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HomeMy WebLinkAbout020-1000-80-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 563868 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: Hammer, Joseph & Deann Hudson, Town of 020-1000-80-000 CST BM Elev: Insp. B Elev: BM Description: M j C Section/Town/Range/Map No: cJ 07.29.19.1 H TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER , CAPACITY STATION BS HI FS ELEV. Septic 4 Benchmark ' 4.0.~tf-F/ate 1, 4z Dosing Alt. BM Aeration Bldg. Sewer Dret-.~ , b g s s$ $ / Holding St/Ht Inlet -_72 7, TANK SETBACK INFORMATION St/Ht Outlet TANK TO Wllf WELL BLDG. Vent to A Intake ROAD DtInlet Septic '7 66 9b / J L Dt Bottom ,711:~ '9 • (p Dosing / -7 5-b 76/ / Header/Man. / Co Z 7 Z. l 9`1.3 Z Aeration Dist. Pipe Z • q $ -ne. (41 Holding Bot. System 3 97• (4, s.~ 95•Co Final Grade PUMP/SIPHON INFORMATION 3.B ' 97-59 Manufacturer ~-4 GPM and St Cover (::Tl~a Z ,7 - Model Number A_ 3.3 Q '3. Z . Z TDH Lif~~. 1 Friction Z. System H_e'r7 TDH/' / o Forcemaiin LeniW Dia. Dist. to Well `O 90 / SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO / P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR TypeQ~Sy~st~~1 d ll fad /3 / UNIT Model Number. ' 06" DISTRIBUTION SYSTEM Header/Manifold, f Distribution x Hole Size x Hole Spacing Vent t4 Air I ake Pipe(s) E Length 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/Sodded r Mulched Bed/Trench Center 3 Bed/Trench Edges \ Topsoil Yes ❑ No es ®No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:9,/ 113 Inspection #2: Location: 1078 Golden Oaks D five Hudson, WI 54016 (SW 1/4 NE 1/4 1/.4 7 T29N R19W) ^metes & bounds Lot 36B Parcel No/~11. 07.29.19 H 1.) Alt BM Description = r I ~~J~ ~ ~ws Y (n( « 51-5 ~ ~ , , d~ • 2.) Bldg sewer length = Z-7 I^s J` pfA J vd - amount of cover = G h y ~K Plan revision Required? ❑ Yes No Use other side for additional information. O -4, Z/FZ'; (0 Date Insepct s Signat a Cert. No. SBD-6710 (R.3/97) 1 3 0 L~o Q3 `v S K Effluent Wastewater SEN-40 Series 4/10 hp Submersible Effluent Pump, 3/4" Solids Construction Flow - Liters/Minute 0 50 100 150 200 250 300 Cover Epoxy-coated cast iron 35 11 Motor Housing Epoxy coated czIst iron 10 30 y Impeller Material Thermoplastic Elastomer 25 $ Impeller Type Non-clog, 0 20 6 Volute Epoxy-coated cast iron g 15 5 9 Power Cord SJTW , t o t Mechanical Shaft Nitrile with carbon and = 10 4 CO 3 Seal ceramic faces 5 2c,~'~ 1 Fasteners rewhles et T 0 0 Shaft Steel 0 20 40 60 80 ' Upper - Gallons/Minute Bearings sintered sleeve andlowerball bearing 9.80 4.63'--{ 9.15 6.60' 6.85 4 69` 9.60' SEN-40-AF SEN-40 Specifications 'A 111111111A SEN-40 509211 4/10 115 1-1/2" FNPT 9/920 80 70 60 45 25 32 14 20 26.5 1750 SEN-40 509212 4/10 115 1-1/2" FNPT 9/920 80 70, 60 45 25 ' 32 14` 30 27.5 1750 SEN-40-AF 509213 4/10 115 1-1/2" FNPT 9/920 80 70 60 45 25 32 14 20 27.5 1750 SEN-40-AF 509214 4/10 115 1-1/2" FNPT 9/920 80 70 60 45 25 32 14, 30 28.5 1750 Franklin Electric 400 East Spring Street, Bluffton, IN 46714 Tel: 260.824.2900 - Fax: 260.824.2909 Form: 996199 7-11 www.franklin-electric.com i W~ 3~119nl MUD. 6 : 0® SEN-40 Series 4/10 hp Submersible Effluent Pump, 3/4" Solids Features ■ 4/10 hp PSC motor with thermal overload protection ■ Energy saving low amp draw ■ Cooler running motor which extends the life of the pump ■ Cast iron pump housing with protective epoxy coating for corrosion and rust resistance, polypropylene base ■ Stainless steel screws, bolts and handle ■ Mechanical seals (stainless steel spring, nitrile parts, carbon and ceramic faces) ■ Upper sintered sleeve bearing and lower ball bearing ■ 1-1/2" FNPT