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HomeMy WebLinkAbout020-1404-04-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Divisien INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. Permit Holder's Name: City Village X Township Renton Homes Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Vent to Air Intake ROAD Dosing O 020-1404-0"00 TDH Lift Friction oss System Head Aeration Holding ` TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic O 020-1404-0"00 TDH Lift Friction oss System Head TDw r:t Dosing ` Bldg. Sewer ( �-- Aeration r M 41 i s m M Cert. No. Holding IVA E ELEVATION DATA County: St. Croix Sanitary Permit No: 4 jQ6 :iQ9+P6 State Plan ID No: Benchmark Parcel Tax No: O 020-1404-0"00 a9. 0139. 19.a63 � PUMP /SIPHON INFORMATION u Manufacturer Demand �,iQ. Benchmark Model Number V h \� TDH Lift Friction oss System Head TDw r:t cemain Length I Dia. Dist. to Well ` Bldg. Sewer ( r M 41 i s m M Cert. No. Insepctor's Signature Dt Bottom Bot. System PUMP /SIPHON INFORMATION u Manufacturer Demand �,iQ. GP Model Number V h \� TDH Lift Friction oss System Head TDw r:t cemain Length I Dia. Dist. to Well ` SOIL A ORPTION SYSTEM 21' c_",n TRENCH idth f Length No. Of Trenches DI w-A 3 SETBACK SYSTEM TO P/L IBLDG IWELL INFORMATION Type Of System: I LAA / lab DISTRIBUTION SYSTEM PIT LAKE /STREAM LEACHING Mar�yfulrer: r CHAMBER ORCHAMBER OR ,( 1 -,�, UNIT Model Number:,, 9t Gs (g0. � Header /Manifold �Q Length \ — 5 Dia u Distribution Pipe(s) 1 1-en Dia Spacing x Hole Size x Hole Spacing Vent to Air Intake ' � 1 I Bed/Trench Edges SOIL COVER x Pressure Svstems Only xx Mound Or At - Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded Mulched Bed/Trench Center Bed/Trench Edges Topsoil FI Yes U No ❑ Yes r COMMENTS: (Inc a f discrepencies, persons present, etc.) Location: 436 Jack Pine Drive Hu on, WI 54016 (NE 114 NE 1/4 29 T29N 1.) Alt BM Description= 2.) Bldg sewer length= 13.. -L0 ` - amount of cover = �� Plan revision Required? Yes No Use other side for additional information. SBD -6710 (R.3197) CC`S f Inspection #1: N) vl Dt- t /Z Dpz ' Inspection #2: ) n I 9.29.19.253 , (2-t z = �O- 0 4D �3 fLot3 r Cert. No. Insepctor's Signature / nlacp complete plain (to the County only) for the n per not leas than SllZ s 11 inches In <� �►^�cve.KP.c� a,�.- �ti`� Q SBD -63D8 (R. OS /01) t a4 �t r jpG Lt t14 sR l�Dvt•S v .P/ Vc— S3ld) Safety and Buildings Division County Y � �„ 201 W. Washington Ave., P.O. Box 7162 D ! X Site Address Z visconsin Madison, WI 53707 - 7162 Dep artment of Commerce o -a. -09. 007 jh Sanitary Permit Application Sanitary Permit Number In accord with Comm i m 83.21, s. Adm. Code, personal information you provide ❑Check ' Revision " may be used for secondary purposes Privacy Law, sl5. 