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020-1342-10-240
Wisconsin PjarrtmentofCommerce PRIVATE SEWAGE SYSTEM "Ofety and ltilding Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Seguin, Peter I Hudson Townshi SST BM Elev: Insp. BM Elev: BM Description: �O.Z lo. Z- t2 6 Q q1' 1 ANrI !NrUKnnA I IU TYPE MANUFACTURER CAPACITY Septic Vent to Air Intake (Z00 Dosing > ? 5 - r �Ob Aeration y,, 0 0 Holdin � 2 S / 7 ' TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic > ? 5 - r > - �S ,/ 7.-d y,, 0 0 Dosing � 2 S / 7 ' Friction Loss System Head TDH Ft Aer /Ua.SO 2, 1 0, Z Forcemain HoldiFl Dia. 2 '' Dist. to Well > SETBACK y.s' P/L PUMP /SIPHON INFORMATION Manufacturer St. Croix Sanitary Permit No: Demand ELEV. 408243 0 State Plan ID No: � i Model Number ri Alt. BM 0 5 TDH Lift ZS Friction Loss System Head TDH Ft /Ua.SO 2, 1 0, Z Forcemain Length i Dia. 2 '' Dist. to Well > SETBACK y.s' P/L JBLDG SOIL ABSORPTION SYSTEM tLtVA I IUN UA I A County: St. Croix Sanitary Permit No: FS ELEV. 408243 0 State Plan ID No: q3 Parcel Tax No: q0•z Alt. BM 020 - 1342 -10 -240 STATION BS HI FS ELEV. Benchmark 3 0 q3 Liquid Depth q0•z Alt. BM I LengP , - , , , y 76 V .5 - Bldg. Sewer cs�..� /Ua.SO S Ht Inlet St/Ht Outlet SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Man act rer Dt Inlet CHAMBER OR UNIT e y Type Of System: Dt Bottom > / 7 �tq0 I Model N mber: 2 VW Header /Man. I, e4 r L Dist. Pipe S Bot. System 3 Final Grade St Cover z.s�. BED/TRENCH Width Distribution No . Of Trenches xx Mulched PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Pipe(s) Length _ I LengP , - , , , y �V V S / SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Man act rer INFORMATION CHAMBER OR UNIT e y Type Of System: > / 7 �tq0 I Model N mber: 2 VW DISTRIBUTION SYSTEM Header/Manifold Depth Over Distribution xx Seeded/Sodded xx Mulched x Hole Size x Hole Spacing Vent to Air Intake Length Dia ( Pipe(s) Length _ Dia Spacing f -? / I �V V S / SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 0 Yes 0 No Yes [2 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: -7 / 2 -' � / OZ Inspection #2: i Location: 459 Carriage Lane Hudson, WI 54016 (NW 1/4 NW 1/4 32 T29N R19W) Windsor Heights Lot 24 Parcel No - : 3 1.) Alt BM Description= �oP 0 � 'ewes+ �L +a�n,h 9 GIR �I �•) p I (�er �V' 0 l`J y-1 f- v�f/1t.1 // 9 r�.lAC 2.) Bldg sewer length I - amount of cover = 7 `f L' QJkl ' re /Of 3•�6PO Ia e Oh !' �i�5 / otctzirh �/a> slnQ�� k -�ore G cv p'ACe(�u`ew� Plan revision Required? Yes o ? Use other side for additional informati 4 , PSBD -6710 (R.3/97) / ,/ 8` D Insepctor's Si Cert. No. IW,+ J&�, A � 0 � 6ev"", 04123!02 TUE 10:38 FAX 715 386 4686 ST CRC CO ZONING Q 002 .Me......... .............b ............ . the effects of a weak sandy loam, t e owns ope trenc es may not a ms a e > 2 ' below grade, otherwise additional sizing shall be added. SBD -6398 (R. 05101) Safety and Buildings Division N *isc 201 W. Washington Ave., P.O. Box 7162 n.�1n Mpilison WI 53707 - 7162 Site Address Department of Commerce 3446 Z 3 $S � Sanitary Permit Application Sanitary Pc t N ' t Ur 3 In accord with Comm 83.21. Wis. Adm. Code. personal information you provide ❑ if R evision ffcolEd ma he used for I_ Application Information - Please Print All Informati ED State Plan I.D. Number - Property Owner's Name Parcel Number 3 Z_ L•P / ! Yl] e-t �e i? Se u r'q JUL 1 9 2002 �y�G Property Owner's Mailing Addrds 1 33 A5 ��/Uti S ZONINNGO Property Lo 1 / 44 ; S�� e OFF r4/- A�! City, State Zap Code Phone Number Lot Number Block Number J J L v n L✓ y U/ L r� / i a " .�,7� Subdiv Name CSM Number �' /'l (� s q,? 14e-, 4 t .s H. Type of Building (check an that apply) L OCity ,-, � Vd'l or 2 Family Dwelling - Number of Bedrooms _ ❑Village U Public /Commercial - Describe Use ❑ State Owned Nearest Road t ry-R , M. Type of Permit: (Check only one eme for internal use). Complete line B if app 'cable) A ' 1 ew 2 ❑ Replacement System f3 ❑ Replacement of 6 ❑ Addition to For County use stem Tack On1 Existing System B- heck if Sanitary Permit P=-+ionsiy Issued Permit Number 3�y Date Issued -� rG IV. Type of Permit: (Check A that apply)(numbering scheme is for internal use) 44 E'Non - Pressurized IwGrou d 210 Mound 47 ❑ Sand Filter 50 ❑ ConMcted Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 11 Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Othe V. DispersallTreatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System _ El yvation _ Final Grade 2I Proposed Rate(Gals.rl>ays/Sq_Ft.) (Min - /Inch) q0t t '✓ �k , Elevation 10 co(aae& VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanis Septic or Holding Tank Iwo ( La , ` C S G- t _ Dosing Chamber u U VII. Re sponsibility Statement- I, the made ed, a ss mm res for installation of the POWTS shoran on the attached plans. Plumber's Name (Print) St PS s Signature bfP'IMPRS Number Rum -mess Plane Number s-� -� G -e- #,q Plumber's Address (Street, Ci rate, Zip e) 3P e VIII. Count /De t Use Only_ Approved 1-] Disapproved Sanitary Pemut Fee (includes Groundwater Surcharge Fee) �R�-f Pep Date Issued Issuin Agent Signature (No Stamps) ❑ Owner Given Initial Adverse �� Determination , Z3 Z I7L. Conditions of Approval/Reasons for Disapproval 1. This revision was submitted to reflect a change in plumber and a slight change in system placement due to the location of the property line. 2. Effluent filter to be maintained per manufacturer's recommendations. 