Loading...
HomeMy WebLinkAbout020-1409-11-000Q' O ~ ~ a M a 4 0 0 N n N tl C b ti .~ 0 N [~ \/ •~ O V r.~ r '~ C 3 LL 3 I 3 v v _ rn w I ', ~ Z N ~ ~ ~ d z °' a m N H fn c C7 o z a ++ ~ ~- N H r a> rn V m v C O r 00 ~ 16 a v',~v a O o °- t O ~ ~~ O ~ ~ H ~ C ~ O ~ N ~ 7 O N 2 C~ W b L~+ .~ e~ A dt a .~ E ~ •c v a ~ v C 7 O °' a C ... ~ e N ~ N r •C v °~~' ~ 3 C ~ Y p ~ C Z m ~ c d N ~ co y ~_ y O O. f~6 w ~ o a a O .oaaa ~ o ~ ~ N N U N N goo c m° d v ~ ~ ~ ~ N N C N C OO m L Y ~ U ~ a v o y •E E a m ~ a c :; ~ O N V ~ O 3 0 O ~ a~ c 0 N 0 3 ~ O ~Q m V1 N O L t ~ m U ~ ~ y .~.~ ~- O ~ ~ C Y C •- coa ~° ~ m ~ rn~ a~ y ~o O O ~ L Z C w-.. i0 ~ C' 4C-- CO y N O 'J c6 O a N ~ ~ Q c rnr N d E N .~ N `m 7 f0 a .n C 7 •N ~.~ fn ai } m m ¢zin C C d ~ z° ~ a c 0 .~ U 4- O z '~ M c 0 .~ w. 0 Z v c N c •o U 4_- O Z N N a 0 ~ n c a ° ~ ~ N ~ N_ C N ~ '~ L ~L ~ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTN REPORT GENERAL INFORMATION (AT~fACF O PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: Particka, Sharon City Village X Township Hudson Townshi CST BM Elev: /DO , ~ 9 Insp. BM Elev: ~ oy BM Description: ~T.,~ ~~ TANK INFORMATION ' ' U ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic ~ ~~ Dosing `~ ~ ~ lv U U Aeration (/11, f Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air I take ROAD Septic > ~ _ \ y 2 Dosing , ~~ ` I D i ~f' ~S i f o-,~ Aeration Holding PUMP/SIPHON INFORMATION roiuuei rvunioer /~~- TDH Lif~ ? ~ Frictio~Loss ,7 Forcemain Length /~ Di Z „ SOIL ABSORPTION SYSTEM to~~~ Demand GPM ~jD Ft b ~ county: St. Croix Sanitary Permit No: 453106 0 State Plan ID No: Parcel Tax No: 020-1409-11-000 Section/Town/Range/Map No: 24.29.19.2569 STATION BS HI FS ELEV. Benchmark ~~ 3. ~ ~3• ~oQ .FI 9 Alt. BM 61d~er . 3,~ q~ 3 St/Htlnlet ~ 9 ~ q / St/Ht Ou t p. 2 y 3 Dt Inlet ~ a .,3r 9 3 . `j Dt Bottom ! / 7•~ p ~~d ead / -~-•~~ / ~ t q~• ~ Dist. Pipe lo• ~ 9 q~ • ~t Bot. syst ~ use ~>~ ~ !s ~ s ~ ~~ ~ q ~- Final Gra Si ~ • ~ ~ Gt'~S St Cover i ~t^ ~~ ~ ~ , ~ t DOL 9 ~'' tin a S BED/TRENCH Width I Length o. Of Trencb~s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 Q ~ • 00 1 J SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Man r~r: l Q -P / Ty e Of System: ~-{-~ Soy .}~ ~ UNIT ~ Model Numbers DISTRIBUTION SYSTEM rr,,, vlna f`l _Pnr~ Headar/tnanifn~rl Distribution R 7 ~ f s) ' Pipe x Hole Size x Hole Spacing Vent to Air Intakev~ - is Lengthy U ~~ X Len th Dia S acin 9 v ~- p 9 ~ ~!J~ ~ ~.SS d SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Onlv ~~'t~I:~Yu.