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020-1094-80-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 569569 0 (ATTACH TO PERMIT) GENERAL INFORMATION 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: Bast, Kernon J. I Hudson, Town of 020-1094-80-000 CST BM Elev: Insp.BM Elev: BM Descri1pi n: Section/Town/Range/Map No: /fsD- d /OU• O 76r` d iL-A� 33.29.19.386B TANK INFORMATION ELUNATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �71-- Benchmark �J 2 .� �o 3, o O ` a Alt. --ray 411111110iii / Aeration � Bldg.Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO /L WELL BLDG. Vent to Air Intake ROAD Dt Inlet S�c > 1 > 1 Dt Bottom pfg / Iwo- Header/ n. A sill Aeration Dist.Pi / •� Holding Bot.System -C •�/►�� ?r D O Final Grade PUMP/SIPHON INFORMATIO M jt� S S 3 •S . ' Manufacturer Demand St Cover GPM ICY\ �j �-�c Z•y rob Model Number 11�n k*—&- S/ TDH Lift Fric' o System Head TDH Ft Forcemain Length Dia. SOIL ABSORPTION SYSTEM Z BED/TRENCH Width T en th L No.Of Trenches PIT DIME S No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 2 r I- SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM ACHI G ManufaaurerA INFORMATION Type f System: I ��� m O 7 HA UNIT OR Model Number: y DISTRIBUTION SYSTEM Al�g Header/Manif Id Distribution t p x Hole Size Hole Spacing VentV Pipes) Length I Length Dia Spacing SOIL OOVER 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 Yes ;�� No � Yes 0 7N, COMMENTS: (Include code discrepencies,persons present,etc.) Inspection 411: / �/ 04)spection#2: Location: 680 Cty.Rdudso 1 544016(NE 1/4 NE 1/4 33 T29N R19W) metes&bounds Lot `` Parcel No: 33.29.19.3868 1.)Alt BM Description= "" 2.)Bldg sewer length= 370 -amount of cover Plan revision Required? ❑ Yes W o �j Use other side for additional information. SBD-6710(R.3/97) Date Insepctor's ig ature Cert.No. PLOT PLAN PROJECT Kernon Bast ADDRESS 948 LaBarae Road Hudson Wi 54016 NE 1/4 NE 1/4S 33 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX SYSTEM ELEVATION 93.0 GPD 231 CONVENTIONAL X0( AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 800 gallons DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 465 # of chambers 23 BENCHMARK V.R.P. Bottom of shop siding ASSUME ELEVATION 100' ❑ BOREHOLE O WELL rg,R,p, same as benchmark , X` U" �0 �° Property Line rl m D B-3 Z P" GDd-ai Vent B- DW Failed 2.5 acre lot B-1 Huffcutt ST Seale = 1 /4" = 10' 99, old system is to be pumped and buried 2% Slope 100' (L�1G B.M. ell Existing 8 0 employees and floor drains, no catch basins 8 employees at 13gpd per employee discharging to 2 floor drains at 25 9P d per drain P � Cty Rd H system = 154gpd, X 1.5 for peak flow = 231 gpd I I III 231 gpd /.5/ 20ftA2/chamber= 23.1 chambers 5.6 ft^2 per pair of end plates, 23 chambers, 1 pair of end plates. Cty Rd U County j r � Safety and Buildings Division \d 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(to be fined in by Co.) Madi 317-"2 �.G� Permit Application Transaction Number In accordance with 138321(2),Wis.Adm.Code,submission of thus form to the appropriate governmental unit 2 t9 A0�7 is required prioyzaoing a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department di Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Prhwy Law,s.15. 1 m Stets. �Q" L Application Information—Please Print All Informati &Z It Property Owner's Name / Parcel# L- r end - Property Owner's Mailing Address Property Location 30D D Z , GovL Lot (. Q City,S Zip Cod Phone Number �/y 1/, Section 4'1', Type of Banding(check all that apply) Lot# T N; R W 2 Family Dwelling—Number of Bedrooms Subdivision N C Block# blic/Corimrercial—Describe Use y' G _ —r-- ❑City of ❑State Owned—Describe Use CSM Number ❑Village of 23 r 3 .n , on of ZrL Z III.Type of Permit: ( eck o oz on Complete line B if applicable) A. ❑New System >Swlacement System Treatmemt/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) B• ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Numbs