3. The trenches, especially near borings 6 & 7, must remain shallow due to slowly permeable soils reported for these borings. In order to avoid now .Me......... .............b ............ . the effects of a weak sandy loam, t e owns ope trenc es may not a ms a e > 2 ' below grade, otherwise additional sizing shall be added. SBD -6398 (R. 05101) l 3 t r � I rr � ioh0.� e� aw.bcr s I,ve-V'e aijeb - 6 COCK- ,OehK& j,- 4r ro p esei..ct 0- wode.6-4, 5 6L (,$), 6� yZ �s, �� w�ah as 1 ►.d«s Lc a UbWeGY TD 1Gi S� �� Gl `� l�adr vale gx s ( Ne- ac�eq St �.ecl. �c �d ObscrU�`��cy.f 6� �� �r Q�osed wo�,(� � GGI ° P""^" CVO- Gt, W4 Rl e S e 1: oK e 4 S O f 2( � / � v 2 1 �x _ .� � S9iI5 w ere bVtDre i� �G �-t � o a � �,dy c�aY lo�,� 44,e a't rr e 4 . , ,.oj (wer e,<- fobe�y CH S y (�� 3 0 0� z �� e F �►. � w� b 3 _� 1 T (: �L. q C .�" � 2 � • � $O K - � 2� b N iwS��� o" 3 / ( _ pn� R • .. r . \� `(,�) V �� , \ v ZQ � Ut Se�ba�K 3 �O l �2 "el Gv; 6/ �C 1M 0 veW (Meet g,_, Co W, (I 5�r'll �la ✓e ackJ7k4le 5e e h ex to �� �o p o(' r 2.3 ql, vr- �� avau jai (e. o� IF 10 .3 -1 tV prtL 3�" P(SC C � 6 Ef e J J 1 s 1 J� 4 J � --v 30 oa: Z �vC � M• � S 6 p �p 3 D � yv� r? 2 �3 W � 5' _ - Combination Se* tic Tank and 'PUMP CHAMBER CROSS SECTIOM AMO SPECIFICATIOEIS PAGE OF VEIJT CAP � WEATHER PROOF JUI.JCTIOW BOX . y'C.Z. VEN7 PIPE .APPROVED LOCKING lO' FROM DOOR, A JHOLE COVER A01V .iINDOW OR FRESH u�P'pr.�11JG �-p`8EL -• tF� 3P *�g1atJ PIP ` ` . R wTAKE coraD��r 7, ©� - 1 S G DoE 18' /�IIAI. ---- -- - - -- Is UJLET i" PROVIDE I - AIRTIGHT SEAL I III — T I v ,� I I Approved Z��- ��� II Approved joint w/ —L800 I III joint w/ PVC pipe . II A LP,KM PVC pipe Is I I I I ON C I I 3. I CLE fL PUMP OFF D - COUCKETE �O I 5LOCK RISER EXIT PERMITTED OQLy IF TAWK MAIrUFACTURj`R HAS SUCH APPROV B AL EDDING, Fpt� t lv4 SEPTIC E SPECIFICATIOKIS DOSE TAWK MALIUFACTU0.CR: WLESE-7'Z C � ) NeR - IJUMUR OF DOSES: L4'-7 PER DAw TAMK SIZC : lZ / b oo GALLOOQS� DOSE VOLUME I ALARM MAUU FACT URER: - SS�� S�ISI y- t� INCLUDING 6ACKtlOW: 133�� GALLONS MODEL WUMBEK: -L YrW CAPACITIES: A= I s I OR goo`3 GALLOAIS SWITCH TtJPC: "kDZLJ(2- 8 = _ 2 IAICHES OR �' �•' S G LLO US PUMP MAWUFACTUREK: GC)U% -O - S 3 3. c = C y fir, INCHES OR GALLONS MODEL IJUMHER: 4 D- M INCHES OR Z 2Z• � GALLOAJS SWITCH TYPE: IUOTE: PUAP AMD ALARM ARf�T0� MIMIMUM DISCHARGE RATE 4 GPM INSTALLED OM 5EPARATE CIRCUITS VERTICAL DIFFERENCE 15ETWEEIJ PUMP OFF AIJO..DISTRIBUTlow PIPE.. ' �- 7 FEET + MIIJ IAUM N SUPPLY PRESSURE FCET '+' FEET OF FORCE MIIJ X 4.14 00 F CFRICTIOU FACTOR_. Li FEET TOTAL OtIUAMIC HEAD = a'S� FEET As per manufacturer ZZ• 3 " P gal /in. Liquid depth 6 . APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPE CIFICATIONS Pump: EPO4 • Solids handling capability: 3 /4 maximum. • Capacities: up to 55 GPM. • Total heads: up to 24 feet. • Discharge size: 1 NPT. • Mechanical seal: carbon- rotary/ceramic- stationary, BUNA -N elastomers. • Temperature: 104 °F (40 °C) continuous 140 °F (60 °C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Pump: EP05 • Solids handling capability: 3 /" maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1'h" NPT. • Mechanical seal: carbon - rotary/ceramic - stationary, BUNA -N elastomers. • Temperature: 104 °F (40 °C) continuous 140 °F (60 °C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EPO4 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length, 16/3 SJTO with three prong grounding plug. Optional 20 foot length, 16/3 SJTW with three prong grounding plug (standard on EP05). METERS I FEET 101- 0 a w x U a z 0 J F 0 9 a 7 6 5 4 3 2 1 0 3( 2; 2( 1; 1C 00 IV zu sU 4U oU GPM 0 2 4 s a 10 12 mom CAPACITY ®1995 Goulds Pumps, Inc. Goulds Submersible Effluent Pump �E . c1F X5 3871 EP05 • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Automatic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ■ EPO4 Impeller. Thermo- plastic Semi -open design with pump out vanes for mechanical seal protection. ■ EP05 Impeller: Thermo- plastic enclosed design for improved performance. ■ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ■ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. in Motor Cover. Thermoplas- tic cover with integral handle and float switch attachment points. ■ Power Cable: Severe duty rated oil and water resistant. m Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING SP• Canadian Standards Association (CSA listed model numbers end in "F' or "AC ".) Effective May, 1995 B3871 aaa� -- • Effective May, 1995 B3871 vvlsronsin Department of Commerce SOIL EVALUATION REPORT Page of ? "Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in