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Home My WebLink About020-1116-40-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: SAN-2018-177 Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] Permit Holder's Name: City Village Township Parcel Tax No: Jesse Mares TOWN OF HUDSON 020-1116-40-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 19.29.19.482 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aerati n Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration ~p Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number f-V TDH Li t Friction Loss System Head TD t Ft 3. Forcemain Lertg Dia~a Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width nth o. Of Trenches PIT DIMENSIO No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /^,I vrrAl f I SETBACK SYSTEM T /L j\j LA EA G Manufacturer: INFORMATION Type of System: CHA BER OR -4-167 11 A UNIT Model Number: DISTRIBUTION SYSTEM _ Header/Manifold 1 Distributio x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ❑ No es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 887 ASPEN VIEW CIR T-_ a T)i f-~ ~8/y_ roc~ p 1.) Alt BM Description PL-~ J, Q,"g-W a4t C6,"Vk1"k . kw'u'A Tt,~ af f.~ 4,",dw 2.) Bldg sewer length sd -amount of cover= Ct O~Z5~1A~v.k:v. k t 3 ~s~S~a ~e ~o pangwe 'TTII; u-" Q w„ou,.l of It,tc..{ o-. pub,, t did „ltfl-. "~a.&~ Plan revision Required? Yes ❑ No + / /1n Use other side for additional information. 741 l.~ l J L/J__ uT -Ile Date Inse or's nat Cert. No. SBD-6710 (R.3/97) Eq-4,7.5z ~4-5 ` QF Jet <'-677 !'County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN In accord with Chapert 12 St. Croix County Sanitary Ordinance PLANNING & ZONING DEPARTMENT Personal information you providefpay be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER [Privacy Law. S. 15.0 , 1(m)] 1101 Carmichael Road ad Hudson, r 54016-7710 101, ~ (715)386-4680 Fax(715)386-4686 x 11 inches in size. ~rp~X m complete plans for the system siq Oom ounty Sanitary Permit # ❑ Check if revision to previous application 1. Application Information - Please Print all Inf ion Location: Property Owner Name / Am 1/4 jr114, Sec 9 J_,e.5_5 e- aS T - N, R L E (o Property Owner's Mailing Address Lot Number Block Number 6?&' -7 Viec,) c 7 : City, State Zip Code Phone Numer Subdivision Name or CSM Number M4 S S- c Y%/ 5 t G It - - 7 c) - ~J 22 L 1j "A. uj et, < 1 II Type of Building: (check one) amity ❑ Village [Town of A k " 1 or 2 Family Dwelling - No. of Bedrooms: ❑ Public/Commercial (describe use): ❑ State-owned Nearest Rq d It. Type of Permit: (Check only one box on line A. Check box on line B if applicable) 0 4j Z Parcel Tax Number(s) ~ 1 , 1.epair 2. 11 Reconnection 3.❑Non-plumbing 4. ❑ Rejuvenation ~J y A) ~r Sanitation Permit Number Date Issue B State Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) "KNon-pressurized In-ground ❑ Mound ? 24 in. suitable soil ❑ Mound 24 in. suitable soil ❑ Mound A+0 ❑ Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In-ground ❑ Holding Tank ❑ Single Pass Other ❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade j Required Proposed (Gals./day/sq.ft.) (Min./inch) /G" •S~ Ele~Cvaatiop 0 1 1~J$ G~ r7 ~J ~ v t ° q0 VI. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks f" c, j& C i I~ee ❑ ❑ ❑ ❑ VII. Responsibility Statement I, the undersigned, assume responsibility for repair/reconnenction/rejuvenation/installation of non-plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non-plu ing sanitation system. Plumber's Name (print) Plum' gnatur sta s): MP/MPRS No. Business Phone Number -el 7( Plumber's Address (~Street, City, State,'Zip Code) J _ "O .ti h ,vt .k cJ L R 1 f' L✓y .