discharge ■ Handles liquid and solid waste materials up to 3/4" diameter ■ Available in manual or automatic operation with piggyback mechanical float switch ■ On level 9" - 14" ■ Off level 2" - 6" ■ Two year warranty I en%& i Franklin Electric ~sfa 'd ~"'~~?h~'~. ounty Industry Services Division r1 [jF 1400 E WashingSanitary Permit Number (to be filled in by Co.) Sp P.O. Box 7 V s 1k f Madison, WI 53707-7162 ~ FD 3 g Alin n 1 , State Transaction Number Sanitary Permit Application /✓P' In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the apprA TI~q rnMental unit is required prior to obtaining a sanitary permit. Note: Application fors for state-owned POWT~~ ~~AJW to Prgject Address (if different than mailing address) d~dtGsti ~ot.4C.5 the Depar tment of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1 (m), Stats. 1. Application -information - PleasePrint All Informs 'on Property Owner's Na me q 4- e. Ay. Parcel # Property Owner's Mailing Address Property Location / h 615 ~I ~L-4G Govt. Lot City, Ste f' Zip Code / Phone Number (J 914, Section T N; R 'Section 11, Type of Building (check all that apply) Lot # k1l or 2 Family Dwelling - Number of Bedroom Subdivision Name ~G Block # ❑ Public/Commercial -Describe Use ❑ City of CSM Number ❑ Village of El State Owned -Describe Use Town of 111. Type of Permit: (Check only one z on line A. Complete line B if applicable) A. ❑ New System eplacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. El Pen-nit Renewal El Permit Revision El Change of Plumber P0.Per7 Transfer to New Before Expiration er IV. Type of POWTS S stem/Com onent/Device: Check all that a I) A P-1 on- 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) 1 V. Dis ersal/Treat ent Area Information: Jr Design low (gpd) Design Soil Application Rate(' Dispersal Area Required (s Dispersal Area Proposed ( System Elev io S 3 ,3 . 8 9S S Cd - VI. Tank Info Capacity in Total # of Manufacturer Ode- `oy,~ ~ Gallons Gallons Units c U n N\01r New Tanks Existing Tanks o Z °•3 a - ~►(/2~ ~ ~ ~ U rn v~ v. C7 a. Dosing Chamber 1►►~-+ OD VII. Responsibility Statement- I, the undersigned, assume res sibility for in lation of the POWT wn on the attached plans. Plumber's (Print) Plumber's Si re MP WdW b er Bus ss Phon Number of 00" me I'L oz v .Sr zEr- Plumber's Address (Street, City, State, Zip o VIII. Coun epartment Use Only Permit Fee Date I sued Issuing t Signature pproved i$ r _!J /_3 1 4 2:5 't' for Den'al ( ` A IX. Conditbt VfAg9lgfc easons for Disapproval of d O aY+ tAt_ 1.' Septic" tank, eflluont filter and .dispersal cefl must all be services / maintained as per tnanagement plan provided by plumber. 5 6 t tt) -7,3 2, :AN se4ack iequilrerne!nfs must, be maintained st n Attach to complete plans for the system and submit to the Countyonly on paper not less than 8 in x I 1 inches in size G ID,) Q SBD-6398 (R0313) I Private Onste Wastewater Treatment System i. Index and Title Page Project Name: it/u1 t tip ~ r Owner's Name: Owner's Address: ID 7 d 6-0 / ~fJSivj Gc%L ~~Dl~ Sw % Al 1 9 ~-d Legal Description: Municipality.: Town Village, A2ityrrf 147JSon/ U County: 57= - Subdivision Name: Lot Number: Block Number: Parcel I.D. Number: DLD/~D DODD Page 1 no % Page 2 ~olI T/YI Page 3rl~DSS Page 4 /J ~?4 f fo ss r. •r'~r -1 t Page •5 ~74,19 E/G Page 6 7-' Page 7 s Page 8 Page 9 Name of Designer: WZ License Number: -79 Signature: % - Date: Designed Purs t to e of ing POWTS Component Manual sP5 3$ 30 C o M 0 9 _ Ct -7 Q'I Soil Absorption System Cross Section 4' Schedule 40 Final Grade PVC Vent Pipe With Vent Cao ft J' System Elevation ft Soil Absorption System Plan View '7 ft 