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HomeMy WebLinkAbout026-1294-32-000 Wisconsin Department of Commerce Count PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division I INSPECTION REPORT Sanitary Permit No: 499220 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. Smith, Gerald J. avy;; 41-C, Richmond, Town of 026- 1294 -32 -000 CST BM Elev: J Insp. BM Elev: BM Description: Section/Town /Range /Map No: (� •C7 CST (gtA�� ( 28.30.18.1514 TANK INFORMATION ELEVATION DATA TYPE r (+a NUUF /C CAPACITY STATION BS Hi FS ELEV. � Septic Benchmark 6•tS /06 -K r Dosing � � � Alt. BM Aeration Bldg. Sewer O I � 0 i S.bs Holding St/Ht Inlet t r cvo TANK SETBACK INFORMATION SUHt Outlet TANK TO P/L WELL BLDG. Vent to Air intake ROAD Dt Inlet �. Septic 3(a f Dt>Ze4tonr 12. 9 4 ( 2 0 Dosing < <i ... Ll J Header/Man. r (--S-0 /LTD •,�{ Aeration 1 p r17 • ?�/ J 0 & Cam` 6 T 7 Holding Bot. ystem q p %. p, Final Grade '• 7 i Ov f PUMP /SIPHON INFORMATION •10 6D• Manufacturer Demand t Cover M��t�"IC GPM�k 3�1Z O3•F�3� Model Number k S us" 33 S TDH Lii` � Friction Loss System Head Ft 0.111 TDH - ' 3.91 Forcemain Lengt4 , I Dia. I J Dist. to well SOIL ABSORPTION SYSTEM 9 i.N L BED /TRENCH Width Le / No. Of T nches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS f 3 , Z� SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manuf er:�l L INFORMATION CHAMBER OR Type Of System: df 41 L f A UNIT Model Numb DISTRIBUTION SYSTEM '�p / Header /Manifold LIP Distribution le Size x Hole Spacing Vent to Air Intake e Lengt Dia Length Dia pacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed /Trench Edges Topsoil Yes No Yes ]N, MM !�328"l (IncI d ddiscre ncies, per o p sent, etc.) Inspection #1:!�' • � _4. � Inspection #2: oca — ti 16th reet UnknNW S 2T30N R18W) Richmond Acres Lot 32 Parcel No: 28.30.18.1514 1.) Alt BM Description 2.) Bldg sewer length = 3f amou t o; cover = r• f Z, u �— • ` JA L 3 w 0 - t . oc o� e. Plan revision Required? Yes No ` O le lam/ 4 4' � �Ispcto�s Use other side for additional informaf n. /p Dat o Signature Cert No SBD -6710 (R.3/97) Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 8 visc l onsin Madison, WI 53707 - 7 162 Sanitary Permit Number (to be filled in by Co.) De artment of Commerce (608) 266 -3151 -41 - Sanitary Permit Applicatio State Plan LD / Number In accord with Comm 83.2 1, Wis. Adm. Code, personal information yo V may be used for secondary purposes Privacy Law, s 15.04(1 V. ) Project Address (if different than mailing address) I. Application Information- Please Print All Information RECEIVED 1 3 Z F �C Sr; Property Owner's Name Parcel # LQL# Block # ago T. .S OCT 2 0 2006 e 3 � \ Property Owner's Mailing Address ST. CROIX COUNTY Property Location / /de 90 �� Al. *4 y., J:!' ' /., Section �8 City, State Zip Code ( circ l e one um er Gr�K l!/E /7/1/ SS3>'o 7, `��/ 88 T 30 N R /8A w (• �S�? H. Type of Building (check all that apply) o k 06 5u" W1 or 2 Family Dwelling - Number of Bedrooms 3 4,o-w. p 1 a Subdivision Name CSM Number 11 Public/Commercial - Describe Use ; ,` ( 1 ,O 1e*110A1,f 14eArS ❑ State Owned - Describe Use Z i 5 Ce ��S w j 1 Z 4- 13 e " .,.. e ! S gGity_QV4Mge gTownshi p f G,d�e.J4 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) 7 Z A ' New System ❑ Replacement System El y Treatment/Holding Tank Replacement Only Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner - tlt-- IV. TyDe of POWTS System: Check all that appl O VNon - P ressurized In- Ground ❑ 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 So '� ✓ SD ✓ 77.7 ..5' .7 LI Q VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing W 7-4 J� Tanks Tanks V 1 1 Septic or U*Wia%Zmk v , / �OnJG.rCre Aerobic Treatment Unit Dosing Chamber e4d — VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's at MP /N 1 W Number Business Phone Number Plumber's Address (Street, City, State, Zip ode) VIII. Countoy /De artment Use Onl Approved ❑ D' rove Sanitary Permit Fee (incl es Gro dwater a Issued Issuin ent Si e o Stam ❑ Surcharge Fee) / p� en Reason for DL Conditions of Approval/Reasons for Disapprov . J / SYSTEM OWNER: J f evY� ° rOtJ' ✓tn. - 1. Septic tank, effluent filter and q 1�2t J IAOtM dispersal cell must all be services (maintained ✓�a n� e A� t _Q� �C as per management plan provided by plumber. 2. All setback requirements must be maintained as per apple" code / ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) /ao.7 N o rrt "r via r "PdG ti ,gA�Kf /�L ti XAI -IdA.14 -C 1rrri. � � Eaadr �i,+� 2 7 94 7 1---3 3 —! .too � u.SE �.rlf s'� roc. - .fTiV.JD.IRO �i✓.PiYBl�L,f 13 Laxly � � -- Q,4 ' roi° of P I I ��� 7s Y1.7 � .t " /oc f•.�« a . E • lle.✓ (70 i 91.1 a' ,6JS y "0 04 �1 t -- I p� peo d4-tw r I �ErtL 1 I La r.�,3 i0 [c Lo.yy, d'3. y3 ,te i'r6AcAcs � t7 = 6 IC,E'h'at br i'1 r 1' yirs A� I 1 Loy' 3l !4 A dO Z) a .j 7 r y Z o rrtr �� r LAP r p/-7 1 1� ,6A�Kf /tt 1� St✓ Cea.Jra sr�cL r ; i , f E[. ,Too' uSE �.r/fiL s'�lo ro.C. - .fT.v.✓ �NgryBla,S /Z LN,gyBt'�c /I`��•J�� ,7S dN.lras'.cs rer�vt. Zor ly y'e,° eF xv ' S reel. r°rP� BY Le rdlr.T�fdS' .trr � � . o, 7 $ / I PNt 1 J� N.7 -� "Put Frsiar t' �aoss y' I `� b /oe, 1 o J/ Ns4- Z I t7 = BAC,eNac ar i`Jr!' R t i Lo% 3Z P Yr a AO i 49b� x s f� rJ \/w ti • 1 � 41 • ilk • R • w ` r1r f T r • + , *Aft a Z,d Wtbt ZLL 9 lL Ae6eni)l I r d9Z :£ su 9 4 po Wisconsin Department of Commerce EVALUATION REPORT Page __— of Division of Safety and Buildings i accordance with Comm 85, Wis. Adm. Code County 5t C: o 04 Attach complete site plan on paper not less than 112 - include, but not limited to: vertical and horizontal r ferenc =1r and Parcel I.D. percent slope, scale or dimensions, north arrow , a d to i a heares road. Please print all lnf rmation. R ewe Date . cy L Personal information you provide may be used for sen ary pur�s�Pridac9LaZ; ko .04 (1 ) (m)). Property Owner (( ST. CROIX COL N Mperty 1. ocation G e ral . S M 1 ZONING OFFi 31jovt. Lot 1 NI,J 1/45E 1/4 S a$ T30 N R E (or Property Owner's Mailing Add re Lot # Block # Subd. Name or CSM# / 90 Me. NW 3-�I- I 1pl of tc m cry City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Roc FIK R•JeK KI 3p ( - (` rn a r4 C9 New Construction Use: Residential / Number of bedrooms Code derived design flow rate s __ GPD ❑ Replacement ❑ Public or commercial - Describe: -- _ — Parent material .0 -t'd e �s_h . �• ion - Flood Plain e;evation if applicable �' FO r � w'h S . t G • General oomments = S �,s - �, - 'Trthc. L (, (�� • and recommendations: ' g�.87�, - 3 ( 9 (-- 5 ' J 6 - F I : - a. s : +` a :.�., y to a y • ) . � I Boring # a Pit ng Q ' -- 4 .� Ground surface elev. _ 19•� $ 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 'Eff#2 L ! PL L •t r �7 Y�' 4/ 1. ea v'l t � "' � Y • C W 1 + �, / t 1 .