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HomeMy WebLinkAbout020-1353-18-000 r Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM County: St. Croix • INSPECTION REPORT Sanitary Permit No: 420798 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Anderson, Frank Hudson Township 020 - 1353 - 18 - 000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: �,0O•c7 ItO • `�;n,.�/�. - CAT. � 36.29.19.201B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 2 Ek5e_ 17. eb 1-31 60z-s) ) •v Dosing Aft. BM Aeration Bldg. Sewer S , 13 t Holding /' St/Ht Inlet t - s (n• 1 rl ) 5.96 7 le -3S St/Ht Outlet TANK SETBACK INFORMATION 6•.19 q /6.12! TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet I . Septic )15i 00 1 ( Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System 1 1 2 .0' Final Grade PUMP /SIPHON INFORMATION 01.( -k° ) Manufacturer Demand St Cover PM r,� i ,. " ..A i I , Model Num • ,1 - 6 IN* 6:9 D. 8 0(I CO •ate r Ica .00 TDH ' tion Loss 'System Head TDH Ft Forcemain Length . • - Dist. to Well — SO ORPTION SYSTEM 4 )fl iL.;.• - - RENCH Width I Lengt 1 No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Depth DIMENSI • ` ,D(v. ' / 2` 1Liquid SETBACK SYSTEM TO P/L 1 BLDG WELL . LAKE /STREAM LEACHING Manufarer:�� _s4644204 INFORMATION CHAMBER OR ✓�{: Type Of System: V j UNIT I� i. 3 a 4 3 3 ) .-----.. Model Number: 2 DISTRIBUTION SYSTEM H /) Header /Manifold I ( Distribution x Hole Size x Hole Spacing Vent to Air Intake 'ipe ' 1 4 Lengt is L gth Dia Spacing SOIL OVER 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 , Yes 0 No 0 Yes a No COIVENTS: (Include code discrepencies, persons present, etc.) Inspection # • 1 2.46D Inspection #2: / / r w LZatio : 656 Hillary Farm Rd. Hudson, WI 54016 ( W 1/4; 29 19 ) C on o id ott a Lit 18- �[ Parce No: L .44...14._ 1.) Alt BM Description = 0 Vi*s‘e,3) � ' — i�o( •� $ A . 2. Bld sewer len th = ^ amount of cover = S ' v ' ' — oko ; o�sMar 4 40.J _ f 2 . " 4 c ,....... c ,....... p,et t 44- kck Avis S taBt►Ca' n 441.0 , —(0 1 Plan revision Required? ( Yes X No LZTt I it Use other side for additional information. ___I SBD -6710 (R.3/97) r n C t� _ [ C Insepctor's Signature Cert. No. r Safety and Buildings Division County 1 • NV'sconsin 201 W. Washington Ave., P.O. Box 7162 ,‹Jr* 7 /n n/ X • Madison, WI 53707 - 7 162 Site Address Department of Commerce / ( iii x._ _ ! f-1.4-s« Ldl Sanitary Permit Applicatio itNumber , In accord with Comm 83.21, W is. Adm. Code, personal Information you provide �� may be used for secondary purposes Privacy Law, s15.04(lxm) Chock if Revision L Application Information - Please Print All Information State Plan I.D. Number Property ss Name / Parcel Number • 2 z---* r2 _ 6 _ G 6�. ✓ d ' .roi/ 2 /3,5-.3- ( -oc Property n er's Mailing Address n r N Property Location t 8 72 4,/ �E9oos/ _`//f /'w %. t/'k; fe Lip N /f Z 1/ City, State Zip Code Phone Number Lot Number Block Number Al y� Subdivision Name CSM Timmins. _d, / ,./ _ .h fro/ . , Nob, Of IL Type of B ding (check aU that apply) / ,/ / / , / // „ 1 or 2 Family Dwelling - Number of Bedrooms 7 Public/Commercial - Describe Use _ Township __,..44;iSS.✓ State Owned c G4 1 Q Nearest Road pp....� 1 ,(P7 r ) 4* rro YAA /L III. Type of Permit: (Check only one box on Une A (numbering scheme for internal use). Complete line B if applicable) A © New 2 Replacement System 3 Replacement of 6 Addition to For County use System Tank Only Existing System B. Check if Sanitary Permit Previously Issued Permit Number Date Issued W. Type of Permit: (Check aU that apply)(numbering scheme is for internal use) /, � ,.,..: l r/t ,4,,,, /1�*'2/ 44 Non - Pressurized In -Ground 21 Mound 47 Sand Filter 50 Constructed Wetland S • y . 