~J` '~Lj ~~l' VIII. Count se Only ❑ Disa rovedSanitary Permit Fee Date Issued Issui Agent Si nat a (No S) .X"'Approved Owner Give iti~ al Adverse ?z ion IX. Conditions of Approval/Re ns for Disapproval: ~~l(~ j o ►"ttt°~C` ~L VIA. Rev: 8/05 1 ST CROIX COUNTY REPAIR DRAIN FIELD HEADER PIPE REPAIR FOR A THREE BEDROOM RESIDENCE Owner's Name Jesse Mares 887 Aspen View Cir Hudson, WI 54016 Located in the NE 1/4 of the NE I/4 of Section 19, T29N, R19W. TOWN OF HUDSON ST CROIX COUNTY WI Parcel # 020-1116-40-000 Lot # 7 INDEX Page 1 Index & Title Page 2 Information and repair scope Page 3 Pipe repair detail Page 4 Septic tank maintenance agreement Page 5 Septic tank Certification Page 6 Aerial Photo with approx. locations Page 7 Dose tank Cross section with new settings Page 8-9 Manual and Management plan Attachments: Bird inspection, Permit File/ awp-y 'Deek, Pk~ Prepared By Michael Rodewald 285 County Road SS River Falls WI, 54022 715-821-6229 MP S 931 4 Signature a ' + try " r lis, ~f;" w 9s G a 110 4, PIN- IN 3 n ~ x H Ar. ^r_ 4 v - rn q , n. 1 r x ~ ~ , n u -47 .40 Y ¢r Lar~ s s i a v" n 57 'k'k a R"'=YV^ 3,k r~ m 'a 'V► ,'"~y1~"1 live v ' x ~ m +1 r d 50 * Y fA Air law r ,EXCAVATING.. 285 COUNTY ROAD SS RIVER FALLS, WI 54022 T" A rr""" 800 828 3723 - 715-425-8466 FAX c r~ 6/29/18 RE: Septic Repair Jesse Mares 887 Aspen View Circle Town of Hudson Septic permit #119442 4/19/1989 Reason for repair: System was inspected on 6/26/2018 by Bird Plumbing. During pumping the Lower trench was filling and back siphoning into tank while Upper Trench was dry. The assumption is that the system was incorrectly plumbed and the upper trench is not taking effluent. See attached inspection report. Derived system information: Weeks 1000gal septic Weeks 800ga1 pump tank Two 5 x 50ft rock trenches TDH = 19.1ft Anticipated Repair: 1. Install a NDS distribution box at header for upper trench. 2. Temporarily install a 90deg bend and riser pipe inside the box on the outlet pipe to the lower trench. This will allow the lower trench to dry out, but still allow the trench to take effluent during surge loading. Elbow can be removed at a later date. 3. Reset the pump switches to reduce the dose volume. P~y-p- z f K ' f,t) 1. i S , c IA" A rd A ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Te 5! ee Mailing Address FS / 14 5,0,e V iec~ A Property Address (Verification required from Planning & Zoning Department for new construction.) Q City/State W So ~~/i`l~L Parcel Identification Number Z(~ - ~l '~Q -00 d LEGAL DESCRIPTION nI Property Location / V r/a , V&"14 , Sec. TAN RIq W, Town of YUCCSd~l Subdivision Plat: w t ((a ,/2 'b L , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house OyesQio Lot lines identifiable ❑yesOno SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, 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. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 1/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services 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 Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on is 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 w rranty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATURE F APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) esj e- ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence:' (Street address) f; 7 ~1~a kS4 VI(") C (iL located at: IU4E1/4, 11 /4, Section, Townes N, Range W, Town of uP scryli , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service L2-, OA 6 Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: I&j ' - e boo Construction: Prefab Concrete X Steel Other Manufacturer (if known): 1N~e4e k"S Age of Tank (if known): Permit number (if known) y y Z_ Lensed Plumber y y Signature) (Print Name) 1-73 3 Qy (Title) (License Number) MP/MPRS (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 f,C S-R PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VC WT CAP M"C. I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MAWHOLE COVER 2' 25' FROM ODOR, WINDOW OR FRESH 12"MILT. AIR INTAKE GRADE ( 4" MIN. Ali, CONDUIT-- 10"MIN. ~ 11~ - PROVIDE ImI-.E1 1 111 AIRTIGHT SEAL I II V APPROVED JOINT A v I III APPROVED JOIAITS W/C W/C.Z. PIPE. . I III .I. PIPE ENDIAJC- 3' ~Ic Jv i I i ALARM EXTENDING EXT S 0►JTO 501.110 SC':. ONTO SOLID SOIL B I I ! 