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HomeMy WebLinkAbout020-1474-08-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 574386 0 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: Waters Edge Construction Inc., James L. Krue Hudson, Town of 020-1474-08-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: 1&-)b /�t'� ✓n �u 13.29.19.3005 TANK INFORMATION ELEVATIOIQ DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic J:;% Z Benchmark e F•It.., 34 1660:2 /og. Dosing 3.5 Alt.BM I C � $• � /0 Q ` Bldg.Sewer Holding - St/Ht Inlet 13 - 1 95. 3 TANK SETBACK INFORMATION St/Ht Outlet TANK TO n )t P/L WELL BLDG. Vent Air Intake ROAD Dt Inlet !y Septic . )-/) N _ Dt Bottom 6�� 4�•�•S Dosing 7 z i Header/Man. 45* g Aeration Dist. Pipe Holding Bot.System 11•35 y'7. oS `�.. Final Grade •7 $ / PUMP/SIPHON INFORMATION QO • �P Manufacturer / ` Demand St Covey`� g•3 /r7G ( \ GPM �, Model Number TDH Lift Fri t' }ads System Hea� T •! �t Forcemain Length 4P5 (0`Djia.Z ! Dist.to Well l� J SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No.Of Trenches r PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG IWELL. LAKE/STREAM LEACHING Manufacturer: INFORMATION r CHAMBER OR �� �' �r,4-,,t- Type COhJCwT-�tb UNIT Model Number: 1 Q� a('• DISTRIBUTION SYSTEM � — / •' ICo V4(0 i3� Y• Header/Manifgld Distribution x Hole Size x Hole Spacing IVe to Air I ke Pipe(s) �— " Length 7 Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only , s Depth Over c Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center �• S J Bed/Trench Edges Topsoil s No s [fl No COMMENTS: (Include code discrepancies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 878 Yellowstone Tr it Hudson WI 54016(SW 1/4 SE 1/4 13 T29 R19W) Yellowston Vail Lot 8 Parcel No: 13.29.19.3005 (,•t� G� � �cc.��.S 1.)Alt BM Description= a• ^'S 2.)Bldg sewer length= �lyr! -amount of cover 4cr Plan revision Required? Y\s ; No /I t_ ' Use other side for additional information. �P y -! SBD-6710(R.3/97) Date Insepct s Signatype Cert.No. . r � O aA a "All � v r o ^a� ^�4, aa} 6 o ti f A%off �� C t. 'i a °• �w If 11 n 10\ Z t c a ti ;0 4L a N �T \ � 4 A �7 -"'•" yi County 40 XI� 'PI ndetshy-Se,MCI Vivision Ar'�� 1400 E Washington Ave Sanitary Permit umber(to be filled in by Co.)�4� 1 P 01� P.O. Box 7162 Madison,W 53707-7162 rt. a G,� �- it Application State Transactio/n�N�u�mbbeer In accordance e4ith G.21 � 5%mCode.. submission of this form to the appropriate governmental unit ' //A is required prior rngIiitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address�,i different than mailing address) the Department' ty an6 Professional Servies. Personal information you provide may be used for secondary purposes in acc ce with the Privacy Law,s. 15.04 1 m,Slats. �-- I. A licat' •I p nformation—Please Print All Information o 7� EJ:eo�JSra�JE Y/1A� Property Owner's Name Parcel# f j7 �i¢T l j&.'X �o.Jr m4r�..J G o -/ E-t /WegAllL 0 z0'/ 7 - Qo 'vl�U Property Owner's Mailing Address Property Location Govt.Lot [ J City,State Zip Code Phone Number �/ SAI y„ _ge �/,, Section /3 6✓/L d o t� Syo�7 >'/S ;Y - 07a 7 circle one 11.Type of Build g(check all that apply) Lot# T 9 N; R�s o� I or 2 Family Dwelling-Number of Bedrooms 3 O Subdivision Name Block# YEtLOC✓sTDalE (//ql L Y ❑Public/Commercial-Describe Use �/ 9-eT of ❑State Owned-Describe Use CSM Number/ ❑i'itFege of ��// 19 Town of /7WOa� III.T e of Perittit: Check only one box on line A. Complete line B if applicable) A' New System-,) ❑ Replacement System ❑Treatment/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 Number and Date Issued Before Expiration Owner IV.Type of POWTS S stem/Corn onent(Device: Check all that apply) ONon-Pressurized In-Ground ❑Pressurized In-Ground At-Grrade ❑ o nd>24 i .of'suita=it 1 ELycrwnd<24'm-of sui a soil ❑ Holding Tank ❑Other Dispersal Component(explain) retr tment t to V.Dispersal/Treatment Area Information: OL' Design Flow(gpd) Design Soil Application ate(gpdsf) Dispersal Area Required(s() Dispersal sed(0), System Elevation ySc . 