Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
026-1057-70-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 572810 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: Tudahl, Duane R. I Richmond, Town of 026-1057-70-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: /46 1 /(n k 19.30.18.290D TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / i Benchmark 'd5 /Z Dosing / Alt. BI4 K.Z, /,dd Z ion 1 Bldg.Sewer F•t i`M�-tL G� iii Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht outlet TANK TO P/ WELL LD Vent o Air Intake ROAD Dt Inlet a�,�-- $ 66- •$ q` Septic /Z /L / f Dt Bottom C, Z 7 •� Dosing .7S Z7 "7.O Header/Man. cr$ s( 5/ Aeration ll . __ S' Dist. Pipe T; Holding �TtDJ'Ki Bot. System 16 -s. Final Grade PUMP/SIPHON INFORMATION 04 1= Manufacturer e'�G� Demand St Cov r Old � S• /a�•Z Model Number n AJ L-,t) TDH L Frictio�Lgss System H�ac�_ TDH •� Ft �V Forcemain Len th Dia. 0f ist.to Well $7 SOIL ABSORPTION SYSTEM 0 ,S ,'1�•... BEDITRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 13 3* 1 ( ( SETBACK INFORMATION SYSTEM TO P/L JBLDG IWELL LAKE/STREAM CHAMBER OR Manufacturer:=^ Type Of�Sy Jster� �. /3 > >• UNIT Model Number: Qv. VV� ck• 4 /mss DISTRIBUTION SYSTEM w (,•� a,.� �o J l $; 2S X, 02,4,= Header/Malfol q Distribution x Hole Size �_ 7acing Vent to Air Inta OM- Length T Dia Length Dia Spacing ` w SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 4— Aj..0 4A--41 Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulc ed Bed/Trench Center Bed/Trench Edges To soil g pes � No Yes No COMMENTS: (Include code discrepencies, persons present,etc.) Inspection#1: / / Inspection#2: Location: 950 140th Ave. N1e Richmond,WI 54017(SE 1/4 SW 1/4 19 T30N R18W) metes&bounds Lot Parcel No: 19.30.18.290D 1.)Alt BM Description= c•-�JtJ�- C wa l�{ ,S h 2.)Bldg sewer length= / 0 �C 1� -amount of cover= (.—.x-1,`J�''� nn i ln• Nf Plan revision Required? FE] Yes °' No � 043 Use other side for additional information. 7 SBD-6710(R.3/97) Date Insepctor's ignature Cert.No. PLOT PLAN PROJECT Duane Tudahl ADDRESS 950 140th Ave New Richmond Wi 54017 SE 1/4 SW 1/4S 19 /T 30 N/R 18 W TOWN Richmond COUNTY ST.CROIX SYSTEM ELEVATION 96.7/96.4/96.1/95.8 5' below DATE 10/7/14 BEDROOM 3 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 662 # of chambers 32 IL BENCHMARK V.R.P. Walkout slab ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. 140,ti� ve Scale is 1" = 40' unless otherwise Scale _ 1 4' = 10' Right vva noted Vent ALo Quick4 Standard Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 2" Grade at System Elevation 34" B.M.* Well Existing 3 Bedroom House 20, od 28' AC 20' 51' 10' Deck Footings T 10' LT 100.5' 10' 50' 4-4' X 32' cells with 3' spacing B-2 0 20, D W Drywell is to 15 be pumped and buried B-3 3 4% slope 0' B-1 Property Line(next to easement road) 101.5' 10' 55' County Safety and Buildings Division + / �0 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(to be filled in by Co.) $ Madison,WI 53707-7162 State Transaction Number R.,o./� �t ermit Appli ater-- j in accordance C, 683 1(2),Wis.Aden Code,submission of this form to the appropriate governmental unit is required 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 purposes in accordance with the Priv Law,s.15.04 i m Stats. tion 11 Information Information-Please Print A I. Application Inform parcel# Property Owner's Nam r-- �� n� � w `" Property Owners Mailing Address Property Location ` 2 A� c D Govt.Lot ) y G� City State)C J e Phone Number _/,��G/ '/., Section ircle o tType Vol 13(-2 N, R/ —of Building(check all that apply) Lot# e Subdivision Nam I �--- !' �l Bcdroo / Family Dwelling-Number of �•!G Block# �Z f �i ❑Public/Commercial-Describe Use CIS ,.