22 Pressurized In- Ground 41 Holding Tank 48 Single Pass 51 Drip Line At -Grade • 46 Aerobic Treatment Unit 49 Recirculating 30 Other fkfn'1 • 'V citive...L.4m.. V. Dispersal/Treatment Area information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required ✓ Proposed / Rate(GalsJDays/Sq.Ft.) (MinfInch) Elevation ✓ 9,i. V Co 6 7 87 o. 8 . 7 — (P• 7 W. S7 y / VL Tank Info Capacity in Total Number �M�an�ufa Prefab Steel Fiber n Gallons Gallons of Tanks bizi -4 /14-/l>C7 Concrete Constructed Glass New Existing Tanks Tanks /2v0 ^ /200 ,, !✓ /.!'flit /.✓GkFY ~ Dosing Chamber VII. Responsibility Statement - I, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. 0 Plumber's Name (Print) Plum 's Si /NOW Number Business Phone Number Plumber's Address (Street, City, State, Zip ode) SO a 4/d /1h ,. le _ .70 VIII. Count /De. artment Use Onl gar /� ' �vf�r�fS� .. for - _ • Opioved Disapproved Sanitary Permit Fee (includes Groundwater a a Issue • Stgnatur (N Surcharge Fee) LI / - Owner Given Initial Adverse 4- 22s- oor.? / O o- , - /6 Determination ✓ IX. on otApprov / sop: Disc oval ;�4 e P� (lh - r - n t�� 03 • C �� ! � _ IA. Oat-7 /osd , 2a t� ,�loit,(, z ih , G ' 0 / iii . ��1 .Lit . _, ..1 Ai , i .. / ' /lit ..% A / CO 1 if 1,/ 1 / L. 1 A tL J 4. . � A asell eempiels th plans (10 e County only) for the syd not e on paper t teas the s t l inches is she C. r�.�/f ���,, +�Q � 771.1"71'W' SyrI17y.. p a 2 0-4.4.;-,,,. g3 • S Z ei / / G�� rtive/A Rf• RRI� -639R (R. 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'Rojf- fee rAd , 6 do' Yo CA/ .7 SLALr) / / II .� X 4 is x /Z A/L Cor►n. 844/1 fs r,Q 4cKf "e r 1sr /n/f /L r/L .6:64,44 a44 N /o Sdd■LL S • / SW" gis/ Tit r./6W .2 9 sweets rarAC. 6.4.. /oo '- Alga /A' I R «IPim red P,.,/a / L/ /.04Aac� i 1 l S.EL,- Y27 r PA t r 4 k A H 2 /oS. o 1 .vA it N /w red,(Pswrra /1i.rx) b t A ®i .// 4 r ( r /r i6 1 :°.° 5 , �s /e / 7., o f KAIVi t • 0 p % DO za /2 _ _ _ A Alto A S r / 1 S r. - y. ' / ,t_, piLO� yd 9�,f y�0 / 1 G4R40! 1 ,/s : 1 • , . Q Y i,/oodS +1. t Zo r /g A"t or. .3s-d/ % c* \ Pi. f xi.) w N Is 0. 1, Lc r jo.Jdsdo P" -r4 /4. k _______ 1 V 1 v YI►- — — 985.5 ►i, t� - r6A/P.. ► I yJ/r, 4"4 "1 •'s+✓ r _,, N... - - � ► , r 979.6 r , tg is fir � , � � \� 974.7 7 : a : ' % : �` il k` owner, Possessor. user, Iicen - `� ti p$ 1 � ' ogress from or egr ess to any a "94 "; as shown on the land ` _ t., n constitute o restriction for ts., and shall be enforceable b roi'l ' � . i e,....‘„,,, i I,. l . � ' M , `, s v . , ♦ \ O S 7 , � , , • ♦ ♦♦ �0 • � a ♦ • • � iejs, „ 0 .re'r : • s1: 64 ' � 4 • �� '' ♦ ♦,%,�.., ,, ►.•. ♦ ♦o I � �. ,` . + � �' + � � , e � ,, � ♦ �.l 111AV 16 i . � ► \O� \. '.� •'�� .,.�......0� e. .......��♦� X44 • .4;84, 1 . .fi.....- s. ♦ ♦�'�\ ,„ 1,.i. :•••i•� :., ,...a ♦ „ , • ,,,-,. A 1 ** C Ir 'It S lt.% ‘ SSN'.. N . .. • . N x-N, ......-...:•:•:4:4-......... - 44:::4,4 41•4 . ,, ' .:, ,r, i . 'L to. . N` ' * ;. i N.: N :0,N : \\44,\,.. s vim ' ff - ''• ii tiik 4 1 \ 964.3• s 1 \ F !\\ , \ � 1:10,:z z�;:•: 4 ; . f ` t 983.7. , U V! \ �r -4 Ns$4 , 44%tik . „ „. , N. .. , \ i it 111k . ' ��” ,.`�-. , ' ,e H. 'may �� �'�. � �� - t f ; ,` l' 964.3 � \\ ,........: 946.4 ��� ©♦ ON CORNER 1 ?' * ' � ow el 11F . , .0 ' N: �'. !t .-.. , ' , - . .. , ',, • r. -01,0,p! ,. .., „4„... ..,..„,,,rr,„; LINE ► � : ;r�� � Irt .NT � � R 942.9 .. ym f ..., 401 14e l k Pall • iii. y 2.0 • �. z _ ` r � r d „ `� �.