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HomeMy WebLinkAbout004-1055-95-000 7 6, � c ,�I. A -2, _,&'79 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division G �?) INSPECTION REPORT Sanitary Permit No: 430017 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: Bauer, Eugene I Cady Township 004 - 1055 -95 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: * 11 I p A', a , ; G�t S & y CA_( 24.28.15.379 TANK INFORMATION ELtVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM eration Bldg. Sewer Holding �, St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet ep is / Dt Bottom Dosing Header /Man. 1 1 �t 7.8�i ion Dist. Pipe ,L, �� 4 , 2 Holding Bot. System T' ZA7 O Final Grade PUMP /SIPHON INFORMATION Manufacturer i 1 n Demand St Cover Ff tJ t�A % GPM Model Number 3 , 7 -$ 2. 02 2 1A3. ' L0C) TDH Lift Friction Loss System Head TDH Ft -13 R•I( 3 ,3 I I Forcemain Length Dia ,, I Dist. to Well SOIL ABSORPTION SYSTEM Tz BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS (a I SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufact r: INFORMATION Type Of System: CHAMBER OR UNIT Model Nu r. DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake 11 Pipe(s) 3 1 Length Dia Length Di a Spacing t SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx xx S Depth of eeded /Sodded xx Mulched Bed/Trench Center Bed /Trench Edges Topsoil Yes L, j No E] Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: o / / 0 3 Inspection #2: Location: N239 320th St Wilson, WI 54027 (NW 1/4 SW 1/4 24 T28N R15W) NA Lot /� "� Parcel No: 24.28.15.379 1.) Alt BM Description= -!5;T rover ( 9 ll qN�E 2.) Bldg sewer length = fv0 / 5 Qn1✓�� -Q kEw7• ,�i - amount of cover = �- S> AYtiLtrw` Plan revision Required? 'Yes I No Use other side for additional information. _____.___._ SBD -6710 R.3/97 Date Ins is Signature Safety and Buildings Division County / �� i 201 W. Washington Ave., P.O. Box 7162 C l �'�Onsl Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce 08)266 -3151 4 / -3 0 1 State Plan I.D. Number Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, personal information you provide I trt O 1 - 15 S i 4t U may be used for secondary purposes Privacy La 1 (m) Project Address (if different than mailing address) lVr I. Application Information - Please Print All Information Property Owner's Na me MAY 2 2 2003 Parcel u Lot N Block u Lin Property O er'ss M ailing Address � C NING�� UNTY 11.- 6—X0 - 3-r 54- O�� l r ��Vt� Z 38 ** ii 11 City, State Zip Code Phone Number ��' !4,Section Q� '� \nfI (circle e) N Y� tl on, "�� J I ��" '1� I T J N: R 15 E II. Type of Building (check all that apply) 14 �1 or 2 Family Dwelling - Number of Bedrooms n Subdivision Name CSM Number ❑ Public /Commercial - Describe Use `���.""� ❑State Owned - Describe Use d kJ GGLA.f •� (o ' XIO� Ort �� i ❑City_ ❑Village Township of� 0 III. Type of Permit: (Check onl ne box on line A. Complete line B if applicable) A ' ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS Sy stem: (Check all that apply) ❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic reatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ G vel -less Pipe QOther (explain) V. Dispersal/Treatment Area Information: 7 - 2 4 1 Z 0 7) Design Flow (gpd) Design Soil Appli do te(gpdsf) I Dispersal Area Required (st) Dispersa Area Proposed (sf) System Elevation (.D 4( �. 1 54. 3 "� 1'w �l �� ✓ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber' a /MPRS Number Business Phone Number i -}e► -b �.