��, ❑City of CSM Number ❑Village of ❑State Owned-Describe Use Town of III.Type of Permit: (Check only one boa on line A. Complete line B if applicable) A' El New System ment System El Treatment/Holding Tank Replacement Only El Other Modification to Existing System(explain} List Previous Permit Number and Date ued B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New I LI — L i / Before Expiration owner IV. a of POWTS S stem/Com onent/Device: Check all that apply) Non-pressurized in-Ground ❑Pressurized In-Ground Q At-Grade El Mound>24 in. f s!uitablee S 1Cfound<24 in.of suitable soil ❑Hol g Tank ❑Other Dispersal Component(explain)J Pree atrne L e plain) V.Dis ersaVTreatment Area Information: °? Ar S' ` r Design Flow(gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required(si) Dispersal Area Proposed(sf) System evasion 9�� A/_ �� 1 1?1-:. -7,' 9-1 VI.Tank Info Capacity in Tl #of Manufacturers Gallons Gallons units New Tanks ° ° `t Existing t Existin Tanks cu A.C) Septic or Holding Tank �' Dosing Chamber VII,Responsibility Statement-1,th ndersigued,assn r ponsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumb i ature MP/MPRS Number Business Phone Number Plumber's Address(Street,City,State,Zip e) / 2 c� Coun /De artment Use On] Permit Fee Date Issued lssuulb Agent Sir ure Approved ❑Disapproved S ❑Owner Given Reason for Denial --" IX Conditions of Approval/Reasons for Disapproval ' /IIv nd"'n € C. is s SYSTEM OWNER: ' !�� c 1.Septic tank,effluent filter and �� � ���"/ dispersal cell must be serviced/maintained t 'L C� L L'��Gu n �` ►�` ` h ? as per management plan provided by plumber. y e d submit to the County only on paper not less 12 11 i' es in size as per applicablecoet°e ��inances. G� > ��,✓ �'G t c%�-vt Ck SBD-6398(R. 11/11) J C Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 1017/14 Owner:Duane Tudahl Location: SE1/4 SW1/4 S19 T30 N,R18W 950 140th Ave Richmond System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Pressure Distribution Manual (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet 8. Dose Tank Cross Section 9. Pump Curve 10.-12. Soil Test 13. St. Croix County Exis i S ank form Signature License number# 6 0 PLOT PLAN PROJECT Duane Tudahl ADDRESS 950 140th Ave New Richmond Wi 54017 SE 1/4 SW 1/4S 19 /T 30 N/R 18 W TOWN Richmond COUNTY ST.CROIX SYSTEM ELEVATION 96.7/96.4/96.1/95.8 5' below DATE 10/7/14 BEDROOM 3 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 662 # of chambers 32 BENCHMARK V.R.P. Walkout slab ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. 140th Ave Scale is 1" = 40' Right of Way unless otherwise Scale = 1 4' = 10' noted Vent >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 4' Long 12" Grade at System Elevation 34" B.M.