(I~~~Yd'YJ~~+u` Depth Over / Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ ~ Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ /~/~ Location: 896 Boundar Cr Hudson, WI 54016 SE 1/4 SE 1/4 24 T29N R19W Bounda Rid e Lot Y ( ) ry 9 ~~ 1.) Alt BM Description = S'~', '(~~i~Z~'Z/ 2.) Bldg sewer length = ~ D ~ - amount of cover = \ ~ ~ Plan revision Required? / 'Yes /No Use other side for additional information. ~ ~~ ~~ G~i~2i~ __ _ ___ SBD-6710 (R.3/97) Date Insepctor's Sign ure Inspection #2: / /_ Parcel No: 24.29.19.2569 ~p~~d Cert. No. Safety and Buildings Division County ,. ~ ~, 201 W. Washington ve., O. Box 7162 ~ a~L t ~-~t-~ ~ ~ _ ~seons~n Madisoti, WT 37 - Sanitary Permit Number (tc be filled in by Co.) Department of Commerce (~8) 266- 51 ~'~ ~jr~ ~Olo Sanitary Permit Applicatio ,~~ I.D. Number ~~ p In accord with Comm 83.21, Wis. Adm. Code, personal informatio you provit~~l may be used for secondary purposes Privacy Law, s15.04 )(m) ; T ~ ~ CO Projec Address (if different than mailing address) ~'~ii. I. Application Information -Please Print All Information '~~/',~~ ~~~%~T._ ~~" (~ ~~~,r~ ~(~j,h~ (~~ ~~~t` Property Owner's Na me P eel # Lot # I i~1ee#t-# ~~ i ~~~'iCLI~'r?-~l ~~' ~;'~. ~i. ~, ~' ~~._ Uir~A;~ -~ ly~~{_ (I-~~~>( .2569 Property Owner's M ailing Address ~ Property Location `~ ~~~ = ~/ ~~/ ti S City, State Zip Code Phone Number ,, ., ec on ~1.1~i~~ f~~i/i~ i~~~lr~/~t~~ ~_:J`'~~~:~ iC' (circle one) - ~ j ~ ~ - ( Irer W T _ N; R II. Type of Building (check all that apply) o„~ ~w ~ rl S 1 or 2 Family Dwelling -Number of Bedrooms 1 Subdivision Name CSM Number ^ Public/Commercial -Describe Use v _ / ~~JI t~,'1~,~ r~l~„7/'_ ~ -- ~/ny__ ^ State Owned -Describe Use 3~ 0. 'stet ~~ r l / _ ^Village Township of ~:.;.`.{%ir { ^City 3 ~ to _ III. Type of Permit: (Check only one box on line A. Complete line B if applicable A' ~ New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner ][V. T of POWTS System: (Check all that apply) ^ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass S<tnd Fi ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ rculating San Filter ^ Recirculating Synt etic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explai ~ S,~t V. Dis ersal/Tre ment Area Information: ~~ Design Flow (gpd) Design So' lication Rate(gpdsf) Dispersal Area Required (s~ Dispersal Area Proposed (s Systet Eleva 'on ~` _ ~ ' VI. Tank Ltfo Capa ' Total Number Manufacturer q Prefab SitC~~ Ste I Filer Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tank Septic %r~;1~.~ . _ _ ~ _ Aerobic Treatme~it Unit Dosing Chambe ~©Oo ~ JDOp, l L(%~tlSer ~ VII. Respo Sibility Statement- I, the un ersigned, assume responsibility for installation of the POWTS shown on the attached plans. lumber's Na me (Print) Si a re MP{••^o,Rr~:n,,. ~°r Business Phone Number P `L~~- v~ ~t.. ~ ~ , ~_ / - ~ a , •-~ Plumber's Ad re ss (Street, City, State, Zip Code) VIII. Count /De artment Use Otrl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued I ui Agent Signatur (No Stamps) ^ Owner Given Reason for Denial Surcharge Fee) ~ ~ '- [l~ (~ 0 ~ IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 7 Septic tank, effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach complete plans (lo the County only) for the system on paper not less than 81/2 x 11 inches in size SBA-6398 (R. 01 /03) [-__-~ J a-~= C P Imo, SGa1e !"