� labd AlOOR esi d en fi a l an d d • `F °Sr • 4 C omrnercial Ef SPECIFICATIONS , • APPLICATIONS: The A100 is used in residential and co septic systems. It i 0 s effective in multifamily housing, rental property, schools, offices t and everywhere wastewater has high suspended solids content. FLOW RATE 3,000Jpdperfllter. Install two or more filters in a PVC orconcrete - i � for de adds o achieve flows of 6,000 gpd or more. Check with Zabel \_______ FILTRATION: The 26 Disc Dams 6 1!16 inch provide 198 lineal feet of `�Cii'�i - filtration. 0 INSTALLATION: The filter maybe installed inside the tank or installed in a Zabel I. `1 J Container Assembly outside the septic tank. SERVICE Service residential installations whenever you pump the tank. \� . \� . r O.D. 4.1/2• I.D. .. ... 0 4 \ • � ._. ,0 0 1,4/16' I ._.._ 11. 13/16• • DIA te 6• 3 -9/1 104Minan•mil tit 111.111 • s, • �.r.o tti,e, . � v rr.. *. 16 isiii. •�.• 11 1 4 .4.1110111.1.6.4.111111•111/11111111*. ; ,111 sremmo.me.mirmac N 11 11141=111111110.1 I MN 4=14.1111•1 • •r..+..UMMIIN.IIMO... �.IMP∎IU r.sI� 1 1 1 1 11 1 n.rtrsrr..... •11111..1111. - -.... q , MEW MIIIIIMIll 811•10 MINK I. . rr.rr•,r...rrsrr.o� Zit 4; 1 s•.=rr♦ar•.r r.�I .r.�.. . `"1 .�.vo_.�._ f ` - 113/8' DIA. • Item Q um• Description Material Spectfcations nat 1 i 1 Case Cases, Lids, Reducers Rigid Vinyl PVC 87371 2 26 , Filter dim Discs High Impact Polystyrene LIST 3 1 Cover Rod, Nuts High Density Polyethylene '` 3 Rod , 5 3 Nut U.S. Patent No. 4,710,295 Ca111- 800 - 221 -5742 or Fax (502) 267 -8801 for further information. r 1 t a B iv 0, 1,, e , ,..... t, A ' k - i : i / r .: A rr - i ; 1. ,� ry Maintenance The interval for servicing septic tanks is set by state and local code. Throughout the United States there is a wide difference of opinion on what this interval should be, but most regulatory agencies suggest two to five years. The Zabel" filter, which does not increase the frequency of servicing for the tank, should be cleaned when the septic tank is normally inspected and pumped. However, our filter is virtually self - cleaning. The continued action of the anaerobic organisms on the Zabel filter causes lodged particles to disintegrate and fall to the bottom of the tank. If your filter contains a SmartFilter'" alarm, you will be notified by an alarm when the filter needs servicing. N \ To service the filter: 'Servicing any zabel filter should only be done by a certified septic tank pumper or installer. siiii 4 Locate the 8 , ‘ outlet of the septic tank. .,.,,,., " +' ,` 00 , ",, ' x 1 , a ` t d Firmly pull Firm the filter handle ,t y _? ,!:..4;z::' 404, 0 ` x 1., and slide the cartridge out Remove the tank - .' of the ca _ - f f` v _ _ e1 If r 'Note: A tee handle ma mg 1 and pump the + l x, t necessary top 1, 0 P - to be used Il the filter is tbtt , , — any solid ,, ~`4 .r.r.w < below ground level to R escaping to th ua.l:: Contact Zabel for info • , { .r P 9 " ' handles t , y when t f �K�rp s rem ' .y; ?: – '' r 1.1, , S S r , t; 4 .-• . i While holding the cdrttld A OVet' • 1 ,e_i the access opening rit a igfs 41 Insert the fllteeddr lidge cartridge with frdatY Mfie • = ,� back in the MA it`tAWn• «; careful to rinse all •, ,4, ¢ l ; �I sure t fe + f ;; „ ,� �t „ } — mow* i- a- , ,, ,,,,,,�,,,, 4 ` � 4 n;: ' I • a" ' • _ = r Note It is not neces i i ? .. �I ,, 4 ' " ri,, Completely I r ,; a Apr; , 1.. . ` ,r I r spotless". The biome ' ',i`14413: . 3; - 1 �� .J a ,, y , � ,. r lodes In the pretreatme + rr • °1? +s -0 t) , t it E '' '''''Y : ( . ' . be left on the niter. (If n. x �,,,r35�,,.. ,- 4•�^.