1 m I. Application Information - Please Print All Information State Plan I.D. Number Property Owner's Nam Parcel Number Off aop AM k i'� Property Owner's Mailing Address Property Location 0, Z. -. "6 V, S • S 7 - ' l 2 - q j T l N. R /t $' City, State Zip Code Phone Number Lot Number Block Number �-- Subdivision Name CSM Number s,9 Al II. Type of Building (check all that apply) w „" " ❑City 1 or 2 Family Dwelling - Number of Bedrooms []Village ❑ Public /Commercial - Describe Use )(T ownship ❑ State Owned Nearest Road III. Type of Permit: (Check only one box on line A (number' sc eme for internal use). Complete line B if applicable) A. 1 )I New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use. ti System Tank Only Existing System B • El Check if Sanitary Permit Previously Issued Permit Number Date Issued K IV. Type of Permit: (Check all that apply) (numbering scheme is for internal use) 44 Non - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed 7 22 Pressurized In- Ground 41 ❑ Holding Tank 48 El Single Pass 51 El Drip Line 45 ❑ At -Grade 46 El Aerobic Trea t Unit 49 El Recirculating 30 El Other V. Dispersal/Treatment Area Information: Z 4­6 it/ Pt L Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate Sys m Elevation Final Grade Required Propose ��•8�1 Rate(Gals. /Days /Sq.Ft.) (Min./Inch) QO O f b� 3 5g ffq 74 : 0 ) Elevn , 83 o7 8/ VI. Tank Info Capacity in Total Number Manufacturer Pr ab Site teel Fiber Plastic Gallons Gallons of Tanks Conc Const Glass New Existing Tanks Tanks Septic or Holding Tank 1 U ( _ �� L Dosing Chamber t��✓l p� VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plum is Name (Print) Plumber's Signature MP/MHSNumber Business Phone Number bL � G n� ZZ6 Z73 fcs�t� Plumber's Address (Street, City, State, Zip C e) (C3_ 2 _ u_ S o VIII. Co ulz /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surchar a Fee) ❑ Owner Given Initial Adverse . 2 — Determination - 17C. Conditions of Approval/Reasons for Disappr�oovppal` _)� SAS +vw�s � t� w tom. �t�p jLe �e e�juS�1 oQua 5 � 5�^� vu w� SAO kW;C 4 °0 ( p� � n � � I � �y 5.�.•- t-a -'��.G K2.SG.r ���.0� Lo c � S �S v-""' X�l".". _ „' t / nlacp complete plain (to the County only) for the n per not leas than SllZ s 11 inches In <� �►^�cve.KP.c� a,�.- �ti`� Q SBD -63D8 (R. OS /01) t a4 �t r jpG Lt t14 sR l�Dvt•S v .P/ Vc— S3ld) , N w I N t Ov' r st �M a (�Lfi '700 f�a % M / It: I pp tip Cut- 06.0f+ Q� LL 6 t L L, Pco t �co I T � eM yXa� ti L L �� a $b fti %t / I pr ti p Cut- ve ' L L, Q� >G ~ 9 -Q/ 1469 WisconsiriDepartmentofCommerce SOIL EVALUATION REPORT page of 5 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Sal & Site Evaluations County Attach complete site plan on paper not less than Wh x 1 inches in size, titan must St: GCo include, but not limited to: vertical and horizontal reference point N), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.. 020- 1083= 3b -000, ID #29. .19.334C P /ease print all lnfomaatton. R { e Personal informatlon you provide may be used for w wsimy purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Lot N S V11Rt S 29 T 29 ' N R 19 W Midwest Const. & Develop Of Hudson INC. Govt _ E.1 /4 _ , M P 4 ' - - y Property Owner's Mailing Address Lot # Block # Subd. Narne 6i� P.O. Box 932 4 ,�r akien Wo6d City State Zip Code Phone Number City j Village 16 Town N Hudson WI 1 54016 1 715- 760 -1149 Hudson Glenna Drive New Construction Use: 16 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD f Replacement ] Public or comirnercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install 3 trenches using 29 high capacity infiltrator chambers at elev. = 76.0', 78.0'& 