7 6y3 GY 9..2 i1 97.0 .� Vi.Tank Info Capacity in Total #of M fargr Gallons Gallons Units // l New Tanks Existing Tanks U/ r v in H to ,(5 a Septic or IJaWhV.Fettic Ocs d �; /do G 1 E6C 2 G.O nl tnt�rdt' Dosing Chamber VIL Responsibility Statement-I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's Si re MP/toO t6 Number Business Phone Number D •� lvx4r .23/3 Y4 71S Plumber's Address(Street,City,State,Zip Code) .S . wY o?�'. lOUlUnL0 LJr SY734 VII .Coun /Department Use Only Approved ❑ Disapproved Permit Fee 0 Date I sued (suing Agent nature ❑Owner Given Reason for Denial $ 7 Z >' IX.Conditions of Approval/Reasons for Disapproval i �PGLV�T,S Le ih S 4Z?!a kt_ SYSTEM OW�'ia' 1.Septic S�llYt dl,i� fl±er a t! D tea/ dispersal ' '` ii4t'e��'r`"��r1/maintained , plumber. f S as per mars � ,, t o1a 1 p,n,ided by OU Ali-,Ptbac;, �.r;�rN, ;�,s,A.;n;ust be maintained as per for the system and submit to the County only on paper not less than 8112 x I I inches in size SBD-6398(R0313) r t: Private Qnsite Wastewater Treatment System Index and Title Page Dili,►., Project Name: r.-,t kiet-a je Avi rs !✓�1//Aiv.CariC Owner's Name: �� " �� �/ .T.r„iss K.t�E-cE•c Owner's Address: 3ola Go r-t'` Av,r. 4.)_T .5-yoa7 7/S NO-.0701/ Legal Description: St✓ SE /3 .?9N /9�✓ Municipality: T_ own, Viibge, Oky of County: Sr. LAa/K Subdivision Name: yEttoa✓s roaE LJAicEr Lot Number: 8 Block Number: Parcel I.D.Number: Page 1 Page 2 f /26-; 1111Er*t Page 3 S4or/[ /AiYK ��u„rP G'iYA.x�t�e �itosS-.�EC riro.J Page 4 Page.5 t /""44or—r r 00-OkAd Page 6 Page 7 /" !L r.r, /`AIAIA 44d'CE NFo Page 8 Page 9 y'TAG,yi,►jr,�s' • �a�� �r/Al ua r�o.✓ �E.00a�' Name of Designer: License Number: CAP- o?3/3yG Signature: 4:�;4,t Date: 7-.?3-,?o iy Designed P scant to the Following POWTS Component Manual and Comm 81-85: S (Ver 2 Ol SBD-10705-P (N. Ol/011 In Ground Soil Absorption Component Manual for POWT n U 41 �s 4 U M Z ell h w / Qt' p orb ^i . R1 \ a tit W �► �, k n N 41 V) x \ T vi Z � ^ Nei . r , - ( SAC.) '��di'i,_ ` . ``�.` Ism 66' HAD ` �y°' \ �, / �',`• • \�Q •T49MPORARY , \ LOT 5 L,:DK-SAC 2 Of ►CRS ♦ • \�� � A �,�A$B`,IVIEN'F., ► ' \\(f .60 ACS) I► �.•�-. . , ♦' •' f fir; .OS ACRES •'• \ x:06 ACRES ' `/ (0.81 AC.) Jr. \ (1 .07 AC.) ,I 1I i \\\ \ \�HWB=991L0 \ HWEr-994.0 �+ \\\ 0�99l�b" / \ \ L.80a998.0r A �. DRAINAGE EASEMU*. IN ow '•I' J � ' �-••'�. L1 NWE=99 :0 `•/.•• �` . '� • � '� / r ' LB0-998.0 •� _• • SKIED \ Ifoust La RIVBWAY ��® � \� / / �..-•.- 2.12 A, \O\ �.,a .,��'�`�®fig► N. \\ ��RG !�w�✓: / � \ .''�• �� Pa V a 3 Of 7 - SEPTIC TANK S' PUMP CHAMBER CROSS SECTION' AND SPECIFICATIONS 4" Cl VENT PIPE 12" MIN. ABOVE GRADE 8 WEATHERPROOF > /O' FROM DOOR, WINDOW OR JUVCTION BOX APPROVED FRESH AIR INTAKE WITH CONDU$T MANHOLE COVERS Div AW4,,0 < G avow W/ PADLOCK E G�Ggaer wtAO� WARNING LABEL -- 4" MIN. 18" LIN.. [NLET fq i ` WATER TIGHT SEALS GAS- 11 i l A-/s r � .