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004-1022-60-000 (2)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Budding Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal Information you provide may be used for secondary purposes [Pnvacy Law, s 15 04 I1)(ml] Permit Holtler's Name city Village Township ZZh McCloud c/o Ken Cook I TOWN OF CADY TANK INFORMATION TANK SETBACK INFORMATION TANK TO P/L WELL BLDG Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Head m NN, 1 1 1 1 1 SOIL ARSORPTICIN CYRTFM TION DATA Pe Grade HI I FS BED/TRENCH DIMENSIONS 'Xdth Length No Of Trenches PIT DIMENSIONS No Of Pds Inside D o Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer Type Of System Model Number UIJ I ISI O V I I V IV J T J 1 CIVI Header/Mandold Distribution x Hole Size z Hole Spacing Vent to Air Intake Pipes) Length Dia Length Dia Spacing JV IL V V V CR x Pressure Svstems Only xx Mound nr At.Rmde A—+— noh. Capth Over Depth Over xx Depth of Seeded Sodded xz Mulched Bed/Trench Center Bedr7rench Edges Topsail -, _! F Yes !� No Yes n No COMMENTS: (Include code discrepancies, persons present etc 1 Inspection #1 Location: 439 HWY 128 1.) Alt BM Description = 2 ) Bldg sewer length = - amount of cover = Plan revision Required? E I Yes No Use other side for additional Information SBD-6710 (R 3/97) Date Insepctors Signature Inspection #2 Cart No reran-. ram( RIFF"fn1 'I �< rra" 1 r`TQ2 eJ SfjyU-aQa1— 39-�' I -' -'-° Industry Services Division County Ysrds Way T, (Mesa 4822 Madison I or fiin by Co.) OSP OCT 12 2021 Madison, WI 53705 Sanitary Permit Number (to $ P.O.13ox 2 �� /CjZ - Madison, WI 5 —7 nt' - — Co Applieatio State T ensartion N°mbe` in accordance with SPS 383:2I (2). W ti Adm. Code, wbtmmon of this Conn to the approps I unu mieet Address (rfditfcrent than mailing address) Is required prior to obtaining a samucry Permit. Note. Application forms for slamotmed P WI S am so the Depanment of Safety and Professional Services. Personal inlbrmation you provide he use for dary purposes in accordance with the Privacy Law, s. I S.t14(I Nm), Sails L� �Q / 7Q T I � Q 1. Application Information — %ease Print All Information aperry Owner's game 4io kt_ c Parcel # ,Cook [ �d[ OON Pmpe wner's Mailing Address I,cation Sr.Properly y 3 9 SNJY, /;,8 _ Gnvr Lot _ City, Slate Zip Code Phone Number �c%/[ fowl Cal 1511o1 /S 7/9- Y/3.3 - /W A' S/.1 v., section T 8 N R /S E o ll. Type of Building (check all that apply) VLot # _ sviswn SubdName © I nr 2 Family Dwelling-Numbcr ofB t ' par_ ❑publiclCummemial Desur6c Use_—_. Block# _ -❑Gty of ❑Statwm e Oed - Describe list _._ Viilageof e1 CSM Number y,310 f I r ©Town of 4,Bgy DoC : U 41 ICI. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on fine A. Check one box on line B. Complete line C if a —� A. ®New System I ]Replacement System 110ther Modification to Existing System (explain) �QAddinonai Pretreatment llm[ (explain) L❑J[n-Ground B'❑Holdine Tank �AAt-Grade Mound Z Individual Site Drsi Other 7 ex las ga Type Pni (conv cntionel) C. I ❑ Renewal Belbre �Rcvision ge of Plumber ❑1'ransfer to New OwnerList Previous Pcrnsit Number and Date issued Lxpirott I/ I f u ) IV. Dispersalfrreatment Area and Tank Information t9•(d.1i = r — Ds•clgn Flow fgpd) I Dcs,gn Soil Application Rate(gpd/sf) ispersul .Area Required (sf) Dispersal Arp posed (sf) Systna El Lion r [/SO___ /•d YSo S So 42•� 9`17 eJ 98.0 [adreac Capacity m Total : of Manufacturer s C� 1_ 'tank information I. _ Gallons _ Gallons Units n� / r�•_�O _\ Pam, `fir 'P 'R{J Kim Tanta FciningTmk< —.