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HomeMy WebLinkAbout020-1474-07-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 5743_87) 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)). Permit Holder's Name: City Village X Township Parcel Tax No: Speer-Bast Land & Construction LLC, c/o Jaso Hudson, Town of 020-1474-07-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: too_ v 13 PK j — 13.29.19.3004 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic -2-49 _ Benark — 3 4M, #1 /00-0 Dosing Alt BM sj -ii / r / _ D kd`— Aeration Bldg. Sewer sub 9134 Holding St/Ht Inlet1h jc?�2h �•3 Q Z TANK SETBACK INFORMATION SUHt outld TANK TO � VVJELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / Dt Bottom �1' �S wo Dosing /r eader/ anSi� 7_ Aeration (/ftA4► Dist. Pipe ` Holding Bot._ ,ys�e�_ /_ t� �i .Z y0, (- ��- (tJC.� G��"� 0 Final Grade • PUMP/SIPHON INFORMATION �1 Manufacturer Demand St Cover GPM /CfIL 2 -1. Model Number n,(q,Q� p'h nAn TDH Lift Friction Loss System HeA TDH Ft Forcemain Length Dia. Dist.to Well SOIL ABSORPTION SYSTEM 5 BED/TRENCH Width Length No.Of Trenches PIT S S No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 3 __ SETBACK SYSTEM TO P/L� IBLDG WELL LAKE/STREAM LEACHING M u INFORMATION T Of S stem: r / AMB Y Y Zo ZV �/ !� IT Model Number: D IBUTION SYSTEM 0 Head enifold f Distribution , �,( C Hole Size x Hole Spacing Vent to ir take/j („ .}� r / /� Pipe(s) 67 + .�� , R%r,- Length�v 'Dia "l Length y Dia Spacing_ 1� 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 L] Yes E] No M Yes L] No ItL COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: 0/ 15/ Inspection#2: Location: 882 Yellowstor Trail ud WI 54016(SW 1/4 SE 1/4 13 T29N R1 9W) Yellowstone Valley Lot 7 Parcel No: 13.29.19.3004 1.)Alt BM Description 2.)Bldg sewer length= 2 -amount of cover=,,t r -- �, Plan revision Required? [201 Yes J2/No / Use other side for additional information. Q r / -- Date Insepctor's Signet re Cert.No. SBD-6710(R.3/97) Soil Test and system PLOT PLAN PROJECT Jason Bast ADDRESS 400 S. Sencond St. Hudson 54016 SW 1/4 SE 1/4S 13 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX SYSTEM ELEVATION 91.2 91.3/91.4 4' below grade DATE 10/12/14 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 916 # of chambers 45 IL BENCHMARK V.R.P. Top of steel fence post ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Yellow Stone Trail Scale = 1 /4" = 10' All piping shall be SDR 30/34,within 10' of tank, piping shall be Schedule 40. q�cvr�� Pro 4 Bedroom � , House r 1 5' a 1C N h ST 173' v d 3-3' X 62' Cells with>3'spacing 3 20' 5' 97' Vents B.M. 95' B-2 7% Slope 70' B-1 5' 15' Nom" 11 Z-e T /v Drainage easement,surveyed ,/s-k�-pia,.. Vent >6„ Quick4 Standard Leaching Chamber 208' Property Line of Cover with 20.0 ft2 of Area 4' Long 12" 5.6ft^2/pair of end caps 34" Grade at System Elevation Safe nd Buildi/n s Division County q�% 201 � � b .BOX 7162 Sanitary Permit(Number(to be filled in by Co.) a ison, 3 162 OCT 13 2014 7 397 SanePermit A State Transaction Number �'Y �� i�burvrY f /� In accordance with SPS 383.21(2),Wis.Adm Code,subm"&M t r®FM tttn �ental unit _ is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary �2 purposes in accordance with the Privacy Law,s.15.041 m Stats. L Application Information—Please Print All Information Property Owner's Name Parcel# .-,� Property Location Property Owner's Mailing Address op m' i /,3�4) S 5e. - Govt. Qt l City,State lip Code Phone Number �(,c/ i/, _'/4, Section /� (circle on II. ype of Building(check all that apply) / Lot# ily Dwelling—Number of Bedrooms ✓ Subdivision Name Block# � �O' (l ❑Public/Commercial—Describe Use r ❑City of CSM Number El Village of_ _ El Owned--Describe Use _ wn of III.Type f Permit: (Check only one box on line A. Complete line B if applicable) A. .