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HomeMy WebLinkAbout026-1147-26-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 453252 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: Rousar, Jamie P. Richmond Township 026- 1147 -26 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 16 A". \ GSA 24.30.18.1084 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark r es /tom 0, 3 / o /0� Dosing � Alt. M S Ig /off Aeration L ` / Bldg. Sewer /3778 C , Z Z I,b roiding St/Ht Inlet /y G 1�-7 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ Septic / / N` I& I ' L) " Dt Bottom Dosing / ?6 / ZI , �, / Header /Man. /mot .-� S A / . `{ Aeration Dist. Pipe 5''�100•f Holding Bot. System !, �• 71 /()a. Zs - z5 PUMP /SIPHON INFORMATION Final Grade Manufacturer 1 GPM Dema St Cover Z5 106 Model Number - 79 1 z' _ 4 Co�.� r 76 TDH Lij z ,,73 Fr,ctio7Los� System Head y � TDFi - � t -3 cy Forcemain Length / I Dia. Dist. to Well 0 SOIL ABSORPTION SYSTEM BED/TRENCH Width I Length No. Of Tr ches PIT DIMENSIONS No. Of Pits Inside D' Liq id Depth DIMENSIONS - 7 5 SETBACK SYSTEM TO P/L JBLDG IWELL LAKE STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT ,y^ av 3 G ' p 1 7 2- I�/ I) Model Number` DISTRI BUTION SYSTEM `s. Header /Manifold Distributionr / x Hole Size / f J xHoleSpacing Vent to Air Intake 7 Pipe(s) Z-l 7 I th- l 5 Length Di a Length Dia Spacing ` SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over J Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center / r /� Bed/Trench Edges \ Topsoil 1 �, Yes E] No Yes R No COMMENTS: (Include co discrepencies, persons present, etc.) Inspection #1: / S / A Inspection #2: / , , / Location: 1465 142nd Street New Richmond, 1 54017 (SE 1/4 NW 1/4 24 T30N R18W) Rich m ad T �o o of 26 Par el No: 24.30.18.1084 �jtS�o b� J °� IIQ'S �t1. as w J 1.) Alt BM Description= '�`t � P 2.) Bldg sewer length = 33 ) - amount of cover = 7 Plan revision Required? � � Yes o it Use other side for additional information SBD -6710 (R.3197) Date Insep rs Sign t Cart. No. I I �_ Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 Visconsin Midison, W1 53707 - 7162 Sanitary Permit Nutuber (to be filled in by Co.) De artment of Commerce (608) 266-3151 Su # 682115 Sanitary Permit Application TRANS ID # 987136 In accord with Comm 83.21. Wis. Adm. Code, personal information you provide ) may be used for secondary purposes Privacy Law, s15.04(IXm) Pro�ec - /yes I 1 12 I. Application Information - Please Print All Info rn lation i 17 k, P rty Owner's Na me �,eQ A Parcel a Lot N Block / �rr1'D 0 V,A '- 3 _!!i'ti 26 JAMIE ROUSAR ���' Property Owner's M ailing Address ! Property Locution C 503 CADY ROAD SE -A, NW A, section 24 City. Stan Zip Code Phone Number 54016 (circle one) HUDSON, WI r 30 N R 18 Eor II. 'Type of Building (check all that apply) 6t"4 SJt,261 Subdivision Name CSM Number Q 1 or 2 Family Dwelling - Number of Bedrooms 3 Richmond Meadows 520539 ❑ Public/Commercial - Describe Use C3 State Owned - Describe Use _ X - ❑City_ ❑Village growrlship of Richmond III. Type of Permit: (Check only one box on line A. Complete Une B if applicable) A. ® New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only Other Modification to Existing System . List List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of C1 Permit Transfer to New Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) El Non - Pressurized In- Ground Q Mound > 24 in. of suitable soil Mowu1 < 24 in. of suitable soil ❑ At Grade [3 Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In - Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel Pipe ❑ Other (explain V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Appl' scion Rate(gpdst) Dispersal Area I cyuircd (slj [ Dispersal Area Pr puled (sf) System Elevation 450 1 d,c f Z„ 3, 450 �� 7 0 100.25 VI. Tank Info Capacit m Total Number Manufacturer Prefab Site Steel Fiber Plastic Gall to Gallons of Units Concrete Constructed Glass New Existing Tanks I Tanks Septic or Holding Tank 1000 1000 1 WIESER CONCRETE X Aerobic Treatment Unit � - i Dosing Chamber 600 600 1 1 JWI SER CONCRETE X VII. Responsibility Statement- 1, the lutdersigned, assuute respowibiltty for hlstailution of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature MPRS Number Business Phone Number BENNIE HELGESON MP / 220292 715/772 -3278 Plumber's Addre ss (Street, City, State, • Code) W1229 770TH AVENUE, SPRING VALLEY, WI 54767 VIII ount /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued suing Ag SI ttu ( $ ) Approved ❑ Disapproved Surcharge Fee) S 3 J V • / �, ❑ Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval 3 ��bn.° v>n S �iy STEM OWNER: (fit XA N ` 'r" Septic tank, effluent filter and (0 yVt 0113,'1j �l7 /d dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plaas (to the County only) for the system ou paper not less than 81/2 x 11 inches in size s n °- � o �- r0 7 69 , 7 m 4 c) o vi - �o s o co G 0 _ Ol / FJ w �J O D Safety and Buildings commerce OV 4003 N KINNEY COULEE RD g LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 i www.commerce.state.wi.us /sb t epartment of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary April 20, 2004 CUST ID No.220292 ATTN: Rod Eslinger BENNIE W HELGESON ZONING OFFICE HELGESON EXCAVATING ST CROIX COUNTY SPIA W 1229 770TH AVE 1 101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/20/2006 Identification Numbers Transaction ID No. 987136 SITE: Site ID No. 682115 Jamie Rousar Please refer to both identification numbers, 142ND Street above, in all correspondence with the agency. Town of Richmond St Croix County SE1 /4, NW1 /4, S24, T30N, R18W , al Lot: 26, Subdivision: Richmond Meadows FOR:' Description: New 3BR Mound � , 6 ; 4; Object Type: POWTS Component Manual Regulated Object ID No.: 953648 Maintenance required; 21 in Soil minimum depth to limiting factor from original grade; System(s): Mound Compo�nt. °� Manual, SBD- 10572 -P (R.6/99), Pressure Distribution Component Manual, SBD- 10573 -P (R.6/99); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Co 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. 4 <,t 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 construction 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 publication SBD- 10572- P(R.6/99) "Mound Component Manual for Private Onsite Wastewater Systems ". • This system is to be constructed and located in accordance with the enclosed approved plans and with publication SBD- 10573- P(R.6/99) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems ". 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions 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. BENNIE W HELGESON Page 2 04/20/2004 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 Dennis R Sorenson Wastewater Specialist, Integrated Services WiSMART code: 7633 (608)785 -9336, dsorenson@commerce.state.wi.us INDEX SHEET PROPERTY OWNER: JAMIE ROUSAR 503 CADY ROAD HUDSON, WI 54016 PROJECT NAME: JAMIE ROUSAR PROJECT LOCATION: SE 1/4, NW 1/4, S 24, T 30 N, R 18 W MUNICIPALITY: TOWN OF RICHMOND COUNTY: ST CROIX DESIGN: PRESSURE DISTRIBUTION MANUAL SBD- 10573- P(R/99) MOUND COMPONENT MANUAL SBD- 10572 -P (R 6/99) CONTENTS: Page 1: Plot Plan = n Page 2: Cross Section and Plan View of Mound r Page 3: Distribution Pipe Layout Page 4: Septic Tank & Pump Chamber Cross Section & Specifications Page 5: WLP 1000/600 -MR Tank Specifications Page 6: Pump Specifications J' Page 7: POWTS Owner's Manual & Management Plan - Pg. 1 Page 8: POWTS Owner's Manual & Management Plan - Pg. 2 Name: Bennie Helgeson Signed Address: W1229 770th Avenue Spring Valley, WI 54028 Credential Number: 220292 Date: April 14, 2004 � 5 F T l j G ° ' t; a I V b - o v. o ok �o ten �. �LtJ1J2.J el p r✓1'� Ro 5a-r Page Of 8 Synthetic Covering Distribution Pipe ASTM (-33 io a o Medium Sand H G Topsoil �_ =_ F 5 r ioa,�s ` J I E �� 1 D 3 / ` b Gro �leil, 99. G � 4 — Slope CELi.Of % „— 2 % Force Main Plowed 2 2 Layer Aggregate From Pump La Y D /.as Ft. E Ft. Cross Section Of A Mound F g,) Ft. G , - Ft. A Ft. H / Ft. Signed: B_ Ft. License Number: K ,/o Ft. �— L yv Ft. Date: d 7 Ft. T 9� - 7 Ft. W 2 Ft. L 0 Observation Pipe Distribution C- LL- Of 2 — 2 ' 2 Pipe Aggregate I Observation Pipe 6asf —/ �/'e = x/77, A Plan View Of Mound I C )ea�,o• ---t Perforolad PIP• Detoll ' End VIOLA ' P�rlorotad � P PIPr - o` Holes Located on Bottom are Equally Spaced S F. r /"1�t�tt Fy {7 •� P oitlrlbullon... PIP. Distribution Pipe Layout P 7-) 55 R S 3 X r� � .. Y �. Sinned: Hole Diameter Inch License Number: Lateral " Inch (es) Dace: Manifold " Inches Force Main " _.� Inches - 7 6 OLcJnLr' �TIawIlE Rr� Page q Of 8 SEPTIC TANK E; PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" . LX-VENT PIPE 12" MIN. ABOVE GRADE £ WEATHERPROOF JUNCTION BOX APPROVED 25' FROM DOOR, WINDOW OR WITH CONDUIT MANHOLE COVER FRESH AIR INTAKE W/ PADLOCK E WARNING LABEL _. 4" MIN. ZY r. 18" I mIN. INLET I ' � WATER TIGHT SEALS GAS- TIGHT �� VAPPROVED FILTER A SEAL JOINTS WITH ALM APPROVED PIPE :2A $ rt I 3' ONTO APPROVED (a ox /(a I ON PIPE 3' SOLID SOIL ONTO SOLID C I ' SOIL PUMP OFF ELEV . 8 7 S FT • --- OFF D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS 1 SEPTIC / DOSE 3y Y, - 7 G��• TANK MANUFACTURER: uvl eS - er GAL. DOSE VOLUME INCLUDING — GAL. DOSE TANK SIZES: SEPTIC LDd� GAL. I.� G PI, pLOWBACK• 00 ALARM MANUFACTURER: ST cfec.I� `�►S� ?.ns APACITIES: A = /g INCHES = 0 I. 68 GAL' MODEL NUMBER: is N► B = 2 INCHES = GAL. SWITCH TYPE: c - �oc'� C = INCHES = )CCIT(. GAL. PUMP MANUFACTURER: e MODEL NUMBER: / T D = / O INCHES = GAL. SWITCH TYPE: v I REQUIRED DISCHARGE RATE S to LHR 16.23 WAC GPM PUMP & ALARM WIRING AS PER I a5 FEET VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE • FEET + MINIMUM NETWORK SUPPLY PRESSURE . . • • • • • . . . _ � FEET T. + 3 FEET FORCEMAIN X A FT /100 FTOTALIDYNAMICA HEAD F EET INTERNAL DIMENSI NS OF PUMP TANK: LENGTH • WIDTH DIAMETER L QUID 6 -� / L SIGNED: LICENSE NUMBER: DATE: 1/88 CL o O L m U W � J � Ir(%70 Oo M .2 LJ U� N Q IUd 6 d Fo Fa °�s7 ° a 2 �� a\ �� 3p off°: Q r �� oN U � m� ZZ (( � ' L ,,� - �,,�� o i C O 3 -- ►a,Q J U _j -J < n O 0. dN N ° W NaW tn W 00 Z ln0 O (ri N W D LJ �•/A 6 q � N 9 N a °o n 0 '° w *In •V . 2 o �i H m N F- N� , l p� O Q ~ Q 3 �it7 n -V - w- J�U �N� Y M• 0 Z Li U In Li < Z� MuzF -3 w �,< Q'io Q ZO 0 3mvx���m� a p o Z z z v a° - - 0 Z r d a Z* z I , 1 , ' 3 x s* w �� 0 i i i O : i W U N . 1 ' 1 N 1 z I . If 1 W M� O N VL „9S �1.tLrJP� �R t Q au S c�r __ p to 1OTAL DYNAMIC HEAD�CAPACITY HEAD CAPACITY CU EFFLUE CURVE PER MINUTE NT AND DEWATERING N MODEL 152/ 153 w MODEL 152 153 w UJ 50 Lee Meters Col. Liters Gal. Liters 153 1.5 69 261 77 291 12 40 3.1 61 231 70 265 152 15 4.6 53 201 61 231 0 w = 20 6.1 44 167 52 197 U 30 25 7.6 34 129 42 159 a 8— 30 9.1 23 87 33 125 a 20 35 10.7 -- -- 22 85 0 40 12.2 -- -- 11 42 4 Lock Valve: 38.0 Ft. (11.6m) 44.0 Ft. (13.4m) 10 014 0 20 40 60 80 100 GALLONS s I /a LITERS 0 80 160 240 320 3 27j32-- 4 5j8 FLOW PER MINUTE CONSUL ' FACTORY FOR SPECIAL APPLICATIONS 3 27/32 • Timed dosing panels available. ® 3 27/32 • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase I systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. I • Sealed Qwik -Box available for outdoor installations. See FM1420. • Over 130 °F. (54 °C.) special quotation required. l 1521153 Series 12 1 /8 1521153 MODELS Control Selection Model Volts -Ph Mode Amps Simplex Duplex 5 1/8 115 1 1 Non 8.5 1 2or3 BN1 BN152 115 1 Auto 8.5 Inducted 2or3 sKZO64 E152 230 1 Non 4.3 1 2or3 BE152 230 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN153 t15 1 Auto 10.5 Inducted 2or3 SELECTION GUIDE E153 230 1 Non 5.3 1 2or3 1. Single piggyback variable level float switch or double piggyback variable level float BE153 230 1 Auto 5.3 Included 2or3 switch. Refer to FM0477. D CAUTION 2. See FM0712 for correct model of Electrical Altemator E -Pak. All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10 -0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). or (4) float system. RESERVE POWERED DESIGN For unusual co nditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 Louisville, KY 40156-0347 Y Manufacturers ol. . SHIP T0: 3649 Cane Run Road Z >R• = � ' ^® Louisville, KY 40211 -1961 QunurrP�ve S,vcE /9.99 m (502) 778.2731.1(800) 928 -PUMP http ://www,zooller.com P�JMP 160 FAX(502) ® Copyright 2001 Zoeller Co. All rights reserved. Wisconsin Departme F- SOIL EVALUATION REPORT Page of Division of Safety an uildi in accordanc8, with Comm 85, Wis. Adm. Code County S 7 lk es in size. Plan must I& �(} 2 11 inch Attach complete site Ian or>�(�r rtbt f�s� titan 8 1/ include, but not limit to: vertical and horizont refererte point (BM), direction and Parcel I.D. r'Z / I� [� 7 Z percent slope, scale dimq�ign�®oYii� and to lion and distance to nearest road. �O FFiC orm , y Review y ; Da ; P/eafion. Personal information you provide may be used for secondary purposes (Privacy Law, S. 15.04 (1) (m)). U / Property Owner Property Location v' R Govt. Lot 1/4 �oj 1/4 S�.�( T c3 �% N R E ( W Property Owner's Mailing Address Lot # Blxk # Subd. Name or CSM# Ci S to Zip Code Phone Number ❑ City ❑Village own Nearest Road Ric W1 a �A j I ew Construction Use: Residential / Number of bedrooms _ Code derived design flow rate b GPD ❑ Replacement ❑ Public or commercial - Describe: N � s /� Flood Plain elevation if applicable Parent material General comments (�S F . x 7S to; l� �5 �Q ft � d -e r CA Pp -e i^ andtACOr Ge Q, CC3 �t6 c.ur 99. o F_ �Q .� a -� l l M a uh 'ng Boring # Bo 29 3 ft, Depth to limiting factor In. Pit Ground surface elev. P g Soil Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •EGPD *Etf#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -� S L 1 U LGGZ sO /S rr>, It 2 � Boring I l l Boring # II ..G jj pit Ground surface elev. q7 d ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consis ce oundary Roots •EGPD Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. o _ ` c L VK 3 � l D y 6 sb L � „ .� L s� I o S - u-�S�n s• • Effluent #1 = BOD > 30 _< 220 mg/L and TSS >30 < 150 mg/L 'Effluent i32 = BOD < 30 mg/L and TSS _< 30 mglL CST Name (Please Print) Signature CST Number �( 5D � � ba 7D i -e Ad Date Evaluation Conducted Telephone Number dress G 7 f4 U ( 7- © 77 JV y -7 6 1 page � of Property Owner = - Parcel ID # F31 Boring # O Big 97" t`J' Pit Ground surface elev. ft. Depth to limiting factor �_ in. Soil icadw Rate Horizon Depth Dominant Color Redox Description Texture Gr. Sz Sz. insistence Boundary Roots •E GPD/ff E � in. Munsell Qu. Sz. Cont. Color / 8 o -, a OL f " b e � - uF . Wt , J � Boring Boring # , ft. Depth to limiting factor in Soil ication Rate ❑ Pit Ground surface elev. Horizon Depth Dominant Color Redox Description Texture St ucture Consistence Boundary Roots GPD/fF •E in. Munsell Qu. Sz. Cont. Color F-I Boring # Boring Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate ❑ pit Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •Eff#i 002 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Effluent #1 = BOD, > 30 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 5 30 mg/L and TSS 1 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 (K.6/)0) M -� � O � 0 � r / m S � o /\KO CL- Q " 7" a � �- d / Z o 3\ a Kl ca.. C- o .-� `A s ST. CROIX COUNTY WISCONSIN � ZONING DEPARTMENT ' t 1 N / / N ■ N N r ��r ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 Phone: (715) 386 -4680 Fax (715) 386 -4686 Memo to File Fronx Pam Quinn Date: 4/14/2004 Re: Soil On -site Determinations for Lots 32, 37 & 43 Richmond Meadows Subd. On April 8, 2004 on -site determinations of soil conditions at the above lots was performed to evaluate conflicting soil reports submitted by Adam Schumaker and Shaun Bird. At 11:00 a.m. the weather /lighting conditions were acceptable, with temp. 50 °F, clear and. These determinations were requested by the property owner, Orenzo Oevering and the plumber /permit applicant, Dave Fogerty, who were present during the test pit excavations. Additional test pits were located next to borings on the original soil reports to better compare soil conditions in the tested areas. On lot 32 (see attached description) the soil profile contained massive sandy loams at approximately 36 inches below grade, which does not conflict with the soil tester's recommendation for using an at -grade system. What it did reveal, however, is that both Adam and Shaun likely misinterpreted the structure of the sandy loams: Adam called the sandy loam horizon a "2msbk" and Shaun uses "lmgr". There apparently has been a misunderstanding between "structure" caused by handling samples of the soil during texturing versus the soil characteristics in situ. The soil, when chunks were taken out of the profile to hand texture, parted easily into "crumbs" that appeared at first to be subangular or granular in shape. However, these were not true peds that broke apart along planes of weakness , but fragments created by handling. The soil when observed in the horizon did not have distinct units of structure and should have been reported as "massive ". I Two test pits were evaluated on Lot 37, since the sanitary permit has already been issued. Due to the current house and well location, additional tested area will be required to meet setbacks to the POWTS. A pit closest to Shaun's B2 did have a sandy horizon as reported, but only to a depth of 60 ", then underlain by a massive sandy loam. Unfortunately, the boundary between the sands and sandy loam horizon was very irregular, with tongues of sandy loam much closer to grade than 60 ". The recommended loading rate for this site would need to be lowered to adjust for varying pore space at system elevation. Lot 43 had conflicting reports, where Shaun's tested area (near the front of the lot) reported conditions allowing a conventional system and Adam's (closer to the rear of the lot) reported mottling at 32" with a mound system recommendation. Additional test pit B4 was excavated next to Shaun's B3 (see attached description) and massive sandy loams were encountered at 17 inches below grade. Weathered cobbles (break into smaller pieces upon disturbance) and oxidized iron deposits around individual gravel /cobbles were observed in the pit wall, but no mottling was identified to 68 ". Shaun's B3 description of sandy loam with "2mgr" structure starting at 18 ", then sandy loam "lmgr" from 36- 110 ". Again, I think there was a misinterpretation of texture after a sample had been handled. Leroy Jansky, Dept. of Commerce Regional Wastewater Specialist, has been consulted on this situation and advised the zoning department to require on -site verifications for any lots with this potential misinterpretation on the reports. Obviously, one of the concerns is to make sure loading rates for the soils are not in error and allow undersized POWTS to be installed. For example, in December 2003, Lot 35 had to have its loading rate reduced to 0.3 gpd/sq. ft. when the installer encountered massive sandy loam at the system elevation. The sandy loam horizon was described on the soil report as "lmgr" with firm consistence. The zoning department will have a note placed on all soil reports with this type of description as requiring a design using the current code's soil application rate for massive sandy loam @ 0.2 gpd/sq. ft, unless additional soil testing proves otherwise. i ' Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County CYl7 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. 7 Z6 Please print all information. eviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). S UiL Property Owner Property Location TT Govt. Lot 1 /4NO 1/4 S2 T N R Property Owners ailing AAdress Lot # Block # SuV me or CSM #, I D l>222- 2 City State Zip Code Phone Number E] City Village %Down Nearest Road New Construction Use: ( Residential / Number of bedrooms 3 - 'Y Code derived design flow rate G 1 UO GPD ❑ Replacement ❑ Public or commercial - Describe: 7 Parent material ` Flood Plain elevation if applicabl ft, General comments -mil -e Ll' r�? ,SCE C( ED and recommendations: CGrI ( ° u Y 2 V Sv �Ra 7 P APR 6 2 3 2002 ❑ Boring ZONING OFFICE a Boring # n [�} pit Ground surface elev. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color I Gr. Sz. Sh. 'Eff#1 'Eff#2 i In-13 1 z - -51 j 12 L C5 ITC '5 � -- 3 & 39 lD -�ip FZ� _715 r `f /co Z Boring # ❑ Boring pit Ground surface elev. , �U ft. Depth to limiting factor Z -7 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 D Z- S,'/ S 1 �' 0 Effluent #1 = BOD > < 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS _< 30 mg/L CST Name (Please Print) Signature CST Number PO C Sc L u r✓ �i - - Z S J G 9 Address Date Evaluation Conducted Telephone Number z"r' 9130 (1107/00) t e Property Owner I V -e � `>� � Parcel ID # Page of 3 F — Boring # [] Boring pit Ground surface elev. 9? Zy ft. Depth to limiting factor in Soil Application Rate Horizon I Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 _3 z 5, ( 2 k c-s Z ,Z 5 c J rL �r c y el -7 Z rrr�� 5 ❑ Boring El Boring # E] pit Ground surface elev. ft. Depth to limiting factor in. a: Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 1ft in. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. 'Eff#1 - Eff#2 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 /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eft#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 (R07/00) f PAGE OF. NAME /Q 'f- LOT# LEGAL DESCRIPTION XkUJ ,Slf1 T 30 N.R. /8 E(OILVS// SCALE: 1"= L�O BM 1 ELEVATION ,12 0 BM 1 DESCRIPTION BM 2 ELEVATION O 1 BM 2 DESCRIPTION , /op o e,,-- SYSTEM ELEVATION ALTERNATE ELEVATION CONTOUR ELEVATION q5, D� f � Z � z6 SIGNATURE DATE l � Rpr 09 04 06:09a Prey nsion ExI,.avat,nP 9,; s Cizoix COUNT" 'CA Owner/BUYC --J — =,L CA, &,j /? Mailing Address W` — Ad I 7 Prcperty 'U. (Wr-Alcaticu Wn MID 7 l is Pa rce l %Ctywe aj e) I AL P.ICRIPTION 0 iL -�! fA Proporty Location sec. Town C • Subdivision C' Survey INIRP Viarmty Deed 0 P4 �s Spec house 'L yes nc LOL le Y SYSTEM MAINUNANCY, d rew!t mal wemac" Mute -.0 4&U&C wastes ?-'*Per b uso and mainimmuccof YOLV septic cot sizz of puu . out th septic tank avery Uwr- Yean Of s0oaeg. if =C4C b 4 4:1c=rd PAUIP• WI•It Yotl YM ' thC S car z the f=zOlm of the septic t=k as A tt=icat 3tArc in the; wuqe dr-poul sYEICM Tae plopcM owner age= w sub4Wt tv St. C::OiJL D epa .- U=jL L A I=(I–&CAUQZ fir.. Ai by lye O'M= ard Y � Y4 'f�gjg Lut k ri jl,�r on-Sim wa=w&= d"�Qw MAsEa phimber, joumcymar plumber. rcs t L i c wd pLvaber or a In-cascd PumPcf " - r ), tL', "Pric mul i is proper o pm=g coodidan and/ox (2) r,.Axr iasp.-Moa Ud P"Wing r,=Mq 'm Is "CPu=ezt o f 14=31 Rcsory-ts, SuAr of wiro=�C- CCYdf0t=. Sol joaj4 bacj:h as set by 20 DqWUMI Of Cz==CL--G and L= 'Oun'y ec stating L your septic syzmm bas beet: wwantz)-Oea must be completed and returned W thk: � y s of the three- year expiration ca.- A F APPLICANT 0 ON (we , La rc) tba o*%9( 0 ' VMR c bzic of W (ctr) Jmz'w N OF AML I (we) eer that a U C[&tgwj au this form arc mix to �h c;A-1 the property d==*Cd A60VC. by YiMr- er a accd rocoMed in Rcgi-itcz of 'j F I-PU YQT MAT URE OF ApPUCANT Any i A f Q=a tj Q& that is mis-mpteler'=d -J?Y Ssuftir, the Sul Lairy Pc=L berg 1-.vokcd Incladc With this applicatiom: a 4UMPCA wasmary dmo troln zht; Ragimr A C00V o f t h e cvj U[ied sumi map it rcf==c ts 9 ' t - d=d ZG/Z@ 39V8 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page —7 of S FILE INFORMATION SYSTEM SPECIFICATIONS Owner JAMIE ROUSAR Septic Tank Capacity 1000 gal. O NA Permit # S 0 �` a--' Septic Tank Manufacturer IESER CONCRETE p NA DESIGN PARAMETERS Effluent Filter Manufacturer ZABLE O NA Number of Bedrooms 3 ❑ NA Effluent Filter Model A -100 12" x 2043 NA Number of Commercial Units CO NA Pump Tank Capacity 600 gal 0 NA Estimated flow (average) 300 gal/day Pump Tank Manufacturer WIESER CONCRETED NA Design flow (peak), (Estimated x 1.5) 450 gal/day . Pump Manufacturer ZOELLER PUMP C013 NA Soil Application Rate 0.5 aVda /ft= Pump Model 152 C] NA Influent/Effluent Quality Monthly average* Pretreatment Unit M NA Fats, Oil l;< Grease (FOG) 530 mg/L O Sand/C�ravel Filter 13 Peat Filter ❑Mechanical Aeration O Wetland Biochemical Oxygen Demand (BOD 5220 mg/L [3 Disinfection O Other. Total Suspended Solids (TSS) 5150 mg/L Manufacturer Pretreated Effluent Quality 0 NA Monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (BOD 530 mg/L 0 in- ground (gravity) O In -ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ At -grade 0 Mound' Fecal Coliform (geometric mean) 510' cfu1100m1 ❑ Drip-line 0 Other. Maximum Effluent Particle Size Y. Inch diameter vaiues typical for domestic (norncornmerdao wasAwatw and septic tank effluent. •• values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency At least once eve 2 ❑ months ® year(s) (Maximum 3 yrs.) Inspect condition of tank(s) every Pump out contents of tank(s) When combined sludge and scum equals one -third (n) of tank volume Inspect dispersal cell(s) At least once every 2 ❑ months 13 year(s) (Maximum 3 yrs.) Clean effluent filter At least once every 13 [a months . ❑ year(s) inspect pump controls & alarm At least once every 13 Qt months ❑ year(s) O NA Flush laterals and pressure test At least once every 3 ❑ months 11year(s) 0 NA Other At least once every ❑ months 0 year(s) 0 NA Other. At least once every O months O year(s) O 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreattment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintanner. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. 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. OWNER: JAMIE •ROUSAR Pape 8. ofd_ System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fil abovb 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 Se to a Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to P 9 Po P P 9 9 P , 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 trine. ABANDONOMENT 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 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 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 O olding tank may be installed as a last resort to replace the failed POWTS. a ound 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 HELGESON EXCAVATTON TNC Name Phone 715/772 -3278 Phone 715/273 -5811 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY JOHNSON SANITATION Agency ST. CROIX COUNTY ZONING Phone 715/273 -5811 Phone 1 715/386-4680 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanbtlon agendas. This document meets the minimum requirements of ch. Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Adminlstrative Code. Use of this document does not guarantee the performance of the POWTS. GMW(2101) Rpr 09 04 06:08a F-�::cision Excavaz ir,,-- 4 p "D 71' . SAA OF MSCON-iLr i0RIN1 jqs• KA7HLi 2. WALL�j PEGISTER OF DEMM� Doc= cri Number WARRA-NT1,'DEED 'z ST. CROIX CO. . V, This DMTV FFZORY, ftd,,.madc between HANILIC DevelopineLt Limited Liaogily Partnership, a Mzaesota Limited LiAbilit) r4rtuc Ps is- — 1 2 Grantor, and Jainic A. Sb;fts und Jamie P. Rousar. F-'-'Z. 78. 00 r. t v - FM. COPY Fri.. r Graafcc, Gram-or, for a %Tlaablc callsidt-ratical, coeve" to 6 w1lowing describe I rea; egaze is SL Cruix SIRU cf wiscowiD Ur-ort Space is naed5d, plesise uqach addt-rd- Lo[ 26. Flat of Richma:14 M� -adows in the To w o f p. ac: , ,:4 540 rN,:r*be0M&, a prjp-.r, r.ml 2ccepuons to �,v=?xntits; E.gitm -s, rest--icrioLs and rc= -ct�%r3y tf :Naiad this day of August 2001 FULNaie DcYLIE�mcnt Limztcc UAIry Farjaciuilp C P-N cp `VvL E 1) M EN I AWh-I-catod this day X­ :7 TITLE: . ST,N'r-F B.AY. 5L(Y- CUTJ'1062ed — by§ 706.06. Wis. Stars.) 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