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HomeMy WebLinkAbout020-1481-05-000 . Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St Safety and Building Division Sanitary Permit No: INSPECTION REPORT 556373 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: Olson, Mark J & Jamie Hudson, Town of 020-1481-05-000 CST BM Elev: Insp. BM Elev: BM Description: Sectionrrown/Range/Map No: /00 tot. I 07.29.19.3054 TANK INFORMATION ELEVATION DATA TYPE MANUF T~ CAPACITY STATION BS HI FS ELEV. Septic 4P 6 ' 2 Benchmar nl^ /cU/ 6 -7 iv, Dosing n I O r s ~,o Alt. M W-d khz e 9 g 3 (~yV~ Io t -W Aeration Bldg. Sewer K 437 4 ~q3 Holding Ht Inl 6) k TjL• go. 7 Z 6 / :St/ )qt Outlet <"c TANK SETBACK INFORMATION TANK TO ~P/L~ WELL BLD Vent to Air Intake ROAD Dt Inlet rcle r~'vl Septic 2 I ' ~y,~yus Dt Bottom 9 ' G Dosing 1' Z S / Header/ an. Aeration V VV/V' , Dist. Pipe ' t U Y~ I 1/t~ 1r" 3 Holding Bot. yste Q~, ' 7'~_, s3 Final Grade. f .~~af 'p4tj o s S 5 PUMP/SIPHON INFORMATION Manufacturer Demand St Cover- 6, GPM _V r[~♦' 31 l 3 Model Number ( •cl . q TDH Lif Fricti `moss SystVergrri end :1611 U Ft j Forcemain Len / Dia^ I~ 1st. to W II SOIL ABSORPTION SYSTEM a 6`7, 3 if A4 6 BED/TRENCH Width / Length 2 1 No. Of Trenches PIT DIMENSIONS No. Of it Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WE LAKE/STREAM LEACHING a INFORMATION CHAMBER O M clayey ' /z , Typ Of System: 04 47.' 20 1 Model Number: BUTTON SYSTEM 41e Lt AAA6_4111 - Z ~-3 Head anifold Distribution Ix Ho Size x Hole Spacing Vent to Air Intake I I. I _ f ' Pipe(s) 01^ Lekth ~P Dia t/,/_ Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx SeededlSodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes tr No M Yes n ]No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:-/ Inspection #2: Location: 1046 Autumn Oak Lane Hudson, WI 54016 (SE 1/4 SW 1/4 7 T29N R1 9W) Whispe jng Oa s Lot3 Parcel No: 07.29.19.3.054 1.) Alt BM Description = I d ~y~ ~IO / 2.) Bldg sewer length = $ ' ~t 'I 6 y~ y~V, ~f G lh6Q } r / amount of cover I N D'~ Gltw~S ~f-,✓V cYA~ _a'd ~4ke* to/ Plan revision Required? ❑ Yes No Use other side for additional information. Date Insepctor s S gnature Cert. No: SBD-6710 (R.3/97) PLOT PLAN PROJECT Mark Olson ADDRESS 13 Meadow Lark Lane Hudson Wi 54016 SE 1/4 SW 1/4S 7 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/25/12 BEDROOM 4 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE •5 ABSORPTION AREA 1230 # of chambers 60 BENCHMARK V.R.P. Top of 1/2 " pipe ASSUME ELEVATION 1001 Filter BEAR Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 9/4.4/94.3/94.2' 7' below qrade All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. Vent ~6„ Quick4 Standard Scale 1s 1" = 40' of Cover Leaching Chamber with 20.0 ft2 of Area unless otherwise 12„ 10.2ft^2/pair of end caps noted 4' Long Grade at System Elevation h1 n 34" e rive ~Q Well is to meet all Scale is 1 = 40' setbacks required byg B-2 r WDNR 2-3 X 82 cells wit _ s Yif Z~ unless otherwise v noted 2% Sl e 0' -3 146' 309 ~i ro m J 09 0' Area of poor soils 0' Lo-~~ 0 2 Huffc 3 3' Pr erty Line Mok commercEt'~•~o~~r Safety and Buildings Division County ■ t 201 W . Washington Ave.- P.0. Box 7162 ( sc0n Madison, WI 53707-7 62 smliMry Pernale -11 49 (w nv rnva in by Co.) flepartrrterlt of CO - 55~ -373 Sanit I1'y Pe~p~ieation ate I'ransa«ion Number In accordance with s. Comm. 83.21(2), W',.- elm--eode, submission of this form to the a ro riate 9ove \ unit is required prior to obtaining permit. Note; Application Pp p g ftnentai ~tit!"~ary lication forms for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary It es in accordance with the Privacy Law, s. 15.04(1 2(m), Stats. 