+ti� l' . �� 3 Replace t ,` � ra„ '' ' may be disass s 1 , e � r : a . `-, ,., iliv � � .. _ s� MADE IN USA The product(s) shown are covered by one or more of the following patents: U.S. 5,762,793, 5,580,453, 5,591,331, 5,759.393, 5,683,577, 5,582,716, 5,779,896, 5,593,584,5,795,472,5,736,035, 4,710,295, 5,382,357, 5,482,621 U.S. Des. 386,241, 349067, 4605501,5098568, Des. 309007, Australia: 134440; Canada: 2,135,937; Israel: 111574; New Zealand: 264824, Other Patents Pending Call for a free ZABEL ZONE An Onsite Wastewater Magazine 1- 800 - 221 -5742 • Website http: / /www.zabel.com A100/300- I- M,61499 C-L. # tout _ _ RECEIV ED ..c Wisconsin Department of Comm =rce p P D 1 6 206 SOIL EVALUATION REPORT Page / of 3 ,,// Division of Safety and Buildings /4~ ��Q �4 2 �i,c7D, lia in accordance with Com 85, Ms. Adm. Code ST CR "IX ' NI County Attach complete site plan on , aper • • ,,. , , - s i n c h : :. i n size. Plan must ,..,<Y1 �.roi r include, but not limited to: ve , :: • .:_- . - ._1:, - , -: point BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and coca on : distance to nearest road. 020 3c3- "6- 06 Please print all Information. viewed Date dr Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). bliA44, 1 1 7 1 /0_5 Property Owner Property Location- A.✓K Al/t1.0,4-/lSo•✓ Govt Lot A/A/ 1/4, 1/4 S jL Td 9 N R / 9 g(or)00 Property Owner'S Mailing Address Lot # Block # Subd. Name or SSW ,7y.? it/. /4 A. /8 rro,✓.vo•a ZPsd City State Zip Code Phone Number 9 -eity Q- L4liage % Town Nearest Road � it.O.to•✓ 14/ 1 .1 - S/D /L 1 ( ) r , /1 sc.✓ 1 Z rm./4 ooa 1;;.o. e.. IR New Construction Use: (2) Residential / Number of bedrooms Code derived design flow rate LGO GPD ❑ Replacement ❑ Pubic or commercial - Describe: ' Parent material ZVA 6.Aa Dur Flood Plain elevation if applicable Rio ft General comments and recommendations: /cu.,. 74 .J rJ - • 7 // r s ,e. 4 ,90 / .4 /t/r! .r✓oeOro .furl tonto tir4 r 4,4 ..W ) ear il.17ri4 "llco e. �Svr. I o.�" Y / � ,6lse✓ 6,P./O! o.✓ Go At Tem.( Boring # �Oy Boring / LJ Pit Ground surface elev. YA o ft. Depth to limiting factor ) /1 0 in, Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. Cont. Cola' Gr. Sz. Sh. •Eff#1 •Eff#2 / r✓ /f,�orio D /7 /o Y.C ,✓ /,.e -s./ -1 / � s � '6.( Y/ 9 S 2in . S . ? , 1 / 7 l/ /o Yet -T /4 - /S .1 Y tlae !Y ✓Y/' 4 S 1 r - . 7 / 2 G AI ✓• 3 .1/- /or4 s/6 - s sJ .ti✓7. 6 $ /- • . 7 /• 2 y 9Z-/240 /ors ...s-A/ - 0s. sf .r., / --- — .7 Z Z / .✓acs . `.vo.✓i a 1 '4, ' 5 - n /qq- ,2 • ( can, 1 q "_) 2 # ❑ Bodg ©- Pit Ground surface elev. 9 y 8 ft. Depth to limiting factor P / 20 in. - Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsel Qu. Sz. Cont Color Gr. Sz. Sh. '/ /� •Eff#1 •Eff#2 / d -/1 . /D Y4 .7/2 s/ '? -'sGIK r1 7i , Q s -,P-ot . s . 7 ..? 4,9 -,1 y /o Y4 s/ /.i - a / .? ,�L.F ,r ✓ � i s / c-er . t . 7 3 019- /o//t S/` S - s� iota Co e.. s /er . 7 / 2 ' r -/Z, /o Y.r S /i/ - /fr _ /'r/ - ( /. 2 A✓/ D 6C ./ / / �� • Effluent #1 = B013 > 30 < 220 mg/L and TSS > r < 150 mgIL • Effluent #2 = BOD < 30 mglL and TSS < 30 mgl. CST Name / / /C � ( T -i n- - CST Number .v.ssrrr i i 1F - .412 y,7f Address -' to Evaluation Conducted Telephone Number /$ 3 F >e.v i r ,_r. G.v 44 4. ,4,r. xi-S d-9 A y ./- o.3 7/s 83s/ 8t /a / / Property Owner A g•✓,r £444 s..J Parcel ID # ®2D --- 13 5-3 - AP- j Page d of .3 3 Boring # ❑ Boring Ca Ground surface elev. 9< ft. Depth to limiting factor •//o in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fr in. MunseN Qu. SL Cont. Color Gr. SL Sh. •Eff#1 •Ef #2 / , a -/y A , Y-r .7/4 - s / ? -ciA it /3' es .0 civ ..f . 9 2 /y -iv' ` /o y/3 - , / ., f's14 r, 7 s / i=n . S , 9 3 is/- y1 /0,4 ri/9 a7 f sI, „IA z s /M ..s- . 