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HomeMy WebLinkAbout026-1175-13-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No 506183 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: Miller Homes of Hudson, LLC Richmond, Town of 026- 1175 -13 -000 CST BM Elev: Insp. BM Elev. BM Description: Section/Town /Range /Map No: d j(ro� ( 30.30.18.1413 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic S ✓ Benchmark Q, /J 14 U 7 Dosing // Alt. BM 0 — ` 6 2 /O ar 44C le ?- 7 0 Aeration Bldg. Sewer •7S 37 of -D Holding St/Ht Inlet ,, L SU Outlet TANK SETBACK INFORMATION �Qz �9.- `�J 7.3 1D2- TANK TO P/L WELL BLDG. Vent to Intake ROAD Dt Inlet Septic ` '7 � Dt Bottom Dosing Header/Man. O- Aeration Dist. Pipe Holding Bot System 7 �f / 7- Fi nal Grad q PUMP /SIPHON INFORMATION C %�1 1'�•C� -L l�1 ��d S tiyi► (s_ 0 2 Manufacturer Deand St Cov P e Cam . j 10-7 - �. Model Number TDH Lift Friction Loss ystem Hea TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM '1 e (�QJto BED /TRENCH Width Length No. Of Trenched PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO [P X JBLDG IWELL LAKE /STREA LEACHIN Manufacturer: IN CHAMBER R Typ f System: —�� / V� U Model Number: DISTRIBUTION SYSTEM V rri ,&4 — Y Headac[Nlanifold Distribution / x Hole Size x Hole Spacing f�nt to Air Intak / 11 Pipe(s s / Length Dia Length_ Dia Spacing 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 6 1 1V Bed /Trench Center (// Bed /Trench Edges Topsoil Yes No s No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: - / U /0 Inspection #2: / PU Location: 911 131st A New Richmond 1 54017 (SW 1/4 SW 1/4 30 T30N R18W) Willo River East Lot 13 Parcel No: 30.30.18.1413 1.) Alt BM Description = !Qe of bl a j rd� - 2.) Bldg sewer length - amount of cover = Plan revision Required? Yes o Use other side for additional information. Date Insepctor's Si gnat re Cert No. SBD -6710 (R.3/97) e ✓a /liao.� by i31 ��� S Wl'S�SLtd %y 5[C . // .3C, 7. 3G;C 5 6. C ,-o ,E' ti I l I' • b3 I � � 3 °x'30 /o z .so' ` 2 /oGSo ___ -- - -� c p { /off 5,-'aee . NG 3 Safety and Buildings Divi ' n 201 W. Washington Ave., P. 0. 16 Cf 0 *6consin Madison, WI 53707 - 71 Sanitary Permit Number (to be filled in by Co.) Qe artment of Commerce (608) 266 -3151 C Sanitary Permit Applica do to Plan I.D r In accord with Comm 83.21, Wis. Adm. Code, personal info nation you provide may be used for secondary purposes Privacy Law, s1 .04(1 y U 9 2007 oject Address (if different than mailing address) feel( f3f 5t A I. Application Information — Pleas ri Information J ST. C ROtXCOUN+fY w RrC .,, � w, ryoI' Property Owner's Name jarcel # Block # � ! � /fe, � s LL c- l 3 4 3 — Property Owner's Mailing Address roperty Location �� , /� 3 Cd 1 ., 5 1 ., Section e � City, State Zip Code Phone Number ^� �[ 7 'S- 73 (- O 1 t l circle 1+ A S o v\ U�) � N; R `t% II. Type of Building (check all that apply) // .2'or 2 Family Dwelling - Number of Bedrooms � �� ICt V1 Subdivision Na CSM Number Name f� ❑ Public/Commercial — Descri a El State Owned —Describe U �� Q �-+ c k W S �. rity 0c_ ❑Village Township of ¢� Q M. Type of Permit: (Chec only one box on line A. Complete line B if applicable) i -- bQ A. New System ❑ Replacement System ❑ 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 IV. Type of POWTS System: Check all that apply) 2 ^ 3 4 0 ; 5T C.