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Home My WebLink About018-1082-10-110Wisconsin Depx-rtm~nt r,.. Commerce PRIVATE SEWAGE SYSTEM Safety and Building Divi~ion INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) 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 Halle Builders Inc. Hammond Townshi CST BM Elev: ~ Insp. BM Elev: BM Description: dfl •D ~ Dp .p TANK INFORMATION ~ ` ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic ~ (~ Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ ~ I ~ 1------_ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand M Model Number TDH Lift Fric Loss System Head T Ft For ain Length Dia. Dist. to Wel SOIL ABSORPTION SYSTEM( [ a , (~, °f ) county: St. Croix Sanitary Permit No: 430389 0 State Plan ID N Parcel Tax No: 018-1082-10-110 Sectionfrown/Range/Map No: 30.29.17.574 STATION BS HI FS ELEV. Benchmark 2(0 /v s, ~.0~ Alt. BM J~o1 17 OI •~~r Bldg. Sewer q(~.~3r SUHt Inlet 2, s; 99 SUHt Outlet R • ~ `9 `J Dt Inlet Dt Bottom i~ Header/Man. Dist. Pipe Bot. System Final Grade - St Cover pis (~~~~( `x'.93 9533, BEDITRENCH Width f Length r No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ [? )® (02•~ (! C 3 ` SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING M ct INFORMATION CHAMBER OR Type Of System: ~ ~ I ~ UNIT Model Number: i, -n ~' ~ DISTRIBUTION SYSTEM (1 3~' J Header/Manifold Distribution x H x Hole Spacing Vent to Air Intake Pip Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~, [_] Yes No r-, a Yes (,i No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:_~(/- 3~% ~.~ Inspection #2: Location: 706 159th Street Hammond, WI 54015 (SE 1/4 SE 1/4 30 T29N R17W) M w Ridge 11 Parcel N :30.29.17.574 1.) Alt BM Description = ~ ~Z„;~.,,~,a~,~,, ~{'a r~ S ' S S T ' ~ 2.) Bldg sewer length = L3' ` ~ ip . p~ `~s~ ~~ ~ q ~ " q~•~ -amount of cover = [~~~ (I0~ , f ~~ I ~ I . 3~v = 43'90 (-*) 3) w~ n,~' cer-s~ ~-~.~b•~.. ~o . ~' =9`f ~ l • ~- l = R 3• SS j -- _ --- -- -- ~- - ~ ~. U ae of verso de for additi formati No ~_•' ~ I ~' ~ ~' ~i ~ ~- ~ _- ~-6~10to R /~) (4~ E~ ~ ~ . Date Insepctor's Signature Cert. No. Safety and Buildings Division ~' ~ County CROIX ST Washington Ave., P.O. Box 7162 ' ~ 201 W . . ,~CO IX COU Y `Madison, WI 53707 - 7162 Sanitary Permit Nutttber (w be tUled in by Co.) (608) 266-3151 fl , De artment of state Plan 1.D. Number Sanitary Permit Application ou provide nal information r C d y e, pe so o In accord with Cotttm 83.21, Wis. Adm. lx usod for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if different than rttailing adttress) may I. Application Information -Please Print All Information 706 159TH STREET Property Owrtcr's Na me Parcel X ~ , 574) Lot N Black HALLE BUILDERS INC 18-1082-10-110 Lot # 11 Property OwnePs M ailing Address Property Location 1113 HWY 64 SE lk, SE lti.seccion 30 City. Stan Zip Ctxle Phone Number NEW RII/HNIOND, WI 54017 715/246-6813=~ (circle titre) N; RAZE or~ 'f ~ _ II. Type of BuildinE (check all that aPP1Y) ~ ~`~ Subdivision Name CS:d Number 1 of 2 Family Dwe-ling -Number of Bedrooms 3 MEADOW RIDGE ^ public/Commercial -Describe Use ^City ^Village g.