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HomeMy WebLinkAbout040-1306-02-000 Wis nsin�Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix �Safeand Building Division INSPECTION REPORT Sanitary Permit No: 514890 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: Schauer, Anthony Troy, Town of 040 - 1306 -02 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: i ` , I 1 08.28.19.1829 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic r J , Benchmark , Dosing Alt. BM Bldg. Sewer 13 Holding SUHt Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic r. Dt Bottom Dosing ' Header /Man. z Aeration Dist. Pipe • +- }� _ ,l Holding Bot. System SIG, - -f PUMP /SIPHON inal Grade P /SIPHON INFORMATION Manufacturer Demand St Cover. ✓ . GPM t .. •7 - ° /� �, < u. Model Number r TDH Lif4= Friction Loss System Hgaq TDH Ft _ t Forcemain Length Dia? Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width ,' Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ! "'� SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: r INFORMATION CHAMBER OR Type Of System: e . UNIT Model Number: :....: , 1, ,..... „ .. DISTRIBUTION SYSTEM 1.., ' .. , Z, i- -3k ll,� Header /Manifold i; Distribution x Hole Size x Hole Spacing Vent to r Aake Pipe(s) 3 Length / + Dia Length Dia 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 c 't Bed/Trench Edges Topsoil 1. .Yes No Yes No �o- COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 464 Dylan Court Hudson, WI 54016 (SW 1/4 NE 1/4 8 T28N R19W) Sunset View Lot 2 Parcel No: 08.28.19.1829 1.) Alt BM Description = } s 2.) Bldg sewer length = i - amount of cover = t Plan revision Required? ❑ Yes No —I ,! Use other side for additional information. L SBD -6710 (R.3/97) Date Insepctor's Signbture Cert. No. r R w A wu U n Rfl coma rCe.Wi.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 62 - rr LR o/ x i scores i n Madison, V A7- 2 Sanitary Permit Number (to be filled in by Co.) $C? Sanitary Permit Application State Transaction Number In accordance with s. Comm. 8321(2), Wis_ Adm. Code, submission of this form to the appropriate governmental AIA unit is required prior to obtaining a sanitary permit Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide im in accordance with the Privacy Law, s. 15. 1 m , Stab. purposes L A lication Information — Please Print All Information // ,gy�A,V Property Owner Name h I- ��(,�e.,� JUN 0 9 200 Property Ow Mailing A ST.CROIX000N Yro OZ'�C�1i1S�17G1 �T_ ZONING OFFIC �� City, Sta Zip Code Phone Number r\ SSection ©( 7/S d.f S- SS/�3 (circle one T o78 N; f o W R Il. Type of Building (check all that apply) a „d Lot # / 9 1 or 2 Family Dwelling - Number of Bedrooms Subdivisi Name " eAl % �o�ri Block# ( z ) ❑ Public/Commercial - Describe Use 1 eity ❑ State Owned - Describe Use CSM Numberlestof 7 ZZ } GI i/ ArTown of Ro P III. Type of Permit: (Check only a box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Oniy ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Tr nsfer to New List Previous Permit Number and Date Issued Before Expiration O / . IV. Type of POWTS S stem/Com nent/Device; Check all that a C- -% r , K Non-Pressudzed In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mormd >_ 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil P 06 G ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Diu rsaVTreatment Area Information: �,r�C Required (st). Design Flow (gpd) Design Soil Application RV ` Dispersal Area __ uired Di rea Di spersal A Proposed El System evation a e,ti q G6o . 7 8s8 ✓/ 87/. / VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units i o New Tanks Existing Tanks Septic aHoldiog-T4iak f�Sd Doamgtliamber fib — /� �� ✓ 7s'o / VII. Responsibility Statement - 1, the mrdersigaed, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's " MP/ Number Business Phone Number o ,-i /ELKS /� ,�.;' i y� 71 S Plumber's Address (Street, City, State, Zip Code) /l� C-?98 Sr. Hwy S �✓r.��c�+.