3 ft ft Leaching Trench 1 Chambers 4" Dia. Trench 2 Header Vent Or Observation Pine - Leaching Chamber Specifications Manufacturer And Model EISA Rating O sq ft per chamber Soil Application Rate o gp /sq ft `CSC gpd Design Flow+ Soil Application Rate + EISA Chamb ,r rows of l chambers each. f 8 Page of U SNOUVOOSSV 31383NOO 1SV038d NISNOOSM W IVNOIIVN $ uo~;}MJP MMM x IIIL-EZL (SID XVJ :3 Ul •313 b 3 U 00 NNdl 3Ild3S 80 dwnd (L1 :30 OGN3W 9151-4d6 (008) 1 944E-E2L (STD NO"IOd9 009/000'1 h C- 6209 IA 'SIIVJ (U iNVld 03ULL830 ig ~ 133211S p +EZTMbST4 IIRWRH 133('❑bd Nom; z d Q ❑ ~Q F- ~ z vi d < CY 7 ❑ n d' N U Li a 3 d❑ r U ❑ ~ F- ❑ aE w a m J Z ~ W A 0❑ -Q W 2 z =o A o o L ,24 AN 3W F l~ q J W w W W U L N~ f F- v1 Z 11') o w x Z❑ O Ix w W Q U O p W 1 I- U d' N II It w❑ ❑a w w = QU 0 ZJ I- U Ua L'i L) W F ❑O f Q Z. l7 U I- :D MU Q \ Fa Z W z A U W ¢ Q❑ U _ l7 d 0 ti '9 vQ J 3 N Y Cl) --t W .Q. .Q-i ❑ iQi OC > ca a = o W Q- m Zo K v O ❑ N fU r N Q U w~ J v v on cu o z O 0- II II r1 H F- 1!7 U ,Z ,i Z < W y ~ H J R Q -1 Y Z H v w J w Q ,2 ,02 W Oq ('7 m zD F O CO Li ^Q, N U rv ZW ijin U') Q I LL O I Li a 't LL. O u~ D Q N ,44 ,E r 0: C3 W UJ U .8 .L4 LLJ w J ,SS =z W ® F- i~ ¢ iv ❑ P4 o n I ~ ¢ I W ~ I J I Y C3 Q H v I I I I I ~ Ub,'1:i/ZUUZ' 11:x( brJtfl~~~J7F7 JFlrcIT -111 page of - PUMP CHAMBER CROSS SEA©N f,firt:L7`Vznt'"ir7eWit H(;-1P z 10' from door, wirndoµ; l Vent; Lap or fr8311 air intake Weathdr 1''roof Junin l'UOx Appr~:ved be4:'~g rnar•ro1~ cover w/ warning libel 14 t.f,4N 1 Final t Gzadz ! ~ tl h.i1N ~ ~ 11 i t 125' MIN 18' MIN 1 ~ Provius ~ 11 ~ r Ap~n-~.;ed hP~srovad /,l/,, Alrtl9E,t5eal i Jolrsts J ,~D.lrrC A Q r i t 11 I'C Pumper, ~ i On j ~Z,C3~ h / ~ Gr~ncrste E:Tiock + t ~ , anpproved bedding rt~'GCr{al un,:er Tank SPECIFICATIONS Number of DOSES' Per Day j Note: Pump and alarm are on separate G?,41ons PV Day t# of Oose!: 9D.---Gallons ` circuits as per 1LHR 16. IS. Adm. Code l a , Gallons Volume 0+ sac: ow: _ 11 ~,S- GalloR~ } DoSI vol ~~UuT Tatai ul~e: Tank Manufacturer: Tank Size: O Gallons I inches rr 3~ SSGall.s X04 ; Capacities: A 3o,/ Gate-~;s Alarm Manufacturer: g 2 ruches 01- Model Number: G Cars I C 5, 9 inches or G ~ p inches or 41 pump Manufacturer: J Total........ _ -z' inches or ~`>co Ga55ns I Mode) Number: ~ Minimum 0 scharge Rates O GPM / ~ Ft. a s ~T~ J Vertical Difference Between Pump Oft and DistributionPipe : Supply Pressure: ,.........I-,....... + ~ Minimum - Ft. n Required . 1 So Ft. of Force Main x 39 Friction FactorJl QO l:t. Total Dynamic Head [o inlet Ydtkt- rnterrtal Pump Tari`k D' o,*~sion~: Len~r Z-..Date Signature: License Number -70 I PUMP PERFORMANCE_CURVE MODEL 15114521153 < TOTAL DYNAMIC HEAD/FLOW PER MINUTE 14 45 153 EFFLUENTAND DEWATERING 12 4e MODEL 151 152 153 05 152' Feet Meters .Gal, Lters Gal. Liters Gal. Liters 10 30 5 1.5.. 50 189 69 261 77 291 10 3.0 45 170 61 231 70 265 a 25 151 15 4.6 38 144 53 201 61 231 20 6.1 29 0 44 167 52 197 . 7.6 16 61 34 129 42 25 159 ° e 20 - 30 9.1 - - 23 ' 87 33 ' 125 , 15 35 10.7 - - - 22 85 h 40':' 12.2 - 11 4 to Shut-off Head: 30 ft. (9.11) 38 n. (11.6m) 44 H. (13.4m) 2 5 olasoea 0 10 . 20 30 0.. 50 60 70 80 90 110 GALLONS LITERS 40 180 120 1 200 240 2180 310 3180 FLOW PER MINUTE 014SOM :Model 151. Models .152 153 CONSULT FACTORY FOR s7n2 6114 SPECIAL APPLICATIONS..., . 37/9 45/8 327132 1518 • Timed dosing panels available. e Electrical alternators, for duplex systems, pro available'and 3718 327132 supplied with an alarm,. e • Variable level control switches are available for,controlling ® 37/8 e 3 27132 single phase systems. • Double:piggyback variable level float switches 'are available for variable level long and short cycle controls. • Sealed Qwik-Box available for outdoor installations. See FM 1420, • Over 130°F. (54°C) special quotation required. 