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HomeMy WebLinkAbout020-1435-05-100 ~ m o ~1. v ~ :. ~ ~ ~ A ~ ~ ~ ~ \ ~ ~ z . I ~ 0 ~ N ( ; ~. ~ a~ 5 5. ~ w 7 7 ~ y ~O d N C, j a -~ Q ~ ~~ ~ [Xl C 3 ~~ 7 ~ C it J ~ CO W ~ a ~ m c o ~ t o o i m o o i SS o Y' 0 3 ~ ~ o Do p !~ ~ ~ ' c Q° i , O ~ ~ I cn Z D 5 i o, oo i a ~ m ~ ~o D ~' ~ W `~ c ~ I 3 O N o W ` ~ J r, I, N ~ p~! N K C ~1 -+ 3 Q !mil N ~ I '~ ~ Z 000 a ~ o -~ ~ a j < ~+ Z D ~ to cn to ~ ~ ~ v, ~, i ~ p = f~ D ~ N y 7 ~ r t0 ~ C I w 3 d ; cAo N I a ~ •• ~ ~, o t0 `" N I o _ °' I: C D O I =~ ~ O ? ~ ~1 I 7 ~ f~ ~ o I p y i ! ~ • ~ ~ I m C fJ ~ c' m j I w ~ ~ a A ~ Z ~ O i d a ; A~~ ~ ~ ~ a ~ A' ~ ~ i ~ Z ~ I oo~ m~ I a ~ a z I c ~ ~ ~ I N ~ ~ Z _ I g a ~' I I a I a ~ I = ~ I i o ~ I o I a I ~ m I I ~ a I ' ~,e I I b I ! ~ I ~ t I N ~ N ' O i Q A o ,b °° m aro p ~ ~ N ~ ° C o ~. I ~`+ Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT , - GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m) Permit Holder's Name: City Village X Township Beaulieu, Jerem & Beck Hudson, Town of CST BM Elev: r Insp. BM Elev: BM Description: y,~ TANK INFORMATION TYPE MANUFACT~.J~~µZ'(J ^~~ GJ~L2~ ~-t~ (~` CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ ~ ~~ r f~- Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufactur r nd GPM Model Numbe TDH Lift ' tion Loss System Head TDH Ft Forcemain ength Dist. to well SOIL ABSORPTION SYSTEM lil'~ RE C Width f Length DIME S ~ a ~-~ SETBACK SYSTEM TO V 'INFORMATION Type Of System: CmhJ, "" DISTRIBUTION SYSTEM STATION BS HI FS ELEV. Benchmark 2S 113• ~~~ ' Alt. BM Bly.~ wee yw. ~ 52 ~ Q.0 ~ 13•ZS' SUHt Inlet s; f, ~ I O~• ~ i SUHt Outlet X02, ? ? 6.2p [p~•o$• Dt Inlet Dt Bottom Header/Man. v- t ~6a~ II-!oo o(.bS' Bot. System I~}S. ~ f ~ r Final Grade ~ ^ a st Cover 3. ~~ r Q~ !' 0 ~ 3q ~ ELEVATION DATA County: St. CrDiX Sanitary Permit No: 499222 0 State Plan ID No: Parcel Tax No: 020-1435-05-100 Section/Town/Range/Map No: 11.29.19.2705A1 C ~, P/L BLDG --[ CHAMBER OR UNIT 6 •zs Header/Manifold ~~ Distributi x Hole Size x Hole Spacing Vent to Air Intake ~ h ~~ D Pipe(s) h Di i L S 0 Lengt ia engt a pac ng 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 Yes ~ No ~ Yes 0 No COM~VIENTS: (Inc,(ude c~ di~re~nci erson pre~e t, a Insp c' n #1: ~"~l~/~'~IO Inspection #2: S S ~ ~S~ A r ~ Location: 1035 Labarge Road Hudson, 54016 (NE 1/4 SW 1/4 11 T29~lN"" 19W) NA t 5 Paercel No: 11.29.19.2705A10 T. N,o,w~R. C,Qt~/, S ~ S $Tr.tM inns ./lQi ~ ~I.t.u^,..~,cr. ~Tr3•u~.b~t'T 1.) Alt BM Description =S• ` ,~ i ~ ~• 2.) Bldg sewer length = ^' ~'to~ -~'` ;, o• '~ ~ °'~~ u` '""' O• ~~/b7 Z ~a•hd~S. - amount of cover - ~2 f '~•;"M,,v 0.OZ ~ O ~ A.~ t ~ ~ ~) g ~ s ~ b~.