=4~b' 3a~-~'~ got ~z 1~~~ 1~0~ ~, " s'~~f P,~ Fl~v. long ~~ ~ ~~ ~~ (~~~ ~~ t`' q°! . ,~ 3 ~~ i /~ ,:~ ~nf -~ Syst~{~ ~ fuQ1~~a,~ a ~ 9J~ ~, ~. ,~ y.~~. 7a l ~.~----~x - 9 6.0 3 (~ - 9 5, ~ -9`f~~ -~ ~BEQrce~ ~Q~ su-~ ~a A` ~ M ,~ Tod o~ /3a S~Paf VI~~P t'Ic v • /DU.•U 1, Gevag e ~~;~ it ~~ ,~ ~. A~ /~17. ,2~ m ~IQf [ P1 scale 1"=~a` m'~~ iQ~ o ~ ~a ~~ ~ // e t ~~~-~~ ~~ %' -~.=^ $r B !yi 1 Tai ~ /a" st~~.f ~'jaa ,tree U . /DU..U t r ~ o-~ ~ z ~.nf ~~ SyS~~'~ ~ I~UQi~t?t~ '~ ,2 9 d ~, ~ ~__ ~__ arc -`~ (o. 0 3 - 9 5, ~ 9~{_~ , ~B~ava--~ flQ~ Gero~ ~' ~:d"~' : • ~, L A m r A~-AY R!!~~!`~'E~3 r r dale K~KNoN I~i45T , D~NA~~~4 SPF~ ' ,~3~¢s~ GoNOoI S~ 1!d SIB 1/4 S 2! t Z9 N R ~9 ~ (or) W property Owner's Mailing Address lot q Block q Subd. Name or436Mq 9y 8 L9- /3~ipl~~ . T~17 • ~/ " /3ov~v~~-R y IP~I'~if~E- CiIY Stale 21p Code Phone umber [) Cily [] Village ~ town Nearest Road lfv~So ~ W 1. 5yoi~ ~ ~~5 ~ 38~ • 0~7 ~vf~SoN 13A0/.~~uflS ~ ~ New Conslruclton Use: Q~j rtesidenllal !Number or bedrooms _3-~ Code derived design flow rate yS(r/ -' ~(JD C,PD (_ ] IteplaCerrrerd [] public or commercial - Uesc-ibe: parent material _, /OE's j ~ (~~ ~~ ~I!%2. Flood plain elevailon If applicable N h. General comrnenls s `~D 1/ ~V~-~~ c,1 ~, and recommendations: /I J d!/v • ~ ~ ~tR~tt- 7~sr~~ Sv% 7'~JC3~E' ~~' ~,v ~;~ y,~ovvv ~,v vE-vra,~~.,, ~dwTs. Please nrirtt alt tnformallon. Reviewed by r'rrsonal Inromnlbn yo!r provide may be used for secondary purposes (Privacy l.aw, ~. 15.oA (1) (mp. Properly Owner Properly Location _ County 5T' ~R ~l }~ Attach cvmpleM rile phn n pa~Tr.r~tCr3~ dQ~b ~1Y7_ x 1 Inches In size. Plan mull inrlude. hul not Ihniled Io: erlicailllr.•r1~ er point (BM), direction and Parcel l.U. 020 • /Q(p / • ~Q • ~~ perCP.nl SIO)re, SCale or dltTlP,rlSlOn3, north arrow, and location and distance Io nearest road. rMsconstrT beparlmenl or C mmerce O!L EV,ALUATION REPORT Holston of Salely and Flulldl gs ~ ~ ~ ~ rr ~~~~ n cc r e wit Comm 85, Wis. Adm. Code Z Boring ~! ~ boring htl boring ~! ~ Boring /~ ~ ~ • ~3 (1 / ~ pit Ground sorrac elev U lh I li iti r l , • ~ . . ep ng o m ac or in. Soil Application Rale Horizon beplh Uominanl Color Redox description Texture Slraclure Consistence Boundary Roots GPI7lfli . In. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Effgi 'EI'f~2 ~ ° ' ~~- i° YR 3/3 L 17F9i2 ~w-fR w 3 . y . ~ ~• /,~ •a/ io yR Y! -. SQL ~ ,P ~ , • w / . Z . 3 ~ 93.30 / Ground su ace elev. ' / Z ~CS~ . 33 n. beplh to IImiling factor _ _ In. i Iorizon bepih UomhTanl Color rte exlure Slraclure Consistence Boundary Roots aon nppnc 6P aaon rate Dl11* In. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Effg1 •Errg2 ~ o• ~ ~oy~ 3~3 - ~ ~ >~ ~ f~ w ,~ • y . ~~ . y. ? 5 ----- G 5 2 f ~ ~ S . ....~ .-..,,V~,.. •~ . - o~.s = av < «v mgrs ano r ss eau < 15v mg/L • EfOuent q2 = BOd~ < 30 mg/L and TSS < 30 tng/l. CSt Name (please print- - Slgnalurei~~7J- ~. CST Number 'ROBERT' ~!/6RiclltT ~Gf,~ 2z43~S , --~-- --~-• •• .. v....vv.a.v ,c•cv•v~~C I~V~.NCr ht a~ Assooiaces / y • 2vo ~, 7i S • 38( • 8l 8 s Private Sewage onsu 655 O`Nail Rd. ~~ Hudson, Wis. 54016 Page / ol_ D• SP~~• ~3~sr K. l3~-sT" rroperly owner _ Lof#~// 3 ~~~.c 5 o ~ o • ~o~ t • /D • /~ rarcel ID p Z 3 Page of hl Eoring M lJ Eloring _ ~ Q ~(~, rll Grarnd surtare'elev. I o x.03 fl. ~ bepth to Ilmfling laclo- / ~ In. Shc Appllcallorl Rale I lorizon beplh Ornnlnanl Color ecriplhm -" Texture Slroclure Consistence boundary Roots GPU/11: ln. Munsetl Qu. Sz. Cad. Color Gr. Sz. Sh. 'Ellltl 'EIM2 o •g /oYR3~3 L /fsh~ ~fR w 3 f . y .~ _~- ~ /a' R ~' S~ L ~ S h~ ~...+ vii' w - • Z • 3 io yR ` - n~~- S or .~ . ~ i• z., ~l boring if ~ goring L_J l_I f ii vrvunv su~racr. r..ev. _ ... vey....v.~~.oany .a~.v. .... Soil Application Rale tiorizon beplh Dominant Cotor Redox Uescrlpifon : ?exture Sirrrcture Consistence Boundary Roots GP U/11' In. Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. 'EIf1l1 'Etfl12 r r ~ ~ boring A ~ boring n_...,....r e...r....e ..rs.• q h....rM In IL..Mr..n f..nl... r.. - -~ - - -- ----o -_ _._. Shc npplicallon Gale i Iorizon Ueplh Dominant Color Redox Description Texbre Siruclure Consistence Boundary Roots GPU/tlr ~ In. Munsetl Ctu. Sz. Cont. Color Gr. Sz. Sh. 'EHif 1 'EIlN2. .. ' Emuenl 111 = bOD~ > 30 < 220 mgll_ and tSS >30 < 150 mglL ' EtNuenl A2 = bODe < 30 mgll, and TSS < 30 mgll. The Department of Connnerce is an equal orrorlanity service provider end employer. if you need assistance to access services of need material in an alternate format, please contact the departmental G08-26G-31 S 1 or 'iTY G08-2GA-8777. thh~R)tn rR Fian) - Go r# 11 ~.~ v ~~ 3 Q~ ~2 Op °~ ~ ~~- • r ~ ~ o p ,, S f~ Y~- ~ ~, r ~o o , /'''"- ~o -~ s ~~ . g5 ~ 1~'f ~L\~/ I if \'. 0 -~ ~~ 3 J3M -#~/ S~T% ' sf-~e. r~~- ~oo, d ~ _----.: ~ ~~ r oi,v ~~ ~i ; ~' , / e = ~,~ c~~' P,' js, G~ti~ S Ulbricht 8 Associates Private Sewage Consultants ' 655 O'Neil Rd. Hudson, Wis. 54018 PUMP CIIArlitr:li CROSS SF.CTI011 ANI) Sr'F:CIF ICATIOriS Vent Cop NeatltCr Proof Approved Locking June Cion Ilox h(unholc Cover 4 " C . I . ---~ - I Z " }tin _ Vent Pipe ' Pinal ~i" }tin C r a d e ~ J--_--7--_, ' 18" Mtn Conduit ' ~ ~ _ _ _ 18" }lin ~ -- --- ----- ---- 1 ' ;~; Approved Inlet ~ '~; Joints w/ t ~;; C.I. i'ipc d ~ "' ~ Cxtendinl~ pprove pint N/ ~ ~ I ~~; ~' Onto .I. Pipe "~ I ,~~ Solid K t e n d i n 6 1, ~; A Ground ' OnCO ~ lid i ~,~ t ' "~Alnrrn t ,~ CDt3nd i ~~ -- 13 ~ ~ ~ ' On -- /-- ~ 1 L` .Pump , -+ ~l Qf f - Concrcte Illock p Si'i'.CTI'ICA1'I nr1S TANK inufac turcr : ,_ _~215~°~ ink pfatcrinl: GcsK.~r~.t~c ank Sizc: _).000 Cnllon~ cnrnclTt }:s " or ,~L Cnllons y ~,,~~' o r /2p C a 11 o n s /'-( or 39b Cnllona > to 1 'l'ank rpnt:ity Require) ~ ID.QC3 Cnllono ALnIIM ru}IP }tnnuCacturcr: ZD~t~~ rloeJcl iJuu-Lur: / Switch' Type c+a Total Dynamic Iicad : ~~ i'umt~ Uischnri;e Ratc: S/O (~ Total Daily DCflucnt: (g,Cl'? Gallons i~ u to t~ c r o f U o u c s: ~ Per Dray Dose Yolumc:' /20 Gallons 11o tcs : 1 . Scc pur.~p curve for udJitlonnl t)er(OCin.'111CC intortnntion. 