� TIGHT i 1, APPROVED PPROYEQ wit rEa „_ SEAL ALM JOINTS WITH iPE B i APPROVED PIP£ C PUMP OFF ELEV. 9�?o FT. i �' OFF •W* RISER EXIT D PERMITTED ONLY IF TANK MANUFACTURER ' 3" APPROVED BEDDING UNDER TANK HAS APPROVAL CONCRETE PAD SPECIFICATIONS EPTIC. 1 DOSE ANK MANUFACTURER: _ I1h_S6t 41_,q.da41TE NUMBER I50SES PER DAY: S:/ 6m 7.� ANK SIZES: . SEPTIC _ /oao GAL. ' DOSE VOLUME INCLUDING 8o'9 DOSE Goo GAL.. FLOWBACK: 9Z2 GAL, LARM MANUFACTURER: S_rzl.. ilowdws CAPACITIES: A = W INCHES a .�5.2 ' GAL. -r-•— MODEL NUMBER: r'4A C A44Ar .! SWITCH TYPE: _ &, U✓w„�ia,e� 7e bus, B ' .,_2 INCHES = GAL. )MP MANUFACTURER: _ Zoe-d��.t �"�`~ C = GAL. MODEL NUMBER SWITCH TYPE: ,,iA,✓iva D = 7S INCHES /,�17 GAL, :QUIRED DISCHARGE RATE .7.0 _ GPM PUMP E ALARM WIRING AS PER ILHR 16:23 WAC :RTICAL-DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE 7,0 FEET MINIMUM NETWORK SUPPLY PRESSURE . . 7 _ FEET a?° _ FEET FORCEMAIN 'X 1orFT/100 FT. FRICTION FACTOR*. " z FEET TOTAL DYNAMIC HEAD = FEET ITERNAL DIMENSIONS OF PUMP TANK: LENGTH S.3 WIDTH 78,E ; DIAMETER – LIQUID DEPTH 3G Al A6. y of TOTAL DYNAMIC HEADIFLOW — PUMP PERFORMANCE CURVE PER MINUTE MODEL 151/152/153 EFFLUENT AND DEWATERING so 14 45 153 MODEL 151 152 153 1z 40 R2O Meters Gal. Liters Gal. Liters Gal. Liters 0 35 1.5 50 189 69 261 77 291 10 152 3.0 45 170 61 231 70 265 4.6 38 144 53 201 61 231 0 8 25 t51 6.1 29 110 44 167 52 197 7.6 16 61 34 129 42 159 g 20 9.1 — — 23 87 33 125 10.7 — — — — 22 85 15 40 12.2 — — — — 11 42 4 10 Sh"Head: 30 ft.(9.1 m) 38 ft.(11.6m) 44 fl(13.401 olasoee 2 5 Model 151 Models 152 1 153 10 20 30 40 50 60 70 80 90 100 GALLONS Imo— 67132 -� 67132—� LITERS 0 40 60 120 160 200 240 2a0 320 360 3 718 —'�� 45M I 3 7� 4 541 FLOW PER MINUTE --r 014508A _.�— t 3 718 CONSULT FACTORY FOR �� - � SPACIAL APPLICATIONS �o�fe T 3718 ® 3 T1 •Timed dosing panels available. + •Electrical alternators,for duplex systems,are available and i supplied with an alarm. •Variable level control switches are available for controlling single phase systems. i •Double piggyback variable level float switches are available for variable level long and short cycle controls. i I _ •Sealed Qwik-Box available for outdoor installations.See 1111116 �j 12118 I I FM1420. •Over 1307(54°C)special quotation required. -- f „ 16 ` 5M 15111521153 Series —t_ 1 SK2444 SK2064 i 1511152/153 MODELS Control Selection Model Volts-Ph I Mode Amps Sim lex Duplex N151 115 1 i Non 6.0 1 2 or 3 BN151 115 1 1 Auto 6.0 Included 2 or 3 E151 230 1 Non 3.2 1 ; 2 or 3 BE151 230 1 Auto 3.2 lncluded 2 or 3 "Easy assembly" N152 115 1 Non 8.5 1 2 or 3 (pump&discharge pipe BN152 115 1 Auto 8.5 Included 2 or 3 not included.) E152 230 1 Non I 4.3 1 2 or 3 SE152 230 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN1531 115 1 Auto 10.5 Included 2 or 3 E153 1 230 1 Non 5.3 1 2 or 3 BE1531 230 t 1 Auto 1 5.3 1 Included I 2 or 3 SELECTION GUIvE 1. Single piggyback variable level float swtch or double piggyback variable level es potential PUMP STAND e PAN t)-2213 float switch. Refer to FM0477. Reduces potential clogging by debris. 2. See FM0712 for correct model of Electrical Alternator E-Pak. Replaces rocks Made of durable, bricks under the pump. • ,noncorrosive ABS. 3. Variable level control switch 10-0743 used as a control activator,specify duplex Raises pump 2"off bottom of basin. (3)or(4)float system. Provides the ability to raise intake by adding sections of 11/2' or 2"PVC piping. O CAUTION Attaches securely to pump. I 'F • Accommodates sump dewatering and effluent applications. n! a 'ect!Lai and saf,t, . �s imidd 6e. do.eed in ut!111 :.;: Elcctril 'Co,c;t o the f)=ipationi!Snfety