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HomeMy WebLinkAbout020-1161-50-000 . Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St Safety and Building Division INSPECTION REPORT Sanitary Permit r A38887 _ GENERAL INFORMATION (ATTACH TO PERMIT) st!yla ID N Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'GGI/___7 Permit Holaer's Name: City Village X Township Parcel Tax No: Gelein, Harold Michael & Wend Fritz Hudson, Town of 020-1161-50-000 CST E1e : Ins p. BOM~levo BM Desc-ription: / Section/Town/Range/Map No: (J 601 L 23.29.19.922 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION B / HI FS / ELEV. Septic p , ! ) i1 Benchmark 7 25- 27 5 Q w~~ CJ Alt. BM Dosing C7S~~~IYJ~ , I ~ O 3 5~, Cd?~~/L v /0 2.(03 Aeration V Id Sewer 30 IDD • 3 _ Holding SUH Inlet S TANK SETBACK INFORMATION TANK TO P WELL BLDG. Vent o Air Intake ROAD Dt Inlet Septic ( '1 r avvt~d~ Co !It Bottom Dosing , Header/Man. Dist. Pipe Aeration W r 7 ~T• (0 Holding Bot. System Final Grp- / D PUMP/SIPHON INFORMATION Manufacturer Demand Cover / GPM vev- VS LT-11 21 /D Z .63 '41- ZJZ4_0_12_ I C .J a ( Model Number 5--3 0 A Z L7_7 TDH Li Friction System F~ead T H ~2 Ft Z ® s- ►~L ((o< . Forcemain Length ia. 2 Dist. to Well 3(9 1 1 L SOIL ABSORPTION SYSTEM BEDITRENCH Width Length I` / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 31 5U -r SETBACK SYSTEM TO P/ LDG WEL LAKE/ EAM CHAACHIR OR Manufacturer: INFORMATION Type Of System: T UNIT (,/7l CrJ C~ Model Number: /I'l DISTRIBUTION SYSTEM 2: Sao Header/Ma Id Distribution I x Hole Size x Hole Spacing Vent o Air Intake L/Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only f Q~i1G Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulchgd Bed/Trench Cente,L„_s"' Bed/Trench Edges r~ Topsoil / d 0 Yes No 4es No 2r COMMENTS: (Include code discrepencies, persons present, etc.) Inspection n #1: Inspection #2: / Loc ation: 837 Kit Lane Hudson, WI 54016 (NW 1/4 SE 1/4 23 T29N R1 9W) Fox VaA y 1 st /Ad_d Hof 23~ Parcel No: 23.29.19.922 1.) Alt BM Description=_7b ~ 6~d / -9f dz4t _/V ~'/O~ 2.) Bldg sewer length= ti ~ d !a (u~t ~t~rt - amount of cover = > 3' Plan revision Required? Yes /No Z ~ ~ ~O ~ S I! Use other side for additional information. i_L--- - - - Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) J a E Sz.' E/e ti a f , cr ra ~e ~.`~~v~fa cc, L L r~ {D be ee- f o ~"r c2v~0.; - ,r4 Oa~f~ .4SSunt~ e le%_ /GYJ.cD. Aid. 6.M. T,P y2" ~~1,. Uo y _ J w/polyz" /0/--ss.s ^,11 ~k~, n d~7~r efr/u ,,-6F%te,- at h ?,pose.,J w/11U-A-0 17. 5.T outer- L 5.T.w(.303v bLu/d;"~J 6~~~ be ;nsu ~Nd 4.s P1-r P~oPosed I bed~c0m ~.or-r(n(. 8.Z.30(~~~~~ Pte! tio~.se. fCSiden[e { ~+1 commercemi.gov Safety and Buildings Division County 2 as i gton Ave., P.O. Box 7162 St. Croix ' ~%j f_9 adiso g'71 53707-7162 Sanitary Permit Number (to be filled in by Co.) Department of Comm Re, 9'94S Sanita r td cat on State Transaction Number Per accordance with s. Comm. 83.21(2), Wis. dm. CsuLission 's form aim the appropriate go e t Ad ress (if different than mailing address) unit is required prior to obtaining a sani permits 1941 ~ for state-owned POW are submitted to the Department of Commerce. Persoiiat "`ftl a may be used for second $ It Lane purposes in accordance with the Privacy Law, 1. Application Information - Please PrihtAH Information Property Owner's Name Parcel # ,,(a Mike Gelein 020-1161-50-000 Property Owner's Mailing Address Property Location 836 Kit Lane /l. City, State Zip Code Phone Number Govt. Lot Hudson, WI. 54016 (715) 386-6234 NW SE Section 23 , (circle one) U. Type of Building (check all that apply) Lot # T 29 N; R 19 E or W ❑ 1 or 2 Family Dwelling - Number of Bedrooms 5 (233 Subdivision Name gar,,, Looms Block# Fox Valle 1'` addition ❑ Public/Commercial -Describe Use Na Ob ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of i Na ❑ Town of !Tub $ w 7, k i4no C.PC~ III. Type Permit: (Check only one box on line A. Complete line B if applicable) A. 1>~siew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. 