Loading...
HomeMy WebLinkAbout018-1099-39-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 572834 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: Barstad, Alan R. Hammond, Town of 018-1099-39-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 5T 09.29.17.849 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER r a1i~ CAPACITY STATION BS HI FS ELEV. Septic 409 Benchmark 147 J u ~ iFl /Oil -L it Alt. BM OLA, fr. I" Li 1.,N,. 93. 3 Aeration Bldg. Sewer Holding St/Ht Inlet . TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/ L WELL BLDG. entt Air In ake ROAD Dt Inlet Septic 7ZS 2-4 / I Dt Bottom A14- "r /00 1 , Dosing Header/Man. • 7~ ip , .s Aeration Dist. Pipe ~ ~ !o Holding Rot. Systelhn 4a Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM J Model Number TDH Lift Friction Loss System Head DH Ft ` Forcemain Length Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length I Pjo. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 3 - f " f ra SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR C7. Y Type Of System: a / 449 IAJA- J+ UNIT Model Number: a rw Aa s. w d✓ DISTRIBUTION SYSTEM e f A, 7 = tz. 5 Header/Manifold/ it Distribution x Hole Size x Hole Spacing Vent to Air Intake 'M...~_ a+►I~ t'.~ Length J67 Dia r PipeLength(s) Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of eeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edge,--.' Topsoil \ xx S L ❑ No s rx No t COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1046 174th Street Hammond, WI 54015 (NW 1/4 SW 1/4 9 T29N R17W) Pheasant Ridge 1st Lot 39 Parcel No: 09.29.17.849 1.) Alt BM Description a 2.) Bldg sewer length = 3 Obsat'aa~-;an n ~~~p ct rL a fZ lJ~ DYI ~ - amount of cover = .1, ,,read- a k-- Plan revision Required? 0 Yeso Use other side for additional information. Date Insepctor ignat Cert. No. SBD-6710 (R.3197) PLOT PLAN PROJECT Alan Barstad ADDRESS 1046 174th St. Hammond Wi 54015 NW 1/4 SW 1/4S 9 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 88.1/87.7' 3.2' below qrade DATE 10/31 /14 3 BEDROOM CONVENTIONAL )00( IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers 46 BENCHMARK V.R.P. Top of 1/4" rod ASSUME ELEVATION 1001 Filter BEAR Filter ❑ BOREHOLE O WELL - H. R. P. Same as Benchmark B.M.* 150 cafe = 1I4" = 10' 361' Property Line Vents 20' B-3 2-3' X 94' cells with >3' spacing 91' 0' 90' 0 B-2 80' B-1 4% Slope 30' 174th st. Drainage easement Pro 3 10011 House All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. 366' Property Line Vent >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 12" 5.6ft^2/pair of end caps 4' Long 34" Grade at System Elevation $~`1 ? v Safety and Buildings Division County~ 1,0 / K 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, W1 5310-7162 r r State Transadi Number C,~ ~e v S Lary Permit Appli~cartimr' In accor' SPS 383.21(2), Wis. Aden Code, submission of this form to the appropriate governmental unit b~ is rcqutfeZ prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than maffing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary -purposes in accordance with the Privacy Law, s. 15.0 1 m , Stats. G n 7' /a(~~ 171 1. Application Information - Please Print All Informal' n ✓~^"~G~ Property Owner's Name Parcel 4 1 //~J yr Property Own 's ailing Address Property Location Q /0 Govt. Lot V City, S Zip Code Phone Number y,"<, y+, Section VL1 N. R En/W II. Type of Building (check all that appl Lot N # Family Dwelling -Number of Bedro Subdivision Name kls,_::' > - I C-A Bloc r 7`. ❑ Public/Commercial - Describe Use a ❑ City of ❑ State Owned Describe Use ~40,v, CSM Number ❑ Village of Z D; But, 7-3 + 23 GIB. c P4p,- of III. Type of Permit: (Check onl one box on line A. Complete line B if applicable) Z D A. System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Perot