s ze. mast - �' L,\ZI� 1X include, but not limited to: vertical and horizontal reference point (BM),ldirectibil ditd" ` ° ' Parcel I.D. percent slope, scale or dimensions, north arrow, and location and dist nce to nearest road. J Please print all information. J - 1 0 'Reviewed b v Date Personal information you provide may be used for secondary purposes (Privacy)Law, s. 15.04 (1) Property Owner Z Property Location c t �R J C — G "q W 1/4 3 Z- 1 `� 1/4 S T N R E (or W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# )� Y�SPW _Zti •Eff#1 City State Zip Code Phone Number 0l (1lS) 3Z� - Z.9 y� ❑ City ❑ Village OTown Nearest Road v�goiv C 'Iir tit - Q tGE ® New Construction Use: Residential / Number of bedrooms _ Code derived design now rate 00 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material - G VPc@�L Prl_ �;� Flood Plain elevation if applicable ft. General comments 1 ' and recommendations: "[ CX) EEt) 0-1�1L-S , E 3 ` X_ bZ_S LWC w / Gtr CAS e1 �R LIlfi 1.D s , 1� s ® Boring # ❑ Boring �� Iti1 O O>V LSE, Z O r= 3, pit Ground surface elev. O CC • b ft - npnth to limitinn fnrtnr 3 tn Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots aUU r%ppil - duUi1 r%dre GPD /ftz •Eff#1 I Eff#2 - Q �p � sz Z /i - si R ZM s b k w,�r- CIS 1� s s ✓ � �� ✓ Z q - 3e do - s i 1 zw, sbk m-�Y- (-\ - s •� 3 -)SgP_'3 — s 1 csb`rc m U 1� cS - • �( ✓ Ll R_ - 3- 10`22613 — �Sb}z Boring # L.1 Boring ® pit Ground surface elev. ft. Depth to limiting factor 6 g in. Horizon D Depth D Dominant Color R Redox Description T Texture S Structure C Consistence B Boundary R Roots G vvu r.NNnwuvn .moo •c •Eff#1 • •Eff#2 1o�1ZZ -f - - s s'I z z�sb� � �,` - e e� 1 1� s s ✓ � �� ✓ z q q_3 � � 0 -1 (Z3) - -- s s t 1 z z4vc r r,1`� C Cw - - . .5 . .� ✓ Is 1 1cs bh ` `rnv�� — — - - �f • •6 W 1 — OW US J QU Z ," mgn- ana i bb --aU _< 1 bU mg/L - emuent P2 = tjuU < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) signatyre CST Number Arthur L. Wegerer 0 220254 Ad 4i e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Hain St. River Falls, WI 54022 1 -q_OZ '715 -425 -0165 4 � r :11 2 1 YLVl YL F1LV ra�c >. vi Scale vC zo�'Z� O �Yh•#- Z E ' 1� i O i b V � I - Lj "Z� O'U' oNlMV> nF 1` S`tN' Z _ 1� �f �f Z. - �t _ �. � , 2 ' Ou )'Ut°rl. L 3 fl" X01.) �, GI?..e� t.AvD 1 /t, Q `' •D l i�.. 'T1Z -� l 1 - 11 - Fo1Z 1.v�TLA�1°�E t3UL LDL zS_ \-) P�r" 47 ''vQZF LJUP�W ffM al-I M(� Otv -9 -0 - eCXL.s� _ (� Qo.s __ - -- - 1 -c1 -01 715- 425 -0165 220254 oz_ CST Signature Date Telephone No. CST No. Job PTO. V IL Department of Commerce .D)visW Safety and Buildings ' Bureau of Integrated Services in Attach complete site plan on paper not less than 81/2 include, but not limited to: vertical and horizontal refs percent slope, scale or dimensions, north arrow, and APPLICANT INFORMATION - Please prim Personal information you provide may be used for secondary p Property SOIL St.TE EVALUATION r 1tl1-t i ILHF14$3.09, Wis. Adm. Code must County I(point (i ' and on road., Parcet I.D. If � � k` _ � -� e t �'�.94 11 Im11. ' f R !C - s Ynl lii r: i Zip Code Phone Number .ski/ 1( 7 i i slot 1/4 1 1 /4,S - tAt S Sutxl. n Naime or CS ` � � . 4q ❑ City 0/village tlJ Town Page of G ,N,R �ar' ® New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow Z 16 gpd Recommended design badlirtg rate _,__.�7_ gpolf? gpd* Absorption area required p�_ bed, ft Vench, ft Maximum design loading rate _ bed, gpd* Uench, gpol* Recommended infiltration surface elevation(s) �Z' 17? ft (as referred to site plan benchmark) Additional design/site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional I Mound F in-Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system 0 S U ® s❑ U ® s U s❑ u ❑ s CSI u ❑ s . L1 u Boring # 13 Ground elev. Depth t limiting factor �in. SOIL DESCRIPTION REPORT Dominant Cwor, structure Remarks: Boring # 13 Ground elev. 1�2fL,, � .p Depth to limiting �M d I .�l� �Illl factor 82 jn. Remarks: CST Name (P rint) Signa re Telephone No. Address Date CST Number ^e We �y F Remarks: Boring # 13 Ground elev. 1�2fL,, � .p Depth to limiting �M d I .�l� �Illl factor 82 jn. Remarks: CST Name (P rint) Signa re Telephone No. Address Date CST Number ^e We �y F factor 82 jn. Remarks: CST Name (P rint) Signa re Telephone No. Address Date CST Number ^e We �y F 1 ' Property Owner J - rZ Ut Ki F -1 Boring # [j Boring [] ❑ Pit Ground surface elev. Parcel ID # . ft. Depth to limiting factor In J ♦ � dt W Page Z of 3 Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD /ft 'Eff#1 I 'Eff#2 - S otuti S S L wt`11 btS`rz ! V'f U Ki $ iU D O LGLAJ L HLV `- wrL� 'Z (—y B�or�s o>11 L / -tl- q-7 N) MU UT) _ FU C'w 1... -fl t2: 1 N `1rPrt L � ►—ti O � - 1 `- V L Fl of `` �v(�3 f 2- So >N t.J e TAG O1= ( Zco'j ). G c- 32 y ♦ F � r'lv 2 1 q� S Lt_Ow DUS F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots •rr•• GPD /ft *Eff#1 'Eff#2 r- S U L 8F )1U S L wt`11 btS`rz ! V'f U Ki $ iU D c) �12t.J l-j a U 'Z (—y nm�) TvtvLK ' b N) MU UT) _ FU C'w 1... -fl t2: 1 N `1rPrt L f 2- 32 y ♦ F ❑Boring Boring # Ground surface elev. ft. Depth to limiting factor in. F El pit C_:1 A__1:__4__ P._a_ Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots •rr•• GPD /ft *Eff#1 I •Eff#2 r- r1 c N Y-1 o-(-Rs LA 'j L u1 i �►�, D c) �� -�z v►�� Svc 3 v N) MU UT) _ FU C'w 1... -fl t2: 1 N `1rPrt L f 2- 32 y ♦ F Effluent #1 = BOD, > 30 < 220 mg/L 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. SOD -8730 (R.6/00) PROPERTY OWNER SOIL DESCRIPTION REPORT Page - of ti PARCEL I.D.# Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GppIft2 Bed , Trench .41 L u1 D 3 f 2- 32 y ♦ r'c 4) Ud� r� > Remarks: Boring # Ground elev. 4L4ft. Depth to limiting f Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD /ft Bed ,Trench 3 a pL or ' `- in. Remarks: Boring # Ground elev. Depth to limiting factor in ' Remarks: SBD -13330 (R. 07/96) s .y 1.e /i 4 i YY- 1 'Ar 4 f"- 3 rslDePartment of Commerce X-4visim oof §afety and Buildings ` Bureau of Integrated Services in Attach complete site plan on paper not less than 81/2 include, but not limited to: vertical and horizontal refffl d percent slope, scale or dimensions, north arrow, and APPLICANT INFORMATION - Please prin Personal intomnation you provide may be used for secondary pi Prooerth i SOIL.-AWS EVALUATION rtt�e al6-�.JLHR-�Q3.09, Wis. Adm. Code = ' County Oilnt1�,''�fec�n a d � on and to �.rg�t read. Parcel I.D. # infnrnQl - Rovirr hu s 0 Page --/— of 12 9 7 i s " Lot ? 1/4 ) 1/4,S T ,N,R Properly Owners Mailing Address Lot # S". N7me or CSM# City Stag Zip Code Phone Number ❑y clogs (� Town N emw ® New Construction Use: [ Residential / Number of bedrooms Addition to existing buil ling ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow er gpd Recommended design loading rate S` bed, gpol _,s / -- rench, gpd* Absorption area required _ bed, ft MKCh, ft Maximum design loading rate - ._gy bed, Wd* Vench, gpd/ft Recommended infiltration surface elevation(s) 1 ft (as referred to site plan benchmark) Additional design/site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system I JZ s u I m s❑ u ®s ❑ u 10S El u I EIS O u [Is .O U SOIL DESCRIPTION REPO �a. Ground elev. 7 ,� L-- ft. 4a 0 Depth t" limiting factor 7 In. Remarks: Boring # 13 Ground elev. �� Depth to limiting mm Dominant Color Munsell �!�1b7iA MI Remarks: Boring # 13 Ground elev. �� Depth to limiting mm =�� factor m in. Remarks: he-W ode .5� i CST Name (P rint) Sigma re / Telephone No. ��� ZZ'2 Address �� , Date CST Number PROPERTY OWNER PARCEL I.D.# Boring # C1 Ground elev. r Depth to limiting factor -->�in. SOIL DESCRIPTION REPORT Page .'of�.��„ Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Consistence Boundary Roots 2 Bed , Trench r // Sh. b (� -iN [? cJ � L k X3.0 40 Z k 9� L �. y v0 L+ I > 4 Boring # 1 Ground f elev. 24 ft. Depth to limiting factor > Boring # k Ground elev. 4-4 Depth to limiting Remarks: Remarks: Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD /ft2 Bed , Trench r (� -iN � s r .y 57 fa for in. Remarks; Boring # E3 Ground elev. ft. Depth to limiting factor in ' Remarks: SBD -6330 (R. 07/96) a /a�J l C � , f 'Ar; 1 4 ,3e"',3 I • POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION ` Owner T Permit # ( D DESIGN PARAMETERS Number of Bedrooms ❑ NA Number of Public Facility Units ❑ NA Estimated flow (average) r{ Ov gal/da Design flow (peak), (Estimated x 1.5) 0 al /day Soil Application Rate , gal/day/ft' Standard Influent /Effluent Quality Monthly average* Fats, Oil & Grease (FOG) :530 mg /L Biochemical Oxygen Demand (BOD _5220 mg /L ❑ NA Total Suspended Solids (TSS) _5150 mg /L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD S30 mg /L Total Suspended Solids (TSS) 530 mg /L ❑ NA Fecal Coliform (geometric mean) :510 cfu /100m1 Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity 0 0 a l ❑ NA Septic Tank Manufacturer ! �S e? 2 ❑ NA Effluent Filter Manufacturer 2 J3 e, ❑ NA Effluent Filter Model 4, 1 G U ❑ NA Pump Tank Capacity ❑ yeas( ►(s) (Maximum 3 years) a l ❑ NA Pump Tank Manufacturer W 'C.5 e,P ❑ NA Pump Manufacturer , �C{ S ❑ NA Pump Model ❑ month(s) ❑ year(s) ❑ NA Pretreatment Unit ❑ Sand /Gravel Filter ❑ Mechanical Aeration ❑ Disinfection ❑ Peat Filter ❑ Wetland ❑ Other: ❑ NA Dispersal Cell(s) K in- Ground (gravity) • At -Grade • Drip -Line ❑ NA ❑ In- Ground (pressurized) ❑ Mound ❑ Other: Other: ❑ year(s) ❑ NA Other: At least once every: ❑ NA Other: Other: ❑ NA ■wADRI'Mueiurc e11 V Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 � ea�lsl(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ yeas( ►(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑month(s) ,Wyear(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ year(s) ❑ NA ❑ month(s) Flush laterals and pressure test At least once every: ❑ year(s) _E�'NA Other: At least once every: ❑ month(s) ❑ year(s) ❑ 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 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 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 (Y 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 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. GMW 14/01) Page 7 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 that 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 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 Isump 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 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 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 INSTA LER Name Phone POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone S_ 3,P _ y This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.5411►, (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT ' AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �EGa /A. ,O-5 * A, LU.y• . 