�I 15 1-v ; f� 23f Z 3 4 •fib Non — Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil. . ❑ At -Grade ❑ Single Pass Sand Filter El Constructed Wetland El Pressurized In- Ground 11 Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter El Recirculating Synthetic Media Filter ❑ Leaching Chamber Q Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis persal/Treatment Area Information: Design Flow (gpd Design Soil Applic Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units ���� �0 1=i :ZS Concrete Constructed Glass New Existing Tanks Tanks �/ Septic or Holding Tank Z W S-- — /� / Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) I Plumber's Signature ,, MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip ode) n VIII. CountylDepartment Use Onl Approved ❑ Sanitary Permit Fee (includes Groundwater D4ss Issuing nt Signatur (N tam s Surcharge Fee) 1 ❑ IX. Conditions of Approval/Reasons for Disapproval -o ro ✓�'�C O ot. ",_ r: r .3 �� ✓� e �G O iYift II 6"IR'. t 1. Septic tank, effluent flfter and ck.e_ Ae-Lo) kawceo dispersal cell must all be services / maintained I as per management plan provided by plumber. 2. AN se'lback requirements must be maintained a$ per applcable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x I1 inches in size SBD -6398 (R. 01/03) A 1f Na s t-� 3Is 7 - -- WE LL / k QL Rte. 7 r v �C V � Cb �� 3 x ca,li ; 4r s T r � qo � � y 0 � #I LA) I T - / 1 r,-f V!E LL / 2ZSO3� �'Z�f -off � �l, i \ I i 5Q � v �b I 3 Z 3 C'fu+ E Total r 9c� 3' 3 2061 Wisconsin Departmelmyi coerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil 8 Site Evaluations Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must County include, id not limited to: vertical and horizontal reference point (BM), direction and St. Croix b percent slope, scale or dimensions, north anew, and location and distance to nearest road. Parcel L D 026 -117 -13-000 Please print all information. Review By Date Persona inlomvkon you provide may be th ad fe 04 (1) (m)). / Z Property Owner F roperty Location Miller Homes Of Hudson, LLC E DA. Lot swig SW 1 S 30 T 30 N R 18 W Property Owner's Mailing Address t # Block # Subd. Name or CSM# P.O. Box 10 13 Willow River East City State Z C TP J City _J Village 0 Town Nearest Road Hudson WI Richmond 911 131 St Ave. IM New Construction Use: 16 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement I Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable na General comments and recommendations: Site suitable for conventional dispersal cell at 0.7 gpd loading rate. Recommended system elev. _ 98.00. E U Boring # J Boring I 0 Pit Ground Surface elev. 1 03.53 ft. Depth to limiting factor >1 17 " in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Swcture Consistence Boundary Roots in. Munsell Qu. Sz, Cont. Coke Gr. Sz, Sh. - Eff#1 ff#2 1 0-10 10yr3/2 none sl 2fsbk mvfr as 20mc 0.6 1.0 2 10 -28 10yr4 /4 none sil 2fsbk mvfr cw 2f,1 me 0.6 0.8 3 28 -36 10yr5/4 none sil lmsbk dsh cw 1fm 0.4 0.6 4 36-44 10yr4/6 none gr Is 0 sg dl cw if 0.7 1.6 5 44117 10yr5/6 none s 0 sg dl - - 0.7 1.6 0 �t .3b 16Z' Boring # I Boring 01 Pit Ground Surface elev. 101.35 ft. Depth to limiting factor ' 111 ° in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Stnx:ture Consistence Boundary Roots Q PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "E 1 1 0 -9 10yr3/2 none sl 2fsbk mvfr as 1 fmc 0.6 1.0 2 9 -23 10yr4/4 none sil 2fsbk mvfr cW 1fmc 0.6 0.8 3 23-32 7.5yr4/6 none Is 0 sg dl