80.0' on 81.0', 83.0'& 85.0' contours. M Boring # Boring jo Pit Ground Surface elev. 91.56 ft. Depth to limiting factor >98° in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W *Eff#1 *Eff#2 1 0 -16 1Oyr3/1 none sil 2 fsbk ds cs 2fmc 0.5 0.8 2 16 -28 1Oyr3/3 none sil 2msbk ds cs 2fmc 0.5 0.8 3 28-41 1Oyr4/4 none sil 2msbk dsh aw 1fm 0.5 0.8 4 41 -02 5yr4/6 none Is & gr. Osg dl aw 1fm 0.7 1.2 5 62-86 7.5yr4/6 none s Osg dl gs - 0.7 1.2 6 86-98T 1Oyr5/4 none s Osg dl - - 0.7 1.2 Horizon #4 contains approximately 20 %graves &cobbles. Boring If j Boring im Pit Ground Surface elev. 90.12_ ft. Depth to limiting factor >95 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDHt *Eff#1 *Eff#2 1 0 -9 1Oyr3/2 none sl 2fsbk ds es 2fmc 0.5 0.9 2 9 - 36 1Oyr4/4 none Is & gr. Imsbk ds cs 20mc 0.7 1.2 3 36 -74 1Oyr5/6 none s & gr. 0 sg dl gs If 0.7 1.2 4 74 -95 1Oyr6/6 none gr. s Osg dl - - 0.7 1.2 Horizon #2 contains ely 5010 gravel & cobbles, #3 eontatns 20% gravel. Effluent #1 = BOD ? 30 < 220 mglL and TSS 30 <150 mg/L Effl #2 = BOD S mg/L and TSS <30 mg/L ;ST Name (Please Print) S" ure: CST Number James K. Thompson s 3602 kddress AC.E. Sal & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 9/15/01 715- 248 -7767 M property Owner M idwest Const. & Development Parcel ID # 020 - 108 -30 -000, ID# Page 2 of 5 3] Boring #J Boring jo Pit Ground Surface elev. __ 88.08 ft. Depth to limiting factor >94" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f' _ _ *Eff#1 Eff#2 1 0 -7 1Oyr3/2 none s l 2fsb ds cs 2fmc 0.5 0.9 2 7 -21 1Oyr3/3 none sil 2msbk ds cs 2f,1mc 0.5 0.8 3 21-45 5yr4/6 none s & gr. 0 sg dl gs if 0.7 1.2 4 45 -94 1Oyr5 /4 none s Osg dl - - 0.7 1.2 5 80 -100 1 Oyr5/4 none s Osg dl - - 0.7 1.2 Horizon #3 contains approbmately 20% gravel , #4 approx 25% gravel & cobbles. Horizon #3 contains approximately 10% gravel & cobbles, #4 approx 5 0 /6 gravel. Horizon #3 contains approximately 15% gravel & cobbles. F4 ]Boring # Boring Pit Ground Surface elev. 82.74 ft. Depth to limiting factor > 100" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots _ *Eff#1 *EfM2 1 0 -8 1Oyr3/2 no f 2fsbk ds as 2fmc 0.5 0.9 2 8 -27 1Oyr3/3 none sl 2fsbk ds cs 2fm,1c 0.5 0.9 3 27-47 7.5yr4/6 none gr. Is 0 sg dl cw If 0.7 1.2 4 47-80 1Oyr4/6 none gr. s Osg dl gs - 0.7 1.2 5 80 -100 1 Oyr5/4 none s Osg dl - - 0.7 1.2 Horizon #3 contains approbmately 20% gravel , #4 approx 25% gravel & cobbles. F ng # Boring Pit Ground Surface e1ev. 85.4 4,__ ft. Depth to limiting factor _ >97" in. Soli Applicator Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ---GP_ DML 2 _ -. -._. *Eff#1 *EfW2 1 0 -12 1Oyr3/2 none sl 2 %bk ds cs 0.5 0.9 2 12 -36 1Oyr4/4 none sil 2msbk ds aw 72fm, c 0.5 0.8 3 36 -55 5yr4/6 none gr. Is 0 sg dl cw If 0.7 1.2 4 55-80 1Oyr4 /6 none gr. s Osg dl gs - 0.7 1.2 5 80 -97 1Oyr5 /4 none s Osg dl - - 0.7 1.2 Horizon #3 contains approximately 10% gravel & cobbles, #4 approx 5 0 /6 gravel. * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mglL * Effluent #2 = BOD <30 mg/L and TSS <_0 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. property own Midwest Const. & Development Parcel ID # _0 1083- 30 - OOO Page 3 of F # � "� Pit Ground Surface elev. - 7 5.75 ft. Depth to limiting factor >98" in. Sal Application Rate Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0-6 1Oyr3/2 none sl 2fsbk ds as 2fmc 0.5 0.9 2 6 -13 10yr3/3 n one sl 2fsbk ds cs 2fm,1c 0.5 0.9 3 13 -24 1Oyr5/4 none gr. sl 2msbk ds cw if 0.5 0.9 4 2440 7.5yr4/4 n one gr. Ls O sg d l gs if 0.7 1.2 5 40 -55 7.5yr4/6 none gr. s Osg dl gw - 0.7 1.2 6 55 -98 1 Oyr5 /4 none s 0 sg dl - - 0.7 1.2 Horizon #3 contains appraodmately 30% gravel, #4 approx. 