~ -tom ~~-~ ~~ 3 Na t,,~o.R ~t ~~ ~" ~ , - - - Imo{- ~ ~~ t,t,~..lQ . Nof ~ ~ r.,~ :~d~ _ _ _ _ , __ 11tt~ ,"6~ _ ov- ~ , Imo`" n r~ isio Requir d? ~][ Yes No ~ ~~77 ~~~~,,,,//~ Use other side for additional information. ~G' ~~~ ~«+lp ~i ~ ~I~ ~-' 0 Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) ~ ~~~~~ Safety and Buildings Division County ~ ~ 201 W. Washington Ave., P.O. Box 7162 ~lr `+~0~~~~ Madison, WI 53707 - 7 162 Sanitary Permit Number (to be filled in by Co.) (608) 266-31 9~2zZ De artment of Commerce Sanitary Permit Application Plan LD. Number , ~ r- N In accord with Comm 83.21, Wis. Adm. Code, personal information you may be used for secondary purposes Privacy Law, s15.04(1 xm) Project Address (if different than mailing address) // I. Application Information -Please Print All Information ~ /0 3S LaQ,~.~« moo. Property Owner's Name O C T 2 0 2 0 0 6 Par el # Lot # Block # ~ ~ ~EG _ 'r Property Owner's Mailing Address ST. CROIX COON o lion y ~ ~/ .tE '3 ~ 'o"J0 ^ ~ ft! ~/. Section ~ %. City, State Zip Code Phone Number CS/ .? 78 -SY97 , , . / JIS/Dil~d/tL~ ~ ..S-S /S .70 O 3 (circle o e) ~ 2 T o? 9 N; R~~~or~ OOC. TQ~' II. Type of Building check all that apply) ' s wt t '/ ~1 or 2 Family Dwelling -Number of Bedrooms 7 6ubffi~isie~laeale Num CS ~ ^ PublidCommercial -Describe Use s /4 ^ State Owned -Describe Use '~9' ~Ilage ®`fownship of /„fp~J III. T ype of Permit: (Check only one box on line A. Complete line B if applicable) Q / 3 - Q$-' -~ Qb a~0 `~' New S stem y ^ Re lacement S stem p y ^ TreatmenUHolding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T e of POWTS S stem: Check all that a I Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gmvel-less Pipe ^ Other (explain) V. Dis ersaVl'reatmentAren Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevat~n ~~ g I g Coo 8S8 87'0.8 99..3 ~3 ~o VI. Tank Info Capacity in Gallons Total Gallons Number ofUni ufacturer W~.2 ~(t~ ) Prefab Concrete Site Constructed Steel fiber Glass ' New Existing ~ r[~ / J Tanks Tacks Septic or•Iisk QO ~' as o / / •U/~,SB~C Gow~LRe"r~ ~' Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signal a ':' ` MP/ Number Business Phone Number t ~'~ E.cB E~~~ - .3yrz S ~7J -S.? ~~ Plumber's Address (Street, City, State, Zip Code) `aT ~8 ..Sr. ,t~Y a?S ut.~~o L:/ I s'73G VIII. Conn /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee ( lodes Groundwater Date Issued is uing en;Signature Stamps) Surcharge Fee) ^ Own ens '~ IIi;. Condition pprov 1 SYSTEM R: 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 z 11 inches in size zo -1 O 2) aC. V~ SBD-6398 (R. 01/03) ~; n • ~~ O O a l' a ti 'i 1 ~e C ~ a t. o f N T ~~ a ~ \ w o 1 ^` ~ q ~/ r o ~~ S ~ ~ O ~ w a ~ ~ ~ o ~~ ~ ° a `., ~ ti a `~ q `A1 1 ` ~~I ~ \h b ~~ ~ t •~ '~ ~ ~+ ~ '\ "~' a ~ , s ~-~. - 99..3 ~ '' h_ '~ ~ ~- ~v ,f.~E~, - 99.3' ~~ t.a ~ N oyo H ~. ,~EPle~s~+-r.~r .aR~w a a ? ~ ~ 4°~ ~ ~ ^+~o I ~~ a ~ w ~ t` ~ ~ ? c ~ N ~ ~ ~~ A ~ ~ .~~ A ~ ~ ~ n •/ H ~ ~~ ~ ~y I e~ ~~ ~. -- __ __ ~ ~.~ ~~ ~ ., ~ O `~'~ G ~1 ~ ~ ~ ~~ ~ ^i 1 G,` ~ o O ~ 1 ~ n ` a +, o ~~ 1 w . w :1 ~ N ~a n v a A ~~ r 0 w `^ ~~ L v ~ ~ ~ ~ hi ~ ~ ''. ~ ~ . b ~ a y z ~ 1 q a e `b ~ ~ p ~ ~ k~ h ~~ a l~ ~~. ~ o~ s Private On-Site Wastewater Treatment System (POWYS) Index .and Title Sheet Owner: .TF,e~-.