* Well Existing 3 Bedroom AL House 20, 28' AC 20' 51' 10' Deck Footings T 10' LT 100.5' 10' 50' 4-4' X 32' cells with 3' spacing B-2 0 20, D W Drywell is to 15 be pumped and buried B-3 3 4% slope 0' B-1 10' Property Line(next to easement road) 101.5' 55' Cross Section of Quick 4 Standard Leaching Chamber Typical cross section for 2 of 4 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 101.5' Vent Grade Vent 4' 41$ 4' X30/34 Septic Tank 4' Long 191 5' 4' Long 1 14 Grade at System Elevation 3 2F Grade at System Elevation Spacing 5' 4-3 X 34 Cells Observation tubeNent Same on other end To be located on end of Cells %A B System elevations: C A-96.7' B 96.4' 8 chambers per cell D C-96.1 ' D 95.8 Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Minimum Pump Performance Required Tank Model Number 3 Z p GPI Ft TDH Total Tank Capacity 6 -30 Max.Bury Depth Total Dynamic Head(TDH)••Feet Pump Manufacturer Elevation Head / (� Pump Model Number S 3 Distal Pressure - Alarm Manufacturer utc�r^ Network Pressure Loss Alarm Model Number Force Main Pressure Loss J/ 4 ! 5- t/ Switch Type Total , Manhole Min.4"Above Grade With Locking Device Vent Min. 12" Weather-proof Above Cap ve Grade Junction Box �♦ ,1 -- " -� .. •- - - Finished Grade - - - - -- Depth of Cover_ _Ft Disconnect Means r s t >` '< Outlet Switch Settings and Reserve Capacity Inlet ;s Tank Volume= GPI ;t Yt R t }< Dimension Inches Volume Gal. A < /a (reserve)A aft 367. ,.--- YS Weep (alarm) B 2 Q B Y j Hole (dose) C `J j Off Elev. C (dead) D ) 3 -3- 97, Ft Total ` > t tt >t D ; ' ��o. Ft Y` Bottom of Tank Elev. R }SY C-11 - i t GENERAL INSTALLATION: The dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling;or sagging.in . The force main is sleeved with 4" Sch. 40 PVC to bridge the excavation and is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 Wis.Adm. Code. 03/051gj Page of lr--AL [-AD R v i E , CAPACITv C1,:RVE LS 57/55/57/59 25 c e 7 9 T- 20 -trs. 43 .. I` � � �� t �fi. N ___�1'j 4 q ---------- U1 _ f 5 t .2 9 2 C 2 40 r" U.S. GALLONS ' � --EITEFE 0 i 6C 1,6 4 -R MINUTE 009897 Variable level float switches available. Variable level long cycle systems available. Available with special cord lengths of 15', 25', 35' and 50'. Alarm systems available. Duplex systems available. I II '/32 SK856 Single Seal Control Selection Listings s squired. Implex Duplex CSA UL 1. Integral float operated mechanical switch,no external control r- Votts Phase j Mode Amps piggyback variable level 1 . uto "j— :1 Y Y 2. Single piggyback variable level float switch or double pig =&M57/59 —1 —Aulo —1;7 &Nbl/W Non 9.7 2 3 5 Y Y float switch.Refer to FM0477. 10-0075. BN53 17 3. Mechanical alternator"M-PaW'10-0072 or _15 Auto Auto 9.7 ----- N Y BN57 115 4. See FM0712 for correct model of Electrical Alternator.1 Auto 4.8 -—BE5y5_7 230 Y Y I Variable level control switch 10-0225 used as a control activator,with Electrical _D53/55&D57/! uw 48 Y 5. ___A__ .3 .... 1 5 Y —— T---- Non Er4�a Alternator(3)or(4)float system. 59 30 —E5 jq�2-30-1 41 3155&E57M or 4& MO_L _-- Single piggyback switch included. For information on additional Zoeller products refer to catalog on Piggyback Variable Level Float Switches,FM0477; Electrical Alternator,FM0486;Mechanical Alternator,FM0495;Sump/Sewage Basins,FM0487;and Single Phase Simplex Pump Control/Alarm Systems,FM0732. For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O.BOX 61` Louisville,KY 40250-,-3"-" Manufacturers of.. SHIP TO:3649 Cane Run Road Louisville,KY 40211-1961 rZOI/7-Y PWRY SINL-F 11US (502)778-2731.1(800)928-PUMP http.-IAvww.zoeller.com 1011"IF M. FAX(502)774-3624 ------ -1 0.Copyright 2002 Zoeller Co All rights res e rved. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK 1.'hi.s is to certify that I have i spec ed th �-,carving the _ e septic tank present:-! .y rte 1 t c--t a- -' residence located Section / T 30 Upon inspection, I certify that I have f ntn nd the tank and baffles to be in good condition, and it appears to tie functioning properly. h,ist time serviced: i flow back occur from a orption system? Yes N o (If no, skip next 11 Approximate volume or length Of time: writ !