�- Sepvaor!toldwa-Ark 000 /000 i Lc%/f SEd �a.J[w, r' Oaslny Chambc' boa -1 1Loraa V. Responsibility Statement- L the underugoed, assume responsibility for installation afthe POWTS shown on the attacked plans. Plumber's Name(Print) Plumber's Si' MP/WB"Number Business Phone Number oNk Ee[cE (�f l e Le R31314 /s 47,7 salt Plumber's Address (Stan-t, City State. Zip Code) N 1198 Sr. a•r. e75 i✓4tAA O L,ir TY734 Vt. County!_D_ epartment Use Only —Foct Pemmt Dare Issue Iss ing ent Signature Approved ❑ Dssap — I s S / O �p 5Z02OmnRa ❑-ll rn Conditions a � pproe R '�^•' I n n lQr�°� `° 1 P 1 S STEM OWN f 1— ro. ofi rNtt7fL` 1. Septic effluentfilter and U,y PQCri�tvt dispersal cell must be serviced / maintained ,L\ -.. I. _ �� 5 s per management plan provided by plumber. t / fXJ►^�*c6ay V 2. V setback requirements must be maintained 110 D401RC.1![ .r. s per applicable Code/ordinances. VX .Attach to complete plans for the system and submit to the County act%as paper on, lest Nan a 1a 111 inches In size SBD-6398 (R. 03R 1) ,(rnynnY Iafvdars 6 , 7U7 a»oy SC x % t'tb E IafW" I + l °bL j A'76 rff/•IF-p oF•v7S ' (os)nivw�7r°>a V~ vasodord >n/ h Pb 'Y°9 77016' 1 > >rrvl ovwo� 0o7/°oP/ rDf P,(r/ 6�- ,v T -7d PfrC (a9r0Pn7 174roW.2 ,»rYd aa>Y 8'L/ r°rd 197 9n6's J3N s>nryl3s £h'e8f J7WP 7aY s+"d s e7 p�c or m o oh=/i /l •07X"P,7:ts '4017 !o.d r7s" `firer 'o/ l(yS '(TN i 8C/ 'A^n - b£f, CttFq\ DIVISION OF INDUSTRY SERVICES �pN'?a 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay http./ldsps.wi.gov/progmms/industry-services www.wlsconsin gov ��Esvnr�b� Tony Evers - Governor Dawn Crim - Secretary September 20, 2021 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2023-09-20 Plan Review: PWTS-092102346-C JOHN PELKE N6298 State Highway 25 Durand WI 54736 SITE: Zach McCloud Hwy 128 Town of CADY St. Croix County Total Amount: $500.00 Description: 450 GPD (3 Bedrooms —.VeR• Construction) Maintenance Required Conditionally APPROVED DEPT OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE Pressure Distribution Component Manual — Ver. 2 (, S BD-10706-p (N.01 /01, R 10/ 12) Mound Component Manual— Ver. 2.0, SBD-10691-P IN 01/01, R 10/12) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced abot e The owner. as defined in chapter 10 1.01 (10), Wisconsin Statutes. is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, scats The following conditions shall be met during construction or installation and prior to occupancy or use: • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • With new construction; it Is recomniended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on -site or off site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose organic material to be removed from POWTS Dispersal Area. • Divert surface water from all POWTS Areas. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 Inches Smearing and compacting of wet soil will result In reducing the infiltration capacity of the soil Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1 /4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed If the site is too wet to prepare, do not proceed until it dries • All piping shall conform to SPS Table 384,30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382 30 tI NO • Well setbacks to meet chs. NR 81 1 & 812 • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) pnor to installation. • Pump Floats to be set and verified per approved plan. Any changes may result in pump resizing to meet TDH and GPb1 Specifications. • Areas that are occupied urth lock fiagmcnts, tree roots, stumps and bouldcis reduce the amount Of aotl atinldhlc 1ol plupel ll CatmCllt. 