~ y ~ Q!«~ r ~~~N ~:~-.c Project Name and System Type: ,7~-.~g~y +,rlE~Ks-~~,ou<~~-~ - y~,e ~,~«o~~o ~d~ rs Location: LAIII.®A 4 4 ~o Street Address,~u sd _ of it/E S<</~ / ~ a7 %.~/~l 9 // ~a r' .~~, JoS.V u.a ~e [s ~ Dur<e r ~ S4asr /~>~,c s Legal Description ~ ~ / ~au./ aF ~DSo./. ,Sr Gi¢oix ~o. Township/County Contents: Page 1: ~N,®e'X r G ~ r~~- ~~y~~r Page 2: ~ar ~,..~ ~/ G/leJl- S/'G r~.~/ Page 3: G~o<~TS D~,,.~-~. `f /yANUAL ~" /lo,/.Rsl~rr./I' ~°x~./ Page 4: „ .~ ~ r Page 5: " Page 6: Page 7: Page 8: Page 9: Attachments: ~aii L<IJAL uA rte,/ ~s/oat' Plumber ,~Q,~ ~~ ~F` Signed: ~i~~Y!~d '• Credential Number: /~i°- 3 yiz - Date: /o - ~ ~- 6~ 1 r W 1 I h ~"~ J N_ ~~ o ~ N L ® ~M ~o ~o ~w ~.. ~ ~ ~ r O R ~ O ~ ~ ~ ~O `~ Y a \ a ` . ~- ~~~ ~ O ~~^ ~ ~ ~^ o ~. ~~ O ^~ ~ ~ ~- .s~~.- 99..3 ~ ' C ~. .. ~ Qs s'Fi• • 99.3 n ~... ~ ,2EP[~cs.~r~r A~c~'~ a r ~+ a ~ T H L.J r a ~ ~~ w - ~~ ~ +~o ^ ~ ~ ~ a ~ ~ n r g r 0 ..~ ~~,,~~ ~ ~ ~C .- rv ~~~°` e~ ~~ -- 3 ~' .. ~ ' ' c o ~ o ~ ~~ a "t a as a Q i a ~, ~ ,. w ,,, , o a A ~ ~ ay ~ o ~ h q a ~ f h 1 ~ ~~ ti ~ v p N 10\ ~ v` I ~n y~ ~ -- * ,~ ~ ~ ~ ~ O Vt T ! N ~` -_ =~ O. Z ° ~ ~ a i . ~ ~ ~ ~ ~ ~ ' n i ~- o R a ~ a ; ~ ~ ~ a i ~ , wv 1 ~~~ ~Z ~ V n ~ t y c ~ • C.,, ~'d \ '', < ~ r + ~ ~ A n y e ~ e `U ~ ~ qp ~ ~ ~ a ~ ~ k ~ H 1 Qi N e '~ a ~~ POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FIL~'NFORMATION Owner • T~it~.ry ~~~cr___ A ~ i~a Permit # X99 Z 2Z DESIGN PARAMETERS Number of Bedrooms 100 droom ^ NA Number of Commercial Units - NA Estimated flow (average)* Qo al/da Design flow (peak), estimated x 1.5* ap al/da Soil Application Rate al/da ft Influent/Eflluent Quality (NA^) Monthly Average** Fats. Oil & Grease (FOG) < 30 mg/L Biochemical Oxygen Demand (HODS) ~ 220 mg/L .Total Suspended Solids (TSS) _< 250 m Pretreated Eilluent Quality ^ Monthly Average*** Biochemical Oxygen Demand (HODS) ~ 30 mg/L Total Suspended Solids (TSS) ~ 30 mg/L Fecal Coliform (geometric mean) _<10 cfu/100m1 Maximum Effluent Particle Size 1/8 inch diameter *Wastewater Flow Verification and Calculations: (Other than bedroom based) ** Values typical for domestic (non-commercial wastewater and septic tank effluent. ***Values t ical for retreated wastewater. SYSTEM SPECIFICATIONS Se tic Tank Ca ci /0?00 1 D NA Se tic Tank Manufacturer ~/ s a. DNA Effluent Filter Manufacturer ,QED ^ NA Etlluent Filter Model -Jo0 ^ NA Pum Tank Ca cit 1 A Pum Tank Manufacturer ^ NA Pum Manufacturer ^ NA Pum Model ^ NA Pretreatment Unit ~' NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Manufacturer: Model: Dispersal Cell(s) ~(In-ground (gravity) ^ In-ground (pressurized) ^ At-grade ^ Mound ^ Dri -line ^ Other: ~'Leaclung Chamber Manufacturer /„/fit r~tR raa Model S>=A,JAARa Laying Length/Chamber (~?,~' Soil Application Rate gpd/ft2 Area Req. ft Infiltrative