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030-2092-60-000
Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) S Madison, WI 53707-7162 P S (J o State Transaction Number Sanitary Permit Application 2-(V 15 (P 5 ~ n accordance with SPS 383.21(2), Wis. Aden Code, submission of this form to the appropriate governmental unit -owned POWTS are submitted to oject Address (if different than mailing address) is required prior to obtaining a sanitary permit Note: Application forms for state you provide may be used for secondary the Department of Safety and Professional Servies. Personal information N] ores in accordance with the Privacy Law, s. 15.04(1 (m , 1. A lication Information - Please Print All Information Parcel # Property Owner's am 1. j,,1 1 4 li o er 1®91' v V Property Location p~ Property owner's Mailing Address C Govt. Lot rH ` I - YI Phone Number '/4, '/41 Section Zip Code rrcle on City, S E T-=N' R Lot # o W II. Type of Building (c eck all that apply) 5 Subdw~M or 2 Family Dwelling -Number of Bedrooms ^ C q k 4AI0111 y ! + ❑ ❑ Public/Commercial -Describe Use City of ~ V V 1 W CSM Number ❑ Village of ❑ State Owned - Describe Use Town of 0 III. Type of Permit: (Check y ne ho o line A. mplete line B 'f licable) Only er odification Exj~ ern lain) A. ew System ❑ ep Sy Treatmen of in T eplacement `YV1 List Previous Permit Number and Date issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Owner Before Expiration IV. T e of POWTS S stem/Com onent/Device: Check all that apply) 1 ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground XAt-Grade El Mound > 24 in. of suitable soil ❑ Mound < 24 in. of 'tables 1 ❑ El Pretreatment Device (explain) Holding Tank El Other Dispersal Component (explain) ~ V. Dis ersaVTreatmen rea Information: Design Flow ( d) esign Soil Application ate dsf) Dispersal Area Required Dispersal Area Proposed (sf) System Elevation to 000 o00 1 DD Capacity in Total # of Manufacturer o VI. Tank Info Gallons Units Gallons t c w New Tanks Existing Tanks C / U rn s. C7 C, Septic or Holding Tank f Ivy~ U Dosing Chamber / V 1 VII. Responsibility Statement- a undersigned, ass esponsibility for installation of the POWTiiiS~~~,iiisppphf ouNumb~ched Business Phone Number Plumber' Name (Print) Plumb gnature ~J~ 7' ` NO- V5 1 L G / Plumber's Address ( et, C'ty, State, Zip Cod ' (flJ I 2 I Zo +e~ c h m VIII. Coun /D artment Use Only Permit Fee Date Issued Issuing Agen roved Dis ved $ CO ❑ eason nial G ! V 2 Wei IX. Conditions of Approval/Reasons for Disapproval rc U,/,Conk SYSTEM OWNER: Stfb~ 1. Septic tank, effluent filter and , / \ Cbaclj~~►~~ s / S Sfia dispersal cell must bseNt 1 rrlalntalned `7J as per management plan provided by plumber. ~ YDV~ ~ a/"t /,t E' C / 2. All setback requirements' must be maintained tHe a and submit to the County only on paper not less than 8 in z 1 inches in size . 1 t 5 ~'/~t D aS ,T) ~e LUPUjS-flo_7 'ff., / f SBD-6398 (R. 11/11) ~b s 1 D n con-fi o re? L)) #T a ~ ~ c(~S ~U✓(, /5,'1.1-- -~~e ti Q dbWr S l a pe 9-PAR T,1tE~ DIVISION OF INDUSTRY SERVICES 10541 N RANCH RD e~ 9 HAYWARD WI 54843-6462 Contact Through Relay 3 ~ P http://dsps.wi.gov/programs/industry-services ~2' /cam / www.wisconsin.gov O'ssior*tiSw Scott Walker, Governor Dave Ross, Secretary October 09, 2015 RECEIVED CUST ID No. 226900 ATTN.• POWTS Inspector OCT 1 A 2015 SHAUN R BIRD ZONING OFFICE ST. CROIX COUNTY BIRD PLUMBING INC ST CROIX COUNTY SPIXOMMUNITY DEVELOPMENT 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017-6409 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/09/2017 Identification Numbers Transaction ID No. 2615658 SITE: Site ID No. 818035 RoberWty- Please refer to both identification numbers, 1351 Awautukee TAU above, in all correspondence with the agency. Town of Saint Joseph St Croix County Government Lot(S) 6-7, S26, T30N, R19W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1559664 Maintenance required; 600 GPD Flow rate; 38 in Soil minimum depth to limiting factor from original grade; System(s): At-grade Component Manual, Version 2.0, SBD-10854-P (N.03/07, R. 1/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the septic tank outlet filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. • SHAUN R BfRD Page 2 10/9/2015 The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any - others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Carl J Lippert Please Include a Copy With Your Wastewater Specialist, Division of Industry Services Payment Submittal. (715)634-5035, M-f 7AM - 12PM WiSMART code: 7633 carl.lippert@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm v t Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 9/25/15 Owner:Robert Joy Location:Govt lot 6 and 7 S26 T30 N,R19W 1351 Awautukee Trail St. Joseph Manuals Used: At-Grade Component Manual version 2. 