gs if 0.7 1.6 4 32-80 10yr4/6 none s 0 sg dl gs - 0.7 1.6 5 80 -111 10yr6/4 none s 0 sg dl - - 0.7 1.6 y 0 T. .Zy " Effluent #1 = SOD? 30 < 220 mg/L TSS >30 < 150 " Effluent #2 = BOD S30 mgJL and TSS 130 mg/l. CST Name (Please Print) Signature• CST Number James K. Thompson 5--- - 3602 Address A.C.E. Soil 8 Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osc e , 154020 12/15/2006 715- 248 -7767 Property Owner Miller Homes Of Hudson, LLC Parcel ID # 026 - 1175 -13 -000 Page 2 of 3 3] 01 Boring # J Boring Pit Ground Surface elev. 101.88 ft. Depth to limiting factor >111" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. *Eff#1 *Eff#2 1 0 -8 10yr3/2 none sl 2fsbk mvfr as 1fmc 0.6 1.0 2 8 -18 10yr4/4 none sil 2fsbk mvfr cw 1fmc 0.6 0.8 3 18 -29 7.5yr4/6 none Is 0 sg dt gs 1vf 0.7 1.6 4 29-96 10yr4/6 none s 0 sg di gs - 0.7 1.6 5 96 -111 10yr6/4 none s 0 sg dl - - 0.7 1.6 T ,1 d (0 ❑ Boring # Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Sol Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots WNW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 I F-1 Boring # J Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 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. SM -8330 (R.07 /00) A.C.E. Soil @ Ste Evaluatlom • So // e ✓a /uo -�o. -� 6 y So, j e da/ua 6',,h by S . &,-d 42,//S/02 • Low- �/�ro/�. S�a,�f'e i re G� N 13 O R /BGC'� 7 n. o{� PiCh mo/kd S E • C ro iX L"C- Cie - S Q G �l 1 I {'� "rebate E /ev =io3QB i f so I' I 3 a;•d�3 • �o 2 .so' i / /S.os/ &►K 1, y►'tcu.(�: yp o{ /off S . Assume& ew� O tt \\ \ I Q N CV Of \ \ u OW ct O o Ln \dl \ \ �js VU , ,�, L !L1' Fes• � � � Q i � � Z� `�. � 66 O � •1, \ O t \ F � / Y5 / o \ 4. C4 Im \\ \ Z"91 3 ® .IOfly r RIVEyyAY :` $ Q) ul Q / EASEMENT �o ss5 fteaea.t is C O �-� w J c I N ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND nA OWNERSHIP CERTIFICATION FORM Owner/Buyer / ' 1 (ter a y�,� L LC Mailing Address W o Property Address f 1 3 5 t 7 )n - (Verification required from Planning & Zoning Department for new construction.) r d City /State NEVY R it V W o ugh _ Parcel Identification Number 0ft tc '70 - o 75 LEGAL DESCRIPTION / l Property Location :5 Gy '/ , '/4 , Sec. ' S ° , T 3CD N R IS own of k' wo Subdivision W I I o w F QsT ` t' _,C4 � Lot # 3 Certified Survey Map # T7 g - ,Volume 8 , Page e # qO Warranty Deed # 0 Z 3 , Volume Z� , Page # Z Z- Spec house yes no Lot lines identifiable ye no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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 alreatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 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 plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 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. Number of bedrooms ATURE OF APPLICANTS) DATE ** *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) a03a33 State Bar l of Wisc Fo -2003 REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., WI Document Number Document Name RECEIVED FOR RECORD 08/12/2005 09:554M WARRANTY DEED THIS DEED, made between David H. Railsback a/k/a David H. Railsback II and EXEMPT # Aria J. Railsback, husband and wife REC FEE: 11.00 -` TRANS FEE: 1287.00 ( "Grantor," whether one or more), COPFEEEE : and Mi11PrHomes of Hudson, LLC PAGES: 1 ( "Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following Name and Return Address described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is needed, please attach addendum): Lots 1, 9, 13, 17, 18 and 20, Plat of Willow River East in the Town of Richmond, St. Croix County, Wisconsin. - Part of: 026 - 1088 -95 -000 & 026 - 1091.70 -M Parcel Identification Number (P[N) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated SEAL —�� ( ) � � (SEAL) *David H. Railsback, II / * (SEAL) 1• H.