d Date ued Before Expiration Owner IV.Type of POWTS System/Component/Device: Check an that apply) Non-Pressurized In-Ground ❑Pressurized 1n-Ground ❑At-Grade ❑Mound 2:24 rn.of suitable soil ❑Mound<24 in.of suitable soil / ❑Holding Tank ❑Other Dispersal Componemrt(explain) ❑Pretreatment Device(expl " G G V.Dis rsal/Trea ent Area Information: ? r Design Flow(gpd) Design Soil Application f) Dispersal Area Required(sf) Dispersal Area Proposed(sfj System Elevation VL Tank Info Capacity in Tow #of Mamufacnuer Gallons Gallons Units o$ v New Tamka Existing Tanta L12 �� +�+ 015 3 G✓ e -H ink y a Septic or Holding Tank Dosing Chamber VII.Responsibility Statement-4 the undersigned,assume risibility for installation of the POWTS shown on the attached plans. Plumber' Name(Print) Plumber' MPAIPRS Number Business Phone Number 5. 7 Plumberes Address(Street ,State,Zip 2� OUR /De artment Use On XApprovcd ❑ rov Permit Fee Date Issued Issuing t Signature en Reason for mat s 475. 0& J`)J 9 4 1X CoBigf( l/Reasons for Disapproval ?� �n��P.aCif n sy 1.Septic tank,effluent filter and tJ dispersal cell must be serviced/maintained ®S V 3 3 3 as per management plan provided by plumber. 2.All setback requirements must be maintained or the system and submit to the County only an paper not less than 8 Will inches in sift SBD-6398(R.11/11) SHAUN R BIRD Page 2 5/15/2014 n Owner Responsibilities: • The current owner,and each subsequent owner,shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.SPS 383.54(1). • 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. • 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 Industry Services 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 and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 . 7 This Amount Will Be Invoiced. erard M Swan When You Receive That Invoice, . POWTS Plan Reviewer,Integrated Services Please Include a Copy With Your (608)789-7892,Mon-Fri, 7:15 am-4:00 pm Payment Submittal. jerry.swim @wisconsin.gov WiSMART code: 7633 cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm Note: Effective January 1,2012, all codes under the jurisdiction of the Division of Industry Services(formerly Safety&Buildings)will be modified. Code references with prefixes starting with"Comm"have been replaced with "SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to -the Department of Safety&Professional Services.Additionally,all IS(formerly S&B)codes have been renumbered and addressed in a"300"series. For future reference,the Wisconsin Commercial Building Code will be addressed a b by 0S Chapters 360-366. ,. as J ..•d..y.LF I oti4nxTMF� DIVISION OF INDUSTRY SERVICES U°�sti�'.., TO 3824 N CREEKSIDE LA HOLMEN WI 54636 Contact Through Relay 3 K www.dsps.wi.gov/sb/ www.wisconsin.gov �Ossror�+LSti Scott Walker,Governor Dave Ross,Secretary May 15,2014 CUST ID No. 226900 ATTN:POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/15/2016 SITE: Identification Numbers Kernon Burt Transaction ID No.2401067 680 County Road U Site ID No. 802042 Town of Hudson Please refer to both identification numbers, St Croix.County above,in all correspondence with the agency. NEIA,NE1/4, S33,T29N,R19W FOR: Description:Commercial Non-pressurized In-ground POWTS/2%slope Object Type:POWTS Component Manual Regulated Object ID No.: 1484280 Maintenance required; Replacement system; 231 GPD Flow rate; 136 in Soil minimum depth to limiting factor from original grade; System(s):In-ground POWTS Component-Ver.2.0,SBD-10705-P(N.01/01,R. 10/12);Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s)referenced above. The owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code COND requirements. AP No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, DEPT OF stats. PROFESSIO The following conditions shall be met during construction or installation and prior to occupancy or use: DIVISION OF IN Reminders: • 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. SEE ORRE • 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. 