2119 15.111521153 :Series 111111/18 15111321153' MObELS.::.- Control Selection Model Volts-Ph Mode` Am s Simplex Duplex I 5 ve !38 N151 115 1 ...Non 1 .2 or 3 BN1S1 115 1.. Auto :6.0 Included 2 or 3 E151 230 1' 3:2:' 1 2 or 3 BE151 230 1 Auto :;.3.2 Included 2or3 sK24a4 SK2064 3 N152 115 1 Non 8.5 1 200 BN152 115 1 Auto . 8.5 Included 2 or 3 E152 230 1 Non 43 2or3 BE152 230 ...',.1 Auto,:...,, Mduded 2 or 3 N153 115 1 -Ntfn... 105 7 '1 2or3 BN153 115 .1 Auto:. lnduded 2or3 SELECTION GUIDE E153 230 .1 Non::.*. 5.3 ] 2 or 3 BEi 53 30 1 Auto 5.3 Included 2 or 3 1, Single piggyback variable level float switch or double piggyback variable level float CAUTION switch. Refer to FM0477. All installation of controls, protection devices'and wiring should be done by a,qualified 2. See FM0712 for correct motel of Electrical Alternator E-Pak. licensed electrician. All electrical and safety codes should be followed In the most 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) recent National Electric Code (NEC) and the Occupational Safety and Health Act(OSHA) or (4) float system. RESERVE POWERED DESIGN For unusual conditions a resew safety #actor is engineered into the design of every Zoeller pump: MAIL T0. -PO. BOX 16347 ` Louisville, KY 40256-0347 Manufacturers of.. SHIP TO: 3649 Cane Run Road Loulsville, KY 40211.1961 QUa[/TY PUMP9 aFXCr 19, 9 u (502) 778-2731 - 1 (800i 8 PUMP (502) 774-3624 http;//prwwsoRllor.Rom a. -..-l-.u -A 7-ll- All rlnhlc 'aa-AA Submittal Data Sheet 8"-15" Dia. Biotubua@ Effluerd Fifters 1.800.846.9813 ~ General Orenco Biotube® Effluent Filters (U.S. Patents No. 4,439,323 and 5,492,635) are used to improve the quality of effluent Optional exiting a septic tank. The Biotube cartridge is removable for Alarm Float Assembly maintenance; the handle assembly snaps into the notches in (Ordered Separately) the top of the vault, and the handle can be extended for easy removal of the cartridge. A "base inlet" model is available for Handle low-profile tanks. Assembly Standard Models Standard Series: FT0854-36, FT1254-36, FT1554-36 °o Slide Rail Series: FT1254-36R, FT1554-36R Biotubes® Base Inlet Series: FT0822-14B Optional Alarm Float Assembly: Standard: MF1A-Y-1IFTL; Base Inlet: MF1A-Y-5FTL 0 I Nomenclature Pipe tB t ions: Coupling lank - standard series. B - base inlet series/ R - slide rail series (12" and 15" only)' Cartridge height (inches): § Vault 36 - standard 14 - base inlet model Housing height (inches): 22 - bast inlet model Y Inlet 48 - when minimum liquid level is 37" .46" (8" dia. only)" - $ Holes 54 - when minimum liquid level is 46" - 63"•• : ; J•r 60 - when minimum liquid level is 64" - 84"•• tSUppOrt 66 - when minimum liquid level is 85" - 112"•• ± s Coupling Filter diameter 08 - 8"' t Support 12 - 12" 15 - 15" Bracket i Blank- 1/8" filtration t 12" and 15" only. 1 P - 1/16" filtration Biotube effluent filter series • Use the slide rail when only one access is available for the filter chamber Minimum liquid level is measured from the invert of the outlet to the tank floor (Select the housing hrigbt that corresponds to the tank's minimum liquid level to optimally locate the inlet boles between 65% and 75% of the tank`s minimum liq- uid level.) Materials of Construction I Vault: PVC Biotube Cartridge: Polypropylene and polyethylene Pipe Coupling: PVC Handle Components: PVC Support Coupling and Bracket: PVC -FT 1 NSU ® 20010remce 2"mu• Inc. Rev. . 