9 I/ ,e zobi s'A' I \__S-s- ..s;" ,/ / – CiTh / a p.le ' C 1,6444-et bola . w►` e, 6,,c f- „a eZe G1, ¢- - e ,-,Lb " 41=' Sri. - ?5 Boni ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. MunseN Qu. SL Cont. Color Gr. SL Sh. •Eff #1 •Eff#2 Boring # D Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /f' in. • MunseN Qu. Sz Cont. Color Gr. SL Sh. •Eff#1 •Eff#2 • Effluent #1 is BOD, > 30 < 220 mg/t. and TSS >301 150 mg/L • Effluent #2 = BOO. < 30 mg/L and TSS < 30 IngIL 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. SBD4330 (R.07/00) f b b �, x ; o 0 o H C7 n n C 4 H H 0 ti t r0 t=1 Ka % H H O t's y r , 2 7 .∎ =yo i y \ + o Z rZi : . (,voz! / `0;; 1 " Co re.t. 81. 1/3 srr n d ,er .i.rr I� L 0 V0 n ■ k. k, " \ 11 4" 4./44 - / oo -.u.It iA) rite, s✓ /ioi.4K ei,al r ; C4 44.4) ti Pt • 0 H b r L 9S 0 + / 6. i"!. ? SOS. o .✓ 's A-, .j"wt� \ t /,ID ° QS \es .7.401 I � 4LNALJL ' I + 14'1 iaR°Pesia l y- 4 t. \14 I Alsr. A rep of x„I043, 4 r /8 -/ f� /7 /7 4 * t ft• + ■ \ _ . . . .... . • • ,) ( . Ca rro../II000 r.;41/1. r H (\ . e O tr t.a . 'a' .D.ao .. °m 0 • pi Zs. o / R / i ma •• H o y k ,,...... O 7 / Z. 9 4 . J 0 4, I '4' h O „t• go G7 0 4./6KNe ,oi , "�, Act 4,es.t. 81.93 ,trr sc.es r r ,-• ! 4 t. . • • i\ 1\ • . ''° I ) ! � - 4. l - /oe ".u. g ,,i r t lr 4 ./. 0 /..be a ,, , r M ■•\ % N I 0 H z L 1 9 �b � 2 / ' . lies e l✓� Q /✓K /04/4# \ . 140 ' ,.as 70 �c 4 1 ' yl' r ,: 35° 1 4- 4 1 y - b�• 6,' \; r n . rod" o . vo n S �,r /S �P � _ eA vi v : firvi p) %, _ _ o? -/ /,1 i w /161.. Rocao? . 0 ern'ily JOY Cp rr'o"✓.voao ;Ilia. L V" ti Wisconsin Department of Commerce SOIL AND .1TE.E, of 3 Division of Safety and Buildings Page Bureau of.Integrated Services in accordance. 100 s.':JIWF 8$).0' ;,,,Wis. Adm. Code • Attach complete site plan on paper not less than 8 1/2 x 11 inc Ir1:Size. Fla i4 - ' (1 ) include, but not limited to: vertical and horizontal reference po t. a'M), directid r 6ttcci,• ;? �� 4I I percent slope, scale or dimensions, north arrow, and location nd -dista G��W nearest road. 1? : rcel I.D. # i 7 .t fY APPLICANT INFORMATION - Please print all i orinat X a 'ewed by Date Personal information you provide may be used for secondary purposes ( 'v6gy'Law` t1/ m)). ,''' ' Property Owner / ., property . ' atipfi (C Cgoyt 1/4 ,�r'� 1/4,S 36 T ,N,R E (or) Property Owner's Mailing Address Lot # Block# Subd. VV Name or CSM# 130 3 1 :r +uIe Tr. / �o14onU.lc d I2 d , City State Zip Code Phone Number Nearest ad 1 r l ❑ City ❑ Village E.- T own f�1,tcJSQr1 I l 1 1 St-fQ r h 1(7/5- )546_ - fit ic1�SC5i�7 1 c.uffo,.urore d s4-r lEg-New Construction Use: 'Residential / Number of bedrooms 3- y Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow (b3 gpd Recommended design loading rate / 7 bed, gpd /ft • p C trench, gpd /ft Absorption area required bed, ft 7 trench, ft 2 Maximum design loading rate • 7 bed, gpd /f1 ' U trench, gpd /ft Recommended infiltration surface elevation(s) 9A ,So ft (as referred to site plan benchmark) Additional design /site considerations / 4t- 9/' 5 L( 0 Ski Parent material &/IGC1c / (,U / & �' l _ Flood plain elevation, if applicable H'✓L 77 0 ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ® S ❑ U r ®S ❑ U ® S ❑ U © S ❑ U ❑ S © U ❑ S 2 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft Consistence Boundary Roots Bed , Trench in. Munsell 4u. Sz. Cont. Color Gr. Sz. Sh. 6 (Cyr 3/Z - L.3 11))s5 ly) r, <. rc - _1 .. R' a /5 /: rL Ms C' J o)/ c S - . 