11 Permit Renewal El Permit Revision [I Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued ~ Before Expiration Owner 11 . T e of POWTS System/Component/Device: Check all that appl% ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersallreatment Area Information: a ' If 1 14 Design Flow ( d) Design Soil Application Rate(gpds Dispersal Area Requ' d IS Dispersal Area Pr ses Elevation 750 gpd d/sq.tL ASTM-C33 sand 750.00 sq. ft. 750.00 sq. ft. 98.00' 12" above 0.40 s q. ft. native soil 0' contour VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units r, c w v U ti 'a+ New Tanks Existing Tanks O a a U ~ ti ~ w C7 0, Septic or Holding Tank 1,585 Na 1,585 1 Wi er Concrete X Dosing Chamber 950 Na 950 1 Wieser Concrete X VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans, Plumber's Name (Print) mber's SiMP/MPRS Number Business Phone Number Jim Boumeester t MPRS 222904 (715) 386-9020 Plumber's Address (Street, City, State, Zip Code) 1070 Hwy. 35, Hudson, WI 54016 VIII. un /De artment Use Only Approved Permit Fee Date Is red Issuin gent Sign' re e en Reason nial JDL Condift"> qp(Reasons for Disapproval ~sC i~['OI~S ti kz)4" CL Cc I.. Septic tsrrk, effluent filter and ~ l~~ t•J ~"`rS ~iK r~ diS~ oell must all be e / mal 1 o, e- ars ;laer eaarmgetrtent plttrt provided by plumber, 2 AMSaa>ttGCtegpNpiswmft ttwst be mated 10 Caft I P000M Attach to complete plans for the system and submit to the County only on paper not less than 81/2 x 11 inches in size SBD-6398 (R. 02/09) Valid thm 02/11 opgART'N Safety and Buildings 0~1 TQS 141 NW BARSTOW ST FL 4TH WAUKESHA WI 53188-3789 3 $ Contact Through Relay vmw.commerce.vA.gov/sb/ www.wisconsin.gov ~ cSStaNScott Walker, Governor Dave Ross, Secretary November 09, 2011 CUST ID No. 222904 ATTN.• POWTS Inspector JAMES W BOUMEESTER ZONING OFFICE BOUMEESTER & SONS EXCAVATING INC ST CROIX COUNTY SPIA 1070 HWY 35 N 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 11/09/2013 Transaction ID No. 2018776 SITE: Site ID No. 773985 Mike Gelein Please refer to both identification numbers, 837 Kit Ln above. in all correspondence with the Town of Saint Joseph, 54016 St Croix County NWl/4, SE1/4, S23, T29N, R19W Lot: 23, FOR: Description: Mound, 4 Bedroom + Poolhouse (Sized for 750 GPD) Object Type: POWTS Component Manual Regulated Object ID No.: 1345524 Maintenance required; 750 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD-10691-P (N.01/01), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01/01); Effluent Filter 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 above. The owner, as defined in chapter 101.01(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, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.01101) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.01/01). f The designer states that the pool will not discharge into the soil absorption system. Additionally, the poolhouse has no bedrooms, and provides restroom facilities for family d-' casional guests. The building sewer and distribution network piping shall be of material listed in TaLge, 0-3 and 84.30- 5, Wis. Adm. Code. 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. In addition, the owner must comply with the operation, maintenance and monitoring dirties as described in section VIII of the mound rmmnnnent manual A cnnv of this infnrmatinn mnct he given to the nwne.r nnnn cmmnletinn of the nrniect JAMES W BOUMEESTER Page 2 11/9/2011 All holding/treatment tanks are to comply with Comm. 84.25(7)(a). Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Si rely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Julia Lewis-Osborne POWTS Reviewer 2, Integrated Services WiSMART code: 7633 (262) 397-6005, Fax: (608) 283-7481 julia.lewis@wisconsin. gov MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE RECEIVED Project Name: Gelein 5- bedroom residential mound NOV - 8 2011 SAFETY & BUILDINGS Owner's Name: Mike Gelein Owner's Address: 836 Kit Lane Hudson, WI 54016 Site Address: 837 Kit Lane Legal Description: NW1/4SE1/4, Sec.23, T.29N., R.19W. Township: Hudson County: St. Croix Subdivision Name: Fox Valley 1st Addition Lot Number: 23 Block Number: Na Parcel I.D. Number: 020-1161-50-000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Attached soil evaluation report Designer: Jim Boumeester License Number: 222904 Date: 10/25/11 Phone Number: (715) 386-9020 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) Version 5.1 (R. 06/06) Page 1 of 9 ,'l~> Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 500.0_0 Estimated Wastewater Flow (gpd) Table 83-44-3 in-situ soil treatment for i 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of 36 inches. 