145.20(2)(d),Wis.Stats. • A state approved effluent filter is required.Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required.Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • All POWTS component piping material shall be SPS 384,Wis.Adm.Code compliant. • 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. SHAUN R BIRD Page 2 5/15/2014 Owner Responsibilities: • The current owner,and each subsequent owner,shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • 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. • 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 Industry Services 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 and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 • This Amount Will Be Invoiced. erard M Swim When You Receive That Invoice, . POWTS Plan Reviewer,Integrated Services Please Include a Copy With Your (608)789-7892,Mon-Fri, 7:15 am-4:00 pm Payment Submittal. jerry.swim @wisconsin.gov WiSMART code: 7633 cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services(formerly Safety&Buildings)will be modified. Code references with prefixes starting with"Comm"have been replaced with ' "SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to ,-the Department of Safety&Professional Services.Additionally,all IS(formerly S&B)codes have been renumbered and addressed in a"300" series. For future reference,the Wisconsin Commercial Building Code will be addressed z ni sr`% bb SPS Chapters 360-366. RECEIVED Cover Page SAY 12-.2014 IIVh..4 INDUSTRY SERVICES Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 5/6/14 Owner: Kernon Bast Location: NE 1/4 NE 1/4 S33 T29 N,R19W 680 Cty Rd U Hudson System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) T/O Page# Rp Eo LY 1. Cover Page S FTyANt) 2. Plot Plan tuSTR yRV/CFs 3. Chamber Cross Section �RVICE3 4-6. Maintanance and, ontingency Plan 7. Filter Specification heet 0/NV OENCE' 8-10. Soil Test Signature License number 22 900 PLOT PLAN PROJECT Kernon Bast ADDRESS 948 LaBaroe Road Hudson Wi 54016 NE 1/4,NE 1/4S 33 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX SYSTEM ELEVATION 93.0 GPD 231 CONVENTIONAL XXX AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 800 gallons DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 465 # of chambers 23 IL BENCHMARK V.R.P. Bottom of shop siding ASSUME ELEVATION 100' ❑ BOREHOLE O WELL :H.R.P. sameasbenchmark Property Line ❑ B-3 Vent B- DW Failed 2.5 acre lot B- 1 H uffc utt ST Scale = 1/4" = 10' 99, old system is to be pumped and buried 2% Slope 1 QO' ST B.M.* Well Existing 8 0 employees and floor drains, no catch basins 8 employees at 13 gpd per employee discharging to 2 floor drains at 25 gpd per drain Cty Rd N system = 154gpd, X 1.5 for peak flow = 231 gpd 231 gpd /.5/ 20ftA2/chamber= 23.1 chambers 5.6 ft^2 per pair of end plates, 23 chambers, 1 pair of end plates. Cty Rd U i Cross Section of Quick 4 Standard-W Leaching Chamber Typical cross section for 1-of 1 cells Intial Grade Elevation Quick 4 Standard 100.0' To be >1' above grade Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of Finish grade elevation end plates 1 n0 n' Typical Installation Vent Grade 4' 4" ,A/30/34 From Septic Tank 2„ ' 4' Long 34" Grade at System Elevation 1-3' X 94' Cell Same on other end Observation tubeNent Located at end of cell A 23 chambers per cell System elevations: A-93.0' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pie of SYSTEM SPECIFICATIONS LILE FORMAT ION ❑INA Septic Tank Capacity S I' Septic Tank Manufacturer ❑ Effluent Filter Manufacturer ❑ ESIGN PARAMETERS NA Number of Bedrooms 9NA Effluent Filter Model Number of Public Facility Units Pump Tank Capacity I NA j Estimated flow(average) Vd Pump Tank Manufacturer NA Pump Manufacturer NA Design flaw(peak),(Estimated x 1.5) _ NA ! Pump Model Soil Application Rate , aVda 1Rz Standard Influsnt/Effluent Quality Monthly average` Pretreatment