Ronewal 11 Permit Revision El Change of Plumber 11 Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. T of POWTS System/Component/Device: Check all that app! l, tAIJ a-Pressurized In-Ground El Pressurized In-Ground 11 At-Grade El Mound > 24 in of suitable soil El Mound < 24 in_ of suitable soil rJS 11 Holding Tank ❑ er Dispersal Component (exp ) ❑ Pretreatment Device (explain) V. Dis ersal/Trea entArea Information: Ele-vati Design Flow (gpd) Design Soil Application Ra (gpdsf) Dispersal Area Required y Dispersal Area Propo (sf) 01 v S 9cw 93® ~ VL Tank Info Capacity in Total # of Manufacturer fl Gallons Gallons units a g New Tanks Existing Tanks ` o U s w U m to D_ t~ a Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume usibility for installation of the PORTS shown on the attached plans. PI s Name (Print) Plumber's a MP/MPRS Number Business Phone N her (V 1-i Plumber's Address (Street, City, State, Zip Code yv l~ f VI ountv/De artment Use Only pproved ❑ Permit Fee [Date sue L~ Issuing . Signature Own en Reason for Denial q-75. DL Condit ions for Disapproval ~l / _ 1.' `S:01 tank, effluent fetter and 3> /va ~ a y ~ ~ ~ ~ dispersal cell muss all be services I'rbalnta'tnad t as per management plan provided by plug. 2. All saexck requl'rements must be M LT as per aippiidsbla coft / t irelinsncals. Attach to complete plans for the system and submit to the County only on paper not less than 8 Ir z t 1 inches in sift SBD-6398 (R. 11/11) Cover Page Shaun Bird Bird Plumbing Inc. 1,432 120th St. New Richmond Wi 54017 715-246-4516 Date: 10/31/14 Owner: Alan Barstasd Location: NW 1/4 SW 1/4 S9 T29N,R17 1046 174th st. Hammond In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Shget Signature 4 License number #226900 PLOT PLAN PROJECT Alan Barstad ADDRESS 1046 174th St. Hammond Wi 54015 NW 1/4 SW 1/4S 9 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 88.1/87.7' 3.2' below grade 10/31/14 BEDROOM 3 DATE CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers 46 BENCHMARK V.R.P. Top of 1/4" rod ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark B.M.* lso Cale = 1/4" = 10' 361' Property Line 20' Vents B 3 2-3' X 94' cells with >3' spacing 91' 0' 90' 0 B-2 80' ST B-1 4% Slope 30' 174th st. Drainage easement Pro 3 Bedroom 10011 House All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. 366' Property Line Vent >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 12" 5.6ft^2/pair of end caps 4' Long Grade at System Elevation 3 4" Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber To be >1' above grade 5.6ft 2 pair of end plates Finish grade elevation Typical Installation 91.0' Vent Grade Vent 3' 4" 3' X30/34 Septic Tank 5' Long 119 5' S' Long 199 3659 Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 94 ' Cells Same on other end Observation tubeNent At end of cell A B 23 chambers per cell System elevations: A-88.1' B 87.7' Property Owner ,A11r1~~ T~ C11~1 f rUs~ Parcel ID # Page __2 of _ ❑ Boring Boring # pit Ground surface elev. =1_1 -~1_ ft. Depth to limiting factor in. -oil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ i V) r3l 50 2 r L V 5 . Z _Zy 1() r c 2 r C 3 2 -7s ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit 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 Effluent #1 = BOD5 > 30:S 220 mg/L and TSS >30:s 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.07/00) I J ' Wiscovisin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County _ C Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. R sewed b Date Personal information you provide may be used purpases(Pdvacy 15.04 (1) (m)). 