0 SBD 10854 (N. 03/07) Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01/01) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout CONDITIONALLY 5. Pump Chamber Cross Section APPROVED 6. Pump Curve DEPT OF SAFETY AND 7-8. Maintance and Conti enc Ian PROFESSIONAL S` R ~ ES g yp DIVISION OF INDUSTRY SL`dk ICES 9. Filter Specifications Attachments: Soil Test Shaun Bird S E Signature License number 226900 Page 1 of 9 PLOT PLAN PROJECT Robert Jov ADDRESS 1351 Awautukee Trail Hudson Wi 54016 x 1/4 1/4S 26 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX SYSTEM ELEVATION 100.0' 9/25/15 4 DATE BEDROOM CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA 1000 # of chambers none BENCHMARK V.R.P. Top of 1.5" pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL * H. R. P. same as benchmark Scale = 1/4" = 10' All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Pro 4 Awautukee Trail Well is to meet all WDMR setbacks Bedroom House Tank is to be properly bedded and provided with Iockdown covers with approved warning labels G Ile Huffcutt Combo Tank Grading is to be done to divert run-off away from system 101' 100' B-20 ❑ 99' 98' 10% Slope B-3 195' to Bass Lake Area 15' below system is Scale = 1./4" = 101 to remain undisturbed 267 Property Line 1 29' P.L. I I I A y At-grade System Sloping Site Cross Section and Plan View E I~ Dimension Fe_ e~ t ,•~,~,1,,~,.~:,.•.•1.5..'L.S..,.•.. 1.., x'.••.•1•'••1•'••1.1••••'•••• •'.•1.1.1•' A ti." .r1L?ti:.r::':':~.~ti:';•rtirti rLj'.r'•rtir-r'~rti~,•~tir1~'~~,L~;'~''~ I ',•5i~:,j ;'::,?1f1%1r'. %•ti~ti ::.~1~1~1?1%1j1?ti~1~1~1?1r1:1.5~:1••.•1•1•1?1fti 1j1f1f1''`'''•' f I •r,.•r•r1~1~1;1:•:1r.~ti~ti:tirtir;rtir;:tirLrtirti.ti~ti~tirti~tirtirL~tirtirtirtirtirtirtirtirtirtirtirtirti, I B ~ ''r r r r r r•r rrr r ••r•r•r•r•r•r.r•r rr ' r•r•r•r r r r•r• 1/6 B • ti 1 1 1 1 1 1.1 1 1 1.1 1 1 1,.•1.1.1.1.1.1.1.1 1 1 1•ti•ti•1.1•L 1 1.1• I I J ~ ~ r ;1~ ~ ~~1; rti:1: :1:: ~ .•1r1J , ::,f:~;1':.,:1f1~• :1r1'r1r ".:1:•,:1:1r1r1.1•1• I ::J:r"J:::::r•r•r•.••::~jr r•: r•: r•r'r~r r•r r•r;r;r r•r r r• r r•r•r r r r•~ W A r.r.r;r • r, r.r, • r r, ''rrr,. rrr ~J r: }~t~r r~:'~':••'1 1r1?'r1: _ r, 1 5.•ti~ ~ti ••L .L .ti ,ti ~1 ..'•t: : . j~ fti I D I ..•~r.~. •'r. .tir "ti~1~, • •r` fit. •1•'•'. '..1 ~1• .r1 ti••~:1;ti .r r.r. _ .V ? :1f1 .%ti ~L :r:1',•~l}r,:•rti:11'~•••'••~', r:rtir::t ~tir'~.j'LjLrti ;:5,'tir•f1:ti:1 ~'~~~1 ti ti nW4-~ I :::ti:1:! •,~1:• r• :1:•, X1!1 ~1~ti••.~1~•,~1~1~1~1~1r'stir:~rtir:.::~,::,::,'~::titi::r1: ~ ~1r•.: ~ r'.E 1 /6 B - ---------------------------------E B L % Slo e 1 - -I = Plowed = Clean aggregate O = 4 in. sch. 40 pvc - basal area to 2 '/2 in. dia. observation pipe 1. J M Lateral with 'T' Topsoil Cap aggregate over pipe Observation Pipe Geotextile G With Can Fabric • ti: r~' `•_5 Ft Lateral Invert 1.1.1•• r•r•:•r;r;.~r~ •'r r•r• r•r•r•r•r• Topsoil Cap 1.1.1 1~~ 1.1• 1.1••.•1.1.1:'•'1"".•1.1 :•r r•r• r-r•r•r r•r•r•r•r•r• :•r•r•• r• 1.1•ti•1 1%11.1 1.1.1•~.•1.1~1•ti•1.1"L'•'1 d;••..;.;.1••. 1.1.1 • 1'' pro Ft Contour •r•r• ■ ~L.i• J` J.r_r-':': :j.•r•: 'r y,.1.1.{.•,.1.1.1• .i { ~~i. 5 { 5 S,L'x _ - L.•'.1•.~•1.1.1.1.1.1.1. : . 4. { 1 .1 ~ - r.t:••:r, r~ r~ r:r:.•.r•r.r.r..•.r•••....r.r"r 1,.: _~'•t' M15."}S•r''.: 'ti 'C •`ry~`•~ ~ ~ti: `.1•,t~- .i _ - 1!1 _'L ~•1••••1•1fLf~;r•'f': r:~ .5i ~5 +5 r5 :1 1t s.J.r.r; D 5 5 k x,,-Plowed Surface Slope Direction GENERAL INSTALLATION: The at-grade area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The basal area (L x W) is staked out and plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a t/4 inch soil wire when a sample is rolled between the palms of the hands. The A x B area is covered by clean aggregate deposited overhead by a backhoe. Special care mus be used when placing the aggregate to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire at-grade is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are perforated in the lower 6 inches and secured in place. 