1. A lication Information - Please Print All Informatio j 1-R-1 Property Owner's Name r- q, 1-R-1 Pareel 4 a T Oo?O ~d - S- Property Owner's Mailing Address Property Location ~3 c« 305 Govt. Lot ~ City, state Zip Code Phone Number 7 '/a,.jCc/ '/a, Section ~le o 11. pe of Building (check all that apply L T N> R E r w or 2 Family Dwelling - Number of Bedroo Subdivision Name ok ❑ Public/Conunercial - Describe Use ❑ City of _ „ ❑ State Owned - Describe Use CSM Number ❑ Village of ,3P i n4- C,.d`. o w I ,Zb own of In. Type o ermit: (Check a ly one box on line A. Complete line B if applicable) A ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal 11 Permit Revision El Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner iV. a of POWTS System/Component/Device: Check all that apply) ' 5 on-Pressurized In-Ground ❑ Pressurized lu-Ground ❑ At-Grade ❑ Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil plan, Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis rsal/Treat nt Area Information: Desi Flow (gpd) Design Soil Application (gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) system Ele n (~2 00 ~ I 1112- 3-0. G VL Tank Info Capacity in Total # of Manufacturer B a Gallons Gallons Units ~ o New Tanks Existing Tanks w a, COO y w C7 G (Septic or Holding Tank -6osing Chamber Yl- (VII. Responsibility Statement- I, the undersigned, assume sibility for installation of the POWTS shown on the attached pleas. ?lumber's N 7e (Print) Plumber' re MP/MPRS Number Business Phone Nu ber 'lumber's Address (Street, City, tate, Zip Code) J 4-1 ~ViEL OURt /De artment Use Only proved app Permit Fee Date Issued Issuing t Signature $ ~ 7S • °p /d Z 5 /L ❑ O en Reason o ial '54 ~ r e M Condi • m easons for Disapproval Al R.J- a+C 5eptit tank, effluent filter and t' dispersal cell must all be servkes 7 maintained C44 Akeuj-" r as per management plan provided by plumber. 2. AllsedAck ttiaquifements must be. maintained Attach to complete plans for the system and submit to the County only on proper not less than s 1/2 x I I inches in six `.I BD-6398 (R- 02/09) Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 10/25/12 Owner: Mark Olson Location: SE1/4 SW1/4 S7 T29 N,R19W 1046 Autumn Oak Lane Hudson System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Pressure Distribution Manual (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet 8. Dose Tank Cross Section 9. Pump Curve Signature License number #2 900 PLOT PLAN PROJECT Mark Olson ADDRESS 13 Meadow Lark Lane Hudson Wi 54016 SE 1/4 SW 1/4S 7 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/25/12 BEDROOM 4 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1230 # of chambers 60 BENCHMARK V.R.P. Top of 1/2 " pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 9/4.4/94.3/94.2' 7' below qrade All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. Vent >6" Quick4 Standard Scale is F = 40' of Cover Leaching Chamber with 20.0 ft2 of Area unless otherwise 12~ 10.2ft^2/pair of end caps noted 4' Long Grade at System Elevation 34" Amber Ridge Drive Well is to meet all Scale is 1" = 40' setbacks required by WDNR 2-3' X 82' cells with >3'spacing B-2 unless otherwise noted 2% Slope p 100' B-3 146' 30' Pro 4 -1 Bedroom Vents House 20, 50' Area of poor soils 40' 10' 20' Huffcutt Combo Tank 313' Property Line Cross Section of Quick 4 Standard Leaching Chamber Typical cross section for 2 of 3 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 10.1ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 101.6 Vent ACI Grade Vent 4' 4" 