✓o �/I' �"Y7,3G VIII. Conn /De Partment Use On Approved isapprov Permit Fee Date Issuing t signature n Reason for $ Lr 5 L 6:g IX. MW—W easons for Disapproval 1. Septic tank,4fflU&4 filter and dispersal cell mast all be services'/ maintained as per management plan provided by plumber. 2. ;Alf setback r efisnts must be mhintaihed WkAbk code / at dutattt ". Attach to complete phim for the system and submit to the Comty oaty on paper ant len than 81/2:11 inches in size SBD -6398 (R 01 /07) Valid thru 01/09 N n l v y � r 0 r _ a v �K 14 Ml �W y' c e L 14 i Z b 3 � a \ v e e X3 %3 � � a c 1 QJ n Y r v o � ao O . i o r 11 J V �x n i w k v� �•; o ' a LQ � V Z J� 2 z \J c 0� Fcopy Wisconsin Department cm EwED SOIL EVALUATION REPORT Division of Safety�and B ;>,ing Page of ' in accordance with Comm 85, Wis. Adm. Code Attach complete site pi n on Rn19 1As 29n A, 1/2 11 inches in size. Plan must County include, but not limited : vertical and horizor Is� 4efere a point (BM), direction and percent slope, scale or imenfjp%, t�Y�ft ` and to lion and distance to nearest road. Parcel I.D. - fU1 r ONdI IG OFr RE c-t.c r a information. Revi wed by (1 "Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).^�'" • Property Owner ZZ Property Location SW 1/4 1/4•S T N R E( W Property Owner's Mailing Address Lot # [ BI ck # Subd. Name or CSM# P o. Box 3 3 2 — S� s - vi -�L-v, 4-29 City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road ZI New Construction Use: 3 Residential / Number of bedrooms Code derived design flow rate L! S O - �p QQ GPD i ❑ Replacement ❑ Public or commercial - Describe: Parent material G t_�el }=� L Q,� jl.v� } } Flood Plain elevation if applicable General comments ft and recommendations: w,1 //uT ctt�7u 2 ��ffif Ct'Y�is i` 3o`rwt U ❑ I Boring # ❑ Boring ae F �p'.� ®pit Ground surface elev. ISO ft. Depth to limiting factor 7 1 b0 in. Ems• Soil Application Rate Horizon De pth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eft #1 , EffR2 s i I �s ' b Z � y`S_1�U !�`t2y16 � 1 S � CJ S t'►'1 - 7 �.Z �° SS• j. LD 71 - Boring # ❑ Boring ® pit Ground surface elev. u O ft. Depth to limiting factor ? C ) 9 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. + Eff#1 Eff#2 o -lZ IbM re— 3 LZ- -- siI Z`�s h1�- Cw Z� • S -� Z 2 - 3 l0 31(- f s j 1 ZW1 sb k hi 4 �-g - - S • Y, .I, 9s. I f 0 f qs. (,�.2 L3 .. Z Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print)— Si n lure Arthur L: Ve. Y, g 03 -Z,)S - 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Iiain St. diver calls, [7I 54022 1Z _ - 2-03 715 -425 -0165 1 Property Owner -ii Et ` DQ\J q.() P M 0,/--- Parcel ID # J hi G Page ' of a Boring # Boring ® pit Ground surface elev. -! `1 • � ft. Depth to limiting factor ' q in. Sol[ Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fl In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 � 04I? 3 /Z — s i 1 Z.`P s bk YV�- C Lv I b`2 3 16 — si Z� sbl✓c vrl�. CS — a s _g I ,r yZ . Boring # ❑ Boring pit Ground surface eiev. ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color, Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 F-1 Boring # ❑ Boring pit Ground surface elev. ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /f1 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff #1 •Ef1#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. SBD -8330 (R.6100) T Property Owner ` �� [} � NI � Parcel ID # ��.J't] 1 ft/ G Page Z ' of Boring # ❑ Boring C� ® Pit Ground surface elev. -! ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fl in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 �o��e 3 �z — s i 1 -7`p S b� �`�t� C w - z �3 -�to ore 16 — s J Z►� sb�c �nn`F1, cs — S _g 3 uo-�q t 01-fQ VA - s o S9 11-1 F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to IlmiUn factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft 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 6018 -266 -3151 or TTY 608 -264 -8777. SBU -8330 (R.6/00) Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings Page of in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must Count/ include, but not limited to: vertical and horizontal reference point (BM), direction and — percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. Ivy r.1G Please print all information. Revie by "Date Personal information you provide may be used for secondary purposes (Privacy Law, s: 15.04 (1) (m)). Property Owner i Property Location W 1 /4.NE 1/4 -S Z:� T Z8 N R �Q Property Owner's Mailing Address I E (o( Lot # Block # Subd. Name or CSM# P o. �3C �x 3 3 Z - ISurvs o City State Zip Code Phone Number Vl []City [] Village ,® T Nearest Nearest Road B flM 1 ,Rk.