~Towrtshlp of HAMMOND ^ State Owned -Describe Use - III. Type of Permit: (Check o y one box on Une A. Complete litre B if applicable) A' ^ New System ~ ^ Replacement System ^ Treatntent/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ~ Permit Revision ge ui ^ Chan ^ Permit Transfer to New List Previotu Permit Ntunber attd Date lsstted I Before Expiration Plumber Owner f~ ~j fj 3~ ~ ~1 alp G ?j IV. T of POWTS S stem: (Check all that a 1 ) j (~ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mouttti < 24 in. of suitable soil ^ At-Grade Single Pass Sand Filter ^ Conswcted Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Trerunent Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ llrip Line ^ Gravrl-less Pip• ^ Otlter (x I in) ~ V. Dis ersal/Treatment Area Information: l4-" (70 Uis rsal Area Pru wsrd (sf) ystet~~lev3ation 3 - 93.55 Design Flow (gpd) Design Soil Application Rate(gpdsf) Dlsp~nal Afea Reyuirc~ (sl) ~ I 450 ~ .5 900 900 2 - 93.9 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Concrete Conswcted Glass ~ Gallons Galloru of Uniu New Existing Tanks Tu>l:s Septic ur Noldin$ Tank 1000 1000 1 WIESER CONCRETE X Aerobic Treatment Urtit Dosing Chamber VII. Responsibility Statement- I, the undersigned, tassutue respotulhlllty for hutallatlott of the POWTS shows ou the attached laa4. Plumber's Na ttte (Print) Plumber's Si gnature MP/MPRS Number Business Pbone Number BENNIE HELGESOIv' 220292 715/772-3278 Plumber's Addre ss (Strcet, City, State, ode) W1229 770TH AVENUE, SPRING VALLEY, WI 54767 ~ VIII. Count /De artment Use Onl Sanitary Permit Fe (includes Groundwater Date Issued sui Agent Sigrta (No Stamps) Approved ^ Disapproved SUfehar$C FCC) ^ Owner Given Reason (or Denial IX. Conditions of ApprovaUReasotts t'or Disapproval ~ ~ SYSTEM OWNEF2: 3~ ~ ~ ~ t t~,n 5~ S~- S ` 1 Septic tank, effluent filter and ~G (~ ~ ~ _ ~~t~~ ~•„ ,~, dispersal cell must all be serviced /maintained ~ [ , • r ,~ ,~ ! "i*" "" ~~ ~,,~~ 9 - ' ." _ _ `~ as per management plan provided by plumber. I ~ // _ /1 ~ u~` /' 2 ~0~ 't"t ~ . All setback requirements must be maintained ~, y~-$ Swb!~.=__ ' as per applicable code/ordinances. I ` ~" -bQ-cQ~r~~ ~S~ ruu.(~ >~C AttacD complete ptaas (to We County oruy) for we system uu paper our rraa uran wic s a. u,wca r. «.~ NIo1_ l~la~. ~. ._~ct~n~e r . i'la ~ ~ ~ ~t~,,~~ ers.lNC ,'nn ,~ 0 ,~.h..,..~ ~`1~-- Sc4-~e (i~= `~C~~ \.\ ,~ y"per . / oC~ C~~l i , 4 •~~~ c i~ LL 11~ Q+STro brio •~- •~ ~ a B,M. ~ oo, o0 Tip o ~ ~ " St~~.l ~.p-e ~A e~, s ~ .; ~~ Q. 9 7. i{ Y \ ~ ~" v}0 ®~ ~ ,~ Sty e r Pt f ~c '~ r~ E k~, X17. c~ EI¢~. 96,E l S9 ~'~ S~ CppY ,~ N~O~ ~~0.h ,. ,~~.-~ ~ l /_d~ Lt~~ SCu-le ~ I,~ 1V~ ~~eA ~o ~. y" r'~x- . f DUO C~~Y t \ 4 •~~~ c L1 1 r p+STro ~T10 •~ ~ 83 ~oX ,p~ i a~------- B./~. ~ od, 00 P s~o per. ~ ~„ ~\ \~ ~ t ~~ ~ ~ ~ „ Sty ~ ~ ~~,~ ~`~ ~~ E 4ev, 97. ~~ EIe~, 96~v /' ~ ~. ~ S9 tti Sim 1 \ \ ~~ yn~r' `l la~l~~ ~(.l~ I dl~Py-~ ~ ~ rc^~s5 Sec-.~!o~.. _ ~ of _f/~ ~`. ~~~~~~~ ~. _ . _ ~'S._ In t""7~'a'~t~5r5 s ~ G~~ C% ~ T' ~ I , --r-w ~ c~~ ~ c s ~~~-~. CSC ~s ~~~ ~~ ~~~~ ey~s6~~2e~~ ia:s~ ?i~2ahr~~~~ w~~~ sus~v~.ks sr~c ~~;~E ~ ~ ~~ ~ ~ ~' ~ ~~ ~~ L~ ~ c a ~1~~ ~ ~k`~ ~ f ~~~~ i ~~~~ ~~~ ~ ~~~~ ~f~ ~1~1 ~ I ~ ~~ +~ ~ ~ ~ ~ ~~ ~~~ „~'„~ l`l` ~' ~ i ~L~~~ ~ ~~'~,JI~~I{' c~~r~ k u i ,~~~ ~ ~ ~ z E! ~, +~.