Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
032-1020-40-570
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 556357 0 GENERAL INFORMATION (ATTACH TO PERMIT) Stat a ID N Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. ~~L'0 Permit Holder's Name: City Village X Township Parcel Tax No: Hankes, Jason & Karla Kunzweiler Somerset, Town of 032-1020-40-570 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: GS r 08.31.19.99A75 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER,o 5 CAPACITY STATION BS HI FS ELEV. K ~t Septic Benchmark /pJ (3 Alt. BM D / •/D/~ ~Z /VP Aeration Bld . Sewer 3.90 S7 Holding St/Ht Inlet D 7 5.-2 TANK SETBACK INFORMATION St/Ht Outlet S.j 9 y ~'7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet lC. t F L.~ ~ SAY ~v` Septic ;7&6 / 7 /6O / /,S 70 r Dt Bottom Dosing / Header/Man. -7, 51 1-312,7 Aeration Dist. Pipe 1- L-5 113 - L7 4 93.,z Holding / Bot. System „ ok ~I , x.25 ~z z7 Final Grade PUMP/SIPHON INFORMATION 7. 02- Manufacturer GPm~tand St Cover ) L' c J ° S 9 9. O Model Nu er I _Z_ TDH Li Friction Loss System TDH Ft 9!` 9 Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMEN\ S No. Of Pits Inside Dia. Liquid Depth DIMENSIONS sg SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR L std , ° t JAR Type OJ,ylstfm: ie /50 -3 > 166 UNI7 Model Number. DISTRIBUTION SYSTEM ~o l 4 3 L 4-1, _ p4 L /l g HeaderM~anifold Distribution x Hole Size x Hole Spacing Vent to Air Intake S .5 Pipe(s) Length 4 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/So de- xx Mulched Bed/Trench Center 5 Bed/Trench Edges Topsoil ` Yes 0 No Yes E No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: ~ . r7 Location: 2260 40th Streeeet SOMERSET/T, WI 54025 (SE 1/4 NE 1/4 8 T31 N R19W) NA Lot 4 ) Parcel No: 08.31.19.99A75 1.) Alt BM Description = i 2.) Bldg sewer length - amount of cover = Q f Plan revision Required? 0 Yes o Use other side for additional information. T Date Insepctor's nature Cert. No. SBD-6710 (R.3/97) _ PLOT PLAN PROJECT Jason Hankess A DRESS 2260 40th St. Somerset Wi 54025 SE 1/4 NE 1/4S 8 /T 31 / 19 W TOWN Somerset COUNTY ST. CROIX F 11 /10/12 BEDROOM 4 MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN-GROUNII) S URE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 870 # of chambers 42 BENCHMARK V.R.P. Bottom of shed siding ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark All piping shall be SDR 30/34, within 10' SYSTEM ELEVATION 91.4/91.5/91.6 5' below qrade of tank, piping shall be Schedule 40. Property Line x w 40th St. Shed (p,w17-75 /~G r✓rri~ B M.* y13 yF? Vent ~6„ Quick4 Standard of Cover Leachin Chamber with 20. of Area 10.2ft^2/pai f end caps 4' Long 12" 130 Grade at Syst evation 34" Pro 4 Oo Scale is 1" = 40' Hou unless otherwise 1 noted 5 ST 3% Slope, B-3 30' -4- 10' Area of poor soil Vents 30' 200' 10' 150' 15'B-1 65 B-2 3-3' X 66' cells with ' spacing Area of poor soils 2% Slope `t For replacement area see _ 1-1h original soil test, no other OP Y \ room to fit system at this Rice Lake Road rce.W1'90y/ Safety and Buildings Division Count y w 201 W. Washington Ave., P.(d` Uox 62 aeonsM 'i~ 1°t Madison, W1 53707*7Z,62 su„! of CO?ntnYlrC6 r'urmis Nu,nbar u n., rruA in by ~b 3 y' Sanitar er ~ taleTransaiction Number mlk(A;cation '1~ In accordance with s. Comm. 83.21(2), Wis. V6&;'bubmission of this form to the a / J unit is required prior to obtaining a saW*'pennit. Note; Application fomas for state-awnedsPOWTS tai , Project Address (if dill t than mailing address) submitted to the Department of Comaterce. Personal inibrmation you provide may be used for secondary u ses in accordance with the Privacy. Law, s. 15.04(1 m) Stats. 1. Application Information -p ase print All I f mat' Property Owner's Name ~ Pal•cnl 1t _ ova- ode -y . 1) Property Owner's Mai' Address Property Luoation City, State - Govt. Lot Zip Code Phone Number %a, '/n, Section le Oqw) I ; it, CW -1-Type, of Building (check all that apply) Lot G Subdivision N; Name Family Dwelling -Num&U,. berof Bedrooms l/ c/Commerciat - Descr Block El Publi It ~ 0 City of 0 State Owned - Describe Use CSM NNnm 0 village of _ ~l Sao wliofQ/~?E>✓' S- III. Type Permit: (Check only one box on line A. Complete line B if applien'blof ~A w System ❑ Replacement System 0 Treatment/Holding Tank Replacement Only ❑ Other .wd ication to Existing System (explain) N B. © Permit Renews[ Permit Revision Cl Change ofPiumber 0 Permit Transfer to New List Previous Permit Number an Date t sued Before Expiration Owner (P 3 5-7 - r 0// 2 p IV. Type of POWTS System/Component/Devlce. (Check all that apply) 3°yNr on•Prossurized In-Ground 0 Pressurized In-Ground 0 At-Grade I~ ~M~o"und ? 74 in. of suitable soil ❑ Mound < 24 in. of suitablo soil 0 Holding Tank ❑ Other Dispersal Component (explain) a~pretreatment expla V. Dispersal/Treatment Area Information: r•. Dnat~~ (gpd) Design Soil Application Rate(gpdst) Dispersal Area Requir (st) Dispersal osed (st) Sysl El v 9 8 70 VL Tank Info Capacity in Total # of Manufacturer Gallons Galion; Units 0 8 u New Tanks Existing Tanks Septic or Molding Tank 1.2 c70sing Cbambeu• IVII. Responsibility Statement- 1, the undersigned, ass responsibility for installation of the POWTS shown on the attached plans, numbers Name (Print) P1wn ignature MPIMPRS Number Business Phone Number ~/L 4 t~ tip / r _Z 'lumber's Address (Street, City, State, Zip Codeyll/ / ~71 Coma !De rtment Use Only Approved ❑ Disapproved Permit Fee Date Issued suing Agent ignatu _ ❑ Owner Given Reason for Denial u S • ~ ` l L l Gf~ -r~t~` K. Conditions of Approval/Reasons for Disapproval Art to oamplele plans for the System an ubmtt to the County only on paper not less than s tla x 11 inebeS W Sias ,13D.6398 (R 02/09) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 10/10/12 Owner: Jason Hankess Location: SE1/4 NE1/4 S8 T31 N,R19W 2260 40th St. Somerset System type: In-ground absorbtion system (conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet Signature License number #2269 PLOT PLAN PROJECT Jason Hankess A DRESS 2260 40th St. Somerset Wi 54025 7_ SE 1/4 NE 1/4s 8 /T 31 / 19 W TOWN Somerset COUNTY ST. CROIX ,f MPRS Shaun Bird 226900 DATE 11/10/12 BEDROOM 4 CONVENTIONAL XXX IN-GROUND SURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 870 # of chambers 42 BENCHMARK V.R.P. Bottom of shed siding ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be SDR 30/34, within 10' SYSTEM ELEVATION 91.4/91.5/91.6 5' below qrade of tank, piping shall be Schedule 40. Property Line 40th St. Shed I, 624~rW7- ! r'~-rMrl~ B.M.