-System ❑Replacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) B. ❑Permit Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expirations N.Type of POWTS System/Component/Device: Check all that a 1 -Pressurized 1n1-kround ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil ❑Holding Tank ❑Other Dispersal Component(explain) ❑Pr eatment ce(explain) v V.Dispersal/Treatment Area Information: Design Flow(gpd) Design S A plication Rate(gpdsf) Dispersal Area Required(s. Dispcjsal Area Proposed(sf) System Eleva6on 357 VL Tank Info Capacity in Total #of Manufacturer v Gallons Gallons Units ' o " o U New Tanks Existing Tanks p U cz z o5 L Septic or Holding Tank 2 Ly Dosing Chamber VII.Responsibility Sta went-i,the undersigned, me responsibility for installation of the POWTS shown on the attached plans. PI tier's Name(Print) PI is Signature MP/MPRS Number Busyness PhrNZer a 12zoaz> G4G Plumber's Address(Street,City,State,Zip de IV VIII. ountv/De artment Use On Permit Fee Date Issued �kgen 7A- DL. Pro ved ❑Disapproved Oa Owner Given Reason for Denial Conditions of Approval/Reasons to Disapproval Attach to complex plans for the system and submit to the County only on paper not less than 8 it z 11 inches in size SBD-6398(R 11/11) Property Owner`B'^'.Y' Parcel ID# �b T I Page of Z Boring# ❑ Boring ® Pit Ground surface elev.�ft. Depth to limiting factor /I D in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDM in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I 'Eff#2 3 S s^ i) 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 GPD/fF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 F-1 Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 -Eff#2 Effluent#1 =BOD,>30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD,130 mg/-and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SOD-8330(8.6/00) Wisconsin Department of Commerce SOIL EVALUATION REPORT Page—L of J Division of Safety and Buildings in accordance with Comm 85,Wis. Adm. Code n County ��•l �� Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. percent slope,scale or dimensions,north arrow,and location and distance to nearest road. — — WD Please print all information. Re 06CWV Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). - i O I t Property Owner Property Location '7 :Z Govt.Lot 1/4 1/4 S J3 T2? N R E( W Property Owner's Mailing Address Lot# Block# Subd. Name or CSM# City State Zip Code Phone Number ❑City ❑villNe 2&Tcwn Nearest Roa ( ) I y 91New Construction Us,4 2esidential/Number of bedrooms Code derived design flow rate If-00 --GPD ❑Replacement ❑ Public or commercial-Describe: _— Parent material 41/C-�'�r/y Flood Plain elevation if applicable N)A ft. General y°i3eC�v�f and recommendations: System Type &,Ylj j System Elevation Boring# El [ •pit Ground surface elev.` -s` R. Depth to limiting factor &0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsefl Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 -10 s � " 0 / 2 ® � # p� Boring IC!`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 o Z - 16 S/ 4 � Z7 D,5 lr7 r Effluent#1 =BOD,>30<220 mgIL and TSS>30<150 mg/L ' 'Effluent#2=BOD,<30 nvl and TSS<30 mg/L CST Name(Please Print) Signatur CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 /'07 715-246-4516 Soil Test and system PLOT PLAN �pd 6y -0 PROJECT Jason Bast ADDRESS 400 S. Sencond St. Hudson 54016 SW f14 SE 1/4S 13 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX SYSTEM ELEVATION 91.2 91.3/91.4 4' below grade DATE 10/12/14 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK S MOUND SEPTIC SIZE ZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 916 # of chambers 45 BENCHMARK V.R.P. Top of steel fence post ASSUME ELEVATION 100° Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Yellow Stone Trail Scale 1 /4" 10' All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. Pro 4 Bedroom House J s' 10' h OST 173' v 3-3' X 62' Cells with>3'spacing 20' 35' 01 lk 97' 20 Vents B.M.* I 95' B 2 7% Slope 70' B-1 5 15 Drainage easement,surveyed V1 Vent >6„ Quick4 Standard Leaching Chamber 208' Property Line of Cover with 20.0 ft2 of Area 4' Long 12" 5.6ft^2/pair of end caps 34" Grade at System Elevation li i 1 1 rti?,. 