Unit Fats oil S Grease (FOG) 530 mgt 13 Sand/Gravel Filter O Peat Filter ; Biochemical Oxygen Demand (BODa) 420 m9A. ❑NA 0 Mechanical Aeration cti DD Wetland Total Suspended Solids (TSS) 5150 mg/L D Disinfeon Dispersal Cells) ❑NA Pretreated Effluent Quality Monthly average -Ground(gray) p In-Ground(pressurized) Biochemical Own Demand (BODs) 530 mg/L D Mound Total Suspended Solids (TSS) 530 mg/L ANA [3 Alt-Grade etric mean) 5104"00ml ❑Drip-Line ❑Other: Fecal Coflform(9eom Other ❑NA imaximum Effluent Particle Size K in dia. ❑NA Other NA Other: 17 NA Other: ❑NA `values typical for domestic wastewater and septic tank effluent. NTENANCE SCHEDULE Service Frequency Service Event D month(s) 101 Inspect condition of tank(e) At least once every: s (Maximum 3 years) ❑NA (Pump out contents of tanks) When combined sludge and scum equals one-third(Y)of tank volume DNA ❑months) (Maximum 3 years) ❑NA Inspect dispersal 08111(s) At least once every: �„� ear s 1 morrth(s) ❑NA 1-jean effluent filter At least once every: , ar(s � ❑months) NA I nspect pump.Pump controls&alarm At least once every: ❑ s Mush laterals and pressure test At least once every: D fear(s)s) NA ❑month(s) NA �tt�ar At least once every: ❑ s) NA r: MAINTENANCE INSTRUCTIONS ter llnspedions of tanks and dispersal cells shall be made by an individual carrying one of the folkr licenses or rtk spections msust (Plumber,Master Plumber Restricted Sewer,POWTS Inspector;POWTS Maintainer;Septag linckrde a visual inspection of the tank(s)to identify any missing or broken hardware,Identify any cracks or leaks,measure the volume of kiducl a fudge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be ed to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. ,visually inspect 'The ponding of effluent.on the ground surface may indicate a falling condition and requires the immediate notification of the local 1egulatory authority. IJVhen the combined accumulation of sludge and inO any etank or eq d Id p�(%)or more�onch�e�volume, NRe113,contents of the tank shall be removed by a Septage Servicing 14dministrative Code. ent units, 1411 other services,including but not limited to the servicing of effluent filters,mechanical or pressurized components, � jwW any servicing at intervals of 512 months,shall be performad by a certified POWTS Maintainer. 14 service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Pop _of resence of painting products or other Chemicals d*t START UP AND OPERATION treatment tank(s)far the p have the contents of thO For new construction, Prior to use of the PO damage the dispersal C91I(s). If high Concentrations are detected may impede the treatment Process and/or damage the tank(s)removed by a septage servicing operator prior to use. when soil conditions are frozen at the infiltrative surface• r is restored the excess wastewater will bo System start up shall not occur normal III levels. When P or surface discharge of effluenit. During power outages pump tanks may fill above overio�ing the cells)and may result in the backup to restoring power to the discharged to the dispersal ca(g)in one large dose, tank removed by a Septage Servicing OPmatOr al levels have the contents of the pump rating the pump controls to restore norm To avoid this situation ha effluent pump o contact a Plumber or POWTS Maintainer to assist in manually WM within the pump tank. park over,o otherwise disturb or compact.the area within r tanks and dispersal Calls. Do not drive or a Do not drive or pa rk vehicles ove mound or at-grade soil absorption area. per and prolong t fife of the POW* 15 feet down slope of any improve the foundation drain from the wastewater stream may dental diapers; disinfectants; fat: udis; Reduction or elimination of the fol Condoms; Cotton swabs; degreasers; fps; medications; oil; painting Prod ar>tibiotics; baby wipes; it gild cigarette peelings; gasoline; grease; herbiddes, meat (sump Pump) water, fruit and vegetable and