4' X30/34 Septic Tank 4' Long 1 19 5' 4' Long 1 9~ Grade at System Elevation 3 4" Grade at System Elevation 3497 Spacing 5' 3-3' X 82' Cells Observation tubeNent Same on other end To be located on end of Cells A B System elevations: C A_94.4 B94.3 20 chambers per cell C__94.2 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE:: INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity al ❑ PIA Pe mit # Septic Tank Manufacturer ❑ NA ^ El NA Effluent Filter Manufacturer DESIGN PARAMETERS ❑ NA Number of Bedrooms 11 NA Effluent Filter Model ~ ❑ NA Number of Public Facility Units A Pump Tank Capacity al Estimated flow (average) Pump Tank Manufacturer ~ ❑ NA p Manufacturer ❑ NA Pum Design flow (peak), (Estimated x 1.5) .2 ~J ttallda da Pump Model ❑ NA Soil Application Rate al/da /ftz St.rndard Influent/Effluent Quality Monthly average" Pretreatment Unit Fats, Oil & Grease ,FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (i3ODe) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg1L ❑ Disinfection ❑ Other: Monthly averse Dispersal Cell(s) ❑ NA Pretreated Effluent Quality y g ❑ In-Ground (pressurized) -Ground (gravity) Biochemical Oxygen Demand (ig/L Total Suspended Solids A ❑ At-Grade ❑ Mound F ecal Coliform (geometric mean) 510cfu/100ml ❑ Drip-Line ❑ Other: Other: ❑ NA Maximum Effluent Particle Size in dia. ❑ NA Ol her: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Service Frequency Event ~ ❑ month(s) Inspect condition of tank(s) At least once every: ears (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third ('f3) of tank volume ❑ NA month(s) {Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every: year(s) ❑ month(s) ❑ NA Clean effluent filter At least once every: ❑ month{s) 11 NA ❑ month(s) NA inspect pump, pump controls & alar4AAtt'lleasstt t once every: ear(s) F lush laterals and pressure test t once every: ❑ year(s) ❑ month(s) NA Other: once every: ❑ ear(s) NA Other: certi f0owi the MAINTENANCE INSTRUCTIONS dual carrying o Master Inspections tanks and Restricted Sewer; POWTS Inspector; PO'WTS MaintalnernSept ge ServicinglOpe ator, Tankinspectio s must , measure cracks ify any Plumber, Master Plum to id broken missing lume include a visual inspection of tnd to heck forean~y back up or pondi g of effluuenttron thetgrou d surface or IThesdispersal ell(s)oshall be grou combined sludge and scum a of effluen surface visually inspected to check effluent the surface the failing co dit on and requi esn hfegimm d atet otifcat on of the local indicate a pipes The ponding of f effluent on th th ground regulatory authority. more tank volume, ontents of When the combined accumulation of sludge dispos ddof no acco dancee with chapter tNRe1t13, cWiscons in ServicingnOany peratolr and equals the tank shall be removed by a Septg Administrative Code. All other services, including but no limited t he servicing of effluent aeltersd PO ani Mainta ssurized components, pretreatment units, and any servicing at intervals of 51 months, shall be performed A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. WIN I t., .,,r-:.. . LTE CARTIRIDGE INSTRUCTIONS Installation STrp x pry lit the twer case onto the and of the outlet pipe to ensure it is centered under the access opening. If not, then elther insert more pipe into the tank through the outlet or solvent weld (glue) additional pipe onto the outlet pipe. a,'EE a While the case is still dry fitted on the outlet pipe, measure the length of "A-inch pipe needed to brace the filter to the tank end wall if utilizing the optional supplemental side support, If side support method. Is not utilized, proceed to step four. s•ra.P a For installations ttifizing the optional supplemental side support: solvent weld the 'A-inch pipe onto the filter case. If side support method is not utilized, proceed to step four. Solvent weld the filter case onto the outlet pipe. Insert the Aker SY:c>? ifir cartridge into the rase, pressiml down until the filter locks into the bottom of ~a••.