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026-1165-33-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: , 514874 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: Dalstock LLC I Richmond, Town of 026 - 1165 -33 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /dp ps M G5T 22.30.18.1299 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic J i A �I Benchmark 26 /ds Dosing 7"0 5, �✓ Q Alt„BMG s L IrL Q f py. Holding St/Ht Inle �{ �0 �g• 3 St/ Outle •J TANK SETBACK INFORMATION 5GF ( 3 ( *03 r f q• aS TANK TO A' P(L WELL BLDG. Vent to Air Intake ROAD Dt Inlet ? 0 3 [� w/ `''/ Septic 'v 7 / ,f _ �p Dt _ Bottom 1 L la ` B Dosing } Heade Man. r 2 15 f > 33,1(1 a 3 o� Aeration Dist. Holding Bot. Lten)) r PUMP /SIPHON INFORMATION Fin -TU t A 103 �— Manufacturer Demand St Cov r .^� r GPM 6 0"t ']/ G (l ►� L V L.� Model Number . p+tiVpas r `' J TD H Lift Friction Loss Syste Head/ TDH Ft 2 ` '� I l ob 2 vL Q V 1 , ivVD Forcemain Leng / Dia. i Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Or�encls PIT DIMEN I \ No. Of Pits Inside Di� Liquid Depth DIMENSIONS ; SETBACK SYSTEM TO P/L BLD WELL LAKE /STREAM LN ACHINor Manufacturer: INFORMATION CHA BE OR Type Of System: - � � - \ ` M y A / Model Number: M ao �- J I /V DISTRI ION SYSTEM S�2Q `r �'� ytitw,, / � Head lManifo Distributi jo#IR1!5,,, x Hole ize x Hole Spacing Vent to take Length Dia ength Dia Spacin Q, 02.1 3 SOIL COVER x Pressure Systems Only x -- mound 6lr At - Grade Systems Only Depth Over Depth Over xx Dep2 x Seeded /Soddeq xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil es No Yes ���� No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: 7 (_ Z / C ) gp_ Jpspection #2: - 7 Location: 1463 129th Street New Richmond, WI 54017 (N 1/2 SE 114 22 T30N R18W) Lundy Meadows Lot 33 Parcel No: 22.30.18.1299 1.) Alt BM Description = "w" "' 9 g Z q b a Itio ('1�SP(� b✓1'V`!/1 lr a 2.) Bldg sewer length = � t - amount of cover = � � ! L 1 ' a L�,j O ► ` Plan revision Required? gI Yes No Use other side for additional information Date re C ert. No. SBD -6710 (R.3/97) eommeree .wl.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 T C,f.o: K i sco n s i n Madison, WI 5370 -7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce 5 / , q $ 7 Sanitary Permit Application to Transaction N In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this fian to the a / Z governmental unit is required prior to obtaining a sanitary permit Note: Application forms for sate -owned Project Address (if different than mailing address) POWTS are submitted to the Department of Commerce Personal information youprovide may be used for secondary purposesin accordance with the Privacy Law, s. 15.04(1)(ml Stats. I. Application Information - Please Print All Information y&.3 L 9 .3"�'• Property Owner's Name Parcel # ,- �cc Ck �-4.0 UZIo lll�S 33_d dG Property Owner's Mailing Address r I- Property Location 1 1 ) Z S , ST. CROIX COUNTY Govt. Lot /Z �� City, State Zip Code #h Ng&N OFFICE ^1 1/ Section Z Z (circle one) T 3 p N; R /a E0( II. Type of Building (check all that apply) ok oo Lot '� � 1 or 2 Family Dwelling- Number of Bedrooms _ J 3 3 Subdivision Name L-)r "J" �.OJ IA— Bloc-k# k 4l /vd w r Vii. JQ L✓ s ❑ Public /Commercial - Describe Use _ l/ �e..i�� _ ❑ City of _ El State Owned - Describe Use Z I CSM Number El Village of � 75 —ir�,.k Or Town of � G � /M d ov III. Type of Permit: (Check only one box on fine A. Complete line B if applicable) A. New Syste ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) B. ❑ Permit Renewal ermit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Numberand Date Issued Before Expiration Plumber Owner / IV. Type of POWTS System /Component /Device: (Check all that apply) 0 ❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) __ _ ❑ Pretreatme_ntvevice (explain) V. Dispersal/Treatment Area In Design Flow (gpd) Design Soil Application te(gpdsf) Dispersal Area S'o Require sf) Dispersal Area Propo d (sf� System Elevation V/SD 1. o o. 5 y' qob `YS© VI. Tank Info apacity in Total # of Manufacturer Y Gallons Gallons Units U New Tanks Existing Tanks 6 eptii5Dr Holding Tank D Ong C ber ��� 1 VII. Responsibility Statement - I, the undersigned, assume responsibility for installation of the POWTS sh on the attached plans. umber's Name (Print) ature MP umber Business Phone Number n7 it Plumber's Sign Z Z Z87L. Y71 -2VZ / tier's Address (Street, City, State, Zip Code) 2- 1. 