \ \ vim ( } - F Or J L & Y 3 �„ i Lo SEPTIC E A _aPECIFfCATIOU DOS � � 77 TAU,,5 MA►IUFACTUR IJLVAbCR OF 004ES: PEA DAts T*WK $IZC: � pro " (rte, 6ALL014S • .DOSE VOLUME gLARh1 MA"FAGTiiRvR' `� 1 �� �-v„ INCLUDING OACKFI.OW: a C,AL�O}i MUC>kt,. Wu" ° 1 CAPACITISI A �� WCHES OK � , CkALL, OUS 3w1UGH 5fi'L. $ _ I"M£S OR Gwi t DUS PUMP MAWUFAC.TUKc 4t& N N-r C WLr+ES OFt !� [,A L.LOLS i MODEL. ►.)UMDctl 9 D� -- 1Nti:Ht:S�R Ct � GN'�LU7,;u �WITCIi TiiPC: W' v•ry , ,L'O PUAP A)I;D ALARM ARC ro 8C MI!{ 015C+iit►KGF RATE �'M INSTkUI EO Oil SEPti9A VLKTtCAL DtFFCxCijcc bcrwC= PUMP OFF A►1 1 //r U d fl S'f1cIpLlTlau P IPE.. __t���___ FE + MIAtI#kUM WETWORK SUPPL.S PKIttsulte , . D FEET + v FEET OF FORGC MAIN X •� � / {nnr ;t= lttcTtalJ fwcTOlt_.4 FEET TOTAL. OtJ#IAMIC. HEAD ..� FLZT ^� V !UT£RkfAL D)MEL14iogiC Or 'rAwK: L.IMMCPTH , _,w,DT}I f • I 9EH SERIES SUMP /EFFLUENT PUMP ... 11.86 -• ...,.......___... a.eb CD S�4ecificstions - SOLtOS>iTiE AIKAHNNIMO pERiOANANCEWPY 0 Nut) SHy1pFF PWR. C", WtfQHT Qf1lENSif1NS MOOtI W. NO. till MD HP VOLTS (Dig. to-) AIWATT3 1 10 I8' !? (p� (K) (�•) (H x 4 t W) 9EH{IM 509330 U4•/CSA 4 110 115 Nd 13.0 1000 71 68 50 49 32 13.8 2o' 27 9.11 x 11.64 x 8.94 M -CIM $00340 U"Sk 4/10 230 3/4 6.6 1000 71 68 60 49 32 13.6 20 27 9.11 x 11.64 x 6.94 9HH•C - 509350 UU05A 4/10 115 3A 13.0 1000 71 60 60 40 32 1318 20 27 9.11 x 11.64 x 8.94 IA Rf6 609360 Ul1CSA 4,41 23g 314 6.5 1000 71 68 60 49 32 13's 20'_ 27 9.11 x 11,6 x 8,94 FLOW- LITERS /1•011( Construction 0 1000 2000 3000 ��Qtnr !lousing rp47 Coa ted C as! Iron 1.. Impeller Material Poly Carbon 30 10 1rn cllcr Type Closed 1 Volute ARS 7,6 �• � Prawor Card..., ......... SJTW -A LJ 2 W Mechanical Shaft Seal Nitrila with carbon and i S i veramic races _ Fas teners ! Stainlljas Ste - I0 2,s Shag Stainless Stied --{ s Bearin K Upper 514n;ve aril Lower _i 1341 Bearings 0 z0 40 6a as FLOW- GAIL,GNS /MINUTE PUMP PFR CURVE I15v 604z Little Gi&nt pump CO, PO Box 12010 ` Phone: 405.947.2511 Oklx. Cit 731s7 Fax: 405.951.5674 www, Lit0eQ1antPump.com ISO 9001 CERTIFIED (6 Form 99523.5 — 01/00 l/L abed r •YVdLZ E ZO'OZ . `• LZ86 Z99 9L4 ) `•00)E �Or.lasel dH :A8 �Ua �✓�GV T L•►iVNt 1� Ni (i � �+V Jam<L +" r T�wAJ uF ST' 70SC P ilk r4' y - h , loo's Y v� r' D P Ct,',��,j ` ,D 2 1 1 J_ S ri 4 -V4 rr: Safety and Buildings Division County S'r 201 W. Washington Ave,, P.O. Box 7162 VI R n, 07-7162 Sanitary Permit N umber (to be filled in by Co.) Madi sconsin 608) 1 1 " "^ �3 4� s Department of Commerce State Plan 1.D.Number Sanitary Permit Appli ation In accord with Comm 83.2 1, Wis. Aden Code, personal csvlav 3f4tF t>r vids C mailing address) t may be used for secondary putpoaes Pavacy LA , sl5,04(1Xm) 7004 Oc C Q 13 (o g 1 e -JA P aeezK I ��" l�• bDa X) 0 1. Application information - Please Print All Information Z(, t Jf 50 - ,', 1;t7? -� ` Parcel prope owner's Name IJ�TiVCA�+ property on property Owner's Ma Address Section Zip Code Pbone Number Cily, State 7 (circle u 0 V AAhs S SS Z. G0I' 4ZA T J � ! N; R� E or ll. Type of Building (check all tba ply) ✓'"` ' ubdivision Name als s s rt�ch 2 Family Dwelling - Number of or H S" ❑ ot Public/Comerciai - Describe Use `t City_ ❑Village p1'o wn3}Lp of . p ❑ State Owned - Describe Use 33 Ill. Type o! Permit: (Check only one box on Ilne Compi to lin B If applica e) New ❑ edification to Existing System A' System ❑ Replacement System tment/Holding Tank lacement only f 1 B. C1 Permit Permit Renewal ❑ Permit Revision ❑ of ❑ 't Transfer to N 11a v Permi Before