11 Ills UdIC1 �IiC li dv dllhb le. neey In 111C hasdl ,ilea of the IliUnlld must be cut off at ground level A larger fill area is necessary when any of the above condwons are enLounteled, to provide ?IItif CICT11 Infiltlati\C area Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system Owners shall receive a copy of the appropriate operation and maintenance manual and/or owners manual for the POWTS described in this approval SPS 383.54(1). • 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 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. All permits required by the state or the local municipality shall be obtained pnor to commencement of construction/mstallatton/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions at se making them necessal v for code compliance As per state stats 101. [2(2), nothing in this review shall relieve the designer of the responsibility for designing a safe budding, 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Thanks, d isn U.a�t f 'A ear POWTS Plan Reviewer— Wastewater Specialist Department of Safcty & Professional Services ! Division of Industry Services Cell: 608-516-6134 Paue �of9 11 A lvate Onsite Wastewater Treatment System index and Title rave ON%ner'c. Name " Owner .�darc s Contlrf,onally r`3 y _ /�� , ,' B ._ ._ _ _APPROVED DEPT, OF SAFETY AND PROFESSIONAL SERVICES ;�c; ft Sc.: �...�� �"Lv7 DIVISION -OF INDUSTRY SERVICES SEE CORRESPONDENCE County - �,zo.• Lot Ntt S= Flock \Urnow. Min Subdl�lston Same Parcel 11) `.umber Pate l,l C)r z, dliu -1t1. Mwe _ Pot Phil Page ? 0a,w-sanon Plan Vies, OL ;dulmtl page = P�pc Latua. L.n<mt Paga = Septic Tangy: _It.np Page 6 Pump Perionne_tce lnt6mZaro¢ Page - Pow" f S Owner ; Maw & Nonmemec "Wr Pegs 6 PC)WTS oAW7 ; Manuai a- Manaaement Plw I aJe & Frlte: lnrocnaul:❑ \a:nc In, uwQuc. T ti.c ,/�, �„"1_ pill Xt 'f rcnall, �_ _y Daze 7-_ pia: 1 SHD-10691-P (V.0U0; )" MOMIL Component Manual- Vervion 20 SHE)AD 06-P (\ 01 0 "'P_cyu c DZU1 own C'r..ntrw nt 'vlamA 6civr,n.' ( PLOT PLAN ZAcA 939 N&r. 128 Nu, Sa /O, i8 V /Sal T. cF LeaY Sr. L.-'z LO- T / H34 /so, i11'1"2. u14N � m _ 11 .� rO P.IJ 'i r.� 1 . t _ Sf/ n,i n 1 cadrl. ,g1i.1u �rcl iipy�:>r � cp,l Ila m; r � I ZOO I �. �'T it � l,I . q'J lloii'1-W.rit 44 Mul l VIA: `�. U(l - r. !fi 1'bfla 1.1 i`�1.i1. i .. :�i Dt•s:.�:� :} �/ - it i'� lir(Ip,- PIPE LATERAL LAYOUT OF MOUND (End Manifold with Aggregate) HOLE DIAIM-TER - 3//6 in. LATERAL DIA.PVC ,1}— bIANIFOLD DIA. _ lrin J s pipe D26 5) odeJ PORCR MAIN DI�, A. in. ft,`J`nQ a&e Gcj\e s =-3 ft. P SNae X '% ft. Xa\ Y _._ �� _ _ f t . H � A� F rs ,I X rY y t• MANIFOLD y' \ (Pla in. sch. 40 -_—\,j\fix ' PVC D2665) r.,. FORCE MAIN (2" sch. 40 PVC D2665) Page __ _5' of . 9 Access �r6ox s'c �\ x� vy Y� yrY„ r X-- ' g` �r as` L HOLES LOCATED EVENLY ON BOTTOM OF PIPE, Minimum Number of Holes = y.9`o _ ftz - 12 = .38 Holes Holes/Lateral x 2 Laterals = (3/16") Holes x 0.66 gpm / (3/1613) Hole G�M = SYSTEM FLOW RATE PIPE VOLUME = ft. Laterals (total) x 0,092 gal/ft. = 11. 5 x 5 = /4-W5 GAL = MINIMUM DOSE VOLUME PIPE INVERT ELEVATION = 140.2 ft, Page 5 ci 9 COMBINATION SEPTICIDOSE TANK CROSS-SECTION (DP.AWING NOT TO SCALE) FINAL GRADE MANHOLE RISER E COVER P[oar SPS 384.25(7) a (a), approved :or proper {yiope ground u W away Dom Mckvrg devlCB, & vrzmlab el: bel: Extend , �nhote(s) drainage} mamme riser as nacescary.) 4' Mac Sch. 40 PVC Tar& Vent 4" Min Scb. 40 PVC Tank, Vent ELECTRICAL ]=led 12" abova grade w 24' BUILDING SDIVER roclad 12' above grade orW JUNCTION BOX abova Ragionai Flood Elevation /{per SPS 382.30(11)1 above Regional Flood Elevation {comply vnTh SPS 316 I J and NEC 3001 J .... _... _. FORCE MAIN �I 5 I `1z OPTIONS ! I s e- cover I' y a18" .I ibVlnOLE __11 �Fa. INtci T— ao-OU OF WLITT i�.en timatrs:� twatTrr°—i \Yran� —3 -- It L 3 EST l M rxav w �y c � imec xr= Ap .