* y8 3 yFy Vent `6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 10.2ft^2/pair of end caps 4' Long 12„ 130 Grade at System Elevation 3419 Pro 4 Bedroom Scale is 1" = 40' House unless otherwise 10, noted 25 ST 3% Slope B-3 30' 10' Area of poor soil Vents 30' 200' 10' 150' 15' B-1 65' B-2 3-3' X 66' cells with >3' spacing 2% Slope For replacement area see original soil test, no other room to fit system at this location Rice Lake Road Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber To be >1' above grade 10.2ft^2 pair of end plates Finish grade elevation Typical Installation 99.1' -7 Z~ Vent Grade Vent 3, 4„ 3, A4„ Septic Tank 1 5' Long 1 5' Long Grade at System Elevation 3657 Grade at System Elevation &d M l0~ Spacing 5' 2- 1 6" Cells Same on other end Observation tubeNent At end of cell A B C~~ 7 ~Chambers per cell tions; _E System elevaA 4' Q B 92. ' q(, c' t1-(~~ Wisconsin Department of Commerce SOIL EVALUATION REPORT Pagef Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County i, r fY- Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D percent slope, scale or dimensions, north arrow, and location and distance to nearest road. D3 ~pL Please print all information. viewe b Date Personal information you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (m)). `1(` Property Owner Property Location S' Govt. Lot S ~ 1/4 1/4 S T N R E (o W Property Owner's Mailing Address Lot # Block # Subd. Nam or CSM# Z a %o - ~a ~~7- "o-s- 530 City State Zip Code Phone Number ❑ City ❑ village ;KTown Neares Road So fs 5DS/- New Construction UsAe Residential/ Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or corn al - Describe: Parent material ~G%C/GG Flood Plain elevation if applicable ft. General comments System Typei System Elevation Boring F-/1 # ❑ Boring EU Pit Ground surface elev~ ft. Depth to limiting factor / In. Soil 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 8 z- l's 3 Z/1 o o~ < Boring # Rpit Bonng Ground surface elev. ~ ft. Depth to limiting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 177 -7 r-y 7-- X o J.. S r ? L JV /W Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgft ' Effluent #2 = BOD 130 mg/L and TSS < 30 mg/L CST Name (Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715-246-4516 Property Owner _ Parcel ID # Page of Bori ❑ Boring F31 ~ # ] pit Ground surface elel 2-,ft. Depth to limiting factor ~in- Soil 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 0-,g /04" f' aw Os F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring Bonng # Ground surface elev. ft. Depth to limiting factor in. F-1 ❑ Pit Soil ication Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 1220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BODS 130 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. SBP8330 (8.6/00) ,y N O° 'O O° N 03 ~ p in r a0 N C 0.' 0 I ~ I i ~i f~i ~ :3 0 N O N O "r V N N U .E L O fa i N E N ~l N C E NFL N Z' LO N O Z' N V ~ N L T O U O/ N y (Un 'n 0 O U N w U E N 3 Y 0 0 7~ E N O c N Dm 0 E U m L N N N a. O W f9 N D U .L O T.~ O. O. D O c0 (n E '0 O L V O V c L N to E _ O N c 0 f6 to 7 m V1 to O a L N N `O N .0.. 0 N U~« CL O c LL C: O 0C,=M O -6 z Z -0 7 3 L L O O) (0 Q N 7 fD N U. c L 0 0-0 C U. c '0-0 fl 'O N U) y s O - amp ` rn c~ N N a ' Q w 3 U C ~ Q I~ Z> O O N O O Z Li ~ E a) Z j C p 4.; O 4) 4) m d CO Oa 00 H U) `m I O Z ? c a> Z ~ 0) ti N N P c d E c o E ! 04 N N U O NO O t N v CL f` L T a N lv LO O O 0 Z Z z z N o' w w d ( CC) O_ E w E 4) , o CL N O W d N L N D C] E a U) D O CL a U) Q o N N (A N E o N N N N 'o H F- F- zv>Il cn000 am 000 o m •►y ~ 'oaaa ~ I~aaa ~ I v N (D 7 O N N w O N O O N fn J U N N 16 Z N (~O O O} ~l r Z~ N N Z O r O E 3 0 . a) a) N O 'O N ° C O O 7 0 'O 7 Y a l ° ml m Y v w A p c6 Q n <n-a° N~ Q n ii> Q m O Y H y Y U) N 06 - 6 c E O c otf to C r- LO r V N O V p) U CL M ` O O Q c y (D C-,) N c N C N O O O q U) -T 40. No 7 y I: aNi i y S d a~ Y co y c d c a•°i rn s a) ►~i N M E c O N O O 0 O ~ E c6 L 1=x,1 M co O f0 to O y O M ccoo O N T f0 U • 1 O O w S LO O Z N GL Z 2 d' O Z 0' CL (n ~ a d a : 'a CL CL am .5 , a) c °,3 t`N o R 3 3 '0 3 'o t A U a 2 j 0 (1) U 0 U) U 0 611> e a o ry N I I N 0 .o w I 0 O N GL, ~ II 7 m o C Z LL o cco W N Q (n.5 3 ~ I m Z Z j' = C V Z w d M W a. co co H U) I II o Z c (D Z N CY Lo N N C\l O L LC) O Q Q N II ~ Z Z Z I W C N LO L it M 0 CL v N! o o a a E Z v> co H H V 000 a • 4i NN a ~i 0 (3) U) N ~ N V) J V N O O N Z IrV r l 7 co ~ w Q 0 Q Z U) i7 Y 3 +g c j o~S N C O n o o o rn~ ocE m m O N y } H i fh O Y N C 04 E • O O (n 2~ O Z 10 a' Z \ i6 = E Vj y m a V #i a L a r A 0 a 0 a 0 comrmerc06w1.901V Safety and Buildings Division County c oru 201 W. Washington Ave., P.O. Box 7162 / e I s f~ns i n Madison. W1 53707-7162 v tt9 l ORM.ores Sea ileuy forenle Numbe~ te be filled in by Co-1 - Sanitary Permit Application Slate Fransactroil a ber In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to th y' unit is required prior to obtaining a Sanitary riprietepernm tai /V submitted to the De t Note: Application forms for ow l'pWSe Project Address address) parhnent of Commerce. Personal information you provid be ed f'oreco ary different than mailing oses in accordance with the Privacy Law, S. 15.04(1 m , Slats. , 1. A ation Inform n - Please Print All Information Q Property Owner's N tX a-6 0 YET lti Parcel # Property Owner's ding Address Property Location City. State ~ Govt Lot ( e { / ~ [ 5 r1 / Zip Code Phase Numbe 114,A1 Section II. Type of Building (check all that apply) Lot # T I-_ //~irc1 one}, N; K / 7 ` E ~'qr 1 ) or 2 Family Dwelling - Nuipber of Bedro s ~~C Subdivision Name -7`- 3 W/,O ass I b l.-- 2 2 wr. Block Al ❑ Public/Commercial - Describe Use _ U, 22- ❑ City of ❑ State Owned - Describe Use CSM Number- ❑ Village of 3~' 13 53~~ Town of Ory~ i[II. Type of P beck only one box on line A. Complete line B if applicable) i A. PNNeewYS_ ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B• al ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Lius Permit Number and Date Issued Owner IV. Type of POWTS System/Cam onent/Device: Check all that apply) on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound?: 24 in. of suitable soil ❑ Mound r 24 • . Of sui le tl ❑ Holding Tank ❑ Other Dispersal Component (explain 4AI9 retreaUnent Device (explain)-a ~ V. Dispersal/Treatment Area Information: ;Design Flow (gpd) Design Soil Application Rate{gp f) Dispersal Area Req red (st) Dispersal Area Pro sed (st) System Elevati n 'VL Tank Info Capacity ~S 7 < in Total # of Manufacturer Crailoas Gallons Units s a New Tanks Existing Tanks L' ° v a fn n y w c7 a Septic or Holding Tank x Dosing Chamber o~S VV S~ EVIL Responsibility Statement- 1, the undersigned, assume re •tbility for installation of the POWT shown on the attach plans. ~?lu er's Name (Print) Plumber's Si e MPIMPRS Number Business Phone Number -7- Z11111 11timber's Address (Street, City, State-Zip Code J O 1/~ ~j IJIII ount /De artmentJJ2a Onl Approved rs Disapproved $Permit Fee ~ Date I sued lsst id gent St ature Glk Denial J /-~G'G~'h~ ~X. ea" #pr bisapproval $YB I / f• soft tmtk,tillhtlw*lor 200 Co /lf G'4. . I 1 dispersal co'nWIll'itill ►equ)ttttes , 3 ST~XtV (fit S 4r2~/ J~77I.Ui✓T U~ O lV 2 AD 800=k _ ! 