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Home My WebLink About018-1087-61-000Department of commerce PRIVATE SEWAGE SYSTEM .d Building Divison :~ INSPECTION REPORT NERAL INFORMATION (ATTACH TO PERMIT) rsonal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'emtit Holder's Name: City Village X Township Withuski, Joe Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic iaaD Dosing 6 u d'Ov Aeration ~,~/ ~ _ ~~~ Holding TANK SETBACK INFORMATION TANK TO P/L WELL DT '~ Vent to Air Intake ROAD Septic ~.- / ~ ~ ~ / e Dosing / , 2 Aeration Holding PUMP/SIPHON INFORMATION sr LAS ber ~~_ ~ 3 i'h o~ Frictio Loss Syste Head .0 ~1 ~• ~ Length ,r Dia. Dist. to well E 7S Z~ Nor-,, PTION SYSTEM l?• .~ DIMENSIONS SETBACK INFORMATION DISTRIBUTION SYSTEM h ~ ~ No. O~ renches oO1n~' St. Croix Sanitary Permit No: 399646 0 plan ID No: Tax No: 018-1087-61-000 I STATION BS HI FS ELEV. Benchma ~/ x•!03 ~oS- 3 /ad .~ Alt. BM ~~ ~~- // /o Bldg. Sewer b, 7D t/ t Inlet y3 ~ S SUHt Outlet Dt Inlet ~~ Dt Bottom ea er an. ~•~s y. Dist. Pipe 7.6„ Ip o3 Bot. syste~~. ~ 23 "7 q Final Grade ,r , t over G. ~ y. y3 9 2~ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth ®/ ~ / , ~~ / .~ D1, ei/.,. _ Header/Manifold ~ r 2~r Distribution ~ / rr Pipe s) ~ , ~ ~ , lIJ ~~ t x Hole Sliz~(/ n x Hole Spacing ~ ri Lent Dia g g P 9 Len th Dia S acin / D SOIL COVER r Praeeura Svstems ~nlv YY Mound Or At-Grade Svstems Only ~d Vent to Air Intak ~~ r Gn ~ ~jyL ~I Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched ~ Bed/Trench Center ~ 'r `,,,.Y ~• Bed/Trench Edges Topsoil [~ Yes ~] No (] Yes ~ No COMMENTS: (Include~code discrepencies, persons present, etc.) Inspection #1~( / ~3~/~ Z" Inspection #2:~1/ jlU ~--- Location: 1630 86th Avenue Hammond, WI 54015 SE 1/4 SW 1/4 20 T29N R17W) Hammond O~ks 1st dition Lot Parcel No: 20.2 .1 81 ( ~ _ /_ 1.) Alt BM Description = ST ~ Cov~~~ ` "" "`'+'~/-'~'8'rA~n ~'°-f iN ~t~' s(,j57~ vy. ~ f ,~ Q 2.) Bldg sewer length = 3o'r / I ~ __ - amount of cover = Plan revision Required? [; Yes ;_ No I~I Use other side for additional information. l_ ~ ~ I ~ 31 Date SBD-13710 (R.3/97) U~ I_ Insepctor's ature Safety and Buildings Division County ?Al W. Washington Ave., P.O. Box 7162 ST. CROIX _~ isconsin Madison, wi 53707 - 7162 S-~ Add3 ~~~ e . De artment of Commerce ~ ~ S ~~ SaaitaryPermicNumber Sanitary Permit Application 3 q q ~ Y(~ In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ^ Check if Revision rna be used for second ses Privac Law, s15. 1 m Sm~ plan I.D. NumbergjTE ID #639486 I. Application Information -Please Print All Information 6 2$78 Parcel Number 20 • L 9. I ~. It ~~ Propcrry Owner's Name 018-1087-61-000 JOE WITHUSKI property Location Property Owner's Mailing Address 17W $i 77 COULEE ROAD , APT . 120 SE-= ~ NW Sf • S 20 T 29 N R Zip Code Phone Number Lot Number Block Number City, State Subdivtston Name CSM Number HUDSON WI 54016 -~_~-1~•-,~7 HAMMOND OAKS 1ST ADDITION \,` 2 II. Type of Building (check all that apply) tk der r~ ., ti...:~ ~ ~`~~~ur~ ~ ^Ciry 4i rw6ai~ed C Village ~ 1 or 2 Family Dwelling -Number of Bedrooms HAMMOND _ _ ~.., ownshi ^ Public/Commercial -Describe Use ~- cares[ Road -- ~~. ^ State Owned i ST CROt:~ ~ - ~~taN ~.