�allon ini.ntat� construction: Prefab Concrete �/ /�- Steel Other 9,-inufacturer: (If known) •L�.��✓�crrvr✓ � ' �� ©c l�t A 1 e of Ta (I f known) :Lc A K ox-4'/ ture j (Name) G Please p/r�int 1 -_ - -- -. _-- � 2— (License Number) Date t"017111 to be completed by licensed plumber (s. 145. 06, Wisconsin ,Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: _ y try accepting the above statement regarding existing septic tank condition, I certify that the tank to the t of my knowledge will conform to the requirements of ILHR 831 Adm. Code (except for inspection opening o r outlet baffle) . Name' � Signatur ? MP/MPR-7—! T4 kl 175 3"� 75 FLOW If _rE 06E,98 HYMN GAY NNIH RD BG'YNE- CITY, MI 49712 M VAX 12')�-TL -7124 SNT[CH P1_7P A7'11 OPP, . 10HOWE F�J I I...... GARY KubkP'LiNtk- .- � r�1-4 -.-4t:HA 73 Awned (1:3�IN3338d 898LVLGSTL Lt-1:A_T TTOZ/913/ t Property Owner_ Parcel ID# Page of aBoring# ❑ Boring Pit Ground surface elev. ' ft. Depth to limiting factor�_in. n*Eff#1 Hori zon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots D/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#2 71- �----� � - F-1 Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 F-1 E] Boring Boring# Ground surface elev. ft. Depth to limiting factor in. 11 pit 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 =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(R.6P00) Wisconsin Departnient of C � SOIL EVALUATION REPORT Page of-,3 Division of Safety andj� ^G �rpr ance with Comm 85,Wis. Adm. Code County Attach complete sit�AaPi®�r a`p rylot less than 8 1/2 x 11 inches in size.Plan must `� �` fo/ include,but not limit` Vi rtical and horizontal reference point(BM),direction and Parcel I.D. percent slope,s5 altA dimensions,north arrow,and location and distance to nearest road. {�� /25 70— P/ease print all information. Reviewed by, Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). �r (� � �(✓ t ' Property Owner Property Location �Q, ��� Govt.Lot 1/4S(,J1/4 S [ T ,�0 N R E(or W Property Owner's Mailing Address Lot# I Block# Subd. Name or CSC.>l—C(J � city State Zip Code Phone Number ❑City Village Town Nearest Ro ❑ New Construction Usf' sidential/Number of bedrooms Code derived design flow rate 7�,' GPD eplacement ❑ Pubii r commercial-Describe: Parent material ®� elevation if applicable A'l qL General comments and reconvriendat ones:: System Type System Elevation b° �• / v / ✓' MBoring Boring# C]"Pit Ground surface elev.I-Mi ft. Depth to limiting factor 1/ 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 I •Eff#2 C'� s Boring# Boring Zo 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 D C/ Ir • Effluent#1 =BOD,>30<220 mg/L and TSS>30<150 •Effluent#2=BOD,<30 mg/L and TSS<30 mg/L CST Name(Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 5401 ��°� —1 715-246-4516 Soil Test Plot Plan Project Name DuaneTudahl Sha rd Address 950 140th Ave New Richmond Wi 54017 TM #226900 Lot ------ Subdivision --------- Date 10/5/14 SE 1/4 S W 1/4S 19 T 30 N/R 18 W Township Richmond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Walkout slab System Elevation 96.7/96.4/96.1/95.8 *HRpSame as Benchmark 140th Ave Scale is 1" = 40' Right of Way unless otherwise noted B.M.