5Z 52O m 8101 Pape 7 of 2 PLAN POWTS OWNER'S MANUAL& MANAGEMENT Page of FILE INFORMATION ; SYSTEM SPECIFICATIO Owner] Tank Manufacturer [I NA Permit# ,~Sephc ❑ Dose ❑ Holdi n Volgel' Tank Manufacturer ❑ NA UE51GN PARAMETERS N~m4er of bedrooms` ; ❑ NA ❑ Septic P6 ose E] Holding voL`1) gal NumlSerbtPUbIICPaCilityUnit§ NA' Effluent Filter Manufacturer ElNA Fstirpated,:(2verege).flow) alltla Effluent Filter. Model - Pump Manufacturer[I NA Design (peak) flow (Estimated x 1.5) ai/da tioRate. r T al/da /ftz Pump Model, JS f In Situ Soil Apphca n. Standard Influent/Effluent Quality Monthly average' Pretreatment Unit A Fats, Oil & Grease (FOG) 530 mg/L, ❑ Sand/Gravel Filter ❑ Peat Filter B ODD) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (B Total Suspended 50lids`(TSS) 5150 mg/L, El Disinfection ❑ Other Pretreated Effluent Quality Monthly average Manufacturer Biochemical Oxygen Demand (BOD5) 530 mg/L Dispersal Cell(s) ❑ NA • In-Ground (pressurized) Total Suspntled 5olitl`s (TSS) 530 mg/L ❑ NA J x In Ground (gravity) ❑ Fecal Coliform (gedtrietric<meah)cfu/100m1 Q At-Grade ❑ Mound Maximum Effluent Particle Size rn dIa. ❑ NA ❑ Drip-Line ❑ Ot`er. ❑ NA Other: ❑ NA Other: • c.tank effluent Other. ❑ NA •Values typical for domestic wastewater and septi MAINTENANCE SGHEd,ULE,' . Sef'(rice Event- Service Frequency .t;.:: cnth s) (Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: 3 ears ~ti 1 = -7[; en combined sludge and scum equals one-third ('h) of tank volume NA Pump out contents of tank(s) [?,-V7F-en,the high water alarm is activated n month(s) Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every: G earls least once [I month(s) ,,pp ❑ NA Clean effluent filter At every: year(s) !T'C month(s) [J NA Inspect pump, pump controls; alarm At least once every. c ear(s) O month(s) NA Flush laterals and pressure test At least once every: ❑ ear(s) Other. ; :'At least once every ❑ month(s) NA ❑ ,ear(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 (pumper). 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 eom.bined..sludge ,a..fi.d scum and a 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 pending ;of effluent one the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authonty. When the combined accumulation of sludge'°and scum in any treatment tank equals one-third ('h) 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. F~16,:OthBr~B®fV1C8ti,.II1CIUdlflq~bllt"lltlt„11n11t8d t0„the servicing of effluerft,,pfil(ef5, maGhellt6gl or, pressurizedcomponents pretreatment units, any 9e tlice ;a rtenance requirements that require servicing at>intervals of 12 months or less require documentation ndays of completion the deed reaing , _ y A service report shall be provided to the local regulatory auth l GMW (12/02) I - - . 51 Page of START UP AND OPERATION For new construction, pnor,to use o the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals that may impede the treatment process,and/or damage the soil dispersal cell(s)-. If high concentrations are detected have the contents of the tank(s) removed by a sePto9a servicing operator p , nor to use. - , ,System start up.shall i'1dt occur W* fib i soli conditions are frozen' at the infiltrative surface. During extended power outages pump tanks `*6y! fill above normal high water levels When power is restored the excess wastewater will be discharged to the dispersal cell(s).in one large dose and:may overload them:resulting in thebackup or surface discharge of effluent. To avoid this situation have the` cortents of 'the pump `tank` removed ti y a Sel?to9a SENICIri gOPerator prior to'restoring, Power to the ' r POWTS Maintainer to assist in manually`. operating the pump controls to restore normal `levels effluent pump or contact a Plumber o *151 i 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 1.5 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; rg 9 peelings: g g , degreasers; dental floss diapers disinfectants fat foundation drain pcsm baby wipes; cigarette ruit 8 ves etable ocotton gasoline; ease, herbicides, meat scraps, medications; oil painting products; pesticides; sanitary napkins; tampons; and water softener brine.