Surface/Chamber-ESIA Rating ft2 Minimum Nwnber of Chambers ^ Aggregate Desi n Flow/Loadin Rate= ft min Materials: all materials must comply with WI Adm. Code COMM84 and be installed per manufacturers specifications and a royal letters. DF.Si(:N ('RiTERIA ^ "Wisconsin At-grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.a1.1990) ^ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 ^ "Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems" Publications 9.6 ^ "Design of Conventional Soil Absorption Trenches and Beds". R.J. Otis - ASAE Publications 5-77 and "Design Manual - Onsite Wastewater Treatment and Disposal Systems". EPA 625/1-80-012 October 1980 D SBD - 10570-P (R.6/99) "At-Grade Component Manual Using Pressure Distribution" 'SBD - 10567-P (R.6/99) "In Ground Absorption Component Manual" ^SBD - 10705-P (N.O1/O1) "In Ground Soil Absorption Component Manual" Version 2.0 ^ SBD - 10628-P (N.6/99) "Recirculating Sand Filter System Component Manual" ^ SBD - 10656-P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" ^ SBD - 10572-P (R.6/99) "Mound Component Manual" ^ SBD - 10691-P (N.01/O1) "Mound Component Manual" Version 2.0 ^ SBD - 10595-P (R.6/99) "Single Pass Sand Filter Component Manual" ^ SBD - 10657-P (R.6/99) "Drip-line Effluent Disposal Component Manual" ^ SBD - 10573-P (R 6/99) "Pressure Distribution Component Manual" ^ SBD - 10706-P (N.O1/01) "Pressure Distribution Component Manual" Version 2.0 ^ Drip-line EIDuent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units MAIN"1'1N;NANC:L ANll MANA(i1N:mEP1 1 MATNTFNAN(`F. MC1NiT()RiN(= C('HF.i1iSi.F. Service Event Scrvicc Frc ucnc Ins ct condition of tank(s) At least once eve ^ months ,~ ear(s) (Maximum 3 rs.) Pum out contents of tank(s) When combined stud a and sewn a oats one-third (1/3) of tank volume Ins ct dis rsal cell(s) At least once eve ^ months ear(s) (Maximwn 3 rs.) Clean effluent filter At least once eve /'/ months ^ ear(s) Ins ct um , um controls & alarm At least once eve ^ months ^ ear(s) NA Flush laterals and ressure test At least once eve ^ months ^ ear(s) ^ NA Valves At Least once eve ^ months ^ ear(s) ^ NA Other: At least once eve ^ months ^ ear(s) ^ NA Yagc 1 of 3 START UP For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of ttte tank(s) removed by a septage servicing operator prior to use. . System start up shall not occur when soil conditions are frozen at the infiltrative surface. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water Veatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. ° This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton svabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. ^ Valves Valves shall be operated in the following manner: ^ Alarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. INSPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). Septic Tanks Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any backup or ponding of