� Ike ��' 3� la � 15- ��a -5a1� Plumber's Addre ss (Street, City, State, Zip Code) VIII. ount /De artment Use Onl pproved ❑Disapproved Sanitary Permit Fee (includes Groundwater t Issued uing A nt Signa Stamps) Surcharge Fee) !0- 3LS U !� El Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval ` s ( 6 /1 qlgob ) �Zu / r Attach complete plaits (to the County only) for the system o per not less 81/2 x 11 inches in size SBD -6398 (R. 01/03) O 0 Q y a w k Q NO 00 o 0 % k O W Q � V C � � Q � t V 2 O � W k � v d Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 Visconstn www.commerce.state.wi.us /sb www.wisconsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary VrU May 19, 2003 MAY 2 2 2003 1 CUST ID No.3412 ' HERB J PELKE tai - ATTN: POWTS Inspector L�IV ZONING OFFICE PELKE PLUMBING ST CROIX COUNTY SPIA N6298 STATE HWY 25 1101 CARMICHAEL RD DURAND WI 54736 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/19/2005 Identification Numbers Transaction ID No. 867175 SITE: Site ID No. 659106 Gene & Judy Bauer Residence Please refer to both identification numbers, N 239 320TH St above, in all correspondence with the agency. Town of Cady, 54027 St Croix County NW1 /4, SW1 /4, S24, T28N, R15W FOR: Description: Four Bedroom Mound System (replacement) Object Type: POWT System Regulated Object ID No.: 903364 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: • 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.01 /01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD- 10706 -P (N.01/01). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. L'Otfdl • The existing POWTS must be properly abandoned per Comm 83.33 Wisc.Adm. Code. DEPARTMENT 0 f SAF7 • 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. SEE C(3RRE • 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. Stat • Comm 83.22(7) 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. RECEIVED MAY 12 2003 SAF ETY & BLDGS DI's. Private On -Site Wastewater Treatment System (POWTS) Index and Title Sheet Owner: z ..04e'.E Project Name and System Type: 4 �-V J4o r Arguo� - y ZA p A� r Location: Street Address Legal Desc ription ' dos✓.✓ of L i�o Y Jy' � Co. • Township /County Contents: Page 1: /,vodx ,o.ro kirx r .$5arrr Page 2: _ o r Page 3: _ �il - �Et r'i�.✓ ,v.✓e Ai.✓ fir..! .f Page 4 : _ Ao r LA ri/t,IL Zfeno , r ;. Page 5: G 0✓"""d'.! G /1011 • ��� r...� Page 6: ��,yi �6'i1 Fer,y...ra liir ✓� Page 7 : j0 O .v✓r4.'s /-1Aw1*Ieb �.o.� .�s/ir/.✓t �`.,,� Page 8. :Page 9. ions y " Attachments. i a EvASN.v rirr �o•,•i,, r /-/,AO coAyME c - • Sp V O xulmi�(G;s Plumber/Deegner: wr Signed: 6 !,Credential Number: ' ,Aoo t3 yiZ Date: �N axroo .fdD - job 9 / -P �u.vo �o�yPo.vrvr ~ lfd t.rW..O .410 W sno J S�0 - /0 7,0,e -,00 ���itlssw� �s r r r�aN r..r LO �l�Ir✓!w/J' �iL✓NAi ~ dE,e tyo 07 .0 v o �I • 0 V � V i , ; w M K k v tt iz h o I Z I N d � Ot k Nb "lot f 0 v © 14 o C � b �i Q E 8 v O � W v Z a PAGEwOF_ ` E- t CROSS SECTIOW=OF MOUND Q a�l'ai war "rl.�sa SYNTHETIC COVERING DISTRIBUTION LATERAL • .:isr.�r• MEDIUM'SAND H G �. TOP SOIL .:s : or CEU of -2" . aggregat •FORCE MAIN PLOWED LAYER . :. 8 Slope ". :. �• fXr0.7 � . a a P ✓� _ . , L 8- /D:Z Ft. FORCE JIM -,T fi wc J- 9 Ft. t. X K K:LF x it -,Ft. • x A : Fbse Observation pipe rvatioa P ipe ` �Dist�bi ution Pipes -� /'T �r2� . . G tts of k-2 aggregate o X s u.0J'srwA✓so L.� rrc s s TAX VIEW .OFD D � o ea v 3 • v O � p, r ` �s,, .