750.00 Design Flow (gpd) 13.00 Site Slope 97.001 Contour Line Elevation (ft) 24.00 Depth to Limiting Factor (in) 0.401 In-situ Soil Application Rate (gpd/ftz) Distribution Cell Information 100.001 Dispersal Cell Length Along Contour (ft) = 7.50 Cell Width (ft) 1.001 Dispersal Cell Design Loading Rate (gpd/ft2) 1, Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) - C 1 Center or End Manifold 2.50 Lateral Spacing (ft) If N above, enter the elevation (ft) 6 Number of Laterals of the highest point. 01251 Orifice Diameter (in) 2 501 Estimated Orifice Spacing (ft) = 6.25 ftz/orifice 2.00 Forcemain Diameter (in) 60.00 Forcemain Length (ft) Does the forcemain drain back? Y 92.000 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 9.79 Forcemain Drainback (gal) 5.67 Vertical Lift (ft) 135.80 5x Void Volume (gal) 2.93 Friction Loss (ft) 145.59 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 49.43 System Demand (gpm) 15.10 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 _ 1.25 1.00 x _ 1.50 x x 1.25 x 2.00 x 1.50 x x 3.00 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information 9150:9 0{ Total Tank Capacity (gal) 1585 00 Septic Tank Capacity (gal) 38 00. Total Working Liquid Depth (in) Wieser Concrete Manufacturer 25.00 gal/in (enter result in cell 1349) Dose Tank Information Effluent Filter Information 950.0 Dose Tank Capacity (gal) ! Polyr _qk Filter Manufacturer _ 25.00 Dose Tank Volume (gal/in) PL-525 Filter Model Number !Wieser Concrete Manufacturer Project: Gelein 5- bedroom residential mound Page 2 of 9 Mound Plan and Cross Section Views 1/10BJ Observation Pipe - FK A 5 W :F ::::::::::::::::::::::d:::: - B I L Mound Component Dimensions ft A 7.50 ft E 23.70 in H Eaft ft K Aft B 100.00 ft F 9.50 in 1 ft L ft D 12.00 in G 0.50 ft J W 750.00 (ftz) Dispersal Cell Area 2356.56 (ft2) Basal Area Available 7.50 (gpd/ft) Linear Loading Rate 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 99.79 (ft) ♦ H G j 98.50 (ft) Lateral I F . . Dispersal Cell 98.00 (ft) - - Invert Dispersal Cell [ Elevation D . 97.00 (ft) Contour Elevation 13.0 % Site Slope Geotextile Fabric Cover Shading Key o. Dispersal Cell See lateral details on 'o. Page 4 for number, size, 10 Topsoil Cap c 1.5 ft andspacing of laterals. Subsoil Cap Q Q Laterals are equally ASTM C33 Sand o F spaced from the Tilled Layer c d 0.5 ft Typical Lateral 0 N distribution cell's ©0 Aggregate o~ ' centerline in the _ A distribution cell (AxB). Project: Gelein 5- bedroom residential mound Page 3 of 9 Center Connection Lateral Layout Diagram Fact main connection via tee or cross to manifold at any point. Latotals are identic all 'F- s t I P y dr- • = Turn-up wlball vslvv or 41+3x.12 Laterals & face main of PVC Sch 40 clesnoutplu9 COMM Table $4,30.6 Holes drilled on the bottom of the lateraNumber of Laterals 6 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 49.34 ft Orifices per Lateral 20 Lateral Spacing (S) 2.50 ft Orifice Density 6.25 ftz/orifice Lateral Flow Rate 8.24 gpm Manifold Length 5.00 ft System Flow Rate 49.43 gpm Manifold Diameter 1.50 in Total Dynamic Head 15.10 ft Forcemain Velocity 5.05 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and Comm 16.28 WAC 4 in. min. Disconnect Tank component is properly vented F- Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Ca acit 950.00 Gallons Volume 25.00 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 20.18 504.41 B 2.00 50.00 C Pump off elevation (ft) C 5.82 145.59 92.83 D ! 