� tiv ► ► 5 cl $ l0 I (I I S ) q$S .33 5 ) i New Construction Use: ® Residential / Number of bedrooms – 4 Code derived design flow rate ❑ Replacement — GPD Public or commercial - Describe: Parent material G t_�el 1 s L j1.�i1�� } Flood Plain elevation if applicable I� General comments ft. and recommendations: Z0T ` t EE Boring # Boring ® pit Ground surface elev. IO0 ft, Depth to limiting actor 7 b0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture I Structure Consistence Scundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0 -\-Z 1D�1(Z - S1 l I c'Sbk wt�fy. ��, Z� I 's ,g 3 �_�o0 1 o�trz�l6 � I S I U S ►� i - .`� t•Z Boring # ❑ Boring I ® pit Ground surface elev. u 0 ft. Depth to limiting factor ? C ) 9' in. Soil Application Rate I Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 1ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 •Effn2 16`1IZ3 i Z — -, i I Z`F-s b� do-t 2 3l6 - s I Zwl sb k h2`P>- �g - . 5 • �, Rq Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ign ture CST Number rl'rthur L: yWegerer C AAPt L ', 03 -Z )S -- Z 220254 �` F1 e g e r e r Soil T e s t i n g Date Evaluation Conducted 421 11. 1 - -lain St. River ralls,� 1 - Z - ZZ - 03 Telephone Number 715 -425 -0165 r PLOT PLAN Paae 3 of � Scale 1' , i a ° D 1 ry t`n pt-t_, J � J J 7 ' LuT Z I w r 1 uTI QUA. �1'v'i ( 2-0 ^ 7 -oQ 6t t j Su ed f LUT C Q 12 . - 1 Cy`, 10 `Tp - - 1A6 L , �2 - -Z-Z- 03 715- 425 -0165 220254 03 —Z1S_ Z CST Signature Date Telephone I�To. CST Alo. Job PIO. vv L I cy') co S 00'00'04 "E 230.25' Z I E- 0) o I �O r CO ca r) ----- - - - - -J �� � �; I �: L - -� N/ Cd I O ,0Z•LK 3.WSZ.00 N -- Z 00 "E 210.25' O `c C\2 I O O "' 145.48' J N \ � d I rn 24.59 \ E-- 0 /J 1 w O O Lo in v) \ 3\ Or \ � ° / Z �s� N w - \\ \� �;\ ,� �, /, ,Cs` .moo a I mac, / /'� s .@ E- cc) L' I Q lP \� \ s Q � Q� �� \ (`J O A \ E \ QCVC IN 4f I 09� w � I O s N s 00 1 o N Lr) L0 0 / / z O 00'09 47 0 159.98' N / o I REC. AS N00'05'30"W D 05 3652 �4 �� 0 1 d I N z � o , N N �� I oo - o ao � j- �- r� 1 N 1 E rn o N a o / I� I d O co m 0 O1 .. d N I w 1 O 0 0 I w I O r, � 17 p i p a a / �� C . .l N w Z o 3 p) �j N N ,bk1 Q� 00 � J: o c° Z �S �� � a c �� � Z O M ►�' ° 0 00 ° o ° o /'/'p 3 Z M. z o / o= a N 171.5 N 1 ' 185.15' 205.17 ° N F v ..... ....... �� >...►. 138.49' N 00'37'42 "W 561.83' C-4 U) � TOWNSVALL D L%, O % AD _ . N-r N 00'56'46"W 1010.47' cs voL. 10 PAGE 2795 y 5275.66' CSM VOL. 10 PAGE 2795 I LOT 6 LOT 5 I VIA I Private On -Site Wastewater Treatment System (POWTS) Index and Title Sheet Owner: n Vl G r' Project Name and System Type: �Qe_ y Gig. / i,eot.�a �o�rs 41 -1,cr .trer Location r Street Address .St✓ irJE 8� aB.�J, / 9 A✓ Zes -�, Sa,✓ �/is�✓ Legal Description }- � [/own/ of �i�aY, �!' Gltoix Lo. Township /County -- Contents: Page 1: Page 2: G e r G'� �.✓ _ ..r��C�o ss- �r� ria.� Page 3: G'ura �.f/.I�roiti Coors -moo xio.✓ Page 4: G'uMP �Lrlt'Foit�JA.✓Gr `u�r Page 5: A0A1 rs 49AIWCA "s /' W-W.0 6 f 1'14 t: gf:,Yd ✓r ��.✓ Page 6: /f tj tt Ll tl Page 7: Page 8: .Page 9: Attachments: Z i06EL � c r�.c /yAi.✓ rr.✓�.�aE �.✓ <o. Plumber/Der: Signed: Credential Number: Date: S 14X6 7 9� Page 3 Of 7 SEPTIC TANK E'PUMP CHAMBER CROSS SECTION'AND SPECIFICATIONS 4" Cl VENT PIPE 12" MIN. ABOVE GRADE WEATHERPROOF ?' /O FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE T WITH CONDUIT MANHOLE COVERS W/ PADLOCK E Fl..vi e.r.4 WARNING LABEL • j ...._ -- 4" MIN . 