� a° p IW O O • Hai ai ai si � 1 , a�wwww � N • ° P.wy J Page S Of Y -SEPTIC TANK E'PUMP CHAMBER CROSS SECTION'AND SPECIFICATIONS N 4" Cl VENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF ?' /o" FROM DOOR, WINDOW OR JUNCTION $OX APPROVED FRESH AIR INTAKE TWITH CONDUIT MANHOLE COVERS W/ PADLOCK E f'i.vi :,vro WARNING LABEL ,eIS'rx �i�� • a4" MI N. 18" IN. INLET �► WATER TIGHT SEAL Z.varc GAS- '► Ficrr� T TIGHT ► 1 �IAPPROYED A SEAL JOINTS WITH APPROVED —�-= i ; ALM APPROVED PIPE B 3' ONTO PIPE 3' OH70 SOLID ON SOLID SOIL SOIL' OFF c RISER EXIT PUMP OFF ELEV . 90 FT. LD PERMITTED ONLY IF TANK ' MANUFACTURER • 3" APPROVED BEDDING UNDER TANK 1 HAS APPROVAL CONCRETE PAD SPECIFICATIONS SEPTIC./ DOSE TANK MANUFACTURER: �awc.c - /7/,k'NUMBER DOSES PER DAY: /a 7.a t S. 7 : TANK SIZES SEPTIC dSo GAL. DOSE VOLUME INCLUDING DOSE - o GAL.. FLOWBACK: //J. 7 GAL. ALARM MANUFACTURER: , T c CAPACITIES: A " INCHES 83' GAL. MODEL NUMBER: „i • SWITCH TYPE: B = 2 INCHES = GAL. . . POMP MANUFACTURER: C 7 INCHES GAL. 'MODEL NUMBER: �"�` ~— _ �1 7 SWITCH TYPE NA D = .� INCHES = �y GAL. REQUIRED DISCHARGE RATE GPM PUMP 6 ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE S, 7_ FEET + MINIMUM NETWORK SUPPLY PRESSURE . . 3 FEET t ' L. FEET FORCEMAIN 'X _„ S FT /100 FT. FRICTION FACTOR .'9� FEET T-OTAL DYNAMIC HEAD = fa. 9 FEET. INTERNAL DIMENSIONS OF PUMP TANK: LENGTH S'G ; WIDTH o ; DIAMETER LIQUID DEPTH - Y) ,• ti����ack Swit p' HYDROMATI. rpr 1 icol Applicol a Effluent and Dewoleri Typical Ap tKdon' Corrosive liquids, Effluent and Denteri Capacities to 60 GPM (3.7 Vs) Capacities to 60 GPM (3.7 Vs) Heads to 25 ft (1.6 m) Heads to 25 ft (7.6 m) Electrical 115%, le, 8.5f1A, 60Hz Bedrkal 115Y le, 8.5F1A, 60111z 230% le, 3.6FLk 60Hz Motor 1/3 HP split phase w /thermal overload protection Motor 1/3 HP split phase w /thermal averlood protection 1750 RPM 1750 RPM Minimum Recommended Simplex =18' (457mm) Minimum Recommended Simplex =18' (457mm) Sump Diameter Duplex = 30' (762mm) Sump Diameter Duplex = 30' (762mm) Automatic Operation Diaphragm pressure switch (manual ovailawe) Automatic Operation Diaphragm pressure switch (manual available) Materials of (onstruction Naval Bronze Materials of Construction (lass 30 cast iron Impeller Open vane Navel Bronze Impeller Open vane Naval Bronze or thermoplastic vortex Discharge Size 1 -1/4' (31.8mm) Discharge Sae 1 -1/2' (38.1 min), 2' (50.8mm) Solids Handling 5/8' (15. mm) Solids Handling 5/8' (15.9 mm) Power cord 20' STW Power Cord 10' S1TW, (20' optional) Superior Features • Naval bronze construction for corrosion resistance Superior Features • Carbon/Ceramic type 21 mechanical seal • Carbon/Ceromic type 21 mechanical seal • 01 filled motor w /automatic reset • Oil filled motor w /outomatk reset thermal thermal overload for maximum protection overload for maximum protection • Upper and lower single row ball hearing construction • Upper and lower single row ball bearing construction • Piggy -back plug ovoloble for easy maintenance and replacement 32 1750 R.P.M. 24 LL 0 1/3 HP w x 16 Z 0 J Q 0 $ 0 e 0 10 20 30 40 50 60 CAPACITY -U.S. G.P.M. ' Refer to your authorized local Hydromatic" Distributor, Representative or the factory for other applications. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and ParW I•D•c6 '7 ^ Q percent slope, scale or dimensions, north arrow, and location and distance to nearest road Please print all information. viewed y Date 7 Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). S Q Property Owner Property Location t �,p Govt. Lot ,� 1/4 a 1/4 S y T 6 N R /r # Property Owner's Mailing Address Lot # Block # S or CSM9 ,?c rd` -- City State Zip Code Phone Number 044 - 941age ® Town Nearest Road ❑ New Construction Use: ($( Residential / Number of bedrooms _ Code derived design flow rate GOO GPD JZ Replacement ❑ Pubic or commercial - Describe: Parent material to acts a ✓sa Gz os.,.