91J3 Property Owner C f operty Locatio uviH ~ r amt l Y usC ovt. Lot fU w 1/4_5yV 114 S q T 29 N R/ E (or W Property Owner's Mailing Address 1 ` t # Block # Su .Name or CSM# d X-) t5t-~ kd~ City State Zip Code I Phohe Number. City ❑ Village 91jown Neares oad New Construction Use: [j0 Residential 1 Number of bedrooms -3 _ Code derived design flow rate ~LS71(O 0 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material 7I, _ _ _ Flood Plain elevation if ap licabl ft. General comments sy C {gym Q (ev 9 ~ ~ ,3 and recommendations: J k07-'JOT /~lrhEl✓sior D PRoP R-Z.y- B 2 a R~ -(V-~ reu r ~O~ i' e rk t uIWIC'>X awkia. -ea-ft 1'1'&► v+, So SyS- i+. Svc -J- (;e /5 br1 B2- Boring # Boring ® Pit Ground surface elev. C 70_ ft. Depth to limiting factor_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 d-~ 10 S' 2 k C5 1v~ '5 $'2 Iclr`I) Pc-1 2m5bk mfr c5 L( _ 46 ~v s F2--] 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 GPDlflz in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 •Eff#2 0-12 3 s;' I 2tnabk c~ I>v~' S 8 Z I2-zeo 5i t Z sk- r -C _ Z I I3' 2M r - - 5 R Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name Pie Print S' nature CST Number Address Date Evaluation Conducted Telephone Number f3 U ` Sa e 2 /z - s-- o ~'71S-)2-7-YX o Wisconsin Department of Commerce SOIL EVALUATION REPORT page of I Division of Safety and Buildings _ in accordance with Comm 85, Wis. Adm. Code County 0,4 Attach complete site plan on paper not less than 8 1 /2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print aN information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner ~ Property Location tQ }~1 -Y w5rk Govt Lot J~j Lj 114_~W 1/4 S q T 29 N R /'I E (ore Property Owners Mailing Address Lot # Block # I Su Name or CSM# 54. 3q PhnffirA t) Is1-f City State Zip Code Phone Number ❑ City ❑ Village &.Town Nearer oad EN New Construction Use: fj) Residential I Number of bedrooms -3 - Code derived design flow rate _~5KZ J~-' 4 a _ GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material 7 Flood Plain elevation if applicable ft. General comments syS~`/►1 2 0 ' -7 d and recommendations: z; s.rl n 3' U- a M Boring # Boring ® pit Ground surface elev. rv ►5~_ ft. Depth to smiling factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfF In. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. •Eff#1 •Eff#2 I 10 - 5' Z cS Ivy' .5 .2 Z $-2 10~r'4-41 t cl 5bk m-'r L4 -4 1 3 21- l ~5 Zm F2-1 Boring # ❑ Boring f' ® pit Ground surface elev. ~`t6 ft. Depth to limiting factor 8y _ in. Solt Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF In. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. •Eff#1 •Eff#2 0-12 , 51 r 2i k c5 I,,~' S Z IZ-Z14 Lic~l Sit S IL r c5 - `-E - w 3 Z I M 2 nn mv-flr- - - -t) .9 Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (PPrint) Sjgnature CST Number er Z'5 3-ZS61 Address Date Evaluation Conducted Telephone Number ry 13 U' 5-on-)c e 2 Property Owner ~~1 I! t j~M I (USk Parcel ID # Page - 2 of E~ t64 Boring # ❑ Boring Q pit Ground surface elev. =1 1_30_ ft. Depth to limiting factor in. Sol nGPDM e Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary 4Roots in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. EfI --i 10'4-36 Si I v- c 5 . Z -2 I r ~I~ 2 r CS .1-4 .40 3 24 -?s p rj 5 2 J r - - 5 1-0 ( a Boring # ❑ Boring ❑ Pit Ground surface elev. - ft. Depth to limiting factor _ in. Sol 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 F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Sol ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 1150 mg/L ' Effluent #2 = BOD, 130 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 608-2648777. SOD-9330 (R.07/00) PAGE 3 OF5 NAME y i ~.e ~ ~ LOT# 39 LEGAL DESCRIPTION 4' L,,j Y 5w t4 S 9 T 2 2N.R. / ~-Ro y SCALE: 1"= yL BM 1 ELEVATION /DO U BM 1 DESCRIPTION R V t ~I S'~c e/ lei N BM 2 ELEVATION Yq, - a BM 2 DESCRIPTION i~ sec. SYSTEM ELEVATION Y9, -7 U C~ SYSTEM TYPE Co vi yt A 4, ort a ( _ 4 CONTOUR ELEVATION t Q. o u