1( `~G I It PUMP-~ --J L ~ OFF V CONCRETE BLOCK RISER EXIT PERMITTED ONLY IF TANK MANUFACTURER HAS SUCH APPROVAL SPECIFICATIOKIS f~ SEPTIC AND Vii, LiFC~' •w DOSE TANKS MANUFACTURER: NUMBER OF DOSES: PER DAy TAWK ;PIZE : fco GALLOIJS DOSE VOLUME Z ALARM MANUFACTURER: ~PwL~ rr~ INCLUD!! ' Z GxPLOW: ( GALLONS MODEL NUMBER: wL CAPWTIES: A= ,-INCHES OR GALLONS .376 SWITCH TyPC' ~J ! ~j B= INCHES OR GALLONS 6 PUMP MANUFACTURER' 2 7 INCHES OR GALLONS 114) MODEL NUMBER: d.QZ ~'Z D- INCHES Olt GALLOWS 2-1b SWITCH TYPE: MOTE:, PUMP AND ALARM ARE TO BE PUMP DISCHARfiE RATE y~ GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFEKEWCIE BJ9'wEE1J PUMP OFF AMC) OISTRIBUTIOIJ PIPE- -42 FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . .2-,d-// FEET F/ O IOO fxFRICTION FACTOR..~sL- FEET C Yv~ ♦ FEET OF FORCE MAIN Y. - TOTAL DYNAMIC HEAD = 1L- FEET I~ l INTERNAL QIMEIJSI6RJC OF TANK: LENGTH ;WIDTH ZZ -;LIQUID DEPTH `fs 51GNED: LICENSE HUMBER: DATE: -117- q3 i y qlz -aa -0 I INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 t To ba a compiete and accurate soil test, your report must include: I . Complete legal descilption, 2. The use section must clearly indicate whether this is & residence or commercial project; 3. MAX IMUM number of bedrooms or cornmercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 9 PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; T. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale ie preferred. A separate sheet may be used it desired; g. Male sire yo;ar benchmark and vertical elevation reference point are clearly shown, and are permanent; 0 Coinplrte all appropi late boxes as to dates, names, addresses, flood plain data, percolation test exemp- ti<:n, if appropriate 10- If the infotmatlon (such as flood plain, eievationl does not apply, place N.A. in the appropriate box; i'I. Sign the form and place your current address and your certification number; ?2 Ma4e legible copies and distnhute as required, ALL SOIL TESTS MUST BF FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLFTION. ABBREVIATIONS FOR,CERTIFIED SOIL TESTERS Soi! Separates and Textwes Other Symbols r - Stone (ove`T, 1(3i 'BRA Bedrock roh Coub!e l3 10 ;A SS Sandstone gr - Gravel Iundel 3') .'y' • a LS Limestone - Sand 1 *HGW - Hiyh Groundwater Coa,se Sand wp T Perc - Percolation R-te ;1e: krm Sand " W - Weil Fm(: Sand Bldg - BUIldlnji Lnamy Sand > - Great,-; Thor 'd Sandy Learn - Less i r-" Learn Bn Br-vn `slk - Silt Loam BI - Bite i* S;It Gy ,d Clay Loam Y _ ye;r("' sci - Sandy Clay Loam R Re,i :ICI Sdty Clay Loam mot - Mori r - sandy Clay w; - o'Wi. JIB Silty Clay fif - iew, ilne `',Int cc - eomntnn, Coe :Su Clay Pt~at MITI - Many. medium M, k d - dist,nct HWL - High vaati-i icvei, S,v.:, :aral soil textures surface water fog hlrJd waste disposal L.1il - Bench ml ;k VRP Vertical Reference Point n N,FR: i seairim a se .,e v I:,:. "i,t. l i- county w o, Department may request A e~ w fiF°!d prior to permit issu r u:e. Aron, (ete "I of olnfl; for the. pi ivate to the aPP10pria tr: Iscal Iw.Lho~jty in prder to 0 ew;lt'd prior "o rt of all" onsU'tict(dh'. fft POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner eSfrc: ~ o+3/~iS Septic Tank Capacity CCjU gal ❑ NA Permit # Septic Tank Manufacturer ~f MKS ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer N$SNA Number of Bedrooms ti ❑ NA Effluent Filter Model ANA Number of Public Facility Units ❑ NA Pump Tank Capacity ❑ NA Uv gal Estimated flow (average) / gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer ❑ NA Soil Application Rate gal/day/ft2 Pump Model ❑ NA Standard influent/Effluent Quality Monthly average* Pretreatment Unit i2~,VA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODS) <_30 mg/L ArIn-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coiiform (geometric mean) <_10' cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size %e in dia. ❑ NA Other: NA Other: ❑ NA Other: ER NA *Values typical for domestic wastewater and septic tank effluent. Other: 1'9 NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: El month(s) (Maximum 3 ears) ❑ NA ry'year(s) y Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) El NA ear(s) Clean effluent filter At least once every: ❑ month(s) .ANA ❑ year(s) inspect pump, pump controls & alarm At least once every: ❑~onth(s) ❑ NA R year(s) _3 Flush laterals and