2. 1'utnp and alarm arc to be inntrilled on acrurnt~~ circuit uu l~cr ILIIK 1G. 19 NnC. tnuf ncturcr: ~cJlc~ ~'~erc~^~~~ ~~icl I:urnbcr:_ ~j ~ltc:lt 'rYPu~ _flo,~t page of TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEWATERING 12- U _ ~ 8- 0 J Q.:,'. ~: o- 4- 0 20 60 80 100 GALLONS LITERS 0 80 60 240 320 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS Timed dosing panels available.' • Electrical alternators, for duplexsystems, are available and supplied with an alarm. , • Variable )evel,control switches are available for controlling single phase systems..: • Double piggyback variable eyel float switches are available for variable level long and short cycle controls. • Sealed Qwik-Box availablefor outdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. 152/153-Series ~' .1521153 MODELS Control Selection Model ' Volta•Ph Mode Am Sim lex Du lex N152 115 1 Non 8.5 1 2 or 3 BN15? '115 1 `•`Auto 8.5 Induded 2or3 E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 `1 Auto 4.3 Included _ 2 or 3 N153 - '115 "' -1 "Non 10.5 1 2 or 3 BN153 `115 ' 1 Auto ' 10.5 Included 2 or 3 E153 230 - 1 Non `' "` 5.3 1 2 or 3 BE153 230 1 Auto 5.3 Included 2 or 3 >.30.~ A CAUTION All installation-of controls, protection devices and wiring should be done by a qualified licensed electrician. All elechical and safety codes should be followed including the most recent National Electric:Code (NEC) and dre Occupational Safety and Health Act (OSHA). MODEL 152 153 Feet Meters Gal. Liters Gal. Liters 5 1.5 69 261 77 291 10 3.1 61 231 70 265 15 4.6 53 20.1 61 231 20 6.1 44 167 52 197 25r 7.6 34 129 42 159 30 9.1 23. 87 33 125 35 10.7 -- -- 22 85 40 12.2 -- -- 11 42 Lock Valve: 38.0 Ft. (11.6m) 44.0 Ft. (13.4m) 3 27 o~asoe 32 32 i IZ ~/e 5 1/ SELECTION GUIDE 8 sKZasa 1. Single piggyback variable level .float switch or double piggyback variable level float switch. Refer to FM0477. ~~ 2. See FM0712 for correct model of ElecUical Alternator E-Pak. 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) or (4) float system. RESERVE. POWERED. DESIGN For unusual conditions a reserve safety. factor is engineered into the design of every Zoeller pump. - ~ MAIL T0: P.O. BOX 16347 ,~ ~'~ " ~~~~ Louisville, KY 40256-0347 o ~ SHIP T0: 3649 Cane Run Road Manufacturers of . . ,~~ Louisville, KY 40211-1961 O !~ 502 778-2731.1 800 928-PUMP Qanurr Puwas SacE /9~9 http://www.zoeUer.com ~ %~ PUMP lO. ( ) FAX (502)774-3624 © Copyright 2000 Zoeller Co. All rights reserved. 1 2 ~ ~~ C 11 ~ ~$'ATE DAR WARRANTYIDE DM 2 - 1982 DOCUMENT N0. Kernon J Bast and Donalda J Sneer-Bast conveys and warrants to Sharon _ PartiC]Cs"~_ -- the following described real estate in St. CroiX County, State of Wisconsin: Lot 1 Plat Boundary Ridge, in the own of Hudson, St. Croix County, Wisconsin • / Kernon J. non-ian4-11-0-00 PARCEL IDENTIFICATION NUMBER ~Ietl•o Legal Services I~DI[~,T ;77079 A ,~,~~; G~'D 10935 This i .