� ® Boring # a Boring I 6 6 • ' a Pit Ground surface elev. _ ��• ft. Depth to limiting factor in. Soil ADPlication 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 'Eff#2 �L CW Vt it Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L T Name (Please P ' f, Signature CST Number c9ca 4 K �. r � A �re� a 7 S� Date Evaluation Conducted Telephone Number L r --fig -O S 'l IS a ya -358 5Y0 10 e A Page CQ _ of � S r 1 Parcel ID # Property Owner � � �'r) Boring # ❑ Boring c� �• Pit Ground surtace elev. Di 1 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 'Eff#2 i ! DYO/ N L n rr ;r C U) FS NeaVI r L ❑ Boring # ❑ Boring — ❑ Pit Ground surface elev. ___ __ ft. Depth to limiting factor in. Soil lication 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 'Eff#2 Boring # ❑ Boring F ❑ 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 '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•9330 (R.6=) s a 'tee . , rn CA ` 4 `4 p Q co 7 w = a �- 3 S % W OD VD Vo w 1 s gi (�J J }� (A �, J -.� - -- ------------- - - - - -- --- - - - - -- - - - - - -- - - RICHMOND ACRES (A CONY PLAT) ;0cote0 in Go of She "zIheos' ouorte' of h e s ovf5wesf Ouorler Dart of the Ncrrrfosr Ooorts ct She Souldwes! 0o7qP" Ca of the 5 J,, o f h, 5,,q " >tro a Se70' 5 2 Nest. 'ow o` 51 Cr), "w,'): _ E 1 "E Ell" D Curer r . 2 Tak, I ^C, paunl 'cn Pipe Set 1-1/4' A �B' l Reba, E.E III LSGS NAVD 3 SAGE) ON GPS D'SrIVATOkS (,eighing 4.A13 I's per Lrei `act . At EARN S)i GS AV REFER 10 7) "4 EXIT LNP OF - dr 1/4 OF SECICN 2,1, WHICH IS ASSJUED TO EEAR other lot comers marked with a TxIB" iron 5 9919!9 W, 1 6TV pipe wenoing 113 Its. per ineor foot) THE PARC13 SHOWN 01 1H!S VAR ARE s TO STATE, N N Meng Setback b CCJNTY AND TOWNSHIP LAWS RULES AND REGULATIONS (IE (100' f'" Rot of Way 01 Cs noted) OETIANDS. MINIMIX LOT SIZE, ACCESS TO PARCEL ETC.). BEFORE PURCHASING OR DEMELOPING ANY PARCEL CONTACT THE ST proposed vve.a toco!ion CIOX COUNTY 204NC OFC: 49 THE APPROPRIATE TOWN BOARD FOR ADIAGE. Alo,abhe Eftatior of Lowest Foiki Coming NO OWNER 051 RESIDENT SHALL DO All WHI7 WOULD 11 MERE NTH OR CHANGE K OPERATION OF THE APPROG H.W iGO-Year HIP Wotv ten* COMPRIFI WATER DRAINAGE AND -SOL EFI PLAN FOR THIS PLAT. THIS INCLUDES BUT IS NOT UNITED TO LF.O(NG UPON, 130TH AHf1NE OBSTRUCT% ALTERING, FILING EXCAVATHING OR PLANT 14 ANY Benchmol - To, of iro Rebor v Pipe DRAINAGE EASEMENTS, WATER DRAINAGE DITCHES Ni RUNWAY' wA q � (U: �VERTS. BERMS CP 7AS5 SEEMrZ i2' Vit Easement o1m: m3dl Re'vdc as 7 rov Pxrner co,, of - REMMI Ma -051 6do'!, F, .0or 23-J948 /Fond ClUDIX Co. w, ovlty u4E , :* Ram *tYr counly oon'jarl) 804 ANS RACRAPY CA-X-SJC Ourfer 114 bne M EXZVYM OF W R040) 975.8 0 11 of 200.06 1710' 1111 17100' 527.08' Q, 1 1958.91' - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 316 9DI 16 lsmi 15 19R ,a Akb ar.� 2 ' sq. ft. Cres ' 1.60 acres a 92,17d k 9 22 00' r A, 20 1 17 98 oc'es 23 l� 699 sq k so �'t )5 Fs xv 14 22 SG- Z i NNIA a'E soi 23 LB.0, 964,0 SMARI LEG 9609 80' RAM EAMf 13 1 . CA-1-54C i (TO of FXG firaskov or RIF RX) Y -�s acres - CFV - - ak 95.760 so. q RM 617 No SS C:3 S1 3791 40t�- 586 51865 076 12. NIP Cie Q6 40'74" 3m. "'S.— 12 2,12 acres 92,5 sq ff.. z ti 8F D3E n 455 0111 30 t 29 1.68 acres 26 27 m 28 e 72,979 sq. ft 25 2.26 Gives 1,97 acres 2. N acres d 24 S 98,419 sq. ft. d 65,7j5 sq. ft gjj48 sq . R. 2.25 acres 2.40 acres 98,168 sq. ft. 04 sq. k $ Ea �n2C9'w 2.05 acres 31 10 69268 sq It. 964.6 I 2.12 acres 1.75 acres 151 sq, ft 76,J69 sq. 966.9 DRAINIC SCALE SCALE N FEET 0 1 .