`•:'i the case. a" If a AS switch is utik,xd: insert into the filter and luck by turnirt ginn~ tit Clockwise 900. Maintenance The effluent filter should be cleaned every time the septic tank Is serviced. 2. Open the outlet access opening to inspect the tank and filter, s. Pump the septic tank conipicttely, making sure to remave the sludge layer on the bottom of the Unk and not just the scum and effluent, 4. Once the effluent level has been lowered below the invert of the outlet pipe, firmly pull up on the filter handle to dislodge the cartridge from the case. 5. Slide the cartridge up and of it of the case for cleaning. d A 4 6, it a VAS switch connected to an alarm is present, the switch should be removed by turnir+g counterclockwise 909 and cleaned r- with water only. 7. While holding the cartridge nn its side (large fiat surface facing A down) over the access opening, rinse off the cartridge with water' # ` only, making sure all septaglr notarial Is rinsed back into the tank. 'Y ' a. If VRS switch is utilized, replace by inserting into filter and _ turning clockwise 90°. 3 d fir{ ,r•" . 9. Insert the filter cartridge back into the case, pressing down until the filter locks into the battorn of the case. Io.Replace and secure the access opening on the tank. t:• 6tlv~.+" 1'$% rxrST, , UrQi -'v r,r : S+ct' C.r~ :.v:+A?rra ~r", www.beamnsiltexom 877-1► VILTEAS [653-4583) /2 -yz Septic-Dose Tank Cross Section And Pump Performance Specifications f Tank Manufacturer Pump Manufacturer Tank Model Number I D- 5-u Pump Model Number Lj 3 Total Tank Capacity Alarm Manufacturer Max. Bury Depth Alarm Model Number r- L/ Switch Type rn e AL.- r Filter Manufacturer 1= Zr Total Dynamic Head (T DH) - Feet Filter Model Number Elevation Head D Distal Pressure Network Loss Minimum Pump Performance Requir!Ft Force Main Loss 2 v GPM @ TD H f Total D Outlet Manhole Min. 4" Above Grade With Locking Device. Inlet Manhole Manhole Min. 4" Above Grade < 6" Below Grade Sealed Watertight Securely Mounted With Locking Device © Weather-proof l Finished Grade Junction Box o Depth of ~ Cover Vent Min. 12" Above Grade Disconnect Ft With Vent Cap Means y;7 SySySytyi}S}SAS S7t S't t?S'S it S i'i iitYS}S'SyS S { S S { } } SFS 7S Outlet Filter Outlet Inlet >s> Inlet Baffle {Pt 77 { { - - ,t7 {s{ 7 7`? Syi iS tt A i } P Switch Settings and Reserve Capacity %a" -..-Tank Volume = bty GPI . } t Weep 7{7 Dimension Inches Volume Gal. { { B t Hole ?i? (reserve) A S t X (alarm) B 2 ? Off Ele ion C ` 7 S. Ft ` (dose) C /Z yt 7 7 { i ?t r{~ (dead) D Bottom / tt D } Elevation Total y 2 } } t' i t Ft y°} } } } 7 } f } A } a } } Y > } } Y Y } } P 7 P } } } } }f { S { S S i S i '-1" 01 r S >i>i>iliPi}S7i>tyt}{y{}°yty iyiyiyiy{ytytyi,~,i>;>i}iytyty t>tbtyi>SYt>t>t>t>{Yi>t>iAt>{y{y{?{}{}~7{>{s{>i>i7 t>'>i}iai GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 WAC. 02/05 LJ Page of W HEAD CAPACITY CURVE TOTAL DYNIAMIC HEAD/CAPACITY MODELS 53/55/57/59 PER MINUTE EFFLUENT AND DEWATERING •25 Model 53/55/57/59 6 20 w Ft. Meters 001. Ltrs. 15 - 5 1.5 43 63 z 4 10 3.34 29 10 15 4.6 19 72 Strut-off Head 19.25 ft. (5.9rr) I 2 - 5 ,4 ~ ~3 15/16--6 5/32- ( I ( - 1 4 5/8 6 0- 1 1 1/2 '/2 NPT _U.S. GALLONS 10 30 40 50 LITERS p 80 160 3 15/6 FLOW PER MINUTE coeae~ } 4 1/16 "'ACT Ay ~ Variable level float switches available. Variable level long cycle systems available. - Ewailable with special cord lengths of 15', 25', 35' and 501 . N ~►larm systems available. Duplex systems available. 