� td/� 0 CG (SEAL) *Aria J. Railsback AUTHENTICATION ACKNOWLEDGMENT Signatures) David H. Railsback. * II and Aria J Railsback husband and wife STATE OF ) authenticated on ) ss. COUNTY ) *Kristina O land Personally came before me on TITLE: MEMBER STATE BAR OF WISCONSIN the above -named (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: * Attornev Kristina Ogland Notary Public, State of Hudson, WI 54016 My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledge. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED O 2003 STATE BAR OF WISCONSIN FORM NO. 2 -2003 • Type name below signatures. INFO -PROTM Legal Forms 800 - 655.2021 www.infoprofonns.com POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _ of FILE INFORMATION SYSTEM SPECIFICATIONS Owner �/ ( Il -✓ �70��g L.� C Septic Tank Capacity gal ❑ NA Permit # Septic Tank Manufacturer "/ ❑ NA DESIGN PARAMETERS pfluent Filter Manufacturer /0,v �'� 11 NA Number of Bedrooms ❑ NA Effluent Filter Model �[ - T2_ ❑ NA Number of Public Facility Units ' %NA Pump Tank Capacity gal l NA Estimated flow (average) al /da' Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) © al /day Pump Manufacturer X NA Soil Application Rate d. 7 gal/day/ft' Pump Model 0 NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit $r 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) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L yIn- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) _510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA y ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA ❑ year(s) Clean effluent filter At least once every: 1 _ Z ❑ month(s) El NA 9 year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ year(s) El 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. START UP AND OPERATION Page _ of 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 bell(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. ❑ T pp,6(4 (61 Tgo F' ©R #6W ceN St iPucT10N ❑ 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 M; k 4__ l ` Name Phone 15-- '790 - Z F Z.s Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 5-: Cio t k Phone Phone - 3S6 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. 'START UP AND OPERATION Page of 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 lev . 91s. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cells) 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. ❑ T pp, F"Op - #ew r -sly sr&)0 /oN ❑ 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 M1 W �I7oti� r Name Phone 15'_ 76 D . Z F Zs- Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 5t. Cia ; X t o -q A, ; �, Phone Phone -7 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. "' ILL EAC l LO �� ��� � � �! ® sue► - _ i. Aa'.'A tnS _,ti, ',�.>>) f®YialCSH is "W U► �. -. Ise'. , � r :� �rnts • I !1T -t / r I.dd ;,1iE5 � 61 to :0.t • a [a v u 14 3 r/ (, / V . 1 .� i 1•. '11� v ern M r % cs � r 3 P OO L07 3 i �Cl F 1 / \J\ :Sr - LCY -M lb LOT 10 kCrjM 'LJJfI 75JAWE`' j~p LCT0 ,�' Itcnn:n.n J PL rt n1 Y \ �A { .