03/05lgj Page of • + I Pressure Lateral Layout One Lateral - End Manifold .4 Threaded Cleanout Lateral Turn-up Plug Force Main X L Long Sweep 90 Bend Pressure System Construction Distribution Ne ork Specifications Lateral Diameter Z- In. Laterals are constructed of Schedule 40 PVC Orifice Diameters Z In. pipe. Orifices are drilled perpendicular to X (Orifice Spacing) In. the pipe with a sharp drill bit and face down. L Lateral Length) Ft. Lateral turn-ups terminate with a threaded Force Main Diameter In. cleanout plug and are enclosed in a 6-8 inch Ft. diameter lawn sprinkler valve box accessible Force Main Length from finished grade. • • • • • Grade • • • • • • • Q • • • • • • • 6-8 Inch Lawn Sprinkler Valve Box 031051gj Page of Septic-Dose ~ank Cross Section And Pump Performance Specifications T - Pump Manufacturer Tank Manufacturer Pump M d ber - - 1'`l _ d s , I tank Model TI umber _ - - Alarm Manufacturer_ i C`'^`r `f P ! I 1al 1 ank , acity y . - o C~~ umber Alarm Model N Max. Bury DE:,pth Switch Type -rer - - - Total Dynamic Read (TDH) Feet Filter Manufeu,tu - ` Filter Model Number _J Elevation Head{ Distal Pressure Network Loss performance Required Force Main Minimum Pump Loss - GPM: • , _ Ft TDH Total Outlet manhole Min. 4" Above Grade With Manhole Min. 4" Above Grade Locking Device. Inlet Manhole Securely Mounted With Locking Device < fi" Below Grade Sealed Watertight Weather-proof Junction Box Finished Grade Vent Min. 12" Disconnect Above Grade Means With Vent Cap 1 : ,'a~a~ Qutlet Filter Inlet inlet Baffle - - Switch Sett; ngs and Reserve Capacity A Tank Volume UPI Weep Hole Dimension Inches Volume Gal. (reserve) A a' - (alarm) B 2 Off Elevation C; (dose) C - , Ft i, Bottom -5 x (dead) D D Elevation - Total -1- «T<i1"S-i-1T-i-~t~~1~T♦T~~>,>-~~~ s~ '~~ias t•<`+. . •a•4•••i•a . r rr • • • • . a a . a . . . . • ,•1 1 r r , f )•)•,•Y >•1•r•1 1•,aa•Y•, x a 1 1 t I < t•<•t 1•i { 1•.•1.1 •,'f•/•. ♦•1•• .•1•a GENERAL INSTALLATION: The septicldose 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. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation aid the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28. 02/45 U Page of a CI rN, V Y A~= :NU rrD CAPACi~Y CURVE ~2 u, i 50. - - „ -,53 - 2 152 z 2 V I - - -i , I i ~I I p i 7 V. 40. - _ j 'ERS o 150 _ C - FLOW K " ~l Q~\\~ CONSULT FACTORY FOR SPECIAL APPLICATIONS Timed dosing pane's available. ed with _L • Electrical alternators, for duplex systems, are availabip any st•pp an alarm. Variable level control switches are available for controlling single phase systems. ario'o`e - Double piggyback variable level float switches are available for ` ievej long and short cycle controls. Sealed Qwik-Box available for outdoor ins:aP:ations. See F^S 420. - • Over 130"E. (54°C.) special quotation required - 1521153 series b 41 Control Selection--; j~ 1521153 MODELS - Duplex Am s ' SimFrex - r - 7E 2 Model ! Volts•Ph Mode 2-rt---- 2 rr 9 Ytll SK-2064 115 i Auto 8 5 new ~ed ~ ~r-. -1 BN'.52 115 1 - - 'r-- 2 or,) E152~230-' Non 43 r 4 3 I I- -ed orr BE152 230 u,0 i -_-r -1 p or 3 SELECTION GUIDE Non 105 N153 _ 115 _ back va labia level float '--T-t0-'ed piggy ~BNt 3, 115 ~I Auto I 1--~ tor, Single piggyback va'iaGle i2wel float . s witch or double -E153 23G Non 5.3 _ - Auto ncluded 2 or 3 s v't h. Re!er to F',10477. GE153 ~ 230 3-! - 2. gee =(x107 12 for correct, model of Electrical A.Itemator E-PaF:. fy duplex (3` Variacie ievei control switch 10-0225 used as a control activate(, spec' p CAUTION 3 All installation of controls, followed es should be protection devices and wiring should be done by a qualified L, ,4, f!Oat syste licensed electrician, All electrical and OSHA) recent most RESERVE POWERED DESIGN For unusual ccnditions a reserve safety factor is engineered into the design of every Zoeller Dump. MAIL 70: P.O. 3OX 163" 7 Lowsvile KY 40256C3 7 kAanfacrurerW ppp SHIP 70: a64S Dare r'o G3d ~UMPS ,7lNCf ~iJ✓~l " O',;isvil e. KY "02' 1 61 ~IU.dL/i Y ZQ ,5x2) 778-2731 ! i800' 925 PUMP O A.. 17,'4-3624 BUMP y i5' „2, _ httpa/www•zoeller.com !D v Copyright 200.0 Zoeller Co. All fights reserved. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of f IFILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity al ❑ NA Permit # Septic Tank Manufacturer ❑ NA )ESIGN PARAMETERS Effluent Filter Manufacturer r ` ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA !i Number of Public Facility Units NA Pump Tank Capacity al ❑ NA Estimated flow (average) C ( al/day Pump Tank Manufacturer ' ❑ NA Design flaw (peak), (Estimated x 1.5) 1- 0 tip gal/day Pump Manufacturer 0 cl? If 1:1 NA Soil Application Rate al/da /ftz Pump Model fe 1 ❑ NA Standard Influent/Effluent Quality Monthly average- Pretreatment Unit Fats, Oil & Grease (FOG) _<30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) I <_220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <_150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD5) <_30 mg/L ❑ in-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS} <30 mg1L NA -Grade ❑ Mound Fecal Coliform (geometric mean) <_104 cfu/100m1 ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size in dia, ❑ (~A Other: ❑ NA 11 Other: Other: NA ❑ NA Other: "Values typical for domestic wastewater and septic tank effluent. ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency ❑_month(s) Ilnspect condition of tank(s) At least once every: ears (Maximum 3 years) ❑ NA 13 (Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ NA ilnspect dispersal cell(s) At least once every:, ❑ yea~(sjs) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ~ year(s)s) ❑ NA Inspect pump, pump controls & alarm At least once every: ea~(s)s) ❑ NA i=lush laterals and pressure test At least once every: 1 q menu(s) ❑ NA ether: D month(s) At least once every: NA ❑ year(s) I}ther. I NA r MAINTENANCE INSTRUCTIONS ,Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: 'Master (Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must iinclude a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of icombined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be 1,/isually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. 'T'he ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. Nhen the combined accumulation of sludge and scum in any tank equals one-third (X) or more of the tank volume, the entire contents of 1".he tank shall be removed by a Septage Servicing Operator 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, iind any servicing at intervals of s12 months, shall be performed by a certified POWTS Maintainer. I% service report shall be provided to the local regulatory authority within 10 days of completion of any service event. s 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 or other chemicals thzt may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the 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. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effuent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area, Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWT3: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. 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 prope+,ly and safely abandoned in compliance with chapter 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 tanks and pits shall be removed and properly disposed of by a Septage Servicing 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 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 soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requiijed setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the noed for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the ruled 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 evaluatiior must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed: a: 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 s ace. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NiO- ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE 01= ~ PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name 7 r Name C C~ i r!C Phone 1 t a ! ` Phone J SEPTAGE SERVICING OPERATOR UMPER LOCAL REGULATORY AUTHORITY Name [IM7; Phone /J cument was drafted in compliance with chapter SPS 383.22(2"1"111011f) and 1113,14'1),'2'11'3', Wisconsin Administrative Code. This do j \ ,y O f\~ V` R V i ~ G 7 7 ~G t' ' ST. CROIX COUNTY SEPTIC TANK MAINTENANCE E'~G~NT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer L Mailing Address Property Address (Verific ' u required from Planning & Zoning Department for new construction) City/State Parcel Identification Number/ - ~ ~ LEGAL DESCRIPTION Gov f Go ~ 6t -7 Property Location V4 , 1/4 , Sec. , T N R/? W, Town of XA~ Subdivision Lot # Certified Survey Map # VcAume , Page # Warranty Deed # Volume , Page # Spec house yes no Lot line., 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, it 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 wasiz 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. 