� r a4ua =k-, - I� a mvxel s:c Parritla eea 9 i fix: 9106 MINIMUM OF 3" OF SUITABLE BEDDING BENEATH TANK « MAXIMUM BURY DEPTH OF 96' Anchoring of tank may be req•_dMd per SPS 383.4;(8)(g) Tank Manufacturer 4✓/6sfA Loy< �rF _ Daily Wastedvater Flow (DVVF): 5 SO GPD Septic/Pump Size: /o oo /Goo gallons Number of daily doses. S. '1r ( /S.T 7a Alarm Manufacturer. 5 7 E 1Noer4us Model Number. T,o,iK Xi rAr / Switch Type: _ MEcxiu/LAL Efflueni Pump Manufacturer: 24 E,� ce< Model Number /SI Minimum Discharge Rate: o?S 0$ GPM Vertical liii (pump of to lateral invert).. _ .. 10.2 System head (distal pressure a 5 x -1.3 fi): 3,3 R LD ft Force main x —/—y /100 friction factor.8 ft Filterfriction loss. ...... f I offal Dynamic Head (TDH): /it. 3 ft Force main volume: 60 R x L 3 gaBH =_ a gal Actual dose volume: 93.8 gal - 9.8 gal = 8j(.40 gal (total dose volume - volume of Torte main) DOSE TANK CAPACITIES: Reserve above alarm ad.'1 in = 3Y�. 4 gal (D) Alarm float above on float a2 in = 33.5 gal (C) On/Of float measurement S. L in = 934 gal (B) Of above tank bottom 8 in = 13V. / gal (A) DOSE TANK DIMENSIONS: Length /6-0 in Outlet height .i6 in Width 8 Y in Gallonsfinch /4.76 SILL PUMP PERFORMANCE CURVE Ml 1511152.'153 v I I 3 I I 7 � I l2 o ` 1e m 30 a m in m au ze anL.ons _ LnERS 0) j) 2N Jm 3En FIMVKRWM E a,<vea Timed dosing panels available Electrical alternators for duplex systems, are available and supplied with an alarm Variable level control switches are avallabie for controlling single phase systems. Double piggyback variable level float switches are available for vanable level long and short cycle controls. Sealed Owik-13ox available for outdoor installations. See FM1420. Over 130°F (54'C) special quotabon required. 1511152l1S3 MODELS Control Selection Model volts_-0h Mode _ An,m s_unpkx Do le N151 1115 Non 60 1 2or3 dial _1_-_- 115 1 Auto G O Sr,,udsd 2.,3 E151 _ 230 1 Non 32 -_� — 1 2or3- eE151 7 230 1 _ Auld 32 Included 2or3 N152 115 1 Non 85 1 2w3 &N.52 115 1 Auto _ 65 imodetl_ 2or3 E152 230 1 _ Non 43 1 1or3 DE152 L 276 1 Auto _ 43 Incuded 2 or 3-- N153 115 1 Non 105 I 2013 BN153 115 1 _ Auto 105 _ Impaled 2 v 3 E153 230 1 Non 53 1 2or3 aE153 230 1 Auto 5.3 Included 2or3 TOTAL DYNAMIC HEAD/FLOW PER MINUTE EFFLUENT AND DEWATERING MODEL Feel l Will, 5 1 5 10 30 151 I GA Lve —L— -- { H1 leg 0 +10 i Giv 69 G 152 Liu, T 28' Tt 153 Gel Lners I 71 29+ _ - j 1(I 265 61 1 231 52 197 46 ,R 44 53 20 2 _ at ]6 2y o 1 '6 61 :4 34 16, 129 25 42159 30 0,, 4a �2z -- — shofar aid _ + 23. _�87 - - - - 30 h I. - ..im1 30n 111;1 31 125 22 � 65 j � 4 11 134m) Model 151 i I „ �n6 a P'6 J _ ,rtwrvm 11 r 1 Single pggyback variable level float sw ich or double piggyback vanable level float switch. Refer to FM0477 2 See FMO712 for correct mount of Elecfmcal Allemator F-!'ak 3- Vanable level control switch 10-0743; ed as a control activator, specify duplex (3) or 14) float system Y CAUTION Models 1521153 e6e — �. r �6 n9�a "Easy assembly" (p,x+'p 8 darharge one 1 ml�al � 2 1� gr Reduces potential clogging by debris. Replaces rocks or bricks under the pump. Made of durable, noncorrosive ABS. Raises pump 2' off bottom of basin Provides the abddy, to raise intake by adding sections of 1'/::' or 2' PVC piping. Attaches securely to pump Accommodates sump. dewatering and effluent applications. NOTE: Make sun Baal is free from obstruction. For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump 0 Copyright 2008 Zoeller Co All lights reserved POWTS OWNER'S MANUAL AND -MANAGEMENT PLAN FIL2 iNFORN ;TION Owner Permit [DESIGN PARAI ETERS - 4 Number of Bedrooms(100 pd/bedroom) 1 3 Number of Commercial Units _ - Estimated flow (average) -:0o qat,&- Design flow (D WF), estimated x 1.5 �/,jo al/da Soil Application Rate 1..4 I/da ft'Influent/Ef±lueot Quality (❑ NA) Monthly Average Fats. Oil & Grease (FOG) <_ 30 m_v/L Biochemical Oxygen Demand (BODs) 1 S 220 mJL Total Suspended Solids (TSS) i - - < mg,L Pretreated L-ffluent Quality (® NA) Monthly Average Biochemical Oxygen Demand (BOD.) < 30 me,'L Total Suspended Solids (TSS) < 30 mg/L Fecal Coliform (geometric mean) <<-! 