`` 160TH STREET III. Type of Permit: (Check only one box on line A (numben'~g sthe ej~ ~,W mplete line B ie applicable) ~'oc ounty use A• 1 ~ New 2 ^ Replacement System 3 ^ Replacement of G.^ Addition to S stem Tank Onl Exis _S ste Permit Number Date Issued B. ^ Check if Sanitary Permit Previously Issued lV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 50 ^ Constructed Wetland //o 47 ^ Sand Filter 44 ^ Non -Pressurized In-Ground 21~ Mound Ca X ~ 5~ 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 22 ^ Pressurized In-Ground 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other 45 ^ At-Grade ,, S ?3 V. Dis ersal/Treatment Area Information: - percolation Rate System Elevation Final Grade Design Flow (gpd) Dispersal Arca Dispersal Area Soil Application Elevation Required Proposed Rate(Gals./Days/Sq.Ft.) (Min.Mch) 600 f 600 ~ 600 ~ 1. / N/A 97.4 ~ 99.21 ~ Tank Info Capacity in .Total Number Manufacturer Prefab Site Steel Fiber P18S[lC Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Scp[ic or Holding Tank 1280 - 1280 ~ 1 WIESER CONCRETE Dosing Ct[ambcr 800 VII. Responsibility Statement- I, the undersigned, assume respotuibility for Installation of the POWTS shown on th$ ausi ess Lone Number Plumber's Name (Print) Pltunber's Signature MP/MP12S Number BENNIE HELGESON 220292 715/772-3278 Plumber's Address (Street, Ciry, State, Zip Code) W1229 770TH AVENUE, SPRING VALLEY, WI 54767 VIII. Coun /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Ltstted Issuing Agent Signature (No Sumps) Approved ^ Disapproved Surcharge Fee) ^ Owner Given Initial Adverse ~ 3Z ~ ~2 L Determination 1X. Conditions oP ApprovaUReasons for Disapproval 1. Effluent filter to be installed and maintained per manufacturer's recommendations. 2. All setbacks to system and residential structure must meet applicable code requirements. Attach complete plain (to the County only) for the a7stem on papa' nat lw than 8111=11 laeha In ,! ~p t ~ll~v` ~~~~~~~~ ~ ~~ L~.~~f11~~u.~ ~r ~lu .,,.`~~ ~a r: l~~ non, ~_~1-~~~ c sc ~._ ~a O~y'~ .~:~__.. _y ~~~ c: o~~~w.n.~ ~r~. ~~~- rcllo.{: s {-.~4.-~ ~~ i ~ ~ 3 \ \ ~~..I ' ~~3.0 _~~ i i o.~. o~ ~- ~ { ~~.y Y r 4 t P~.ia~-s (., r~~.^~ I ~rcPaS~CX ('(~C7/SnC7 ~sn-~ - ry`I ~~ ~- y~•p,,~ 1 ro~sG~E ~( ~r& (SV~er. ~~~ S~~~t~f~c~Q ~ ~~ Q ~. 01- __ ~-. ~. -~ / r , _,~_. ~ r1 j_ ~ X00 Oi, ~ cy~~~o.J.~ v y `I S'. I f J r ~~ ~~ ~~~ '~ isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi. us/sb www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Acting Secretary December 11, 2001 CUST ID No.220292 BENN[E W HELGESON HELGESON EXCAVATING W 1229 770TH AVE SPRING VALLEY WI 54767 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 12/11/2003 A7TN.