1.1v ON1110 Svo (02 \'�' �5t gfi65 0 �N i �►^' vN y mgr tiw tD ri N p ow v' y i to 4s co m / v _ A b r- ,�• yto s11b3py 1 #y �+ /8 ol mN _ Fn= w r— bas ; �� N?B3 ao Fm cA to to m to to N W W /y v>r{ �+ / ..- O O W I,' fix.•` 1 / /' /S N `•' ,',• i' vN loo. t,• ,� i Al ADM +' County Safety and Buildings Division b J�- „. �✓ 201 W.Washington Ave.,P.O.Box 1162 Sanitary Permit Number(to be fined in by Co.) TY, Mad' WI 3 �2 A G J R State Trans�tipn Number Permit Applica ton _ !�'IIJJ// Io accordance 1(2),Wis.Aden Code,submission of this form to the appropriate governmental unit is required a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Add&ss(if differem than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary ses in accordance with the Privacy Law,s.15. 1 m Stats. C/c7 ^► L Application Information-Please Print All Information — d`- Property Owner's Name C�ND Pnrcea tf�-surer ,� © i o �-1 :7q-a- Property Owbees Mailing Address t Property Location Q V b Govt,Lot C City,State Zip Code / Phone Number �i.t� '/a _y4 Section J Z 15q U[ �j T ry f, N; R onoy--F--�ki II pe of Building(check all that apply) o le �# L/ '�l,or 2 Family Dwelling-Number of /� Subdivision Name Block# .Q ❑Public/Commercial-Describe Use r �_ ❑City of ❑State Owned-Describe Use CSM Number ❑Village of '�- Town of Ait (wr�J III.Type f P it: (Check only one box on line A. Complete line B if applicable) k- " New System ❑Replacement System ❑Treatment/Holding Tank Rep ant y to Existing System(explain) e"\ I K J— B. ❑Permit Renewal El Permit Revision El Change of Plumber ❑Permit and Date Issued Before Expiration Owner IV. S stcLI�T nent/Device: Check all that a-p1 d� Non-Presstaiud In Groan essnriztd In Gr ormd ❑d�-1i�'�� Mo >24 in of soil ❑Mom G-- its oil /J❑Holding Tank O1ha D Component(explain ant Device(cxplam) d(� V.Din rsal/Treatment Area Information: CJLXX T f gn Flow(gp7Desip ppliction Ra te(gpdsf) Dispersal Area Requir Dispersal Area Proposed fit) Elevati VL Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units 3�� ��t a 1 d 6 ew Existing Talcs L � Z 2 � a 54 is 3 C, Oq Septic or Holding Tank Dosing Chambar VII.Responsibility Statement- I,the undersigned,ass a eaponsibility for installation of the POWTS shown oa the attached plans Pl s Name(Print) Ptum rgnaturr MP/MP&S Number Business Phone Number Plumber's (Street.City,State,Zip � � / o VIII. ountv/De artment Use Only approvedEl Disapproved Permit Fee Date Issued Issu Agent r attne ❑ 'Owner Given Reason for Denial �s, 01/� / Ix al/Reasons for Disapproval �Y( v �s'�' 61ti�; 1.Septic tank,effluent filter and /i�L ti/��� .6 PQ HAA CRspersal cell must be serviced/maintained J�� as per management plan provided by plumber. 4 S � 2.All setback requirements must be maintained 88 pe, @, ,for the system and submit to the Co Delp tier pa not less thaa g W x 11 lacier;n size SBD-6398(R- 11/11) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 9/17/14 Owner: Jason Bast Location: SW 1/4 SE 1/4 S13 T29 N,R19W882 Yellow Stone Trail Hudson In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and C 9MIngency Plan 7. Filter Specifications et 8-10. Soil test Signature License num #226900 PLOT PLAN PROJECT Jason Bast ADDRESS 400 S. Sencond St. Hudson Wi 54016 SW 1/4 SE 1/4S 13 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX SYSTEM ELEVATION 96.8/96.7 4.5' below grade DATE 9/17/14 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 890 # of chambers 44 IL BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be SDR 30/34, within 10' Scale = 1 /4" = 10' of tank,piping shall be Schedule 40. �P�hyS fey, Yellowstone Trail �� * �G' Scale is 1 = 40 o _ B.M. unless otherwise 20' At1.B. noted 50' `� �k ` Vents 101.5' B-1 100.5' Pro 4 Bedroom House 80' 3% Slope ST 20' O B-3 40' 10' B-2 2-3' X 90' cells with>3' spacing Vent >6„ Quick4 Standard of Cover Leaching Chamber 423' property line with 20.0 ft2 of Area 4' Long 