Wa softener brine. pesticides;sanitary napkins;tampons; r Is permanently taken out of service the following steps shall be taken to insure that the system is propetlY ABANDONMENT sin Administrative Code: When the POWTS fails ra�pl Pe r Comm 83.33,WLscon and sefery abandoned lance with chapte • All piping to tanks and pits shall be disconnected and the abandoned pipe opening sealed. Of by a Septage Servicing Operator • The contents of all tanks and pits shall be removed and�rope��i it Covers removed and the void space fined with spit, • After pumping, all tanks and pits shall be excavated gravel or another inert solid material. CONTINGENCY PLAN be repaired the following measures have been, or must be taken. to provide a code Complirpnt If the POWTS falls and cannot replacement system: replacement soil absorption systelm. eras has been evaluated and may be utilized for location ld not be infringed upon by re4uhlad ❑ A suitable replacement should s protected from disturbance and compact man;area will result In the nded The replacement sod structure,lot lines and wells. Failure to protect the reP� must comply with the ruter4 in setbacks from existing and propo t area. Reps for a now soil and site evaluation to establish a suitable replacemen effect at that time. advances In POWfS technol09V a lable due to setback)A suitable replacement area as a last we' the to replace t failed PO limitations. 8artir►S holding tank may be in failure of the POWTS a soil and a installed � ❑ The site has not been evaluated to identify a suitable replacement Srcees 1JA ' avallabie a holding tank may be must be performed to locate a suitable replacement area. if no rep/ a last resat to replace the failed POWTS. place ❑ Mou nd and at-grade sot absorption systems may be reconmtruct��in ffect atlthat time.�val of the biomat at the infiltra# E surface. Reconstructions of such systems must comply with <NVARNING» E8 AN DEATH MAY RESULT. RESCUE O DIOR INSUFFICIENT OXYGEN. DO IMO' SEPTIC,PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL-GAS ENTER A SEPTIC,PUMP OR OTHER TREATMENT TANK UNDEROA MCIppgSIBLE NCEB. PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT ADDITIONAL COMMENTS _ pow I S MAINTAINER a ME Name y Phone E .� J LOCAL REGULATORY AUTHORITY SEPTAGE SERVICING OPERATOR LIMPER Name u Name L phone �b U Phone 7 JJ This docwrrreM w�dratted in compliance with chapter SPS 383.22(2)(b)(1)(d),(fl and 383.54(1),(2)&(3).VViaconain AdminiatratN+e Code. ILTER .RTRIDGE INSTRUC S 20OS TN Installation STEP f Dry fit the filter case onto the end of the outlet pipe to ensure it is centered under the access opening. If not, then either insert more pipe into the tank through the outlet or solvent weld (glue) additional pipe onto the outlet pipe. STEP 2 While the case is still dry fitted on the outlet pipe, measure the length of 3/4-inch pipe needed to brace the filter to the tank end wall if utilizing the optional supplemental side support. If side support method is not utilized, proceed to step four. STEP 3 For installations utilizing the optional supplemental side support: solvent weld the 3/4-inch pipe onto the filter case. If side support method is not utilized, proceed to step four. STEP 4 Solvent weld the filter case onto the outlet pipe. Insert the filter cartridge into the case, pressing down until the filter locks into the bottom of the case. STEP 5 If a VRS switch is utilized: insert into the filter and lock by turning clockwise 900. , Maintenance 1. The effluent filter should be cleaned every time the septic tank is serviced. ' ' , 2. Open the outlet access opening to inspect the tank and filter. 