• POWTS Inspector ZONING OTFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Joe Withuski - 160` street St. Croix County, Town of Hammond SE1/4, NW1/4, S20, T29N, R17W FOR: Description: Four Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 823043 Identification Numbers Transaction ID No. 692878 Site ID No. 639486 Please refer to both identification numbers, above, in all cones ondence with the a enc . The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD-10572-P (R 6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD-10573-P (R 6/99). • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.2G(2)(d), Wis. Stats. • A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. Owner Responsibilities • A copy of this letter including instructions and information regarding proper use and maintenance of the system must be given to the. owner and each subsequent owner upon completion of the project. • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. BENN[E W HELGESON Page 2 12/t 1/Ol • The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon. -Fri., 7:15 am - 4:00 pm j swim@comme rce. state. w i. us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 INDEX SHEET PROPERTY OWNER: PROJECT NAME: JOE WITHLTSKI 77 COULEE ROAD APT. 120 HUDSON, WI 54016 JOE WITHUSKI ~~ .s `F ~`~ o ~~ goo, ~O~ so ~~ PROJECT LOCATION: SE 1/4, NW 1/4, S 20 T29 N, R, 17 W ' MUNICIl'ALITY: TOWNSHIl' OF HAMMOND COUNTY: ST. CROIX P•~'W p~Qlty DESIGN: PRESSURE DISTRIBUTION MANUAL SBD-10573-P~I~~It MOUND COMPONENT MANUAL SBD-10572-P (R 6/ ~~VEp ~~ p R~ ~~~ERCE CONTENTS: " pEPA~~~~ AND pNtS1QN OF Page 1: Plot Plan Np~NC~ SEE G4R~ Page 2: Cross Section and Plan View of Mound Page 3: Distribution Pipe Layout Page 4: Septic Tank & Pump Chamber Cross Section & Specifications. Page 5: Wieser Concrete W 1280/800-MR Tank Specifications Page 6: Pump Specifications Page 7: POWTS Owner's Manual & Management Plan - Pg. 1 Page 8: POWTS Owner's Manual & Management Plan - Pg, 2 Name: Bennie Helgeson Signed Address: W 1229 770Th Avenue Spring Valley, WI 54767 Credential number: 220292 Date: December 3, 2001 \ j~~CJ4\YfV'~ ~?~L l.~-1~~'LLI~ ~I \ ~L ~ r i .,,,~4~ ~ r: ,~ hi/l ~ ~ ~~. C SC e ~ ~~ C~c~~~l r3 r~. ~~7. a P~,~o~g ~ ~ ~`f - - _ _ - - - -- - - ^^ ~ I -1 ~ 1 ~ ~ 3 1' ~ ~ i ~'~ f? ~~ ~ ~ '~ 1 3 ~ .O i 6~ i 9 V Ij ~ ~ - C d .t"~ a ~ y- `` ~o ~ r ~ ~._: ~ r-l _ ~ 00 . C i~ ~ ~' r ` ~~ '~ ~ r v ~ ! n //.~ Elw. S.-p~',c j l~u~ry~ ~ah~ ~ ~,~~,,~ fi ro(zsG~Q ~ ~acx (3a~'. j-b~c I n( ~ ~v S~~~t~l-{cQ ~ ~~as Q { ~c.~ b L F- ~ ~~ ,t' L. ~~ ~~ ~~~ ~4~n~r• ~, -Jae ~ ~ -l-~,us~~~ Synthetic Covering Medium Sand Topsoil _J~ E 3 7 % Slope Cc (I 0 f 2N- 2 '2 Aggregate Page ~. Of ~ istribution Pipe • ID G C ~ l~u 9~fy Force Main Plowed From Pump Layer D % Ft. Cross Section Of A Mound System Using E l.S~ Ft. A Bed For The Absorption Area F °~l Ft. G , S` Ft . Signed: License Number: Date: ` Force Main L A ~ Ft. B ~_ Ft. K ~ Ft. L ~ Ft. ~ .~, ~S Ft . r Jb. y~ Ft. W ay.