5*/6 Mailing Address . Property Address /�l `G/U (Verification required from Planning Department t4 aA� ►l new construction) City/State ��nsa N Parcel Identification Number 0- - 13 y2 - /a, 210 LEGAL DESCRIPTION Property Location &A)- '/4,i& t_ '/4, Sec. 3L , T.Z ?f N- R -Lf—W, Town of l�GlD i�t7 Subdivision W/N &S D 4- � 1 466e7_X , Lot # Certified Survey Map # . Volume . Page # Warranty Deed # " 3P 7 , Volume 1.5'V 7 . Page # F-Z Spec house ❑ yes 0 no Lot lines identifiable §d 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 masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying 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 the three Year exp ation date. rte- lo SIGNA OF PL 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 describe above, virtue of a warranty deed recorded in Register of Deeds Office. /D/ .5 SIGNA OF APP C 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 VOL 047PA082 6--3p979 STATeBAR OF WISCONSIN FORM 2 -1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between West Lake Builders, Inc., a Wisconsin RECEIVED FOR RECORD Corporation, 10 -03 -2000 8:30 AM — IIARRANTY DEED EXEMPT 11 Grantor, and D. Peter Seguin a single person CERT COPY FEE: COPY FEE: TRANSFER FEE: 202.50 RECORDING FEE: 10.00 PAGES: I Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lot 24, Windsor Heights in the Town of Hudson, St. Croix County, Name and Return Address Wisconsin. EAGLE VALLEY BANK, N. 1301 Coulee Rd., Unit 2 Hudson, Wl 54016 020 - 1342.10 -240 Parcel Identification Number (PIN) This is not homestead property. 01) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this J(q day of September 2000 West Lake Builders Inc. 2 0 '�� • Richard J. Grekoff, President s AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. St. Croix County ) authenticated this day of " oQ da Personally came before me this y of ✓ September 2000 the above named West Lake Builders Inc. a Wisconsin Corporat by • ' Richard J. GrekofT, President, TITLE: MEMBER STATE BAR Of. WISCONSIN = to me known to be the person(s) who executed the foregoing (If not _ ' instR ent a d acicrtowie tl same. authorized by § 706.06, Wis. StaO,) r'� THIS INSTRUMENT WAS DRAF`PELI BY Q,_ e!1 e"e 4 -- , n n Attorney Krishna Ogland Notary Public, State of Wisconsin Hodson. WI 54016 My Commission is rtnanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) 3Lr S°� 00 l , ) • Names of persons signing in any capacity must be typed or printed below their signature. w,w^^.uon Frdassienws comomy. Ford du teo. W eaoass.=1 WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 -1999 to INCLUDING LOT f OF CERTIFIED SURVEY YAP RRC01 If. PAGE 3232 AT THE ST. CROIX COUNTY REGISTER Go UNPLATTED LANDS ti " N 88'3247" E 1322.08 NORTH UNE 904.80' 1.108 ACRES , ` 4 + 48,260 SQ. FT. 6 I z 1.011 ACRES EXC. R/W.' \ Z 1.048 ACRES 44,026 SQ. FT. l \ J' 1.241 ACRES 45,630 SQ. FT. w o • p. 54,045 SQ. FT. N to i . � ` , . �-- • --V a te ° ��' Q , c A E LANE- _ ��• RRIA C \ s ib � v! + �_ a •. ts` c 24 23 F ' 1.422 ACRES 1.090 ACRES 61,961 SQ. FT. 47,467 SQ. FT. 1.465 ACRES 63,794 30. FT. \ OR rn of _ �� 25 • L 1.304 ACRES � j • �� - — — — �- ` jz 56,818 SQ. FT. v t o \ 6A A CRES 4 f` N ' r � ��' 1.05 - 1�' � ' � 6 A �l c� 45,989 SQ. FT. O - \ — - 1.214 ACRES X0 . 29 '• 1r � � . . -• —•— N 78, ' J _. 52879 S FT �' 317.89 i in YV LOGrro !N pApr or roX Sll /I or Tol XrJ14 p,�f or Tim sirl /� Or rol .vz l /s AJ P.uer o/ rot N91/4 of rxr ss/ / o 4 as, nsx, Tol �,� y r sscrlox lNCLU17lNC LOT I o or gUdSON, ST. C1totr COURT?'. . M PACs SlJS 4T T8r Crartriza SURi? Y,l Y p Rrco"za rN YOLUNY ST CROLt COUNT? Rr6 /STZJt o1 DtrDS or, CINPLATTED LANDS v •-- - - - - -- ---- - - ---- N 88'3 •' 322 08' N� _ 7 47 E 1 MC* $f LK CW lw sE+ of n"E mvn a _ 2 l' _ 66 Lr 904 60 X x =3 -- X u 11 0 1 1 ►C*ES �- i I 46.260 S0 FT, , �/ • °'* / — —�- 1 2d1 JI i 6 z 101+ -RCS C R/r.' :S \ t5 630 54 R u u •a.02b Sd i T. t 1' 1.190 ACRE FT. ., 1 d < < 5.J29 l0 1 ` j • -- S 36`S3 06 _ 'E ( / l w l fc t 1 I— tUP OR AR Y 54 Aj - - -4 • - / o v } 1 12 ACRES •EZ,GATEO TO J , h '2 ! 37.127 5 AGS S UOU A• . , 1.249 •CJZES 34.397 • o v 4S, Vv � r w � h •'h• t� . ! u i 1.076 ACRES • . 