10 1/16 _ 3 3/32 ~ SK858 Single Seal Control Selection Listings 5EL . i it's7vr zUtOC Model Volts Phase Mode Amps Simplex Duplex CSA UL 1. Integral float operated mechanical switch, no external control r quired. N1055 & M57/59 115 1 Auto 9.7 1 Y Y 2. Single level float switch or double plggybar.k variable level N 5-3w&-Ts 59 116, 1 Non 9.7 2 3 or 4& 5 y y piggyback-variable 453 115 1 Auto 9.7 Y Y float switch. Refer to FMO477. rE 457 115 1 Auto 87 N Y 3. Mechanical alternator "M-Pak" 10-0072 or 10.0075. ,_53/57 230 1 Auto 4.8 Y Y 4, See FM0712 for correct model of Electrical Altemator. 13/55 & 057159 230 i Auto 4.8 1 Y Y 5. Variable level control switch 10.0225 used as a control activator, with Electrical 3/55 & E57159 230 1 Non 4.8 2 3 or 4 & 5 Y Y Alternator (3) or (4) float system. Sinc Is piggyback switch included. a caunow For ini xrnation on additional Zoeller products reforto catalog on Piggyback Variable Level Float Switches, FMO477; c7~ c,Yals z r. tc uV;ca a rWIT')g `5,WOC t,y Sectri,al Alternator, FM0486; Mechanical Alternator, FMO495; Sump/Sewage Basins, FM0487;andSingle Phase ! : a f : Al ettcmca: t~aarety c.+.essraul<.~,~;ioneC ding;r m ,,1 Simply x Pump ConlroVAlarm Systems, FMO732. fac E~:&crnc Cade ts'aFt;`; and thE 4iC;;L;pa6c1'1at ;-^,iecy f:nd " ^ ac; (DSHA;. RESERVE P0 WItPED D y 4' For unusual' conditions a reserve safety factor is engineered into the design of every Zoeller pump, MAIL TO. P.O. i30X'-`A"7 Lovisvige, KY n Manufacturersof.. ~ - SHIP TO: 3649 Cane Run Road LoursviUe, KY 40211-1961 u My p:/1www.zoeUer com A/Mff !O. (502) 778.2731.1(800) 828-PUMP 4L/TY PUd/P6 SNCE FAX (502) 774-3624 0 Copyright 2002 Zoeller Co. All rights reserved. - - Page of _,,,r _ START UP AND OPERATION For new constructlon, prior to use of the PO S' check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or d mage the dispersal cell(s). If high concentrations fire detected have the contents of the tank(s) removed by a Septage servicing ope or 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 ne 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 prop(Ay and safely abandoned in compliance with chapter Comm 133.33, 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 filed with soil, gravel or another Inert solid material, CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A w-k-ble replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systfsm. 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 fines and wells. Failure to protect the replacement area will result in the rxied for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the ruleab In effect at that time. Ll 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 rernovai of the biomat at the infiltra1ve surface. Reconstructions of such systems must comply with the rules In effect at that time. °t<WARNING~-y 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 DIFFICI,ILT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name=~ Name ~ ~ Phone 1-' 7 ;:iEPTAGE SERVICING OPERATOR PU ER LOCAL. REGULATORY AUTFIORlT r.~.. (Name Name o` Phone Phone / Zt7 '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. i ST. CROIX COUNTY f SEPTIC TANK MAINTENANCE AGREEMENT ' AND • OWNERSHIP CERTIFICATION FORM Owner/Buyer m o, Y 0 h Mailing Address t~1il 2C~ CS w lG ✓ _fn 90v\, • S ~4 1 Property Address (C) q to fk-v yr ivy ©G ~'l IAO (Verification required from Planning Department for new construction.) City/State j--v 3'& UV\ UJ / Parcel Identification Number L 0 S pry U LEGAL DPSC MC. N S u Property Location .Sw W, N~ ' T a°1 NR / Town of g-Aj _~5 ! /s , Sea Subdivision \kL b j't ✓l. © C' ((_S Lot # S , Certified Survey Map # , Volume . Page # Warranty Deed Volume Page Spec house yes no'' Lot lines identifiable (_7__)n0 S'Y§TEM MAINTENANgE _ Improper use and maintenance of your septic system could result in its premature failure to handle writ Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner ma' tenance responsibilities are specified in § Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Zoning Department a certification form, sign by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site- 1 ewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is i s than 113 full of sludge. Uwe, the undersigned have read the above rcquirements and agree to maintain the private sewage dispo l system with the standards set fo erein, as not by the Department of Comm and the Department of Natural Resources, Stat of Wisconsin. Certificati that your septic system has been maintained must be completed and mtumed to the St. Croix County Zoning Do t 30 of three year expiration date. l0 I?i~_ GNA OF APP ANT DATE Uwe all stet on this form are true to the best of my/our knowledge. Uwe am/sre the o er(s) of the property o v' a warranty deed recorded in Register of Deeds Office to 12 SI NATtIRB OF APPLICANT DATE sssss♦ Any information that is misseptesented may result in the sanitary permit being revoked by the Zoning Plepartramt. Include with this applieadotu a stamped warranty dead from the Register of Deeds Office and a copy of the certifi d survey map if reference is made in the warranty deed. N02`57408T 185-70' .139 a 32$ } b ~o- 0 0 0 1 1 rt r_ ~ ~ c1l) (X) k 0 Cl) U) cn { s .1 03 1 co CO CD V'z . . 147.65' EAST LINE ^Q~bA ^ ~ N 0. OA ~W~rIaQQ 0 a _N OZ yUul 0 . 4 v 'o N MQaWw IL W0 0 U Q o x h~OC -,W o w z 03 b ~t 0 z ~ 01 ..~o WN u mHuO xWZ oz a w 0 X: c o,; y WNW o° 0 v o. c^ c Ezoc~ cv Nor 0 c Q L. uc 3 0 0 z z wv3 av z °c~ 3E Q ~~a 4. c c Q 0E}- 0 U~0 a0ia cq C~ 0 ~ 02 m ~Z Eu .0 0 a ~FU~ t~ u'0 0 C u 0~0 to n 0 ° EG°o~ am a~ 3U _E c x ro c 3 a Z~N0 ago 0~ oa,o=c a~nEo v C bAv T wcL y 0~x F La ~r z N =0 v Cro QU acaEL u~uN 0 0 3 o = ~w v3 a N ~z~ 9 3 NQ 00 ro3 AiI 0 \ cn W o f 0 z a 311v~~, E m~ Vl •p a. ~ 0 .II bA ~ ~ 4 z V3r ox bJ 0 Lv~ c 0 e 7 v° u U z u c Oro N N bA= c U) Q 0 ro V) c L-L 9 0 Q to >c 3 v3 m 0 3 00 ct 00 da Q Q i a"U u a s Gl Q 9 T R7 fC C a+ ^ C =0 's 0.x 0 `s - m a W a b 0 U N ~ F u X O s Q Zro0.roU 0 to ~0 N r u 4 o 0 0 CA U ~ n ca z m 3 Z ~ r w u C 0 0 ro v 0 y W w o 3c>u= U) JCL m x u O c a C fl y 1 w C Q Vl O o E a c 0 m Z 0 F - Q= L > m- m cl u 0 U \ u Q yr 2 C c C E F= c v oD _ m 'C i - C 0 _ C N m W .0 s m Q N 0~ c c 4rov.. a~ to z v v T o ^ Wu r 40 -n 3 ~ w n-0 4 u m N x .0 L: 6'a cd ' b ~ _ 3 ~ C ~ R ~ 0 0 u c r Ul= 0 0~ a E G 5 cz - u 0 ko = u 0 '0 = N -1 ti r sro~~N a m 3 m to ~'t7ba U~ 0 z * s F ~z cc 4 PAID Wisconsin Department of Commerce SOIL EVALUATION REPORT Page-t- of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code minty 'S 4. 74, Attach complete site plan on paper not less than 8 112 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. Please print all information. view W-f _ Date Personal information you provide may be used for secondary purposes (Privacy Low, s. 15.04 (1) (m)). V d Property Owner ~ Property Location /11/60 ~ i; M ovt. Lots 1145j(j114 S T2,9 N R E (o i property Owner's Mailing Address of # Block # Subd. Name or CSM# 52-3 115 1 ' r(n 4. City tale Zip Code Ph u N City Villag T Barest oad ` ( ) ^j~plX COUNTY Ft E Al New Construction Use.