~g Ft. H l~ CU Ft. ~ Observation Pipe ~ ~- B --- ------ -~K-. ~r-------------------- ----------------- ----~ . i L ~~~9h A ~~---- °---------------- ----------------------•~ o~ Cell W I~ -T------- ------------~~ Distribution ~~II Of Zp- 2 %2~ Pipe Aggregate Observation Pipe C/«„ o~..fs aSa rc~- Plan View Of Mound Using A Gell For The Absorption Area C )~o-~.o~ i" ~"G ~ r' S • C• IE'CtviC~~ C i~C.~.,c«~~ ---a Perforolnrl Plpe Onioll J / ~ End Vlew Perloroled PVG Pipt \~~ VI ~ ~„ PvC Force •I.lain From Pump ~ ~/ Distribution Pi ee L Signed: License Number: Dare: Oitl~lbullon..• Pipt ~'S 3~~'a C' leap o~-~-~ Holes Located on Bottom are Equally Spaced P 3~ d `~3 ~.. . . `~ J R - J `` S 1'~ x ~G a ~f ~„ Y ~ ~ _ Hole Diameter f ~$ Inch Lateral /~_ Incn (es) Manifold " ~_ Inches force Main " ~_ Ynches ~.,UVE~~ ~l~e~. 97e9 -J~.uv, bey- o~ ~, atc r Qls X ~o ~o+~~ ~ww..b~r of ~o~~ ~ ~ ~D~ ~I.~YlP.Y`; ~1~~. ~,t~~~`~"~kSl~~ Page yOf~ ' ~ D SPECIFICATIONS SEPTIC TANK E PUMP CHAMBER CROSS SECTION AN 4" CI VENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF JUNCTION BOX APPROVED > 25' FROM DOOR, WINDOW OR WITH CONDUIT MANHOLE COVER FRESH AIR INTAKE W/ PADLOCK E ~ - ---WARNING LABEL FINISHED GRADE ~ a " ,~ MIN. ~_4 6 ra,n. 2yi, y'~ C .1. a?ySERVnT~o~l S. D. ~~ 18" IN. PIPE ~ ~~ 18 rniN. INLET ~~ ~ ~ . GAS- WATER TIGHT SEALS T TIGHT ~ ~, ~IAPPROVED _ A SEAL ~ JOINTS WITH ~~ $~ R ~_ ~ ALM APPROYEO PIPE APPROVED B ' ON 3' ONTO PIPE 3' ~O ~X~~~, ~- ~ , SOLID SOIL ONTO SOLID C ~ ' SOIL PUMP OFF ELEV . /,ppFT. -~-- OFF D 3" APPROVED BEDDING UNDER TANK SEPTIC / DOSE TANK MANUFACTURER: TANK SIZES: SEPTIC DOSE A LARM MANUFACTURER: MODEL NUMBER: SWITCH TYPE: PUMP MANUFACTURER MODEL NUMBER SWITCH TYPE: REQUIRED DISCHARGE RATE ~,~ GPM CONCRETE PAD SPECIFICATIONS T _ 1 n'1'~ rct~S le .S~el~ `' t ~~?C7 GAL. DOSE VOLUME,FLOWBACKG GAL. S?E~C1 GAL . ~ Y. ~7 J (~-I: A = ~5` INCHES = D/.7 GAL. B = 2 INCHES = _~_GAL• C = ~j INCHES = /63 GAL. D ~~,.5 INCHES = GAL. PUMP E ALARM WIRING AS PER ILHR 16.23 WAC ~~ec~ro ~S!~.~APACITIES: b ~ L I Xis J,~I.~.= •P1fY-ia 7f~ ` ~OcLL.~ _~ FEET ' VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE lO~_ FEET + MINIMUM NETWORK SUPPLY PRESSURE ~~ FEET ~ + / ~p FEET FORCEMAIN X r'~'.~FT/100 FT. FRICTION FACTOR ~ "~- T~Q,TAL DYNAMIC HEAD = ~3 FEET ~ ~ ~~'J ~ Y/C~s'~' S~~ ~~.,~c .S~ mac. ~ S ~~~ MP TANK: LENGTH WIDTH ~ DIA~7E~'-n __- INTERNAL DIMENSIONS OF PU LIQUID b~A- ~~,~a CS`cc,) Per 1ytC~ ;IGNED: LICENSE NUMBER: DATE: 1/88 ~.. 11~ V, c • a o ~ ~ ~~ ~ Z a ~Ln~ U V ~ Z ~ ~ ~ ~ WJ O U ~~~ NS ~ ~~ ~ w O I QUO. ~ p F-~ w ~~~ I a\ O ~W j.-. N ~O ~ ~N pWU M N Y~ ~ w~ o oz U o o_ I oVw o Q O Op S O H •Ni~'' ~ ~ N Z ~~ O N a N N ~ U om Z~= ~~ a ~Fiy U ~~~ ~~O O U o ~ vi oN ~wW ~~ ~ ~~ N ~n o z 0 0 ~ °~ f-a ~ovWi .rte _ ~ ~~ ~ ~ I_LI e•\~O~MO Nr mwN MNf O Z41 O \~ ~~a ~..JWO H'~N ~tnQ M is 00 O>= O N i7~ N~~~J>~ ~~U ~ZN ~ Z W J U ~ z !n ..0~==~ ..30= mY UW a wo NJ O YZ Q w~~~ZOZO°~~ °z. a °z o ~ ~ a~ f- o3°mc°~~i~~m~~ a~c~ a~" o Z a~ a ~N !w- F- D F" O Y J ~ ~ ~ Z. NQ ? ? J J ~ ~ 1- O H N U W J N FzcW.> ~ Q U O ~ Q .~ in W II ~ ~ d. Q U N F- Z F s s r~~~ e W M W ~ U N ~~$ SJW h ~w ; ~v e ~~ ; -~~. u s Ic .