1-- - ttsr aPp ble Code % adCl~ib~t, /JQ217 ( ~~J~ o t- ~ ~mplete plans for the syrl men submit to the County only oa prper not tree thrn 81h Y 11 inches in sires f -f >4~ 1 TS Q i 5th c t3v t.R ~ aT Tn B~ VSb 2 9J) utt✓ Li~ICT I Al :I3D-6398 (R- 02/09) l - •Wisasin Department of Commerce SOIL EVALUATION REPORT Page ( of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code C~ County O L /gyp C Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel LD, percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Q . Please print all information. Revie y Date Personal information you provide may be used for secondary purposes s. 15. (1) (m)). 9 z4 m- Property Owr C3 r- r-1 V I,- Prope Location P i J ~!r ✓r- ovt. L tS~ 114A,/~ 114 S T N R1,9 E( W Property Owner's Mailing Address Q 'Lot # Block # I=S- me or CSM# Z r O City State ` Zip Code P e Nurgf. 3p,Ot c' ❑ Village -``Town arest Road q i yOas-( New Construction Us~Residenfial / Number of bedrooms3 Code derived design flow rate GPD ❑ Replacement Public or comme 'al - Describe: Parent material Flood Plain elevation if applicable General comments and recommendations: ~f 9 p g, 5 bad System Type ~✓L'(JPrLTi System Elevation Boring # ❑ Boring Y Q L a Rit Ground surface elegy/ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Muns~ell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 -z2 T '9L,'/ I d , - 3 It-2-4 --7 1 r IV- Boring # ❑ Boring //ll nn ® lia-1 Pit Ground surface elev,'4 ft. Depth to limiting factor L~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 ,I Effluent #1 = BOD > 30 < 220 mg& and TSS >30 11 50 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mglL CST Nerve (Please Print) re CST Nun'Iber Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, W! 5 17 r' 715-246-4516 Property Owner Parcel ID # Page of ❑ ® Boring # Boring ~ Pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Boundary Roots GPD/H? Horizon Depth Dominant Color Redox Description Texture Structure Consistence in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 c r~ Z l,7 ❑ Boring # ❑ Baring ❑ Pit Ground surface elev. ft. Depth to limiting factor in Soil Application Rate 1- Texture Structure ' Consistence Boundary Roots GPDIfF lpizon Depth Dominant Color Redox Description * in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. ❑ ❑ Boring # Boring Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon 7epth Dominant Color Redox Description. Texture Structure Consistence. Boundary Roots GPDM in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mglL and TSS >30:5 150 mg& ' Effluent #2 = BODS 30 mgll., and TSS 30 mglL 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 608-2648777. seesaw QLWOor Soil Test Plot Pla Project Name Denise Gunderson Shia), ird Address 333 Rice Lake Rd Somerset Wi 54025 CS #226900 Lot 4 Subdivision Date 6/06 SE 1/4 NE 1/4S 8 T 31 N/R19 W Township Somerset Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 93.4/92.8 *HRPSameasBenchmark Alternate Benchmark Top of Steel Fence Post @,/09,0 699' Property Line Scale is Y' = 40' unless otherwise noted B.M. 80' 20' 6% Slope 90' B-2 343' Property Line B-1 97' ' 30 45' B-3 99, Rice Lake Road RECEIVED _ ;a t 8 3 8 1 3 7 DEC U o vb VOL 22 PAGE 4 WAJ_ KATHLEEiT R. REGISTER OF DEEDS - - - - ST. CROIX CO., MI ST. C (RECEIVED FOR RECORD S1RVEYOR e Z yv If % 11/06/2006 08:30AM Z m o 't O • ;2t I CERTIFIED SURVEY liAP a, 19 m N Z 1 REC FEE: 13.00 o, c L-N cn $ a y~ I COPY FEE: 3.00 40 = ° g 1 1 ~o ! ~o ro I PAGES: 2 j' D cvi~ ~ ii C) 45~ If C2 Z Q No~ r f' ? f~ If '`Yp I OoR'~ C~i4 M L If rn r" 2n If IM rn rnccn D`Z'i ~ g O NE I o 8 $ ~c ~W 7 C.n O J Z C~°~ (n -1 I Z c~ r m l _ C p° I Z ~Q ~ QD ~ SL2 i i ~ N2r• fID~`p~ Q~z j 165.21 8 j• " 7"E e p~ Q-~ 132.18'_ 131. ° ° a° p; ; Ll rr8 r0 A I nil l I 1 i~ ml ~nnil oc, to I P %u P 0 - If w . 0 y w C -A a+' ~4• 638.16' .a l S0435'44E 670.40• +P ~~go ~m~ I CA i. Fri 5 :M 44 33.27• 686.68• ; P m m o S S03.59'05'E 899.95 QAA , o ;o ism ~p-~ m .4 . s QQ I EAST UNE THE NE 1/4 x - # S01 55"W 672.78' 1969.65' w 2 20 L2 c4 TERUNE _ S01 'S5"W 705.81' . ' - $ ~ CA I ~ . AA tN1 ~ 4 THSTREET A~~OCm V a3C ~~O ~~1> CS b O pp A rn 'oo•55"w 2676.46•-- q:, $ F N ~V SHEET 1 OF 2 E0 2!2 1 Of 2 ( h i vol 22 Page 5304 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 I' Date. . 10/10/12 Owner: Jason Hankess Location: SE1/4 NE1/4 S8 T31 N,R19W 2260 40th St. Somerset System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0 Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet Signature License number #2269 PLOT PLAN PROJECT Jason Hankess ADDRESS 2260 40th St. Somerset Wi 54025 SE . 1/4 NE 1/4S 8 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/10/12 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 860 # of chambe Cs422 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be SDR 30/34, within 10' SYSTEM ELEVATION 93.4/92.8 5.5' below grade of tank, piping shall be Schedule 40. Scale is 1" = 40' unless otherwise Well is to meet all noted setbacks required by WDNR 699' Property Line Scale is 1" = 40' unless otherwise noted B.M. 80' 2-3' X 86' cells with >3' spacing 20' 6% Slope 90' B-2 343' Property Line B-1 97' 3' Vents 45' 99' B-3 10° ST 10' Vent Pro 4 >6„ Quick4 Standard Bedroom of Cover Leaching Chamber House with 20.0 ft2 of Area 10 2ft^2/pair of end cans 4' Long 12" 34" Grade at System Elevation Rice Lake Road Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber To be >1' above grade 10.2ft 2 pair of end plates Finish grade elevation Typical Installation A(I 99.1' ,jVent Grade E 4" x/30/34 Septic Tank 19 5' 5' 3 6" Grade at System Elevation rade at System Elevation Spacing 5' 2-3' X 86' Cells Same on other end Observation tubeNent At end of cell A B 21 chambers per cell System elevations: A-93.4' B 92.8' i ST. CROIX COUNTY SEPTIC TANK MAINT ENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FO RM Owner/Buyer J So, Mailing Address - _o---q _b4k__SIlso Property Address (Verification required from Planning & Zoning Department for new (,onstruction. ) /a City/State Parcel Identification Number i LEGAL DESCRIPTION Property Location, ~ "See. R_/_4w, Town of Subdivision - - _ Lot # Certftlied Survey Map # - - Volume Warranty Deed # 0 0 Page # - Volume Page # Spec house ye uo - - - Lot lines identiftab yes no SYSTEM MAINTENANCE AND OWNER CERTITICATION Improper use and maintenance of your septic system could result in its premature f maintenance consists ofpumpv:ig out the septic tank eve ailure to handle wastes. Proper the system can affect the functi every three Years or sooner, if needed, by a li,sensed pumper. What you put into on of the septic tank as a treatment stage in the waste disposal systvin. Owner responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 -,qt, Croix County Sanitary Ordinance. maintenance The property owner agi-ees to