~ not homestead property. (is) ~5 1~~ Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this 2 5th day of Novembe ~~~ ? -'<'` (SEAL) Donalda J. Speer-Bast (SEAL) AUTHENTICATION Signature(s) authenticated this da) of 19 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROI X CO. , M I RECEIVED FOR RECORD 12/17/2002 08:10A}l EXEMPT # REC FEE : 11.00 TRANS FEE: 209.70 COPY FEE: CERT COPY FEE: PAGES: 1 THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS rss~.-~hra ~ o~~~ t i c k a 2-8~4--~~ ale c S t~N E ~g~}-s, , 18 ~'~YU (~ ~ ~. ~ NI ~~ _ PYIi F~ru.i~~- __ A.D., D9 (SEAL) (SEAL) ACKNOWLEDGMENT State of Wisconsin, ss. St. Croix Counry. Personally came before me this 2 5th day of November ~S20Q~the above named Dohatd~, 5 -- _.... r lrnu.,~ GCS POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION Owner f" / _ I Permit __ ___ ~S3 J~~ PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units A Estimated flow (average! ~ al/day Design flow Ipeakl, (Estimated x 1.5) al/day Soil Application Rate al/day/ft2 Standard Influent/Effluent Quality Monthly average• Fats, Oil & Gr a (FOG) <_30 mg/L Biochemical Oxygep-Demand (BODE) _<220 mg/L ^ NA "---Total Suspended Solids (TSS) _<150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD5) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Coliform (geometric mean) 510` cfu/100m1 Maximum Effluent Particle Size YB in dia. ^ NA Other. ^ NA °tValues typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity ~ ~p al ^ NA Septic Tank Manufacturer ~e ~ ^ NA Effluent Filter Manufacturer ~ b ~ ^ NA Effluent Filter Model ~O ^ NA Pump Tank Capacity DOO al ^ NA Pump Tank Manufacturer S ;~~,, ^ NA Pump Manufacturer Z ~, ^ NA Pump Model ,2 ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: NA Dispersal Cellls) t~ln-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA Service Event Service Frequency Inspect condition of tankls) At least once every: ^ month(s) (Maximum 3 years) earls) ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third IY3) of tank volume ^ NA Inspect dispersal cell(s) At least once every: ~, „~ year(s) s! (Maximum 3 years) ^ NA Clean effluent filter At least once every: ^ monthlsl year(s) ^ NA Inspect pump, pump controls & alarm At least once every: ,~ ^ month(s) fA year(s) ^ NA Flush laterals and pressure test At least once every: ^ month(s) ~ yearls! ^ NA Other: At least once every: ^ month(s) ~ yearls- ^ NA Other: ^ NA 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 include a visual inspection of the tankls) 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 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 tank equals one-third IY,! or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter 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 s12 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. GMW 14/01) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal celllsl. If high concentrations are detected have the contents of the tankls) 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 cellls) in one large dose, overloading the celllsl and may result in the backup or surface discharge of effluent. 