` ABANDONMENT.: - , When the POWTS Wlp. ihd/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandons ih Compliance with chapter Comm 83.33, Wisconsih Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. The.conte";gf:all tanks and pits shall. be removed and properly disposed of by a Septage Servicing Operator • After puMoirlg all tanks and pits shall be excavated and removed 'or!their 'covers removed and the void space filled with soil, gravel or gnother.inert solid material. CONTINGENCY PLAN If the POWTS°fails°and cannot be`~repaire&the following measures•;.have-been; or-must.be-taken, to provide a code compliant 'replacement system: ; 1 0 A suitable replacement area has been evaluated and may, be utilized for the location of a replacement soil absorption t system setbacks from a are should oe protected. d tune, lit I r ance.and,.compactlon a_n.d.,Should not be infringed, upon by qoan g p po s' and wells Failure to protect the replacement area will rASiJIt iri the need fbi`i nBW Sdil'and site `evaluati'on.to establistl a suitable replacerrient'area,.- Replacement systems must cdhlpfy` With ti i'rttlee in effect st that time. A suitatfle"rioli6"*nfere9~is, not available due'to setback and/or soil limitations. earring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS he.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:,.lf no replacement area.is available. a holding tank may be installed as a last resorrto"replace the failed POWTS. w _ . 0 Mound and at-grade soli absorption systems maybe 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 OtAil TREATMENT TANK UNDER" ANYiCIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR'OF A TANK MAY BE' DIFFICULT OR IMPOSSIBLE. - ADDITIONAL COMMENTS POWTS MAINTAINER "POWYS INST LLER . Name Name j Phone- fl Pnone SEPTAGE:SERV CING OP T . PUMPER „ LOCAL REGULATORY.„AUTHORITY Nariie, , • ~ . Phone "Phone This document was drafted by the Chippewa County Zoning Department in compliance with chapter Comm 83.22(2)(b)(1)(d)&(0 and 83.54(1); (2) & (3)1: Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Z~~ u lnck lb. e k\ h u a vy\Wye - Mailing Address 101% GJVJc,A Aak IJr►v1C.I flujS?i1T W j ,0 PropertyAddress 01 D G~` jr n 04 L ~r► yr _ (Verification required from Planning & Zoning Department for new construction.) City/State N u s ,n , Via Parcel Identification Number O Q O 1 0 00 X10 D O 3 LEGAL DESCRIPTION ' Property Location ~ %a , IM '/a , sec. 7 , T V9 N R l 7 W, Town of t4~5'fAl Subdivision , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (D $ 0_1 O off- , Volume m(Q , Page # qS Spec house yes Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed corded in Register of Deeds Office. Number of bedrooms 3 er_ /'h 4/~71~7_d~ g SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey reap if reference is made in the warranty deed. (REV. 08/05) J 1 9 0 tf ( 0 11 5 6 8 0 7 8 2 STATE BAR OF WISCONSIN FORM 1 - 1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO-, WI D current number RECEIVED FOR RECORD 06-04-2002 9:00 AM This Deed, made between John C. Bezdicek and Marion L. WARRANTY Bezdicek husband and wif EX EMT # DEED XEAP7 lk