efnuent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one-third (1/3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. ^ Pump Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of any filters. Any service needs or repairs shall be promptly taken care of. In-Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Pagc~of .S ^ Mound, At-Grade, In-Ground Pressure The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any ' ~ evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) yeazs. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code. - All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. - The contents of all tarilcs and pits shall be rerrioved and properly disposed of by a Septage Serr7cing Operator. - After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other 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 repl~eJ~ent system: /~ A suitable replacement azea has been evaluated and may be utilized for the location of a replacement soil absorption system. 1 The replacement azea 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 azea will result in the need for a new soil 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 azea. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement azea is available a holding tank maybe installed as a last resort to replace the failed POWTS. D Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIItCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IIVIPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name /`d~B C~,F'~.~E ~N- .~ Y/Z I Phone 7/S G7.?-S.?LL SEPTAGE SERVICING OPERATOR (Pumper) - ~/./,rvvw.~ Name Phone K:\WPDATA\EI3\POWTS OWNER'S MANUAL.doc POWTS MAINTAINER Name ~r,~ ~ ~ ~~KE u~gsidL ~ Phone /S L .7 - SdLL LOCAL REGULATORY AUTHORITY Agency -Sj- ~i2oix Zo./i./t Off/cA" Phone 7js' ..Pd6 - yL 80 Page .S` of .S` ,~' J ~r; ~ ~. `J~ V 9 J a V :~ , Maintenance The interval for servicing septic tanks is set by state and ibca( code. Throughout the United States there is a wide difference of opinion on what this interval should be, but most regulatory agencies suggest two to five years. The Zabel'" filter, which does not increase the frequency of servicing for the tank, should be cleaned when the septic tank is normally inspected and pum ed. However, our filter is virtually self-cleaning. The continued action of the anaerobic organisms on the Zabel filter causes lodged particles to disintegrate and fall to the bottom of the tank. If your filter contains a SmartFilter"' alarm, you will be notified by an alarm when the filter needs servicing. To service the filter: 'Servicing any zabel /filter should only be done by a certified septic tank pumper or installer. Locate the outlet of the septic tank. While holding the the access opertfn cartridge with fr~s careful to rinse all ~0 'Note: 1t is nol nece 'spotless'. The biom aides in the pretreatn be le/t on the h7ter. (1! maybe disa: Remove the tank and pump the I necessary to pr any solid: escaping to the when the f rem sr -- ,~-- /, j i carttfd~A;over~t:.