* Well Existing 3 Bedroom House 20' 28' Ac 20' 51' 10' Deck Footings 100.5' T 10' 10' B-2 20' D W 15' B-3 30' 4% slope No- 0' IF B-1 101.5' 10' Property Line(next to easement road) 55' 1 4 ,, at N w , s _ rn . ti F I (I I y p,s r � x � ma r t a i P j k ST. CROIX COUNTY SEPTIC TANK MA AGREEMENT AND UWNDRSHD^ CEKIDqC&TK`N F&QDN &4ai6np���chomm '' '-^-~~�-------�'��=�^-°^-^''-.�~-~=_'__"=�=._=°�' Property Address (Verification required From Planning&Zoning Depaitinent tbi,new construction.) � Poronl \duutij�cudouNuru6mz ~�-� «�. LEGAL DESCRIPTION . ��-� ' Property Location �� , Soc. I,=� I� YV' Town o[ j Subdivision ~�— �nt� -- Certified Survey Map# -----_______, l//`lmuoPage#_____ ^� Warranty Deed # _�r � _ ^ ' \/miuco�7 � � , I`aAolt Spec house yes �o Lot�m:. �o�Ouh� Oes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION �� Improper use and maintenance of your septic system could result in its pr',mature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years oz sooner, d needed,byu licensed puo9/,r. What you put into the system can affect the function of the septic tank usn treatment stage im the p/uo|o disposal system. Owner maintenance responsibilities are specified hu§Comm. 83.52(1)and io Chapter 12 St. Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Plauning&Zon.ing Department a certification foini, signed by the owner and 6yu master pkozbnz,joornnyzoun plumber,r°otyi tedploo6,cvrulioonoodpuopcxvorUying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspeudon and pumping(if necessary),the septic tank is less than l8 full nfsludge. I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein,uvset by the Department ofCummeic:uodUeUopunmvotnfNaturalMxamxrnu,Staten[Wio:mmiu� Cozi6cu6uuotudz4gt6�your anpdcuyotoomhas been omiodu�o6 must 6o complete,|and zobom:6to�e St. Croix County P\ i 6t Zoning I)oportaocot within 30 days nf the three year expiration date. I/vo certify that all statements oo this form ure.true to the best o{iny/unzk oowledge. Dweuodure the uvnm(x)ofthe property described above, 6y virtue of»warranty deed recorded iu Register of Deeds Offioo. Number of bedrooms �11'3-- ----~- S\{ U'T [TCANT(S) --- '- DAT� - ***Anyidozouuhonthatiomderopneaentodomyrosobio~keomd1oryornotbe6o8n'*oLrJbydzo9/umzin&8:ZooiugDnpurbnoot. *** Include with this application u recorded warranty deed from the ReAixtv,o[Dxodh Office and u copy of the cerdfindsurvey map if reference is made in the warranty deed. (REV.08/05) i POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page_j_of FILE INFORMATION SYSTEM SPECIFICATIONS Owner T Tank Manufacturer: ❑ NA Permit# Septic ❑ Dose ❑ Holding Volume: OV-0 (gal) DESIGN PARAMETERS Tank Manufacturer: ❑ NA Number of Bedrooms: 3 ❑ NA ❑ Septico-Qpse ❑ Holding Volume: 30 (gal) Number of Public Facility Units: )fB-NA Vertical Distance Tank Bottom(s)to Service Pad: Estimated(average)Flow: (gal/day) Horizontal Distance Tank(s)to Service Pad: 60 (ft) Specific servicing mechanics must be provided if vertical is>15 feet or Design(peak)Flow=(estimated x 1.5): C� b (gallday) if horizontal is>150 feet. Speclttc Instructions to be provided on back. In Situ Soil Application Rate: (gal/day/ft) Effluent Filter Manufacturer..5„j/Y)T� ❑ NA Standard(Domestic)Influent/Effluent Monthly average Effluent Filter Model: S Trir— Fats,Oil&Grease (FOG) 530 mg/L Pump Manufacturer: �O P L�i ❑ NA Biochemical Oxygen Demand (BODs) 020 mg/L ❑ NA Pomp Model: L''j kJ S 3 Tc4al Suspended Solids(TSS '&150 mg/L High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L • Manufacturer. l A (BODE) >220 mg& 4NA ❑Mechanical Aeration ❑Peat Filter SS) >150 mg/L 0 bisinfection ❑Wetland Pretreated Effluent Monthly average ❑Sand/Gravel Filter ❑Other. (BODO 530 mg/L Soil Absorption System (TSS) 530 mg/L �trFGround(gravity) ❑In-Ground(pressure) ❑ NA Fecal Coliform(geometric mean) 510 "Cl At-Grade ❑Mound Maximum Effluent Particle Size ya in dia. ❑ NA ❑Drip-Line CI Other: Other: NA Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) hen combined sludge and scum equals one-third(%)of tank volume ❑When the high water alarm is activated month(s) Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: 3 year(s) m Inspect dispersal cell onth(s)s) At least once every: ear(s) (Maximum 3 years) ❑ NA Clean effluent fitter At least once eve i ❑month(s) ❑ NA every: l 1 ❑year(s) Inspect pump, pump controls&alarm At least once every: ❑ea sjs)❑ NA Flush laterals and pressure test At least once every: ❑month(s) NA El year(s) 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 fikers,mechanical or pressurized components, pretreatment units, and any servicing at intervals of 5512 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 k' START UP AND OPERATION roduds, solvents or other For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting p 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)prior to 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 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 sal 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 are@ within 15 feet down slope of any mound or at-grade sal absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the a e�off'the treatment tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette''butts, condoms, cotton swabs, herbicides, meat diapers, disinfectants, fats, foundation drain (sump pump)discharge,fruit and vegetable peelings, gasoline, greases, scraps,medications,oils,painting products, pesticides,sanifllry napkins,solvents,tompons,'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 replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement of i soil absorption�uiired. 0 ' nand should not b 9 d om adio The replacement area should be protected from disturbance an c p setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result the e need table replacement lacement area. Replacement systems must comply for a new soil and site evaluation to establish a sui 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 te p The site has not been evaluated to identify a suitable replacement area. Upon failure of the hOV Ssoil may and sit stalled evaluation must be performed to locate a suitable replacement area. If no replacement area is available a g tank last resort to replace the failed POWTS. C3 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 TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK y 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 csw yl Name �f Phone Phone w X02 : — o9 /j-- 6 �.� SEPTAGE SERVICING OPERAT R PUMPER LOCAL REGULATORY AUTHORITY c Name Name Phone �j��02 L Phone 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)(t)(d)&(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code. I is n DOCUMCPIT NO. . T.+.� AnrF Resekz A!. FOR nceorsarn:. t.STA YItA#�tRsltdTlt' DEED STATE Y3AR 7Fr WISCONSIN FORM 2—108- JI Pm- VOL FOGISTER'S OFFICE Gordon Green a/k/s Gordon B. Greer, and Evelyn Green ST,d ROD(C0.,INS a/z/aa Evelyn C.• - e en by P o.A. Gordo n 3. Recd for Record .