~ a L4; ~ ~• ~ ,~ i~it ~.~ .~~~~ ~ i tx+ ;,, ~ ~ ~ / ~w ~T ~~o I 09/1612003 'l A' 18 ?15'.'.45?2~? HaLLE Sl!ILDER'~ ~PJi~ F'~~aE 09 K~ y,~ nos N~' '~ ~ ~ ~ ~~~ ~ ~ i ~~~ ~~ ~ ~W~~ I a ~ ~ i ~~ f~ r ~ ~~ ~ ~~~ '~ ~ ~~ ~I~~ i ~ ~_`1 ~ ~ ~ ~ Y lP~Eltr' ~ r, "'°~ V i' t~ ~ ' g ~~ ~ I~ ;! ~, tt I~ L ~~ , n ~ ~ ~~ ~i I I ~ ~ Q ~I ! r S~ 't i '+-~ ~ _r 1~ Y` ii ~ ~ ~ ii ~~ !I r w ~' r _; i~ S' i' .I ! ~ f ~ ~ ~lA~UM~~ f~ u`4. ~-' 4J ~~ ~4 ~~ .~~ W ~3'3i16/2k~d3 i4:18 15::=~?2~7 =:<! LE L3lJILIiER~,:hiC F'A~.~iE. 1~ r. ~ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safet~ and B.f~ilding Division INSPECTION REPORT GENERAL [NFORMATION (ATTACH TO PERMIT) 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 Halle Builders Inc. Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix sanitary Permit No: 430389 0 State Plan ID No: Parcel Tax No: 018-1082-10-110 SectionlTown/Range/Map No: 30.29.17.574 STATION I BS I HI ~ FS I ELEV. I Alt. BM Bldg. Sewer St/Ht Inlet SUHt Outlet Dt Inlet Header/Man. Dist. Pipe Bot. System Final Grade BED/TRENCH 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 ER OR CHA Type Of System: MIN Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) 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 xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil U Yes U No ~ J, Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 706 159th Street Hammond, WI 54015 (SE 1/4 SE 1/4 30 T29N R17W) Meadow Ridge Lot 11 Parcel No: 30.29.17.574 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = i Plan revision Required? ~ Yes ~ No ~ i I; ~ ~ Use other side for additional information. L__ __ __ ____,_ l I___ ~ __ I__ SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. ' Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 County ST. CROIX ~ ~ OnSIn ~ Madison, WI 53707 - 7162 /SC Sanitary Permit Number (to be filled in by eo.) . ~ (~$) 266-3151 7 v ` ~ ~ g' nt of Commerce t me De ar Sanitary Permit Applicati n ~~ ide'C'~I~~ ' state Plan 1.D. Number n you prov In accord with Comm 83.21, Wis. Adm. Code, personal informs may be used for secondary purposes Privacy Law, s15. (1)(tn) lirtg address) trtai Pr ect Address (if different ~ L^ ~ ~ y,,~i ti t All I f i P ~~ ~ C J l ~~ orma on n n r I. Application Information -Please ST ~~ N1,NC Usti' ` ` Property Owner's Na me ZO OFF reel N t Y Bdodet C.S~ ICE HALLE BUILDERS INC 18-1082- I10 11 Property Owner's M ailing Address Property n 1113 HWY 64 SE SE u,section 30 City, State Zip Curie Phone Number NEW RICHMOND, WI 54017 715/246-6813 (circle tine) T N; R~7 E orQ l ~ II. Type of B l: (check all that app y) nn~ S ~ ivision Name CSM Nwtabor ~ or 2 Family Dw -Number of Bedrooms EAD06J RIDGE cial - D ibe Use bliGC ^ p ommer u 3 X 81, ~S S OVillage ~'fownship of HAI`1MOND OCity , O State Owned -Describe Use _ III. Type of Permit: (Check on ne box on line A. Complete line B if applicable) A' ~ New System ~ ^ Replacen t Systcrn ^ Treaunent/Holding Tank Replacemer my ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change