~ ~- Insert t back in t sure the prop complete Replac :,~f{1`~l`~,i Firmly pull the filter har and slide the cartridgA of the c2 'Note: A tee handle may f fo be used it the tiller is t below Around level to Contact Zabel for info handles ., ~ FC he fli(er`~~rtfld~,e s> fill erl ,< ly i ~ ,. et ris;,~~ ~~ ~4l ~~( . i F~A'~+t +1 ~. 4AOE W USA The product(s) shown are covered by one or more o/the lol/ow/ng patents: 1J.S. 5,762,793, 5,580,453, 5,591,331, 5,759,393, 5,683,577, 5,582,716, 5,779,896, 5,593,584,5,795,472,5,736,035, 4,710,295, 5,382,357, 5,482,621 U.S. Des. 386,241, 349067, 4605501,5098568, Des. 309007, Australia: 134440; Canada: 2,135,937; Israel: 111574; New Zealand: 264824, Other Patents Pending Call for a tree ZABEL ZON E An Onsite Wastewater Magazine 1-800-221-5742 • Website http://www.zabel.com A100/300•I~M,61499 "~~ # ~, ~ jg~~~g,~p O SOIL EVALUATION REPORT Department of Commerce Q/O in accordance with Comm 85, Wis. Adm. Code Division of Safety and BuildinasC~/ / #1659 Page 1 of 4 Steel's Soil Service, Inc. V Attach complete site plan on o ss than 8%: x 11 inches in size. Plan must County St. Croix include, but not limked to: v n ho percent slope, scale or dimen ' ,Wort rizontal reference point (BM), direction and to nearest road. D C VED Parcel I.D. Pendin Please print Personal information you provide may be u ! 11 in for secondary purposes (Privacy La , s. 15.04 (1) (m)). Reviewed By Date Property Owner P operty Location Felling, Bill & Liz G vt. Lot na NE1/4, SW1/ , S11, T29N, R19W Property Owner's Mailing Address 1026 Tanne Ln ZONING OFFICE L t # 5 Block # na Subd. Name or CSM# Joshua Hills . y City State Zip Code Phone Number ~~ City ^ Village ~ Town Nearest Road Hudson WI 54016 715-381-1240 Hudson Labar a Rd New Construction Use: ~ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ^ Replacement ^ Public orcommercial -Describe: na Parent material Stream terraces and pitted ouiwash plains Flood plain elevation, 'rf applicable na ft. General comments Conventional system, system elevation 98.65ft Trenches spaced and depth to code 5.75tt below grade. and recommendations: Boring # ^ ^ Ground surface elev. 104.40 tt. De th to limitin factor 110 in. P 9 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP D/ff= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0-15 10yr 3/2 none I 2msbk mfr cs if .6 .8 2 15-53 10yr4/4 none sicl 2msbk mfr cb is .4 .6 3 53-110 7.5yr4/4 none cos osg ml na na .7 1.6 a~`~ 3~ 61.2 4 - L Boring # ^ Ground surface elev. 104.40 tt. De th to limitin factor 110 in. ^ P 9 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP D/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-17 10yr 3/2 none I 2msbk mfr cs if .6 .8 2 17-110 7.5yr4/4 none cos osg ml na na .7 1.6 4q, v .2 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ature: ~ CST Number