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 POWTS: 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 properly 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 replace nt system: / ' 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 that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement 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> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name Q ~ i'-~ n ~,- Phone 7 ~ h y~ 3 y4 SEPTAGE SERVICING OPERATOR (PUMPER) Name ~ e ~ Lt Phone [~ ~ ~ ~ d ~ h' POWTS MAINT ER Name ~ rt, ~ G' S f-PJK err Phone LOCAL REGULATORY AUTHORITY Name ~• 2D f ~C. C I `r ~N ~ Phone ~s, ~~ This document was drafted in compliance with chapter Comm 83.221211b111)Id1&(f) and 83.54(11, 121 & 131, wsconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT .AND OWNERSHIP CERTIFICATION FORM Mailing Address Properly Address (Verification required from Planning Department for new City/State ~~C)~ . ~~ Parcel Identification Number QED ~ ~~ ~ ~ j~(• Z-StP~~ LEGAL DESCRIPTION 1 ~ ' '/,, Sec. T -~ N-R W, Town of t.l Properly Location ~ C. /4, y~_ ~, Subdivision Lot # ~_. Certified Survey Map # ~ nq_~' •7 q~~~ ,Volume G Page # Warranty Deed # 7C9 ~tn~ .Volume a~8a .Page # ~?5t~ Spec house ^ yes J~( no Lot lines identifiable ~ yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix 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 thin 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. S~IGN~~~ ~ OF APPLICANT /~~/~ DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE *"**** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. *****~` ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ~ ~~ ~~~ ~ ~ ~~~ 1 ~ !4~ -I ~ $ 4~:~ I ------ L- 6 R ______-~ ~ Z m g b ~ ~~ ~~~ ~ .moo m w~ u ~ u ro SF .p m ! W N V A $~g~~~~~~~~~~~~~~~~ ~ w~ u ~ m~ w ~ u 'aa :o .o m a ~' m m ix '3', $ F as ~ a^qq~ '~~ $ i N $ $ ."'~ q ~ u u m N P o P~ P V Ix R ~` C Y2 ~~ m ~' N Z~ F 2v !~l ~ Y^ N N N^ N~ m p V~~ u U `L P N~ V O ~C .0 N Y . N y • • C ~ u yy ~O V ~0 V ~ ~ ~ P P 13y yR yI ~ p P u V u~~ 1 0 Y u W ~. Y O~ T 1 ~ ~ ~ ~ ( U1 ~ 111 wl [ N i'1 N ~ [ f'1 1~ N p v~ Q p p A~~ N j~ m 'P,. N o~ O iJl ~,~Y~~-~~~~~~~4~~~ Y N ~pv IM N11 1N~ ~ b r ,Np S~ ~' .u0 111 ~' ~ Y U~ 4 IL In 4 N e 0 IS ~ ^. ~, A Y ~0 &' 1 1 S yy~~ 1y~~ yy~1 s O~~~. Y Y O~ ~ N Y Y N m~ N N 41 .y ~~ a I~ N N W W g PPP N a Y °~ b ISgji '~` IR ~ 1 1 ~ rS ^S t t "i ~ ^ ~ C C ~ ^ '.G s~-~3~~~~~ ~N~ ~ ~~~~~~~~~~~~z~~~~l ~~~~ '~~ - - NJq(?6G~44CDD l~~ ,- ,,, ~,_, -~~ ,~ -' I I I C I I I I >>P I mho l.c~ m ,; I n n ;~~ I ,~, ~ ~~z IZQ'0 ----~JC C~,O 3~ mZ~ ~z m pnA~ a~~i Q 'O O C ~C~~` J ~; m. A Q: ~ ~~ ~~~i°~S ~ oZ~~i RppZ~~: cm~~ ~omv r m5 '~ n pwa~ C '"r~n Z CA~ N m m ,~ m A ~pA a ~ C R G ~z m~~ ~ Z m Z °~~ c ~~~ O ~~~ ~ ~i ~~ Z ~~~~ S N -~I C/ :/ l~ '; __ ..._,r rte'! C~ y ~ (7 T ~ C F~..t N