3. Pump the septic tank completely, making sure to remove the sludge y t layer on the bottom of the tank and not just the scum and effluent. I + r 4. Once the effluent level has been lowered below the invert of the outlet pipe, firmly pull up on the filter handle to dislodge the cartridge from the case. 5. Slide the cartridge up and out of the case for cleaning. W 7 t; 6. If a VRS switch connected to an alarm is present,the switch should be removed by turning counterclockwise 900 and cleaned with water only. 7. While holding the cartridge on its side (large flat surface facing { down) over the access opening, rinse off the cartridge with watery �. only, making sure all septage material is rinsed back into the tank. 1r rte, 8. If VRS switch is utilized, replace by inserting into filter and x turning clockwise 900. 9. Insert the filter cartridge back into the case, pressing down until the filter locks into the bottom of the case. 10.Replace and secure the access opening on the tank. k 5• °� °° "'- ' BEAR ONSITET"FILTER CARTRIDGE-FIVE-YEAR LIMITED WARRANTY Bear Onsite filter cartridges are warranted to be free of defects in material and workmanship for five(5)years from the date of consumer purchase. BEAR ONSITE-Filter Case-Lifetime Limited Warranty Bear Onsite warrants the filter case will be free of defects in material and workmanship during normal use for the period of time the original purchaser owns the product. If a defect is found in normal use,Bear Onsite will,at its election,repair,provide a replacement part or product,or make appropriate adjustment.Damage to a product caused by accident,misuse,or abuse is not covered by this warranty.Improper care or malfunctions resulting from units not installed,operated,or maintained in accordance with instructions provided will void the warranty.Proof of purchase(original sales receipt)must be provided to Bear Onsite with all warranty claims.Bear Onsite is not responsible for labor charges,removal charges,installation,or other incidental or consequential costs. In no event shall the liability of Bear Onsite exceed the purchase price of the product. - �a ST. CROIX COUNT''rr SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Addres !^Q' Property Address D (Verification re ' d�fromPhavnning&Z.oning Depaitinent for new construction.) City/State Parcel Identification Nuriber LEGAL DESCRIPTION Property Location '/4 3/U '/4 , Sect , T -�N R h'W, Town o z Subdivision /� C:z/ �f /�l?.rinG / Lot# / Certified Survey Map#a ^_ , V(qume ,Page# Warranty Deed# S� 5 , Voltune 17 /0 ,Page# Z Spec house yes no I.ot line:: identifiab Dyes 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 wasl:e disposal system Owner maintenance responsibilities are specified in§Conan. 83.52(1)and in Chapter 12-St. Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zonng 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. 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 Planning& .Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to a best of my/our knowledge. I/we am/are the owner(s)of the property described above,by virtue of a warranty deed record in Register of Deeds Office. Number of bedrooms GNATURE OF APPLICANT(S) DAT ***Any information that is misrepresented may result in the sanitary permit being rr:voked 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 map if reference is made in the warranty deed. (REV.08/05) 1710FRfF GO 2 t655�45 Doeument Number WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between K2 PROPERTIES RECEIVED FOR RECORD 08-31-2001 8:20 AM a Wisconsin partnership Grantor, WARRANTY DEED AND KERNON J BAST EXEMPT N CERT COPY FEE: COPY FEE: Grantee, TRANSFER FEE: 954.00 RECORDING FEE: 10.00 Witnesseth, That the said Grantor, for a valuable consideration of one PAGES: 1 dollar and other valuable consideration, conveys to Grantee the following described real estate in St.Croix County, State of Wisconsin: Recording Area This is not homestead property. Name and Return Address X5S,.,,n,d rt F. Wall Together with all and singular the hereditaments and appurtenances Street thereunto belonging; And Grantor warrants that the title is good, on,WI 54016 indefeasible in fee simple and free and clear of all encumbrances except