1/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 Commerce and the Departrr.L=t 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 k tiowledge. Uwe am/are the owner(s) of the property described above, by virtue f a warranty deed recorded in Register of Deeds Office. Number of bedrooms -SIdNATORt PLICANT(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) OA Y ISSb h m o {eIl g ipm tai€o T T 'o o 000 ~6 o o a M f w ~og£ase 3 Z0 a 10 = 2 Lai ~HIN i V _ OFaK MEN ~ ad 0 W ~ P, bb J €ygna°C€.~C 3a~°S a'a~ Q€age e m 111 s g a 3 Ali rIll- I I I'd Fl-~ to Lo LL I~ III III. 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Adm. Code County Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must =10 7 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. D-3 0 -p? Please print all information. Review b Date /D-Z&-2 IT Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.14 (1) (m)). Property Owner 6R5 Property Location UA. (TQ 4-1 Govt. L f- 1/4 1/4 S/-T~ 0 N R ,C ( ) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# - ~ a l'2 :50 LA~- e,-?-A is I City State - Zip Code Phone Number ❑ City ❑ Village Nearest Road 4 Lk";V I ' ;,I ( 'a'~11'A- New Construction Us Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Pub is or commercial - Describe: Parent material g, A FFloqA Plain elevation if appl• We ft. General comments and recorrwnendations: U f Cwl `~~~tttW W System Type ✓ System Elevation / G' -"O~ Boring # ❑ Boring I 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. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef1#1 'Eff#2 2- Id -Y.; At, a 4 71 Boring # Boring E ® & Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0- I , I L2 Z ~,r3 A,1~4 k/)-./,4 4,70,', 44/f i Effluent #1 = BOD- > 30!c 220 n-dL and TSS >30:5 1 So nV& ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 .r- 715-246-4516 Property Owner _ Parcel ID # Page -2-- of © Boring # ❑ Boring 9 it Ground surface elev. ft. Depth to limiting factor 39, in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 0-1 L Z ❑ 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 F1 ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 •Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/l- ' Effluent #2 = BOD5 < 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 (8.6/00) Property Owner Parcel ID # Page Z of 131 Boring # ❑ Boring q / E~Rit Ground surface elev. ft. Depth to limiting factor A 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 L V , sc In- 417 1 ✓J ~r~ 11 dill R ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Col Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Etf#2 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. F-1 ❑ Pit Soil Application Rate Horizon 'Iepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont Color Gr. Sz- Sh. 'Eff#1 'EfM2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD5 < 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.6I00) Soil Test Plot Plan Project Name Robert foy Shau ird Address 13 Awautukee Trail Hudson Wi54016 M #226900 Lot 5 Subdivision Date 9/23/15 1/4 1/4S 26 T 30 N/R19 W Township St. Joseph Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1.5" pipe System Elevation 100.0' *HRpSameasBenchmark Scale is 1" = 40' unless otherwise noted Awautukee Trail ~I? Pro 4 ! Bedroom House 101' B-1 B.M.