1 ; ' Ground elev. 930° ft. Depth to limiting factor /J v / 3Oin. k e S Remarks: Boring # 1 CY(H /c ir 3 /Z" L S / n-7c twit- c_5 4' . -7 . g ' 2— l�1 --12 -1 /v yr yl� �" r►- s asf n)/ C S — . --] . g Ground elev. WO ft. . Depth to limiting factor /zf in. Remarks: CST Name (Please Print) Signature Telephone No. 2c%lr -? Sci urii6ker --T _/ (7 /s) 7 -y5 o Address Date CST Number L/D ? c, rh - s4 .``/ S 0 Mer--se -7 f 1J/ S4U z.s `l-/ - 25-3369 SOIL DESCRIPTION REPORT PROPERTY OWNER S CJ a Page L - of PARCEL I.D.# Boring # Horizon De Dominant Color Mottles Structure G D /ft 2 g Texture Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench ) O 2 lU j r 31 Z LS I rr rr >-C' c 1' - 1 g 2. ►2 ►21 /O yr(eke vm5 6 ..15 tyl l C -- . 1; - 2 Ground elev. 74ft. Depth to limiting factor I ZI in. (9�' q,e' Remarks: Boring # 1 6 to- 3 /Z_ L 5 ImS) mfr . - 1 , 8 z to -q to ,f r q/4, Yr1 S C) s rYt 1 c S — , l - 8' Ground elev. ON ft. Depth to limiting a •�3 factor /IS in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # 1 0_1(1 (o rr ri U J Mt — L I m5J r c �) -P 1 - 8 3 Z 0 4' 12 4 /) y L i he — r i 1 S — • 1: Q 11 Ground elev. 9G, Yoft. Depth to limiting factor / Zi in. Remarks: Boring # Ground elev. • ft. Depth to limiting factor 'n ' Remarks: SBD -8330 (R. 07/96) 1 e 3o 3 siou 4-- 0 i--- ir epliartwv-004 e:1:1., e,.... _,,,....---"Zse...‘ .. ic sec- (-e (' (csc) ' - A.u ;1; ,,G o�r — /6 0 ,.,� I .e l of • (0G' 0 no.; 1 i v zg "bwK 13 ."Z elev. (UV N ,Sic,„ Ll_u. „SU Al— f . t I' e , ✓• 9 /..5-0 a r.1 a2 A►-t , • (33 �1 N • S 4 1 Z P • 14, L'-' IT q 7 1.0 i e off^ 1 POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner ,749,V,r '4./49,4 s o-‘) Septic Tank Capacity / gal ❑ NA Permit # 1/42o r7 Vi Septic Tank Manufacturer ,44rj E4. ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 2.hs E4 ❑ NA Number of Bedrooms 100gpd/bedroom V ❑ NA Effluent Filter Model Al -zoo ❑ NA Number of Commercial Units — NA Pump Tank Capacity gal BIQA Estimated flow (average)* yoo gal/day Pump Tank Manufacturer 0 NA Design flow (peak), estimated x 1.5* gal/day Pump Manufacturer ❑ NA GaO g y Pump Model ❑ NA Soil Application Rate , 7 gal/day ft P retreatment Unit C NA Influent/Effluent Quality (NAP) Monthly Average ** ❑ Sand/Gravel Filter ❑ Peat Filter Fats. Oil & Grease (FOG) 5 30 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BOD ❑ Disinfection 0 Other: Total Suspended Solids (TSS) 5 220 mg/L Manufacturer. Model: 5 250 mg/L Dispersal Cell(s) Pretreated Effluent Quality ❑ Monthly Average * ** L- ground (gravity) ❑ In-ground (pressurized) Biochemical Oxygen Demand (BOD5) 5 30 mg/L ❑ At -grade ❑ Mound Total Suspended Solids (TSS) 5 30 m ❑ Drip -line ❑ Other: Fecal Coliform (geometric mean) <10 cfu/1 0 nl 2 Chamber Manufacturer /,✓iiz r44 rod. Maximum Effluent Particle Size 1/8 inch diameter Model Si .f/ /o Laying Length/Chamber t. ZS ' *Wastewater Flow Verification and Calculations: Soil Application Rate_,J Area Req. 8s - 7 ft (Other than bedroom based) Infiltrative Surface/Chamber -ESIA Rating 3/. / ft Minimum Number of Chambers 14' ❑ Aggregate Design Flow/Loading Rate= ft min ** Values typical for domestic (non - commercial wastewater Materials: all materials must comply with WI Adm. Code and septic tank effluent. COMM84 and be installed per manufacturers specifications ** *Values typical for pretreated wastewater. and approval letters. DESIGN CRITERIA ❑ "Wisconsin At -grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.a1.1990) ❑ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 ❑ "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6 ❑ "Design of Conventional Soil Absorption Trenches and Beds ". R.J. Otis - ASAE Publications 5 -77 and "Design Manual - Onsite Wastewater Treatment and Disposal Systems ". EPA 625 /1 -80 -012 October 1980 ❑ SBD - 