Grantor, REC FEE : 13.00 and Joseph R Hammer and DeAin M. Hammer, husband and TRANS FEE: 654.00 COPY FEE: wife CERT COPY FEE: PAGES : 2 Grantee Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wiscons' (the "Property"): Recording Area r Name and Return ddress T `~1n en R ammer~5 ``P Ne QOS {h,v D1Q7 old Oaks Dr Hudso WI 54016 020100080000 Parcel Identification Number (PIN) This is not homestead property. (isj (is not) (Continued) Together will all appurtenant rights, title and interests. None Grantor warrants that the title to the Property is good, indefeasable in simple fee and free and clear of encumbrances except Dated this 30th day of may 2002 (SEAL) (SEAL) VAL_ hn C. Bezdic arion L. BezdiceW, (SEAL) (SEAL) s LUEN AUTHENTICATION A loam AfUXWO Expires corrvois- Signature(s) 31. 2003 State ss. n authenticated this l01i c o• County. day of Personally came before me this - 3 st day of "1)0. 2 O 0 2 the above named John C Be dicek and Marion L. Bezdicek husband and wife s TITLE: MEMBER STATE BAR OF WISCONSIN to (If not, me known to be the person who executed the foregoing authorized by §706.06, Wis. Stats.) instrument and acknowledge the same. THIS INSTRUMENT WAS DRA~ Coldwell Banker Burne 02-05274 1301 Coulee Road Notary tic, of n t. zo+,~ Hudson WI 54016 My co ission is pe ent. (If not, state expiration date: ( Signatures may be authenticated or acknowledged. Both are OC f f~ , ~C7C~3 ) not necessary.) Names of Demons si in in an ca aci must be ed or g1jIted below their si ature. 5-17AXE AR ISC NSIN Wisconsin LegalBlank o.,inc. WARRANTY DEED FORM No. 1 - 1998 Milwaukee, Wis. J 190Llf' 0`l6 EXHIBIT "A" Legal Description A parcel of land located in the Southwest Quarter of the Northeast Quarter of Section 7-29-19, Town of Hudson, described as follows: Commencing at the East Quarter corner of said Section 7; thence South 89 degrees 26 minutes West on the south line of said Northeast 1 /4 2165.89 feet; thence North 0 degrees 46 minutes East 525.31 feet to the place of beginning; thence South 89 degrees 26 minutes West 338.03 feet; thence Northeasterly 129.04 feet on a 252.33 foot radius curve concave Southeasterly, chord bearing North 14 degrees 05 minutes East 127.64 feet; thence North 28 degrees 44 minutes East 158.91 feet; thence Northeasterly 202.95 feet along a 406.50 foot radius curve, concave Southeasterly, chord bearing North 43 degrees 02 minutes 10 seconds East 200.85 feet; thence North 57 degrees 20 minutes 20 seconds East 19.17 feet; thence South 2 degrees 09 minutes 40 seconds East on the Westerly line of town road 45.06 feet; thence Southeasterly 185.23 feet on the Southwesterly line of said town road on a 223.99 foot radius curve, concave Northeasterly, chord bearing South 25 degrees 51 minutes 10 seconds East 180.00 feet; thence South 0 degrees 46 minutes West 209.95 feet to the place of beginning. Also a roadway easement 30 feet in width located in the Southwest Quarter of the Northeast Quarter of Section 7, Township 29 North, Range 19 West, Town of Hudson, being all lands lying 15 feet radially and at right angles each side of the following described centerline of roadway; commencing at the East Quarter corner of said Section 7; thence South 89 degrees 26 minutes West (true bearing) 2620.30 feet along the South line of said Northeast Quarter; thence North O degrees 10 minutes East 525.20 feet along the West line of said Northeast Quarter; thence North 89 degrees 26 minutes East 106.88 feet to the Point of Beginning; thence Northeasterly 136.70 feet along a 267.33 foot radius curve concave Southeasterly whose chord bears North 14 degrees 05 minutes East 