- u ~~ ~ ~ F 8 ~u~~~ ruent ' Performance ''un'~ Curves ~ METER S FEET 90 25 ~ ~ S 20 70 FQ- O F- ~ 15 ~ 40 10 ~ 20 5 10 0 0 p 10 0 CAPACITY GPM 30 m'/h ~GOULDS~. PU~M~PS~IN~Ce. l METERS FEET 120 35 110 100 90 25 ~ ~ g 70 z 20 H ~ O H 15 ~ 40 10 ~ 20 5 10 0 0 0 L 0 10 CAPACITY 20 J 30 m'/h EfMctlw July 1985 20 30 a0 x, ou , ., ,,.. -- ~ -- 10 ~ POWTS OWNER'S MANUAL 8~ MANAGEMENT PLAN Page 7 of 8 FILE INFORMATION Owner JOE WITHUSKI Permit # DESIGN PARAMETERS Number of Bedrooms 4 ~ ^ NA Number of Commercial Units ^ NA Estimated flow (average) 400 aVda Design flow (peak), (Estimated x 1.5) 600 aVda Soil Application Rate aVda /ftz Influent/EffluentQuclity Monthly average' Fats, Oil 8 Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODE) 420 mg/L Total Suspended Solids (TSS) 5150 m /L Pretreated Effluent Quality ,~ ^ NA Monthly average** Biochemical Oxygen Demand (BODg) 530 mg/L Total Suspended Solids (TSS) 530 mg/L Fecal Coliform (geometric mean) 510' cfu/100m1 Maximum Effluent Particle Size Y inch diameter MA{NTENANCE SCHEDULE SYSTEM SPECIt=tcA ~ wn5 Septic Tank Capacity 280 al ^ NA Septic Tank Manufacturer IESER CONCRETE ~ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model A-100 12!'x16" ^ NA Pump Tank Capacity 800 ai ^ NA Pump Tank Manufacturer IESER CONCRETE ^ NA .Pump Manufacturer GOULDS PUMPS ING^ NA Pump Model 3885 WE03M ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection Manufacturer ^ Peat Filter ^ Wetland ^ Other. NA Dispersal Cell(s) O In-ground (gravity) O At-grade ^ Dri -line ^ in-ground (pressurized) ®Mound ^ Other * Values typical for domestic (non-commerciaQ wastewater and septic tank effluent. ** Values typical for pretreated wastewater. Service Event. Service Frequency Inspect condition of tank(s) At least once every 2 ^ months ~ year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y) of tank volume Inspect dispersal cell(s) At least once every 2 ^ months ~] year(s) (Maximum 3 yrs.) Clean effluent filter At least once every 1 ^ months C~year(s) Inspect pump, pump controls & alarm At least once every 1 ^ months C~year(s) O NA Flush laterals and pressure test At least once every 3 ^ months C~year(s) ^ NA Other. At least once every ^ months ^ year(s) ^ NA Other At least once every ^ months ^ year(s) ^ 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 Servidng Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y) 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreattFment components; and any other maintenance or monitoring at intervals of 12 months or less 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. STARTUP AND OPERATION. For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. dW h ter' : So e 1-t) i ~ ~.~.5 ki ' Page 8 of 8 - 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 surtace 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 s{ope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the pertormance 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. ABANDONMMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to Insure that the system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ^ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction. and should not be infringed upon by required setbacks from existing ar)d proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ~J Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surtace. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAYBE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name - . Phone 715/772-3278 Phone 715/273-5811 SEPTAGE SERVICING OPERATOR (PUMPER) Name JOHNSON SANITATION Phone 715/273-5811 LOCAL REGULATORY AUTHORITY ~ ` Agency ST. CROIX COUNTY ZONING OFFICE Phone 715/386-4680 ~ This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agendes. This document meets the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)8(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. GMW (2/01) Wis~snsiADc~partmentofCommerce SOIL AND SITE EVALUATION Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Page 1 of 3 Gustum Septic Service Attach complete site plan on paper not less than 8%2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and l l di t i St. CrO1X percen e or mems s ope, sca ons, north arrow, and ~ a ~t~nce to nearest road. parcel I D # . . APPLICANT INFORMATION - p/ease`ti " all ir->~br~ a(ti p lti Personal information you provide may be used for•S~oh~ary purpo~. (PrivacyLavG~. 5.04 (1) (m)). ~ ~ Y Date 2 Property Owner ~--~~ ~_ ~ ' ~•°~ r perry Location Humbird Land Corporation ° .Lot n/a SE 1/4 NW 1/4 S 20 T 29 N,R 17 W Property Owner's Mailing Address 3~ al { Block # Subd. Name or CSM# ~~ 332 Minnesota Street, East 1404 `' + ~~Olx _,~ ~ ~l n/a Hammond Oaks ~B Addition City State Zip Code P City ^ ~Ilage ®Town Nearest Road Saint Paul MN 55101 ~~ - ~``` Hammond ~ 160Th Street ^ New Construction ~ Residenti~ll Ntjm~ f ms 3 ^Addition to existing building Use: ^ Replacement ^ Public or commercla describe Code Derived daily flow 450 gpd Recommended design loading rate •5 bed, gpd/ftz .6 trench, gpd/ftz Absorption area required 900 bed, ftz 750 trench, ftz Maximum design loading rate .5 bed, gpolftz .6 trench, gpd/fC~ Recommended infiltration surface elevation(s) along 96.4' contour ft (as referred to site plan benchmark) Additional design I site considerations BM 2 = 97.0' Parent material ground moraines Fkxxd lain elevation, if a livable n~a ft S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U=Unsuitable for system ^ S ®u ®S ^ u ^ S ®u ^ S ®u ^ S ®u ^ S ® u SVIL DESGRIPTIVN REPORT Boring# 1 Ground elev o~n'a Depth to limiting factor 7A" '2 Ground elev DA 7' N Depth to limiting factor . ,,. Horizon Depth Dominant Color Mottles T r t Structure Consisten Bounda Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color ex u e Gr. Sz. Sh. ry Bed Trench 1 0-10 10yr3/2 none sil 2msbk mvfr as 2f,2m 0.5 /; 0.6 2 10-13 10yr4/4 none sil 2msbk mvfr cw if 0.5 ~ 0.6 3 _ 13-16 7.Syr4/4 none gr. sil 2msbk mvfr cw - 0.5 0.6 4 - 16-28 7.Syr4/6 none gr. sl 2msbk mfr cw - 0.5 0.6 5 28-35 7.5 4/6 yr c2-3 10 7/2 7 ~yr~ 8 sil 2msbk mvfi - - n.p. n.p. Remarks: 1 0-9 10yr3/3 none sil 2msbk mvfr as 2f,lm 0.5 0.6 2 9-14 10yr4/4 none sil 2msbk mvfr cw if 0.5 0.6 3 14-21 10yr4/6 none gr. sl 2msbk mvfr cw - 0.5 0.6 4 ~ 21-27 7.Syr4/6 none gr. sl 2msbk mfr cw - 0.5 0.6 5 - 27-36 7.5 4/6 yr c2-3p 10 7/2 7.gyrg/g sil ~ 2msbk mvfi - - n.p. ~ n.p. Remarks: CST Name (Please Print) Signature: ,,~~ Telephone No. Tom Gustum ~i~~r»~ _ 715-658-1344 Address Gustum Septic Service ' Date CST Number Ref# N13450 937th St., New Auburn, WI 54757 3/1/00 227618 1181 t.c coy •s ,~ .5 ,5 ,~ .~ .S 7 .S PROPERTY OWNER; xumbird[.andcor~oration__.._,__.__ _ SOIL DESCRIPTION REPORT PARCEL LD.# - __ 3 Ground elev 97.0' ft Deprh to limiting factor 25' ~~a,~ Page--2--pf :3... Gusrum Septic Service Honzon Depth Dominant Color Mottles Texture Structure sistence Boundary Roots GPDIft in. Munsell Qu. Sz. Cont Cokx ~. ~ ~ Bed ~ Trench 1 0-6 10yr3/3 none sil 2msbk mvfr as 2f,lm 0.5 ~ 0.6 2 ~ 3 - 6-13 13-17 7.Syr4/4 7.Syr4/6 none none sil gt. sil 2msbk 2msbk mvfr mvfr cw cw if - 0.5 0.6 0.5 0.6 4 ~ 17-25 7.Syr4/6 none gr. sl 2msbk mfr cw - 0.5 0.6 5 25-32 7.Syr5/6 c2 7 Sy 5/8~~ gr. sl 2msbk mfi - - 0.5 ~ 0.6 tiew Lode .r ,s .S ,~ ,s Ground elev limiting fades KemarKS: Remarks: ~ I ~ -~-• -, C Property Line ti ~~ ~ ~~ 0 ~ 0 \ ~ m ~ zJ 0 C °- C° ~ ~I '' C cfl m ~ N s/ J O ~ A F ~ >3 ,O L6 o no}uo0 ~„ ,b 96 ono}uo0 ~ ,Cti6 ono}uo0 Property Line ~ ~ ~ ~ ~ ~ Cn N -' r~ II II II II r,-I rn cn ~ m ~ o < C r fTl ~ Z ~~ co ~ ~ fTl ti O ~ z O ~ p O Z7 ~ ~ ~ - o z o cn ° - ~ ~ w ,T, o ~ i I o c~ ~ v ° ~ cn ~ ~ =i O ° _ c ~ ~ S. ~. ~ z o W o ~ ~ C n n ~ ~ ~ O ~' ~ _ C m O z m rv O --i cn ~` ~ D N o yw~ z ~ m o~m3c o ~, o s ~ a , ~ ~ d Z N d ~ 3 ~ 'c. ° ~ n~,c~ ~.~ c cfDyi°'om~ ~ m N o m ~ N - ~ a AAo ~ _ l~ CT1 n ~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer d o e ~.t~ r ~~ L~ S lC i - Mailing Address %7 C>a N ~~ ~cQ 1'a~ ~ c~dso ~'- ~ ~~lO[ b - Property Address (Verification required from Planning Department for new City/State }-~I~mr,n-ohC~ v~T Parcel Identification Number DI8-1 ugh - 6t - [~Do LEGAL DESCRIPTION Property Location ~~ `/<, IV W `/<, Sec. ao , T_~N-R l'7 W, Town of ~/9 m m oh ~ . Subdivision N a..vn m v n d ~ a,k s ~ s+- l~dd ~~ o n ,Lot # ~_. l Certified Survey Map # Volume ,Page # Warranty Deed # ~,~y~/ `~ ,Volume ~ 1 3 ~ ,Page # ~3 Spec house ^ yes ^ no Lot lines identifiable ^ yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber or alicensed pumper verifying that (1) the on-site wastewaterdisposal 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system: with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. An `~ 1 *!'