� rr lJT1J - 7 14 ICAE° • / c . � aJW .q r. 4 3 t. ti v �� �\ r f �) X LOT ,c �g.� OT 12 a OY �.'..rl�(Vi N lv .'�yr� *' lfl..V> y �' �`��� r r ., / /���1 / ✓' ' ' 111..1 i wt- ,'.'.A.'/rR.r_�r•C •f ' ( i .'\ \L� .• .�, \f; tE.'er�.p:rprr Ul J)F -�JJ rfT -1 " LOCATION SNFTCN \ F L& T f. Tf i I Call Jim Henry & Associates for more details. • (800)221 -SOLD RUMNX Information deemed reliable but not guaranteed. Jim Henry & A ssocia tes C�Qir Need LLc w; /how ie:uIr" tj Quick4 STANDARD CHAMBER i Quick4 Standard Chamber --- —- - - - - -- 4e" — - - - - -- I (EFFECTIVE LENGTH) e i e SIDE VIEW SECTION VIEW I MultiPort End Cap r - i - r 1. 16" TOP VIEW -- 34„ I - - - - -- _..� SIDE VIEW I - FRONT VIEW Quick4 Standard Chamber Nomm� , " iCtons ? MuItlPort End Cap Nominal Specifications ' Size (W x L x H)' r ' Ow 4MtStt52" x,12 h Size`(W x L x H) : 34" x 16"x 12" Effective Length InVert,Helght r 8" or 1.25" `t Invert Height- F , 'a;'� r"h I-- NFILTRATOR SYSTEMS INC. STANDARD LIMITED WARRANTY :. .,I "in I nt 1,7h ehamtwr, bed slat ^.. wedge and other accessory manufactured by ofilPalor [ "I lnib; - r when m5laltfxl and opnralc'I of -, cvVe" ir, a,c, rdan;e. wilh Inlllrator's mslrucllons, is warranted to the ongin 11 r I el3 t -,, ( "riolder'1 aorr nsi dofm:flva - r ) 'e c IFe , late Iha the sepllc palm t is SSUed IOr the ,,I, Syslnn' coma , ng IhY L fS. U V V ried. howoye et dh a)II t"I" a the . pP oclwll beg Upon the d 1( Ih 1 n;Iallalo n II snotf Y. IP. .( ; n n. o I g I I Coroorale Headgl art Old Sdyfl n k, , OCI 11 rlt , I ,1 - ' • - ' f •+ . Jar_ e I I I IS to '1 Is d rm elened by Inlltr, 0 o I eovr -,or , ,j .,v L.: Ind Wananly - -a) anti /nr ,.lanai", of Iha Un is. O ,• r 1. t`;'A ;If W R IN S U BP ARA GRA PH I IES MER CHANTABILITY tai ARE EXCL FE AHF, NO 01WI_R 110 )S TIF> WITH HESFr.( * S Y STEM S I N C l 'A", E El I W A R l. a:1M IES OF MERCHAN'TABII 11V CSR R FIT FRN[SS Hf� I -(1F A I'r11711C;L IL l�F Plll il'()>E he vo.d l any I,a l of he chamber system s rnanufacl,red by an,con other Iha, II Ilritol In, LII1 War Inly ,In v _ C l a lb-11 n indlrecl dan,agas. Infiltrator shall not bb liable to nonatlas or no,MI1,11 damages indirbog less c Environmental Onsite Wastewater Solutions'" J Tale a s o F -d costs or nine losses or expenses ncI ,raft by Iho Hnld or IfIrd briny. Spnolcally V, y cn .r a i ,,e d; r ace to u e LMR, dire to ordinary wear and r. - ,u it rc d t. e. ab or neglect or Bu siness O eh c' t a ", > her con<fLOnS which are not permitted by tl e 1111, o t o 11l e to rn Ian Ihn 6 Bu siness P ark R P O. • f :0. Box 768 •s s, fblh,n n ns Mal 11 n. I UGI O the placement of Improper male IO it n y 1 'n I� 1 Ih LI I I rte nl am due t') g p p ofv. _ z,g. excenNe water usa f pe . , p d s' r � 11 n, - ;,;I1 Old Saybrook, CT 06475 `. d by Infiltral Th I eci Warranty shall be ypld H the Holder falls to co ,pro wlh au I th ItRmv ^.et lone n Ihis L rn tat 860 - 577 -7000 " FAX 860 - 577 -7001 I shall lnfitir,,jol be c hl - „any o55 n, damage to the Holder 11 Unils or any t. rd t d o.'.II g nsl: '111 n 0 sit I' ���'�� ' �� 37 r�� " orc liability Clan 1 .e' o am n rh rd oarty For this Limited Warranty f, l pl I l t 1 1 5 alle r , Int.. 1'. cn reoured by Slat- , '.O fes 111 other applicable laws: 3 (I Firato ,..1 anal nn or 'I ,r 5la- a,i ahangc or extend I he Lnnled War N uy�'Pplc h;" i I a',ly 011(it' by Infllral nr A Ln,lod nI nbn, of „air r; I•.Ilnr ,t ,1 -oI ralor'S Cnroomle Heaclo,aners in Olo Sayb <,( �C. „ nc1 I � >r..r, I, .1 4 i cha :f? tc ol n 1 c 1 aI' -10 i ra..l i1, .a .,.I1 wr rranty prior In Iha b rcha:ae of 11 Ii1 Oa 5 1 `16. r' 81. 