46.435 SQ FT. 269.45' .rF a •- �_ � - 217 ._ 1.013 ACRES �• r. 44.116 SC. FTC SBD -6398 (R. 07/00) Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. lvisconSln See reverse side for instructions for completing this application PO Box 7302 Madison, WI 53707 -7302 Department of commerce Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1)(m)J (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) for the s , n p of less than 8 -1/2 x 11 inches in size. County State Sanitary Permit Number ❑ Ch if e* v' us lication State Plan I. D. Number I. Application formation - Please Print all Information ky Location: Property Owner N L.) Property Location . X ieAA Lt , S zT.Z9,N, RX g7 Property Owner's Mailing dress %'T OFO Lot Number Block Number 6 (q33 .e ra City, State Zip Code e � Sub . sion a or CSM Number r X50 Yl Q �i / l 0'I �$OY S II. Type of Buildin . (check o I �s ' ¢ ❑ City ❑ Village h 1 or 2.Family Dwelling - No. : _ S gib la Town of \droomns ❑ Public /Commercial (describe us 6'u10Sc --? • State -Owned Nearest Road �e P ce 0 `a! NumW)_ _Z Yd T ' X gJcZs III. Type of Permit: (Check only one box on 1 A. Check box on line B if a icable) 32 . L 9 / `/6 A) 1. V New 2. ❑ Replacement 3. Replacement of 4. 5. 6. ❑ Addition to System System k Only Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) fp Non - pressurized In- ground ❑ Mou ❑ Sand Filter ❑ Constructed Wetland • Pressurized In- ground ❑ Holdi T ❑ Single Pass ❑ Drip Line • At -grade ❑ Aerobic tment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: L 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil lication 5. Percolation Rate 1 6. System Elevation 7. Final Grade Required Proposed Rate (Gal . y /sq. ft.) (Min. /inch) r 2 / Elevation (gyp ✓ cf 3 .tea %.% 9,G.�' ✓ VII. Tank Capacity in Total # of Manufa rer Prefab Site Steel Fiber- Plastic Information Gallons Gallon Tanks Con- Con- glass crete structed New Existing Tanks Tanks VIII. Responsibility Statement I, the undersigned, assume responsibi ' for installation of th9AWTS shown on the attached plans.., Plumber's Name (print) I Whinber's Signature (no s ps): PRS No. Business Phone Number L: 79 umber's Address (Street I MCe) IX. County/Department U Only ❑ Disappr ed Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) [� Approved ❑ Owner iven Initial Adverse Surcharge Fee l L Determi ion Z Z S d Z 2 4 o o X. Conditions of App val /Reasons for Disapproval: 1. Effluent filter to be installed and maintained per manufacturer's recommendations. 2. System shall be installed < 46 inches below uniform contour line to ensure adequate separation distance to limiting factor. SBD -6398 (R. 07/00) f Y E o ��nm'� t o e k 00 C w 00 O U. � Nv N .� 3 x � o � I v p ti A ,'a b FL h, "1 . � •II II Cie c _ ; wo ..: cd+ Al OJT a N O N v •: a , W-4 NJ U tel: O Cd �,.;.. cd \ Cd .a \ n - •' • v N . - -- - v a m, W O CM W C7 ` #00 o� a U N v NN O o 8 ca. � Y j�a mo cv O� �0J is ti 7 c O V) a Y r Fogerty Plumbing #221180 28288 McKenzie Rd. Spooner, WI 54801 (715) 635 -9609 Cross Section of an Inground Component Cell Using Leaching Chambers ObservationNent Pipes Finished Grade = j yr, ,; r - - — Finished Grade = Slope /o Original Grade = qV .5 1 -_... Original Grade = Top of Shell System Elev. = P r.o 3 X s /. a ss' y� Treatment and Dispersal Zone - - - - -- Limiting Factor ObservationNent pipes to be constructed and capped with approved materials for the particular use. KN ,M anidmu."'i Y OE r 1 1 , C I .b9, . ' POWTS OWNER'S MANUAL 8Z Ir1/�trtiuct - scr. r..r�.� :TLE INFORMA Owner Permit # cvcrvm cPF( Septic Tank Capacity y N' .•Z�4� al ❑ NA Septic Tank Manufacturer gal /day .T ❑ NA Effluent Filter Manufacturer G ❑ NA Effluent Filter Model Fats, Oil aZ ase (FOG) , r. ❑ NA Pump Tank Capacity Total Suspended Soli ( TSS) gal ❑ NIA Pump Tank Man Biochemical Oxygen Demand (BO ) :530 mg/L ❑ NA Pump Manufacture Fecal Coliform (geometric mean) :510 c l 00m1, ❑ NA Pump Model �— ❑ NA Pretreatmen , nit ❑ NA ❑ Sand /G el Filter ❑Peat Filter ❑ Mec ical Aeration C3 Wetland ❑ Dis' ection ❑ Other: Ma acturer D' ersal Cell(s) In- ground (gravity) ❑ In-ground (pressurized) ❑ At -grade ❑ Mound ❑ Drip -line ❑ Other: W &J..a....-....-... Number of Bedrooms y N' Number of Commercial Units ❑ NA Estimated flow (a rage) gal /day Design flow (peak), timated X 1.5) gal /day Soil Application Rate gal /day /ft' influent/Effluent Quality Monthly average* Fats, Oil aZ ase (FOG) !00 mg/L Biochemical Oxygen Dema (BODs) :220 mg /L Total Suspended Soli ( TSS) 1 5150 mg /L Pretreated Effluent Quality ' ❑ Monthly average* Biochemical Oxygen Demand (BO ) :530 mg/L Total Suspended Solids (TS :530 mg/L Fecal Coliform (geometric mean) :510 c l 00m1, Maximum Effluent Particle Size % inch MAINTENANCE SCHEDULE Service Event inspect condition of tank(s) Pump out contents of tank(s) Inspe dispersal cell(s * Values typical for domestic (non - commercial) wastewater and septa tank effluent. * * Values typical for pretreated wastewater. Service Frequency At 19& o every 3 ❑ months 0 year(s) (Maximum 3 yrs.) W, en comb! d sludge and scum equals one -third (36) of tank volume A t least once ev 3 ❑ months ;? year(s) (Maximum 3 yrs.) ❑ nth ❑ earl's) Clean effluent fliter AAt least once every At least once every mo s ❑ months y ❑ year(s) ❑ NA Inspect pump, pump controls 8z:213rm Flush laterals and pressure lest At least once every ❑ months ❑ year(s) ❑ NA Aaetxy At least once every ❑months ❑ year(s) ❑ NA Other: At least once every months [I year(s) C3 NA Other: MAINTENANCE INSTRUCTIO Inspections of tanks and dispersal ells shall be made by an individual carry ing one of following licenses or certifications: a Plumber, Master Plumber Restri ed Sewer; POWTS inspector; POWTS Maintainer; Sep a Servicing Operator. Tank inspect!