submit to St. Croix County Planning & Zoning owner and by a master plumber, 'journeyman $ Department a certification form, signed b the wastewater disposal system is in proper Operating condition rrestricted and/or plumber ber or a licensed pumper veri. Y less than wastewater full of sludge. fying that (l.) the on-sit1/3 e ins ection and pup~g (if f necessary), the septic tank is 11we, the undndersigned hssve read the standards set forth er as set b above requirements and agree to maintain the private ;sewage disposal system with the Certification stating ~ Y the ePa~nent of Co nnnerce and the Department g that your septic system has been maintained must be co plt and returned teethe tu. Croix County plan n. Zoning Department within 30 days of the three year expiration date. ty arming & i I/we cetiifj, that all statements on this form are true to the best of my/our knowledge. Uwe am/are the a Property described above, by virtue of a Warranty deed recorded in Register of Deeds Office, wner(s) of'tlie Number of edr00ms~~~~ - QU _ GNA U"RE.0 OF . P LICAN j 1/p /f Z **An .DATE Y hifarntation that is misrepresented maY result in the sanitary Permit being revoked by the Play (Include with this application a recorded wan-arty deed from the Register of Deeds Office and a copy of the certified survey wrap if ('REV. 08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner. e Septic Tank Capacity A02 S al ❑ NA Permit # Septic Tank Manufacturer ❑ NA 3 !s- DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms PDU5 ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ZNA Pump Tank Capacity al NA Estimated flow (average) y270 gal/day Pump Tank Manufacturer 11 NA Design flow (peak), (Estimated x 1.5) 6 GG gal/day Pump Manufacturer NA Soil Application Rate gal/day/ft 2 Pump Model 11 NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit NA Fats, Oil & Grease (FOG) <_30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) <_220 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 (BOD5) <_30 mg/L * In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) <_30 mg/L .)<NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) <_10' cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size in dia. ❑ NA Other: ❑ NA Other: eNA Other: NA *Values typical for domestic wastewater and septic tank effluent. Other: lil NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tanks At least once every: ❑ month(s) ears (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (36) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA year(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA ear s Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ 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 (X) 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 <_12 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. START UP AND OPERATION Page of 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: -A 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 Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Name Phone - _ Phone ~jv = slvg This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. LTER CARTRIDGE INSTRUCTIONS Installation STEP Y try 8t the filter case auto the and at the nutlet pipe to ensure it is centered under the access oponing. If not, then either Insert the tank through the outlet or sol cant weld (glue) additional pipe onmove pipe to the Outlet pipe. STEP 3 Whit the case is std dry fitted on the outlet pipe, measure the length of a16-inch pipe needed to bract, the filter to the tank and wall if utilizing the optional supplemental side support, If side support method. Is not utilized, proceed to stop four. FF* ; For installations utilizing the optional supplemental side support: solvent weld the viler-inch pipe onto the filter case, tf side support method is not utilized, proceed to step four, 're'v ya„d'' 4 Solvent weld the filter case onto the outlet pipe. Insert the filter ,_~•,i'>! S,. cartridge into the case, pressin l down until the filter locks into the bottom of the case. If a VIRUS switch is utili:,s:d: insert into the filter and lock by turning clockwise 9M. ,7,1 Maintenance 1. The effluent filter should be leaned every time the septic tank Is serviced. 2. Open the outlet access opening to Inspect the tank and filter, a 9. Pump the septic tank corriplotely, making sure to remove the sludge layer on the bottom of the Wrik and not just the scum and effluent, 4. once the effluent level has been lowered below the invert of the outlet pipe, iirtnly pull up on the fitter handle to dislodge the cartridge from the case. ' • x 5. Slide the cartridge up and at it of the case for cleaning. Whys 6. if a VRS switch connected to an alarm is present, the switch should be removed by turning counterclockwise 90v and cleaned with water only. 7. While holding the cartridge on Its side (large flat surface facing 4 down) over the access opening, rinse off` the cartridge with water at:' only, making sure all septagte material is rinsed back into the tank- ` a. if VRs switch Es utilized, replace by inserting into filter and turning clockwise 90', 9, Insert the filter cartridge back into the lease, pressing down until the filter locks into the bottom of the case. 'iii •wu 10.11epface and secure the accens opening an the tank. r•7 4:' ii4 S," , f+ "b L; ; 441 :'$t :rl(r4r C -'7 t:.! : ir4i':.4] l+VAr^•f•43.Y. t www beamnAte.com 877-ML-FILTERS (653-4583) 12 -I(Z !11111 IIII! !1111 IIIII IIIII Iifll 1111 II#III lilt I##1 0 5 1 X State Bar of Wisconsin Form 2-2003 8 8 6 3 886305 5 WARRANTY DEED BETH PABST Document Number Document Name REGISTER OF DEEDS ST, CROIX CO., WI RECEIVED FOR RECORD 01/07/2009 03:OOPM THIS DEED, made between Denise Gunderson, a single person WARRANTY DEED EXEMPT II ("Grantor," whether one or more), REC FEE: 11.00 and Karla 1. Kunzweiler and Jason J. Hankes, husband and wife TRANS FEE: 135.00 PAGES: 1 ("Grantee," whether one or more). Recording Area i1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Name and Ret'}Q' Ad interests, in St. Croix County, State of Wisconsin ("Property") (if more space is vaV ~ Estreen needed, please attach addendum): 304 Locust Street That part of Southeast Quarter of the Northeast Quarter (SE 1/4 of the NE 1/4) of Hudson, VIII 54016 Section 8, Township 31 North, Range 19 West described as follows: Lot 4 of Certified Survey Map recorded in Volume 22 of Certified Survey Maps, Page 5304 - as Document No. 838137, St. Croix County, Wisconsin. 032-1020-40-570 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any. Dated (SEAL) bL1Sa- cu.1//1(lUl24! (SEAL) * *Denise Gunderson (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) Denise Gunderson, a single person STATE OF ) authenticated on 7PC ) ss. COUNTY ) *Kristina O gland Personally came before me on TITLE: MEMBE STATE BAR OF WISCONSIN the above-named (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: * Attorney Kristina Ogland Notary Public, State of Hudson, WI 54016 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. 