* 100'6-211 El 99, 98' 10% Slope B-3 195' to Bass Lake Scale = 1/4" = 10' P.L. 267' Property Line 129' P.L. d ) f 1 E Page o SOIL EV A lent of Commerce Code and Buildings j "V^T Comm 85. Wis. Adm. ty of Safety, ~C Y-0) 77gc ~ in size. P~ t Parcel I.D. 03 O j'~, 00 4J- less then 8 112 12 X x I1 inures direction and (BM). Date Attach complete slue plan on paper not point w, and location and distance to nearest road. Review y 6 include, but not limited to. vertical and horizon.. refs / percent slope, scale or dimensions, nrtn al, info"a>(an- f please p La-, s. 15.04 (1) (m))• for secondary PutPpSes (Privacy Personal intonrtatlon you provide may be used Property LoMfiOn N R _ 1 E (or) Property O r Govt lot d- # 114 114 S Z M# T ~~C~,O.r d Lo Slock# ubd. Name a CS • r, I V o & Town J' Near st Road 3 qq,4 property e Owner's mailing Address ity 9e a Vd C State zip Code Phone Number City GPD Code derived design flow rate _ - - Ct W Residential !Number of bedrooms ft. Now Construction Use: IS Replacement Public or commercial - Describe' Flood plain elevation it applicable Parent material ~ a C p S~S✓✓~ ' i A 5164e,,,, Y-Wf, General comments d f O t and recommendations: Q ~ ~ S~i1,el P..`a•~- ~ t lication Rate Boring Q/ ft Depth to limiting factor _ - in. Soil A a Boring # Ground surface elev. GPD/ff uy-Pit Consistence Boundary Roots Texture SWdure •Efftfl •Eff#2 Gr_ Sz. Sh. Horizon Depth Dominant Cotor Rodox Description Munselt Qu. Sz. Cont. Color ~j in. 5)- 2 Y1n c - 5 0-. (0 3(3 L Z k . 5 SL 3 2~- i p (q y Fj .5 Boring p , ZO ft Depth to limiting factor~ in. Soil A PDfff ication Rate Boring # Ground surface elev G Pit Roots •Ef(#2 lion Texture structure Consistence Boundary •Eff#1 I Redox Horizon Depth Dominant Color u. SZ Des t- Color Gr. Sz. Sh. in. Munseil Q u. Cont c Z c 1 d l 10) /5 LS fr-s 2 2 120 1D y~4 5 O - BOD < 30 mgll_ and TSS < 30 mg/L • EtRuent #2 - - CST Number > < 220 mgll and TSS >30:S 150 mgft 30 • Effluent M1 = BOD _ Signal r Z~ O CST Name (please Prim i _ 1 ~ Telephone umber ~ St=- V(~% ~4 jc2 pate Evaluation Conti`jed 7~a 'oZ~ Address /0 `,J z - - „ u u e r^ni 1NTY NO, Parcel ID # Page of Property Owner Boring Boring # ~y in. Pit Ground surface elev. /Z ft. Depth to limiting factor ~ Sorl A ication Rate,,,, Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlft~Eff#2 in. Munsed Qu. Sz. Cont Color Gr. Sz. Sh_ 6 cs . 5 ' S L Y- Boring a Boring # Pit Ground.surface elev. aa_ ft. Depth to limiting factor _ (2 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots -E GPDlft'Eff#2 in. Munsetl CU. Sz. Cont Color Gr. Sz. Sh. ( 8 1 SL 2 c c ILS v~'r CS ? 12 t ti F-1 Boring # Boring Ground surface elev. ft. Depth to limiting factor in. Pit Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/ft2 in. Munsell Qu. Sz. Coal. Color Gr. Sz. Sh. `Eff#1 'Eff#2 I I Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 130 mgli- ' Effluent ; < = BODS < 30 mgIL and TSS < 30 mgfl 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 604-264-8777. M433o Mmrom i k 114 K 1/4,0-14,9- LEGAL DESCRIPTION LOT# NAND: SCALE: Qom` ELEVATION: Y BM 1 DESCRIPTION:cl, 100- BM 2 ELEVATION: N BM 2 DESCRIPTION: ylu' _ Oa - SYSTEM ELE~IATION: TYPE: SYSTEM rGo 6o q ~t W-e rS • d' V® a~ DATE: /l-/K 1 SIGNATURE A, ho LEGEND FOUND ALUMINUM COUNTY SECTION CORNER MONUMENT County Safety and Buildings Division J 201 W. Washington Ave., P ox 62 S Pemtit Number~(r by Co.) Madison, W1 53707 t2 r~ iX COUNT`( DEVELOPMENT q07 3s Sanitary Permit Application State Transaction Number in accordance with SPS 38321(2), Wis. Ache. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of safety and Professional Servies. Personal information you provide may be used for secondary ourposes in accordance with the.Privacy Law, s. 15.04(1 m Stats. L Application Information - Please Print All Information a Property Owner's Name o _ C G _ Parcel;; -20 ~ 6)30 Property Owner's Mailing Address f -OPert3' Boa 6A 17y / w 1LC 1 n Lot / C' ,State y Zip Code A Section z C J L ( cle o II. Type of Building (check all that apply l Family Dwelling-Number of ❑ Public/Commercial-Describe Use (51C ❑ State Owned -Describe Use XV e III. Type of Permit: (Check only one box on line A. Wat Corn \ \ v BABIES ® A. D Replacement System ❑ Tre byCoppertone® won to Existing System (explain) ~ ~ J)l Permit Renewal 11 Permit Revision Ch !W Suncare Products ;mitNumberandDate issued B. ❑ ❑ Before Expirations IV. of POWTS S atem/Com onent/Device: Check all that a 1 Non-pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 it, of suitable soil D Ho Tank Otber Dispersal Component (explain) D Pretreatment Device (explain) V. Dis rsalffreatmcut Area Information: Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (sf) Dis Proposed (st) S EI on V Is Capacity ~ m Total tl of ufacnucr as k I nfo S Gallons Gallons Units a e T3 0 Now Tanks Existing Tanks w A cy`d C6 V C6 m A U. C' 4. e Septic or Holding Talc Dosing Chamber