ui ^ Permit Tr er to New List Previous Permit Number tud Date Issttod Before Expiration Plumber Owner ' IV. T of POWTS S stem: (Check all that a ) ' l)D Non -Pressurized [n-Ground ^ Mound > 24 in. of 'table soil ^ Mound 24 itt. of suitable soil ^ At•Grade ^ Single Pass Said Filter ^ Constructed Weiland ^ Pressurized In-Ground ^ H ing "I'attlc ^ Y Filter ^ Aerobic 1'reaunent Unit ^ 1` ircul Filter ^ Recirculating Synthetic Media Filter caching Chamtxr ^ Drip Lin ^ Gravel-less Pipc ^ OdIC( (CX lain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(glxlsf) Dispcrs r\r • teyuirud (sl) Disptrsal tees Proposed (sp _ ~ 9 ti _93 5 600 .5 1200 - •`~ VI. Tank Info Capacity in Total Number Manufacture ted t S I Phsuc G Gallons Gallons of Uniu re . New Existinr Tarts Tarts Septic or Holding Tank 1250 1250 1 WIESER CO ETE X ACfI)blt Tre1l1r1e1H UNl Dosing Chamber VII. Responsibility Statement- I, the wtdersigued, wne respattsibility for utstallallou oft POWTS shown on the attached p Plumber's Na me (Print) Plu is Si tore MP/MPRS Numbe Busir-ess Phone N ~ ~~ 20292 715/772-3278 BENNIE HELGESON .,_._,, Plumber's Addre ss (Street, City, State, Zip Code) W1229 770TH AVENUE, SPRING LLEY, 6~'I 54767 VIII. Count /De artment Use Onl d ` d ^ Di Sanitary Permit Fee (includes Growtdwater Date Issued g Agent Signs a (No Stamps) Approve sapprove Surcharge Fee) ~r~ ~ " ^ Ow Reaso or Denial J V iX. Conditions Approv 1 SYSTEM ER: 1 Septic tank, efflu filter and dispersal cell mu tall be serviced / maintaint~d as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach cocupteu plans (to the County only) for the system ou paper not tens tnau sus x u ttuues m ruse ~.~ W ~ ~.---- f 14. ~ I °L ~~t.U el-S-LNG ,~~ _L~ ~~ ~~ . GaraS e 1 y 43e~ ~e~~ Iy''~~ ~' I cJ',~. ~~ r S9 f~ S~ Ipso ~I, 1 Seao~--e ~a~{c ~:..bel ~-160 \ ~. t~ox ~ ~~ ° f ~ 1 Ob, d0 4~ ~ s tt A cj 4 fo -r o~ ~ st.~e, r P~~~ C ~~, y7. o E-e~. 96,E .. • ~•- r ~• ~ ~ .. .' ', Wisconsin Department of Commerce SOIL EVALUATION REPO ~A~~ Page~of~ Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code ~~ S - C~('01 CO , Attach cemplete site plan on paper not less than 81/2 x 11 inches in size. Plan must inGude, but not limited to: vertical and horizontal reference point (BM), direction and p~ l,p, percent slope, scale or dimensions, north arrow, and location and distan to nearest road. ~ ~ ~, D 8 ~ .• ~ •- d ~ I Please pii all ~~~ ~ ~ Re iewed by Date Personal information you provide may be us for secondary purposes (Privacy Law s. 15.04 (1) (m)). ~ . ~~ roe er , p rty ,s , ; „ Properly Location glJe k~U1 e~ ~,'~iM ~~ ~ 203 ovt.Lot SE 1/4SE 1/4 S3Q T ag N R f 7 E(or Property Owner's Mailin Address ,~ ~ i ~ L0l'' ' of # Bock # .Name or CSM# I City State Zip Code Phone Number ^ City ^ Village Town Nearest R d ` N~'~;chroo l.~t SNo/7 (~IS)a` - 4-3 ~'I'Q~lwlon Sq~' S7' ~- ~.S ~.o~r New Construction Use: Residential /Number of bedrooms Code derived design flow rate U 5~ GPD ^ Replacement ^ Public or commeraal -Describe: Parent material Flood Plain elevation ff applicable ft. nd recomme dations: J- 5 (''S t 5 ~' 3 - ~o o~ ~ ~ ' "(• ~ ~ YVC-1^ ~ S FD /`' ~ 4-G 1~ 5 ~`{~'e w T3 93,ss') '~- i. C 9a~Ys') 1 Boring # ~ Boring l ~ pit Ground surface elev. ~ v' ~ ~ft. Depth to limiting factor ~~ in. Sal lion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consister~e Boundary Roots GP D/(F in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 a--l Ioy R 3/a ------ SL aIcUR m F Gs a F 15 .