12" 5.6ft^2/pair of end caps Grade at System Elevation 34" Cross Section of Infiltrator Quick 4 Leaching Chamber , Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber To be >1' above grade 5.6ft 2 pair of end plates Finish grade elevation Typical Installation 101' Vent Grade ELvation 3' 4" 3' x/30/34 Septic Tank 5' Long 1 5' 5' Lon3 6" Grade at System Elevation Spacing 5' 2-3' X 90 ' Cells Same on other end Observation tubeNent At end of cell A B 22 chambers per cell System elevations: A-96.8' B 96.7' - Le7rence >e W;scon3in Department of Commerce VALUA ION REPORT Page of 3 Division of Safety and Buildings YY in a gQ. Ad . Code County 1 Attach complete site plan on paper not less te. Ian must include,but not limited to:vertical and horizo ),direction and Parcel I.D. / —7 r 1!_ percent slope,scale or dimensions,north arrow,and location and distance to nearest road. (} 1 / T Please print all information. R ew b Date Personal information you provide may be used for secondary purposes(Privacy taw,s.15.04(1)(m)). 9 Q Property Own r Property Location 1145,67114 C Govt.Lot SC�J 1141/4 s /-3T7- "I N R E(or W Prope is Mailing Address Lot# I Block# Subd. Name or CSM# City State Zip Code Phone Number ❑City ❑Vil g wn Nearest Ro 14 1 59/0/'41 ( ) ew construction Use: esidential 1 Number of bedrooms Code derived design flow rate 6170 GPD ❑Replacement ❑ Public e�alr�esc ibeL� --_----- 4g�0�Parent material � G[/ ✓I J U�T�J'f Flo—W Plaingleyation if appli�ablle General and racorrurie nrldations: ! 's,3 l FY�J il,P; ,�� � y�a/� ✓a system Type-e! S s em Elevation j G�AI J'� 11h• " Q Boring# Boring %�7 Pit Ground surface elev. ft. Depth to limiting factor m. 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 p-I a /j i7 3 Z-r rs� / �J✓� �/ 1. ® Boring# O Boring it Ground surface elev. + ft- Depth to limiting factor 0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. I 'Eff#1 'Eff#2 0-1t 3/ SI Y C's rto w f 3 �d-r1 v a U Effluent#1 =BOD >30<220 mg/l.and TSS>30<150 �` 'Effluent#2=BOD <30 mg1L and TSS<30 nxi/L CST Name(Please Print) CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evalu tion Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 540;-?" 715-246-4516 t1 . Property Owner_ Parcel ID# Page _of F-31 Boring# ❑ Boring rQ� I Apit Ground surface elev/,�-! ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNf in. Munseli Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 FBoring# ❑ Boring❑ pit Ground surface elev. ft. Depth to limiting factor in Soil liption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munseli Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff##1 'Ef1#2 ❑ Boring BOn�# Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Sal Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence. Boundary Roots GPQW in. Munseil Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 Effluent#1=BODS>30 1220 mgll and TSS>30<150 mg/L 'Effluent#2=BODS 130 mgA-and TSS 130 mglt. 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. seu47)0(RAM) Soil Test Plot Pla Deojed Name Hudson Holdings LLC Sh ' i Address 703 Pine St. N. Hudson Wi 54016 TM #226900 Lot 7 Subdivision Yellowstone Valley Date 4/26/06 S W 1/4 SE 1/4S 13 T 29 N/R19 W Township Hudson Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1/2" pipe System Elevation 96.8/96.7 *HRPSameasBenchmark Alternate Benchmark Top of 1/2" pipe @ 100.7' qV �K 30, z� Yellowstone Trail 70 *B.M. Scale is 1" = 40' 20' unless otherwise 20' At1.B. noted- 50' B-1 J so' 3% Slope ' B-3 40' B-2101.5' 100.5' / ,✓/ ��� 4 ' property line \ m tot gpa -060 % g.65 .... . 0 10 % M. M 174' U) 3p L 0 0 10 z it > 0 0 0 M > 06 11 11 0 0 31 1 rn to to I M.. loo to a w S/)� ! (?,(.- Ul ca 0 Jay->r �nx 03) Ile CO oil. /oil 06, 0 m It k (Q (O %WOO m CO it vo '0 ..........A, > 0 tol Z -,-/ lot I COOD > pop- X, 1p fn ._. 