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HomeMy WebLinkAbout040-1019-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 561064 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: Nelson, Gregory R. Troy, Town of 040-1019-30-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: d(~ ~~'Yl C' 04.28.19.63G TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ` CAPACITY STATION BS HI FS ELEV Septic Benchmark Bee ^4111 a d Alt. BM ✓ 3 /J Q Aer ion Q ~ I Bldg. Sewer (See,- 40'H% Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht/ utlet S "i 4d , z TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Bt-irtfet Septic 30 #9 At M z4 A)4- Dl Bvt~r 77,-5 8A61tl~. / / Header/Man. 33 30 Nq S.9 ~QiT 8D'r5 no ('03 Aeration o(` Dist. Pipe YS• ZS S'r9' . Holding Bot. System 9.41 7• it io . 14 H 12 Final Grade PUMP/SIPHON INFORMATION 9Z• G Manufacturer Demand St Cover GPM G.3/ q3p~ 5, p Model N er TDH Friction Loss System He TDH t Forcemain Dist. to Well SOIL ABSORPTION SYSTEM 'r 1% BEDITRENCH Width Length2 No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 /rG~t4 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Man a~tyre~r: A I INFORMATION CHAMBER OR F' I C~.1~ CJG Tyf Systerp: UNIT Mo 1 Num r: nl~ I /WG I O ,7~ / J~ T q r rL DISTRIBUTION SYSTEM 1+11 /S/[ew ~p Header/Manifold fF-I p/ Distribution x Hole Size x Hole Spacing Vent to Air Intake p to Pipe(s) ` N Length pia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 5 Bed/Trench Edges Topsoil XYes ❑ No Yes f No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 517 Old Hwy 35 S Hudson, WI 54016 (SW 1/4 SE 1/4 4/T►28N R1 9W) metes & bounds Lot Parcel No: 04.28.19.63G 1.) Alt BM Description = IFi Gay, we3aC, cL{Dae 2. Bldg sewer length = ' t r L~ - amount of cover = / f .15 Plan revision Required? ❑ Yes No Use other side for additional informs ion. Date In ;ctor's nature Cert No. SBD-6710 (R.3/97) !~,qnc 34 R-: 4-6 e.ci 33 4-4 63 (j ek- IJ a-Q- 4, (p CJs 6.3 6Q ,d-m~ J PL, e /b • 3 _ ( 4- 160 ~L ` C) i 7L 60Y tw C-S ~c co) S'i f c 0 0 0 fD ~ 1 j c n 3 m~ n 3 " 1 O 0 d O O N O ° m O d N O O m A • Q ~C 11 CD O a a m p a 3 N p0p~~ 0 co W O A C m m m -2 p N 0 m 10 = N A 7 1 O ■w, p~ m D 7 m C 7 O f0 O 0 o j a 3 3 3 00 m l :3 N rn w w -0 ID to ~p toi ~G) ° O N `z 7 'z O O m co ;u CD cn D y a a w l ~n a 0 J w rn 2 O W O c a _ O O a a O O a N N 3 CD O 2 O t\n 2 v O O O O Z W ! j 0 W O co V N O Z1 n r (a 0 o to m w Cl) 30 Q Z C CL 0. i "a "a T OOO' OOO0 - - - 3 :3 -D ~ 3 fncnN~I a~ NNN~' m `~~1 O Q O cn o• O b 0 m m N e•r m en m N A U! ~1 'O O m Y1 .0 O j QO C - d m O O O O 0 3 m (D m C CL I D D o D 0 O - O O H • m m m o m CD N N N N m C p N c c c m Cl) I - N <O N OIQ C C x m m 3 3 ° CD c6 m o U) ua A Z C m N C ql CO) e0i CL N a A Z O CL Q N N A CD N A m ao CL 3 a A z 3 I B i m p N Z N \ m m A O A y n>m o co y-0 N< y am N m n y CLM CO < 7 7~ C y 0 a M a "O y 0 a m oc 2 a-CD 3 m a vm0 m30 ~oocr: c o o j m c o d C m c m o- O O 7 = "a =r z 7 E; N d j N O~ O N O C N _ m j _ .0 ID -O ck N N y 0 7 (m/l ! 013 :E m CD OD D (p CD Fl C'D 0 0. :3 CL In CL 8z6@ 6m N N A d m a fi O O0' O lD D0 CL O HMO < y ID C m N A O CL -a m 0 p) 3 m o O m N d C (D C C Q m CL 0 n a m ?3 c cr CL N< 0 Wo 7 d ~ 7 0 7 D 0 m m m ! E O N _x = v ~ C a a O O O O O N N N p CN b ti C 7 A CD ! m Oro A Efl O 69 O co ° f ! a 0 CD 0 L ! O L ,3' PLOT PLAN PROJECT Grea Nelson ADDRESS 517 Old Hiahwav 35 Hudson Wi 54016 SW 1/4 SE 1/4S 4 /T 2 N/R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 4/30/13 BEDROOM 4 CONVENTIONAL XXX IN-G, UND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/280 gall k1fT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE ! ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Bottom of 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 89.0/88.4' F below qrade of tank, piping shall be Schedule 40. Scale is 1" = 40' Property Line unless otherwise Well is to meet all elil~ted v setbacks required by ALo Quick4 Standard WDNR » ' Leaching Chamber Scale is 1 = 40 with 20.0 ft2 of Area unless otherwise 5.6ft^2/pair of end caps noted 34" Grade at System Elevation Well (under deck) O 150' Existing 4 Aje"~ Bedroom 2-3' X 88' Cells with >3' spacing House B-1 B.M. 100' 90' 20' 400' 1 20' 49 5, 90' AC 94 'VF- B-2 15' ST Vents 92' ° 60' Huffcutt 280 ST 0° haS a B-3 PS 3 3, 90' 7% Slope Old Dryweil is~o be D W - f VS), 6" pum e and ied ~jr a o 'ng to ill b O done a a valve insta d ossible Vent To Old Highway 35 Property Line ZIA, C IAft fro County fr Safety and Buildings Division . b v 0 S R ;r 201 W. Waadss ington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) $a TA o V! ' r u>rr a AL Sanitary Permit Application State Transa(ctioJnNumber In accordance with SPS 3$3.21(2), Wis. Adm. Code, submission of this form to the approp 0Qvemmental unit 'v is required prior to obtaining a sanitary permit. Note: Application forms for state-owned ctrl S are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information y*t wvPBe may be used for secondary oses in accordance with the Privacy Law, s. 15.04(1 (m , Stats. 1. Application Information -Please Print All Information Property Owner's N7e Parcel Property Owner's Mailing ess Property Location - i I t 3 S- Govt. Lot 3 City, S to Zi Code P Phone Number C.t _ ~ ~~a, Section 1 ~j /(circle IL Type of Building (check all that apply) Lot # T Z N; R or r 2 Family Dwelling - Number of Bedrooms Subdivision Name Block # ^ ❑ Public/Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of X,.n of f7'~ III. Type of Permit: (Check one ox on to Complete line B if applicable) C/ A. El New System lacement System Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) g• ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner )IV. Type of POWTS S stem/Component/Device: Check all that apply) on-Pressurized In-Ground ❑ Pressurized In-Ground At-Grade oun > 2 in. of sui le sg i El Mound < 24 M'. .Of suitab a iI Z Holding Tank El Other Dispersal Component (expla Pretr ent Devi exp ain) 2 V. Dispersal/Treatment Area Informa on: Design Flow (gpd) Design Soil Appli orl/Rategp persal Area Require s~ Dispersal Area opo~ed (sf) System Elevation e / ~J 7 I? n7 1 $Y. v S, 7 VI. Tank Info Capacity in tal # of Manufacturer Gallons i Gallons Units 4plans. New Existing T Saptic or Holding Tack a 9 r VII. Responsibility Statement- I, the undersigned, assume nsibility for installation of the POWTS shown on the attPlumber's Name (Print) Plumber's a MP/MPRS NumbePlumber's Address (Street, City, State, Zip Code) /Z0;WCZ V oun /De artment Use Onl Approved ❑ Disapproved Permit Fee Date Issu d Iss ' g A en Sign e ❑ Owner Given Reason for Denial 13 JX Conditions of Approval/Reasons for Disapproval \ SYSTEM OWNER; p GO 1. Septic tank, effluent filter and ti X9(1 S~ /V ' dispersal cell must be serviced / maintained / as per management plan provided by plumber. ~{,CG~ 2. All setback requirements must be maintained as per applicable Qa Sys nd submit the Coun my on p er not less t 1!2 x i ch`,, tze SBD-6398 (R 11/11) ps 3 ' 3 3' 7a Safety and Buildings Division Coun~~ f b 1R 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) p Madisg~y,VP, 7~7 ~ IONA~ Sanitary Permit Application State Transaction Number In accordance with SPS 3$321(2), Wis. Adm. Code, submission of this form to the approp vemmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned ~WI'S are submitted to Project Ad ess (if different than mailing address) the Department of Safety and Professional Servies. Personal information yctitiev"rtle may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1 (m , Stats. Q.u~~ I. Application Information - Please Print All Information Property Owner's N e Parcel 4 GR01X',QU0 Property Owner's Mailing ess Property Location 3 CT / ( CSC. S Govt. Lot City, State Zip Code Phone Number Section SY vi b circle qm~ T Z_ N; R / or II. Type of Building (check all that apply) Lot # Subdivision Name r 2 Family Dwelling - Number of Bedrooms Z_ di I;j Block ❑ Public/Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of own of III. Type of Permit: (Check one oz on in Complete line B if applicable) A. ❑ New System lacement System Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) ❑ Change of Plumber List Previous Permit Number and Date Issued g• ❑ Permit Renewal ❑ Permit Revision ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that a } on In 11 Pressurized In-Ground At-Grade ound > 2 in. of sui le ❑ Mound < 24 in. f suitable,~oil Holding Tank El Other Dispersal Component (explain d Pretr tment Devi exp ain) V. Dispersal/Treatment Area Information: d E Design Flow (gpd) Design Soil Application Rate(gpdsf) persal Area Required (sf) Dispersal Area Propo ed (sf) System Elev ion K66 I - 7 • 7 X5- 73 ~ 61;? SY 0 8, VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks Existing T 3 w c a3 ° w a U yr rn w C7 A~ Septic or Holding Tank % C7 Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume risibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's 'e MP/IvlPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) " ~__X 7 Z - / z/~; W. 5,Z V our /De artment Use Onl Approved ❑ Disapproved Permit Fee Date Issuf d Iss ' g A en Sign e ❑ Owner Given Reason for Denial I~' IX. Conditions of Approval/Reasons for Disapproval ~Jl- r _ qp Z SYSTEM OWNER: ' e 5 t~ 1. Septic tank, effluent filter and ~w dispersal cell must be serviced / maintained ON /O 5 as per management plan provided by plumber. "a s s ^ • - - 2. All setback requirements must be maintained A_1401n S, na g as per applicable ~ Qr la rY. Wa4t46~ ab coaa my on p er not less th trz x i It W AIM SBD-6398 (R 11/11) PS 3s 3 3 3' - ~ I v0 1 ~O o c n o °p 4 c 3 ai m c c c M 00 N N O N N C 7~f0~ O Y C, 0 C C w L C m o> ° v'Na~ N v u o;nv a~ cco ~ EL y I :;=ZN U m~ CL (D w o 0 m o N N T C .C 7 in N U ZS - C .0. 0 .0. N ~O a> m Co 'a - a- 0 f0 l6 V U N p 2 2 Z° UN O a= ONm~ O yC=•-• ~ O N a0 NY N C m 3 N O o. ? C O 7 N w C y O) N N N C Q N o m O N C Z O C N .m C O Z .0 C C m O 7 f6 (6 N O O C2 y w LL (D 0 U w m o'3: Q 3 v '0 4).Q C" mo w 0)-o c 3 v c N a`o .N v o 5,? o> ao Q U N N N O. y a) N M 'O Q > 0 ° i Z a m ° a 3 m viN•~ I m c t7 c ° = W r 7 U) « O avi Z a 2 w c M P r 1 c.2 E ~ o v (D _ N V 7 N L_l~lVl 7 d Q N O ' N t NN a~ r I a p o Q Q O Z Z Z Z Z m E o i f0 C ♦ O y- o o y c N q G G a o a` °c C'j w E v H co cn c E 333 co a333 a~ o 0 0 0 0 0 a. CL CL 'o. OCL IL CL a v N o 0 LO m (mil N I (n M O p 0) n O -O Z Z v y J U o co - M cn o o M Z `,C OO O ti~ N N 1 *!V 3OO p = 2-01 ~O O p O O° O N a CO M _ a? O c l O m u)l n d Q Z F N N Q A In tD y O LL y N O 'O N O V O ICI Z' C O '0 Z' U) C O CC °i : O U C O N C C U d 0 0 0 O O M O 'II y C N E '0 N -O N N N \ y;i M Zo N C C~ ` y C j v Ooi C O d CO M W p C w U N o y N '00 '00 C N co H O N y° p vOi c0 O 1 N O N O O z o z Z Z • ►~j' o I- Z ~i o Z a z I 1 E r \ vt ! = € d v ~ ~ € d I € a Q j`aa u0. `N E c 1 ; 0 of 0 LETTER OF NOTICE OF VIOLATION Number 85-V-82 Certified Mail/Return Receipt Requested Mr. Gregory Nelson DATE: October 21, 1985 R. R. 3, Box 295 Hudson, WI 54016 LOCATION: SW's of the SE-k of Section 4, T28N-R19W, Town of Troy Dear Mr. Nelson As required under the ST. CROIX COUNTY ZONING ORDINANCE, notice is hereby given that you are in violation of Article 6.3 of the ST. CROIX COUNTY ZONING ORDINANCE, 145 of the WISCONSIN STATUTES, and/or ILHR 83 of the WISCONSIN ADMINISTRATIVE CODE. The violations noted are failing septic system and the following actions should, be taken by November 22, 1985 Contact a certified soil tester and have a percolation test taken. Have a licensed plumber obtain permits, design, and install a system according to the results of the percolation test. The first violation is noted as having occurred October 4, 1985 and any penalties provided for in the ST. CROIX COUNTY ZONING ORDINANCE shall be applicable as of that date. Please feel free to contact this office," for we are available to assist you in clarifying this matter. Yo rs truly, HAROLD C. BARBER Zoning Administrator HCB :aj j cc: Town Clerk District Attorney Leroy Jansky, Privat Sewage Consultant L