18" IN. INLET ` . WATER TIGHT SEALS GAS- Z,v BEL � F�c rErt TIGHT \IAPPROVED ,q /ao A . SEAL JOINTS WITH APPROVED - i ALM APPROVED PIPE PIPE 3` B ON 3' ONTO ONTO SOLID � � SOLID SOIL SOIL' PUMP OFF ELEV. 8o FT. - f - OFF " RISER EXIT D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE.PAD SPECIFICATIONS SEPTIC./ DOSE TANK MANUFACTURER: /ESEa Go✓c.re NUMBER DOSES PER DAY: S ,73. P.) TANK SIZES SEPTIC GAL.' DOSE VOLUME INCLUDING /39.9 f S = DOSE 7so GAL.. FLOWBACK: IYY 9 GAL. ALARM MANUFACTURER: S.T. Eo.yr�� CAPACITIES: A = - ,T8 INCHES = .So,$ GAL. MODEL NUMBER: SWITCH TYPE: 62cvar B = 2 INCHES = 322 GAL. PUMP MANUFACTURER: /YyDito�.o r� c /^�� C = �_ INCHES = - Sys! 9 - GAL . MODEL NUMBER: ,tom _23 . SWITCH TYPE D.= 9 INCHES = IYy 9 GAL. REQUIRED DISCHARGE RATE _ GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE FEET MINIMUM NETWORK SUPPLY PRESSURE . . - FEET f = FEET FORCEMAIN - - X � FT/100 FT. FRICTION FACTOR � FEET TDTAL DYNAMIC HEAD = � FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH SS ; WIDTH 8o ; DIAMETER - LIQUID DEPTH y8 DG, yaf 7 t - SD33 VS 33 SW50 Typical Application* Sum /Effluent pump Typical Application* Su /Effluent pum (opacities SW /SD/VS33 - to 48 GPM (3.0 Vs) Capacities SW /SD/VS50 - to 44 GPM (2.8 Vs) Heads SW /SD/VS33 - to 26 N. (1.9 m) Heads SW /SD/VS50 - to 24 ft. (7.3 m) Electrical SW /SDNS33 - 115V, lo, MO FLA, 60 Hz Electrical SW /SD/VS50 - 115V, le, 8.0 FIA, 60 Hz Motor SW /SD/VS33. 1/3 HP shaded pole vi/thermal Motor SW /Sp/VS50 -1/2 HP shaded pole w /thermal overload overload 1550 RPM 1550 RPM Minimum Recommended SDNS33 =12" (304.8 mm) Minimum Recommended SD/VS50 =12" (304.8 mm) Sump Diameter SW33 =18 "(457 mm) Sump Diameter SW50 =18" (457 mm) Automatic Operation SW = Wide -angle float switch Automatic Operation SW = Wide -angle float (manual available) SO = Diaphragm pressure switch (manual available) SO = Diaphragm pressure switches VS = Vertical float switch VS = Vertical float switch Materials of Construction Cast iron and engineered thermoplastic Materials of Construction Cast iron and engineered thermoplastic Impeller Thermoplastic vortex Impeller Thermoplastic two vane semio en Discharge Size 1.1/2" NPF (38.1 mm) Discharge Size 1.1/2" NPT(38.1 mm) Solids Handling 3/8" (12.8 mm) Solids Handling 3/4" (12.8 mm) Power ford 10' , SJTW,(20' optional) Power Cord 10' , SJTW,(20' optional) Superior Features • Carbon /Ceramic mechanical seal Superior Features • Carbon/Ceramic mechanical seal • Oil - filled motor w /automatic reset • Oil- filled motor w / automatic reset thermal overload thermal overload • Uses single row ball bearing construction 9 9 • Uses single row ball bearing construction • Piggyback plug available for easy maintenance qnd • Piggyback plug available for easy replacement maintenance and replacement 9 30 40 SD3 ,SW33, 33 30 SW/SD/VS50 6 to 20 rn � � I 0 - 20. 3 1? 10 " 10 t topaJiy ti s 6,P 0 20 30 40 5 0 0 10 20 30 40 SO 60 70 . i "` UUrs/Second 0 � - 1 2 3 GPM b ack Switch a s m �gy A Q. o � h POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FILE INFO T N SYSTEM SPECIFICATIONS Owner r\ fit Vt. e— Septic Tank Capaci JSO' gal ❑ NA Permit # - - - Septic Tank Manufacturer A, 6„u. ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ZAda O NA Number of Bedrooms 100 m ❑ NA Effluent Filter Model 4 - oo ❑ NA Number of Commercial Units - NA Pump Tank Capacity So. O NA Estimated flow (average)* Y4o ga Yday Pump Tank Manufacturer lerrpt !n. ❑ NA Design flow (peak), estimated x 1.5* Coo gal/ day Pump Manufacturer DaoHA r c p NA Soil Application Rate 7 fV Pump Model ri.1 .? ❑ NA Pretreatment Unit 1$► NA Influent/ESluent Quality (NA ❑) Monthly Average ** ❑ Sand/Gravel Filter ❑ Peat Filter Fats. Oil & Grease (FOG) 5 30 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (8005) < 220 mg/L ❑ Disinfection ❑ Other: Total Suspended Solids (TSS) Manufacturer. Model: s 25011 Ce Dispersal Cells) Pretreated Effluent Quality [3 Monthly Average* ** Dispersal (gravity) 13 In- -ground (pressurized) Biochemical Oxygen Demand (HODS) < 30 mg/L ❑ At -grade ❑Mound Total Suspended Solids (TSS) � 30 mg/L ❑ Dri line ❑Other: Fecal Coliform (geometric mean) 510 cfu/100m1 V Leaching Chamber Manufacturer .dFid Teen re /L Maximum Effluent Particle Size 1/8 inch diameter Model A/&x I / Laying Length/Chamber sl *Wastewater Flow Verification and Calculations: Soil Application Rated gpd/ft Area Req. ?