2-2003 " Type name below signatures. INFO-PROTM Legal Forms 800-855-2021 www.infopmforms.com 1 of 1 ;Nisconsin Department of Co,Amerce iT PRIVATE SEWAGE SYSTEM County: St. Croix Safety and BuildinIg Division , INSPECTION REPORT Sanitary Permit No: ~ 1 0 GENERAL INFORMATION 'YTTAC;H TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [PrivaL - Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Hankes, Jason Somerset, Town of 032-1020-40-570 CST BM Elev: Insp. BM Elev: BM Descripti Section/Town/Range/Map No: 106 ' 6 .~D4', S/ 08.31.19.99A75 TANK INFORMATION ELEV ION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmar, / 13 O&hX Dosing n yr f ( O IN Alt. BM 5 I F~ Aeration J•X~ Bldg. Sewer Holding /Ht inlet ~•S ISM TANK SETBACK INFORMATION S Ht Out t l~'sG 9y. 9s TANK TO P/L WEJLI BLDG. Vent to Air Intake ROAD Dt Inlet Septic _O / Dt Bottom 2 5u 4 4, Dosing Header/Man. Aeration Dist. Pipe ~7,0 Holding Bot. Sys m u D, 1 3, cso% Final Grade PUMP/SIPHON INFORMATION 97' D Manufacturer Demand St Cover / Z GPM r:-/ 9c7- Model Number TDH Lift Friction Loss stem Head _T DH Ft Forcemain Length Dia. Dist. ell SOIL ABSORPTI YSTEM BED/TRENCH Width Length No. O710 hesPIT NS No. Of Pits Inside Dia. Liquid Depth ;;-T DIMENSIONS D4- / INFORMATION ON SYSTEM TO P/L, BLDG WELL LAKE/STREAM HA ACHINIG O Manufact r/ 1 _ L.Y VV Typ Of System: 2, U-I- U Model Number: DISTRIBUTION SYSTEM V / / 5 b Header/Manif )I Distribution x Hole Size x Hole Spacing Vent to A Intake N Pipe(s) / / n Length a Length ` V Dia Spacing )__1A SOIL C VE x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil FTI Yes M No ~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 176 / I'D Inspection #2: Location: 2260 40th Street SOMERSET, WWII ~544~0255 (SE 1/4 NE 1/4 8 T31N R1 9W) NA Lot 4 Parcel No: 08.31.19.99A75 ,q -T~,a q 1.) Alt BM Description A~ k#h- SQb~U/ 2.) Bldg sewer length U- 22 0 / /~L~ ~ smzk "(~^~c'( - amount of cover = I / Alt- A Vw 7, in - AV W4 z 14~ 10 WD Plan revision Required Yes No FqT-2- 0 l0 Use other side for additional informatin. SBD-6710 (R.3/97) Date Insepctor's Sign ure Cert. No. - P AJLD Cofl'tfllerce.whgoV Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ~7 . C r 1~ turknerit cone i n Madison, WI 53707-7162 Sanitary Permit Number (t be filled in by Co.) of Commerce 4/~ 3 58 Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Pr jecct Ad re§s (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04 I m , Stats. ~ 1. Application Information - Please Print All In ation 7 J Property Owner's Name / reel # ' J/~ sun, afFc~ / D - 7 0 Property Owner's Mailing Address operty Location J~ S T'G~ J71 [ fj ST. CROIX COUNTY 14 s Vt. Lot _ City, State Zip Code y,, Section SC C Q. ( trcle on H. T pe-of Building (check all-that apply) Lot T -3/ N; R, E W 2 Family Dwelling -Number of Bedrooms vision Name Block ❑ Public/Commcrcial - Describe Use rti Clp ~G1..~~. ❑ City of r ❑ State Owned - Describe Use Z CSM Number ❑ Village of I/Q Z l.. owa of III. Type of Permit: (Check onl one box online A. Complete line applicable) A. ' w SYstem ❑ Replacement System El Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) B. Permit Renewal Permit Revision Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued etoreExpiration Owner B~' tom,` IV. a of POWTS System/Component/Device: Check all that apply) n-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 ersaUTrea ent Area Information: Design Flow (gpd) Design Soil Application Rate( dsf) Dispersal Area Required 1) Dispersal Area Propos s ystem Elevati n VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units & a New Tanks Existing Tanks w v U gU G✓ 1~8b~ a U A Y A w c7 P. Septic or Holding Tank t 4 Dosing Chamber VII. Responsibility Statement- I, the undersigned, assu a onsibility for installation of the POWTS shown on the attached plans. Plu er' Name (Pr' t~ Plumber' re MP/MPRS Number Business Phone Nu~r Plumber's Address Street, ity, State, Zip CodeeJ VIII. Coun /De artment Use Only Approved rn,7Rcas,n Permit Fee Date Is ued Issuing A Signature for enial IX. Conditig"?t"Wwasons for Disapproval 1. ' Septic tank, efflUW filter and Pt/~~,t' 1 aI, $ dispersal cell must all be servlCes /main fined as per management plan provided by plumber, 00 P1 p 2 AN sgtback requifements must. be maintained Attach to complete plans for the system and submit to the County only on paper not less than 8 112 x 1 [inches in size SBD-6398 (R. 01/07) Valid thru 01/09 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 9/17/10 Owner: Jason Hankes Location:SE1/4 NE1/4 S8 T31 N,R19W 2260 40th St. Somerset System type: In-ground absorbtion system (conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-5. Maintanance and Contingency Plan 6. Filter Specifications et Signature License num #226900 PLOT PLAN PROJECT Jason Hankes ADDRESS 515 Polk/St.Croix Road Somerset Wi 54025 SE 4/4 NE 1/4S 8 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX 9/17/10 77 GPD MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 165 # of chambers BENCHMARK V.R.P. Bottom of Shed Siding ASSUME ELEVATION 1001 Filter BEST Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 93.8'3' below qrade Well is to meet all 40th St. setbacks required by WDNRScale is 1" = 40' Property Line unless otherwise noted or Buildin No bedrooms, no livin quarters,no commercial, being sized for 1 flo drain and two people occuping the unit Plans Designed Using during the day. Conventional Powts Manual Version 2.0 40' 3 30 3 Weeks St VOSUq VP 21Oi515 B-1 l ,J ,P-,d 25' 1% slope thus no contours t 1 ~~~54~ B-2 25 ° Vent Su~ saw' Quick4 Standard-W 1-3' X 34' cell >6 Leaching Chamber B-3 of Cover with 20.0 ft2 of Area Ven 2 5.8f A2/pair of end caps 1 " 50' 4' Long 34" Grade at System Elevation ~ 25' cJ Property Line ` PLOT PLAN PROJECT Jason Hankes ADDRESS 515 Polk/St.Croix Road Somerset Wi 54025 SE '1/4 NE 1/4s 8 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 9/17/10 77 GPD CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 165 # of chambers 8 BENCHMARK V.R.P. Bottom of Shed Siding ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 93.8' 3' below grade Well is to meet all 40th St. setbacks required by WDNR Scale is 1" = 40' Property Line - unless otherwise noted Acessory Building No bedrooms, no living quarters,no commercial, being sized for 1 floor drain and two people occuping the unit Plans Designed Using during the day. Conventional Powts Manual Version 2.0 40' 30' Weeks St 15' B-1 25' 1% slope thus no contours B-2 25' Vent >6" Quick4 Standard-W 1-3' X 34' cell Leaching Chamber Vent B-3 of Cover with 20.0 ft2 of Area 12" 5.8ft^2/pair of end caps 50' 4' Long 3 4) Grade at System Elevation 25' Property Line ,Cross Section of Quick 4 Standard-W Leaching Chamber Typical cross section for 1 of 1 cells Quick 4 Standard-W Intial Grade Elevation 97.0' Leaching Chamber To be >1' above grade g with 20.0 ft2 of Area per Chamber 5.8ft^2 pair of Finish grade elevation end plates a7 n' Typical Installation Lvent ACI Grade /34 From Sep tic Tank 4' L4 3 Grade at System Elevation 1-3' X 34' Cell Same on other end Observation tubeNent 5' A 8 chambers per cell System elevations: A_93.8 Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan Option #1. If system fails, determine cause of failure, use alternate area and install new em ir, tested replacement area. Option #2. stall system at a lower elevation, by removing chambers, removing biomat, and-i~"stalsystem. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715-246-4516 St. Croix County Zoning 715-386-4680 Pumper Tom Mondor 715-246-5148 Shaun Bird #226900 Z . O w N r Z CO N ~ (D a O O O I? MA 11 _jWr Z < (D o (D o F- Z r cn g UJ ~LL 0 J O LL WN W CR O N tr H J 5LL LL C, LL JEEP N 01 I IV IF V iv gig -Y IV O N r F- d' d ~ V (O r ~a O --A-1--- RECEI EV D Wisconsin Department of Commerce SOIL EVALUATION REP T SEP 16 2010 Pag of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code C Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must FFICE include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. oat; D - s v Please print all information. Revie by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 7 Property Owner Property Location s Q Govt. Lot S~ 1/4 x'114 Y T N R 4?E (o W #67 A / Property Owner's Mailing Address L Lot #M Block # Subd. NarrA or CSM# s C Sf. ~r~ l City State Zip Code Phone Number ❑ City ❑ village ;PZ?wn Nearest Road wl 5 ohs ( ) Construction Use Residential / Number of bedrooms Code derived design flow rate 7 GPD ❑ Replacement ❑ Public or g0imercial - Describe: Parent material Gl✓ Flood Plain elevation if plica ft. General comments 14,, 1 C,vrt,J ~ S S @ 3 ~?/'4,(_ r t rlpl~ / ~cG and recommendations: Z ~O~°/~ System Type L l Oe?~7_5/of (0 System Elevation a" 7. 1] Boring # Boring / 7 Pit Ground surface elev. !y- ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell / Qu. Sz. Cont. Color ~Gr. Sz. Sh. 'Eff#1 •Eff#/2 - .Z Q~ r h V S ~1/ ' Nly1 / Cj t ® Boring # I ` :tdng Ground surface elev. ~ 7 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 T r( / LIA Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 • Effluent #2 = BOD < 30 mg/L and TSS 130 mglL CST tine (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 - 715-246-4516 4 Property Owner _ Parcel ID # Page of n Boring Boring ' ~ d~.Z~,1JJ ED-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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 l1.v 114- A a Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # ❑ Pit Boring ❑ Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I Effluent #1 = BODS > 30 < 220 mg/L and TSS >30:5 150 mg/_ ' Effluent #2 = BODs 130 mg/_ 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. Seu8330 rxVoo> Property Owner _ Parcel ID # Page of n Boring # ❑ Boring J LPit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 01.v 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 GPDKf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDKf 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 = BODS 130 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. 580.8330 (8.6(00) an Project Name Jason Hankes Soil Test Plot PlShau ird Address 515 Polk/St.Croix Rd Somerset Wi 54025 TM #226900 Lot 4 Subdivision Da a 9/17/10 SE 1/4 NE 1/4S 8 T 31 N/R19 W Township Somerset Fj Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of shed siding System Elevation 93.8 *HRPSame as Benchmark 40th St. Scale is 1" = 40' Property Line unless otherwise noted Acessory Building No bedrooms, no living quarters,no commercial, being sized for 1 floor drain and two people occuping the unit during the day. 40' B-1 25' 1% slope B-2 thus no contours 25' B-3 50' 25' J Property Line k :5 'N ST. CRO rK COUNTY SEPT C TANV MATtq 1"ENANCE AGRBENLEENT AND OWNERSHIP CERTIF)<CA.TION FORM OWMA3uyer M91ing Property Address. ~_.r (vorinestion raWi ed hum Planting & zowng Department far now cdttstmetiotn.) 570 City/Siac~~~ ~T7•---- Parcel Wenti~ication Number PrapertY Loaworl 1/4 , Sec. T `3l N R.,,• 1, W, Town of... `'o /YJ~JIf' Lot # Subdivisiott - , Volume Page # 5 0V Certified Survey Map # ....-~.....---r..-~-~ Warranty Deed # _ - , Volume . , Page* Spec house yes W Imes identifiable y° no W lrrtproper use and mutim oce of yottr septic system could smolt is its pret7 bare m me to b=& wastes. how maintevance consists of pumping out the septic tank every tluee years or sooner, if needed, by a licensed punVer. What you put into the eyatem. can affect the fumdon of the septic tank as a troatnnvat stage in the waste disposal system. Owner Mintenat>oe m4"nsibilities am spoctfied ka §Cortna+. 8152(1) and in Chaptcr l x - St. Croix CA=ty Sanitary Ordinanca. 'T'he p uperty owner agrees to submit to St. Croix Casty Pluming & Goiting Departnuid a ccrWiccation form, signed by the owner and by a maMer plwnber, loumeyrow pltmim, resWeted plumber or a licensed pwqm verifying that (1) the on-sin wastewater disposal system is in proper operating condition andlor (2) after insWtion snd pnn4*g (if ttecessaary), the septic tank is less d=1/3 AM of sludge. Uwe, the undarsiped lave read the above requitenoms and agree to w aintarh the private ""go disposal system with the standards set goth, k4tai% an set by the Dapattrrtettt of C4mtnerca and the Department o Naturai Resources, State of WiscoAsim Ca lillmhon stating Mast your septic system has been rrisihamed and be m"Ieted fund rWurned to the tat. C-mix C City Plantang & Zoning Depai t mit within. 34 days of the ttuec year etpirsdion date. Uwe certify that all statemeau on this f6cm are true to to best of mylour knowledge, I/we aunlilre the owner(s) of dte property described above, by virtue of a warranty deed recorded in liter of Dow$ Office. ~C N,Qmlt*e d roo 1" I V ~tNF SIONA OE ~FV:" ]ANTS DATE ***Any information thin is missrapr mitod may result is the sanitary permit being revoked by tha 1?imwin & Zoning DepartnHtnt. Inckwis with this application a mconxted wamluty deed 'Moat tho Register of Demb Office ssMd a copy of the co tifiod survey map if refesonce is made in the w musty deed. (RXv, 08M) 77,-Soek 6 PA/'--c~' 2009.07-0314:07 SCHUMAKEP WN Page 2 . " ~1IINil{illl{I{IIIIIIIIIINIIIIllNl111111IllsIIII * 8 8 6 3 0 5 1 State Bar of Wisconsin Form 2-2003 WARRANTY DEED BETH PABST Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 01/07/2009 03:OOPM THIS DEED, made between Denise Gunderson, a single person WARRANTY DEED EXEMPT # ("Grantor," whether one or more), REC FEE: 11.00 and Karla I. Kunzweiler and Jason J. Hankes husband and wife TRANS FEE: 135.00 ("Grantee," whether one or more). RAGES : 1 Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Name and Re Ad¢ interests, in St. Croix County, State of Wisconsin ("Property") (if more space isaVii, Estreen needed, please attach addendum): 304 Locust Street That part of Southeast Quarter of the Northeast Quarter (SE 1/4 of the NE 1/4) of Hudson, %M 54016 Section 8, Township 31 North, Range 19 West described as follows: Lol 4 of r Certified Survey Map recorded in Volume 22 of Certified Survey Maps, Page 5304 r] y r as Document No. 838137, St. Croix County, Wisconsin. 