Department of commerce SOIL EVALUATION Page of REQUW"" Wisconsin Division of Safety and Buildings ST CROV COUNTY in accordance with Comm 85, Wis. Adm. Code n~,vr / (7 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 toje: t" Date d by Please print all information. Revie e w, s. 15.04 Personal information you provide may be used for secondary purposes ( Y Property Owner Property Location Govt. Lot, j LO 1 /4 l 1 /4 S T N R E (or r e- e., Ir Property Owner's Mailing ress l Lot # Block # Subd. Name or CSM# Nearest Road ~tat, p ode P umber ❑ City ❑ Village Town D ,(2 ( ) d GP New Construction Use:Residential / Number of bedrooms Code derived design flow rate GPD Replacement ❑ Public or commercial - Describe: Fl Plain elevation if pplicable ft• Parentmaterial y/~~ General comments ~r~% v -r ►'0>''t and rec omirriendations: System Types System Elevation v / ❑ Boring G/ sing # Ground surface elev. / ft. Depth to limiting factor U in. F Tl /rte. Pit Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM 'Eff#1 'Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. shl'Q 1 k1- 77-c '0 --112-161 / ~ u ®ng # Q Boring 1 _ - S. pit Ground surface elev. ft. Depth to limiting factor a in• Sal lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff Gr in. Munsell Qu. Sz. Cont. Color 0-17- "Ps t----- Z- .s , All,.f A,'l 130 mg/- Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 1150 mgA- ' Effluent #2 = BOD < 30 mg/L and TSS 226900 CST Signature CST Number f~rne (Please PrirtU Bird Plumbing, Inc. Shaun Bird 22 hone Number Address Dataluati_on Cone p 715-246-4516 1008 192nd Ave, New Richmond, WI 54017 Property Owner - Parcel ID # 3-1 Page of Boring # ❑ Boring DRI.Pit Ground surface elev. -qL~ ft. Depth to limiting factor o 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 ditrd p z S~ - ' 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 GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/f? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Effluent #1 = BOD,, > 30 < 220 mg/L and TSS >30 < 150 mgA- • Effluent #2 = BOD3 < 30 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. SBD-8330 (R.6r00) 1 Soil Test Plot Plan Project Name Greg Nelson Shau d Address 517 Old Highway 35 Hudson Wi 54016 C #226900 Lot Subdivision Date 4/30/13 SW 1/4 SE 1/4S 4 T 28 N/R19 W Township Troy Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of Siding System Elevation 89.0/88.4 *HRPSame as Benchmark Scale is 1" = 40' Property Line unless otherwise noted Well (unde deck) O 150' Existing 4 'Aje~ Bedroom House B-1 B.M.* 90' 100' ' 20' B 20' 400' 15 5' 94'B-2 T 0' 92' 60' 7% Slope DW 0' Vent To Old Highway 35 Property Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 4/30/13 Owner:Greg Nelson Location: SW1/4 SE1/4 S4 T28 N,R19W 517 Old Highway 35 Troy 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 Specification heet Signature License n er #226900 PLOT PLAN PROJECT Grea Nelson ADDRESS 517 Old Hiahwav 35 Hudson Wi 54016 SW 1/4 SE 1/4S 4 AUND N/R 19 W T OWN Troy COUNTY ST.CROIX 2 4/30/13 BEDROOM 4 MPRS Shaun Bird 226900 DATE CONVENTIONAL )00( IN-G SURE CONVENTIONAL LIFT HOLDING TANK 1000/280 gall LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE 6 t~ ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Bottom of Siding ASSUME ELEVATION 1001 Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be SDR 30/34, within 10' SYSTEM ELEVATION 89.0/88.4' 5' below qrade of tank, piping shall be Schedule 40. Scale is 1" = 40' Property Line unless otherwise Well is to meet all vd&oted setbacks required by WDNR >6„ Quick4 Standard Scale is 1" = 40' of Cover Leaching Chamber with 20.0 ft2 of Area unless otherwise 5.6ft^2/pair of end caps noted 4' Long 12" Grade at System Elevation 34" Well (unde deck) O 150' Existing 4 Bedroom 2-3' X 88' Cells with >3' spacing House B.M.* 90' B 1 100' 20 400' 15' 5' 90' 20' 9 B-2 15' ST Vents 92' X60' Huffcutt 280 ST ° haS r~ f B-3lj PS 3 3.33 DW 90' 7% Slope Old Drywell is to be pum e and ied a o ' g to ill bey ~n done a a valve 1V`' Vent To Old Highway 35 insta d ossible Property Line 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 5.6ft 2 pair of end plates Finish grade elevation Typical Installation 93.0' Vent PC/ Grade Vent 3' 4" 3' X30/34 Septic Tank 5' Long 1„ 5 5' Long 191 Grade 3699 Grade at System Elevation at System Elevation Spacing 5' 2-3' X 90' Cells Same on other end Observation tubeNent At end of cell A B 22 chambers per cell System elevations: A 89.0' B 88.4' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS - ~ Owner G ~ 0 . f Septic Tank Capacity / of i permit # S~p 8 ❑ NA Septic Tank Manufacturer 3+ESIGN PARAMETERS -f~1t K ~ afA Effluent Filter Manufacturer 0 MA Number of Bedrooms 0 NA Effluent Filter Model Number of Public Facility Units ~ NA ~IA Pump Tank Capacity al NA i Estimated flow (average) Pump Tank - al/da p ank Manufacturer NA 1 Design flow (peak), {Estimated x 1.5} t`, aNd Pump Manufacturer NA a 12 ay I Soil Application Rate ai/da lft2 Pump Mode! NA i Standard Influent/Effluent Quality Monthly average'' Pretreatment Unit Fats,' Oll & Grease (FOG) 53o n1 /L NA 11 Sand/Gravel FlIter 1:1 Peat Mechanical Aeration 0 Wetlandilter Biochemical Oxygen Demand (BODs) 5220 mg/L ❑ NA ❑ Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection D Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) Biochemical Oxygen Demand (BODs) 530 mg/L 1:1 Total Suspended Solids {TSS} Sap m /L -Ground (gravity) D In-Ground (pressurized) g VA ❑ At-Grade 0 Mound Fecal CoNform (geometric. mean) 4 c 100mi ❑ Drip-Line ❑ Other; !Maximum Effluent Particle Size 3fi in dia p NA other:- Cl ~u7ther: NA ! ❑ NA Other: El NA "Values typical for domestic wastewater and septic tank effluent. Other: _ n NA IAINTENANCE SCHEDULE Service Event i' Service Frequency Ilnspect condition of tank a month s 11 { } At least once every: ) (Maximum 3 ar s Yearn) 11 NA IPUmp out contents of tank(s) When combined sludge and scum equals one-third of tank volume p NA least once very: d month(s) -yea s (Maximum 3 years) ❑ NA Ilnspect dispersal cell(s) Uastonc (:::lean effluent filter very: lyearts(s) ❑ NA I a1s ect ~ P pump , pump controls & alarm ery: © earts(s) NA f=lush laterals and pressure test ery: © mont_ s,s} NA (:)!her: year(s) month ery: p y ar(sjs) NA i NA MAINTENANCE INSTRUCTIO NS ilnspections 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 linclude 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 1^egulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of {:he tank shat) be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Mkdministrative Code. lhil other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, land 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 10 days of completion of any service event. Page - of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals thflt may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of thja 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 effluenit, 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 Iife of the Pow r[1: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drayn (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting product:;; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails andlor is permanently taken out of service the following steps shall be taken to insure that the system is propejty and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • Alf 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 soli, 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 complkUnt replacement system: suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelrn. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requltjed setbacks from existing and proposed structure, lot lanes and wells. Failure to protect the replacement area will result In the nEled for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the ruled 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. 13 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 POWi'S. 0 Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biamat at the Inflitmfive 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 NIOT 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 zil - Name, v1 Phone 7/ j °--,z ( Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Name `yam r Phone Phone i~ .396_ ( V This document was drafted in compliance with chapter SPS 383,22(2)(b)(i)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code, ST, CROIX COUNTY CEPTTFrCATZON SO orFICL FOR UTILIZATION OF STATEMENT AN EXISTING SEPTIC TANK i~ to certify that r have ~e 7.vinc~ theinspected the se `Qr ptic tank Preserrt:.1. y ► Section ~ t residence R 1 o c a t e c~ - ~ 'z.~ c~ N, the tank a Upon inspection, ~ Town 0 f. baffles to be certify that I have z~nc1 tUnrtaonin in good condition 9 .Properly. , and it a . ppears to he time serviced: C) .cJ Inq L'1.ow back occur from absorption s Yes ystem? l: skip next line} API7.roximate volume or length th . Of If no, /g t~ac.iLy; gallons r c'c"pstruction: Prefab Concrete l~.A rlufacturer: Steel Other (If known) : A 9e e o f Ta ncrt.rJ4 G - (If known).: u 1 ! le c~c.cr' No ozt A/~ (Name? Please print-`~.--- - (License Number) i-ite 1;'«rm to be completed Statutes} or License by licensed Corte) d Disposer plumber (NR 113 (s.145.061 Wiscons.i.n wisconsi,n Administrative ".lumber (applying for sanitary permit) _ - _ _ - 1Lr I ac Certification. cepting condition the above statement re , ,I certify that the t 9ardiri conform to the s xisting septic tank requzremettts of ank to thAjuo TLHR Y knowledge w:LJa-nspect.ion openin 'ver outlet bafCode (exceA' t for Na signature mn/Mn.Rs Zl ST. CROIX COUNTY SEPTIC 'T'ANK MAIN.CENANCE AGREEMP NT AND ' O'WNERSH1P CERTWWATION FORM Owner/Buyer r Mailing Address.-1 2.- Property Address (Veri iaation required frorri Planning & Zoning Department for new construction.) City/State - Parcel identification Niuribes- ® 11ESCR~.PTI~C!]wi Property Location Sr J /d V4, Sec. N R/~ W, Tornni o;f, ' Subdivision ' Lot # Cert fled Survey Map # - Volume Page # VVarrtInty Deed # b L{ v _ _._-_,..._-----------._r Volume Page ` Spec house yes n ~Lot lines identifiable no SYSTEM MAINTENANCE ANn f?UVl~llu~» rn~, ~J ..~.RTYP'ICATION I Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists ofpuiuping out the septic tank every Hum years or sooner, if needed, by a li,ensed pumper. What you put into the system can affect the funGlion of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities arc specified in JComm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner aga'ees to submit to St Croix County Planning & 7ottilzg Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) flit, on.-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than W full of sludge. I/we, the undersigned Halve read the above requirements and agree to maintain the private sewage disposal system with tlhe standards set forth, herein, as set by the Department of Cornimme and the Department of Natural I2 osourcee, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned tc. the St Croix County Planning & Zoning Department within 30 days of the three year expiration date. l/we certify that all statements on this form are true to the best of my/our knowledge. Itwe am/are the owner(s) of the property described above, by virf to of a warranty deed recorded in Register of Deeds Office. ' Num of bedroom - I #NAAr_0F'_A_~_PYICANT(S) DATE i - ***Any nifbnmation that is misrepresented may result in the sanitary permit being revoked by the Pbhnning & Zoning Department. i Il:nclude with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if preference is made in the warranty deed. •I:REV. 08/05) ILTER CARTRIDGE INSTRUCTIONS ~1l15~r~t~tt S• 01 Ory fit time 1111Fsr ame snW thus and of thr outlet pipe to ensure it is i~ centered under tits occeas opeolog. If notr amen uither Insert tours otod into time tank through the outlet or solubnt wutd (glue) additional pipe orite the outlet pipe- s7cats a While the rase is still try fitt'od on the oudet phad, rrrsasure the lereytfi of 44-inch pipe molded to brarctu the joiner to the tank and wall if utiltzIng tt►e optional supvlbrrrental ride support. If side support rceathod Is out utifi,eed, praceed to stets four-. g•rk".P r For installatiorrst UU11 lrig the alatienwi rtUpplefrrtNrta! sids supirert- solvent weld the %Aheir pipit orrka the filter cask. If 51de support hiethdei is toot utilised, proceed to step four. All, solvent weld the litter case uhto the nutlet pipe. AlUert the filter V z,I r;§t cartridge into the came, prates4►) doyen until the filter lucks; into the button, of Y-4 ' the mass. If if VR5 switch is utlikAwd: irresrart loco time titter and lock try turrotiq clockwise 900. maintenance 1. 'the ettiuent filter should be tieareed every tirr►e are y„sptic toast is searviced. 2. open the outlet access opot,ing to inspect: Lite tank dtrd toter. ` N. Punip the septic tank cornplotely, makinif mAm to reirtuila the sludyitr lsyer on the bottom of the tank and not just the scum and effluent. yxe' y 4- once tits efilusht tevel has t, van towered below the invert of thu ~ - outlet pipe, firmly pull up on the Hfter handle to dislodge the cartridge from the ease, r 5. slide the cartridge up and of It of the case fiat deatzing. ~ i G, it is VAS s Witch wro-tected to all alarm is RIVIierd, the switch should he removed by tornthq countardockwisa 90W End cleaned , r c with enter only. - 1. •,,L, 7. While holding the cartridge op its sides (large net surf;Ice fac.kry ' `"°bt*^,. dowry) ever the ac'cass: opening, rinse ON the ca ltrkige With WAve s df. only, rrorakiug sure all amptagrk material Is rinsed back Into the trunk- a. lf'vRs switch Ia utilized, rep1mv by losettIng into filter artrd turning clockwise 80t.p 9. ]nsort Moo niter cartridge back into the eater pressing down. ahtll the filter looks Into the bottomrti rat the case. in.Repiate and secure the $1 ouzo ulaehilld an the trunk. rr i:• •]f1:.<•:'' J ri "Y r; ; 4N1 :'$:Tnxtti ' 1..~,, t rrFt' LC :.v:,3ldl.r'1'• . wrw►ww beami Wta.coul nocswaars sra,-:< -2"2 -or ',t -F §M4 z- y~ t 596 UZIWUM B_ MCSC RLEPY arA ALICE M. EICSORLEx, REOiSTERS OFFICE Eizwsbanod '%-n Wk •e and each in hkg or her ot+art ST_ CROIX CO., WM t: aoattt P4- _*d_ for Q`8axarl Htis 5 doy of - A.D. 19 " s sn3 •w+aasals to - G-RE90fty QN any TCFDY s 8: :!*3 , Coady. i'~ tow rot49sW%g dffl= %0d :ream .eatwit I* St- Croix Stet&, of WISCOMaJim A ga.=. :7f 5 acres lecabed 181. the SIA of S E% of Sec- 4, W &V' p1 w, sTa"thPr ribld as kol vus: -r" Kay "o'. Begi main€g at tea. point on the emst Lim of said Spa of SM a Ydistwv= of 761-4 feet: north of the SL cormr of said Sys of SEs; thence &-v-- TdLSt 1122_7 Wit, mom-P, or less, to 'Ww eAsberly rio-&- af- / ➢ i m of: State "trunk Hlcft4ay "350; thence nostvaest arly al s ald eazb s!y rIget.-of-sm y L. on a curve aorv=ve northeasterly kmrjiM a rtto;B: us of _'724.93 feet and, aE► ctx=d of 206.5 feet; thence due East 1173.4 feet, more or , to said East L.l-dam of sir! _SPK% of ScMh; thencie south along said East l ink .,5 WravT the entsxe North tot (10) Ervet of the 200-0 fact to tl%-, Point of BagirinUtg barexdescribioxl paAwl- tPfl T11I 0-tree (3) a d joai mg .1usive easements for in mess P-nd eg ee over a11d the Jarwft i➢t tri, bCg "t him North side of the parcel hein con%,Ex eCl, wh1ch easements shown a Gon-r-Utite d Skumay RKp fa ed r8une- 4. 1979 in vxol. 3, [gage 812, Doc. 1 357297, in the office o the St. Croix CIMMLY fgIstar of Deeds, 3efhlch outs ace agemrally ibied as: (a) A `Gi.''Vy-s:.% (66) f_Aot wit e * *t lye 33 Edet each slcde of the entire north 3.im of Patiaal 1 a rxi of the west Eo -Eire (45) feet of the north Line of Pr1rt7ke-1 2 of said r'ti-fio 3 skwwr<"'y Lam, which eazewmt runs froml the easterly right-of--wmy ijv-- of Scow "L"t"wmk Hisgfiymy "351, them north 890151 east 604.40 feet alang said Ttt."sYS ~ t> 1 p9 +aerty. (eonti=-,ed. co back) (to (Is not) 4'' xcepa loo to .raara9r .cesa i -l'!