- IOD W 9628 9670 -SAC LUSEIPF 4.5 0 - -- - - - - -_ - 9 I `SSO� I P ♦ -(as Ewe [MW a IFF RX) ANW& 5S N61 S V057SD48 2176 �ri13 32 SHA27 prepared b;. acres I 58 8 969.6 95,07 sq. It 2 a s an 1 L1.2v C, - - - Phone No (715) 246-4319 d 35 200 2(7 514,60' FoA No. (715) 246-M 36 P.0 BOA 325 39 38 37 314 4 .1 1 Richmond, M 5401 34 1 33 19 SHEET I OF 3 (SEE SHEET 2) F , 7 Wastewater Treatment System em OWTS Private On-Site Y � ) Index and Title Sheet Owner: T JJyiry, Project Name and System Type: _I.Y/ N - 2-.R Location: rn�l .Sr Street Address � tion Legal Description P /o.c%✓ of �c.s��a.✓ .�r L.eo�x �o. Township /County Contents: Page 1: �,voe-x Page 2: o 6 .4,V. o l e,`4 - zrio.✓ Page 3: G'u r o ZW,4,00�1ti f .40 r r- s'r G AGO.✓ Page 4: G�u,•sP Li G FoQ�sA.✓Gr �u�rv�' Page 5 : Dow rs 4s✓,✓E.c ls �A.✓N.OG F /�.o,✓t��rr.✓r l l G , I .✓ Page 6: Page 7: Page 8: .Page 9: Attachments: .Sai va u.o r a.d 16-00.6r c r.-.c /�Ai.✓ r�.✓.�.✓c f �.dio. Plumberr: Signed: ,l Credential Number: * Z Date: /o -/l - 4 e. Page_j _Of_7._ SEPTIC TANK E'PUMP CHAMBER CROSS SECTION*AND SPECIFICATIONS ..c Scr. yo. 4" Cl VENT PIPE 12" MIN. ABOVE GRADE WEATHERPROOF > /p* FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVERS W/ PADLOCK E �i.�isvdo WARNING LABEL --- ..._4" MIN. 18" IN. � INLET �► WATER TIGHT SEALS GAS- F /r.rEe TIGHT, `� rA PPROVED ,0• /0o A SEAL ; OINTS WITH APPROVED —}— ; ; ALM PPROVED PIPE PIPE 3` B 0 N ' ONTO ONTO SOLID � ' �. OLID SOIL i C SOIL' PUMP OFF ELEV . 89.0 FT. --- OFF RISER EXIT D RMITTED ONLY TANK NUFACTURER HAS APPROVAL 3 APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC./ DOSE TANK MANUFACTURER: NUMBER DOSES PER DAY: 5 -'- 7 f ?� ss TANK SIZES SEPTIC /000 GAL.' DOSE VOLUME INCLUDING DOSE Goa GAL.. FLOWBACK: 117C GAL. ALARM MANUFACTURER: Jr as CAPACITIES: A = �O INCHES = _ ,�,3G GAL. MODEL NUMBER: _ S,o,✓,r L�, I SWITCH TYPE: /yEi[cuay B = 2 INCHES = .� 3,G GAL. PUMP MANUFACTURER: �yp�orsor /c ,� C = _ INCHES = /17.6 GAL. MODEL NUMBER: SWITCH TYPE: D = �_ INCHES = GAL. REQUIRED DISCHARGE RATE GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC ,, VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . 87 FEET .+ MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . . FEET + 7o FEET FORCEMAIN`X /,y FT /100 FT. FRICTION FACTOR . FEET T.OTAL DYNAMIC HEAD = 9 7 FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH S3 ; WIDTH y8 ; DIAMETER LIQUID 15EPTH ' 3G •� J IHY DRO.AA TIC OF SD33 VS33 SW50 i T ical A plication" Sum /Effluent pump Typical Application* Su /Effluent pum (opacities SW /SD/VS33 - to 48 GPM (3.0 Vs) Capacities SW /SD/VS50 - to 44 GPM (2.8 Vs) Heads SW /SD/VS33 - to 26 ft. (1.9 m) Heads SW /SD/VS50 - to 24 ft. (1.3 m) Electrical SW /SD/VS33. 115V, 1 1,10.0 FIA, 60 Hz Electrical SW /SD/VS50 - I I V, I o, 8.0 FIA, 60 Nz ded p Motor SW /SD/VS33 - 1/3 HP shaole w / thermal Motor SW/SD/YS50 -1/1 HP shaded pole w /thermal overload overload 1550 RPM 1550 RPM Minimum RecommendeV SD/VS33 =12' (304.8 mm) Minimum Recommended SD/VS50 = 12" (304.8 mm) Sump Diameter SW33 =18 '(451 mm) Sump Diameter SW50 =18' (457 mm) Automatic Operation SW = Vide-angle float switch Automdtic Operation SW = Wide -angle float (manual available) SO = Diaphragm pressure switch (manual available) SO = Diaphragm pressure switches VS = Vertical float switch VS = Vertical float switch Materials of Construction Cast iron and engineered thermoplastic Materials of Construction Cast iron and engineered thermoplastic Impeller Thermoplastic vortex — Impeller Thermo lastic two vane semio en Discharge Size 1 -1/2" NPT (38.1 mm) Discharge Size 1 -1/2" NPT(38.1 mm) Solids Handling 3/8' (12.8 mm) Solids