pressure test At least once every: ❑ month(s) --b NA ❑ year(s) Other: At least once every: ❑ month(s) $~NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: 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 (%3) 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 <_12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page Z 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 contents of the pump tank removed by a SePta9e Servicing Operator Prior to restoring effluent. To avoid this situation have the 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 safety 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 fines 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. T aluati a o ing~ank be i e ai e t~~D4dl~ TC✓~ ADZ N ~!\TS`l7z(I~"ll~ 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 POWTS MAINTAINER Name 2 u~>ff2 Name Phone , j -`;j Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ST. G~ ( (SUN 20/lf t~ ~rrz.1~5 S ~ ~ Phone -7 r_5 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.5401, (2) & (3), Wisconsin Administrative Code. ptl~ L o6 I Page 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 fife 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 foifowing steps shall be taken to insure ihai 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 property 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 POINTS 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 fines 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. r 1 T r T v a vV holding h( aluati ~nG D v be i + e TaIie 'F2 D1-tl~ Tf~T~ FD 2- ki rz ~ 5 R ❑ 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 POWTS MAINTAINER Name Blame r c 2 ~"L (7 Phone ~S, Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name I D;hfYZ Name ST. Gcn ( C~V" l~ l ZDI~(l ~(_I e `7 fs - Z lC Phone S- G l0- Phon This document was drafted in compliance with chapter Comm E-_.22(2)(b)(1)id)&(f, and E2.54(11, (2) & 12i, Wisconsin Administrative Code. ~)f qd4 I ? 6 a O - Z x3o' Igo,, Pipe, , IVs ICr" IQ "-r 3.CoS LPSS_/LiQr AI. FG ~ qll, OTHER LoT GoRUE~S ST.•.M 9,. N wa ~ZH 1"xz¢' IqO~-1 P~P6,`al f.~CtH~ %bs~ L NEP~ Fool, ,ea°as 0. E AST 41~5~ S 83~ 25Ca.4 30 U u g w a o .a . ay N C7) 2 ' N M• lV OR 4Q N-V De Pr O zj S ' 30, .rJ o 02 rr 0 ®RClF 2~t 50 ~ (per- O ~ J J. - 3~ ir\ y s4"q,53" _ Z9 (p N C4 r ~ SGALE lU FEET o So •op zoo d Q r N~ 2~3q.Co'1EAST ''S2S.33' 2S0' 14't,'3l221. co'3' (n I otyuL; oystern ana well inspection Report r Bird Plumbing Inc 1432 120th St. New Richmond Wi 54017 715-246-4516 sbi rd @ frontiernet. net Shaun Bird, certify that on 6/'26/18 XXX Inspected the Septic System (POWTS) XXX Inspected the Well XXX Obtained a drinking water sample Property Owner/Buyer Jesse Mares 887 Aspen View Circle Hudson Site Address As a result of my inspecton, I certify that: XXK In my opinion, the septic system was, on the date of my inspection, in working order and in compliance with the standards set forth by the Department of Safety and Proffesional Services. Any exceptions or needed repairs will be listed below. Last date of pumping 10/4/2016 System appears to be sized for -3-Bedrooms In my opinion, the well at the date of my inspection, is in good condition and complies with all WDNR standards. Water sample sent to Quality Water Testing Lab Somerset Wisconsin. XXX See attached Property Transfer Wells form. Any exceptions or needed repairs will be listed below. In my opinion, the septic system or the well is not working or not in compliance with the Departmet of Safety and Public Services or WDNR. See attached Property Transfer Wells Inspection form. The well needs new well cap. The drainfield has 2 trenches. The upper trench is dry and is not be served any water. The lower trench is full and is back siphoning to the lift station tank. The line needs to be repaired to service the upper trench first. By doing this, the lower trench will dry out and be working properly again. Once these repairs are done, the septic system will pass and meet codes. eptic System maintance information: Pump tank ev 3 years ano clean effluent filter if installed once a year. or