20% gravel & cobbles. 7 F Boring Bori # m Pit Ground Surface elev. 79.64 ft. Depth to limiting factor >96" in. Soil Application Rate Horizon I Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDI *Eff#1 *Eft#2 1 0 -11 1Oyr3/2 none sil 2fsbk ds as 2fmc 0.5 0.8 2 11 -27 1Oyr4/3 none sil 2fsbk ds cs 2fm,1c 0.5 0.8 3 27-46 1Oyr5/4 none sil 2msbk ds cw 2f,1m 0.5 0.8 4 46-50 7.5yr4/4 f2d 7.5yr5/8 sil 2msbk ds aw 1 f 0.5 0.8 5 50 -73 7.5yr4/6 none gr. Is Osg dI gw - 0.7 1.2 6 73 -96 1Oyr5 /4 none s 0 sg dl - - 0.7 1.2 Horizon #5 contains approDdmately 30% gravel & cobbles. Redox features in Hntr4 are present as a result of the greater matic potential of the finer silts directly above the coarser sand and are not indicative of groundwater. 8� F Boring # 74.87 ft. Depth to limiti factor 70" in. Pit Ground Surface elev. � Sal Application Rate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPOM *Eff#1 *Eff#2 1 0 -18 1Oyr2 /1 none sl 2%bk ds as 2fmc 0.5 0.9 2 1840 1Oyr3 /3 none sl 2msbk dsh cs 2fm,1c 0.5 0.9 3 40-65 1Oyr5/4 none SO 2msbk dsh cw 2f,1m 0.5 0.8 4 65 -70 1 Oyr5 /4 none sil 1 msbk ds aw 1 fm 0.2 0.3 5 70 1 Oyr5 /4 f2d 7.5yr5/8 sil 1 msbk ds gw 1 fm 0.2 0.3 * Effluent #1 = BOD ? 30 < 220 mglL and TSS >30 < 150 mg/L * Effluent #2 = BOD <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. property Owner Midwest Const. & Development Parcel ID # 020 - 1083 -30 -00 ID# Page 4 __ of _ 5 _ F- j Boring � # 7 ft. to limiting factor 76 " im Pit Ground Surface elev. -- ._ - - - -_ -- �� � ft Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' *Eff#1 *Eff#2 1 0 -30 10yr3/2 none sil 2fsbk ds as 2fmc 0.5 0.8 2 30-44 10yr4 /3 none sil 2msbk dsh cs 2fm,1c 0.5 0.8 3 44 -53 10yr4/4 none sil 2msbk dsh cw 2f,lm 0.5 0.8 4 53 -76 10y /4 none sil 1msbk ds aw 1fm 0.2 0.3 5 76 10yr5 /4 f2d 7 .5yr5/8 sil 1 msb ds gw 1 fm 0.2 0.3 F-1 Boring # A 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 *Eff#1 *Eff#2 *Eff#1 *Eff42 Boring #ng Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rods *Eff#1 *Eff#2 * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD -i_30 mg/L and TSS < 30 mg/1- The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an attemate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. SOIL AND SITE EVALUATION f46 p y of 5 PROPERTY'OWNER: Midwest Const. & Developme Of Hudson„ INC. PARCEL LD.# 020 - 1083 -30 -000. ID#29.29.19.334 A.C.E. Soil & Site Evaluations REPORT MEMO Soil evaluation completed for plat review purposes and prior to clearing or lot monumentation. Results indicate that the soils at this location are suitable for a conventional septic system. Additional soil evaluation and clarification of system location /design may be required prior to POWTS design and sanitary permit acquisition. Dosing will be required to reach system area. i— - �55GciYtQLr Q. c a 0 0 0 i C 3 D . N � o a Q a W O V W X o' N V X =. 