9 / SO - 3 h.0 CA VIII. County /Department Use Only Date Approved ❑ Permit Fee D I sued Issuing A t Signatur ❑ $ . �1� rven Reason f or Denial IX. Cond' ' Reasons for Disapproval GTOT 1. Septic tonk,.efflU&M filter and I dispersal cell must all be sery►cea'I maintained as per management plan provided by plumber. ,31 IJeV ego Q J d��•ti. J 2 AN setback t� mtait.be marMaihd J1 as PII' appkow gods / ad i o " i - D �✓ t� Q.�_ /V(ct,? �Y,,,« ,ti i � �.K-w a+'� Attach to complete plans for the system and submit to the County only on paper not less than 8 in xx � 11 inches in size SBD -6398 (R. 01/07) Valid thra 01/09 q) / • I r I �/ J /y�(�(8�k..� (� .'t-.d�.5 (A the. - • r I 1430WO M372Y8 han:r. .: " >a �zum r�rrsme ,up�si xosdtse IIA ega(mv x sb03 9483dggs t!q is Parcel #: 026 - 1013 -70 -000 07/02/2008 04:48 PM PAGE 1 OF 1 Alt. Parcel #: 04.30.18.48B 026 - TOWN OF RICHMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - KOSKI, ANGIE ANGIE KOSKI C - BAAKE, THOMAS THOMAS BAAKE 1748 112TH ST NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description ' 1748 112TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 3.060 Plat: N/A -NOT AVAILABLE SEC 4 T30N R1 8W PT NW SW LOT 1 CSM 21518 Block/Condo Bldg: 5 AC EXC PT TO CSM 11/3204 & EXC PT TO WEST SIDE WINDING TRAIL ESTATES Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 04- 30N -18W Notes: Parcel History: Date Doc # Vol /Page Type 11129/2007 864862 WD 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/19/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.060 32,000 121,000 153,000 NO Totals for 2008: General Property 3.060 32,000 121,000 153,000 Woodland 0.000 0 0 Totals for 2007: General Property 3.060 32,000 121,000 153,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: 126 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ti A Ln O �• T4 c4-- ----� o , �Q �Q C w A h J o: -: tr � M N O 3 z M W mow„ N �J 0 o o � � cri c OP 3 6 y -� o o , j - r x � ri 1` r v o ° s p 0 b O � � h p � a • �; v t /V 4 M N V O `t^3 3 o � o 4 CI— h Safety and Buildings 3824 N CREEKSIDE LA commerce.wi.gov HOLMEN WI 54636 : TDD #: (608) 264 -8777 i sco n s i n www.commerce.wi.gov /sb/ www.wisconsin.gov Department of Commerce Jim Doyle, Governor Jack L. Fischer, A.I.A., Secretary June 27, 2008 CUST ID No. 222872 ATTN. POWTS Inspector JACQUE M HAWKINS ZONING OFFICE HAWKINS SOIL TESTING & SEPTIC ST CROIX COUNTY SPIA 2659 150TH ST 1101 CARMICHAEL RD LUCK WI 54853 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/27/2010 Identification Numbers Transaction ID No. 1554069 SITE: Site ID No. 739082 William Stock Please refer to both identification numbers, 129TH St above, in all correspondence with the agenc Town of Richmond St Croix County N1 /2, SETA, S22, T30N, R18W Lot: 33, Subdivision: Lundy Meadows FOR: Description: Three Bedroom Mound System / New construction / 2% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1188377 Maintenance required; 450 GPD Flow rate; 32 in Soil minimum depth to limiting factor from original grade; Sysem(s): Mound Component Manual- Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual- Version 2.0, SBD- 10706 -P (N.01 /01) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Code and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during corstruction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions ofSec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • Maintenance information must be given to the owner of the tank explaining that periodic cleating of the effluent filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A copy of the approved plans specifications and this letter shall be on-site during_ construction and open to inspection by authorized representatives of the Department which may include local inspectors P.O.W.T.S. Conditionally nV E Do, JACQUE M HAWKINS Page 2 6/27/2008 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.Comm 83.