VII. Responsibility Stateme I, the undersigned, assu r possibility for installation of the POWTS shown on the attached plans. Plum s Name (Print) Plumber' i MP/MPRS Number Business Phone Number n ~ 2 0 Plumber's Address (Street, City, State, ZAP n Coun Spartment Use Only D Approved D Disapproved Permit Fee Date Issued Issuing Agent Signature D Owner Given Reason for Denial DL Conditions of Approval/Reasons for Disapproval Attach to complete plans for the system and submit to the County only on paper not less than 8 in z I I inches in sift i SBD-6398 (R. 11/11) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 9/23/15 Owner:Robert Joy Location: Govt lot 6 and 7 S26 T30 N,R19W 1351 Awautukee Trail St. Joseph Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contin cy Plan 7. Filter Cross Section Signature License number #2269 PLOT PLAN PROJECT Robert Jov ADDRESS 1351 Awautukee Trail Hudson Wi 54016 1/4 1/4S 26 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX SYSTEM ELEVATION 91.0/90.5/90.0 4' below grade DATE 9/24/15 BEDROOM 4 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1036 # of chambers BENCHMARK V.R.P. Top of nail in pine tree ASSUME ELEVATION 1009 Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. Same as benchmark All piping shall be ASTM SDR 30/34, within Cale = 1/4'1 - 10' 10' of tank, piping shall be ASTM F891 to be >5' from p.1. V,nts B-3 60' B-4 B.MtI 80' Pro 4 Bedroom 4% Slope House 40' 5 ' B-2 ST 10' 30' 10' Replacement area is a at-grade Vent >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 12" 5.6ft^2/pair of end caps Bass Lake 4' Long Grade at System Elevation 34" Cross Section of Quick 4 Standard Leaching Chamber Typical cross section for 2 of 3 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 95.0' Vent Grade Vent 4' 4" 4' X30/34 Septic Tank 4' Long 119 5' 4' Long 1 3 4" Grade at System Elevation 34" Grade at System Elevation Spacing 5' 3-3' X 72' Cells Observation tubeNent Same on other end To be located on end of Cells A B System elevations: C A-91.0' B 90.5' 17 chambers per cell C90.01 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of (FILE INFORMATION SYSTEM SPECIFICATIONS I Owner Septic Tank Capacity al El NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA i Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units Al-NA Pump Tank Capacity al 1A I Estimated flow (average) Q ® gal/day Pump Tank Manufacturer A Design flow (peak), (Estimated x 1.5) b -U gal/day Pump Manufacturer 12<~A Soil Application Rate al/da /ft2 Pump Model A Standard Influent/Effluent Quality Monthly average" Pretreatment Unit Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODr,) i :_220 mg/L ❑ NA O Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg/L ❑ Disinfection ❑ Other: 'Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD5) 1 _<30 mg/L n--Ground (gravity) ❑ In-Ground (pressurized) .01 Total Suspended Solids (TSS) 1530 mg/LA ❑ A -Grade ❑ Mound Fecal Coliform (geometric mean) :_104 cfu/100m1 ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size in dia. ❑ NA Other: ❑ NA 11 Other: i NA FOther ❑ NA "Values typical for domestic wastewater and septic tank effluent. ❑ NA t'JIIAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank(s) At least once every: ❑ ears onth(s) (Maximum 3 Years) 13 NA !Pump out contents of tank(s) When combined sludge and scum equals one-third ('h) of tank volume ❑ NA (Maximum 3 years) ❑ NA ilnspect dispersal cells At least once eve ❑ onth(s) ear(s) Clean effluent filter At least once every: { 4month(s) ❑ NA C year(s) l nspect pump, pump controls & alarm At least once every: ❑ month}s) ❑ NA year(s !=lush laterals and ressure test At least once every ❑ month(s) NA P ❑ year(s) ether: At least once every: ❑ month(s) NA ❑ year(s) Other: ~ NA MAINTENANCE INSTRUCTIONS ,Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Laster (Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer, Septage Servicing Operator. Tank inspections must iinclude 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 to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be ivisually 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 i-egulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (X) or more of the tank volume, the entire contents of Phe tank shall be removed by a Septage Servicing Operator 