~ a `1- Dy1231s SL aF56 r~F- Ct~1 1 ~r ,5 .9 3 IS-30 y~ W~~ ScL. amsQK ~~ ~ CvJ lv ~' r~l ,~ 30-3b ?msyR`'16 -S aFSa) rnv} R cal Iv F .5 .9 5 36- ~,syR 6 I Fs aFSa rnvFl~ .5 , 9 •3~~ ~. c~~ ~S -(o ~ Boring # ~ Boring ® Pit Ground surface elev. 7~ a ~ ft. Depth to limiting factor ~ Q 0 in. Sal licaaton Rate Horizon Depth Dominant Caor Redox Description Texture Structure Consistence Boundary Roots GP D/fi? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I 3 = ° 0-10 Iby a SL t~R a1 -MF aS ,S , I oZ 10 -I 10 Y 3~3 SL, aFS(3 vY1 ~ Ct.J .S , 3 I -30 to yR yl s~~. amsa rv~ ; C~.J Iv F , y s Ryi - ' 3o-yu 7 ?m -~ ~ S a~5a my c 1v~ .5 5 y~ i ~,5y1?6I~ --~~-~ a s +mvF - - ~ , ..,_- .~+ ~ a" ~~ ~a~ei~ S ' Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 ntglL and TSS _< 30 mglL CST Name (Please Print) r Signature CST Number IJo nr ~ ~", S ~ ova Icy Address Date valuation Conducted Telephone Number a~ ado' s-~. 5fa P~;~~e wi syoa g- I - 03 CIS -ayg -358 P1 . ~ ~ ~ ~'~ol / ~ c~~°~ Property Owner ~C, ~'Z ~ti. ~~ ~/~ 5 Parcel ID # Page ~ of ^ Boring # ^ ~~~7 - pit Ground surface elev. / •a ~' ft. Depth to limiting factor ~ D ~ in. Sal iraition Rate Horzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 'Eff#2 ~ 0 9 layK3 a S~. aF ~ ~nF as aF ,S ,q a -i ~oyR33 s~ aFSi3K w,F~ cw IF 3 iy-a~ ~oyR`-1 SQL, a~s~K r~F~ cW IvF a8-y0 7,5yR`-~1, FS arsaK nnvFR C~J IvF .5 5 /0 7,5yR 6 ~ FS aFSa rnv ~' - .5 5 - s-~~eaKea w~~ 5`IR`~ C= 5 Boring # ^ Boring Pit Ground surface elev. ~~ ft. Depth to limiting factor O ~ in. Soil ption Rate Horizon Depth Dominant Color Redox Description Texture ` Structure Consistence Boundary- Roots GP D/ff _ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I d-13 OyR3~ SL o~~1s rhFR QS a'F •S ,q cZ 13-I JD R33 L o1FS(3 Y~'1F~ 1 F ,S , 3 -9 -a9 ioYR~+I s~L apse ~nF; cal v F • y . ~ y a9-35 ~~Sy Y S aFSBK nwF C1.~1 1vF .5 5 35-~ 7.5 `lR 6 S a S(3 v~'R -- - . ~ ^ ~;~ Bonng # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil 'cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fC~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Etf#2 • Effluent #1 = BODS > 30 _< 220 mglL and TSS >30 < 150 mg/L 'Effluent #2 =GODS < 30 nglL and TSS _< 30 nglL 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. S80.8330 (R.07/00) _~-~li~ .~3U;1~~rs ~S~:~Jy~ SE'ly, Sic. 3v,T~-9N~ ~217~„~ '~ I `'-t' 301, a y~ ~ ~ rtops ~ ~a~~ s+<< ~ P , pi's ma Qa. ye.. 3 ~.. 3 DAN /9 ~} ~" , ~' a. ~'' ~ ~-~ ~~ ~~ ~ ?°~ to re F~ccv, ce p-I- 5 (~m a, 87.88 gi 9$.yy` ~ sa 9-~,aa' ~ ! o .~~~~L 9L,3y ~ Ml~ 7, i fIr s m ~~ ~ ~ t e `~- ,~ ~ . ~~ l ~• ~~ ~ ~ }- '~ , ~ ~ ~ , F 5~U X as Q~ d fl~ o S~ a ~ ~ , ~ i i I ~So~th lat l; re ~,,~ J~ I ~I -I CF-OSS ec~~~oy. G.ti,.Q:~'4~c^~ l IQ{ I~e ~Ll~ 1[~f~P/r~~7.ruc.. of e : ` -e~ e o~--~ ~~~c~~ n ~ rh ~ ~ers ~~~~~~ v ~ta~~~ I1~J .