10.00; 250.00 D Total 38.00 950.00 -Dose tank elevation (ft) Bedding under tank. 92.00 Alarm Manuafacturer ~SJE Rhombus Alarm Model Number SJE 1011421 Pump Manufacturer Zoeller Pump Model Number BN 153 Pump Must Deliver 49.43 gpm at 15.10 ftTDH Project: Gelein 5- bedroom residential mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Jim Boumeester Phone (715) 386-9020; POWTS Regulator's Name St. Croix County Zoning Dep't. Phone! (715) 38674680! System Flow and Load Parameters Design Flow - Peak 750 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 500 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1585 gal Maximum TSS 150 mg/L Soil Absorption Component Size 750 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished • • • • • • • • • • • • • • • • Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Gelein 5- bedroom residential mound Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals (SBD-10691-P (N.01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continuency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 9 N PUMP PERFORMANCE CURVE TOTAL DYNAMIC HEAD/FLOW MODEL 151/1521153 PER MINUTE 14- 46 153 EFFLUENT AND DEWATERING 12 35 MODEL 151 152 153 35 ,o 152 Feet Welers Gal. users Gal. users Gat. users 30 5 1.5 50 188 89 281 77 291 10 3.0 45 170 61 231 70 265 c ll25 151 15 4.6 38 144 53 201 61 231 S 20 6.1 29 110 44 167 52 197 6 25 7.6 16 61 34 129 42 159 30 9.1 - 23 87 33 125 TD 4 35 10.7 - - - 22 85 /7 10 40 121 - - - 11 42 ShuFoflHead: 30 ft.(9.1m) 381L(118m) 44L(13.4m) 2 5 01450Be 0 10 20 30 10 60 TO 80 90 1 GALl.ONB 0 2110 I.fTF3tS b 80 1 1 316 31l0 FLCW MUTE 014506A Model 151 Models 152 /153 5/~. ~3J p..p. n n7mkm s vo /arc lc~d. CONSULT FACTORY FOR SPECIAL APPLICATIONS 67/32 814 - 7 7/B .SIB ~ 27ra2 . Se Timed dosing panels available. -r • Electrical alternators, for duplex systems, are available and 1 718 , 27112 supplied with an alarm. 4 • Variable level control switches are available for controlling ® l , 327a2 single phase systems. • Double piggyback variable level float switches are available for variable level long and shat cycle controls. • Sealed QvAk-Box available for outdoor installations. See FM1420. • Over 130'F. (54'C.) special quotation required. 15111521153 Series 11111,8 12118 1 5111 5 211 5 3 YODELS Control Selection Yodel Volts Ph Yoda Amps Slmpf" _Duplex a s,ro N151 115 1 Non 6.0 1 2 of 3 BN 151 115 1 Auto 6.0 included 2 ow 3 E151 230 1 Non 3.2 1 2 or 3 13E15/ 230 1 Auto 3.2 Included 2 or 3 SK2444 sK2064 N152 115 1 Nan 8.5 1 2 or 3 BN152 115 1 Auto 6.5 included 2 or 3 E15-52230 1 Non 4.3 1 2 or 3 BE152 230 1 Aub 4.3 Included 2 or -S N153 115 1 Non 10.5 1 2 or 3 8N153 115 1 Auto 10.5 Included 2 or 3 E153 230 1 Nan 5.3 1 2or3 SELECTION GUIDE BE153 30 1 Auto 5.3 Included 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float O CAUTION switch. Refer to FM0477. _I eta aunr. of controls, protection devices and w rtnq should be done by a qualified 2. See FM0712 for correct model of Electrical Alternator E-Pak. .,',-i tl i Veclrician All electrical and salary codas should be followed including the Pose National Electric Coda (NEC) and the Occupational Safety and Health Act (OSHA). 3. Variable level control switch 10-M used as a Control activator, specify duplex (3) or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. YA1L 70: P.O. BOX 16341 ` Lousalk, KY 4 02 58-034 7 Manulacduersol.. HIP 70: 3649 Ca Louis ne kun Road vl8e, y ao211-1961 Quaurr PUMP.- 511my MY 731 502)71436248.PUA4P 778-2 http/hvww.zoollrcom PUMP LO 1(5SO2I FAX( 0 Copyright 2004 Zoeller Co. All rights reserved. ~ a N 04 ProP05cd 140u4 da 6 2,f.5-i X IH-68 / v N 7 S X/OD,o ct//. 5ik ~6JdiSfli6u'fiOrj ~ x ~ ~ ~ ~ 7C /a~~a-/.s a£ /l~ X s~9.3y'~.a/,B •,m-;,4"~-s~ao~c✓ ~ o ~ `~1 ~ QY1` . at z•53.' E/ed Q~d 8raucG;.~~eifacr A au W L h /3 be 9,e m "a-tz /2l C 6oue9Ta ,cc., -60a,-. 0"7 1 ' fro 1 J/ o 'Al •v 6 tt~ ,lam ` Q~-.~ n ® e Q. v~ VA~ ` cY ~ g1 CL 0 Pr -7,,40 2 F~rapasec~ W: C5~/"Caner! CYO PaGi koc~sz w~pi585/9So dan4Aa4cn S.r./NC. ~No/rta Pc-sus C- 17 It ~C 303y6C/d,"r' Su~~ 3 Carne/y w/l~4 CoInloe. f?,2. 0 r Proposes ~bzdr~ ~c S i p~ [.+7 CC, 2268 SOIL EVALUA Page 1 of 3 WisconsinDepartm tof Commerce TI ORT Division of Safety an Buildin L t , A.C.E. Soil & Site Evaluations in,liqcorda with Comm 85, Wis. A y G,,~,~3 .at'\C~F Coun Attach complete 'te plan tl+8 ' inches in size. Plan must St. Croix include, but not li 'led to- reference point (BM), direction and percent slope, s d? north arrow, and location and distance to nearest road. Parcel I.D. 0 0-1161-50-000 Please print all information. R iewed B Date Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1) (m)). Property Owner Property Location Jay R. Willet (Mike Gelein - Buyer) Govt. Lot NW 1/4 SE 1/4 S 23 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 