easements,covenants,and restrictions of record, and will warrant and defend the same. PART OF THE NE 1/4 OF NE 1/4 OF SECTION 33,TOWNSHIP 29 NORTH, RANGE 19 WEST,ST.CROIX COUNTY, WISCONSIN (Parcel Identification Number) DESCRIBED AS FOLLOWS: THE EAST 352 FEET OF SOUTH 408.52 020-1094-80 FEET OF THE NE 1/4 OF NE 1/4 OF SECTION 33-29-19 EXCEPT PART CONVEYED TO STATE OF WISCONSIN,DEPARTMENT OF TRANSPORTATION IN VOL. 1194,PAGE 463, DOC.NO. 548040. Dated thisjO'bay of OU0.gs. , 20•I. RO IES a Wisconsin partnership By: Paul J. Cramer, Partner By: David A. Kramer artner AUTHENTICATION ACKNOWLEDGMENT Signature(s)�� J.. kAA.ndw, STATE OF WISCONSIN COUNTY OF ST.CROIX Personally came before me this day of 20 auther jcaia t t.L5!j5!4bay of soot the above named K2 PROPERTIES,by Paul J. Kramer and David A. Kramer,partners L� to me known to be the person(s)who executed the foregoing signature �-J g instrument and acknowledge the same. type or print name signature TITLE: MEMBER STATE BAR OF WISCONSIN type or print name (If not, authorized by §706.06, Wis. Stats.) Notary Public ST.CROIX County, My commission is permanent. (If not, state expiration date: THIS INSTRUMENT WAS DRAFTED BY ) Robert F. Wall 'Names of persons signing in any capacity should be typed or printed below their signatures. Property Owner_ Parcel ID# Page of Boring# ❑ Boring ® %Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 --3Z �'' � s � I 11 F-1 Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. _Sc_ilApplicafion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 a Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I 'Eff#2 Effluent#1 =BOD3>30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BODS<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SB68330(RAM) Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85,Wis. Adm. Code L County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must ©/ include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. n percent slope,scale or dimensions,north arrow,and location and distance to nearest road. V —000 Please print all information. Revie Date ST � L Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Property Owner Property Location �`C� r of 1/4 1/d N R E or Govt L Property Owner's Mailing Ad dress Lot# Block# Subd.Name or ��.N oo /�CX----.7// r City State Zip Codf Phone Nu ber City El Vill Town Barest Road . -O C3 New Construction Use:❑ idential I r of bedrooms Code derived design flow rate �_ GPD c Replacement ublic or commercial De/ cnbe: Parent material G¢ ✓ Flood Plain elevation if applicable ft. General oomments � 'log-✓ J j and reoommendationn/s: �/ /� System Type Litz P dLt System Elevation // 3,4 v Bofi E] Boring n9# >�f C gL pit Ground surface elev. ft. Depth to limiting factor // D in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell �Quu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 I -Eff#2 r l tit All V F1 Ong# ❑ Boring / Z [ pit Ground surface elev. ft. Depth to limiting factor bin. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 J m S6� A/1W p <- ,,71 w U �1 it •Effluent#1 =BOD >30<220 mg/L and TSS>30<150 uent#2=BOD 130 mg/L and TSS<30 mg/L CST Name(Please PnrY0 Si a CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 6 — 715-246-4516 Properly Owner_ Parcel ID# Page of ❑ Boring ® �# %Pit Ground surface elev. ft. Depth to limiting factor -�, in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff' in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 'Eff#2 1 -32 �,' F-1 Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil—Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Etf#1 'Eff#2 F-1 Boring# ❑ Pit Boring ❑ Ground surface elev. it. Depth to limiting factor in. Sorb ication Rate Horizon -XWM Dominant Color Redox Description. Texture Stricture Consistence. Boundary Roots GPQM in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 •Effluent#1=BODB>30 1220 mglL and TSS>30<150 mg1L 'Effluent#2=BO05<_30 mgJL and TSS<30 mgll. 