--- FEB E0 2 2 t 99 3 convey and worrunt-_ r_ io'oo A M , 3 I� sl Jrzu9hdz ir�fe a Dreds _ M1 �€ -:te r. avtevw mas duseriben real estate In ........,,u l,ty, SUAte of Vfi iacx,ngin- Tux Parcel No: ,,.............. ............. Part of tho ;E 1/4 of SW 1/4 of fiction 19-3C-18 desari mar� as foi 1„L,s: .e -- --- ... ';opt c3 n... l! at arse :youth-vast cornea of the SW 1/11 of Section 19-30-18; t-l-mence North 33 feet; l thence West 66 feet, wl.ich is the point of begi..nrling; thence West 358 feet; thence North at riryl� i3r17.`r f`ti 183 feet; thence,.s aat ciu 1:igiri. angles ,350 Ieet; thence i=T a la ity u--Ls,1c1m wo 3 Ieeb to the join or UegJzU -ng. tI 1� FEE Al i This 3.".. .............. homes:end property. (is) (Is not) Exception to wurrantiesc easem-nt5, restrictions and rights-of-wzy Of record, if any. i 1 ' Rated this brnuar'y tJ 93 �irs ._ ...�yt......... . ..........' ......... day of .._.. .hy' _.. . .. `) i.a.r:i�.-+ . r4Y . . (SEr�L.) tS ,i9. i� -✓fir' (SEALI I!# Cordon•Green--a/Icla Gordon•.B.-,Goren • _Evelyn Green, a/k./a Evelyn C. Green .. by P.O.A. Gor-don B. Green i .. .. ......... ..... ............. .(SEAL) _(SEALj � AUTHENTICATION ACKNOWLEDGMENT Signatures) .....!?t0rdon Green a/k/a STATE OF WISCONSIN 4 !, is 4i autl+entl ate'd/Chas daydaf t? .... 14.9. - Personally- came before me this tai of If �c __..... , t9. the above namcat {!. TITLE: $SEMHER STATE BAR OF WISCONSIN €: (If not .............. f i authorized by § 706.043, Wis. '. ern _ ` to I known to be the person who Pet•CUted the g o; forer_..ing instrument and acknowledge file same. #3 TWS INSTRUMENT WAS DRAFTED BY ?; Attm—n-e y at ;an ....:............................ ..... .......---.----- ._:. (Signatures may he authenticated or acicnomicdw d. Both Mfr t"omminsion .. pern:anr-nt.(1, not, stns ex•piration are not necessary.) 'N�mo OL P'°is�nn n1YniR¢in •n9 ca pn:,i9 91t ,*.cI M' t}-.t .. -'.- :1 .. ...,, t, ,r:IK.n...ri - W.IRRA.N r° DEM. - STATE BAR Or WISCONSIN FORIM No. H— 1112 Qo °' °• I h 0 6n, Ci m, LY N �Y o \ � r `1 N C. c O 0 -5 O N D) I O O a ti 00_00 @ v .+L 0 E C E d U N ca L U C� O O O O a) U C O N @ m m CL r LL C a� _ N @ O = @ U 3 € a).a d a N N M v 3 z oD E � I = 00 Zo rn Cl) w a m H U) c O O 2 a 1 c N 2 C O to 1- r O N Z v co a) 1 N a of ^� N 'D C • N N O) O N ._ CL O N O I', O N d wU-_- Z (n Z o N z N L '0 N — C O R E _ = ` N �l o CL U Lo N d L a) N O Q) _ 'coa - Fy- IN— o w d a �y 0000 z ►�i. a c N N .j U o m m z ti I z a� > N M w E d O O m CL aO N O iP � U) O p � W O c U') N c jr y O N D C U d 0 N O v p LO ao C C7 c oo a`) ? � ° o E C �• N o v a� � -o `'� I �I 1;-D -r- 0 U O @ N O U •O y' w 0 O y m Z (n tC +LO' Xt M dl d • a m .'? (D a CL c E u cd f� U a(a o N U Wisconsin Department of Health and Social Services Plb. #67 Division of Health Gy PERMIT APPLICATION for 02�O VV/.J O 5-7-�O"G/L�CJ/ 6 'Y 44-/3 / PRIVATE DOMESTIC SEWAGE SYSTEMS w8 V&Q - 320 TYPE OR USE BLACK I, � A'/04,6 ~ A. OWNER OF PROPERTY Address (Streets City, Zip Code)� � J � r County B. LOCATION OF PROPERTY WHER& SYSTEM WILL BE CONSTRUCTED ALTERED 0.- EXTENDED Check One: iSLC' �� SC' �"'C- /? --I CITY VILLAGE LEGAL DESCRIPTIONt ? �- S / " X�TOWNS, P v 3 C. IS LOCAL PERMIT REQUIRED FOR THIS WORK? YES NO D. SEPTIC TANK'CAPACITY 1y77:� Gallons NEW INSTALLATION REPLACEMENT ADDITIOON MATERIALS: Prefab Concrete �X, Poured in Place Steel Other NLtMER OF TANKS TO BE INSTALLED3 E. TYPE OF OCCUPANCY Check One: One or Two Family Residence Commercial Industrial Other Specify Number of Persons to be Accommodated F. APPLIANCES, ETCs Food Waste Grinder YES NO Automatic Clothes Washer YES NO Dishwasher