--1 owed I%Lix 2r"k d27 01 - .1 U 1v 19 79. FEE (SEAL) Y ~ - ~ ~ ~ (SEAL) (S+EA ~ tel. i7_ (SEAL) Zvi/Ft ALICE M. Mc ORLEY6,,~"rS AUTHENTICATION ACKNOWLEDGMENT Sigriatures authcatieated this Axy of STATE OF WISCONSIN a9 ss. Personally carne before mr. this dry of • _~v l ..i 1979 the above named TITLE: MEMBER STATE BAR OF WISCOz-iSfSN Bernard B•. McSorley and Alice M (tf not, KcSorley,, his wife autlsorixed by 57067.06.. Wis_ Statsl This asrnrment was drafted by - Will.zam J. Gilbert, Attorney "s GWIN, GILBERT & GW IN to rice known to be the person ks %ia}io exeeuted'the fare- 430 Second Street going instrument and acknowte48~d thw as--ae. H rid;n W' r.spnsin 54016 _ `~ti vtitF#~_;,_C{• ~ (Signatcres may be authenticated or acknowledged. Both • ~ ` are 6M necxasary.) notary Pisbtic_~ Csgety, Wis. My Commission is permsnent. (tf got, sffite expirotio date; srn~rw~~Tr n[ca-ssnsx u7r ai erncor SM. •omr NO. 3-9077 (corm +ed 3r frcff-.:a tnar9_h Lim of Parcel l and the umst f6rty-use (45) -feet of the naru?a line o~` Pe'wroe9. ? of (b) A sixty-six (66) fbot wjjcL- easemmt ~-oss the unesterly 66 aees O Parcel" 3~ of said Ce_rt'afled Survey map, %&aiCh its rwr; Er-cm t-fte ~b_rly end Of the ease u*'-it described in a'- : (a) asb r-ae at its ja m w-iz:A easterly thence S~r~3b 11'45' i_as X3.55 met, airht-c - y lame off State TrwL E~~" y `35". m=,e or less, tv tiw-- NV corner of the parcel ies -i hes. oanr-ro ,i-bs (c) A t3ni- lac easement 45 feet cue oar t~ve ntw&d end, and 85 feet wide on the south end :across the %esterly porit n n of -Parcei 2 of said Certified Fes, r-S ich easement runs trom the easbarly end of the ~ +t dc-vCribed in W ia7 above, U sout-herl to app vD?mately the center off the Nnzttn Lane of the l l descr-M2ad abom being ooffve.yed have jn. AU three of the faxegoiM easemrts 6oemg sixxen on sand oerta=_ied SLMMy :00,5_ 'i t U=4 and SLBJBCT To a-U of dm rujiTts aced~o7b~La.ga:~ons comasroad in .a certsan Roadway ~t bet a ~ Corley and Alice M GSarlca, and i th Ciose and Joan Mose, dated. Sabviary 19, 1979, roo3rftd 9' a 7, 1979, in F7t'la 590, page 465, Dooa ment No. 3SSS17, in the office a lE the Sr. Cxv)i a meaty Pe star oi• Deveds I STEVE MUENICH ULBRICHT & ASSOCIATES PUMPING LLC - Private Wastewater Contractors - Hudson 105 East Chippewa Street Main Office 715-386-8277 Cadott, Wisconsin 54727 715-456-1440 Owners Name s/ 7 11J t- Date G-- C ~a1 a It Time 1,0 -20 od Address 2L/- (;7,PX Service Call: Routine IK Emergency ❑ Operator Comments ugh b ~,A~ c f/ I/ i~I1 W:C'~ v/`!1v 2 4) J C- /---L Y 'rj'V"'6'4 d ~ - Septic System Conditions - S.T. Size 2C2e) 1.200 Amt. Removed ®v Gals. Pump Chamber Size, Amt. Removed Gals. Depth Scum S.T. Depth Scum P.C. Depth Sludge S.T. ` Depth Scum P.C. Trenches or Drainfield, inches of effluent (D .2s ! 0 - Costs - • Pumping I'L • Digging up Covers • Adding Manholes, New Covers, Locks, Repairs, etc. • Extra Travel Service Labor " • Taxes, if applicable Total Due dpd. In Full ❑ On Account Parcel 040-1019-30-000 02/04/2011 09:58 AM PAGE 1 OF 1 Alt. Parcel M 04.28.19.63G 040 - TOWN OF TROY Current ❑ ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - NELSON, GREGORY R & JUDY L GREGORY R & JUDY L NELSON 517 OLD HWY 35 S HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 517 OLD HWY 35 S SC 2611 SCH DIST OF HUDSON SP 1700 WITC Legal Description: Acres: 5.000 Plat: N/A-NOT AVAILABLE SEC 4 T28N R19W 5 AC IN SW SE BEG 761.4 Block/Condo Bldg: FT N OF SE COR SW SE; N 190 FT; W 1177.4 FT TO ELY R/W HWY 35 SLY ALG HWY TO PT W Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) OF POB; TH E 1122.7 FT TO POB AS IN VOL 04-28N-19W 596/471 Notes: Parcel History: Date Doc # Vol/Page Type 2010 SUMMARY Bill Fair Market Value: Assessed with: 81385 257,000 Valuations: Last Changed: 08/12/2010 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 85,000 174,200 259,200 NO 08 Totals for 2010: General Property 5.000 85,000 174,200 259,200 Woodland 0.000 0 0 Totals for 2009: General Property 5.000 85,000 192,500 277,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 121 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00