and near!: NOTE:Make sure float is free front obstruction. RESERVE POWERED DESIGAN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. ©Copyright 2008 Zoeller Co.All rights reserved. � � D ��.CE Wisconsin Department of Commerce �Y ] � RE RT Page-L of Division of Safety and Buildings i accordance with C Code �. GR Zr unty T must Attach complete site plan on paper not les than�'172 x 11 inche us include,but not limited to:vertical and hori ntal ref ),direction and Parcel I.D. ) �7 percent slope,scale or dimensions,north a ow,and location and distance to nearest road. Please print all information. 2e2wb - Dat Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). � PropB1ty Own Property Location 7Z'- C' Govt.Lot 34/ 1/4 5,114 S /-3T N R E(or w Prope is Mailing Address Lot# Block# Subd. Name or CSM# 03 f/ez City State Zip Code Phone Number ❑city ❑Vil ige own Nearest Ro ew Construction Use: esidential/Number of bedrooms-3/4/ Code derived design flow rate 5 GPD ❑Replacement ❑ Public Qc commercial-Describe: Parent material yLG/C Flood Plain elevation if appli General comments .J J' �i3t'��JUJ y J" .I VV and recommendations: / S7 System Type-, �t J�rt- I � System Elevation -2r L 6. y�l F/-] Boring# Boring pit Ground surface elev!Uo ft. Depth to limiting factor_L - in. Sal 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 Ll 2 ' erg# ❑ Boring 'RrRit Ground surface elev. f ft. Depth to limiting factor/_oz)—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 --)Z- i ll� s cs an la >o 5/ t w 3 Z ' Effluent#1 =BOD >30:!220 mg/L and TSS>30<150 mg/L 'E15jent#2=BOD <30 mg/L and TSS<30 mg1L CST Name(Please Print) Signa CST Number Bird Plumbing, Inc. Shaun Bird — 226900 Address ate Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 y 7�/ - 715-246-4516 UU Property,Owner Parcel ID# Page of ® Boring# ° Boring ,�pit Ground surface elev.�_ft. Depth to limiting factor�n• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 1 I ' in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 Z,z s aifl cv l d 3 Ej Boring# ° Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sod 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 ❑ Boring E Boring# Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Sol{Application Rate Horizon . Iepth Dominant Col Redox Description. Texture Structure Consistence. Boundary Roots GPDAf in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 i Effluent#1=BOD6>30:E 220 mg1L and TSS>30<150 mgA_ 'Effluent#2=BOD,<_30 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. SBD4330(8.6/00) Soil Test Plot Plan Project Name Hudson Holdings LLC Shaun d Address 703 Pine St. N. Hudson Wi 54016 C #226900 Lot 8 Subdivision Yellowstone Valley Date 4/26/06 SW 1/4 SE 1/4S 13 T 29 N/R19 W Township Hudson Boring a Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1/2" pipe System Elevation 97.0/97.5 *HRpSameasBenchmark Alternate Benchmark Top of 1/2" pipe @ 100.5' 174' P.L. J 100' B.M. #1,B.M. 100' Scale is 1" = 40' unless otherwise noted 382' Property Line 90' 102.5' 45' 30' B-2 0' 90' ry , B-1 `t 8% Slope 208' P.L. 308' Property Line L•d d9Z:Z0 00 L L Env m ot I e 63 f Ij ; lfj ov z 0 10 cZ r 11 11 MA > > 0 m Z 30 0 1174 U) Vi m 0 0 110 r OD > U) 0 m 01, toto 7 %WOO S4, CO) co x C0 lip OOW% a it 06� a) r pop. r z 0 0 M 0 11 j *4 (0 40 > m CP V, r > 0 > 0 i 000D > 0 -4/ CAY m 1p f A 0. LO W� 57 — i = -0. E- w IX f E;-5 '0 < r :3 0 < 0 o I- AL =2 :R Mrl D P 0 -5, ib ET -0 (D 72. 0. 'D O W M O 12, EF 2b .-AMMM 0�=r_ —M 9; a 0 = ro ID 0 Q =, �Q_ E 0 Z57 u 0-3 M rD X ,v 0 CL F s, ?1? * 3 �� g 0 =r w M 0 — -rh P.J M 6 P "D = M U2 0 < rD cr ;3 rD Qj a T :D S n 73 M I F a. < 4p E: f:79 ;3 ID w M M ID + M 9L 2.Pr 0 =r rM C n ID to CL 0 co w M 10 M 3 a: o M w 0, (D ='(a M (D 3 rD V1 SL mom! r vzTM1GqwMM O(A LA BL M Lo — su obi &A CD Cr ER 2 �+ M rD ci 0 0 rD 0'o @ jF P 2. fD ro M M NOWAVAIM zo POWTS OWNER'S MANUAL & MANAGEMENT PLAN page S of 7 FILE INFORMATION SYSTEM-SPECIFICATIONS Owner YE t EiOLE o.J 7'Rwt /e.J Tank Manufacturer. A//x se t 4 v.,au er6 Q NA Permit# O Septic 0 Dose Q Holding Volttrfie: /o0 0 (9w) DESIGN PARAMETERS Tank Manufacturer /n//ESE'2 Cd,,,?44 Ar Q NA Number of Bedrooms: .3 Q NA Q Septic tV Dose ❑ Holding Volume. ,Coo (gal) Number of Public Facility Units: DrNA Vertical Distance Tank Bottom(s)to Service Pad: /Q (tt) Estimated(average)now: &40 Wavday) Horizontal Distance Tank(s)to Service Pad: 7s I (ft) Spedfic servicing mechanics must be provided if vertical is>15 feet or Design(peak)Flow=(estimated x 1.5): yj-0 (gaVday) if horizontal is>150 feet Specific instructions to be provided on back. In Situ Sol Application Rate: '7 (go"daye) Effluent Filter Manufacturer. ,(,3 ES T Q NA Standard(Domestic)Influent/Effluent Monthly average Effluent Filter Model: Fats,Oil&Grease (FOG) 530 mg/L Pump Manufacturer: Zd ELL dry ❑NA Biochemical Oxygen Demand (BOD5) 5220 mg/L 0 NA • Pump Mode[: /S/ Total Suspended solids(TSS) x150 m L High Strength Influent(Efftuent Monthly average Pretreatment Unit (FOG) >30 mg/l! Manufacturer: (BODs) >220 mgfL Q NA 0 Mechanical Aeration ❑Peat Filter SrNA (rSS) >150 mg/L Effluent Months e 0 Disinfection ❑Wetland Pretreated E Y average ❑Sand/Gravel Filter ❑Other. (BODS) 530 mg/L Soil Absorption System (TSS) <_30 mg/L 0 NA Fecal Coiiform(geometric mean) 510°- Win-Ground(gravity) 0 Irt-Ground(pressure) Q NA Maximum Effluent Particle Size 31i in dia. 0 NA Q riGrade Q Mound Q DrilrLine Q Other. Other. 0 NA Other: Q NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) 2f When combined sludge and scum equals one-third(%)of tank volume 9 When the high water alarm is activated Inspect condition of tank(s) Al least once every: El months) (Maximum 3 years) Q NA 3 mryear(s) Inspect dispersal cell(s) At least once every: 0 mvnth(s) (Maximum 3 years) Q NA 3 lR year(s) Clean effluent filter At least once every: 13 month(s) Q NA Q year(s) Inspect pump,pump controls&alarm At least once°every: ❑month(s) Q NA 3 year(s) month(s) pressure test 'At least once every:. 0 year(s) )^A Flush laterals and Other: At(east once every: ❑month(s) Q NA Q year(s) Other: Q 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(3�)or more of the tank volume,ttie 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. Alt other services,including but not limited to the servicing of effluent frfters,mechanical or pressurized components,pretreatment units, and any servicing at intervals of 512 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. START UP AND OPERATION Page 4 of 7 For new construction, prior to use of the POWTS check treatment tank(s) for the presence of paingng products, solvents or other chemicals or 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)pdorto use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these overload that may result inn the backup or surface will f e�uentrand damage jto tthhe�on system in one large dose causing an contents of the pump tank removed b a S g ��. To avoid this sltitation have the or POWTS Maintainer to rem in manually ee Servicing Operator(pumper)prior to restoring power to the pump or contact a Plumber 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 al-grade soil absorption am 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: adds, antibiotics, baby wipes;-cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants,fats,foundation drain(sump pump)discharge,fruit and vegetable peelings, gesgline, greases, herbicides,meat scraps,medications,oils,painting products,pesticides,sanitary napkins,solvents,tampons,'and water softener brine discharge. . ABANDONMENT When the POWTS fails and/or is permanently taken out of service an the fniiowing steps shall be{altar to instrre that the � d safely stem ely abandoned in with s. SPS383.33,Wisconsin Adrriirii system properly strative Code., i e . ° All piping to tanks,pits and other sal absorption systems shag be disconnected and the abandoned e Pe openings sealed. The P e 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 shalt be excavated and removed or their covers removed gravel or another inert solid material. and the void space filled with soil, CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a node 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 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 ruses in effect at the time of their permit issuance. ❑ A 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 D The site has not been evaluated to identify a suitable replacement area Upon failure of the POWTS a soil and site evaluation ip act resort to replace to locate a suitable replacenert area. If no replacement area is available a holding tank may be Installed as a r eplare the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the btomat 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: POWTS INSTALLER POWTS MAINTAINER. Name a „! ELK£ 3/.3YG Name oN� El,KE L E Lug► l.�s Phone / `7.?„n LL Phone SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORITY Name Name �r; G,Qmiz ZOA/i6✓6 Or�ile Phone Phone ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address 6 Z wo� -7 Property Address b � D V(-,- t 1 , (Ve ' cation require from Planning&Zoning Department for new construction.) City/State LIU55 6 Parcel Identification Number 0 2 0 0(4 LEGAL DESCRIPTION Property Location '/4 , 1/4 , Sec. I '�>_, T_Z�_N R_1 q__W, Town of 4(II)SD Ij Subdivision Plat: Lot# . Certified Survey Map # °Y �b 1 / ,Volume / , Page# 25l 3 Warranty Deed# / / d 7, (before 2007)Volume '� , Page# '- Spec house Pyes 0 no Lot lines identifiable C9"yes 0 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in§SPS.383.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 full of sludge. 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 Safety And Professional Services 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. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s)of the property described above,by virtue of a warranty deed recorded in Register of Deeds Office. Number of edrooms I DATE OF APPLI T(S) � / ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) II Ili III II I 8244079 Tx:4199707 STATE BAR OF WISCONSIN FORM I -2000 998721 WARRANTY DEED BETH PABST Document Number REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED, made between Environmental Holding Company, LLC, a 07/17/2014 10:44 AM Wisconsin Limited Liability Company, Grantor, and Waters-Edge EXEMPT#: NA Construction, Inc.,Grantee. REC FEE: 30.00 Grantor, for a valuable consideration, conveys to Grantee the following TRANS FEE: 210.00 described real estate in St. Croix County, State of Wisconsin (the PAGES• 1 "Property"): Lot 8,Yellowstone Valley in the Town of Hudson,St.Croix County, Wisconsin. Recording Area Name and Return Address: Land Title Inc. #506755 2200 W County Road C.Suite 2205 Roseville,MN 55113 Together with all appurtenant rights,title and interests. 