q/, o v - _ Bm~ ama Y1y 1 o l ~ ~B~Z ~ ~ 8"s~ 9/•dl~ 'fie ,49ysi~,,o l 911 i SIGNATURE DATE °3 PAGE 3 OF_ E u i F-er t LOT# 39 LEGAL DESCRIPTION fl w Y Sw to S 9 T 2 ~l N.R. / (or)V SCALE: 1"= f6' BM 1 ELEVATION & D BM 1 DESCRIPTION n d e ( lad BM 2 ELEVATION 9~l o BM 2 DESCRIPTION 4,sj2 SYSTEM ELEVATION O Cb~ SYSTEM TYPE o 1ly e r► -k o vt cd CONTOUR ELEVATION g -00 + W. c J'C qou emI0I1 3•~ a`~,iY , h -3 ys, ~ lye 'ti f6.6 a ervl f 2 - s Lf 6-Yh,s ~ C ~ 13 l~sytr~. arPJ~ O r SIGNATURE DATE ~.3 • PAGE 3 OF~ NAME 0 LOT# 3Y LEGAL DESCRIPTION f'w X Sw 14 ,S T Z Y ,N,R / ~Ror SCALE: I"= BM I ELEVATION BM 1 DESCRIPTION r~ y e ( zl~c11 N BM 2 ELEVATION yq, I o A BM 2 DESCRIPTION goc9 S nC , SYSTEM ELEVATION SYSTEM TYPE CC -14 v e v4, ",t c CONTOUR ELEVATION u Y, CC) ,Y B-3 4 lj~ B'Z X 1 D U 9C~,GU SIGNATURE DATE °3 o n I T H - a , 3 2• / v I / U o X c w • ' ' N V r 1 .t i sF~ X4+ in i ~ c ZN / t I Q lit n S ' ; j O • - - W N: to co V co~ d r OAS ~D a V y z s. ~ x -J e~ J r ti b o b' 3S 8 /y ~ X S,`~+ , o d X 'Ai 09 ST. CROIX COUNTY SEPTIC `l ANK MAINTENANCE I' GP FFMENT ANI.) OWNERSHIP CERTITWATKi N FORM Owner/Bityer ct r.-~--- - - - Mailing Address l 74-5 PropertyAddress (Verification required from Planning & Zoning Department new constiuc.tion.) City/State ~-cl Vl'l hZtl''I~~- WJ~_ _ Parcel Ideaitlfication N w-ber LEGAL DESCIRp'I'ION Property Location - J ,5 tO Y, Sc u? _ 27 N I21_ Z bV, Town of Subdivision Lot 41 . Certified Survey Map # _ _ - c lutnc; Page #J ' Warranty Deed V o l ume I age It Spec house yes no Lot line identifiable yc: O SYSTEM MAINTENANCE AND OWNER CERTIFICATCON Improper use and maintenance of your septic system could result in its pr,-mature failure to handle wastes. Proper maintenance consists of purirping out the septic tank every three years or sooner, b needed, by a licensed pumper, What you put into the systern 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 & Zo.n ng 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 (ifnecessary), the septic tank is less than 1/3 full of sludge. I/we, 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 Cornrnerce and the Depar inmi of Natural Resources, State of Wisconsin. Certification stating that your septic: system has been ruaintained must be complete, t and returned to the tit. Croix County .Planuurg & Zoning Department within 30 clays of the ttrree ear expiration date. I/we certify that all statements on s form are true; to the best of ruy'our knowledge. 1/we aril/are the owner(s) of the property described above, by virtue of a w• arty deed recorded in Register of Deco Is Office. _ Number f e SIGN TUBE OF AI LICANT(S) DATI-, *'**Any information that is misrepresented may result in the sanitary permit being o-:yoked by the Planning & "Zoning Iepartment. Include with this application a recorded warranty deed .fiom the Register of' Deeds Cjffice and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Tank Manufacturer: ❑ NA Permit # Septic ❑ Dose ❑ Holding Volume: /OUV (gal) DESIGN PARAMETERS Tank Manufacturer: -6NA Number of Bedrooms: O NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal) Number of Public Facility Units: >19 NA Vertical Distance Tank Bottom(s) to Service Pad: (ft) Estimated (average) Flow : ~3co (gat/day) Horizontal Distance Tank(s) to Service Pad: (ft) Specific servicing mechanics must be provided If vertical is >15 feet or Design (peak) Flow = (estimated x 1.5): y.SV (gauday) If horizontal is >150 feet. Specific instructions to be provided on back. In Situ Soil Application Rate: J (galidaye) Effluent Filter Manufacturer: ❑ NA Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model: Fats, Oil & Grease (FOG) s30-mg/L Pump Manufacturer: Biochemical Oxygen Demand (BODs) s220 mg/L ❑ NA I~NA Total Suspended Solids (TSS) x150 m L Pump Model: High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L ,C Manufacturer.NA (BODs) >0 mg/L ~~[LI NA ❑ Mechanical Aeration ❑ Peat Filter SS) > 11550 mg/L ❑ Disinfection ❑ Wetland Pretreated Effluent Monthly average ❑ Sand/Gravei Filter ❑ Other. (BODr,) 530 mg/L Soil Absorption System (TSS) <_30 mg/LNA Fecal Coliform (geometric mean) s10` Ground (gravity) ❑ In-Ground (pressure) El NA At- Maximum Effluent Particle Size t/6 in dia. ❑ NA ❑ Grade ❑ Mound ❑ D Dririp-Line ❑ 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 Inspect condition of tank(s) At least once every: onth(s) (Maximum 3 years) ❑ NA ~-year(s) Inspect dispersal cep(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 7j~ yeails) Clean effluent filter At least once every: 1, 1 month(s) C3 NA year(s) Inspect pump, pump controls & alarm At least once 'every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every:. ❑ month(s) ❑ NA ❑ Year(s) Oo1ef' 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 (35) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code: All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <_12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. GMW-005 (02/05) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals 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 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 ar within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the treatment tanks and soil absorption system: acids, antibiotics, baby wipes, 'cigarettWbutts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sani4r napkins, solvents, tampons, and water softener brine discharge. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with s. Comm 83.33, Wisconsin Administrative Code`. • All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator (pumper). • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: - tC"suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ 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. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the 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 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 S~/~2k~✓ J Name lCZ" Phone ! Phone - - Sl SEPTAGE SERVICING OPERATOR (JRUMPER) LOCAL REGULATORY AUTHORITY Name Name~~ 64 Phone ~O- - 96 - 6 ~D4 Phone J D L~l This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d)&(f) and 83.54(l),(2) & (3), Wisconsin Administrative Code. 1. w; FILTER CARTRIDGE INSTRUCTIONS i 208 TM Installation STEP S Dry fit the filter case onto the end of the outlet pipe to ensure it is centered under the access opening. If not, then either insert more pipe into the tank through the outlet or solvent weld (glue) additional pipe onto the outlet pipe. STEP 2 While the case is still dry fitted on the outlet pipe, measure the length of 3/4-inch pipe needed to brace the filter to the tank end wall if utilizing the optional supplemental side support. If side support method is not utilized, proceed to step four. STEP 3 For installations utilizing the optional supplemental side support: solvent weld the 3/4-inch pipe onto the filter case. If side support method is not utilized, proceed to step four. STEP 4 Solvent weld the filter case onto the outlet pipe. Insert the filter cartridge into the case, pressing down until the filter locks into the bottom of . the case. STEP 5 If a VRS switch is utilized: insert into the filter and lock by turning clockwise 901. Maintenance ~r 1. The effluent filter should be cleaned every time the septic tank is serviced. a 4"! " 2. Open the outlet access opening to inspect the tank and filter. t , 3. Pump the septic tank completely, making sure to remove the sludge layer on the bottom of the tank and not just the scum and effluent. 