Handling 3/4" (15 mmj Power Cord 10', SJTW,(20' o tional) Power Cord 10', SJTW,(20' optional) Superior Features • Carbon /Ceramic mechanical seal Superior Features • Carbon /Ceramic mechanical seal • Oil- filled motor w /automatic reset • Oil- filled motor w /automatic reset thermal overload thermal overload • Uses single row ball bearing construction • Uses single row ball bearing construction • Piggyback plug available for easy maintenance and • Piggyback plug available for easy replacement maintenance and replacement 9 30 40 i 6 20 S03 &S33 S33 30 SW /SDNS50 a 20 3.-S10 10 capacity -U.S. 1 '0 0 30 40 50 10 20 30 40 50 60 70 Liters/Second 0 1 y 3 GPM .9°''jba SWit 10/ � 9 POWTS OWNER'S MANUAL AND MANAGEMENT PLAN 'FILE INFORMATION SYSTEM SPECIFICATIONS Owner E �o S r H Septic Tank Capacit 6d p 1 ❑ NA ---d Permit # Septic Tank Manufacturer A/iES .-,e ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Z fe r l. [I NA Number of Bedrooms 100 droom 3 ❑ NA Effluent Filter Model ,f/00 ❑ NA Number of Commercial Units — NA Pump Tank Capacity -1(60 ga l ❑ NA Estimated flow (average)* Ydo g al /day Pump Tank Manufacturer !✓jEfFie ❑ NA Design flow (peak), estimated x 1.5* ,fp al /da Pump Manufacturer ❑ NA Soil Application Rate , G gal ft - Punip Model ❑ NA Pretreatment Unit JVNA Influent/Effluent Quality (NA ❑) Monthly Average ** ❑ Sand/Gravel Filter ❑ Peat Filter Fats. Oil & Grease (FOG) � 30 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BOD5) < 220 mg/L, ❑ Disinfection [I Other: Total Suspended Solids (TSS) Manufacturer: Model: _< 250 m Dispersal Cell(s) Pretreated Effluent Quality [3 Monthly Average*** gIn- ground (gravity) ❑ In- ground (pressurized) Biochemical Oxygen Demand (BODS) < 30 mg/L ❑ At -grade ❑ Mound Total Suspended Solids (TSS) <_ 30 mg/L ❑ Drip-line ❑ Other: Fecal Coliform (geometric mean) <IO cfu/100m1 (Leaching Chamber Manufacturer 4i, ritOfE Maximum Effluent Particle Size 1/8 inch diameter Model SrA.✓OS.¢A Laying Length/Chamber *Wastewater Flow Verification and Calculations: Soil Application Rate_,_4gpd/ft Area Req._7'.so ft (Other than bedroom based) Infiltrative Surface /Chamber -ESIA Rating_. .3!=L_ ft2 Minimum Number of Chambers d.5' ❑ Aggregate Design Flow/Loading Rate= ft min ** Values typical for domestic (non - commercial wastewater Materials: all materials must comply with WI Adm. Code and septic tank effluent. COMM84 and be installed per manufacturers specifications ** *Values typical for pretreated wastewater. and ap roval letters. DESIGN CRITERI ❑ "Wisconsin At -grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.al.1990) ❑ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual' Converse, J.C. and E.J. Tyler. Publication 15.22 ❑ "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6 ❑ "Design of Conventional Soil Absorption Trenches and Beds ". R.J. Otis - ASAE Publications 5 -77 and "Design Manual - Onsite Wastewater Treatment and Disposal Systems ". EPA 625/1 -80 -012 October 1980 ❑ SBD - 10570 -P (R.6/99) "At -Grade Component Manual Using Pressure Distribution' )(SBD - 10567 -P (8.6/99) "In Ground Absorption Component Manual" " - 1 In Ground it Absorption m nent Manual Version 2.0 BD 10705 -P .O1 /0 G oun So Co ❑ S tN ) po ❑ SBD - 10628 -P (N.6/99) "Recirculating Sand Filter System Component Manual" ❑ SBD - 10656 -P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" ❑ SBD - 10572 -P (R.6/99) "Mound Component Manual' ❑ SBD - 1069I -P (N.01 /01) "Mound Component Manual' Version 