10570-P (R.6/99) "At -Grade Component Manual Using Pressure Distribution" ❑ SBD - 10567 -P (R.6/99) "In Ground Absorption Component Manual" %SBD - 10705-P (N.01 /01) "In Ground Soil Absorption Component Manual" Version 2.0 ❑ SBD - 10628 -P (N.6/99) "Recirculating Sand Filter System Component Manual" ❑ SBD - 10656-P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" ❑ SBD - 10572-P (R.6/99) "Mound Component Manual" ❑ SBD - 10691-P (N.01 /01) "Mound Component Manual" Version 2.0 ❑ SBD - 10595-P (R.6/99) "Single Pass Sand Filter Component Manual" ❑ SBD - 10657-P (R.6/99) "Drip -line Effluent Disposal Component Manual" ❑ SBD - 10573 -P (R 6/99) "Pressure Distribution Component Manual" ❑ SBD - 10706 -P (N.01 /01) "Pressure Distribution Component Manual" Version 2.0 ❑ Drip -line Effluent Dispersal Component Manual for Multi -flo Onsite Wastewater Treatment Units 0 MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months .3 rz year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (1/3) of tank volume Inspect dispersal cell(s) At least once every ❑ months 3 18 year(s) (Maximum 3 yrs.) Clean effluent filter At least once every /y El months ❑ year(s) Inspect pump, pump controls & alarm At least once every ❑ months ❑ year(s) ®'NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) ❑ NA Valves At least once every ❑ months ❑ year(s) ❑ NA Other. At least once every ❑ months ❑ year(s) ❑ NA Page 3 of S I START UP 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. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water- saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface . whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. • Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. Et Valves Valves shall be operated in the following manner: p Alarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back -up of sewage into the dwelling or surfacing. INPECTIONS Inspection 0h311 be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). Septic Tanks Component Tank inspections must include a visual inspection of the tank 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 backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one -third (1/3) 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 NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. 0 Pump Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of the filter. Any service needs or repairs shall be promptly taken care of. pa In- Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Page 1 of .0 1 ❑ Mound, At- Grade, In- Ground Pressure . The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. 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 other 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: pf 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 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 holdin: tank may be installed as a last resort to replace the failed POWTS. f t has not been evaluated to iden ; a sui • . r repl • ement -. a. Upon allure of • PO ` , : a so' •s�'• site evalu • • • m .: pe -..... to 1. • ,- a .` .1 -p :c- ..ent - : I .. epla u.:. • . is • ••iabl> .ol.11.r_ tank ,, • • : G - >; aed asa • t -ort to . aceth• •- •iedPO' . ❑ 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. <WWARNING» • ' SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN 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 RIO OF A TANK MAY BE DIFFI CULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER - �, Name Mass 61r ./,✓ irk- d326 . ' Name Phone TES' 8 z f ' ..5 y Phone SEPTAGE SERVICING OPERATOR (Pumper) _ 4I, v 0 ,,,,, LOCAL REGULATORY AUTHORITY Name Agency S.. eaoAr eo . 