( ntify any cracks or leaks, measure must include a visual inspet:tio of m and to e for any back up o� po ding of effluent o the ground surface. dispersa! volume of combined sludge a scum cell(s) shall be visually 1 d to check the effluent levels in the observation pipes and to ch for any ponding of effluent or the ground surface. The ding of effluent on the ground surface may indicate a failing con Id and requires the immediate notification of the local re latory authority. When the combined accu ulation of sludge and scum in any tank equals one -third (A) or more of th tank volume, the entire scot of in accordance th contents of the tank shall be removed by a Septage Servicing Operator and disposed ch. NR 113, Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pre a c comp en s, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by ertified A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION S check treatment tank(s) for the presence of painting products or other c em For new construction, prior to use of the POWT that may impede the treatment process and/or damage the dispersal califs). If high concentrations are detected have the cont( ,.r rha rank(sj ramovpd by z sentasze servicing operator prior to use. Pate _—of.,_ System start up shall not occur when soil conditions art 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 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 POWT5 Maintalner 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 dis or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction r ellmination of the following from the wastewater rtr•earn may Improve the performs and prolong the lift of the POWTS: a lotla; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; 4ental III ;drapers; dlsl nfeccutu; fat; foundation dra (sump pump) water; fruit and vegetable peelings; easollne; grease; herbidd , meat scraps; medications; oil; painting croducu. estiddes: sanitary naokins: tampons; and water softener brine. ARAN DON EM ENT When the POV fails d /or is pemianently taken out of service th/r� shall be taken to Insure that the system is proper(y and safely aban ed in compliance with ch. Comm 83.33, inUvadve Coder • All piping to tanks d pits shall be disconnected and the aba enings sealed. • The contents of afl ta and pits shall be removed and propey a Septage Servicing Operator. • After pumping, all tarn and pits shall be excavated and remers removed and the void space filled with soil, grav el or another Inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following t replacement system: A suitabie replacement area has been evaluated a system. The replacement area should be pro required setbacks from existing and proposed result In the need for a new soil and sit eva atl< comply with the rules in effect at that ti have been, or must be taken, W provi4e a code compliant I�my be utilized for the location of a replacement soil absorption from disturbance and compaction and should not be Infringed upon by ure, lot lima and wells. Failure to protect the replacement area will to establish a sultable replacement area, Replacement systems must O A suitable replacement area Is not avail due to setback and /or soil 1lmlutlord. barring advances in POWTS technology a holding tank may be Installed as a to replace the failed POWTS. • The site has not been evaluated to 1 entify a Kabk replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to ace a suits replacement area. If no replacement area Is available a holding tank may be Installed as a last resort to re ace the failed WTS. • Mound and at -grade soil abs o don systems may reconstructed in place following removal of the biomat at the Infiltrative surface. Re<ons.GUcxions of such systems st.cornply with the rules In effect at that time. < <WARNiNG> > SEPTIC, PUMP AND OTH TREATMENT TANKS MAY NTAiN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT EN R A SEPTIC, PUMP OR OTHER TMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT•, ESCUE OF A PERSON FROM TKE 1 ERIOR OF A TANK MAY BE DIFFICULT OR 1MplZttlR1 i_ ADDITIONAL COM NTS POWTS IN$T LLER POWTS I Name F Name Phone Pho SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL R Name Aaetxy Phon• n LA U l- OA S . � �.� ,. . .. ,' �. ,� � ► �' "� , .. ., s � ., ��L�. ;� ��. �, .. � a ;•. ;, � - : r ,< r;� 'S' .. .