833 Kit Lane 23 na Fox Valley 1 St Addition City State Zip Code Phone Number City Village yf Town Nearest Road Hudson WI 54016 Hudson 837 Kit Lane J New Construction Use: sel Residential / Number of bedrooms 5 Code derived design flow rate 750 GPD Replacement J Public or commercial - Describe: ~ 2_ .2Dt~ s:/ tit` D w Parent material Glacial till over weathered limestone bedrock Flood plain elevation, if applicable na General comments and recommendations: Site suitable for mound system with 12" of ASTM-C33 sand placed on 97.00' contour. Sand/gravel infiltrative surface elevation to be 98.00'. Boring # I Boring Pit Ground Surface elev. 97.78 ft. Depth to limiting factor 24" 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 1 0-9 1Oyr3/2 none sil 2fgr ds cw 2fmc 0.6 0.8 2 9-20 10yr4/6 none Sid 2fsbk dh cw 2fm,1c 0.4 0.6 3 20-24 7.5yr4/6 none sl 1csbk dh gw 11fm 0.4 0.7 4 24-35 7.5yr4/6 f2f 5yr4/6 sl 1csbk dh ci - 0.4 0.7 5 35-49 10yr4/4 f2f 7.5yr5/8 & L.S.B.R. na na - - 0.0 0.0 H#5 consists of 2" thick x 6" x 10" limestone fragments comprising approx. 80% of horizon. Voids between fragments filled with 10yr4/6 Osg Ifs and limestone residuim. Boring # I Boring Pit Ground Surface elev. 94.93 ft. Depth to limiting factor 36" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 *Eff#2 1 0-10 10yr3/2 none sil 2fgr ds cw 2fmc 0.6 0.8 2 10-22 10yr4/6 none sicl 2fsbk dh cw 2fm,1c 0.4 0.6 3 22-36 7.5yr4/6 none sl 1csbk dh gw 1fm 0.4 0.7 4 36-47 7.5yr4/6 f2f 5yr4/6 sl 1 csbk dh ci - 0.4 0.7 5 47-59 1Oyr4/4 f2f 7.5yr5/8 & L.S.B.R. na na - - 0.0 0.0 H#5 consists of 2" thick x 6" x 10" limeston ents comprising approx. 80% of horizon. Voids between fragments filled with 1 Oyr4/6 Osg Ifs and limestone residuim. Effluent #1 = BOD? 30 < 220 mg/ and TSS >30 < 1 0 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signatu : CST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 10/18/2011 715-248-7767 Property Owner Jay R. Willet (Mike Gelein - Parcel ID # 020-1161-50-000 Page 2 of 3 ]Boring # J Boring N Pit Ground Surface elev. 95.50 ft. Depth to limiting factor 27" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/2 none sil 2fgr ds cw 2fmc 0.6 0.8 2 10-20 10yr4/6 none sicl 2fsbk dh cw 2fm,1c 0.4 0.6 3 20-27 7.5yr4/6 none sl 1 csbk dh gw 1 fm 0.4 0.7 4 27-35 7.5yr4/6 f2f 5yr4/6 sl 1csbk dh ci - 0.4 0.7 5 35-42 10yr4/4 f2f 7.5yr5/8 & L.S.B.R. na na - - 0.0 0.0 H#5 consists of 2" thick x 6" x 10" limestone fragments comprising approx. 80% of horizon. Voids between fragments filled with 10yr4/6 Osg Ns and limestone residuim. 4] Boring # J Boring Pit Ground Surface elev. na ft. Depth to limiting factor 36" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/2 none sil 2fgr ds cw 2fmc 0.6 0.8 2 10-26 10yr4/6 none sicl 2fsbk dh cw 2fm,1c 0.4 0.6 3 26-36 7.5yr4/6 none sl 1csbk dh gw 1fm 0.4 0.7 4 36-48 7.5yr4/6 f2f 5yr4/6 sl 1csbk dh ci - 0.4 0.7 5 48-55 10yr4/4 f2f 7.5yr5/8 & L.S.B.R. na na - - 0.0 0.0 H#5 consists of 2" thick x 6" x 10" limestone fragments comprising approx. 80% of horizon. Voids between fragments filled with 10yr4/6 Osg Ifs and limestone residuim. ❑ Boring # I Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD5 S.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.07/00) A.C.E. Soil & Site Evaluations N cow - VIO ` ' - , - - tla' v~ E't.~e..4ssunc~l ~~e~_ ~CYJ.UJ, a J J I ~ ti, ~ , _ ~ ~ ; p. ~ ~e ..1 i~•~ i J d „~Q,+d~ ~ ~:~y~/ ' ) 1 7..:70.. R~C'~„~C.~ ~ ~ PS~~ti Ott iL`sY. "i~t.~5~ In 0 O ~ e r ✓ r ~ - ~ A ~ PL-525 Eff ttient Filter- Efflueiit Filters Polylrl~ etc, Pagc I oft I'ivy,8,"tte'•fitl'reIfS~•i4iii''` F o k , ; , , : ' f k Inc. 3 Fairfield Blvd, • Wallingford, 4'T 064 ~ i i.l ~ I is . • 92 Call i"W11 Free; US-765-9015 ~ iC.CUIY~ EMU, pa1WI ti You erg Mere, Produt:t Details , u A ` i EFFLUEN 'T FILTER Raising thle her in filter technolo PL-625 Effluent Filter Description i,,{l ICI *4 - Gwent Filters Polyiok, Inc is pleased to add Its new commercial filter to its existing litre of quality efflyent II Extend & LokTM filters. The PL-525 is rated for over 10,000 GPD (Gallons Per Day) making it c)ne of the I largest Commercial filters in its class. If has 525 linear fr•,et of 1146" Cfltrration slots. Like the ~ Risers & Ricer Cowers r I r r • Polylok P1_-122, the now Polylok PL-625 has an automatic shut off bell installed with every 1 filter, When the Ater Is removed fo;^ cleaning, the ball will float Lip and temporarily shut off Distributlon Boxes ant the system sea the effluent won't leave the tank. No other filter on the market can make that Accessories „rrs~ claim! I~_w„~-,,.,..