` 4 rA I1.f' Flood Plain elevation if applicable AIW ft. General and recom�meroidrations: /% 411/10 ®o..� rt .lrs r�.� .7 fi•�o ti.� /Irre.+►,vr..o Jas. 2 td, - 97, / o.J 9r, r Goy/ rro- -t .04A�/or✓ra � srrrrrr M Boring # E3 Boring r �� Q Pit Ground surface elev. 95: / ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I 'Eff#2 -8 ,a Yx j 5 S 8 A kio .z -• .� .� ,. s 3 s s r /sr ,Ysrr / 'a XYZ F?-1 # ❑ Boring .. ® Pit Ground surface elev. 93. ft. Depth to limiting factor �_ In. soy Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF In. Munseti Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 'Etf#2 -/ a - 3 3- T, s'Y.r .? s'Y•c s/d r .vr � r f c � . 6 • Effluent #1 = BOD > 30 < 220 mglL < 150 mglL • Effluent #2 = BOD < 30 mglL and TSS _< 30 mglL CST (Please Print) S' tune CST Number Address Date Evaluation Conducted Telephone Number S 819' -dtra nnn n71n TMInn\ y ,r Property Owner T o1' + E"a c rwgr �4 te r. Parcel ID # Page a2 of J?_ F Boring # E] Boring i ® pit Ground surface elev. ft. Depth to limiting factor In. Soil Appli caV Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAY in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef1#1 'Eff#2 D-' 8 aY't 1 a. r / ✓ S ✓ .Y- A- 3 ,� srt a f41, i� / d i a -3L SY.t y .4..r !4s /dr 6 _ F Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sob Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F Boring # E] Bo dng [] Pit Ground surface elev. ft. Depth to limiting factor 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 ' Ef fluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD S 30 mg/L and TSS <_ 30 rnWL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altemate format, please contact the departrtictit at, -608- 266 -3151 or TTY 608 - 2648777. SBD4330 X01/00) PLOT PLAN PROJECT NAME: _� F,✓E Tamer f. eolfA PROJECT LOCATION is,� F o � ya p CST LICENSE ,a,,y, - 77 rr p r ,el ,4GKNot! firs Q= teres SIGNATURE: ®Aa r of f8 Ac.rE 4 4EL DATE: — -p3 4 i L 611. -f. 8J,V -f frr,(.00d err ® 1-4 AIAI ces Arcr.sr to Q T — BUrf. /Ea Gott ✓!R of Sioi,/G { CL rvrs_ \� P,VMJ! l l � f c/,✓P -A It � bra � .tNEa 9s i �L� plorAlly [, P r4 AMC E dErC6.trr w ! r T r,� E•e-s �Q P /rt o Y. DuLNi•6r 600 / yy / odEa.YsrA 9j > � ��o r� fi �,rleE ro ,?a T'�ier ✓s - Z abel A 100 an C ommercial Ef SPECIFICATIONS APPLICATIONS: The A100 is used in residential and commercial septic systems. It 5 iseffective in multifamilyhoustng, rental property, schools, offices and everywhere wastewater has high suspended solids content. 3 FLOWRATE: 3 t 000Bpdperfiltet. i %' ItwoormorefiltersinaMorconcrete j derails to achieve flows of 6,000 gpd or more. Check with Zabel l FILTRATION: The 26 Disc Dams 01!16 inch provide 198 lineal feet of filtration. Z INSTALLATION: The filter may be installed inside the tank or installed m a Zabel Container Assembly outside the septic tank. SERVICE: Service residential installations whenever you pump the tank. Al O s O.D. 4-M24 I.D. O � � 4 '— s DU1 3 -9/16' � 1 � n — 11.318' DIA. Item 04M. Dewrigim Mam rW Spect9cations 1 Cases, Lids, Reducers Rigid Vinyl PVC 87371 MATSUA 2 26 Filter disc Discs High Impact Polystyrene t� 3 i com Rod, Nuts High Density Polyethylene 5 3 gut 4 3 Clod U.S. Patent