~h i-~ /7~'~TC~~rS ~ [~(~ G P b ~~oob~ ;' 31 ~. i3 c:h~~~~~s ~~~5t~ _ ~3 ~QirS~ POWTS OWNER'S MANUAL & MANAGEMENT P Page-=a 4 FiLE INFO!'tMATION SYSTEM SPECIFIC ONS Owner HALLE BUILDERS INC Septic Tank Ce ty 1250 al . O NA Pem-it # ~3 O 3 Septic Tank ufacturer WIESER CONCRETED NA DESIGN PARAMETERS Effluent F r Manufacturer ZABEL ~:~ Number of Bedrooms 4 ~ O NA Efflue liter Model A-100 12" x 20ID NA Number of Commercial Units D Nq Pu Tank Capacity al ~~ Estimated flow (average) 00 aVda mp Tank Manufacturer IS~NA Design flow (peak), (Estimated x 1.5) 60 aVda ump Manufacturer CIA Soil Application Rate a / Pump Model ®71VA Influent/Effluent Quality Monthly average Pretreatment Unit ®~ O Sand/C~ravel Filter O Peat FUter Fats, Oil & Grease (FOG) 530 mg/L O Mechanical Aeration O Wetland Biochemical Oxygen Demand (BODE SZ20 m Disinfection O Other: Total Suspended SoAds (TSS) 5150 m facturer Pretreated Effluent Quality .~ ~ NA Monthly av ge" pisp Cell(s) Biochemical Oxygen Demand (BODa) 530 ~In-g d (gravity) O In-ground (pressur(zed) Total Suspended Solids (TSS) 530 g/L O At-grad D Mound D Dri line O Other: Fecal Coliform ( eometric mean) 51 cfu/100m1 Maximum Effluent Particle Size Y, diameter Values typical for estfc (non-corm~erdaq wast~wabt pnd septk tank effluent. ' . *• Values typical for pre d wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank(s) At least once every O months year(s) (Maximum 3 yr:;.~ 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 O months C~year(s) (Maximum 3 yta.) Clean effluent filter At least once every months . O year(s) Inspect~pump, pump controls & alarm At least once every months O year(s) O NA Flush laterals and pressure test At least once every O months O year(s) O NA other At least once every O months O year(s) O NA txner: At least once every w O months ,D years O NA - ~ ,,, ,11 MAINTENANCE INSTRUCTIONS ~ Inspections of tanks and dispersal ce a be ma by an ndivl al carrying o e of the follawi certifications: Master Plumber, Master lumber Restricted Sewer, POWTS InWTS ntainer; Septag Servldng Operator. Tank inspections must indude a visual inspection of the tank s) to Identify any missing or hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent e 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, pretreatment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A servir~e 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 othef 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. OWNER: HALLE BUILDERS INC Page l ot,,~,L _ 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 reti(e) and may result in the backup or surface discharge of effluent To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss;'diapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products;• pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMJUIENT 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 and proposed structure, lot (Ines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a §uitat?le 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. BaMng 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 lore#e a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAYBE DIFFICULT OR