further information, contact your local zoning office ,r isclosure: This test is not a guarantee of future perf Filsclaim oemt5ut a proffesional opinion. Usage can change from fferent owners. This is not a warranty of this system Iall liabilty for any loss caused by reliance on this )rfication. Past problems with this system,( if any be o be disclosed by the seller. haun Bird MPRS/CSTM #226900 DNR# 76 i" Date 6/26/18 Slate Of oft DepartmW of" Property Transfer Wei s Form 3300.221 (R 10/14) and Pressure Sysfieim(s)1,rtisPection Pursuant to Ch 280. YVs Slats- am tit. NR 812, Wis Adm. Code, this form shall be to docurr*nt es gait of batrkhS, r, inspeCOOM are voluntary, and well owners are not rpn toed any well and pnssure syslem 4uoled 0or P ed fQrrri fo the requester of the irspection., Do not send forms ,I kft =Wave as a result of ft Inspection Ke4ues6ed By .t? Yx e~phorte Number Mailing Address ,f` City Owner's Name State Z1P Code Mailing Address Telephone Number City . ~ ~ ~ State p Code r Courity pf y~g Grid or skeet 7 Address or Road Name and Number Cd qva Township f J P code; Gov`t Lot #f ` +/d 'Section Town Range , Uitxlue Well Number of the N IdentlIed noncoMplying fie Wrss are noted below 1. Unusedvfrell Should be F wft a check mark, rued and Sealed 2. E]8tOveP!pe or'.Thin-kWed Casing 14. ]Hand Pump 3. Dug Well 15• ❑Of at Pump or Piping Height < 12"Above Floor 4. C]Unpro Buried Sumo, Line 16. []Yard Hydrant 5. DAleove (Subsurface Pumproom) or Pit 17 Materials for Pump and Supply P04V 6• EINon-Vya ant or Below-Grade 7. Poor Crawl Space Well 1$• []Flowing Well installation Casing Condition (Badly Corroded or Cracked) 19. (]Check Valve Location g ❑Contaminant Source less than minimum separation distance 20:Well Cap or Seal from well: 9• OWell in Floodway or Flood 21. []Casing Height 10. ❑Wdl at Risk from Localized Flooding 22. OElec trical Wires Not Properly Enclosed in Conduit 11. QCmwCOnne(*on 23- [JSample Faucet is M ~+v+en Point Well installed 9 or Incorrect 12. Qconstruction report after 1-31-1991) withoyY 24. [:]Casing less shale, q"ice odiameter r granite a web in &yW$b ne, 13. []Nonprawwe Conduit -111 25. []Heaith'Safieiy Hazard (Pre-1981 Driven Point Pipe Depth < 25 feet ®VI/eli Construction Report Not an File or Uniocatabte Inaccessible or'Difficutt Location for, Future VVeli Work ❑Well Located in Special Well Casing Depth Area []inane or Cllfficult Location for Future pump Vibrk ®x-1979 Tw.W a S~~ P Q Other Non-Proof WeH Cap or Well SeW Evidence of 'gip Other: Some Corrosion an Well Casing Pipe teased on my personal insPection of the real property, the well(s) and pressures mplies n More ystem(s): =mPmhens ve or additional g{~ Does not comfy with VWs Adm. Code a an unused research is needed regarding: used well 0 flooci>"rays/floatplains contaminant sources ❑ other r This form lis!visible conditions of the give any g well(s) and pressure system(s) on the pro Sig Icy at the time of inspection and does not Imply ar Oet )Hater Weis Drilier or Pump Installer I!"ual License # paw CDILH SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code STATE SANITARY PERMIT # -AtW,h complete plans (to the county copy only) for the system, on paper not less than '1//194A91.;2 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION r 14 A,5 / T,Z ,N,R E(o PROPERTY OWNER'S MAILI ADDRESS LOT # BLOCK # _ 4 At 1-41/ Z CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR eeM 1 UM19Ef1 /H o 6: w 7- 0 r ] CITY NEAREST ROAD 11. TYPE OF BUILDING: Check one ( ) State Owned O LLAGE ❑ Public LJ 1 or 2 Fam. Dwelling-# of bedrooms P L AX NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ® New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.E] Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ® Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 1 01 / 1,9665- ELEVATION_ 11S-6 9S 5190 , , L Feet c Feet 11 VII. TANK CAPACITY in alions Total # of Prefab. Site Fiber- Exper. INFORMATION Manufacturer's Name Con- Steel Plastic New Existing Gallons Tanks Concrete structed glass App. Tanks Tanks -7 0 El Septic Tank or Holding Tank B d Lift