David J. Steel ~ - 248956 Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 4/19/2005 715-760-0347 SS Property Owner Felling, Bill & Liz Parcel ID # Pending Page 2 of 4 Boring # ~ Ground surface elev. 9$•30 ft. Depth to limiting factor 110 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-36 10yr3/2 none I 2msbk mfr cs if .6 .8 2 36-60 10yr4/4 none sicl 2msbk mfr cb na .4 .6 3 60-110 7.5yr4/4 none cos osg ml na na .7 1.6 ^ Boring # ~ Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary oots GPD/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#t `Eff#2 ^ Boring # ~ Ground surface elev. ft. Depth to limiting factor in. Soil A lication Rate ^ Pp Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#t 'EtT#2 'Effluent #1 = BODS> 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. SBD-8330 (R07/001 Sbeel's SaI 52rVICE. InC. .' ~ ~ STEEL'S SOIL SERVICE INC. David J. Steel Bill & Liz Felling 994 200' St CST-POWTSM NE1/4,SW1/4,S11,T29N,R19W Baldwin, WI 54002 Lic. #248956 Town of Hudson, St. Croix Co. Cell(715) 760-0347 Lot 5, Pending Fax.(715) 684-3449 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this test may or may not be as shown, as permanent lot lines were not established at the time the soil test was conducted. Legend 1" = 40' • =Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe ~ =Alt Benchmark Ele. 99.20 ft Top of 3/4" pvc pipe ~ =Borings Boring Elevations B 1 = 104.40 ft B2 = 104.40 ft N 3of3 i ~a,0~ i` • '~ .~ ~~ s I t ~I ~t~ ~I ~ Z ~ s / „!( ® ~~ Z ~a®i ~ ; ~a~i o~ e.~i ~ owc°co (~ ~ ; t~ ~ o~~~ l x91~~C1 ~~ ~ ~~ ~~~ "a~ 3 00~., ~~ ~~ ao I~''~ o I ;z ~._~ "y f ~l~.jL ~._ ._ _~~ ~; ~.~--. ~ n `~s~t Y ~: f. ~~~;; ~: •~ . : ~;~,: O Z OC . K ::.~:z:.. _.. ., Z~ - ' ~.,, - - - .- . ~~ ~0~7 v~ ~ ~ ~ ~ ~zzd mra ,~, ~ a. ~. A~p1 sv~~rle~rn~ ~m e~e~~~z t~R t° ~ °~~~~$~~~~~~sa~ $~~d ~ ~ .-t ~ ~ ~ ~\O~fS 1 LOT 4 ~.. ~ °' 7.92' ~ 0 'r io x ~--~ E i~ '° ~ ~~ ~ R~1 ~ ~ m G I~ ~~~ c 1 c' ~~~ m~a ~d ~~~ a ~~ , ~~ l_._._. z 't-{ ~ ~O ~i~ '~ a 7'97522 OAL_ 19 __P~ GE 4995: REGISTER OF DEEDS ST. CROIx CO.. MI RECEIVED FOR ~ECQRD ®6/13/2'~iAS 02s10PM CSR7'IFIED SURVEY MAP REC FEE: 13.00 COPY FEE: 3.N PA68S: 2 ~_~~ ~~~~ ~ ~~~~ A o N c7 z ~~~~ ~~ A ~~N ~ v ~~" ~° g r ~ Z~~~ a ~ ~z~~ a ~~ ~~~~ ~) ~~~m ~~~ ~~o~~ N>~€ y ~ ~~~ C ~~QZ C '~ Al O ~~ !74.71' ~ ~ +' ~ ~~ ~+ mm THE EAST UNE OF THE NEl/4 OF THE SW1/4 OF SECTfON 11 BEARS NOO'09'16"E AS REFERENCE TO THE ST. CROIX COUNTY COORDINATE SYSTEM ~ e • o • ~ i . ~ ~ ~~ ~6' '~ j ~ i O ~d~ ~ ~ ~'~+' ~aq~ ~, ~ / ~ ~ ~~ SHEET 1 OF 2 SHEETS 4 Vol 19 Page 4995 _Ln-~ ~ ~ ~~ ~~ ~~~ ~ ~g ~ a ~~ ~w ~N ~~~~ ~ . ~ ~ ~ ~v $~ ~~ m ~~ ~~ v ~ ~ ~~~°~ ~~ g~€ ~rn g~~ y u N \- OwnerBuyer ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM 1 Mailing Address Property Address 1035 L~ (~rq~. ~D , ~~son, u~' (Verification required from fanning & Zoning Department for new construction.) ~ V 1 City/State ~~ 5~ n ~-~ Parcel Identification Number O~~ ~ ~ ~5~5 Z~-oSA~ -to~ LEGAL DESCRIPTION Property Location ~ ~ '/a ,~ ~ '/a ,Sec. ~ i , T ~N R~W, Town of Subdivision ,S 1-~l.t~so -'~ Lot # Certified Survey Map # ~~ ~ ~ ~ ~ ~'C7 ,Volume ~~ ,Page # 4~~s Warranty Deed # ~ 6 ~ ,Volume 2 $~2 ,Page # 3 Spec house yes no Lot lines identifiable yes 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 §Comm. 83.52(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 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. 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 bedrooms ~_ -,_ ~ ~ ~o /,~~ SIG ATURE OF APPLICANT(S) DATE ***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. 08/05) _ u ze~2P 3s ' State Bar of Wisconsin Form 2-2003 • WARRANTY DEED Document Number Document Name THIS DEED, made between William J. Felling and Elizabeth E Hurley-Felling a/k/a Elizabeth Hurlev-Felling husband and wife ("Grantor," whether one or more), and Jeremv Beaulieu and Rebecca Beaulieu husband and wife ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Part of the NW 1/4 of the SE 1/4 and the NE 114 of SW 114 of Section 11, Township 29 North, Range 19 West, including Lot 5 of the Plat of Joshua Hills and Outlot 1 of the Plat of Sunse to the Town of Hudson, St. Croix County, Wisconsin described as follow .Lot 5 f Certified Survey Map in Vo1.19, Page 4995, Doc. No. 797520, ^'--^- ~---• ^_,~_~.__ ~~~ ~r~i 1 ES~~ KATHLEEN H. k1ALSi1 FtEGIS~'fBl? Cif` i71;EIi` S'I'. C.R~IIX CCi. , #I1 RECE~I/EI3 FQR REC012I~ Qi7! 2Bf 205 1 ~ : 4ttaAll NARRANTY IDEED ~X~T' REC f`EE: 11, TRANS elai: 279. f8~ C[1PY FRE: CC FEE: PAGES; L Recording Area Name and Return Address RVAT 2682731 020-1435-05-050 Pazcel Identification Number (PIN) This is not )iomestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated July 22 , 2005 ~_ (SEAL). ~UJ.X/"'' * *William J. E. Signature(s) _ authenticated on ACKNOWLEDGMENT STATE OF Wisconsin St. Croix COUNTY } ss. TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on July 22 , 200 5 , (If not, the above-named William J. Felling.,and Elizabeth E. Hurley- authorized by Wis. Stat. § 706.(~~--uuutrt~ Felling. a/k/a Elizabeth Hurte -Felling husband and wife THIS INSTRUMENT DRAFTED ~' +~Q•~ to me k to be the person(s) who exe ted the foregoing ~`,, ~ ~ . O ~pT AR y'. Z? ins nt d acknowledged the sam . Attorney Kristine Ogland_ . U _ ~'~C Hudson WI 54016 "s ~c :mod, •• g~, ~ * onnie u ixso ~~'•,~'9l~ Of= ~,SGO?.`~~ Notary Public, State of W i s e on s i n _ _ ~~~h~nunnt+~~~` My Commission. (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ©2003 STATE BAR OF WISCONSIN FORM N0.2-2003 " Type name below signatures. INFO-PROT'" Legal Forms 800-655-2021 www.infoproforms.com AUTHENTICATION ~~ ~r -~ F- ' _ b ~~~ ~ 3 ~ F,,, W ~ C7 S W Z~b6oa Q~~`` oa c ~~ ~ Z~~~ ~~ ~m~~ ~~\~ ~~ C7 i~ ZG~ ~ ci°'ZC c~ c~ ~ ~ o ~ ~~ ~~ ~ ~~~ ~a ~~ ° g ~ ~ • o • B j was ~.vNiaaoo~ .llNfidJ X102p '1S 3H! 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