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 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION presence of painting Products or other chemicals that For new construction, prior to use of the POWTS check treatment tank(s) for the impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the may tank(s) removed by a septaga servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will e rargeoof efl out 'n the cell(s) and may result in the backup or surface disch controls to rest g p p tank removed by a Septage Servicing Operator prior to restore normal /eve's discharged is the situation dispersal have cell( the s) in one contents of large the dose, o pump To avoid this h,e effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump within the pump tank. not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within Do 15 feet down slope of any mound or at-grade soil absorption area, the performance and prolong the life of the POWT'3. Reduction or elimination of the following from the wastewater stream may improve p drapers; disinfectants; fat; foundation drain (sum water, fruit and vegetable meat peelings; gasoline; grease; icide c pump) pesticides; sanitary napkins; tampons; and water softener bane OWTS fails and/or is permanently taken out of service the following steps shalll bbdeetaken to insure that the system is propetiy ABANDONMENT ~ When the P and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative • All piping to tanks and pits 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. • 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 compliiin system. absorp replacement system: on of lacem upontby required --A suitable replacement area h be been evaluated and may be ilized protected from disturbance and comopr the lo action anid shoo denot be inent The replacement area should po ll result the nE setbacks from existing and proposed establish lot lines ament ea.t Replacement systemsemuste comply w th the rule:1e~ for a new soil and site evaluation effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS techno og~{ a holding tank may be installed as a last resort to replace the failed POWTS. WTS as soil and ❑ The site has not been evaluated table replacement ilar area. If no replacement a ea isu avre of a0ho d ng tank may be installedevaluation must be performed to locate a a last resort to replace the failed POWTS. es in effect foat that llows tie, moval of the biomat at the infiltrative must comply with the reconstructed ❑ Mound and at-grade absorption sh systems systems surface. Reconstructions rr' SEPTIC, NG» T TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN, DO NOT SEPTIC PUMP AND OTHER TREATMEN ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE Oi= A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS S Q . POWTS INS ALLER POWTS MAINTAINER Name ~ r . Name ~ Phone ~ ~ ~ J Phone ~/,~~p~ LOCAL REGULATORY AUTHORITY SEPTAGE SERVICING OPERATOR PU PER Name ~j~ CFA Name Tip,-,~- ~G Phone ~J Phone This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(t) and 383.54(1), (2) & (3), Wisconsin Administrative Code. i I I~ I 1~ 4 ` N 7 P J 4 ~l iq. r rF. nl~ 1 1 L _ s t t 4 . l I fi x'44. >Ax >ti . t t Parcel 030-2092-60-000 03/13/2008 02:15 PM PAGE 1 OF 1 Alt. Parcel 26.30.19.774C 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 03/20/2006 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - STOY, ROBERT J & CONSTANCE H ROBERT J & CONSTANCE H STOY 804 12TH ST HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 1349A AWATUKEE TRL SC 5432 SOMERSET SP 8040 BASS LAKE REHAB DIST SP 1700 WITC Legal Description: Acres: 3.060 Plat: 4966-CSM 19-4966 SEC 26 T30N R1 9W LOT 13 BASS LAKE SOUTH Block/Condo Bldg: LOT 05 FKA CSM 19-4965 LOT 1 NKA CSM 19-4966 LOT 5 3.06 ACRES Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 26-30N-19W Notes: Parcel History: Date Doc # Vol/Page Type 08/14/2007 857551 WD 04/04/2005 791330 19/4966 CSM 01/31/2005 786197 2739/639 WD 01 /31 /2005 786196 2739/637 WD 2008 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/26/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.060 221,700 0 221,700 NO Totals for 2008: General Property 3.060 221,700 0 221,700 Woodland 0.000 0 0 Totals for 2007: General Property 3.060 221,700 0 221,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00