0 3 c G � a � r r 74 0 m� m Z v D v Z `T7 O m 7v �+-- INVERT 7- "S? C:T OQ4 P tP �I 7 I A J L E T APPROVED JOIIJ W /C.I. PIFc0KP% .IIIJOOw OR FRESH A-P WTAKE aa.apu�r • w .. T bii i.tii�JC � � . , � v `•�: +• PROVIDE • ,R' AIRTIGHT SEAL Z A Zml Tank construction ( shall comply with '( ILHR 8)3.15 and 33.20 b c 1 I PUMP -� -- � 0 CouC.R.ETE Es7 � 1 BLOCK IR3'Mlu. 11� (I� V (� APPROVED J01LJT: i ( w /C.I. PIPE�pj c I ALARM 110" OFF RISER EXIT PERMITTED 0►JLy IFTA►JK MAUUFACTURER HAS SUCH APPROVAL SEPTIC f SPECIFICATIOUS DOSE W 1�2 C0111 TA1.IK MA►JUFACTURCR.: IJUMdER OF DOSES: PER DAy TA)JK SIZE: 6AL.L0QS DOSE VOLUME A MAUUFACTUR.Zjz: S ��L O S�tST I � INCLUDING 0ACKFLOW _ -- - GALLONS MODEL IJUMBER: IOL Nw CAPACITIES: A =z� �d� ,(� IAJCHES OR Al,LP &15 SWITCH T7PT`: IWCHES %OR /�u,Z LLOU5 PUMP MANUFACTURER: C+� ��J IUCHES OR 1aALLOUS MODEL NUM5ER: D = I�iCHES OR l Z- T, 4 6ALL0u5 . 5WITCH TJPE: a IJOTE: PUMP AMI ALARM ARE TO OL MIMIMUM DISCHARGE RATE ZS GPM 77 IN5TALLEO ON 5EPARATE CIRCUITS VERTICAL DIFFERENCE DETWEELJ PUMP OFF AuO._015TRIBUTION PIPE4�� rEET f MWIMUM METWORK SUPPLY PRESSURE J _ p _ FEET f � FEET OF FORCE MAIN X Z � F YoFLFKICTI0W FACTOR.3 FEET TOTAL 0y JAMIE HEAD = C FEET As per - manufacturer . �(J��j gal /in. - Combinatio.n Sep,<ic Tank and PL] -MP CHAMBER CROSS SECTION AND SPECIFICATIOMS ' VE1JT CAP WEATHER PKOOf JUiJCTIOW OOX 4'C.I. VEAJT PIPC APPROVED LOCKING 10' FROM 000f" �t WiCLE COYEK wLV � wARN11.JG L,A6EL.. "S? C:T OQ4 P tP �I 7 I A J L E T APPROVED JOIIJ W /C.I. PIFc0KP% .IIIJOOw OR FRESH A-P WTAKE aa.apu�r • w .. T bii i.tii�JC � � . , � v `•�: +• PROVIDE • ,R' AIRTIGHT SEAL Z A Zml Tank construction ( shall comply with '( ILHR 8)3.15 and 33.20 b c 1 I PUMP -� -- � 0 CouC.R.ETE Es7 � 1 BLOCK IR3'Mlu. 11� (I� V (� APPROVED J01LJT: i ( w /C.I. PIPE�pj c I ALARM 110" OFF RISER EXIT PERMITTED 0►JLy IFTA►JK MAUUFACTURER HAS SUCH APPROVAL SEPTIC f SPECIFICATIOUS DOSE W 1�2 C0111 TA1.IK MA►JUFACTURCR.: IJUMdER OF DOSES: PER DAy TA)JK SIZE: 6AL.L0QS DOSE VOLUME A MAUUFACTUR.Zjz: S ��L O S�tST I � INCLUDING 0ACKFLOW _ -- - GALLONS MODEL IJUMBER: IOL Nw CAPACITIES: A =z� �d� ,(� IAJCHES OR Al,LP &15 SWITCH T7PT`: IWCHES %OR /�u,Z LLOU5 PUMP MANUFACTURER: C+� ��J IUCHES OR 1aALLOUS MODEL NUM5ER: D = I�iCHES OR l Z- T, 4 6ALL0u5 . 5WITCH TJPE: a IJOTE: PUMP AMI ALARM ARE TO OL MIMIMUM DISCHARGE RATE ZS GPM 77 IN5TALLEO ON 5EPARATE CIRCUITS VERTICAL DIFFERENCE DETWEELJ PUMP OFF AuO._015TRIBUTION PIPE4�� rEET f MWIMUM METWORK SUPPLY PRESSURE J _ p _ FEET f � FEET OF FORCE MAIN X Z � F YoFLFKICTI0W FACTOR.3 FEET TOTAL 0y JAMIE HEAD = C FEET As per - manufacturer . �(J��j gal /in. 1 I 1 4q (O 01- conlyf il �N h 0 M E40 Series 4/10 HP Effluent and Drain Water Pumps Performance Curve 5 1 MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 4( 3! 3( Z 2� 0 S J H �c O F— I( 12 10 N W 8 X Z H 6 Q 4 F— O F- 2 Eel F.E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 350 K3326 7/91 Printed in U,$.A. CAPACITY GALLONS PER MINUTE Private O ite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number AfZO 4 Number of Bedrooms Design Flow - Peak (gpd) Design Flow - Peak (gpd) ?qO . Estimated Flow - Average (gpd) Qd Septic Tank Capacity (gal) Zak Soil Absorption Component Size (ft) 8'SS Type of Wastewater Domestic 150 Table 2: Soil Absorption Component - Limits of Reliable Operation Table Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) Outlet Filter ?qO . Maximum Influent Particle Size (in) Inspect once every 3 years 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The u e ilte s hall be c�a aG nPracca�� +n pn p roper operation. The filter cartridge shou d not be removed unless provisions are made to retain so i s in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. PL_�f T 0)- r _ - I i o cc s 0 tJ P�_ J9 6 3 �Y)(�� c c 715 6 7 2 3I/ ° o�( /� ��s �bY �6 ® CO, � 7 4�7 ��cLz Zw?N(n>� 7 3 ST CROIX COUNTY SEPTIC TANK MAINTBNANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address 0 (Verification requu ed from Planning Department for new , �2 City/Statc . /1��'8 7 L Parcel Identification N umber 600 t F.c;,AL DES- - TION Property Location �E- Y., 4 y;V 14 , Sec. � T �9 N -R ) —� W, Town of -H(��"✓ ) Subdivision Od' Lot #. Certified Survey Map # , Volume , . ,Page # Warranty Deed # . Volume � _� 7 . Page # � Spec house Pq yes 0 no Lot lines identifiable 'A yes 0 no h, STEM MAINTENANCE Improper use and maintonanceof your septic system could result in its premature failure to handle wastes. Propermaint00anee 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 affetx the function of the septic tack as a treatment stage in the waste disposal systeao. The property owner agrees to submit to St. Croix Zoning Department a certification form, sipred by the owner and by a maswplumber, journeymanplumber, mstrietedphumberora licensedpumperveAfyiag that (1) the on -site wastewaterdisposal 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. 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 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 year exp' n date. / / © L -- ATURE OF APP DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. the p described above. ) virtue of a warranty deed recorded in Register of Deeds Office. 22, IQNATURE OF APPLICANT 000 Any information that is mis- represented ray Iesult in the sanitary permit being revoked by the Zoning Department. • 0• • 00 I (we) am (are) the owner(s) of / /A z ' DATE 00 Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey trap if reference is made in the warranty deed /L' p1 STATE B4 WISCtJN r a - 1998 Document Number I WARRANTY - DEED This Deed, made between JoAnn E Neubarth and Betty M. Evien, Grantor, and Midwest Construction and Development of Hudson Inc., a Wisconsin Corporation, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property "): NE 114 of SW 1/4 and the Notch 66 feet of South 495 feet of the NW 114 of SW 114, ALL in Section 29, Township 29 Notch, Range 19 West, St. Croix County, Wisconsin, EXCEPT the South 429 feet of West 203 feet of said NE 1/4 of SW 114 and EXCEPT part described in Vol. 461, Page 421, Doc. No. 300625 and EXCEPT part described in Vol. 477, Page 588, Doc. No. 307501. 