YES NO Automatic Potato Peeler YES NO Other (Specify) G. EFFLUENT DISPOSAL SYSTEM NEW EXTENSION ADDITION REPLACEMENT Tile Size No.Lin.Feet '(f/; Trench Width ' Depth _ Number of Lines Seepage Beds Length Width Depth Tile Size No. Lines Seepage Pitt Inside diameter -e177—Liquid Depth PERCOLATION TEST Test Depth Character of Soil Hours Water Test Time Drop in Water Level Inches Minutes Number Inches Thickness in Inches Since Hole in Hole Interval Second to Next to Last To Fall lst Wetted Overnight in Minutes Last Period Last Peri- Period Oi.e Inch Example P- 0 360 To Soil 10" Clay 2 26'r 25 es or no 30 1 1 2 1 2 60 RWORD DATA FRIM MINIMUM OF 3 TEST HOLES Pjb ute size of absorption are+ in accord with H 62.20 Wis. Adninistra.1ve Code. S O I L B 0 R I N G S - Minim= 36" Balow Prop osod Abso tion System _I ng Total Depth Depth to Ground Water Depth to Bedrock er Inches Observed Estimated Observed Estimated Character of Soil with Thickness in Inches ple - 0 7211 72" ' _ Black Top Soil 12". clay 18"• Sand 18"• Gravel 24" Z l i r! 1 C i RECORD DAT OM MIWIMJM OF 3 BORE HOLES I, the undersigned, hereby certify that the percolation tests reported on this form were made by me or under by supervision in accord with the procedures and method specified in Chapter.H 62.20 (3), Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. NAME 1 + ,ti �. (�/ !�/(i'�' r''S "le TITLE R P /C3 (0 Type or Print) REGISTRATION NO. or MASTER PLUMBER LICENSE No. .� ADDRESS %J iG , ) /!�.%(" 1 /`1,7,Z� fl " / 6 DATE �:�Z �r SIGNATUPS MASTER PLUMBER MAKING APPLICATION v S_/ r HP Signatures �i. .{ �;��-t L� \ License Numbers � MP RSW L' ) (To be Completed by Issuing Agent) Date of Application ca/7- 6 Fee Paid $ AQ.e Permit Issued (date) ( /7D Permit Number / Q Agent (name) /Z; ,{�i � 17.)- `�� ( For.;://mil ,� /t i },(J 69 Town, Village, City, County, eta. (Specify) Notes The application cannot be considered for filing until all of the above questions are answered and the fee paid. Agents will forward application, the fee of $10.00 and Copy (b) of the Permit (yellow copy) to the Division of Health. Checks and money orders should be made payable to the Division of Health. Do not write in spaoe below FOR DEPARTMENT USE ONLY DATE RECEIVED ACCEPTED BY RETURNED , / (Initials) (Date) See Corres. FEY RECEIVED v VALID. NO. PEWIT NO. Yea or No) REVIrAM BY APPROVED DATE (Initials) Yes or No) COMMENTSs i i Parcel #: 026-1057-70-000 07/11/2007 10:33 AM PAGE 1 OF 1 Alt. Parcel#: 19.30.18.290D 026-TOWN OF RICHMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner O-TUDAHL, DUANE R&SORENA K DUANE R&SORENA K TUDAHL 950 140TH NEW RICHMOND WI 54017 Districts: SC= School SP=Special Property Address(es): *=Primary Type Dist# Description *950 140TH AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 1.490 Plat: N/A-NOT AVAILABLE SEC 19 T30N R178W PT SE SW COM 33' N& Block/Condo Bldg: 66'W OF SE COR SW 1/4 TH W 358' N 183' E 358'TH S 183'TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 19-30N-18W Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 994/131 WD 07/23/1997 460/320 2007 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/19/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.490 33,800 93,900 127,700 NO Totals for 2007: General Property 1.490 33,800 93,900 127,700 Woodland 0.000 0 0 Totals for 2006: General Property 1.490 33,800 93,900 127,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 214 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00