~.,..,~.~..•,.,:...~....,,.._..,. Pumps, Basins, Pump I and step Systems ordering Inf4rmxarion Request a Quote Relate d Products i Features Baffles, Sanitary Team Rated for 10,000 GPD (Gallons Per Day) I Deflectors u. 529 linear feet of 1116" filtration Reber Spacers Enlarge for details • Accepts 4" and 6" SCHD, 40 pipe 0 Built in 08a AaeflraGtpr * Automatic shutroff ball when filter is mitloverl Handles and Racetvw a Alarm accessibility I Signs Accepts PVC extension handle 1 Landscape I Drainage The PL-525 Effiuent Filter should operatto effiriantly for several years under normal conditions before requiring cleaning. it is recommended that the filter be cleaned every ~Forms & Clam ' time the tans{ is pumped or at least every three years. It the Me%[led filter ContalnS an optional alarm the owner wifl he notified by an alarm whoa the filter. needs servicing, I RW~1I ~8s'trArlls$ Servicing should be done by a certified septic tank pumper or installer. s Concrete Ac aorf s+prie r----- Maintenance Instruct ons, Pressum Fitters 1. Locate the outlet of the sept?c tank. der rnntrai ~'rndu t 2, 'Remove tank cover and pump tank if necessary, i Rater,-Lak and CMU 3, Do not iisEa plumbing when filter is removed, 4• Pull PL-525 out of the housing. Accessories 5. Hose of; fiiter over the septic, tank. Make sure all solids fall k 801l into sefatic tank. 6, Insert the fiiter cartridge back into the housing making sure the filter iS r l~eb r Sa a and liwl Cc aligned and completely in5ererl. p openly 7. Replace septic tank cover. PL-525 Installation; ldaal for residential and commercial ~~OZ:Mraflva L arndscape waste flows up to 70,000 Gallons Per Day (GAD). Technical 5pecy~.cati,01 Installation Instructions_ Related ProtltartS 1. Locaiia the nutlet of the septip tank. ~ Pump Filter and Sun 2. Remove tani< cover anp ptamp tank if necessary. i4" x 12" Riser 3. Glum the fitter hni.ising to tho 4" or 6" a,itlrat pipe: If the filter is not cantered under ! SmarcFlari M the access Opening use a Pol Ink Ex a Filter FilterTPane! an 4. Insert the FL-525 filter Into its housing rid Lok or pierce of pipe. to center filter. Control f htt»'//urth:t~r~ ~nic r990~ ~~ult,r4c~ rlr~tstvic stcn~f3rnrloorr T1''ic'1 We'W6 0107 'til '130 uu 14 2U1G 9;12AM No. 3066 P. 2 T ^n~` ~R - A m o b GYd a TI > 0 m r 16 °'x; ~ y r`n CM q $3 P G) w m - 0 t°ra can rn rh r; M I Cw Ell C3 em rl~ .-mom '~J N I+v ~Y to as ~ Lo I ~ ear ~ cL X ° w LU 1.13 6! I uj x LW LL ;ie CL Fo _ ct~ C; csa n A y~ e1 c M U5 ' +++1 e tl y~u~~~yN' r.' - d 990'oN WHZI.6 Olot, b~ ~~n ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND a(bi OWNERSHIP CERTIFICATION FORM Owner/Buyer rn C~ s~~ Qe) N Mailing Address U~'1 J~ L h Property Address 44*.~ Yw (Verification required from Planning & Zoning Department for new construction.) City/State 0q)Q5-0J U1 Parcel Identification Number Q V 1- S 0 0 LEGAL DESCRIPTION Property Location 1 y Sec. T a 7a N R_ AIW, Town of (kV61J Subdivision rd Lot # . Certified Survey Map Volume , Page # Warranty Deed # , Volume , Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, 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. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a w anty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATURE OF APPLICANTS DAT A E ***Any infonnation that is misrepresented may result in the sanitary permit being revoked 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. (REV. 08/05) State Bar of Wisconsin Form 3-2003 8 0 35 84025961 0 9 QUIT CLAIM DEED 940923 N BETH PABST Document Number Document Name REGISTER OF DEEDS i ST. CROIX CO., WI k THIS DEED, made between Virginia F. Jacobson 09/01/2011 1:39 PM EXEMPT#: NA ("Grantor," whether one or more), REC FEE: 30.00 And Harold M. Gelein TRANS FEE: 120.00 PAGES: 1 ("Grantee," whether one or more). Grantor quit claims to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach Recording Area addendum): Name and Return Address Law & DeMaio, S.C. Lot 23,1" Addition to Fox Valley, Town of Hudson, St. Croix County, 2215 vine Street Wisconsin Hudson WI 54016 v 020-1161-50-000 Parcel Identification Number (PIN) i This is not homestead property. (is) (is not) ]X 9 f 1 F Dated Aw74, oR0 (SEAL) * ) (SEAL) is Jacob on i (SEAL) (SEAL) * * A NTT ION ACKNOWLEDGMENT Signature(s 9~` V ,0 2,-1-7o,_) STATE OF WISCONSIN ) authenticated on 10 / COUNTY ) ss. ) * Personally came before me on i TITLE: MEMBER STATE BAR OF WISCONSIN the above-named (If not, A 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:. Daniel F. DeMaio - Law DeMaio, S.C. * f' 2215 Vine Street, Hudson, WI 54016 Notary Public, State of Wisconsin My Commission (is permanent) (expires: ) a t (Signatures may be authenticated or acknowledged. Both are not necessary.) t NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. G QUIT CLAIM DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 3-2003 * Type name below signatures. 1 of 1 f POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Q) Septic Tank Capacity al [3 NA Permit # Septic Tank Manufacturer W kl( ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ppl Lt.." ❑ NA Number of Bedrooms S ❑ NA Effluent Filter Model S ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) ~(S al/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) ( IJ al/day Pump Manufacturer 2d 1 )1 ❑ NA Soil Application Rate -4 gal/day/ft' Pump Model ki 0 ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 5_30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODE) _5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODd :530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade AMound Fecal Coliform (geometric mean) 5_10° cfu/100m1 ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y8 in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 0 east J(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA I3,year(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA 11 year(s) ❑ month(s) Inspect pump, pump controls & alarm At least once every: year(s) ❑ NA Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA Q year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ 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 (Y3) 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 NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of S12 months, 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. GMW (4/01) Page of 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 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. 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. ABANDONMENT 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 chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: L~J 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 IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone l r Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name 1>11 Name S _ LnV°,C, N1W Phone 1 0 1 Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. 2098 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations County Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point M), direction and percent slope, scale or dimensions, north arrow, and location an nce to nearest road. Parcel I.D. 020-1161-50-000 q2 Z Please print all information. Reviewed N Date Personal information you provide may be used for Law, s. 1) Pq IM =4 I Property Owner operty Location vL~ Jay R. Willet Govt. NW 114 SE 1/4 S 23 T 29 N ..R 19 W Property Owner's Mailing Addre Lot # Block # Subd. Name or CSM# 833 Kit Lane 23 Fox Valley 1 St Addition City LIL J Village fJ Town [yearest Road Hudson 6 HudsonF ~j Kit Lane 6 New Construction Use: 0 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD J Replacement I Public or commercial - Describe: Parent material Glacial till over weathered limestone bedrock Flood plain elevation, if applicable Na General comments and recommendations: Site suitable for mound system wit 16" of ASTM-C33 sand placed on 100.90' contour. System elevation = 102.24'. ~3 ~y ryZr 4~ z~ F1 Boring # 0 Boring Pit Ground Surface elev. 9 .40 fl. Depth to limiting factor 20" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/R' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-9 