654704 wATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 08-24 -2001 12:30 PM WARRANTY DEED EXEMPT Ii CERT COPY FEE: COPY FEE: TRANSFER FEE: 1800.00 RECORDING FEE: 10.00 PAGES: 1 Recording Area F Return Address Construction and Development of Inc. ustriai Blvd WI 54016 l 020. 1083 - 10-000 and 020- 1083 - 511`000 Parcel identification Number (PIN) This is not homestead property. ; (is tot) SUBJECT TO the rights of ingress and egress for an access roadway as described in Vol. 461, Page 421, Doc. No. 300625 and In Vol. 477, Page 588, Doc. No. 307501. Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easement and restrictions of record. Dated this 23 day of August 2001. Signature(s) AUTHENTICATION authenticated this _ day of RC' TITLE: MEMBER STATE BAR OF (If not, authorized by §706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY William J. Radosevich, Attorney at Law 502 Second Street Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) Names of persons signing in any capacity must be typed or printed below thei WARRANTY DEED j -,t.i �., GlC JoAnn Neubar Beth . Ev'ea ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. St. Croix County ) Personally came before me this 23' day of August , 2001 the above [tamed JoAnn Neuharth and Betty M. Evien to me Mown to be the person(s) who executed the foregoing instruin d edged the same. Notary Public, State of Wisconsin My om mission is petPtment. (If not, state STATE. BAR OF WISCOr FORM No. r -1998 Professionals Co., Fond du Lac. W1 600455-2021 WALDEN WOODS DOU SL GATED IN PART OF THE NE1 /4 OF THE SWIM, AND PART OF THE NW1 /4 OF THE SW1 /46 TN -0 292 L SECTION � T29N, R19W. TOWN OF HUDSON, ST. CROOC COUNTY, WISCONSIN. g� 8EOB0N P F IN g� PF 0=12 ao4 a ' 4 i �\ ao4 a DEER HAVEN Hu / - - -- -- \ � D / sea xe9x w,3oo.e,f 1 NORTH LINE OF THE SM14 — of _ N9r57'04'1N .sr 131 j . _ - -- n4oI of HERT4IEOSaum — ce,FJ,Tra A0007ON. — ,1msr— Y I OENrM OF TEMPOHM1v •� Ow.oE -SAC 11 eeav LOT 6 I �I n OQZG 80. F. TJ . LOT 6 LOT 1 I 2 ACRES P Qi (IOSJ 0 .) 3100 ACRES W (139.38690. Fr ") Oi 2 HOUSE & 1 R $ I W RAOl(18 T9AFOpARY d' CU M LOT 7 vENrsf EXTENSION. 2.699 AOM-8 P 1 (117.429 SO. Fr) 3 R- w H :Lora LOT 2 i 8� ♦ i ����•• 2028 ACRES i 1 J 09.240 80. F0 Q LOT 13 (109.777 80. Frj H.WA_ 608A 2ZX) ACRES s69•,e1M34e.etr 1 ' o � LOTB � 6 ' \ A. 1 •� j / �� -- \ (12.40 SO Fr) / I I I \ 1 m 1 / i LOT 3 2. 5.2500 .F ----- - - - - -- 'plea (1 FTJ � � � M �tEaLINE' ; I 0 I gx ' \ F� j - 222.02 ,6 FOOr N. ` ........................... ' ` —. J i — NOWWOWS Sry\ \�\ . .--- "- - - SIMM .66 410 > ' -JACK PINE DRIVE LOT 9 ` es2w4, ,• 2.445 ACRES 1911 (100.52490. Fr.) \ •'• /' HOUSE N` 18 I LOT 12 GARAGE E� ua So. i i� zex,ACr(Ee I 19 Fr J j p LOT 10 LOT 11 ��8s weJ 111 (91 .361 S0. Fr.) 3.009 ACRES �IIT.�,g4I3 y / NJUPUL $141 (130,79 SM Fr.) 7 % SC ALI Lwe o - 749.14' — \ -- \ 60d 3 -- - - - - - — -- - - - -- -- -- 'r -- OF THE MONLwB4T® NORTH uNE N"-w-0 E 1114.00' e \ NE,R THESM/4 of MATES V 1 P 1 L�Oo 1� 12 6.�.00d�C�/o06. 3 UD@. IBM \ \\ o f u� LSw 119 1 o i i i -- - - - - -- \ - - -- ---- - - - - -- 6®4 l7S . . \\ P6Q4 OO l� P O oDLPU ---- _ 1 I I - OQ \ If GLENNA DRIVE— / 9„4OOFINER \ \♦ � / ----------------- -�i —�\ � 9607(1„29 THIS NSlwS"IT ORAFrISD BY VAU. At trANE JOB No. 0006.0, OATS 00020200, I C�D ij"b