5. 336. 017 :5,401,116' 5.401,459. 5 1 1 J903, 716,163. 5588 778. -: f139.f344 t 9. 2.007 Sf> Oiher patents pending. -i - o SoFW ooe art: rr,g slered trademarks of Infiltrator Systems Inc. Infilti-hlor is ,l ru>ylstered trademark rn franca. Inf ll,110r Systems Inc ^ a ' "K in VBXICO Contour_ Conlonr Swivel Connection, Micro Leaching, PolyTUfl, Snapl_oek ChamberSpacer. Posit Ock, QuickOUt. OUIckPlay RECYCLED VIPER �f Infiltrator $ystrgms Inc. © 2003 Infiltrator Systems Inc. Prinled in U.SA Rugg C— � ti �XY X94 � 1 l �dLJ �♦ ���.� �5� ����� ® o Filters t � PL -525 EFFLUENT FILTER Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters.The PL -525 is rated for over 10,000 GPD Alarm (gallons per day) making it one of accessibility Accepts PVC the largest commercial filters in its extension handle class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL -122, the new Polylok PL -525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1/16" removed for cleaning, the ball will filtration slots j Rated for over float up and temporarily shut off 10,000 GPD the system so the effluent won't leave the tank. No other filter on the market can make that claim! Accepts 4" & 6" �. SCHD. 40 Pipe q; PL -525 Maintenance: The PL -525 Effluent Filter should - - operate efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned \� every time the tank is pumped or at least every three years. If the installed filter contains an optionalt, alarm, the owner will be notified by an alarm when the filter needs i servicing. Servicing should be Gas deflector done by a certified septic tank `�,� � Automaticshut-ofi pumper or installer. '' 'f �C ball when filter 1. Locate the outlet of the U.S. Patern No# 6,015,488 is removed septic tank. 5,871,640 2. Remove tank cover and pump tank if necessary. PL-525 Installation: 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover ane 4. Pull PL -525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the tank. Make sure all solids fall 4" or 6" outlet pipe. If the filter is not centered under the back into septic tank. access opening use a Pol IOK p 9 ti 6. Insert the filter cartridge back Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL -525 filter into completely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic [ank ; Over z�chnical Specifications PL- -525 EFFLUENT FILTER (CDIVI MER6AL) — 61?'BALL CHECK — EXCEPTS6'SHO40 ` FOR INLETEXTENTICN 11.57 11 35 I .. OUTLET BUSHING EXCEPTS - -• 4' SCH 4086' SCH 40'��' 6.10 ub 10.68 r n i - 527 ��L�i73e � i I 73.02 PL -525 FILTER HOUSING ^; 1&34 PART N0. -3014 2-525 -- - i MATERIAL' HOUSING• POLYPROPYLENE i { ...ill -- OUTLETBUSHING -PVC 6.5 BALL • HDPE u 1 J 1 -- SOCI(ET EXCEPTS FLOAT SWTCN - --- __� - - T 1 Ion -- EXCEPTS I'SCH 40 l )� .9B — I� FOR HMIOLE EXTEN77ON _� - - _ I I 10.84 r I � 570' OF i P 6'SLOTS I 624 4 - J A _617 - -- -- SOCKETEXCEPTS 6.04 BALL PUSH ROD - - -- OPENING - -y 1 O o OPENING 20.71 � O O 19.02 2244 POLYLOK PL -525 FILTER CARTRIDGE PART NO. • 30141.525 MATERIAL • POLYPROPYLENE _ J I Polylok PL -525 Support Stand Should you feel it necessary to add additional support to the PL -525 filter, use a six -inch Schedule 40 or SDR 35 pipe to extend