2o•v..✓s Dffiar Phone Phone yi,, id? 4. - ye' Ba KAWPDATA\EII\POWTS OWNER'S MANUAL.doe Page -Col' S" r ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer rir n C.- a fl a lr e lle viii 1 - - Mailing Address 72 I) , m e ad ow ,br- n _5z/6 /' A Property Address 6 6 CQ %... r .... - - (Verification required from Planning Department for new constructio City/States/ S c o - - ? q ) c (.c) ! Parcel Identification N u m b e r 0 a a ' / 3 y r 3 - / 8 - 06 0 J,EGAL DESCRIPTION Property Location /V u i 1 , MA ) ' , Sec. - IC , T 7 N -R, / Town of ktz/544 Subdivision C.-d7fd4 lt- 2 cC(U 2 , Lot # Certified Survey Map # , Volume , Page # Deed # �� � Warranty - . " , olume , Page # Spec house ❑ yesJno Lot lines identifiable ❑ yes -no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. f /i- l /G/ v SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. / A / 62 SIGNATURE OF APPLICANT DATE * * * * ** * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed r A lops - Private On-Site Wastewater Treatment System (POWTS) Index and Title Sheet Owner: / �,✓,o .r.v sa,✓ • P r o j e c t Name and System Type: A ; ; I n / . c % W(PI !b.✓ - 5 .fl•P. - v _g rs Location: /or Ai; ea 1 41 Street Address • Legal Description /iad.✓ of lit‘..fr 44o /X . Township/County . Contents: Page 1: /.v,a4rXr 1 rZ ire Page 2: a r D./.✓ . ✓ / `,,6.r: - Sic ri. Page 3: %e.'t1 /re4✓u..A r' /Yi.✓.oe t.' i's Page 4: a Page 5: ,� ,� Page 6: Page 7: Page 8: • .Page 9: Attachments: w.os 4,. r #,,✓ £. ate 244 ed. //G rlic / rr"(44✓tt X.✓i✓. S i Plumber/Der. � If .440/4/ r.440/4/ g ned: — Credential Number: /a .. Date: 5' -03 .. • U 1852P 268 67 296 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. MALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIR CO. , MI This Deed, made between Charles J. Denucci and Cynthia A. RECEIVED FOR RECORD Denucci, husband and wife 03 -12 -2002 8 :20 AM WARRANTY DEED EXEMPT t Grantor, and Franklin C. Anderson and Marchelle M. Anderson, husband and wife REC FEE: 11.00 TRANS FEE: 210.00 COPY FEE: CERT COPY FEE: Grantee. PAGES: 1 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 1 Plat of Cottonwood Ridge in the Town of Hudson, St. Croix County, Name t.A(aLM VAL CY BANN NA Wiscon in. 1301 Coulee Rd PO Box 70 Hudson, WI 54016 020 - 1353 -18 Parcel Identification Number (PIN) This is not homestead property. (}I) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this /3 k. day of February 2002 • _ - ___ _ • Ch ties J. Denucci n e Cyn hia A. Denucci AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN C' ) Ss- C tro,)c County ) authenticated this day of Personally came before me this 1 day of February , 2002 the above named Charles J. Denucci and Cynthia A. Denucci, husband and wife TITLE: MEMBER STATE BAR OF WISCONSIN - If not. ' ito •'�•� - .ers. n r (s) who executed the foregoing authorized h ledt » the e, y p 706.06, WisStats.) �' w THIS INSTRUMENT WAS DRAFTED BY * A k. � ; � _ _ Attorney Kristine Ogland Notary Public, State of W • onsin Hudson, WI 54016 My Commission is permanen If not . tate expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) /lui,/ ( , 2-t c .) s Names ot'persons signing in any capacity must be typed or printed below their signature. lnrorrnation Professionals company. Fend du tad, as STATE BAR OF WISCONSIN e0o$55'2021 WARRANTY DEED FORM No. 2. 1999 Marion Standaert Subject: 42079; " -5 -rso : _ _ _ _ Location: Lo : Cotto ' • •d Ridge Hu. on Start: Thu 7/10/2003 1:00 PM r t End: Thu 7/10/2003 2:00 PM Recurrence: (none) 0 36.29.19.201B b ilj1( q) A 0 & c , . ziti , i Hr ( 1 41z 1 (6 C ,. 1