Expiration Plumber a 1V. T e of POWTS S stem: Check all that a 1 C1 Single Pass Sand Filter ❑ [loo - Pressurized In- Ground C] Mound >- 24 in. of suitable soil ❑ 24 as. of suitable soil C3 At -Grade BI < Constructed Wetland ❑ Pressurized in-Ground C) Holding Tank Peat e, [3 Aerobic Ileatment Unit ❑Recirculating Sand Filter ❑ I Recirculatian S thetie Media Filter !]samba ❑ Dd ve6less Pi Odxr I V. Dis ersal/1'reatment Area information: Z Dis l Area Proposed (SO System Elevation Design Flow 00) Design Soil ApPl;catioo Rate(gpds Di rsal Area Required I b' /��� Ncw Exiain 4S Q. V Prefab Site Steal Fiber Plastic Total VI. Tank Info Gallons Gallons of n ' is ( - &� t�oacrete Constructed ll \ /) Tanks TarJts I c t p ODD Acrubic Trainman Unit Du.inK Chambcr V11. Res nslblll Statement- 1, the and D4 is s aslbW for tnstatlatloa of the POWTS rho the 8�„ nns Phone Numbers Plu 's Name (Print) PI 's Si Mp/MPRS Number G L t39 Plumber's Address (Street, City, State, tip , ; ,9'12 0 of /+ _j Ac_ f V111. Count /De artment Use O Sanitary Permit Fee (includes Groundwater Dan Issued lssu' Agent igns e S o Staatps Approved ❑ Disapproved Surcharge Fee) ❑ Owner Given for Denial IX. Conditions of Approval/ aeons for Disapproval 3) - SYSTEM OWNER: '0 � l t 1 Septic tank, effluent filter and iced 1 main i ('? must all be sere II mu to net! dispersal ere by plumber. n � as per management plan p rovided intained � C °- ,� � 2. All setback requirements must be ma as per applicable code /ordinances Attach complete plain (to We County only) ror_the iYrtem oo paper not leer than al/2 x I) lnebea In else SBD -6398 (R. 01/03) r 3 e E% � sZS' rS N mow' To ec). a I Js,r .2 — y mg �J�1sr'rH'� tpo° °�"� {'" p 1 Y 0 L4 3 6sd a Lt- i p l El.�C 4— SiC�NNE �(o r �lrem % 5 7 5" y'3 Tower or �T j6S6pti 5 roi�F to, a D 6 -2 ._ 2, *too St 3 6z� �°Ow1 f () LoId 1 { Wrconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Croix Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must 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. 3 0 - 2-b 3 2 0 - Please print all information. R sewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ' 10 VIj Property Owner Property Location ■ ❑ Quest Development, Inc. Govt. Lot E 1/2 1/4 SW 1/4 S 25 T 30 N R 20 E(or) W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# Suite 150 10700 Old County Road 15 36 Birch Park City State Zip Code Phone Number City El village Town Nearest Road Plymouth MN 1 55441 1 ( 7¢3 -595 -9512 County Road E St losenh Q New Construction User Residential/ Number of bedrooms 3 to 4 Code derived design flow rate GPD Replacement Public or commercial - Describe: Parent material 1.ness over out wash snnds Flood Plain elevation if applicable General comments C�� This site is suitable as a below grade conventional s stern. and recommendations: s Zan Boring # Boring ❑ S >96 �•� Q pit Ground surface elev. ft. Depth to limiting factor in. . ` ' • ��•-_ on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Ro PD /f? $ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 " Eff#2 1 0 -6 10yr3 /2 sil 2msbk mfr cs 2f .5 .8 tp 2 6 -20 10 r4/4 sil 2msbk mfr cs if .5 • . (o 3 20 -42 10yr4/4 sil lmsbk mfi cs - a .3 2 4 42 -96 7.5vr5/4 s Osg ml _ _ ,7 $,.2 r r r --- i `fro .o s 3.