-I 8 fe (Other than bedroom based) Infiltrative Surface/Chamber -ESIA Ratin /9. / ft Minimum Number of Chambers S ❑ Aggregate Design Flow/Loading Rate= ft min ** Values typical for domestic (non - commercial wastewater Materials: all materials must comply with WI Adm. Code and septic tank effluent. COMM84 and be installed per manufacturers specifications ** *Values typical for pretreated wastewater. I and approval letters. DESIGN CRITERIA ❑ "Wisconsin At -grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.al.1990) ❑ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 ❑ "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6 ❑ "Design of Conventional Soil Absorption Trenches and Beds ". R.J. Otis - ASAE Publications 5 -77 and "Design Manual - Onsite Wastewater Treatment and Disposal Systems ". EPA 625 /1 -80 -012 October 1980 ❑ SBD - 10570 -P (8.6199) "At -Grade Component Manual Using Pressure Distribution" to SBD - 10567 P (8.6/99) "In Ground Absorption Component Manual" ❑ SBD - 10705 -P (N.01 101) "In Ground Soil Absorption Component Manual" Version 2.0 ❑ SBD - 10628 -P (N.6/99) "Recirculating Sand Filter System Component Manual" ❑ SBD - 10656P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" ❑ SBD - 10572 -P (8.6/99) "Mound Component Manual" ❑ SBD - 10691 -P (N.01/01) "Mound Component Manual" Version 2.0 ❑ SBD - 10595 -P (8.6199) "Single Pass Sand Filter Component Manual" ❑ SBD - 10657P (8.6/99) "Drip -line Effluent Disposal Component Manual" ❑ SBD - 10573 -P (R. 6199) "Pressure Distribution Component Manuar' ❑ SBD - 10706 -P (N.01/01) "Pressure Distribution Component Manual" Version 2.0 ❑ Drip -line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Frequenc Inspect condition of tank s). At least once every ❑ months 3 0 year(s) xamum 3 Pump out contents of.tank(s) When combined sludge and scum equals one -third (1/3) of tank volume Inspect dispersal cell(s) At least once eve ❑ months 3 MyearW 'mum 3 yrs.) Clean effluent filter At least once every 0 months ❑ year(s) Inspect pump, pump controls & alarm At least once every ❑ months 3 Cg� ear(s) NA Flush laterals and pressure test At least once eve ❑ months ❑ year(s) NA. Valves At least once every ❑ months ❑ ear(s) ❑ NA Other. At least once every ❑ months ❑ earls C3. NA Page of START UP For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water - saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetabletfruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. ❑ Valves Valves shall be operated in the following manner: Alarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back -up of sewage into the dwelling or surfacing. INSPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). Septic Tanks Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any backup,or ponding of effluent to the ground surface . Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one -third (1/3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to main solids in the tank Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. p Pump Chamberfrreatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual duck must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of any filters. Any service needs or repairs shall be promptly taken care of In- Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring Page 4 of 7 ❑ Mound, At- Grade, In -Ground Pressure The inspection shall include recording the levels of pondmg, if any in the observation tubes and a visual inspection for any evidence of surfax seepage or discharge. Any discharge to the ground surf ce must be promptly reported to the regulatory