~Y~ GNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. w ti~ SI NATURE OF APPLICANT ~ / 3 i ~i DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ' y~~ 1738P~~c 23 s-ra rt: I3,1K or t\~ISCttxsl~' FoK\~ :. r~,s WAE2RA:~'T1' DEED Uo_ument \umber This Deed, made bclwccn H_ umbird Land Corporation, a_- __ _ !ytinncsotn Corporation Grantor, attd Joseph .A. ~~'ithusld and Erin K. Gray Grantee _~... _ --- - ----- -- Grantor, for a valuable consideration, conveys and warrants to Gr,Inlec the Col!owing described real estate in St. Croix Counn'.Stalc of Wisconsur 659114 i<ATHLEEN N. WALSN kEGISTEk OF DEEDS ST. CkOIX CO., WI fiECEIVED FOR, kECOkD 10-15-2001 10:15 AM YAkkANTY DEED EXEMGT N -, CFkT COPY FEE: ~ `-"~DF'Y FEE: TkANSFEk FEE: 83.70 kECORDING FfE: 11.00 PAGES: 1 ame and R<u)m AJdros. I of <, I Hanunorxi Oaks I st Addir.on Subdivision,Tovcn of Hammond. St. Groin ~~~ ~' Cotmtc. 11'isconsln 018-1087-61-OOU Parcel ldemiCicaliun Number (I'IN) This is nat ho,nestead property (is) (is not) I c.\cepnens :o warranties Subject to notes, easemenls,restnctions,covenants and nglus ofw:ly of record. [tam. :Deluding taut not limned to [hose for drtinagc,\vater retcnlion,ponding,and or utihua as m;iy he sho\\ n On the plat of Ii:llmnond Oats 1st Addition Subdivision recorded in Vol. 8 of Plats, page 2i, Sr Crolz County, N~ISCUIUm ~ i I;nntcc. or am one in the chain of uUe, to Ute[considerauon c~pr ssedtt>crc n, IWtlbeing the slum of $ 27t}J0~ I~,(,tor to [he Dawd this 5th day of October 2001 1lumbird Land Corporation AUTHF.N'PICATION \Ignalurcisl ^uthcntlcnted Ihls day of I I L[{ MF~4HERS ~\TG RFlR OI WISCONSIN ~I (iI aol, ..- uuthonred by ; X06.06, Wis Stat$_j THtS L~'SIRCbtFFT \VqS DKAFTED Hl' Paul A. Baillon, Attorney at Law I ;Signatures nta\ Fk authenucatcd or acl:rto\s'Iedged. IIoth rue not n~•ce~an I • by'_ __~~L~*A-~(NL~/'~ ~-~~.t~CO7/_Presittcnt -- _ . - U----. --- . . Austin J. Baillon AC1criOWLEnGMENT STA I')r OF WISCONSIN 1 ;$. R_amscy __ County'. ) Personally crone before me thl$ Slh da\ of OCtobcr .21101 Utc ahov¢ named Austin J. Baillon w mu knuwt: to b~ Ilh' i1Cr$Un $f t\hu ~,\~~rlCU r:)e Ian cgunl~ inswment and acknowlcd ^ t"li~T] L 22^ ,/ - ~~ ' PAULA. BAILLON I/ • _ ... -Lfi)IdF!iYyrp~yy7NE5B7A MT C~ 4AI$$ILYv EJ(PIRE$ I-J1.~p~,5 ' Paul A. Baillon ^ Nuturv Public, State of Wisconsin ~ qty Catnrnissum is pemtanutt. ([f not , state dxpiratinn date January 31 _ 211115 - 1 ~, ....,,~.. i>~n_ _ .~ :ar,~nn should be t~~ned ur panted beloH~ thnr slgnamrc.a ~~.\HN.\~I\ DEED , STATE d.\N Of N'ISCO.VSI~ FO(L47 .\'O. I . 19Ytl .\Ftik\I,\Tl'vi~ 1'liuFE$ll~.~n L] i':, \ti'~,,\1' tU.til) UI: L~.i.'.\'I din i.,,t..:. _. I LOT 12 I ~~~. ~ ~~~V r~qC ~LNa FD. STEEL MARKER ~ - - - - - -1 \CpR f~ B),~.RFS/ ~.<\ Nl/4 COR. SEC. 20 tv . 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Bo= 23Z lead SurnT '~ 001 COM 12-14-99 RELEASED FOR REVIEW lfosdsllls, wl b4028 Cowttvat/oo loo zoo nrv v.vr. n.Tr• aMwra OFSCRIPflON~ wII•e MI6-606-, ec ~' +~ ~~ Q r. ~ .~ S N a ~S ~ ~ ti ~ ~ p ~ ~ fJ Q ~ ~ ~ ~ tG ~ 1 1'1 ~ ,Q W ~ .~.. 1 ~ ~ f-" ~ C'y ~ ~ `n ~1 W ~ CV 4- Q ~ ~.J c~ Q O ~ `n ~ u ~' ~ ~ °~ 4~~ ~ o~ Z -~ `'- ~_ ~ ~; , ~ ~ ~ ~ *" y. ~ ~~. 04' I ao j~~'S1f 2.55 ~ 5a~'4$ ~~ E ~3' 3: .,~ 1 ~ . V1- `~' ~ r ~.r. ~ , cfJ '- a' .o ~ r o Q `~ ~ v ~~ (`~ ~ ~ ~ r ~,,~ ~ .J o mot' ~ N r. ht -• ~QO'~48'05'E 32~.~5 _ ~ .. ~, .. - ~~IOt' ,~ w .. ,~ 1 ~~ v ~ fi ~, O ~. v- ~~ o ~ 'tom ~ Q r: ~~ ~