~Mesidential ! Doers w Code derived design flow rate a~ D GPD Y~ ❑ Replacement ❑ Publi or commercial - Des Parent material ~&2u-144-4 Flood Plain elevation if applicable /✓l ft. General comments and recommendations: System Type 112~,-Sww3'1-~ _ System Elevation Boring # °ring '5K / . Pit Ground surface elev. ft. Depth to limiting factor Id- gin. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Z a 3 -3 Aik5-w L71114 06 t Boring # Boring / / Pit Ground surface elev: UC 2, (fit. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAF In. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 dy- Z ~'oZ7 obi Grp 3 G a. • Effluent #1 = GOD > 30 1220 mg1L and TSS >30:S 1 ' Effluent #2 = BOO 30 mg/L and TSS 130 mg/L CST Name (Please Print) nature CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 X IF --/v 715-246-4516 Page of Property owner _ Parcel ID # Boring # Boring n. Ground surface elev. V l ft. Depth to limiting factor Soil Application Rate © Pit Roots GPD/k Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary •Eff#1 •Eff#2 in. Munsell Qu. Sz. Cont. Color Cs 3d- 71 r ~ ❑ ❑ Boring # Boring surface elev. ft. Depth to limiting factor in Soil Application Rate ❑ Pit Ground surface GPD/fF Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary •Eff#1 'Etf#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ❑ Boring in. E] Boring # Ground surface elev. ft. Depth to limiting factor Soil in. Rate ❑ Pit Roots GPDM Horizon 'lepth Dominant Color Redox D~aipti on. Texture Structure Consistence Boundary •Eff#1 -Eff#2 in. Munsell Qu. Sz. Cont. Cola' Gr. Sz. Sh. > 30 < 220 rnand TSS >30 1150 mg/L ' Effluent #2 = BOD, < 30 nvk and TSS 30 m91L Effluent #1 =BODY _gft. nity The Department of Commerce as an ~ format, lea Scontac pure department at 08-2 66-3 151 or TTY 608-264-8777. need material in a sao-8330(RA o) t. % Soil Test Plot Pla Project Name NWP Holdings S Bir Address 573 Cty Rd A Hudson Wi 54016 TM #226900 Lot 5 Subdivision Whispering Oaks Da 10118/10 SE 1/4 S W 1/4S 7 T24 N/R19 W Township Hudson ❑ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1/2" pvc pipe System Elevation TBD *HRPSameasBenchmark Amber Ridge Drive Scale is 1" = 40' 101' B-2 unless otherwise 101.5 noted 2% Slope 100' B-3 146, 30' 1L 30' -1 20' 50' B.M.* Area of poor soils 10' 313' Property Line Parcel 020-1481-05-000 08/24/2012 09:39 AM PAGE 1 OF 1 Alt. Parcel 07.29.19.3054 020 - TOWN OF HUDSON Current O ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 11/08/2011 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner 0 - OLSON, MARK J & JAMIE A MARK J & JAMIE A OLSON 811 SUMMIT AVE N HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1046 AUTUMN OAK LN SC 2611 SCH DIST OF HUDSON SP 1700 WITC Legal Description: Acres: 1.040 Plat: 11-039-WHISPERING OAKS 020-011 SEC 07 T29N R19W PT SE SW & PT NE SW Block/Condo Bldg: LOT 05 WHISPERING OAKS LOT 5 (1.04 AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-29N-19W SE SW 07-29N-19W NE SW Notes: Parcel History: NEW FOR 2012. RETIRED 020-1002-50-055 TO Date Doc # Vol/Page Type CREATE 8 LOTS & 2 OUTLOTS FOR WHISPERING 03/22/2012 952988 COVNTS OAKS SUBDIVISION. 03/07/2012 952075 WD 11/08/2011 945347 AGREE 11/08/2011 945346 11/039 PLAT more... 2012 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/18/2012 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.040 30,600 0 30,600 NO 05 Totals for 2012: General Property 1.040 30,600 0 30,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00