2.0 ❑ SBD - 10595 -P (R.6/99) "Single Pass Sand Filter Component Manual' ❑ SBD - 10657 -P (R.6/99) "Drip -line Effluent Disposal Component Manual" ❑ SBD - 10573 -P (R 6/99) "Pressure Distribution Component Manual" ❑ SBD - 10706 -P (N.01 /01) "Pressure Distribution Component Manual' Version 2.0 ❑ Drip -line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Freq Inspect condition of tank(s) At least once every ❑ months j 0 year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (1/3) of tank volume Inspect dispersal cell(s) At least once every ❑ months 3 I�,r ear(s) (Maximum 3 yrs.) Clean effluent filter At least once eve X months ❑ ear(s) Inspect pump, pump controls & alarm At least once every ❑ months 3 C9 year(s) ❑ NA Flush laterals and pressure test At least once every ❑ months ❑ ear(s) 0 NA Valves At least once eve ❑ months ❑ ear(s) ❑ NA Other: At least once every ❑ months ❑ ear(s) ❑ NA Page S of_Z START UP For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water - saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fniit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. ❑ Valves' Valves shall be operated in the following manner: Alarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to.prevent back -up of sewage into the dwelling or surfacing. INSPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). Septic Tanks Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be scaled and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one -third (1/3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. Pump Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of any filters. Any service needs or repairs shall be promptly taken care of. kIn- Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any or discharge. An discharge to the f surface seepage g Y g ground surface must be promptly reported to the regulatory evidence o s , o rl in or impending indicate overloading f he height of the component may to r tiiatt 75 /o o f g pe authority. Pondmg at depths greater gh P Y hydraulic failure necessitating more frequent monitoring. Page G of 7 O Mound ,'At - Grade, In- Ground Pressure The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code. All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. - After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. O 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. p 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. O 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 CONTIAN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name ERQ B1KE /W 3y /z Name E L o urn i✓c Phone 7jS d 7,7 - Xze a Phone 7 1,V , 7,? - r.? 44 SEPTAGE SERVICING OPERATOR (Pumper), L1wXA1cwV LOCAL REGULATORY AUTHORITY Name Agency „5y- ,eoix Z A/i.✓� Fri Phone Phone KAWPDATMEMPOWTS OWNER'S MANUAL.doc Page 7 of,� ♦ I I � ,t' 1 1 i � . t , Maintenance The interval for servicing septic tanks is set by state and local code. Throughout the United States there is a wide difference of opinion on what this interval should be, but most regulatory agencies suggest two to five years. The Zabel`" filter, which does not increase the frequency of servicing for the tank, should be cleaned when the septic tank is normally inspected and pumped. However, our filter is virtually self - cleaning. The continued action of the anaerobic drganlsms on the Zabel filter causes lodged particles to disintegrate and fall to the bottom of the tank. If your filter contains a SmartFilter' alarm, you will be notified by an alarm when the filter needs servicing. To service the filter: 'Servicing any Zabel filter should only be done by a certified septic tank pumper or installer. Locate the outlet of the ST UF septic tank. , f �." Firmly pull the filter handle s� and slide the cartr(dgA 4Ut. Remove the tank, of the C,9d; and pump the ' Note: A tee handle may ri@' necessary to pr t`i to be used it the filter is tbk e + any solid below ground level to escaping to th han dles Zabel for into when the f rem now— While holding the carttidoO <' �C the access opertin '' ���ff nm off hldl + t Insert the fllfer cartridge with frestl W0t.0 w o back in the C& W.Maki careful to rinse all A `t; su re the filt b properl 'Note: It is not neces OKI completely I a 'spotless'. The bioma aides in the pretreatme ` be /eh on the filter. (Ifn may be disass F ,, ii . Replace t y jo 't , h�' MADE W USA The product(s) shown are covered by one or more of the following patents: U.S. 5,762,793, 5,580,453, 5,591,331, 5,759,393, 5,683,577, 5,582,716, 5,779,896, 5,593,584,5,795,472,5,736,035, 4,710.295, 5,382,357, 5,482,621 U.S. Des. 386,241, 349067, 4605501,5098568, Des. 309007, Australia: 134440; Canada: 2,135,937; Israel: 111574; New Zealand: 264824, Other Patents Pending Call for a free ZABEL ZONE An Onsite Wastewater Magazine 1 -800- 221 -5742 - Website http: / /www.zabel.com A100/300-1-M.151499 PELKE PLUMBING Fax:715- 672 -5267 Oct 12 '05 14:02 P.02 ST. CROIX COIJNTY RECEIVED SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FO RM OCT 2 5 2006 pp ST. CROIX.COUNTY Owner(Buyer — : 0 �. cR Mailing Address _ (o � � S �� lZ Property Address 1 32 , s /�(� 5�� - �! c �,�,,�� � c�J,� �/7 (V required from Planting & Zoning Department for new construction.) ^� t l/ �J,Y . Parcel Identification Nb o on wner - ��D ° /a `� T1 �� U City /Stale �e� y�� / - LEGAL DESCRIPTION Property Location _ —' /• , '/• , Sec. ,2, T 30 N R Y W, Town of a n / � 1 L'ot # 2 Subdivision�� Certified Survey Ma P # , Volume , Page # I Warranty Deed # ` c� ( , Volume , Page # Spec house 9 no Lot lines identifiable 0 no SYSTEM MAINTENANCE AND OWNER CERTiFICATIO Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper mainteoancc consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comum. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form., signed by the owner and by a master plumber, journeyman plumber, restricted phtmber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after wspcction 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, C.ettification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Numbe f bedr SIG ATURE OF APPLICANTS) DATE * 9 "Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) z S 4 P 5 3 ]. XATHL.EEN N. MALS11 REGISTER OF DEEDS ST. CROIX Co., yI DOCUMENT NO. WARRANTY DEED RECEI'V1ED FOR RECORD 06/03/201.5 12:00p" WARRANTY DEED EXEMPT N This [seed, made between David A. Bali and iGmber A- Bali, husband R FEE: 13.00 and wife and Dennis F. Ball and Nancy A. Ball, husband and wife. TRANS A FEE: 3185.90 Grantors. and Gerald J. Smith, a married person, Grantee, COPY FEE: WITNESSETH, That the said grantors, for a valuable consideration CC FEE: convey to Grantee the following described real estate in St. Croix PACES: 2 County, State of Wisconsin.: RETURN TO: Parcel 1: The East Half of the East Half of the Southwest Quarter Loberg Law Office (E'/z 359 West Main Street 1E Ellsworth, WI 54011 lSW -) of Section Twenty Eight (28), Township Thirty (30) North, PID #026- 1082 - 40-000 Range Eighteen (18) West, Town of Richmond. St, Croix County, 026 - 1082 -70 -100 Wisconsin, EXCEPT Lot One (1) of Certified Survey Map filed April 026 - 1082 -95 -0001 24, 1990, In Vol. 8 of C.S.M., pg. 2199, as Doc. NO. 457843, being 026-10113-10-OW part of the Southwest Quarter of the Southeast Quarter (SWY.JSE' /.) and part cf the Southeast Quarter of the Southwest Quarter (SEM- 1SW "O.). both in Section Twenty Eight (28), Township Thirty (30) North, Range Eighteen (1 a) West. Parcel 2: The West Half of the Southeast Quarter (WY. !SE's;) of Section Twenty Eight (28), Township Thirty (30) North, Pange Eighteen (18) West, Town of Richmond, St. Croix County, Wisconsin, EXCEPT the following described parcels: 1. Lot One (!)of Certified Survey Map flied April 24.199D, in Vol. 8 Of C.S..M.,, pg. 2199, as Doc. No. 457843, being part of the Southwest Quarter of the Southeast Quarter (SW %/SE' /,) and part of the Southeast Quarter of the Southwest Quarter (SE' /. /SW"/.), both in Sectior. Twenty Eight (28), Township Thirty (30) North. Range Eighteen (181) West; 2. Lot One (1) of Certified Survey Map filed August 13, 1981, in Vol. 4 Of C —S.M., pg, 1093, as Doc. No. 372738, being part of the Southwest QLarter of the Southeast Quarter (SWY./SE %) of Section Twenty Eight (28). Township Thirty (30) North, Range Eighteen (16) West; 3, Cornmancing at the Southwest corner of Lot One (1) of Certified Survey Map filed August 13, 1981, in Vol. 4 of C.S.M., pg. 1093, as Doc. No 372738, for the pointof beginning: thence N89 °59'15" West 20,00 feet; thence NO'01'41" East 262.00 feet; thence S89'59'15" East 224.00 feet; thence SO - 0141' West 15.00 feet; thence N89'59'15" West 209.00 feet; thence SO 01'41" West 242.00 feet to the point of beginning; 4 Commencing at hhe Northeast corner of the Northwest Quarter of the Southeast Quarter (NW /4/SE " /.) of said Section 28; thence South 16 feet; thence Northwesterly to a point 10 feet West of the point of beginning, thence East to the point of beginning. This is not homestead property. Togetherwitn all and singular the hereditarnents and appurtenances thereunto belonging; And grantors warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions, covenants and conditions and will wanant and defend the same. O'd 9£bb ZLL 9 Ll, te6enj)l l r d9e :£0 90 9 L PO U 29 4 532 D thks 16th delay of May, 2005. -(SEAL) tbe SEAL) DBVid .A. Ball A. E3 1 SEAL) (SEAL) Dennis F. Serf Ba AUTHENTICATION ACKNOWLEDGMENT s ; "gnAture _ STATE OF MINNESOTA } :authetnt t this, a of t �ed a � y � COUNTY OF 2 -- Personally came before me this 16th day of May, 2005 the above named David A. Ball Kimberly A_ Ball and Dennis F. Ball and TITLE: MEMBER STATE BAR OF WISCONSIN Nancy A. Ball to me known to be the persons (if who executed the foregoing instrument an authorized §706.06. Wis. Stats.y acknoydedge the same THIS tNSTRUMENtT WAS DRAFTED BY a LOBERU LAYS! 4 F ICE_ Notery Public County,MN M Robed L Lo s Commission Is permanent. (&gnam ums may ba authantic.sed a ad.now"odoed Bph are not neoeac ry " (H not, state expiration date: , 20 ) Xb SST `d 0.42 T Ml.1i�Y� AN Coarrarrrlon gKw.�w 11. � t, 'd gZt7t' Z LL 9 LL ie6eni)i � r d LC :00 s0 L 100 n— I li 4ffi li j II I B fi it I I II $ i� II II i C7�p ii I I C��❑ li II —_ft -- i k II II 11 II A If i A g X11 Ii � H- H �Ii II � D J I K El II II >` II II II + la II ff ❑ i 04a0S NEW MOMC PLANS for. 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