authority. Pa nding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the and of each lateral to be used for Bushing. Thu laterals should be Bushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS Reports for mamUnazice, inspection, and monitoring shall be submitted m accordance with COMM 8355 Wisconsin Admmistrative Code. ABANDONMENT When the POWI'S fails and/or is permanently taken out-of service the following steps shall be taken to ensure that the system is properly and safely abandoned m compliance with Ch. COMM 8333, Wisconsin Adanmistrative Code. - All piping to tanks and pits shall be disconnected and the abandoned pipe openings seated, - The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. - After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replaent 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 fronn disturbance and compaction and should not be infringed upon by required semis from existing and proposed structure, lot lines and wells. Fail= to protect the replacement area will result in the need for a new soul from existing and proceed stsucftzre, lot lines and wells, Fail= 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 furled POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soft and site evaluation be performed to locate a suitable replacement area. Ifuo 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 bias at the infihrative surface. Rwonstructions of such systems must comply with the rules in effect at that time. <<WARNING>> ' SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONIUN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN DO NOT BNTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY C3RCUbWANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE DITERIOR OF A TANK MAY BE Dl3?'FICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name J e'LKE Name ToN.✓ Arzxe E LCf Lu�Gi�i Phone 71s 4 7.2 - sty 4 Phone 71,f d 7.Z - S' . SEPTAGE SERVICING OPERATOR (Pamper)- ,� LOCAL REGULATORY AUTHORITY Name Iftency - <r. eitoix 2 e^JIvg gil .,exl z e Phone I f' one /S ,38G - S/Gg0 KAWPDATAUMMOWIS OWNER'S MMUAL.doe Page7*of 7 I , . Maintenance The interval for servicing septic tanks is set by. state and local code. Throughout the United States there is a wide difference of opinion on what this interval should be, but most regulatory agencies suggest two to five years. The Zabel"' filter, which does not increase the frequency of servicing for the tank, should be cleaned when the septic tank is normally inspected and pumped. However, our filter is virtually self- cleaning. The continued action of the anaerobic organisms on the Zabel filter causes lodged particles-to disintegrate and fall to the bottom of the tank. If your filter contains a SmartFilterw alarm, you will be notified by an alarm when the filter needs servicing. To service the filter: 'Servlcfng any zabel filter should only be done by a certified septic tank pumper or Installer. Locate the outlet of the sr septic tank. Firmly pull the filter hdW.1 and slide the cartrldg¢'t 11 ; Remove the tan k of the and pump the *Note. A tee handle may necessary to p to be used d the rdterls r any solid below ground level to escaping to th contact Zabel for Into when the f handles i rem s 4 While holding tho * *V' G� ** � ��: the access opertin $ g Insert the ft11 d! cartridge with fr back In the careful to rinse all B . ' 3 sure the fiat • ro' eri P P Wrote: It is 1W nets completely I ssppootless' fie , aJdes In the pretreatme be left on ttw Nor. (Itn may be drsass Replace t y P . uw[wus► ; The product(s) shown are covered by one or more of the following patents: U.S. 5.762.793, 5,580,453, 5,591,331, 5,759,393, 5,683;577, 5,582,716, 5,779,896, 5,593,584,5,795,472,5,736,035, 4,710,295, 5.382,357, 5,482.621 U.S. Des. 386.241.349067.4605501.5098568, Des. 309007, Australia: 134440; Canada: 2,135,937; Israel: 111574: New Zealand: 264824, Other Patents Pending Call for a free ZABEL ZONE An Onsite Wastewater Magazine' 1- 800 - 221 -5742 - Website httpY1www.zabe 1.com 11111111l111lIIIIIIIIlllll! I ! III IIII 111111 1111 IIlI 8 6 2 2 6 6 1 State Bar of Wisconsin Form 1 -2003 862266 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number Document Name ST CROIX CO., WI RECEIVED FOR RECORD THIS DEED, made between B & L Land Development, Inc., a Wisconsin 10/12/2007 11:15AM WARRANTY DEED Corporation EXEMPT 11 ("Grantor," whether one or more), REC FEE: 11.00 and Anthony W. Schauer and Lisa M. Kutz , both single persons as joint tenants TRANS FEE: 225.00 ( "Grantee," whether one or more). PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is Name and Return Address needed please attach addendum): River Valley Abstract & Title Inc. 1200 Hosford Street, Suite 201 Hudson, WI 54016 Lot 2, Plat of Sunset View Development in the Town of Troy, St. Croix County, File # 2695846 Wisconsin. 040 - 1306 -02-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, restrictions and rights-of-way of record, if any. Dated October 10, 2007 B & L Land Development, Inc. (SEAL) (SEAL) * * B. Geissin er, Se as. Notary Public state * e i Wi (SEAL) (SEAL) * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated on St. Croix ) ss. COUNTY ) * Personally came before me on October 10, 2007 TITLE: MEMBER STATE BAR OF WISCONSIN the above -named B. Geissinger as Secretary/Treasurer of (If not, B &_L Land Development Inc. authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the foregoing instrument and acknowledged the same.. THIS INSTRUMENT DRAFTED BY: * Attorney Doug Berg 1200 Hosford Street, Suite 201 Hudson, WI 54016 Notary Public, State of Wis My Commission (is permanent) (expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 1 -2003 * Type name below signatures. IofI PELKE PLUMBING Fax :715 -672 -5267 Jun 3 '08 1130 P.02 ST. CROIX CC1ITNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION I Owner/Buyer Mailing Address $ a5 Property Address Cz Co & y f /14 a- z /iyL Jr J / (verifi catiofi required from Planning & Zoning Department for new construction.) Citylstate ���� �� Parcel Identifiication Number o � - 1 306 ' d X © Ob LEGAL DESCRIPTION Property Location 514/ /4, t /4 , Sec. _ $ , T _i�S N R 19 W, Town of Subdivision Lot # Certified Survey Msp # _ , Volume _ , Page # Warranty Deed # , Volume , Page # spec house yes Po Lot luxes identifiable no SYSTEM MAINTENANCE AND OWNER CERTINCATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out tha septic tank every three years or sooner, if needed, by a licensed putoper. What you put into the system can affect the function of the septic tank as a treau=t stage in the waste disposal system, owner maintenancc responsibilities are specified in §Comm 83.52(1) and in Chapter 12 - St. Croix Co unty Sanitary Ordinance. The property owner agrees to submit to St. Croix Coanty Planning &,Zoning Department a certification form, signed by the owner and by a mister plumber, journeyman pluunber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, hereitx, as set by the D,eparUtont of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system bas been maintained must be •completed and returned to the St. Croix. County Planning & Zoning Department within 30 days of the tbree year expiration date. Uwe certify that all statements on this form are true to the best of my /our bmowledge. Uwe am/are the owner(s) of the property descn' bed above, by virtue of it warranty deed recorded in Register of Deeds Office. Number of bedrooms L / ._. r�l�l� SIG T OF APPLICANT(S) DATE ***A information that is misrepresented may result in the sanitary permit being revolved by the Planning & Zoning Department. • ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. ( "V. 08105) s o c Cpp O 0) m 0 is C m m O o .Z o n IF] 11 m A m z m ° °D 00 30'-0" cn O -�- D o � 0 n 2 M � D Cl) 2 X a A N p{ � m m m p z s C 0 m 0O N o li u ° C m �-1 Ln m m z m o0 I ° WE F Ell A I O Q E I � o o X N O c I � N I VAULTED c I 1 VAULTED �7 I p m w I I ° v I I m I O v I = I O O I C I 4 A� ULTED = Q W ' I o I N I 1 1 1 I I I I O I ° Q (1 N X m ' O a o a o 5 . 