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. sea9330*.6root Soil Test Plot Plan Project Name Kernon Bast Shaun Address 948 LaBarge Road Hudson Wi 54016 CS #226900 Lot 1 Subdivision --------- Date 66114 NE 1/4 NE 1/4S 33 T 29 N/R19 W Township Hudson ❑ Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of siding at shop System Elevation 93.0' *HRpSame as Benchmark Property Line ❑ ❑ ❑ DW Failed 2.5 acre lot B- 1 B-2 B-3 Scale = 1 /4" = 10' 99, 100' 2% Slope ST B.M.* Existing 8 W0ell to and floor drains, no catch basins discharging to 8 employees at 13gpd per employee system 2 floor drains at 25 gpd per drain Cty Rd N = 154gpd, X 1.5 for peak flow = 231 gpd Cty Rd U �- �uyr ' PTb. f}67 10/69 Wisconsin Department of Health and Social Services Division of Health PERMIT APPLICATION 6 for PRIVATE DOMESTIC SEWAGE SYSTEMS A. OWNER OF PROPERTY TYPE OR USE BLACK INK_ Name Addres (Street, City, lip Code) l f �} J/79 / / A County r B. LOCATION OF PROPERTY WhERE SYSTEM WILL BE CONSTRUCTED, ALTERED OR EXTENDED Check One: � �a CITY VILLAGE LEGAL DESCRIPTIgN: -TOWNSHIP 0 C. IS LOCAL PEFHIT REQUIRED FOR THIS WORK? �YES NO ��/ PERMIT NUMBER D. SEPTIC TANK CAPACITY/ `f/ ��� Gallons NEW INSTALLATION REPLACEMENT ADDITION MATERIALS: Prefab Concrete / Poure d in Place Steel Other NLMER OF TANKS TO BE INSTALLED: E. TYPE OF OCCUPANCY Check One: One or Two Family Residence Commercial Industrial / Speo�fy Number of Persons to be Accommodated s 7 Number of Bedrooms F. A?'LIANNCES, ETCS Food Waste Grinder YES NO Automatic Clothes Washer YES Y NO Dishwasher YES V NO Automatic Potato Peeler YES _ NO Other (Specify) G. EFFLUENT DISPOSAL SYSTEM NEW EXTENSION ADDITION REPLACEMENT Tile Size No.Lin.Feet Trench Width Depth Number of Lines Seepage Beds Length Width Depth Tile Size No. Lines Seepage Pits Inside diameter -7,*-! Liquid Depth PERCOLATION TEST Test Dept Character of Soil Hours Water Test Time Drop in Water Level Inches Minutes Number Inches Thickness in Inches Since Hole in Hole Intarval Second to Next to Last To Fall 1st Wetted Overni ht in Minutes Last Period Last Period Period Una Inch Ewvnple P- 0 3611 Top Soil 10" Cla 2611 25 es or no 1 30 1/2 -1/2 1/2 60 RECORD DATA FROM MINIMUM OF 3 TEST HOLES Compute size of absorption area in accord with H 62.20 Wis. Administrative Code. S 0 I L B O R I N G S - Minimum 36" Below Prop osed Absorption S stem _ oring Total Depth Depth to Ground Water Depth to Bedrock ! umber Inches Cbserved Estimated Observed Estimated Character of Soil with Thickness in Inches 1 xample 0 72" 72" Black Top Soil 1211, 18"; Sand 1811, 2411 if 't RECOf1D DATA FROM MINIMIJM OF 3 BORE HOLES COMPLETE OTHER SIDE I, the undersigned, hereby certify that the percolation tests reported on this form were made by me or under by supervision in accord with the procedures and method specified in Chapter H 62.20 (3), Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belie NAME �t/ I��-`iI�> - ft ! /�!,( ___ TITLE �'e!r()A/ r i ' J (Type or Print) REGISTRATION N0, or. MASTER PLUMBER LICENSE No. / ADDRESS /` , DATE -" /; �7 SIGNATURE -�`� MASTER PLUMS;R MAKING.APPLICATION JJ � G l2 t!'-' �. %,i , / Y��4;t X"__�_ License Numb MP Signatures- RSW (To be. Compl ted by Issuing Agent) Date of Application ���7 Fee Paid $ Old Permit Issued (d e) .9 / I� Permit Number Agent (name) . �G / - � w F Cpl L i Town, Village, City, County, etc. (Specify) Notes The application cannot be considered for filing until all of the above questions are answered and the fee paid. Agents will forward application, the :fee of $10.00 and Copy (b) of the Permit (yellow copy) to the Division of Health. Checks ,and money orders should be made payable to the Division of Health. Do not write in space below FOR DEPARTMENT USE ONLY DATE RECEIVED ACCEPTED BY _ RETURNED (Initials) (Date) iSee Corres,r j FEE RECEIVED VALID. NO. �{ ���� _ PERMIT N0. (Yes or No) REVIEWED BY APPROVED DATE v (Initials) (Yes or No) COMMENTS: