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HomeMy WebLinkAbout026-1124-05-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division 4 INSPECTION REPORT sanitary Permit No: 453058 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: Powers, Allen I Richmond Township 026- 1124 -05 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: / 6Z� D / O d • 0 �� 26.30.18.758 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. It / ?-I ld�(• ?J0•V Septic Bench rk � I i /2 Dosing 5 Alt. BM j — a �/ Aeration Bldg. Sewer Holding St/ t Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet -� Q Septic ► 6 1 Dt Bottom U Z / lC vv- oS /'7 Dosing ) 3S Header /Maw_ / /b � •7 4 3 U Aeration Dist. Pipe � e Holding Bot. System �- ZS' boo or .� Final Grade ► PUMP /SIPHON INFORMATION �"`� ( Lc s _� -0-0 r Manufacturer /' //� Deman St - 3 n 3 GPM / � I ' t Model Number ' J E-b q tlL - 0 +0 W 'l Q TDH Lift Friction Loss Systerrri Head TDH Ft Forcemain Length Dia. 2 'i I Dist. st to Wel b-F f y� wi SOIL ABSORPTION SYSTEM g j J BED /TRENCH Width Length No. Of Trenches PIT DIMENSI No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S 2 y 4W SETBACK SYSTEM TO / P/L BLDG IWELL LAKE /STREAM EACHING 'Manufacturer: INFORMATION C BE Type Of System: � / I ('f Model Number: DISTRI ej N SYSTEM , G T C � M Header/ !! DistributiAn x Hole Size / x Hole Spacing Vent to Air Intake 27 2� Pipe(s) ► f it 2 � Length �. Dia Length Dia ! Spacing / / / p SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only i S a Depth Over Depth Over xx Depth of xx Seeded /Sodded j xx Mulc ed Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: � I 2�C I Inspection #2: / /� Location: 1329 140th Avenue New WI 54017 (NE 1/4 NW 1/4 26 T30N R18W) Sunrise Mea o Lot 5 Parcel No: 26.30.18.758 OA 1.) Alt BM Description op G),� 2.) Bldg sewer length - amount of cover = ► Plan revision Required? Yes /No l Use other side for additional information. Q / , or / y SBD -6710 (R.3/97) Date Insepctor's Signature Cert. N — 70 6— 0-74Y A M A, Safety and Buildings Division Cou 201 W. Washington Ave., .P.O. Box 7162 �sconsin Madison, WI 53707 - 7162 Sanitary rermit Number (to be filled in by Co.) Department of Commerce (608)266- g5305- Sanitary Permit Applicatio c� c State Plan I.D. Num In accord with Comm 83.21, Wis. Adm. Code, personal informal you p ovide ��C — 7 (oV ­ �—S. maybe used for secondary purposes Privacy Law, s15.0 1)(m) lVf q P Address (if different th mailing address) R 2 I 9 / yay �-� �. I. Application Information - Please Print All Information r C 4 ZON� C Proper O ner's Na me FF Y rcel # �Q pow _Q (Is Lot # Bloch J� Property Owner's M ailing Address Property Location J hcl I V 'A � l l)'k,Section City, Stafe Zip Code y Phone Number tr e) II. Type of Building (check all that apply) *. S tM T R E or Y 1 or 2 Family Dwelling - Number of Bedrooms amS. Subdivis,on Name CSM Numbel ❑ Public /Commercial - Describe Use ,gyp h, Is t� ❑ State Owned - Describe Use . St) 1 r► - ❑City ❑Village Pownship o III. pq of Permit: (Check only one box on line A. Complete line B if applicable) A. A New System ❑ R System y p y ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System B. El Permit Renewal El Permit Revision El Change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that ap ply) ❑ Non - Pressurized In- Ground K Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ 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 -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation LOD7 1 -3 /.o s Gco &Do 91 "/&o VI. Tank Info Capacity in Total NuF1&r Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Septic Existing Tanks Tanks r Holding Tank INt� ?11 1 J Aerobic Treatment Unit Dosing Chamber 1 7 5D I VII. Responsibility Statement- I, the undersign ume responsibility for inst of the POWTS shown on the attached plans. P tiPer's Nam r Plumber's i gnatu W mber Business Phone Number I 7IS -QL 6 -skls Plumber's Addre ss (Street, City, State, Zip Code) u, A),.�P_ L,_�, O hn (')I() VIII. Count /De artment Use Onl X Approved ❑ Disapproved Sanitary Permit Fee tncludes Groundwater Date Issued Assumi Agent S' na t re (No Stamps) Surcharge Fee) 350 _ O El Owner Given Reason for Denial y30 0 IX. Conditions Approva w� SYSTEM OWNER: 1 Septic tank, effluent filter and � v dispersal cell must all be serviced /maintained V as per management plan provided by plumber. 2. All setback requirements must be maintained T nnvLL t I as per applicable code /ordinances. �n LI Attach complete plans (to the County only) for the system on per not less than 81/2 x 11 inches ' size SBD -6398 (R. 01/03) Ql o� Is Qv� mod► R� -!r Po w�rS E uw S cl ti y ! �y a 3C f Qi '7 Id a1.c� c amrQQ� RLJ1 cL f S Cro;X �1J TTY �r►no✓1k wa- Svc, m Q-o c) v-:S LOT# -5 -05, oo o 2S 1p d ' 00 v F � 1° __ �� ��. -�� Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 �sconsin www www.commerc .wis c ons .wisonsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary March 15, 2004 CUST ID No.220537 ATTN.• POWTS Inspector CALVIN W POWERS JR ZONING OFFICE POWERS EXCAVATING, INC ST CROIX COUNTY SPIA 1969 185TH AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/15/2006 Identification Numbers Transaction ID No. 976089 SITE: Site ID No. 671514 Allen &Sue Powers Please refer to both identification numbers, 1329 140TH Ave I above, in all correspondence with the agency. Town of Richmond, 54017 St Croix County NE 1/4, NW 1/4, S26, T30N, RI 8W Lot: 5, Subdivision: Sunrise Meadows FOR: Description: Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 945844 Maintenance required; 600 GPD Flow rate; 51 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01/01), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 101); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes 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 construction or installation and prior to occupancy or use: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01/01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD - 10706 -P (N.01 /01). • The mound area must be deep chisel plowed to help break up the platy soil structure that was reported at the Cond site. The county may, at their discretion, request verification of the plowing prior to continuation of system APPF construction. DEFARTMENI OF • The dose to the system is to equal five times the void volume of the distribution laterals. For this system the M= minimum dose to the system shall be 144.26 gallon assuming 140 feet of two inch force main drain back. SEE CORRI • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. CALVIN W POWERS JR Page 2 3/15/04 • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • 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 of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) 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. Owner Responsibilities: • Comm 83.52 Responsibilities. 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). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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. 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 �k? 4— Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer 11 , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz @commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 TITLE SHEET PAGE( g DATE: — - o y a M ED OUND SYSTEM " ` FOR A BEDROOM RESIDENCE o"� 1 n r4 This Plan has been prepared in accordance with the Mound Component Manual VERSION 2.0 SBD- 10691 -P (N. 01 /01)and the Pressure Distribution Manual VERISION 2.0 SBD- 10706 -P. (N. 01/01) LOCATED IN THE AZE /4 OFTJIE Al w 1/4 OF SECTION 5 4 c J30N, RIZW, TOWN OF ; cl ST. CROIX COUNTY, WISCONSIN. INDEX PAGE 1 OF 7 TITLE SHEET PAGE 2 OF 7 PLOT PLAN PAGE 3 OF 7 PLANVIEW CROSS SECTION PAGE 4 OF 7 DISTRIBUTION PIPE LAYOUT PAGE 5 OF 7 PUMP CHAMBER CROSS SECTION PAGE 6 OF 7 SYSTEM MANAGEMENT PLAN PAGE 7 OF 7 PUMP CURVE PREPARED FOR 3, q t•oT S PREPARED BY 2205 POWERS EXCAVATING INC. 1969185 TH AVE. NEW RICHMOND, WIS. 54017 PHONE: 715- 246 -5135 FAX: 715- 246 -5135 CELL: 715- 381 -9920 iO E D OF COMMERCE fEYA U DiNG3 SPONDU4CE P ot 41 Ie h �d '-4- N uw S 3410 « w !" J I til - Q5 -2rS �� Ca6 - i I a� Ian %7. e m0 LL "\L 4F"6 1Si1 y �C 1 r / ,� 3 C.(Q 1 it u c f G { toy v m r � � b$ �� I .Mar 15 04 01:46p CALVIN POWERS 715 -246 -5135 p.4 �� 3.4S -&*9 9W isri Page 3 Of 7 r Synthetic Cov:ring S7M- .33 Distribution Pipe Medium Sand H G , Topsoil -- -� F/ p lei �,3 % slope Bed Of 2 %2 Force Main Plowed Aggregate Layer D I 1t.Ltn Cross Section Of A Mound System Using E F A .t^^ A Bed For The Absorption Area G A 'AS Ft. H Ft. iili"�.,Lr LO2.i�2 ?n re �. P= �.� �.ii'% .!.e�\ n t g La Ft. t K 7 Ft. L 1S Ft. Ft. Position I 17 Ft. of Force Main W Ft . L Observation Pipe ' K 8 ----- A --- - - ----- -- - _- ___ -_ - - -_ -__ -- �Dlstributiory Of 2�— 2 % Pipe. Aggregate t Observation Pipe QnC1+or Ss cu tup. Plan View Of Mound Using A Bed For The Absorption Area D iSLr lbU t ! Oa Pipe L Page °f Place the holes at ch• boccom of the discribucion pipes at equal apacina. Remove all burrs from the pipe and hales. F. wad the and *few* kwd rp wpb an ow of loop cum or t s" BMW eo► a point SbE imda QUO Sat psis. TmmWo the m& afire jwne t *0 a "Ive d cap or piap. No Sam am Sit Pea Sr Se nim l a■p arttieatlrd pbw •tailiM -- R_'4} ry G jar - ---- .. ----- P t ftc-ce" lay, o' — t'+M,I ti�r0� P Ft_ Hole Oia"ter I - 7 nch / Ft. Lateatl / %2 1nckf") f tamer Manifold Inches Force Main Indies / of holes /pipe / 7 Invert Elevation of Laterals /0015 Ft. ---- SEPTIC NK E�PUMP TA ) •"" WEATHER PROOF APPROVED 411 Cl VENT PIPE 12" MIN. ABOVE GRADE JUNCTION BIT MANHOLE COVER ? 25' FROM•DOOR, WINDOW OR WITH CONDU W/ P ADLOCK E FRESH AIR _INTAKE N WARNING LABEL 411 MIN 13" IN lei LET GAS- WATER TIGHT SEALS TIGHTS A SEAL PP OV ED / Cl 4„ --3-- i ALM PIPE 3' ONTO CI PIPE B ON SOLID SOIL 3' ONTO SOLID C I r' OfF RISER EXIT SOIL PUMP OFF ELEV . FT . PERMITTED ONLY D IF.TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE -5 - DOSES PER DAY �___— TANK MANUFACTURER : (�`i y,.= rS ' �' SEPTIC G? GAL. DOSE VOLUME INCLUDING fz}o? 5 GAL. TANK SIZES: GAL. FLOWBACK: '__.�- DOSE 3 GAL. _ CAPACITIES: A = INCHES ' ________-- ALARM MANUFACTURER: _.__ GAL. — MODEL NUMBER: B = �2 INCHES = 15? d- li2 _p SWITCH TYPE: SEE CO C S.1 INCHES = G L PUMP MANUFACTURER: AL MODEL NUMBER: D = .1LL INCHES SWITCH TYPE: 23 WAS REQUIRED DISCHARGE RATE y.£9 GPM PUMP S ALARM WIRING AS PER 10� 15. � /Q FEET VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE 5 FEET + MINIMUM NETWORK SUPPLY PRESSURE •` ,7S FEET + l P FEET F QRCEMAIN X �/,/ FT! 104 FT . FRICTION FACTOR _. ----2s FEET TOTAL DYNAMIC HEAD —-- / Z DIAMETER INTERNAL WIDTH � INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ��.! - ---- -- H LIQUID DEPT pOvVTS OWNER'S MANUAL & MANAGEMENT PLAN P v � BONS ❑ �tA ar wrotow► Tank L� �S Q Sapdc o n oaea n HOIC&M . 1 Std vW Permit # W ; , S sir ►'�� o NA T� _ 9 rwt+l s NA a Sepf '4� Q ar VOL 7S� 0 DN A Its of 0df0wtw 0 NA effte. wwnbw of Pudic Fedw units 6� isorr Q DNA Damien jpamW flaw . {Estirnsted x 1.51 ©'O C� Mad US AppftgdM _ hNnP af � O NA Fatz. ON & ratesse W-Ml s30 "WL Q UAe� Ae�a6ot+ 0 Vl d Died - 0 1 1 � rw t80nd 22" M40L L7 HA O � 0 {)alter: Total Sup�artdsd Saida Maw Stso "VOL Mond* aNOWSW k%w^dvvOxw ❑ NA Ptrxuw ted Eftkwvt t p tsd CAW 8iodwa icat OxvgM Dsrnww wow 130 � D Uri � Total Sq pWWad Sands tTSSI 130 capll DNA © ft ) mean; S10" cf bgoond Q At -Hnde P=d Xi in me. D NA Q Dri�p-t�M � O'tl� Q HA W apcitnum Effheant Particle O NA Q NA . Other: 'Vsko" t for doasoft via Ow sapoc W* MAIIFI�lrAM6lE sloe` 1 3 YO NOW O NA Wopect coon of tw*W At facet anoe evstY W of tW* V6kWw O NA When cxtrr�ated � � PUP* out contents of tw*ts) *am *w high 3 ) Cl NA daperse; omew At 104W OPOR eiv"W- Q 0 NA Cieen eflh�ar>1 filter At leant once tvwr— woo ❑ NA bspect PAP+ Puaw Mwalm, & alarm Al iaam once wwWr m4 Q NA Fkjah laterals arw Pwour'e test At lest ance ewrY= ❑ NA ❑ enol At WW OPAO Ovwr d ❑ NA 11�11di i l�iAl'E WjqTWjCfKlft wes of a ors : ane of the foNowin9 fiosr W"PeCborw of tanks and d caft shall be made by an wuli!rrdud cwrt� Sewvk*ig Operetrx tP�P P! Raat&ftd Sawa; POWTS �% �WTS - cracks or Malta► Pkx Ov tsr Plumber a of Me ttnktal der idart"Y am of effluent on *her t To* ipspecfiorw i a visfal �' and : and a d Mxk for any bw* UP +a PA'S for atxv teaks. messu'e #0 % ma of corrJitwd dud offteat lads in the ob vWd0 + pg affil M dwelt ane surfece. The tx� W aha2 ail ate on the g eutfaca am a faiiinl3 " pon&V of e"k ant an the ground the knnwxrnft noWication of to lord teWA%taY wd+odw— one -third IN or more of the tank volume, tau When the t:cttjbinad 4jCCt3rnlAfWdon of siw w and scum in ant► tlw� tank OW Wspowo of in acconkrob With chmp ef' NR 113 entire cotttatrts of the tank stray be t rnw*ed by a SW"W 5arvkM* Operator Wisconsin Adr+nitrisarWWO Coda- cornpo�s• pretreatrner AN other serowm. Y but not WniW to the s Of °fi ' � � units. and airy savWft at irrtervats of S12 months. stwk be performed by a Cert ifi e d POW A servICe nWon aha■ be prowMad to the local ngUlotorY to of ew ef arrll awv'" a"a Guw Rifiz Goulds d � -7 Effluent Pump 388 Ove _ • rload protetion must Spec#tiraily designed for the be provided in starter unit. smooth W X1orL S can be operated continuously togowin, uses: • Shaft threa b1e as without damage. • Names stainless steel an option 400 series u�� ■ Baarin s, U ' a 9 ' per and Farms • 'Bearings: ball bearings t �r�n avolu kn�er heavy duty bag bearing Trailer courts upper and lower, efficie construction. • Schools Power d � � ■ POW" Cable: Severe duty oPtional rated, oil and water resistan #. le r • Industry s SkIle t sa: � Saar: &M0* Epoxy seal on motor end Provides • El7buent systems • % and % HP- 16/3 SJTO � lames. barrier in�t jacket with 115 V or 230 V three SWnbSS sued tt W parts, die and to prevent oil �'EWICATC -an prong plug. BLN" elastomers, 9 pump bare leads. -14/3 STO with N Shall: Gotrasbn -rem • O-riag: Assures posurve SO W S �dbKi capabdq*& Tkee phase: � ' Threaded 9 against Contaminants magnum. ' % - I% NP -14 • • 14 STO design- Lodvwt on three and ON leakage. Phase Models INsdarge size: 2~ NPT, with bare leads_ On CSq agakrst carm>pa�n� • T t0 128 GPM. listed models - 20 foot on i �e rotation. A6EItCY LtSTtJl6S broods: up to 123 lest length SJTW and S W TDN, m standard. ■ A10101:` FWy submerged in s • Mechan seal. silicon high f►� turbilae OR for c � seat/sMCm FEATURES � and 4111110M beat ---I ls�aramr►rs Ilona y sea, 300 sus staln1less steel metal • kwatler. Cast h+on, semi- • Designed tar C4011B mus T " ft BUN" elastome O1W% non w" pump_ der fUmp rates are amperature: Out times stir mil seal war mofir mat>utatSurmEr's 1 4CPF (n) In �t for recommended working grafts, 140°F (6p•C# yttern»ttant. • f'astaners: series NEMNS FE" stainless st"L 90 * without dam dry ,so SER*S;- Sees +nlronents SUE W SOLIDS Motor 20 70 GM skwe phase. 60 % "p. 115 V. 200 V. 230 V, z 60 HZ 1750 Rp&t % Hp, is so 115 V. 60 N4 � ,, tf Ni' -114 HP. 230 V � �° 6 0 N4 3500 RPM. !a & O`MiOad with ^Ikmork reset Ckss 8 insulation, s m time pluss: 10 4 NP -1 % NP 200/230/ 0 V, 60 Ni. 35M RPM, 0 0 Class 8 Insulat #on, ° 10 20 as 4 So 60 # - --____ 70 So 90 100 110 120 130GPM � Goulds Pumps _ CAPACITY � I myth E;ftect" May. 1995 .1- Page 2 of 2 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. jf T /�'' aluat a o ing tank be ' e ai e . FRD418 771✓ �� l�l�✓ Co N S`T1ec1�t O 10 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 �* /N Name Phone S 2 `fro , 5_7'3 5— Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name s-j', ckb It eju ZOtill�(l Phone 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. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS F Septic Tank Capacity a l ❑ NA # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA Estimated flow (average) gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) g al/day Pump Manufacturer ❑ NA Soil Application Rate al /da /ftz Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA 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) _ <150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) _ <10' cfu /100m1 ❑ 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 eff luent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 0 ean1 )(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: • mont ►(s) (Maximum 3 years) 13 NA year • month(s) ❑ NA Clean effluent filter At least once every: ❑ year(s) Inspect pump, pump controls & alarm At least once every: • month ❑ NA Y Flush laterals and pressure test At least once every: ' ❑ month(s) ❑ NA ❑ year(s) ❑ month(s) Other: At least once every: ❑ year(s) ❑ NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Wisconsin Derortmentof Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and. Human Relations Division 6f,Safely & Buildings in accord with ILHR 83.05, 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 St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REV WED Y DATE G S PROPERTY OWNER: PROPERTY LOCATION Derrick Construction, Inc GOVT. LOT N E 1/4 NW 1/4,S26 T 30 N,R 18 or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #� 1505 H 65 5 na Darx; c R a CITY, STATE ZIP CODE PHONE NUMBER [ []VILLAGE ®TOWN NEAREST ROAD (71 Richmond 140 ] New Construction Use [x] Residential / Number of bedrooms 4 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate _np— bed, gpd /ft gpd/ft Absorption area required �n� bed, ft 500 trench, ft Maximum design loading rate np bed, gpd /ft .3 trench, gpd /ft Recommended infiltration surface elevation(s) 100.00 ft (as referred to site plan benchmark) Additional design/ site considerations system el. based on contour 1 ine of el. 99.00' Parent material glacial drift Flood plain elevation, if applicable na It S = Suitable for system CONVENTIONAL MOUND 71 PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S U ®S ❑ U S El CA ❑ U ❑ S IL U ❑ S g] U SOIL DESCRI TP ION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -10 10yr2 /2 none 1 2msbk mfr cs 2f .5 1 .6 2 10 -20 10yr4 /4 none sicl 2msbk mfr yw if .4 .5 Ground 3 20 -51 7.5yr4/4 none sl lcsbk mfr gw if .4 .5 elev. 99 ft. 4 51 -84 5yr4/4 `P" we_t scl M na na na np i . 2 Depth to limiting factor 5 Remarks: Boring # 1 0 -8 10yr2 /2 none 1 2fp1 mfr cs 2f np .3 2 2 8 -16 10yr4 /4 none sicl lcsbk mfr gw if .2 .3 3 16 -54 7.5yr4/4 none sl lcsbk mfr yw if .4 .5 .................. Ground elev. 4 54 -80 5 r4/4 wet scl M na n , .2 Y 1- -? 99 ft. Depth to limiting factor 54 c . T J' Remarks: ti :;un,GF ~. CST Name: -- Please Print Gary L. Steel Phone: 715 -246 -6200 Address: 1554 200 Ave. New Ri hmond WI 54017 Signature: Date: 5 -12 -99 CST Number: m02298 e2y PROPERTYOWNER Derrick Const., Inc SOIL DESCRIPTION REPORT Pager 2 of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourbay Roots GPD /ft ................. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends .................. 1 0 -10 10yr2 /2 none 1 2msbk m r cs 2 10 -2 10yr4 /4 none sicl lcsbk mfr gw 1f .2 .3 Ground 3 24 -5 7.5yr4/4 none sl lcsbk mfr gw if .4 .5 elev. 97.5 ft. 4 56-75 7.5ry4/4 none sl M na na na .3 .4 Depth to limiting factor 75" Remarks: Boring # Ground elev. ft. Depth to - limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) i STEEL'S SOIL SERVICE Gary L. Steel Derrick Construction, Inca 1554 200th Ave. CSTM2298 NE4NW4 S26- T30N - New Richmond, WI 54017 MPRSW -3254 town of Richmond (715) 246 -6200 lot #5- Derrick's Plat This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. IN 1 top of 2 pvc pipe C el. 1 00.-W .' t. nail in Elm tree C el. 9 5.70' e a� 45 � zap 2 C1 , Gary L. Steel 5 -12 -99 w ' ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Mailing Address 3 �J. luz !S;"zq:Ej - , tkaj A Lt- ,taro 14-L � '5yo t 7 Property Address Z 9 `V4 - [7-) A ✓ (Verification required from Planning Department for new construction) City/State f 4LH -04 Parcel Identification Number O S - 010 a LEGAL DESCRIPTION Property Location W Y4, 8 � %,, Sec. AO . T N N -R `g W, Town of " '�'t D Subdivision JyS'c /'�AOw� Lot # Certified Survey Map # - ` ` . Volume '? Page # Warranty Deed # G LAO (O _ , V o l ume 7 © 5 , Page # .3 lb S Spec houseXes 0 no Lot lines identifiable yes 0 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 masterphunber, joumeymanpl*nber, restrictedplumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification . stati—t that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days o ee ear a i&on date. Z - T/ o 9 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 pr es crib d above virtue of a warranty deed recorded in Register of Deeds Office. �� Z 2,/ O S GNATURE 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 vi- 170,5PAGE 3 H 10 STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number ST. CROIX CO., WI . . . .. . ......... RECEIVED FOR RECORD This Deed, made between Willow River Joint Venture, a_ Wisconsin Partnership 08-24-2001 9:30 AN WARRANTY DEED Grantor, EXEMPT # and Allen J. Powers and Susan A. Powers, husband and CERT COPY FEE: COPY FEE: wife, as �survivorshi TRANSFER FEE: 107.70 RECORDING FEE: 10.00 PAGES: AGES: I Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St Croix County, State of Wisconsin: Recording Area Name and Return Address BREMER BANK NA 532 KNOWLES AVE S 4 NEW RICHMOND W1 54017 026 Parcel Identification Number (PIN) This is not homestead property. (is) (is not). Lot Five (5 Plat of Sunrise Meadows in the Town of Richmond, St. Croix County, Wisconsin Exceptions to warranties: i Dated this 14th day of August 2001 (SEAL) (SEAL) * Ronald L. Derrick (SEAL) lAa g (SEAL) * Michael R. Stevens AUTHENTICATION ACKNOWLEDGMENT 1� Signature (s) State of Wisconsin, County. St. Croix authenticated this day of Personally came before me this 14th day of August 2001 the above named Michael R. Stevens and Ronald L. Derrick, as Partners of Willow River Joint Venture, a Wisconsin TITLE: MEMBER STATE BAR OF WISCONSIN Partnership to (If not, me known to be the person 5 who executed the foregoing 7 authorized by §706.06,Wis. Stats.) instrument a owledge t HEIDI L. DILLEY p k6tary Public THIS INSTRUMENT WAS DRAFTED BY — ��2 I of wiseensin Willow River JOint Venture Heidi L. Dilley i PO Box 44b Notar Public, State of Wisconsin County of St. Croix New Richmond, WI 54017 M commission is permanent. (If not, state expiration date: (Si ma be authenticated or acknowled Both are not March 24th 2002 necessar ....... ................ . . ......... ......................... ..... ....................... ...... ........... . . . ......... Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., inc. WARRANTY DEED FORM No. 2 - 1998 Milwaukee, Wis. mill 140TH VFNUE Nt VON IMM" an IIICATEII TO TINE PUBLIC ..... ,....�. .. ..., _„ . ' T.... ., .,.. , NMI ♦ _ 3 1►Mw i , , , , 5 ACRES 4195 �l C^ , 3 r?' .e , i Rv" , , �tt+g� t+t �f sit xa sk .. c ... ........................................................ � s ,. a ski .,;c$ z �,� ``,., <,, , t Z �✓ �xs 9 � r j t �'•,3 ��� a �t �� � �����.� �q r :f� �3 cr � r � "� ri r,r x f UNRI'E . MEADOW ,S MY SW1Y ZACANtlR SCM'TCR ( LOCATED IN PART OF THE NW114 OF THE NW1 14 AND IN PART OF THE NO 114 OF TVZ HRdEYCYA NW1 14 OF SECTION 26 TSON Ri8W, TOWN OF RICHMOND, Sr. CROIX COUNTY. IV'ISCONSIN. r r+s 4. Own ���.. �1 l41Lt'RXf a(V� rvx C fRS*D'�.w, fi, eory +rc.rm a ,. r , er» SBC td. TUN. R78!♦ r,l o 9f-t. rsx asa:a C I W� I I D.O. T: NUMBER 556S29fA•1994 tIhPLATi£D LAAAS O WNED AE'D BY OTHERS r4. 140TH AVLNUE —� .,...�.«,.a ..n.. 'fevns Ni,. na zqr wss! ere•... w• y_.. _� .. . •.. zu' w.znw ,u, �s,s ., \ SU9'S6'S. "E 26361ft' F DEDICATED TO THE PUBLIC '. I '� i/'.> } .. .... ..,k, ..........�.... ...�, nw _ .. tea.: ,I, .... ... _... .�, ..............._ l' 4 'a 6 7 ar .... LOT !� <•,. C.S L /h ,� 1'hPl ATTE.'A 4ANI) OWVjrD BY 0T37AR5 OANSA BY OTHdHS SCMk R1 ff,.zl . 10k' � Y .a'aytr 4'. ,iwz ezzaO U�i✓��zIPfi tt / Y