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptabb to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additons should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. . The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 �/ Fee Received $ 175.00 Balance Due $ 0.00 6erard M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7 :15 am - 4:00 pm WiSMART code:'7633' jerry.swirn@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. MOUND AND PRESSURE DISTRIBUTION COMPONENT DE o7, Residential Application n8 A I , # INDEX AND TITLE PAGE Bog? 8 Project Name. William Stock + Steve Dalton Mound ,7 ,0 ZQ- Owner's Name: William Stock and Steve Dalton Owner's Address: 1748112th St. New Richmond WI 54017 Legal Description: N1/2 -SE1 14 Sec. 22 T30N -R18W Township: Richmond County: St.Croix Subdivision Name: Lundy Meadows Lot Number. 33 Block Number. NA Par nre I.D. Number. Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Designer. Jacque Hawkins License Number: MPRS# 222872 Date: 06/12/08 Phone Number. 715 - 653 -2324 Signature: Designed Pursuant to the Mound Component Manual for POWTS Verses 2.0 SDB- 10691 -P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706 -P (N. 01/01) Version 5.1 (R. 06/06) DEPARTMFHT OF COr,FkLnk,E Page 1 of 8 DIVISION OF SAFLTY AND BUILDSNGS HE CGRRL 'PONDL- :�11Ct 06/25/2008 22:38 7153492520 KEITH + DLB 51 UNLM taut n�ino Mound and Pressure Distribution Component Design Design Worksheet Sifie lnfbnTmon (R or C) R Residential or Commercial Design Naw Santa fin (D) cnkutet WS assurre a 300.00 Estimated Wastewater Fkmf (gpd) ablea� .no- 3r�u So aesansntirxi�Cat 7.50 Peaking Factor (e.g. 1.5 = 150°/x) caF,Yorrc► a 3s tsrrare3 450.00 Design Flow (gpd) 2.00 Site Slope ( °k) 100.80 Contour Line Elevation (ft) 32.00 Depth to Limiting Factor (in) 0.50 In -situ Soil Application Rate (gpd/ft ) Olistribution Call information 75A0 Dispersal Cell Al ong Contour (ft) 6.00 Ce Width (ft) 1.00 Dispersal Cel Design Loading Rate (gpdAe) 7 influent Wastewater Quality (1 or 2) Are the laterals the highest point in the cftftuWn I Y- Piresswe Dftnbufion hTlkwalaltim network? Enter Y or N (C or E) C Center or End Manftl t 3.00 Lateral Spacing (ft) if N above, enter the elevation 4 Number of Laterals of the highest point. 0165 Odw Diameter (in 208 F_stim ed Orifice Spacing (fl) = 67.25 felffm i 2.00 Forcemain Diam eter (in) 1 oraemain Length (ft) Does the forrernain drain bark? 0 Pump Tank Elavakm (ft) Enter Y or N 4.55 System Head (ft) x 1.3 24.47 Fornemain Drainback (gal) 8.80 Vertical Lift (it) 67.44 5x Void Volume (gal) 4.67 Lose (ft) 91.91 Minimum dose volume (gat) tr.loo In -lime Filter Lass (ft) 38.77 System Demand (gpm) 18.02 Total Dynamic Head (ft) L.atermd DiameterSelection Manifold Dioneter Selecdm in. dia. options choice in. dia. options 1 choice 0.75 1.25 x 1.00 1.50 x x 1.25 x 200 1.50 x x 3.00 2.00 x X Gallonsilinch Cakolator (optional) Treatment Tank ltfbnna*m Total Tank Capacity (gal) 1000.00 Septic, Tank Capacity (gal) Total Working Liquid Depth (in) Skaw Precast Com Manufacturer gain (enter result in cal B49) Dose Tank hftmuftn Ef fluent Filter Wai ma0un 868.61 Dose Tank Capacity (gal) Best Fster lFillorManufactorer 20.831 Dose Tank Volume (galhn) I GF-10 Filter Model Number Skaw Precast Go. Maaufadim Project: William Stock + Sieve Dalbn Mound Page 2 of 8 Revised 6- -25-08 ;p Ti Z Z i3? Z 2:'d 0226S8L.809T :01 T2172- W7 -STL -T 9IiJ3S SNINMbH :WOdd db2 :90 eo02- 92 -N Mound Plan and Cross Section Views FK. .... . .............................. 1 . T * P �, J — + p, 1 t A W B: — L Mound Component Dimensions A 6.00 ft E Ain H 1.00 ft K 7.06 ft B 75.00 ft F in 6.10 ft L 89.11 ft D 6.00 in G ft J 5.07 ft W 17.17 ft 450.00 (ft) Dispersal Celt Area 1 907.58 (ft) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 1 7.50 (ft) 1 /10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 103.09 (ft) --► H � rirrrif,.i 2 friirtu,. G F Dispersal Cell 101.80 (ft) Lateral 101.30 (ft) —► Invert Dispersal Cell Elevation 1, ?, f,. J, J,_ J, J, ,J, .I l J ,J, tid .d J, J ,J r J .J J. J. J. J. .{ )., 5, ? �{ } J, 1 J . ! �,t. „ 1 • l - . [ 1 J .f 4 J. J J �l —,., .J .+�..�.. ^J. _,' ".�..^�. �. { ,J, ��J, J, �J � 1. •!. �. �, '. ~3 A, ! A~-:I " -! ., .., _.$ .. . —. "• - -3 ` ^ - ��' -_� - 'j • j _�. — .• —� 100.80 (ft) Contour Elevation 2.0 %Site Slope Geotexxtile Fabric Cover Shading Key ' Dispersal Cell See lateral Mails on Q Topsoil Cap = 1.5 ft Page 4 for number, size, © F /fir Subsoil Cap a o Q and spacing of laterals. Laterals are equally ASTM C33 Sand F Tilled Layer m 0.5 ft TYpimI t atera spaced from the F5� Aggregate e 5 distribution celPs centerline in the distribution cell (AxB). Project: William Stock + Steve Datton Mound Page 3 of 8 i 06/25/2008 22:38 7153492520 KEITH + DEB STONER PAGE 05105 Center Connection Lateral Layout Diagram FwoewsoWewaec*mAaeeear=U=$Dm o�dx«�wfit taeeralsarctdedloat S I� ----- —�-- P •a'it�riwpnt0e11saMevr �x-1 xr2� laeeratsk(a�ee+�nfPYCSCh40 deanoutpiug ` perG0FAMTailes4JM kf oles drAed dt 111! Iwo* of Oro lateral. Number of Latetats 4 Orin Diameter 4156 in Lateral Diartew 1.50 in '� C drm Spacing (X) 2.10 It Lateral Length (P) 36.75 It Oriiims per Lateral 18 Lateral Spacing (S) 3.00 ft Orifice Denaity 6.25 feWfice Lateral Flow Rate 9.89 gpm Manifold Length &W "/ - System Flaw Rabe 1 38.77 9pm Man'lfold Diameter 1.50 Total Dynamic Head 1802 ft Fomcemain Velocity fttsec Dose Tank Information looking cover With VMn" Sabel and lumim device and sealed vraleltight �IecMeal aspet — ter- PEC 300 and - --^- -► Comm 10.28 WAC �4 in. loin. Tank conManwd fS plWe ly venlso �---- gl¢xrntlp outlet bcation F0MWVf t dlanxder Skaw Precast CO. Manufacturer 2 in. Ge ® 868.61 Gallons Volume 20.83 gailinch A Weep twee or anti. Dimension Inches Gallons B siphon d A 23.29 485.06 8 2.00 41.66 C PUMP off eirrauo+t (it) C 4.41 91.91 93.00 D 12.00 249.1% D Total 41.70 868.61 Ir � oo�se tent elawalion 8" Bedding - un&r tank. 9200 Alarm Manuafaclum IS.J. Eleafra Alarm Model Number JTank Wert Rump Manufacturer I Goulds — Pump Model Number I EP05 I t f 6'� Pump Must Deliver 3877 gpm at 1802 Project: Wiliam Stock + Stem Dalton Mound Page 4 of 8 R 6-25 - 2'd 0 €26S8L809T :Oi T202- 2Lb -STL -T 3Iid3S SNI>IMUI Mound System Maintenance and Operation Specifications Service Provider's Name _.. _ Raska Sewer Service Phone; 715- 755 -4888 POWTS Regulator's Name St Croix Coun Zoning _Office Phone? 715 - 386 -4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg /L Soil Absorption Component Size 450 fe Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Freguency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and dean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Ins for ponding and seee once every 3�rears Miscellaneous Construction and Materials Standards 1. Observation pipes are skitted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished •������������• •�������������• Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution ... / ....... Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: William Stock + Steve Dalton Mound Page 5 of 8 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adhn. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals ISBD- 10691 -P (N.01/01), SSWMP Publication 9.6 (01181), and Pressure Distribution Component Manual Ver. 2.0 SBD 10706 -P (N. 01/01)] and local or state miles pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shat be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 84nches in diameter shall be secured by an effective locking device to prevent accidental or unaudwnaed entry Into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may millrace surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and stun in the tarn exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump ( dosing) tank shall be inspected at least once every 3 years. AN switches, alarms, and pumps shad be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Disbibution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since SON compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October - February) dilate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD 30 mg/L TSS, 10 mg/L FOG, and 10 chdl00 mL for highly treated efflueaL Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 ninths. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice dogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Condnaency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shah be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater of begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically dogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretseahnent Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatrnent units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 8 Page 7 of 8 XGOULDS PUMPS Submersible Effluent Pump EPO4 3871 EP05 APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses: heat transfer. • Effluent systems ■Casing and Base: Rugged thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion • Farms manual operation. Auto- Canadian Standards m • Heavy duty sump matic models include resistance. • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "C" or 7".) factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic Goy" Prnps ts Aso 9001 FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. '/<" maximum. ■ EPO4 Impeller: Thermoplas- 0 Power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: 1 NPT, seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA -N elastomers. • Temperature: 104°F (40`C) continuous 140"F (60cC) intermittent. METERS FEET 10 • Fasteners: 300 series stainless steel. 9 30 5 °rM • Capable of running dry without damage to a zs components. 25 o a Motor: _ • EPO4 Single phase: 0.4 HP, ij- 6 20 115 or 230 V, 60 Hz, 1550 RPM, built in overload with o s 15 automatic reset. • EP05 Single phase: 0.5 HP, o 4- EP05 115 V or 230V, 60 Hz, 1550 3 to RPM, built in overload with EPO4 automatic reset. z • Power cord: 10 foot 5 standard length, 16/3 SJTOW with three prong grounding plug. Optional 20 ° 00 10 20 30 ao so GPM foot length, 16/3 SJTW with three prong grounding plug o z a 6 a o 12 m3 /h (standard on EP05). CAPACITY G Pumps 0 2001 Goulds Pumps ITT Industries Effective May, 2001 83871 Wisconsin Department of Commerce SOIL EVALUATION REPORT Paste of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code �O Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County �- x include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. , �:i z_ 'L- - 1 . 4 (o S f 3 " O d d Please print all information. Revi d by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). G �$ P roperty Owner / Property Location 5q d c x + Govt. Lot 4-/ rZ_ :0,5 E 1/4 S 4 T G, N R I(g E (or W Property Owner's Mailing Address Lot # I Block # S Name or dj City Sate Zip Code Phone Number El city [I Village ® Town Nearest Road New Construction Use: LYResidential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable — ft. General comments RE CEIVED and recommendations: �j JUN 3 0 2008 S S IZT r C OUNTY Boring pit ZONING OFFICE /❑ Boring # n l� Pit Ground surface elev. �Q - ft. Depth to limiting factor 3 Z fin. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDH in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 i 3 5 �'r -- C / /, k -. � aJ' / Z 3 3z9 aye'% ? sy���8 A. ❑ Boring # Boring Pit Ground surface elev. �' ft. Depth to limiting factor 33 in. Soil Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 ��� D �-' .Sys 5 18 5 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST N e Please Print) Signature CST Number aC!E !A ,A -.s �ZLa Z Address Date Evaluation Conducted Telephone Number Y55 3 - LY V7z-1-Vz -1 Property Owner Parcel ID # / Page C�- of 3 Boring # ❑ Boring pit Ground surface elev. �l • 8 ft. Depth to limiting factor 3 Z— ✓ ✓ ✓in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff #2 J3 a 'K- %- s I Z .� .�-� tom- Q S ,, - .S' 9 J 3 :3 7— 0`1 A `'� ---- l?' I . i ❑ Boring # ❑ 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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 * 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 (11.07100) � L � ~ e f I r W r o Q` x ti h - l f. 'V 4) M n 0 3 IQ Ar � � 3 i commerce.wl.gov Safety and Buildings Division County // 201 W. Wasltingto ve., P.O. Box 7162 ��. ello l k scons�n Madison, 3707 -7162 Sanitary Permit Number (to be filled in by Co.) ' t i Department of Commerce Sanitary Permit Applicati State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this to propriate It governmental unit is required prior to obtaining a sanitary permit Note: Application fo s for sate -owned Project Address (if different than mailing address) POWTS are submitted to the Department of Commerce Personal info for q� secondary u osesin accordance with the Privacy Law, s. 15.04(1)(m� tats. /7 / / * 2q I. Application Information -Please Print All Informati I Property Owner's Name Parcel # MAY 14 200$ rJZ`- /tl 33 -Goo Property Owner's Mailing Address Property Location /. / 7 1317 ST. CROIX COUNTY ( J lG.. —7 +11 ZONING OFFICE ` � S 1 � Z �"�. Govt. Lot City, State Zip Code Phone Number N 2, 5 �/ Section 2. Z �� ►CI 0 � ��> O`7 ? (circle one) I TY 0 T d ' N; R I B E or'0 II. Type of Building (check all tha ply) 6k e Lot —- Y 1 or 2 Family Dwelling- Number of Be El Change of rmit Transfer to New ms 3 1 3 Subdidision Name /(� 5 �bW,: Inc 14�. Boc # ," -1 -4� 1 t f OL ow S El Public /Commercial - Describe Use _ _ _ ❑ City of _ CSM Number El Village of El State Owned - Describe Use �. rr�� 2 ► - Town of 0 A+ III. Type of Permit: (Check only one x on line A. Comp line B if applicable A ' /Ho ' ew System ❑ Replacement System ❑ Treatment g Tank Rep ement Only ❑ Other Modification to Existing System(explain) B. ❑ Permit Renewal Permit Revision List Previous Permit Numberand Date Issued ❑ Before Expiration Plumber wn IV. Type of POWTS System /Component/Device: (Check all that a y) on Pressurized ItrGround El Pressurized In Ground El At -Grad El Mound > 24 in. suitable soil Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain)_ _ retr ment Devic n) V. DispersaUTreatment Area Information: -C / 5 `R (� 8 Ts iFa / u; k- �' 1 Tf2tiS Design Flow (gpd) Deaign Soil Applicatio te(gpdsf) Disp sl Area Required (sf) Dispersal Are ro osed (s System Elevation v , S ,7 90� ✓ 9110 -10. 47,°94 7 VI. Tank Info Capacity in Total # of Manufacturer i Gallons Gallons Units V New Tanks Existing Tanks r e g t L f U v� ti w C7 LL eptic r Holding Tank .G N 000 0.ti►� L e►��/ 1 L'sl Y Dosing Chamber 7 � VII. Responsibility Statement - I, the undersign assume responsibility for installation of the POWTS qmqon the attached plans. tuber's Name (Print) P M MPRS umber Business Phone Number ►�;�t.s Z LZ S?z V74- Z'141 Amber" Address (Street, City, State, Zip Code) 0 11 Z L. S 5 1 So � ki, C VIII. County /De artment Use Only P roved ❑ isapproved Permit Fee Date Issued Issuing gent Signatur $ $ f ! J� 15Q ❑ O Given Reason for Denial 1 /� IX. Conditions of Approval/Reasons for Disapproval 3� C J SYSTEM OWNER: t 1. Septic tank, effluent filter and dispersal cell must all be servk:es / maintained �� as per management plan provided by plumber. J 2. All adbWk W#*Wn ft ntgst be rrgwttsiflad `J OL Attach to complete plans for the system and submit to the County only on paper not less than 8 ttt x it inches in size SBD -6398 (R. 01/07) Valid thru 01/09 v D ' � O / � v Q . a f � h O� • p a � W O 3 M F r 14 m 1 o ti N) V m 23 gg a W �� ��p� o. / � v O (� � � D 47 �n 7 c O w ' O o Uj QL w x h 00 ICA IVY V) o m �► ° a V , o a qo d Wisconsin Department of Commerce SOIL EVALUATION REPORT Page � of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code , County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must �?^ include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Re wed y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location s • �e , , .5 71) C,�-� i � Govt. Lot 1/ , j 1 A S Z N R E (o W Property Owner's Mai ' Address Lot # Block # Subd. Name of City tate Zip Code Phone Number i ❑ City ❑Village r Nea rest Road W—Ae / S ( ) A 7 New Construction Us Residential / Number of bedroom Code derived design flow rate 'PD • ❑ Replacement Public or mercial - Describe: _— ___ —__ --- .- -- - - -- - -- -- -- Parent material n Flood ' Plain elevation if applicable y � / ft• comm General an recommendations: ` P✓?�r�✓ / l/ ✓ lea ^rX4 �/ Or ' //! Boring # Boring s/ Pit Ground surface elev. �i (/ tt. Depth to limiting factor in. SW Application Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Efl J 1 ® Bori ng # /2 grins / Pit Ground surface elev ft. Depth to limiting factor �^ Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 0 ✓ C L tv Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 :� 150 ' Effluent #2 = BOD < 30 mg& and TSS < 30 mg/L CST Name (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54 -- f� v 715- 246 -4516 Property Owner rcel ID # Page of 5 Boring # [] Boring Pit Ground surface elev ft. Depth to limiting factor Z//0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/T in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i C , 7 i Boring Boring # pit Ground surface elev. ft. Depth to limiting factor in. S Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. 'Efl#1 'Eff#2 a Boring # 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 GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 mglt. ' Effluent #2 = BOD, < 30 mg& and TSS _< 30 M91L 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. SBO.3330 (8.6100) Soil Test Plot Pla Project Name William Stock/Steve Dalton Sh Address 1748 112th St. New Richmond Wi 54017 STM #226900 Lot 33 Subdivision Lundy Meadows Date 8/11/03 N 1/2 SE 1/4S 22 T 30 N /R W Township Richmond [] Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 97.0/96.7 *HRpSame as Benchmarkq Alt. BM Top of 2" Pipe @ 100.2' 458' Property Line Scale is 1" = 40' unless otherwise 101' 5 , 45' noted 45' 35' 5' .M.S .11A Please Note: Tested area B -3 B- 125' may not be suitable for 4% desired building area. Check system location Slope before excavating. 100' Please note: Installer must verify all lot lines and setbacks before installation. tn �o 3 aA a 0 00 N N 213' Property Line c6 . w 1,r, ca - w 325.69 0 87.3102 t Q) `.! - . - / •~ (y } LOT 4 — 68,672 sq. - 3 1.58 acres S�3 ¢ -w 57 'LOT 3S ca - 66, 001 sq. ft. tti 1.52 acres : i Z N • ... � \3 - 331 N `' O °' ^` i C 3 5 LOT 34 66' Join t �,�, 65,961 sq. ft• - �O -�--' DriVeWa '? acres C12 Y ^� _ / s 1.51 ac - Po 1 Eosemen t h wry S - I o QI j h � I o Z° LOT 33 - I \ ° 121,313 sq. ft. : / 3 T w s 3 2.78 acres AL T 32 '��, ��s - I r3l o 01 = w 66,861 sq. ft. � \��, �° \� F I ac Q es t 1.99 acres ?�, z z o o ^ L o L.8.0.=972.0 Ayh% N I �1r24V52o £ O : N 50 _N89 47'47 £ I l 19765 -mss - \ 65' a a i Drainage Easement SEE NOTE "A "- 2 2 ^ H W. E. = 968.0 S89'43'19 "W , 300.04` 65. 02 ' I 988.10 ^ 310.45 51.4 ' 248 56' 213.44 � 1 r 3 _LOT_ 1 W ' 33' 40 9724b C. 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YANw,lyd Rhea n:lwwwlwlrywrsxw.Ya 10 Km 9171.1 IK,I V C, r r • e CIO tA rb � i POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity l0 O d al ❑ NA Permit # Septic Tank Manufacturer 1,� ❑ NA � 1 A.uJ DESIGN PARAMETERS Effluent Filter Manufacturer Z a 6 C 1 ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model A l p p ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity a l 0<A Estimated flow (average) ysd g al/day Pump Tank Manufacturer ii:KA Design flow (peak), (Estimated x 1.5) 3 7 S gal/day Pump Manufacturer M Soil Application Rate S al /day /ftz Pump Model "A Standard Influent /Effluent Quality Monthly average" Pretreatment Unit &-KA_ Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 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 IBOD 530 mg /L kLIn- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu 1100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 1 0 year(s) 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: ❑ month(s) (Maximum 3 years) ❑ NA 1lyear(s) .X-month(s) ❑ NA Clean effluent filter At least once every: 3 ❑ year(s) Ins Inspect pump, pump controls & alarm At least once eve ❑ month(s) P P every: ❑year(s) Flush laterals and pressure test At least once every: ❑ month(s) ©,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 (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 (4/01) Page 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 (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant 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 INSTALLER POWTS MAINTAINER Name a w i Jv S s£ P +i Name �a C U C a, Phone 7 j $'- Sf 7 Z Z � 1 Phone - Y72. Z YZ / SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ��_ C�v i k Co Phone - 7 1 5 -- - 7 $'S - Y 888 Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Page 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 (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant 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 INSTALLER POWTS MAINTAINER Name q,w i 1� S se +i Name �Q C U, G Q t. N s Phone 7 / S �7 L Z �FZ I Phone -] l - Y 7L Z 4 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name u S a Name �•� _ �� o i k - t�o �."� Phone 7 l s ` 7 s5' 888 Phone W680 This document was drafted in compliance with chapter Comm 83.22(2)Ib)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGRBEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer a 1 -7f k L L C Mailing Address I c Property Address (Verifica 'on required from Planning Department for new construction) Ci /State , S Parcel Identification Number _ tY LEGAL DESCRIPTION Property Location /-' dd, S C Y., Sec. Z Z . T 3- N -R I& W, Town of i c� Subdivision �, u .A- / ' E Q do L, S . Lot # 3 3 . Certified Survey Map # . Volume . . Page # Warranty Deed # 7 7 3 . Volume . Page # Spec house ❑ yes M no Lot lines identifiable M -es ❑ 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 phm1ber, journeyman plumber, restricted plumber or a li cense d p 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. i/we, the undersigned have mad m v d the above requirements and a !;� 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. �( 3 a8 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 2 property y described above, by virtue of a warranty deed recorded in Register of Deeds Office. S' 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 — U 2`I39P 6 3 y STATE BAR OF WISCONSIN FORM 1- 2000 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO., WI This Deed, made between L. Lawrence Williams and Virzina R. RECEIVED FOR RECORD Williams, husband and wife and each in their own riizht Grantor, and 10/21/2003 09:45AK Dalstock, LLC, a Wisconsin limited liability company Grantee. WARRANTY DEED Grantor, for a valuable consideration, conveys to Grantee the following EXEMPT # described real estate in St. Croix County, State of Wisconsin (the "Property") REC FEE • 11.00 (if more space is needed, please attach addendum): TRANS FEE • 3015.00 The South One -half of the Northwest Quarter (S '/2 of NW '/< of Section COPY FEE: Twenty -three (23), Township Thirty (30) North, Range Eighteen (18) West, CC FEE: EXCEPT Lot One (1) of Certified Survey Map recorded in Vol. 8 of PAGES: 1 Certified Survey Maps, Page 2305 as document number 465057; AND The North One -half of the Southeast Quarter (N '/2 of SE '/) of Section Twenty -two (22), Township Thirty (30) North, Range Eighteen (18) West. Virginia R. Williams joins in this deed for the sole ur ose of conveying an Recording Area P P Y� g Y interest she may have in the subject property under the Marital Property Laws of the State of Wisconsin. Name and Return Aadre Robert J. Richardson Parcel Id numbers: Bakke Norman, SC 026- 1068 -80 -000; 026- 1068 -90 -000; 026 - 1066 -80 -000. 026- 1066 -90 -000 S233 McKay Ave., P.O. Box 399 Spring Valley, WI 54767 Together with all appurtenant rights, title and interests. See above Parcel Identification Number (PIN) This is not homestead property (+s) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: easements, restrictions and rights of way of record Dated this 15th day of October 2003 00 * L. Lawrence Williams * Vir is R. Williams * * AUTHENTICATION ACKNOWLEDGMENT Siznature(s) L. Lawrence Williams and STATE OF WISCONSIN ) Vireina R. Williams ) ss. County ) authenticated this 15th da f October , 2003 �-- Personally came before me this day of 2003 the above named * ob rt J. Richardson TI LE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the verson(s) who executed the foreeoine authorized by &706.06, Wis. Stats.) instrument and acknowledeed the same. THIS INSTRUMENT WAS DRAFTED BY ROBERT J. RICHARDSON, Bakke Norman, SC SPRING VALLEY, WI 54767 Notary Public, State of (Signatures may be authenticated or acknowledged. Both are not necessary.) My Commission is permanent. (If not, state expiration date: ) * Names of persons signing in any capacity must be typed or printed below their signature, fNFO PRO (800)655 -2021 www,infoproforms.comSTATE BAR OF WISCO WARRANT)' DEED FORM No. 1 -2000