X10.4,710,295 Call 1 - 800 - 221 - 5742 or Fax (502) 267 - 8801 for further information. —ji 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 SmartFilter'° alarm, you will be notified by an alarm when the filter needs servicing. To service the filter: *Servicing any zabel filter should only be done by a certified septic tank pumper or installer. Locate the outlet of the septic tank. ;.k Firmly pull the filter handle i a. and slide the cartridgA out Remove the tank of the c�(s� r ;1 and pump the *Note: A tee handle may f! necessary to p to be used # the river is t any solid below ground level to d escaping to th Contact Zabel for info when the f handles A rem s 4. While holding the Crttid A oul' ;. �C the access o flirt " 1 cartridge wit pfre Insert the Al dt .� ii eH careful to rinse all back in the b - sure the filt proper) *Note: It is not neces completely 1 "spotless". The bioma aides in the pre"atme be left on the filter. (If n may be disass Replace t MADE IN USA 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 http: / /www.zabel.com A100/300- 1-M,61499 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �"" �uc bu P'- Mailing Address . N z3 - � 0T9 -57) 1 ° o � � 5r, � LjL_ 1: 3q0 2 - 7 7 Property Address OJ 2- � 1— 3 >t - !�;T ► V-11 l w= " x277 (Verification required from Planning Department for new construction City/State ` � � ► (A= Parcel Identification Number U 0c) LEGAL DESCRIPTION 1 o Vl� Z �[ �, g Property Location / <;. /a, Sec. j , T N -R W, Town of Subdivision , Lot # j .n. � Certified Survey Map # , Volume . Page # Warranty Deed # 3 5 7 , Volume I SS . Page # Spec house ❑ yeso Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix 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 Zoning Office within 30 days of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION 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 warran deed recorded in Register of Deeds Office. g,�)j � �. g S -/ � �v o - 3 SIGNA OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed POWTS OWNER'S MANUAL AND MANAGEMENT PLAN Rlif.E INFORMATION SYSTEM.SPECIFICATIONS Septic Tank Ca ci o ' O NA Owner � R Se tic Tank Manufacturer - All - " .c O NA Permit # 3 ov Effluent Filter Manufacturer o O NA DESIGN PARAMETERS' Effluent Filter Model X-1 O NA Number of Bedrooms 100 room O NA Pump Tank Cavacity gal 0 NA Number of Commercial Units NA pump Tank Manufacturer A,//0- O NA Estimated now (average)+ oa gal/day Pum Manufacturer ,� p NA Design flow (peak), estimated x 1.5* o gal/day Pum Model s O NA Soil Application Rate () in Si /, O al/da ft Pretreatment Unit l A Monthl Avera e' • Influent/Eflluent tZttality (NAD) Y g p Sand/Gravel Filter p Peat Filter Fats. 011 & Grease (FOG) 5 30 mg/L p Mechanical Aeration 0 Wetland Biochemical Oxygen Demand (BODS) 5 220 mg/L ❑ Disinfection c3 Other: Total Suspended Solids (TSS) Manufacturer. Model: 5 250 MWL Dispersal Cell(s) Pretreated Effluent Quality D... Monthly Average* • • C] Ih- ground (gravity) a I - ground (pressurized) B mical Oxygen Demand ($ 5 30 mg/L p At -grade ound To C .4s) 5 30 m Cd Drip-line O �Otlierf F _ c 100ml a Leaching Chamber Manufacturer ft eca Maximum Effluent Particle Size 1/8 inch diameter Model ngW/Chamber ---� *W Flow Verification and Calculations: Soil Applicati a ft=Area �N. ---- (Other than bedroom based) Ill a Surface/Chamber - ESI Minimum Number of Chambers ❑ Aggregate Desi Flow/Loading Rates fe min ** Values typical for domestic ( non - commercial wastewater Materials: all materials must comply with WI specifi and septic tank effluent. COMM84 and he installed manufacturers spec' ** +Values typical for retreated wastewater. and a royal letters. DESIGN CRITERIA p "Wisconsin At -grade Soil Absorption System, Siting, Design & construction Manual" (Converse et.21.1990) C3 "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 C3 "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 C) SBD - 10570 -P (8.6/99) "At -Grade Component Manual Using Pressure Distribution" C3 SBD - 10567 P (8.6/99) "In Ground Absorption Component Manual" E3 SBD - 10705 -P (N.01 101) "In Ground Soil Absorption Component Manual" Version 2.0 C3 SBD - 10628 -P (N.6199) "Recirculating Sand Filter System Component Manual" Q SBD - 10656 -P (N.6199) "Split Bed Recirculating Sand Filter System Component Manual" .p SBD - 10572 -P ..(8.6/99) "Mound Component Manuar' jKBD -10691 P (N.01 /01) "Mound Component Manual" Version' 2:0 C3 SBD - 10595 -P (8.6/99) "Single Pass Sand Filter Component Manual "• E3 SBD - 10657 -P (8.6/99) "Drip -line Effluent Disposal Component Manual" C3 SBD - 10573 -P (R 6199) "Pressure Distribution Component Manual" G(SBD - 10706 -P (N.01 /O1) "Pressure Distribution Component•Manual" Version 2.0 C3 Drip -line Effluent Dispersal Component Manual for Multi -flo Onsite Wastewater Treatment Units O MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Fre uenc Service Event In condition of tanks At least once eve ci months j �' ear s mum 3 Pam out contents of tanks When combined sludge and scum equals one - third 1/3 of tank volume t dis rsal cell s O months ears 'mum 3 I At least once eve Clean effluent filter At least once eve Mnonths 13 ear s Inspect pump, Pump controls & alarm At least once eve O months 3 ears 13 NA Flush laterals and pressure test At least once every O months ear s c3 NA Valves At least once eve O months c3 ear s C] NA Other. At least once eve O months D ears O page�ot� START UP For p ducts or other che'mlcals that . For new construction, prior to use of the POWTS check treatment tank presence s) for the of painting p ro 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 priot 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 POW tS. 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, vegetable/fruit 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 rvater'supply. Maintain a regular steady now 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. p 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. INSSPECTIiONS 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 efiluent 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 retain solids in the'tank. Filter cleaning maybe necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. t0"Purrip Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check 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. p In- Ground Gravity Component Dsppersal 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 ` qg Mound, At•Giade, In- Ground Pressure The inspection shall include recording the levels of ponding. if any in the observation tubes and a The inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding 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 end of each lateral to be used for flushing. The laterals should be flushed 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. REPOR Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.SS Wisconsin Administrative Code, ABANDONMENT When the POWTS 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 