� . , ...,• .:, . ,. �; i /s � � �'^�. ' «�s ��:�► "�'� Ksm -_nkdn Cdp.wunent of Commerce D1vfuiWbrSaife1y and Buildings Bureau of integrated Services, in Attach complete site plan on paper not less than 8 1/2 include, but not limited to: vertical and horizontal percent slope. scale or dimensions, north snow. and APPLICANT INFORMATION - Please prig Personal Mb- ah- you provide may be used for sewrbary PropeAy�i ) r -X /„/u r' SOIL ,%.M EVALUATION qjlr� Wis. Adm. Code County point (BIIAT; = must and \' on y to road -. Parcel I.D. s IJ b�,caax n 3t.(ik =01t . / 1�� l . { 1 1 Y�— R id I , Page —4 of _? Date ® New Construction use: W Residential / Number of bedrooms _� Addition to existirg building ❑ Replacement ❑ pt w or commercial - Describe: Code derived daily Clow Zen gpd Recommended design loafing rate _ ` gy bed. W111F gpd* Absorption area required _ bed. ft — frarKk ft2 _j�b. W ile �Z trench. WW Recommended infiltration surface elevations) 9. R (as referred to site plan bereimarit) Additional design/site considerations Parent material Flood plain deva8on, if applicable R S = Suitable for system I Conventlorual Mound "round Pressure AT -Grade System in Fill Holding Tx* U unsWbd)le for system im S u m s u ®s ❑ u ®s ❑ u ❑ S 0 u ❑ s .® u SOIL- OESCRIPTION REPORT ®® M === =M-M Remarks: MEN Address �� I Telephone No. Date CST Number SOIL DESCRIPTION REP ORT PROPERTY OYMER _ Page of PARCEL LD-# l` Boring # U Ground ei Depth to limiting factor 2�k in. Boring # Ground elev. Depth to limiting factor >,RSS in. .. . . WEI • • ®® ® ®® Ge.n�r4c•• _ Depth to limiting factor in. Remarks: SBO -9330 (R. 07196) Remarks: Remarks: d b�, t L r .j , , // zi ma y, /,c ti s \ V4 -- - - -- I ti t � 4 -so �'3 ac y ,,Wiaconsin Departrpent of Commerce wnsron of Safety and Buildings SOIL EVALUATION REPORT Page 1 of in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must �' Q.1Z0 1Y_ include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Boundary Property Owner Property Location ?t:TER S T- G C u) )\,J z N G 1/4 N W1/4 S 3 (or W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# N - 1 1 ftS PLAN W-J G H-T City State Zip Code Phone Number ❑ City ❑ Village OTown Nearest Road wt�r C� ® New Construction Use: Residential / Number of bedrooms —__ Code derived design flow rate (o C)o GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material G 1,[ p L �;� Flood Plain elevation if applicable 1U 1a ft_ General comments and recommendations: y D U S �� e �tl .S , e�} 3 'X b Z.S t LO J6 w S L p�wlsv ��Z L Cl� itM B 0i= FD2 Ct1L ZHV P,�1Q Iv , Boring # ❑ Boring (5�� )v0`� Or j l t?i e Z O r— 3, F ., Pit Ground surface elev. a' �C • h ft nea, t„ m , „i fin f. +r ? - 2 3 - Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots •lull rypi1 UVII nda; GPD /ftz 'Eff#1 •Eff#2 > O -4 10`'1 . Z/! - S t ti Z%vi S �4 k wt�r C� - • S - � Z a -30 l D`-t 2.3) b -- s i 1 �n sb� M +r c�,j - 3 3u -68 - isgrL3 — S CsVM YA — -�j - �q S7 _1.S — s I owt �/v� `Fi Cw -- . 3 . s s s, `lR_ — \S o s Boring # Ll Boring ® Pit Ground surface elev. 0 fL Depth to limiting factor 1, $ in. Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots vvu r.Mpawuvn �aac GPD /ftz 'Eff#1 'Eff#2 1 0 -9 1o1-I1zZ0- - si ( z. Z a -30 l D`-t 2.3) b -- s )1 Zlic so - 3 3u -68 1.S`tR.� /� — sl - �CS rn V� - — -�j •6 - ��•• • - ���, - �� "u rngr ana i aO -su _< 1 5U mg/L - tmuent mt = two < 30 mg/L and TSS < 30 m g/L CST Name (Please Print) Signalyre CST Number .Arthur L. Wegerer 02-168 220254 la4l ; 6� Address W e g e r e r Soil Testing & Design Service Date Evaluation conducted Telephone Number 421 N. Bain St. Ri ver Fal HI 54022 0 Z '•715 -425 -0165 Property Owner S Parcel ID # ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor Page Z of 3 In. Horizon Depth In. a y J Property Owner S Parcel ID # ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor Page Z of 3 In. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots r GPD /ft •Eff#1 1 "Eff#2 rir� S U L $ )Al StM L w - - $ e3 OF lG(lU L 'U� LV f 1 ^��STLVt1z s 8t_DY2 s oY�l 1� -1 �� q-, o� �z1►"1 �� e0riJ1v�ZL C - _ L T U)QU U3 ICJ 1-3 b `T C_\ Q Z. i_ , v Fl "17 (3Q 01= Pi L JNS s_2 Pu YZ M n 13 1J So tJ ►TR G Ol= _ (Z C mIj Zk)) 1, J i G O —i c - _ bU� i U r�►'R'SS�u� SI r -�_ L I� N 'ro s7 A S LLOw DVS F] Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots •rr^ GPD /ft •Eff#1 I •Eff#2 rir� S U L $ )Al StM L w - = $ e3 OF X12 F.1 P�'r FLULJ 1 1 U S W \ , �C CL L.S rq"_ Yb o� �0 Ij 0_(fus - `rte F-1 Boring # ❑ Boring El Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots •rr•• GPD /ft •Eff#1 I •Eff#2 rir� C k- 1.1 G r L C e -Ln l ti - = OF �� -`nz u►�� Svc �� v o� Y-:-v _ C,W Lt- , , 1 fu `rte ' Effluent #1 = BOD > 30 < 220 mg /L 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. SBD -8330 (R.6/00) • PLOT PLAN Page of �. Scale 1' =30' J i . 2 I% i \ZTL"C S1 Q 1 U G �1�ow1 e. - L1tJV� ql0 • sM �I - - - -- -- — Yli+ - fit. C10. Z' 0►j YJ1 30 fSov1 Gt2? Ul !11,j q _ X11__= 11 = q7_ Fo�Z Lv� I t�'1°C.� 3Ul L.I�LZS_ 715- 425-0165 2202 oz- CST Signature Date Telephone Igo. CST No. Job NO.