Pump Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No S mps) -MP/MPRSW No.: Business Phone Number: 2P lumber's Add (Street City, Stat , Zip Code): r Or~ X. OU /D EPAdkTMFNT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued I suing Agent Signature (No mpg) 14 Approved El Owner Given Initial `surcharge Fee) r~ QU f ~fi U(~~ t hh Adverse r in tion X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-8398 (formerly Plb-67) (R.11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & B DING ABOR WHUMAN REL*TIONS DIVISION .0. BOX 7965' ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION MADISON, WI 53707 State Plan I.D. Number: NE 4!! ' 4j S19 I i" -F19?J ]CONVENTIONAL ❑ ALTERATIVE (If assigned) 70~•d El Holding Tank ❑ In-Ground Pressure El Mound I 9 NBill HelwigER A14010Laurel,LDHudson, Wa 54016 INr01 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: Name of Plumber' MP/MPRSW NO-: County: Sanitary Permit Number: David B. Fogerty 3289 St. Croix 119442 SEPTIC TANK/HOLDING TANK: MANUFACTURER LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO BEDDING: VENT DIA.', VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM FEET FROM LINE: AIR INLET' ❑ YES ❑ NO ❑ YES ❑ NO NEAREST DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE' AIR INLET: PUMP ON AND OFF ❑ YES ❑ NO NEAREST -1110' SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS'. LIQUID BED/TRENCH TRENCHES: MATERIAL: PIT DEPTH: DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH BELOW PIPES: ABOVE COVER: ELEV. INLET: ELEV. END: PIPES: FEET FROM LINE: AIR INLET: i NEAREST MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: SERVATION WELLS; [71 YES [__1 NO OB ❑ YES [__1 NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED. MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: TRENCHES LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL. NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND ELEV.: ELEV.: DIA.. ELEV.: PIPES: DIA.: DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO COMMENTS: PERMANENT MARKERS OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING. FEET FROM LINE: ❑ YES ❑ NO ❑ YES ❑ NO NEAR EST-♦ i i _ J Retain in county file for audit. Sketch System on Reverse Side. SIGNATURE: TITLE: Zoning Administrator SBD-6710 (R. 06/88) DEPARTMENT OF SAFETY & BUILDINGS REPORT ON SOIL BORINGS AND INDUSTRY LABOR HUMAN REiATI NS PERCOLATION TESTS (115) P.O. BOX 7969 DIVISION ` / MADISON, WI 53707 46 (H63.09(1) & Chapter 145.045) LO TION: SECTION: OWNSHIP/MHN4BfPktii~(; OT NO.:BLK. NO.: SUBDIVISION NAME: F /TN/R / E, s T ui r/ COUNTY: OWNER'S BUYER'S NAME: [AI IN ADDRESS* SS: USE We _ ~ ~ C DATES OBSERVATIONS MADE NO. BEDRMS.: COMM R AL DESCRIPTION: ROF NS: N TESTS: Residence New ❑Replace 3 L /."/.e~aP ? RATING: S= Site suitable for system U= Site unsuitable for system ONVE(cNTI NtAt''L: MOUNpD: IN- G S STEpM-I(N~-FRILL O,L]I I G TANK: RECOMMENDED SYSTEM: (optional) ~J❑u ❑~U1l ~S(A ❑$UtY ULIJEU «c~i 2 So~rve XSwi t If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.0915)(bl, indicate: If Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL PTH TO ROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED I HES TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B D 2- SYf~ 7 O B- 2- S E S M d ' S S /L s B~ - I G~ /a, Gs / 8 .s IB- G p 7 " 7 /Its 3, 9, nnS 1 u f "B,r rni 7 > G6 PERCOLATIO TESTS( rc/ TEST DEPTH WATER IN HOLE TEST TIME z d e" nrS NUMBER INCHES AFTERSWELLING INTERVAL-MIN. MIN. DROP IN WATER LEVEL-INCHES RATE MINUTES P RIOD 1 PERI D PERIOD PER INCH P- 2 t P CL Ice r P- 3 dh ~ P- rr P- S m C P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. I COL. 5 SYSTEM ELEVATION ~Z .~v,3 T -m - 7' F i 1 . i r I Y i y ii - - - N - A7?!1C~~D car ~ _ D~2n cvr~~ I i the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the ministrative Code, and that the data recorded and the location of the tests are correct to the best of my k' ME (print DAVE FOQERTY PLUM9INGI TESTS ~RESS: & Plumber Foerty He+g is Road CERTI FI C. 114023 Phone 749.3656 CST NA OISTRIe))TIMV: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 02/82) ~ OVER A. d- cr t ~