from the base of the e needs to be i anchored to filter to the bottom of the tank. The extention p ipe the filter housing with one or two #10,.X 112" SS screws. Anchor 1 -2 Stainless steel screws through housing nd into pipe, g Use #10 X 112" 6" Schedule 40 Pipe Pipe rests on bottom of tank �� Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach compete site plan on paper not less than 81/2 x 11 inches in size. Plan must C � I include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions. n a0M a[Ig loca and distance to nearest road. Please prfn all l� E � R by Date dag, a Personal information you Provide may be ro secondary purposes (Privacy Law, s. 15.04 (1) ter))• \ y _ - N 5 2003 P ` � sv) 30 �Q Q GoLLot N0 1i4 1/4 S' T d N R U E( W Property Owner's Matting Address ST. CFZ01X000iVTY Block# Sub Narpeor N G OFFICE i 6 l T' ow ` V EfLOt c* / pate , Zip Code Phone Number ❑ City ❑ V T Road L�� ( ) Af New Consbud'ion Use: Z Residential / Number of bedrooms Code derived design flow rat GPD ❑ Replacement ❑ Public or commercial - Describe: -- Parent material © -c ) � Plain eleva ' if appNdable NI l3 ft General comments and recommendations: Sy Sk , — , Bori / Q4 .�.� �. ieri M R # a Pit Ground surface elev. Depth to limiting faclor �� in. Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDII? In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EW1 •01192 Z 1230 -- S t s D / - 9fa • so ® Boring # Boring Pit Ground surface ee / v. � ft. Depth to ikriiting factor &a in ' Sol Rate Horizon Depth Dominant Redox Description Texture Structure Consistence Boundary Roots GPDW In. Mansell Qu. Sz Cont. Color Gr. Sz. Sh. •Efl#1 •Etf#2 1 61 3 -- 5 L -M r s Z ry, r ' .� 2 a-� CL 3 .Z 3 t Cur y/ . i S / ri La I • 7 JA or�-Rb •sv' • Eftmx t #1 = WD > 30 710 mg& and TSS >30 1 • Eftent #2 = BOD < 30 mg& and TSS 130 nVL csr (Pease ,r�a�. 2Z rwr,bar Address Date Evaluation Conducted Telephone Number n J Property Owner Parcel ID # Page d M - 1 &WIng # Boring apit Ground surface elev. JS1SL ft. Depth to limiting facto in. sod Application gate Hortmn Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 'E9#2 i d�)2 IO ,�31z 5 V G 5 2 C rw t� �;Z y� 5 m► 11 0 la n A - /z Boring at 4� •o F-1 # ❑ Boring ❑ Pit Ground surface elm ft. Depth to limiting factor au. Sod Applicab Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlFf in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # Boring ❑ Pit Ground surface elev. ft. Depth to limiling factor in. Sod Rye Hodmn Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDfff In. Munsell Qu. Sz Court. Color Gr. Sz. Sh. `Eff#1 'Eff#2 I ' Effluent #1 = 8013 > 30 220 mg1L and TSS >30 1150 mglL ` Effluent #2 = BOD _< 30 nV& and TSS 130 mgll 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- 2648777. seo4330(r.eoo) r I3 -3 M Soil Test Plot Plan Project Name David Railsback Shaun B' Address 845 133rd Ave New Richmond Wi 54017 CS #226900 Lot 13 Subdivision Date 12/12/02 SW/NW 1 /4SW /N W 1 /4S 30/31 T 30 N/R 18 W Township Richmond E] Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 97.0/96.5 *HRpSame as Benchmark Alt. BM Top of Steel Fence Post @a 104.0' Please Note: Tested area may not be suitable for desired building area. Check system location before excavating. Soil test was done to satisfy Zoning Requirement. 307' Property Line — 0 c+� B -3 100.5' 45' 100' -1 20' 65' M. B -2 1% 5' Slope 10 Property �p Line e Line