0 cfu/100m! Maximum Effluent Particle Slze ! i'8 inch diataeter Caicuiations: Sod DW'F = Application rate = SYSTEM SPECMCAT10_ NS Septic Tank Capacity /Q00 gal p NA Tank Manufacturer 4)1g,SEa Ce.u., E2 NA _Septic I Effluent Filter Manufacturer EST O NA Effluent Filter Model 6f-/o ❑NA Pump Tank Capacity le 00 gal ❑ N, Pump Tank Manufacturer 441,Fg;« Ceor.... 0 NA -' Pump Manufacturet ZO£LLE-X ❑ NA P2LR2 Model 51 NA Pretreatment Unit ( to NA) Q SandlGravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland 1 ❑ Disinfccrion ❑ Other. ',ylanufdcturcr. \lodcl: Soil Absorption Component (❑ NA) ,71 In -ground (gravity) At ❑ In -ground (pressurized) Mound -grade to ❑ Drip -line ❑ Other. G Dispersal iirti¢—Manufacturer ! { n Aaghegate Cells) Model Dispersal End -Cap (Dispersal Unit EiSA) or Area Required - EISA - (Trench Width) Units Or Total Lenath of Trench(s) 75 ` "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publication 9.6 (SSWMP Manual) ❑ 1CC Flowmch Mound Component Manual" Version 12 C "EzFiow Mound Component b?arival' Version 12J15/2017 ❑ SBD - ! 085•`.-P (R. 11 i2) ' :At-Gradc Component Manual Using Pressure Distributiori' Version 2.0 Cl SBD - 10705-P (N.01/01) "In Ground Soil Absorption Component Manual" Version 10 Cd SBD - 10691-P CN.0i/01) "Mound Component Manual" Version 2.0 ❑ SBD - 1065 7-P i R.h199) "Drip -line Effluent Disposal Component Manual' Ill ❑ SBD - 10706-P (N.01/01) `Pressure Distribution Component Manual" Version 2.0 ❑ Other - MAINTENANCE MONITORING SCREDULE-N 41FNTF.NANC-.4NDMANArR..N1ENG Service Event Service Frequency _ Pura has ect tank(s), ins ect dispersal cell(s)- clean filter I At least once every: g 13 months M 3 years ❑ Other - lns2ect Lmp & pump controls alarm, pretreatment unitI At least once every: m_ months 3 years M NA Flush and pressure test laterals At least once eve •: months ®; ears n 1vA START UP AND OPERATION: For new construction, prior to use of the PO WTS check treatment tanks) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use System start up shall not occur when soil conditions are frozen at the infiltrative surface. The property otimer is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water -saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength Nastewater, however the d sposat of food based greases and oils, vogetableffimit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biode¢radahle ilems aueh ,c h.hy wipes, wmpons, ®..Itary nopkina condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, Pave 7 of q disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply Maintain a regular steady Sow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up INSPECTIONS & MAINTENANCE: Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber. Master Plumber Restncted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge mid scum and check for any backup or pondina of effluent to the ground surface and test all electrical equipment such ds pumps and alarms. Any defects shall be promptly corrected. Exposed openings greater than S inches in diameter shall be secured with efRctive locking devices to prevent accidental or unauthorized entry the tanks. When the combination of sludge and scum in any tank exceeds one-third (1/3) or more of the tank volume, the entire contents of the tank Shall be removed by a Septage Srrincmg Operator and disposed of in accordance with Chapter NRI 13. Wisconsin Administrative Code. The cutler filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Solids washed from the filter shall be retained in the tank_ I'dtcr cleaning may be necessary at more frequent intervals than stated in fie maintenance schedule to keep the system operating Alai ins should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a I day reserve under regular operating conditions, however water sbould be conserved until any problems with the system arc con ected to prevent back-up of sewage into the dwelling or surfacing. ABANDONMENT: \N hen the PORTS falls and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. SPS 383.33, Wisconsin Administrative Code- - All piping to tanks and pits shell be disconnected and die abandoned pipe openings sealed. - The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. - After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other inert sold material CONTINGENCY PLAN: If the POWTS fails and cannot be rcpaited the following measures have been. of must be taken, to provide a code compliant replacement sysierr A suitable replacement area has been evaluated and may be utili7Ed for the location of a replacement soil absorption sysiem. 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 render it unusable Replacement systems must comply with the rules in effect at the time of replacement. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POINTS technology a holding tank may be installed as a last resort to replace the failed POWTS. X The site has not been evaluated to identify a suitable replacement area. Upon Failure of the POINTS 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 resat to replace the failed POVdTS. X Mound and at -grade snit absorption systems may be reconstructed in place follow ing removal of the biomar 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 iVIAV CONTIAN LETIIAL 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 111POSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name JON.✓ OEzXf iY/-,t3/3s'C Name Et'<c __ LarrJr✓G ' Phone 715' L7�-J1GL ] Phone --- - 715' 471- S.JdZ SEPTAGE SERVICFNG OPERATOR(Pumper) LOCAL REGULATORY AUTHORITI' Name Agency Sr. Laa.Y CaivM ..„ rtutu/rro r Phone Phone yzS 386- f486 Page 8 of 9 Installation Instructions for the GF10 Filter Caf•:RfS_=_T3'3,i7� Ef..'En:C..-_—mot-< ^^ It^pQ C I i �•, Step 1.Locatoand ncvnove the Sep l lc tank cover, on the outlet stole of td nk Stop 4, Glue the filit,,v enter the outlet pipe. Inseq the filter cartridge Into the case (Make sure the filter Is complete y Inserted into the<ase.) BEST Step Before Installation. place Ilse filter case on to the outlet plpe Make sure the case is positioned so the filter con be tenwved from the hrrk fo, mdole nn noel and scrvicp Stop3 rorinsladat'cnsthat require or desire adcillonal support fit addrttonal support Is notneedeergoto Step4) Gluea sectlon of I' Sc Il 40 pipe to the t+vo Isubs located on the Cotivni of the case and B•o hub I W ated on the side of the case. EasaM—e�_-1 1 © i I StepS Forl stallalionsvrhereitwl'd Le ddhcult ro reach the hero dle. piece •' Schedule 40 pipe Into the tee on the hande and extend it height that wll'i make a cosy to remove the filter . M LID I. . . tb Mn so . 6l. CV . r'u CJ . K rya . [..*1 i-ll a Installation of an Sameasa now system only the septic tank 8 0 existing system• met be pumped prior to Installation. 