032-102040-570 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any. Dated (SEAL) bMi%Q- l hf,G~IYI (SEAL) * *Denise Gunderson (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) Denise Gunderson, a single person STATE OF ) authenticated on > ) ss. COUNTY ) *Kristina O land Personally came before me on , TITLE: MEMBER STATE BAR OF WISCONSIN the above-named (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: * Attorney Kristina Op-land Notary Public, State of Hudson, WI 54016 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 IDENTMED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 * Type name below signatures. INFO-PROt1 Legal Forms 800855-2021 wwwInfoproforrns.mm ~i065 a8ga ZZ Ton iz F) Z U) Ln ~~m og ~aZ~ Z :40 l 133HS N 06(69,01Z z?~ _ _ n- to NW (n _f w < .91►'SL9Z M«99,00. WS _ N t- ~O NZ7~ ~U ~5 NZU ~U ----------tp1._._ t0i z F= ~i J9.90L M«99,00JOS 3NNnnaxN30 OP ss•s9si \ g z \ ~et•zcs M«92,00 tos ` x x v $ */I 3N 3H1 ENnISV3 U9 m F5M ~eiN II I X , J 6o cn -z 1.2ui I I t q} N I 6 IN W o C<L 0 ~I I M 56'669 3«90,69.£OS ! C; uj 3 N m Q= 13 1 M .89'999 -4 'i IZ c >Nw Qirn CID 91 W t II III Z W I Ic M OUpZ "1 0. Q ~ ! na08 Sgig ow °1"' QV) UaV) I I W1 DD 10 0 F: Q. At m~i2 aI~ N J O'~d:~WN I' I I soft . ~1 U ~Oc o I ~~M ~p a J W Ww oNW~- N N ~ Ow 117 Ili:~ jzId 05 J] M ~M ~ I Wye cb glut 9 Za~ mTI U~ J(~in \ 0 ~0W~* N p L O►0'•~ ~MO I ' IZ 10 M 0 sip o o Q [thy 3 L Let 10 I a w z v~~ o QQ i .5`S£. ~zN F0 M«rZ a 5 N j tp~ / W i uj;3 v Z Q tt. FIL, t i s -~-w PA, I D gad ~sttimf Diviseon CAMIY Ong ! Ave., 1'.O. Box 7162 Z cor ~ M adison. W1 53707 7162 s/ of seniary 1 ooft linnd>er (lobe hued ib by Co,) Sanitary Permit Application 5/5 1n acoordsat;e vAth s. C so" ranue" Nnaeber tenit is C.M. 83.21(2X Wis. Aden. Code, submimiaq of•#his Pons to rho approp jw, llovmttmeatsl /"A Rr prior to obtaining a sanitary permit, Naieti A ic~don anbmitbed to the PP1 fbrms for slate.uvyned POWTS we as in poomnlDOPAT"o4ftwith the ivaQ f eq, s IPse ~i m i~TV ®°0ndary' Pro ect Addmea//(ifdiflbmnt then meifin~ edd~e) Abu - pLdne prht All to kada w' A ow P proprty oweer' s Name Z Z b 6-j-01 Aj JUL 312009 Pored0 No" Owner's Making Addnm 3 ST CROIX COUNTY -7-1 -1 / PLANNING. & ZONING OFFICE ) City, Statn 7UP Code phone Numbs ;:5-`G 'K Section r 44 IPe of Bni 4 SI - a q 8 to LiS t 1 Il (cheek trR th ni apply) l of # T,' N; 9 13E 01w wl or2 Family Dwelling Number of mid" ~ Stelydivieioii Neon E]Pubticg' - ze 4 0 1-Describe U ~1 0 I~ ~iddc# Of f ^'19 p~ ~ e C~nktG~j~ b✓ s ~ City of i . ! beUsG (+ere,A: te4* a. CSMNum VilkyeoP P~" Tolim of -e I11. of Perni#t; (Ch k only one buxom line A. Comp ins B if ) A' New System, lteplaeemmu T ding k Replacement Only Other AfaNcotlon so ftb ft sow (errpwn) gyrtem fi. Permit Permit 84*ioa CMnge of Polnit Tronew so List Peaviow 1'erodi Neunber arrl Disc Issued Reno ml Netbre Plumber owner Brt tion IV. Type of POW'lY9 Ai/C tJllaviee: ch k all t MNon-PmwuriwA- ~In-~(~tw---ill. Pnnirywd 1n.,pmu~ ~ 94in. aPnUMesoil MamW <20 in. Of=fMbie soil Holding Tank U OUW DispefMd Compaaeat (axp/aii) Armucataxw1)aY Y_ i er~ra11frroo dinar xnfenisition: S /o a Design Flow (Spil) Design 34i# Application spersal AwAs lltequireet ( t~ g ystem Devotion _lo d 7 if Vl. Tank info L'apsaily in Total # of Mmdtial (WINS Gallons [3nits Nate Tasks W"Ing Tmka Sepde nr 1#~dding Tact o7dd ~G,S'eY ~ sn/~ e nosing Chrmber ao 1 o~Sr° r Vll, Reapnslalb11111!z statemsent- I, the as8ere~aed, ammo lbtr bngpillo" t atitie povM M MM pttpe6ed pltmdrer's Name (Print) Pl 's Slgeiettu a N abet Snehrasa phone Nw dw PI 's AdtMew (Sorer, City, State, Zip Code) ~~~L~ S~r~ iP y' Gc~ t" G~~ v . Cab IDe " use Apt d tie Patmiilree note wwd t SillgabM Owner ()I o for Den~l B / /5• ~ Ix. C001111 , ffA ,pa a for DbsappaWAI ~ 3 D 1. Septic tank, effl(ilnt finer and I i ~ ~ ~ dispersal cell must all be services/ maintained t^ V; l~itO as per management plan provided by plumber. rJ C..et~ - 2. AM setback equirements must bs ma intapned C ia Go n . 5 8' Q- as v W* P to Ibesyeeena Mil iabaerk #a Comfy edy en a4K 0w a w caw p trsx to JIM S]ID-6398 (R. 01107) Valid thni 01/09 o-lv r Far~ve tc P a ~~3k B8 ~,Jc e 83 tau 1; 4 a k,E ~P~ ~--"ice 12..E 3Bal ,~~'as ~6 ~'.S 1~ ~3 x'!37 %6us.rf a f~"o7~ c-- 7 ~ma ToPryf ~,o~sl t ar u ,5'4-9 , 'tom L .1 c POWTS OWNER'S M, NPIA4 $t MANAGEMENT PLAN Page of FILE INFORMATIONS ~Sa MT 11M SPECIFICATIONS j aS Septic Tank Capacity ❑ NA l # / a S a Septic Tank Manufacturer ❑ NA EP DESIGN PARAMETERS Effluent Filter Manufacturer j_20_V,k,4,'&1r ❑ NA Number of Bedrooms 0 NA Effluent Filter Model. ❑ NA Number of Public Facility Units Q NA Pump Tank Capacity Q Z) al 17 NA Estimated flow (average) p, p a~/da Pump Tank Manufacturer P_ R. ❑ NA Design flow (peak), (Estimated x 1.5) Pump Manufacturer © v~.1 D NA ~n © ~I/da G C), Soil Application Rate 41/ a ;/W Pu)np Model - O NA Standard Influent/Effluent Quality Monthly average" Frstr*sltment Unit D NA Fats, Oil & Grease {FOG) ( 530 mg/L 0 Sen[f/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand ($ODs) 5220 mg/1 ( NA Q Mephanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mgll- q C)isl infection © Other: Pretreated Effluent Quality Monthly average i~iaperaal Cell(s) ❑ NA Biochemical Oxygen Demand (SOD j 530 mg/l, Q In4rpund igravity) ❑ in-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L NA p Atl()rade ❑ Mound Fecal Coliform (geometric mean) 510" cfu/100ml Q. Drlp.Line D Other: Maximum Effluent Particle Size Ys in dia. NA father:'' ❑ NA Other I NA Other; ❑ NA *Values typical for dornestic wastewater and septic tank effisdeht. Other: ❑ NA MAINTENANCE SCHEDULE Seirvice Event Service Frequency month(s) Inspect condition of tank(s) At least once every, (Maximum 3 years) NA ~ year(s) 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, C3 month(s) (Maximum 3 years) ❑ NA 13 year(s) Clean effluent filter At least once every: O month(s) 0 NA _ /o - I _tyear(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At leapt once ever ❑ month(s) ❑ NA y' ❑ 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 beck 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 elquals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servieillg 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 512 months, shall be Performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 