3 0 0 m: DH1 -3640 N O O S D1ii -3&40 25.0" _� « »:� •� .s, , +< :a= . : ... ....... . a ... .:.. . cn © » n i c j *| § ) §° ) k § § § k ¢ \ \ . 0 ;D m , k ' z n - m k . - ■ j v � l & � .....2 ■ . } � + 2 2 2 m s « v... - > » • co FR § I c F , , . .. . . , > _ ) \ a« PUMP • l PUMP EFFLUENT P ERF OR MANCE AN D/OR 1 I •I 11 S OLID ' ® ■ ■ ■ ■m��■mmmmmmmmmmmmmmmmmmm o ® ® ®mmmmmmm ®m ®mmommm ©m ■ \ ■ ■ ■ ■mm ®mommmo ®m ®mmommmm ®m■� ■� ■ ■ ■ ■m�aaaaae ®omm ®�m�o�o ® ® ®� �� ���� ®maaaaaaaaavommm�■mom0m mmaaeaaaaeoaaammaa ®m ®® \� \1���m ®aaaaaaaaeaaammaaaa0m m ®aaaaaaavaaaaaaaaaaaa , \ ■ ■� ■ ■mmaaaaaaaeeaaaaavaaaaa m ®aaaaaaaaaaaaaaaaaaaa � � ■� ■ ■mmaaaaaaevaaaaaaaaaaaa �������mmaaaaaavoamaaaaaaaaaa ■■ „ 1'■ �amaaaaaaaiaaaaaaaaaaava \� ® ®e■aaaaaaaaaaaaarsaaaaa OWN 6 XI �mm ®�■ ®aaommm■�mmm Iii\ a11mbomm■■ ■ ■ ■ ■m ®amm ® ° aammmm ® ®mom �����1 ■I ■��� ■ ■ ■ ■�mmm ® ®mmm m� ®mm ®ae■�m ®m ®s�amm \ ►11 \ ! ■ ■��► mom ® ®.�m�ommmmmmm � � � ■ ■ ■ ■mmm ®om ®mmmommmmm SIII \ \■■w1% ■ ° s ° aa■ ®moo ®�® m�0 m1 � � q, iX \\\wI■■ ■W SEWAGEAND DEWATERING mom 0m ©mo ®o ®o�m ®�.mv © ®v ®ose�v ®_m ® ® ®oo0ao ©o0mvo ®v0oom ®_v_ ■■■■■■■■, om ° ss ° s ° ° s ° ss ° s ° s ° s ° s ° s ° sss ° ss0 � o ®vim ®v0v ■■■■■■, v® s ss_ s s ° s os s ° ° ss ° ° _ ° ss ° ° _ ° s ° s ° s ° as ° s ° asoao® m\■■\m■■■■■■■■■■ ■ MEN ■■ ,,..,. s.bjected to less than 15 feet TDH. SUGGESTED METHODS OF FLOAT INSTALLATION On some installations it may be desirable to install an independent hanger for the level control switches to avoid possible hang ups on the pumps, piping, valves, etc. Float hangers are available from Zoeller Company on Catalog Sheet FM0526 or can be fabricated from standard pipe and fittings. ACCESS COVER STANDARD PIPE FLANGE A • 10 -1411 FLOAT TREE WITH 3 FLOATS SHOWN • A TYPICAL FLOAT HANGER ON CONCRETE PITS PVC OR LIGHT WEIGHT OR SEPTIC TANK RISERS PEAGRAVEL STAINLESS STEEL PIPE SK1217 TYPICAL FLOAT HANGER ON CONCRETE PITS SK1218 TYPICAL FLOAT HANGER ON STEEL COVER PITS OR SEPTIC TANK RISERS "EXTRA PROTECTION SYSTEMS" TWO PUMP SYSTEM The "Extra Protection" Two Pump system is an economical solution to the costly duplex alternating ALARM pump system and its easy to install. PM1014MILLUSTRATED The "Extra Protection" Two Pump Systems consists of: a. The two nonautomatic pumps with VLFS of your choice b. One Alarm System C. Two Unicheck Valves as required ADVANTAGES PEW�AVEI (1) The Two pump systems offers high pump performance without the high price. It is a system that fits your needs and your budget. ALARM ON (2) Delivers more dependability than a single pump system and greatly reduces the chance of costly and ON time consuming problems associated with wear out or damages and the resulting system failures. P °M " °" UM P 20FF ® PUMP OFF (3) Affords greater satisfaction and peace of mind to all concerned by providing state of the art protection for costly and expensive surroundings. & ®° ' �i LEV FLOAT SWITCH PUMP PUMP (4) Ability to change lead and lag positions by changing pump plug connection. SKS78 (5) Easy and economical to Install. •MINIMUM DISTANCE 2 °BETWEEN PUMPS THE BASEMENT SENTRY® 12 Volt backup sump pump system model 507 & model 510 Application - For Clear Water, emergency backup usage when power is off or primary pump fails. Extra Protection - When the primary AC pump fails due to power outages or system problems. • Storms • Brownouts • Wiring or electrical problems Extra Protection - When the primary pump fails to keep up with excessive water due to rain or overloading. r Includes: MODEL 507 MODEL 510 Pump and control TDH (ft) Flow (GPM) TDH (ft) Flow (GPM) Charger 5 23 5 33.8 Fittings Battery Case 10 15 10 21.6 (Battery Not Included) 15 5 15 10.6 17.5 Shut -off Head 19.9 Shut -off Head For submersible or pedestal installations. See FM1311 (507) or FM1139 (510) for information. Suitably sized basin required. © Copyright 2008 Zoeller Co. All rights reserved. 5