10yr3/2 none sil 2fsbk mvfr as 2vf,f 0.6 0.8 2 9-15 10yr3/4 none sil 2fsbk mfr cs 1vf,f 0.6 0.8 3 15-20 10yr4/6 none sicl 1f&msbk mfr aw 1vf,f 0.2 0.3 4 20-24 10yr3/4 m1 d Mg depletions siel 1 msbk mfr ai - 0.2 0.3 5 24-46 10yr4/6 none L.S.B.R. na na - - 0.0 0.0 Boring # Boring ✓0 Pit Ground Surface elev. 102.54 ft. Depth to limiting factor 35" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-14 10yr3/2 none sil 2fsbk mvfr as 2vf,1f, 0.6 0.8 2 14-25 10yr4/4 none sicl 1fsbk mfr cw 2vf,1f, 0.2 0.3 3 25-35 7.5yr4/4 none sl 1 msbk mfr cw 1 of 0.4 0.7 4 35-52 7.5yr4/6 f2f 7.5yr5/8 _sWs 1 msbk mfr gw - 0.2 0.3 5 52-65 10yr4/4 m2f .5 y 6i8 & L.S.B.R. na na - - 0.0 0.0 --T H#4 consists of stratified layers of 1 msbk 10yr4/6 sl, 1 csbk 7.5yr4/6 Its, & 10yr 4/6 Osg s. ' Effluent #1 = BOD5> 30 < 220 g/L and TSS 30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) gnature: CST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evalu ti Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 10/22/2007 715-248-7767 Property Owner Jay R. Willet Parcel ID # 020-1161-50-000 Page 2 of 3 3] Boring # J Boring V1 Pit Ground Surface elev. 100.15 ft. Depth to limiting factor 35" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-11 10yr3/2 none sil 2fsbk mvfr as 2vf,f 0.6 0.8 2 11-18 10yr3/4 none sil 2fsbk mfr cs 1vf,f 0.6 0.8 3 18-35 10yr4/6 none sicl 1f&msbk mfr aw 1vf,f 0.2 0.3 4 35-49 10yr3/4 f2f 7.5yr5/8 Ilvfs/Is 0 ml ai - 0.4 0.6 5 49-61 10yr4/6 none L.S.B. R. na na - - 0.0 0.0 H#4 consists of an undifferentiated mix of 7.5yr4/6 Ivfs & 10yr 4/6 Is. Redox. concentrations found at interface of textural changes. 4 ] Boring # Boring Pit Ground Surface elev. 112.00 ft. Depth to limiting factor 34" in. Soil Application Rate F Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10yr3/2 none sil 2fsbk mvfr as 2fm 0.6 0.8 2 9-18 10yr3/4 none sl 2fsbk mfr cs 2vf,f 0.6 0.8 3 18-34 10yr4/6 none Icos/Is/sl 1f&msbk mfr aw 2vf,1f, 0.2 0.3 4 34-72 10yr3/4 f2f 7.5yr5/8 Ivfs/Is/s 0 sg ml - - 0.4 0.6 H#3 consists of an undifferentiated mix of 7.5yr4/6 Icos, 7.5yr 4/6 Is, & 10yr4/4 1csbk sl. All textures exhibit high clay content. Redox. concentration in H#4 found at interface of textural changes. ❑ Boring # Boring ~f Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 L30 mg/L and TSS a 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 (K07/00) A.C.E. Soil & Site Evaluations ♦ C,Y,'S~lnq grade t.le k (gip Sca/e= sue, 0 V ~e~' '~.za98 dQ //t y / Lb/-w/d, r mj q u~ yy SEry, s¢c. 23, 7-Z 911, of. /9c.1, c~dson, .5~ • Gro;,r G, ~i o24- //4/- so, 63 910 % f =i .IX47' aw" ~ ` by ne;~fi.bos t Mara': fop ef'/ "5y,7 tc~c e,,4SS"P"4C1 e/4[ ~/2t/: a 91i.03~ Parcel 020-1161-50-000 06/17/2009 05:03 PM PAGE 1 OF 1 Alt. Parcel 23.29.19.922 020 - TOWN OF HUDSON Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner 0 - WILLETT, JAY R JAY R WILLETT C - JACOBSON VIRGINIA F JACOBSON VIRGINIA F 833 KIT LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 837 KIT LN SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.700 Plat: 04-098-FOX VALLEY 1 ST ADDN 020-1982 SEC 23 T29N R1 9W FIRST ADD TO FOX VALLEY Block/Condo Bldg: LOT 23 LOT 23 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 23-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 02/02/2000 617780 1487/531 WD 07/23/1997 950/85A 07/23/1997 848/505 2009 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.700 60,100 0 60,100 NO Totals for 2009: General Property 2.700 60,100 0 60,100 Woodland 0.000 0 0 Totals for 2008: General Property 2.700 60,100 0 60,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 O * C O C 3 ' CD C-) ~ ` 1\ ¢A7 z r) O W G C W N `C N• O 40) ` O N O 1 CD O 3 N A D N O N- O J C frtp O =r z N :z N N N O N 3 O 0 ~ O O N N j' 1 t0 CL N O O 00 N N O X * W O O N c a ~ A7 O 3 co C O C) O C C (w cn c D - a m cQ ' w a of rn W CO m 7 m o rn N 3 O N N N C) 0 O O ! r O OD OD z O 0 co co n r to o co w N Q 3 v• I O O O N D N Vy N T MA -0 m 3 co) co) co) c A X CT ° N w _ D 3 N .41 CL a p o 0 Z W Z O C) a~ O D a n n fD N CD CD O O_ O W CD O O N N N C 3. c m m Oro a m Z C A N N C - ;u 0 4 C:3 z A j L O Z N W OD T m (0 O p. 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