in compliance with Ch. COMM 83.33, Wisconsin AdmWstmtiv.4 Code. All piping to tanks and pits shall be disconnected and the abandoned pipe•openings'sealed rotor. . The contents of all tank ► and pits shall be removed and properly disposed of e s Se move d and the v an d t h e; i s . After pumping, all tanks and pits shall be excavated and removed or their covers removeoid d span filled with soil, gravel or other inert solid material. ' CONTINGENCY PLAN red the following measures have been, or must be taken, to provide a code compliant If the POWTS fails and cannot be repai replacement system: C3 A suitable replacement area has been evaluated and maybe 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 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 a rules effect at tha e. E3 liable p cem in. Is not last la a due p etb ck m l � or' 1 limit ' ns. ar h duce c ' O 1 'ng Y ti pp soil to ev tion e not n ide ' a 'tabl c acement f 'lur � instal In be o ed to e a Sul a repla area. no ace t area availab e a holdin Y as last 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 riles in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONT�N LETHAL GASSE ND IN S M S TANCES. TANK OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER THE DEATH MAY RESULT. RESCUE OF A PERSONXROM'THE INTERIOl 'OBA+TANK.MAY.:�IK I?II?'FYCULT OR IMPOSSIBLE.. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER — .✓x.✓aaW Name ��6 Fs.rr /%P . Name Phone 7 /s' t .?- .s-.7l Phone SEPTAGE SERVICING OPERATOR um er = !WiA ✓oa-/ LOCAL REGULATORY AUTHORITY Name A en Sr � �a Phone Phone KAWPDATAXEMPOWrS OWNER'S MANUA"doe page P of t a —FORM 1 DOCUMENT NO. STATE BAR OF WISCONSIN WARRANTY DD n _ r r( � 3 "� VOL ,S ` % �,5 J THIS SPACE RESERVED OR RECCCRDIKG DATA • 2 REGISURS OFFICE THIS DEED, made between Martin E. 'Crudell and Grace ST. CROIX CO.. WIS. $, Trudell, husband and wife, as joint tenants Recd. for Ilecard IN 14th Grantor day of_ and Gene N. Bauer and .Judith R. Bauer, h LIS ba lld at and wife. as joint tenants Grantee, Re�yGtef of 6ee�r Witnesse That the said Grantor, for a valuable consideration nfS RETURN TO conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: N31 of SW4, Section 24, T28N, R1SIV Tax Key No. FEE This L S homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And Martin E. Trudell and Grace R Trudell warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements and restrictions of record and will warrant and defend the same. Dated this 14th day of September 1978 (SEAL) I (SEAL) ilart E. Trudell (SEAL) — ,�`1� -�-G� c�CtG� (SEAL) e , Grace R. Trudell AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this— day of STATE OF WISCONSIN 19 PIERCE County, j SS. Personally came before me, this 1 14th day of « Sept 1978 the above named TITLE: MEMBER STATE BAR OF WISCONSIN Martin E. Trudell and Grace R. (If not Trudel authorized by § 706.06, Wis. Stats.) This instrument was drafted by Keith D. Rod 1 i , Attorn to me known to be the person who execuj ed the [ore going instrument and acknowledged * 'yaMe, , River Falls, Wisconsin S4022 M" (Signatures may be authenticated or acknowledged. Both '__ Meal R Gop le fl w "; •r'.ti are not necessary.) Notary Public_ P ierce Ceuntyy, Wis. My Commission is permanent. (If not, state expiration date: August 15„ , 19 82 • Names of persons signing in any capacity must be typed or printed below their signatures. ` WARRANTY DEED -STATE BAR OF WISCONSIN, FORM NO. 1- 1977 i v� 57, c)D j