IMPOSSIBLfE ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name IiELGESON EXCAVATION INC Name JOHNSON SANITATIO ~ ' Phone 715/772-3278 •Phone 715/273-5811 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name JOHNSON SANITATION ~ Agency ST. CROIX COUNTY ZONING Phone Phone 715/386-4680 ~ 715 273-5811 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agendas. This doCUnlBnt rttesti the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)8(f) and 83.54(1), (2) & (3), Wisconsin Administrative Coda. Use of th(s document door OOt guarantee the performance of the POWTS. GhfW (?JOt) ~9~'16I2@a3 14:1'0' 715~46i2~? F-::LLE L'IIILi%_r-:~ ?^Il~ P1-1[~ 'v' 5T CROIK COUNTY SL~PTIC TANtC 14iAIlri'PBNANCB A+-,~~tEBN,Q3NT AMID 4WIIEELSI~' GBRT1FIt^A,'1'1QN r^aRM t~vyat:~Buyer Mailing Addres,5 , Property Address i ~ ~~ d to ~ ~ Q ~' (Vct#ficatioa z~uired from pl,armiag.Depaxbmcnt fax sew City/Statc _ ~ ~~ +~ an,~! Parcel Identification Nttmbcr ~.~ ' f D ~dld G L>~'.GAL TaIi:SCRUrt ~ C~ ~ `~ N-R ~ ~ W Tovrn. of 1 ~ ~i'~ r~. en Property Location /., Ya, Sec. T ~ Subdivisiau Lot #~. ~- Ct.~tified Survey IViap # ~- . Valtlmc '-- Page # Warranty riead # `~ ~ ~4 "~ ~. _. Vo-txtue _~~ . Pa$e # ~ 1 bo«se [~ y~ ~ na Lot lanes zdentifaable t~! yes O n4 S'I'F~NT~NAi•1G'l~ laapt+oper use and maiatenastceaf yt~ septic system could result in its pssmatttre fuiitacti t~ hanrtkwastes. Proper a~intcax~acc oa~ists of pumping out the stiptic tar~lc every three yeas or sooner, if Headed by a licansed pumper. R'hst you gat itsta gad system can affcet the ft~actioa of the septic taalc as a treatment stage is the vrastc disposal bystcm; 'ibe praptxty oavaer ogress to submit to St t~oiA ~ a certtfiartion form. signed lay the oases' and by a a~astCCP~~•]~l?1~~+ r+esinictedplvmbor ar a licenscdpctmpet vctifyi~ that (l~ the arr~site wastevraterdisposal system it; itt proper ~~8 coaditiaa and/or (2} after ia~pectiaa and P~P~6 (~ aeccs~',~ ~ septic tauly u less thzua V3 full of sledge. U~+.'S ~ tmdecsig~aed have ccad thz atwvc requinmhats and agree to tnairrtaia the private sewage disposal s~yattcan with ~dards rrtt fartb„ hexciq as act by the Llepartmaut of Commerce sad the Depattmeat of Natural Rasouttxa, State of W' Office ~~ 3q statiaa8 that Your tic rystrm bas bees maintained mast bto txnaplt:bed sad ret>tioned tv the St. Crotx t,.ottaty Zoning ds: tlxe tlasve year ca italio daft, ` TC3LtE APPIdC,~-.MT RATE O~NI~R tCL+ RTIF~CA'I'ION gie owner~(s} of X (we) certify that ell statements an this form am true io the best of my {our) fosowlodge. i +(we j am (are) I`~.~`ry desccibcd a by virtue of s waztaaty deed racarded is ltegtster of Deeds QfFi:.s. /~ "CURB qF PLICAN'i' BATE 4ttitR• w«~~~+ Any infocmatioa that is taste-represented may result is the sanitary parmsk beitag raveked by the ZO°~g ~' +r ltaclnde frfith filth appltcaEion; a stamped warcattty deed tzotn tlaa Register of 17etxls affiro a copy of the certified ttarvey map if' reftrenac is tztindc in the wat:aury decd 05%19%2E~J3 ;~:56 ~=5::u6r_'_,7.+LLE Fu1~~E<9 :ir_ Ncw;E Er_ , ~ "46':8'Uti ?8L' SJ::~ t:~F 'ISs?C ~dt•.' 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