4. Once the effluent level has been lowered below the invert of the outlet pipe, firmly pull up on the filter handle to dislodge the cartridge from the case. 5. Slide the cartridge up and out of the case for cleaning. 6. If a VRS switch connected to an alarm is present, the switch* should be removed by turning counterclockwise 900 and cleaned. with water only. 7. While holding the cartridge on its side (large flat surface facing „ down) over the access opening, rinse off the cartridge with water , only, making sure all septage material is rinsed back into the tank. 8. If VRS switch is utilized, replace by inserting into filter and turning clockwise 90°. 9. Insert the filter cartridge back into the case, pressing down until the filter locks into the bottom of the case.w A 10. Replace and secure the access opening on the tank. BEAR ONSITE- FILTER CARTRIDGE - FIVE-YEAR LIMITED WARRANTY BEAR ONSITE - Filter Case -Lifetime Limited Warranty htIa' ._:,n51r~ •xa, I ants -Yle `'.I;.. SE .:.I 1,.. `rt E _ 1 fe:-.. r a_ W,-.' Kr a;.y~,„' . a ,,.,r c! lil. .i na ,IS- =.1., u. :-a, "uvto - c u .ell. . d' -ida_ a ,rG...~ C~ „._.IuE~_, m.._C, 3: u I131 'T dl 9 "ec dr c :'l"`7 ' tl 5 y II C 9.e ) j r al: e 'Lh 5 =..E V:a a ":'O 'J ,Lit Ch.a.Y .:t1-..1'ta:. Sole„ e`.P. r 7E P t.-'-ec C_, .t.... .'.IC~ 1Y all 1~:.' ^5 ...__f 5". GE!_ al~.......'i.0 C -t J. VI IC CC Ili Shall -he I"a J t 3-;eii! .:'SItE e ~r 'IX l~ 9 n~ t~`h ~ - f 40 dool LOT 40 I* #I Acup Ma 909 $0. F T. ~ l , LOT 39 Tro "I so, Irr, f - 420 41 M13'0230 49" #3.37 a LOT 38 J t• 3? AS . 1 W. 733 3Q. FT. 1 LM #W - 825r9E,9 STATE BAR OF WISCONSIN FORM 7 - 1999 KATHLEEN H. WALSH TRUSTEE'S DEED ST. GISTER OF DEED Document Number Dine M. Bonte as Trustee of RECEIVED FOR RECORD Karl M. Olferts and Katharina G. ferts Family Trust 05/22/20% 03:20PH for valuabl consideration conveys without warranty TRUSTEES DEED to EXEMPT i Grantee, the following described real estate in St. Croix County, State of REC FEE: 11.00 TRANS FEE: 219.00 Wisconsin (if more space is needed, please attach addendum): COPY FEE: CC FEE: PAGES: 1 Lot 39, Pheasant Ridge 1st Addition. St. Croix County, Wisconsin. Recording Area Est: w -n It 091and 304 Lc- "1 Street 15q-79 Hudson.,, i-l 54016 018-1099-39-000 Parcel Identification Number (PIN) Dated this day of May 2006 * * Dine M. Bonte Trustee Trustee AUTHENTICATION ACKNOWLEDGMENT Signature(s) Dine M. Bonte, Trustee of Karl M. Ulferts STATE OF ) and Katharina G. Ulferts Family Trust ) ss. ) authenticated this S~day of Mme. 2006 County Personally came before me this day of the above named * Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Slats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Hudson, WI 54016 _ Notary Public, State of _ My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, WI STATE BAR OF WISCONSIN 800-655-2021 TRUSTEE'S DEED FORM No. 7 -1999 1 of 1 v I? E O N s> l t~ o x N Og ~5~g`a$ Z Q lp dd P 4ppC tt¢ / $g[pt ! 7 ~ S d a ~.§§E.~$$E3~ 9§$£.§~3F 9~ ~3g O f a s 40~l I n 1 1111111111 -T-1--- W slt Ic w y J J ` ~i s. arv. JF F W w Y 0 - I - ~ 5 I I I I Stt Y9 % 1 „ 1 gg~ I I ~ i SS I I n3rvva or m. o.mans u¢ I • `_l 1 e~~ Ewa + , i $ I I , I I $ q 1 1 ° I I 1 a ~ I I I I I ~ I I I I I 11 I , , t I I I I I Cosa c.ssnnauoov al ' p% I I II 1~ x.c s 1 33 F e I d II I ~ 1 I I I I M1 , I I I 11 1 R © ~e I I 1 1 ~ n~ i t l I I p _ ~ _v ~ I b I ? I I _________I, k ~ I 1 a,e . s 1 T C I 1 I L ~ I _ I I I , I i 1 I ~ „t I 1 I 1 i F I 1 ~s . I ii 1 I Al _ I I I I I a I I , I I I 1 , I I I I 1 I ; I - - - - - - - - - - - - - - - - - - - - - - - - I r„txn rnH.o.arue _ o 88, i R. INN Uj w co '.ry~ a f.44~g a J Q Z Sbg€~gp Z p> Q au W ~ ~ NZW °pa i ,nnav~svv q■ p M ~ "dsv ~ i ■ ~ X Ja ~.r 8w A 4 . e o p 3 {.y O O I ~ I a>snnvM On~vuv 11 I I la ° J I2yIIO~ ~ i r zE~ ~ 9 s ~J I i r8 ij ~f - I' 4- g I i I • ~ I zE~ I I A 8 8 F