135.22 feet; thence North 28 degrees 44 minutes East 158.91 feet; thence Northeasterly 210.44 feet along a 421.50 foot radius curve concave Southeasterly whose chord bears North 43 degrees 02 minutes 10 seconds East 208.26 feet; thence North 57 degrees 20 minutes 20 seconds East 66.14 feet to the Point of Termination, said Point of Termination being on the centerline of a proposed town road. Records of St. Croix County, Wisconsin. Ii S L / Z Wisconsin Department of Co SOIL EVALUATION RE Page of W1 CC~ Division of Safety and Bull s r in accordance with Comm 85, Wis. Adm Co U unty G~ prr,l Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan musty,,. r ~Pa~. include, but not limited to'. vertical and horizontal reference point (BM), direction and Q 7^ _ /~Q ^ Q percent slope, scale or dimensions, north arrow, and location and distance to nearest road.` % ! CJ ewe by Date Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 1504 (1) (m)). 1ti Property Owne Properly Location 'Govt. Lot 1/4' -i14 S Ta N R N Property Owner's Mailing Addre s Lot # Block # Subd. Name CSM# Cit State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road I ]P s011- b i,~- s o (6/a ~y~y- yap c) Id ot/L oaks ~,;O 3 ' F-1 New Construction Use ~~tesidential I Number of bedrooms Code derived design flow rate 7 GPD Weplacement (Public or commercial - D scribe: eLL ka ~ Flood Plain elevation if applicable ft Parent material 1 U General commen and recommendations o2ct~(~nJev~1a N,~ 1 SFO~~OVL✓t~Q~o~~ r~u\\ Fv~ooS l~l f Qwn0JQ f~ga Sra~~ %~l s~y`~Y an ©~eTS~.oti p,.~.>a~c(2ItsZ4r 4s S S~l✓ 97_~f 9~8 Boring © Boring # Pit Ground surface elev. ff Depth to limiting factor -in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots E GPD/~Eff#2 in Munsell Qu. Sz. Cont. Color Gr Sz. Sh 33-6 Z55 y s o. `I l ~5 a a Boring # Boring Pit Ground surface elev,/Q&'5 ft. Depth to limiting factor ! in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots E GPD/ft'Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. 1 d-`I 45jk 3/ ontE ' e~ ~I 0 2 y-14-S~R3/ l 3 lea 45 LO~ Y~ Is z~rC, 6- VC) fq's 197- r5 f - d `7 e 61, 0, Z ~D Effluent #1 = BODS > 30:< 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L a c / A / mbe; CST Name (Please S nat J f 4 D to valuation Conducted Telephone Number Address r- r J, OU VI), r Property Owner ~-~~Cl ✓rr1 y~ Parcel ID # Page Z of -Z_ Boring # Boring ❑ ❑ pit Ground surface elev. ft. Depth to limiting factor ~r in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 3/a t s 3 17-35 3/y i rs sit V/,A, (5 ❑ Boring Baring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 02 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. F-1 ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 ' Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/_ The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-8330 (RO5/13) Property Owner G--Vela vvrlla - Parcel ID # Page Z of Z 73 Boring # ~ Boring F-1 pit Ground surface elev. 0"'F- ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 1 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 .3 f -3 ~~s-~ 3/ l Is ❑ Boring ❑ Boring # ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft I in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 ❑ Boring ❑ Boring # Pit Ground surface elev. ft. Depth to limiting factor in. ❑ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 7 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ` ff#2 ' Effluent #1 = BOD s > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD s < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SB D-8330 (R05/13) I 'J 'q^G Q ~ QA y ~ n s ~ ~ d Qks 0 A J~ . t tT: 100 10 X ,