`f 89•`f a Boring # F] Boring / >98 Pit Ground surface elev. ��O 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 1 0 -6 1Oyr3 /2 sil 2msbk mfr cs 2f .5 .8 (e 2 6 -20 1 r4/4 sil 2msbk mfr cs if .5 .8 ( 3 20 -44 1Oyr4 /4 A lmsbk mfi cs - .2 .3 .Z 4 44 -98 7.5yr5/4 - Osg ml - - .7 1.2 , * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L " Efflu = D < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) Signatu CST Number Thomas C Nelson 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, WI 11/20/01 715 -246 -2454 Property Owner Quest Development.Inc Parcel ID # Page 2 of 3 a Boring Boring # f >90 ❑ pit Ground surface elev. 0 � 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 1 0 -4 10yr3 12 - sil 2msbk mfr cs 2f .5 .8 {� 2 4 -20 10 r4/4 - sil 2msbk mfr cs if .5 .8 3 20 -42 10yr4 /6 - sil Imsbk mvfr cs - • .3 . 2 4 42 -90 7.5yr5/4 - s Osg ml - - .7 1.2 F-� Boring # Boring a pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate I 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 F-1 Boring # Boring FI N 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 * 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- 264 -8777. SM- 8330Test (K09 /00) ti �CG►' X = qV I "S cor) j "' 1 y o 1 o y5 �5z ic)o 140 ts, 75 X04 �d4 . In �. y • 2 PEti0 N 6- LOT To 13 1 + w Ew iwD i U�'D vfi P / 'iv �o� 1:5YV f,v c5 ©F 6 X/ 57 P ✓WS -� PEew j .s 69 3O • 203 • Z 0 • oz7v ce.v r�tc 7- cviS. V 3 Z 03 y. SD • &Zv G- �'GC�v�'G� 107fSTEi O 30 • 2— �� . 70 Ulbricht & Associates Private Sewage Consultants 0 3 0 655 O'Neil Rd. Hudson, Wis. 54016 3 9G • fi/ 8 s ?� S - 77 .2, • 3 yZI-2-- r POWTS OWNER'S MANUAL 8E MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner z7r Z Septic Tank Capacity t p o gal ❑ NA # ❑ NA Permit Septic Tank Manufacturer T DESIGN PARAMETERS Effluent Filter Manufacturer Z "L.6 ❑ NA Number of Bedrooms 3 ❑ NA. Effluent Filter Model A-1010 10 NA Number of Commercial Units ;^A Pump Tank Capacity gal .I.MA Estimated flow (average) L7 gal /day Pump Tank Manufacturer A Design flow (peak), (Estimated x 1.5) S-© gal /day Pump Manufacturer eNA Soil Application Rate t gal /day /ft' Pump Model x14A Influent/Effluent Quality Monthly average* Pretreatment Unit A Fats, Oil & Grease (FOG) 5530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter 5_220 mg /L ❑ Mechanical Aeration 13 Wetland Biochemical Oxygen Demand (BODs) ❑Disinfection ❑Other: Total Suspended Solids (TSS) 5150 mg/L Manufacturer Pretreated Effluent Quality ❑ NA Monthly average ** Dispersal Cell(s) Biochemical Oxygen Demand (BODs) _530 mg /L -ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) :530 mg /L ❑ At -grade ❑ Mound < a ❑ Drip-line Fecal Coliform (geometric mean) _10 cfu /100m1 -line ❑ Other: p Maximum Effluent Particle Size A inch diameter * Values typical for domestic (non - commercial) wastewater and septic tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every • 3 ❑ months Xyear(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (Ys) of tank volume Inspect dispersal cell(s) At least once every o ?— 3 ❑ months A�year(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ months ;year(s) OX /6 0 Inspect pump, pump controls 8T,alarm At least once every ❑ months ❑ year(s) ❑ NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) ❑ NA other: At least once every ❑ months ❑ year(s) ❑ NA Other: At least once every ❑ months ❑ year(s) ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer; POWTS Inspector, POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (%a) 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 ch. NR 113, Wisconsin Administradye, Code. n x� The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatementporents, ~,argci any other maintenance or-monitoring at intervals of 12 months or less shall be performed by a certfm C WTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION For new construction, pri or to use pf-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 , r.A., ­i,/,\ rnm —A k%/ cn taaa c&mArina nnarmtnr nrinr to ntP. S 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 cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist In manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. ' .. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat, foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONEMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with 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 replac ent system: 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. ❑ 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 CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPM1. ADDITIONAL COMMENTS 1 PLUMSIN IN >l�• SINZ PL POWTS INSTA�I�EI� � � INC. ING POWTS MAIN A UMB EMU Min AIE Name Name th AVE. Phone Phone ' MENOMONIE W 64751 W1 54151 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Agency 8f,01 V W • 7 Phnna I Phone '71S_ Wtv ­ T Yb 01407/2004 11:63 6514393284 BLAKE BUILDERS PAGE 02/02 J 04 04:24p Bante Excavating i7151756-2519 P.1 ST C[toxx Coum SBP'i`YC TANK MAMTMMNC$ AGRHHMWT AM OWNRRSIU C .TWCATIoN FORM �► aas 13 r (vt ct tam es Dep fm ww -3 P a n „� --' y*� Sec. S T � �1V; Tom Of ..�... or�lr� a'V # aubdt r --- rVisp # Vntume Page # Deed # Pa # , fn its W=Mm Wdmto hm&cwatu. � o puwfala �� ,, 000 Y CM wormer, !f b3► a • WW ym P b'W *0 ay Cm dw Sian of ea Xvic teak as a ftxxt=l" lltw to the . aisposa rjawm Qab[ ?.anit:8 � * elf its by am *vim end k R'+R8 a vwpav owner ap to tntbmit to SC. that {1�Qtaon- �v+t�ea�tartl3spt day ��x odplmuber '� t bi theiu 1t3 fug, ofslwdgs- im Con didm "&or ('2) niter tim =d P owping Of neoes oylo � lira vatc scww with fm sw du& almd Vwo, die � sot flla a1tG�[C � sad th4 � 40 the S.C. t�otit Uda>�► �g wlthat 30 6ea,,,ptabtsai�ed:aostba� . of y b I 1 DANE t?F AP's qn t z totmt azrt+ ttw to the boa of my (our) konwl I (we) ttm f aro) tba ads} aI y aktue of s W=&nV dood mcotded in Rqc sW of Docds MIX- DATE op API'u . s+►.ss Any • an tHat is mlfrtcPre =� Y uta is d,, s mtWW w k bft mvokodby due Zonbg DopuW L *+ a with a& appti masn: s a ug od rvaxruW flood fYow the Rogue of Dee& affuo o doetl s ovy of the er 00ed sucvay nm if rC&VVwC is =d° to tiro wfu=w 01/03/_2004 .03:20 6513795264 JASON R GORMAN PAGE 03 01/00/2004 W27 PAZ 9528428492 "JMIER TITLE s u �cb1.r `fY8 tiTE BAR aF I'r �QIt 1 w 1�. Q �� x WARXAN Y DMW nO ITL ER of D"F.SUH R ST. *011 CO., V3 poaenedaamper � SEl:B.TYED }`dk lD • This XJead Wade betvrcwt Bixei[ P t, L L. C. �!E$ /3�3 09 t319d1I a limit. �abiliiy c under the lava of tba WABRAM D= statQ of R aaota . FAT 4 Ctsnwr RW PER i2, Go and S M F, mAUM aW Jena T. Bal. aria TRANS FRSe 359.78 wffa joint tetoaYtts cop EEz i KUM I CatttQ. Cranbw, tar a valuable cotsederatIm cony to Ganlft the fon"hl i deatdOWteatwtem9t St, Groin Gamtlt54teNWkCOroln i Km and wean Addax i ' pxmiar 'Pftl.o ' Lot 36 Birch Park 7300 Matra Blvd., #300 Edina, 0 55439 • 30. -21Z �60 -000 Pamal ettr INDOM tAa owop l This U aut Imnteeoru PMPKI t W 0e at) Tngat er with aE appfirtimant dghb. Ode and Ubteft Cantor nvarmta that the do"15 the R:oparty b toa d. lndeieeet5le to fia atanple and do and day of runaa ea cap all eaaexente, faservaiiaabo Z reatzwtione of xecurd, if any- Dated th13 `, dgy of Key . = 2003 Bx14 PARn. 1 C. 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