7 . � F . fi �r t T is{ fyP ?. LB t ! '� +L• t t { } t\ a. u g � t � 3 p POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page a FILE INFORMATION SYSTEM SPECIFICATIONS Owner µ T- Tank Manufacturer: ❑ NA Permit# 7 q 2) 41 jEjcS@ptic ❑ Dose ❑ Holding Volume: (gal) DESIGN PARAMETERS Tank Manufacturer: A Number of Bedrooms: ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal) Number of Public Facility Units: -;4NA Vertical Distance Tank Bottom(s)to Service Pad: (ft) Estimated(average)Flow: (gallday) Horizontal Distance Tank(s)to Service Pad: //W (ft) Specific servicing mechanics must be provided if vertical is>15 feet or Design (peak)Flow= estimated x 1.5 : (gaVday) I horizontal is>150 feet. S Gflc Instructions to be provided on back. 9 (P ) ( ) �� f oriz Pe In Situ Sal Application Rate: (gal/daye) Effluent Filter Manufacturer: ❑ NA Standard(Domestic)Influent/Effluent Monthly average Effluent Filter Model: Fats,Oil&Grease (FOG) s30 mg/L Pump Manufacturer: .�,y� Biochemical Oxygen Demand (BODs) s220 mg/L ❑ NA —,96-NA Total Suspended Solids(TSS) 5150 mg/L Pump Model: High Strength Influent/Effluent Monthly average Pretreatment Unit FOG >30 mg/L Manufacturer. NA (BODs) >220 mg/L IA ❑Mechanical Aeration ❑Peat Filter SS) >150 mg/L ❑Disinfection ❑Wetland Pretreated Effluent Monthly average ❑Sand/Gravel Filter ❑Other. (BODs) s30 mg/L Soil Ab tion System (TSS) 5530 mg/L �JA Fecal Coliform(geometric mean) 5104 Soil (gravity) ❑in-Ground(pressure) ❑ NA ❑At-Grade ❑Mound Maximum Effluent Particle Size in dia. ❑ NA ❑Drip-Line ❑Other: Other: A Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) hen combined sludge and scum equals one-third('h)of tank volume ❑When the high water alarm is activated Inspect condition of tank(s) At least once every: 4monts(s) (Maximum 3 years) ❑ NA Year( ) Inspect dispersal cell(s) At least once every: 3 ,*montn(s) (Maximum 3 years) ❑ NA Years) [�month(s) Clean effluent fitter At least Once eve I NA every: a s) �5'ye K Inspect pump,pump controls&alarm At least once every: ❑month(s) NA ❑year(s) Flush laterals and pressure test At least once every:. El[3 NA ❑YeaK$) Other: At least once every: ❑month(s) NA ❑year(s) Other: NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). Tank inspections must include a visual inspection of the tank(s)to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The soil absorption system 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 treatment tank equals one-third (%)or more of the tank volume,the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper)and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code: All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 5_12 months,shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. GMW-005(02/05) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals pr sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are detected have the contents of the tank(s)removed by a Septage Servicing Operator(pumper)prior to use. Pump anks may fill above normal hi hwater levels prior to startup or due to pump failures. Start up or restoration of power under these P Y 9 conditions is not recommended, as the excess wastewater will be,discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator(pumper)prior to restoring power to-the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. 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 treatment tanks and soil absorption system: acids, antibiotics, baby wipes,"cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps,medications,oils,painting products, pesticides,saniiri"napkins,solvents,tampons, and water softener brine discharge. ABANDONMENT 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 s. Comm 83.33,Wisconsin Administrative Code: • All piping to tanks,pits and other soil absorption systems 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(pumper). • 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 re;7A ant system: 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 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 the time of their permit issuance. / suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology,a holding tank may be installed as a last resort. ❑ 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. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the bio mat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: I POWTS INSTALLER POWTS MAINTAINER. Name Name Phone Phone f SEPTAGE SERVICING OPERAT R PUMPER LOCAL REGULATORY AUTHORITY Name � � Name � � t Phone y f �-- �7 Phone ��( — 4iV019 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d)&(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code. .ox8 - RLTER CARTRIDGE INS'TRUC'TIONS InstsUation STEP s Dry 8t the Met case onto the end of the outlet pipe to ensure it is centered under the scam opening. If rot,then either insert more pipe into the tank through the outlet or solvent weld(glue)additional pipe onto the outlet pipe. a EF 2 While the case is still dry fitted on the outlet pipe,measure the length of 316-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. S'VP.`s For inst3dations utilizing the optional supplemental side support_ solvent weld the IA-inch pipe onto the fot&r case. If side support method is not utilized,proceed to step four. ;fr - Solvent weed the fitter case onto the outlet pipe. Insert tfie filter `^_;.,^.; cartridge into the awe, pressing down until the filter locks into the bottom of the case. c xv? If a VRS switch is utilized.insert into the fitter and lode by fuming clockwise 90°. 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. a 3. Pump the septic tank completely,making sure to remove the sludge layer on the bottom of the tank and not just the scum and effluent. 4. Once the effluent level has been towered below the invert of the outlet pipe,firmly pull up on the filter handle to dislodge the r cartridge from the case. S. Slide the cartridge up and out of the case for cleaning. 6. If a VRS switch connected to an alarm is present,the switch should be removed by turning counterclockwise 90'and cleaned ti 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 water only,making sure all septage material is rinsed back into the tank_ ` a. If VRS switch is utilized,replace by inserting into filter and ` turning clockwise 90`. S. 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CROIX CO., WI THIS DEED, made between Environmental Holding Company, LLC, a 10/25/2012 3.11 PM Wisconsin Limited Liability Company, Grantor, and Speer-Bast Land and EXEMPT#' N/A Construction*Grantee. *LLC REC FEE: 30.00 Grantor, for a valuable consideration, conveys to Grantee the following TRANS FEE: 166.50 described real estate in St. Croix County, State of Wisconsin (the PAGES• 1 "Property"): ' Lot 7, Yellowstone Valley in the Town of Hudson, St. Croix County, Wisconsin. Recording Area Name and Return Address: Land Title Inc. File No.337541 2200 W.County Road C,Ste 2205 Roseville,MN 55113 Together with all appurtenant rights,title and interests. 020-1474-07-000 Parcel Identification Number(PIN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Easements,Restrictions;Reservations,Roadways and Rights of Way,if any,of Record. Dated this 5th da of O sober,2012. Env' onme i Company, LLC *Jeff ey Warren,Member * J AUTFIENTICATION �Q� ACKNOWLEDGMENT Signature(s) *�fa 4i- TE OF WISCONSIN ) ST ROIX COUNTY. )ss. authenticated this 5th day of October,201 pu�`'�� ersonally came before me this 5th day of October, 2012 N� i bove named Jeffrey Warren. as Member of Environmental * C1� ding Company, LLC, a Wisconsin Limited Liability TITLE:MEMBER STATE BAR OF WISCONS ompany, LLC, to me known to be the person(s) who executed (If not. -+ the foregoing instrument and acknowle oed the same. authorized by§ 706.06,Wis. Stats.) ` THIS INSTRUMENT WAS DRAFTED BY *M�eriT_ek J. Bune Notary Public,State of Wisconsin LaiTy S.Mountain,Attorney at Law My commission is permanent. (If not,state expiration date: 10/27/2013 ) (Signatures may be authenticated or acknowledged. 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