020-1474-08-000 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 9`h day of July,2014. Environmental Hold C n LLC * William P. Sherman,member �,D Signature(s) AUTHENTICATION � � 3� 'NT ss. authenticated this ="y'•, ly of July, 2014 ���''• o�h d member of Wisconsin Limited TITLE: MEMBER STATE BAR OF WISCONSIN ,o be the person(s) who (If not. and acknowledged the same. authorized by § 706.06. Wis.Stats.) 1-1-IIS INSTRUiMIENT WAS DRAFTIED BY c .ntc.State of isconsin Lamy S. Mountain, Attorney at Law ..,nunission is permanent. (If not, state expiration date: 10/17/2017 ) (Signatures nmv be authenticated or acknowledged. Both are not necessary.) *Nlime5 nt perSUns$1'Snln•_in am capacinv must be typed or printed below their signature St.Croix County 998721 Page 1 of 1 WARRANTY DT:F.D STATE BAR oP WISCONSIN FORM No. I-2000 _ i B I IR M z eD e m z B z EM e I I m� i pl, r 0 a $ WATERS EDGE CONSTRUCTION SPEC 2014 RFSIDENDAL•MULTIFAMILY•LICHT COMMERCIAL EXTERIOR ELEVATIONS 9 0 F.I.5wµS-101•'Id-*754016 vx a<.w�•n5s I ' I , 1. I ----------- -------------- I ` ..............................,4; ..................................................... I ' , /� e ......................................... II -- 9 t j i -� i I e � I i I I I F � Q� 0 5 Z A WATERS EDGE CONSMUMON ° ti NNI1H1: 116E INW. e R SPEC 2014 AE57DENf1AL•MliL71•FAMILY•tICHTCOaptlRCIAI y� FOUNDATION :9:°E.I.SULSw�clol 'HLlGn.wtS,lplb 6 PH 71t.1i1.977i 4 i I �e ....................... I o YT cx z I ' � z !lit ty s k i e sawn: �� z WATERS EDGE CONSTRUCTION # W PK1 INM RESIDVMAL•MUMFAMILY•I.IOIIT COMMFACIAI SPEC E014 MAW LEVEL PLAN 29=0enlrcsm 4n 101-xudw Wjuale VN 71 t.v11.9N8 III Ljq.MV1A kAjUrl [y r Planning zoning FAX MEMO DATE.: To: Code Administrate FAX NUMB ' 715-3864680 Zaend&formateon FROM: phmnug 715-386-467 FAX NUMBER: 715-386-4686 BeQt eny PHONE NUMBER: 715-386-4680 677 NUMBER OF PAGES, INCLUDING COVER SHEET: y 386-4675 RE: 07 S7.CROIX COUNTY GOVERNMENT CENTER PZ @CO.SAINTCROIX WI US 1 101 CARMICHAEL ROAD,HUDSON, W1 54016 715386-4686 Fax WWW.00.SAINTCR0IX.W1 US Soil Test Plot Plan Project Name Hudson Holdings LLC S L ird Address 703 Pine St. N. Hudson Wi 54016 #226900 Lot 8 Subdivision Yellowstone Valley Date L4126106 SW 114 SE 1l4S 13 T 29 N/R19 W Township Hudson [] Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation loo ft. Top cf l/2" pipe System Elevation 97.0!97.5 *HRPSame as Benchmark Alternate Benchmark Top of 1/2" pipe C& 100.5' Scale is 1" = 40' unless otherwise noted l50' 10' M. tI.B.M. 382' Property Line 90' 102.5' 45' --* El 13-3 87' P.L, 30 B-2 0' 90' 100.51 B-1 8% Slope 467' Property Line Z-d d89'LO 00 Lo Env 1 Soil Test Plot Plan ,A Project Name Hudson Holdings LLC Sha u ird Address 703 Pine St. N. ' Hudson Wi 54016 9WTM #226900 Lot 8 Subdivision Yellowstone Valley Date 4/26/06 S W 114 SE � 1/4S 13 T 29 N/R19 W Township Hudson Boring (D Well PL Property Line County ST. CROIX BM or vRP assume Elevation 100 ft. Top of 1/2" pipe System Elevation 97.0/97.5 *HRpSame as Benchmark Alternate Benchmark Tap of 1/2" pipe @ 100.5' Scale is 1" = 40' unless otherwise noted 150' * 10' t1.B.M. 382' Property Line 90' 102.5' :45:' B-3 87' P.L. 30' B-2 0' 100.5' r B-1 8% Slope 467' Property Line L'd d6£40 00 LL Env