9 it —m® umr1, In, .,1u.R1nu— —r. n. r.o vo c5 Maintenance of the GF10 Filter A Ilrne Irame In which reptic looks are serviced Is set Uy+ram aetl local codes Agho+ph they nny be hlfermt rnnsl mgmdalmy agcnuc+suUgen two to fuel yews We«comelendihe GrlafRm Ue cleaned who the sapte wnk snemal'y cleaned and pumped, akas needed WARNING: Irthe liquid level In theta nk is above the top of the filter, pump the tank prior to removing the filter cartridge. ® CAUTION: USE RUBBER GLOVES WHEN HANDLINGFILTERSI Step 1. Remove the septic tank covet and pump the tank It necessary to prevent any sol'ds frmn estap.ng to the fold when tip filter is removed Step 2. cull the filter handle and slide the 61tcr o ut of iho case �I Step 3: While holding the Flsecearnidgeovn time access opening of the tank, rh•se the cartrldge off wllh fresh water. Take caroto make sure all sopd material falls back Into the tank 1 -•-tey s't---rBEST TECHNOLOGY 3 Faid.ld Blvd WallinoWd, LT 06s33 1.913-765 9596 lax 203 21148514 L3Lrr.F�_�.2 Stop4 d+smlthecarirldge back Into the case making sure that Il Is prorc ly aligned a nd completely Invited Into the case ./ C �t4.i✓� `%[:�_/'� _.-emu `/`/.(c :y_ �. [ n SvSTcry- AvE SITE E MAP OT PLAN L !� Ty V r A 1 nr u vi 46, t� ti w xSMP i 4 r , x k 1 I r DISCLAIMER: 1Tk AipU nq qu�nnbe�bbe - acwrawwrtacicunsnl.IX�WNpbbYd IAffluilUls E2NT T'IM1' wx�mnYY a/t�ta IISI! '4� ` . -T_ ZACH & BREANNA MACLOUO l HOUSE 000 J 6'-912- 33- 6'-41n 24'- 11 1/4• n 19 ] 3- 0- 11'-212" 13'-0.1 11'-212. 25' 31/4" i! it i aeu. III I II a. ZACH & BREANNA MACLOUD HOUSE' FLOOR PLAN 100 -- - - - - - - - - - ----- i Ll - - - - - - - - - - aJ ZACH &-BREANNA-' MACLOUD HOUSE EXT ELEVATIONS I II 71 1 FZACH & BREANNA MACLOUD HOUSE INT ELEVATIONS i I I i f- ZACH & BREANNAJ'' MACLOUD HOUSE 3D p.� i. 180 _ - ���� ST Cfzo UNITY SANITARY SYSTEM File #: nly OWNERSHIP/ADDRESS FORM C,-Offit d0Use 1 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. OWNER/BUYER INFORMATION Owner/Buyer LL ev r �, Mailing Address (Z / ,Z X City/State/Zip n) t�ct� f c J 5 y o,;i -2 Phone Number (required) Cv (� - z! -3 Y, / Email Address Parcel Identification Number UC 9 — / U 11 d (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location AJ uJ t/4 , 5L--t/4 , Sec. � T 2Q N Rjj'_W, Town of �K Subdivision Plat: Lot # Certified Survey Map III % �0 Volume �✓ Page #--70. Warranty Deed # //,'� �1 U (before 2006)Volume Page # Number of bedrooms 3 Spec house ❑ yesprno Lot lines identifiable ❑ yes O no New Property Address OFFICE USE ONLY of new address re�q mrec from Community Development Department for new construction.) (Staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed Community Development Department - Land Use Division 715-386-4680 St. Croix Courty Govemment Center 715-245-4250 Fax cddVsccwi.00v 1101 Carmichael Road, Hudson, WI 54016 wwwsccwi.aov Cwld, R��Ws. Dept of Safetyfopaiogviw1 SOIL EVA UA IO� ONF PORT Division of Safety an11 L' '7`r x Lst-aoa I — 3 `i10 Page o' 3 in d, ardar Rh SPS 385, Wf c- it C,Roq@ Aqn' t;ode ' County ��� m Attach complete site Ian o't x 11 inches in size. Plan must A. � include out not limite n onzontal reference point (BM), direction and percent slooe scale or dimensions, north arrow. and location and distance to nearest road. parcel LD. '� b `{- (6Z2 - &C-00 V j Please print all information. Rev17l,%pe'gdd by Date '/`U%�"" �,(1 ` personal ,nformatmn you prov,de may be used for secondary purposes (Privacy Law, s 15 04 (1) (m)) ,F L V Property Owner Property Locationill" C&-*k p Go Lot /Nt(�114s&✓114 S /a T Zp N R /S E (or)(0) E nit2. L Property Owners Mailing Address Lott# Block # Suod. Name or CSM# 2 to (vvq I 2 'r 16 r4 S i I . Ciry State Zip Code Phone Number ❑ city ❑ Village Zzown Nearest Road `S rY A/! w% SY7l,7 i ( ) 66A 1hxi/Z$ New Construction Use, 2 Residential / Number of bedrooms Code derived design Flow rate S10 GPD ❑ Replacement ❑ Public or commercial - Describe Parent material Q f-� // �i'e�.G� �� Flood Plain elevation if applicable 2-Cyw- k ft General comments and recommendations 1 I / Boring # Lj Baring p / oil Ground surface elev. / 7 d p 2 ft Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz Cont. Color Texture Structure Gr. Sz. Sh. onsistence oundary Roots GPD/ft 2 ff#i ff#2 l 0-9 t6%/ef/L 3-i/ Znrs6/� m✓tl,'- cs 2Jc G 2 y- /S /o yeY/y 3 r5-2/ Io YR S/ s%e-I 2016 �/ zl 2 /o Ylz S/ . 5 did I S / F y $ 2 -yG /o Ye 6/q r s os fxi Cs' G fK -&(1 lo79-5/8' 75rR-�Hol'4 s6-( ,fiff1k n rs — -2 3 Bonng # F-1 Boning p ® pit Ground surface elev �• 37 ft Depth to limiting factor O n. Soil Ao lication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu Sz. Cont. Color Texture Structure Gr. Sz Sn onsistence oundary Roots GPD/ft 2 1 ff#1 ff#2 2 /3 o by/,v C ij 51.4 ?A5kt MA Cs -�3 /oYtiy/ ?yra�8 roc sue/ n�r�K ✓rl� cs — 2 - 3 Effluent #1 = BOD , > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD , < 30 mo_/L and TSS < 30 mo/L CST Name (P easePn ) r SiAlelure I CST -Number / --z� r & ' /C df3 S Aadress J to Evaluation Conducted Telephone Number 29'/f Property Owner_ / LeK14/L `Ci K ParcellD# 00LI'it'022 -40- OUO Boring # ❑ Boring GG pit Ground surface elev O•'7o ft Depth to limiting factor_24�tn Page ?--of 3 Horizon Depth ir, Dominant Color Munsell Redox Description Qu. Sz Cont. Color Texture Structure Gr. Sz. Sh. onsistence oundary Roots .." nu "wuun rtare GPD/ft n f{#t ry#2 o--7 /aYe,?/z- I .n✓/'r leS 1Y 07P-Y/ Z"AskK Inv cS 2� � 3 lY- nips/ sit 2 �+ r6K M V A- E S l� y °f IDY/y5/�4, -s ew �'td �t�l 2,rglK me -31( 74 sr -�� raY25�s 17 5y��/ Ord s� / siK Axle, C F7Boring # ❑ Boring ❑ pit Ground surface elev fl. Depth to limiting factor in. Horizon Depth 1n. Dominant Color!Redox Munsell Description Qu. Sz Cont. Color Texture Structure Gr Sz Sh. onslstence]Boundary Roots y GPD/ft ff#1 ff#2 Boring At ❑Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. Horizon Depth In. Dominant Color Munsell Redox Description Qu Sz, Cont Color Texture Structure Gr Sz. Sh. onslstence oundary Roots GPD/ft2 ff#t ff#2 Effluent #t = BOD , > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD : < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access sen-ices or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relav SBP5330(RI1/1 q CHECK BOX AS APPLICABLE. Z SOIL EVALUATION SITE MAP PROJECT NAME: Kenneth Cook CHECK BOX AS APPLICABLE. Scale: 1" = 40' C SYSTEM PAGE 2 OF 0 40 60 80, PLOT PLAN (10 fl 9da1 10' DESIGN FLOW GPD Attach design flow Calculations for commercial plans. PROJECT ADDRESS: Y 3 7 State Hwy 128 Pipe Material / ASTM Standard (Tables 384 30-3 8 384.30-5) eM mbol: + 100.0 BM Elevatlon: FT N Sanitary Sewer Fwx Main: / BM Description: Nail in pine tree 1 ft off the ground Slope GraNerK(h) or Teeter Area: 0' I /d Well Symbol It applicable)' Q InElmte north by dmwins an. on me avpropft 6e. IMPORTANT : Show ground elevation Contours at suitable Intervals. A l• �t c k sti-er«, ('o. .4,r L��.Jy 7wsp O2- 94.37' 4 �ILI — —• — 95.32' ' I � t r 25H _y a. w r r. Aplee-S7' Z1o7 9,? 5 OWNER PLUMBE TOWN ( qF,c 15 3--8ced�rav%A � COUNTY NO. EXPIRES BLOCK 633992 Y PERMIT O S NO. CHAPTER SUBDIVISION (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and maybe renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. 1Hstory: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: if you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. ISSUING OFFICER -DATE L7 UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI1120)