1o days of completion of any service event. page of START UP AND OPERATION For new construction, prior to use of the POWTS alt( py ttpl t!11e11t tt ►41al f ly the presence of paintlnq products or other chemicals that may impede the treatment process and/or Bann p 1M If high concentrations.are detected have the contents of the tanklsi removed by a septage servicing opetai of pr~slr 400 System start up shall not occur when soil conditions 106 fr4ton ttho ~*Otive surface. During power outages pump tanks may fill above nr►rq{ h I1l1wR~lf ( itlo When power is restored theexcess wastewater will be discharged to the dispersal csll(s} in one large doalaa' Ciiiig) ) ;{ltd may result In the backup or surface discharge of effluent. To avoid this situation have the contents dot t~lflil~l .by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a PlumbefF ~(tdklslY 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 dispei~sl j1,;P I , ~ { t';f fir °park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-gradg ptler( Iell, Reduction or elimination of the following from the Wo tllW{a#tlr. A'ti`i(lliftl fR :Improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; r+M pt:q fyt 1 degreasers; dental floss: diapers; disinfectants; tat; foundation drain (sump pump) water; fruit and =#00 ase; herbicides; meat scraps; medications: oil; painting products; pesticides; sanitary napkins; ta};°►+#Mtli"iF'tine. ABANDONMENT When the POWTS fails and/or is permanently takers 0 t tt$ sler ri tlirlli Vt/Ing steps shall be taken to insure that the system is properly and safely abandoned in compliance with bt}t1~ItAl'kli TMtlt nsin Administrative Code: • All piping to tanks and pits shall be disconniti I ld ffllti P ilt#iA~VtfpM Q kiipe openings sealed. • The contents of all tanks and pits shall be r#ul 0,904 >tritl ~}p g rllr dEiypc pied of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be k AvE1~Ed a ltd ri rtsprrili~ pli 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 fcsllglAi>f1I)l) Ms~lvli blillian, or must be taken, to provide a code compliant replacement system: 13 A suitable replacement area has been 44 44. ! W . iMII~ for the location of a replacement soil absorption system. The replacement area should be Prl+si4{d fr►rhj¢fp pond compaction and should not be infringed upon by required setbacks from existing and prop a~jl ,MIJ)?ttsi't li,Iif ilj` wells. Failure to protect the replacement area will result in the need for a new soli and site eu41Mu: }i a iM h 4~ hoble replacement area. Replacement systems must comply with the rules in effect at that time. A suitable replacement area is not avai) lf. d u a to sa4~ t 00k 000jor soil limitations. Barring advances in POWTS technology a holding tank may be installed d# k ife r Ilrf iA( i the failed POWTS. .1~QG7 The site' as not en evaluated to identl i p It jP *14 t.area. Upon failure of the POWTS a soil and site 1V evaluation be performed to locate a 0it it no replacement area is available a holding tank may b alle s a last resort to replace tfiM11 ~4i C] Mound and at-grade soil absorption systewill .4100 a~ ltf 4~ in place following removal of the biomet at the infiltrative surface. Reconstructions of such :aV..o $ Ma`*at t~drmply v tith the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS M)p SES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT #TANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY 13E ~i~ ADDITIONAL COMMENTS POWTS INSTALLER TAiNER Name Phone 7 SEPTAGE SERVICING OPERATOR (PUMPER) LATORY AUTHORITY Name Nom; 5 . Gro~ G~.~. Zo Phase This document was drafted in compliance with chapter Comm a go(~:I~}t1l{k)~III) lend ~4,j!14(11). (2) at 431, Wisconsin Administrative Code. + PU P SEPTIC CHAMD TI ION AND SPECIFICATIONS SEPTIC TANK ~ .M WEATHERPROOF 4" Cl VENT PIPE 12" MIN. ABOVg PJAP~, 4 JUNCTION BOX APPROVED ? 25' FROM DOOR, WINDOW OR WITH CONDUIT MANHOLE COVER FRESH AIR INTAKE W/ PADLOCK & -WARNING LABEL FINISHED GRADE 4" CI RISE. ,ter 4" MIN. 18 IN. _ 6" MAX. INLET S. ~ WATER TIGHT SEALS TIGHT kPPROVED SEAL JOINTS WITH ALM APPROVED PIPE lIPE 3' PROVED i ON 3' ONTO SOLID SOIL INTO SOLID RISER EXIT ;OIL HUMP OFF ELEV. F'' OFD' PERMITTED ONV.. IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEAAIiia om T- ANK CONCRETE PAD SP O TI SEPTIC / DOSE DOSES PER DAY:41 _ TANK MANUFACTURER : TANK SIZES: SEPTIC 1 ~,~a Q GAL. AO Q FNI.~WBACKG GAL. DOSE GAL, ALARM MANUFACTURER: FACITTM A INCHES = y~GAL. MODEL, NUMBER: y - a 2 INCHES = q GAL, SWITCH TYPE: Tx--mA r, ~$GAL PUMP MANUFACTURER : ~ G INCHES MODEL NUMBER : pa D INCHES SWITCH TYPE: tf`n•e~~ REQUIRED DISCHARGE RATE q() GPM / Pl M-P & A RM WIRING AS PER ZLHR 16.23• WAI DIFFERENCE BETWEEN PUMP QTT A D TR NUTION PIPE 5 FFEET EET VERTICAL + MINIMUM NETWORK SUPPLY PRESSURE . • R • ' ' ' ' • ` FEET + _ FEET FORCEMAIN X ~,boF'~f~c~t? pR;C'~ION FACTOR FEET NAMIC HEAD a int~WgTH~-- INTERNAL DIMENSIONS OF PUMP TANK: LENGTH - DIAMETER DATE: E" SIGNED, ono HGOULDS PUMPS Submersible Effluent Pump EP04 3871 EP05 t APPLICATIONS • fully submerged in high ■ EP05 Impeller. Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine ail for tic enclosed design for heavy duty ball bearing lubrication and efficient improved performance. construction. following uses: heat transfer. • Effluent systems ■ Casing and Base: Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING superior strength and corrosion • Farms manual operation. Auto- 41' Canadian standards Asso&Am • Heavy duty sump matic models include resistance. • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "F" or "C".) factory. strength, and durability. SPECIFICATIONS ■ Motor Cover. Thermoplastic Goulds Pumps is ISO 9001 Registered. FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. 1/4" maximum. ■ EP04 Impeller: Thermoplas- Ill Power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi-open design with rated oil and water resistant. • Total heads: up to 31 feet pump out vanes for mechanical • Discharge size: 11/2' NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104OF (40cC) continuous r.._...._._~ METERS FEET 1401F (60cC) intermittent. 10 s I • Fasteners: 300 series stainless steel. _40-z.f-5GPM _ • . • Capable of running 9 30 dry without damage to 8- components. _ a__..... _ 25 € Motor. i u 6 20'.._..._.. • EP04 Single phase: 0.4 HP, -r 115 or 230 V, 60 Hz, 1550 a RPM, built in overload with o 5 15' automatic reset. a 4 i . _ EPOS • EP05 Single phase: 0.5 HP, 5 115 V, 60 Hz, 1550 RPM, 3 1 o . ......__.A built in overload with EPOa . automatic reset. 2 • Power cord: 10 foot 5 t. standard length, 16/3 1 SJTOW with three prong grounding plug. Optional 20 0 00 10 20 30 40 50 GPM foot length, 16/3 SJTW with , three prong grounding plug o L -L z a e a 10 1 z m)/h (standard on EP05). CAPACITY Goulds Pumps ® 2000 Goulds Pumps ITT Industries Effective February, 2000 83871