HomeMy WebLinkAbout261-1211-00-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name.
City Village Township
Doug Trogstad
CITY OF NEW RICHMOND
CST BM Elev.
Insp. BM Elev:
BM Description:
� , O-D
5 �
TANK INFORMATION
TYPE
MANUFACTURER
rf�n iA
CAPACITY
Septic
r Doi�
161
r {
I I kj , atv�
Aera
I ing
TANK SETBACK INFORMATION
WIFERAIWAIWAIWASEVA
PUMP/SIPHON INFORMATION
nufacturer
wa"
Deman
GPM
Model ber¢,,
•-
TDH
ILift <rriction
Loss
System Head
T Ft
F main
Lengt
Dist to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length
DIMENSIONS LA
SETBACK SYSTEM TO P/L
INFORMATION
Type,pOf System
DISTRIBUTION SYSTEM
Of Tre es
JBUDG j 1W1ELL
0.'1G` t-
ELEVATION DATA J
County: St. Croix
Sanitary Permit No:
615387
State Plan ID No:
Parcel Tax No:
261-1211-00-000
Section/Town/Range/Map No:
Bldg. Sewer
St/Ht Outlet
St Cover
PIT DIMENSIONS No. Of Pits
LAKE/STREAM LEACHING
CHAMBER OR
j UNIT
Inside Dia. (Liquid Depth
Manufacturer
Model Number:
Header/Manifold
Distribution 1
x Hole Size
x Hole Spacing
Vent to it Intake
Pipe(s)
S
Length Dia
Length Dia Spacing
i1
SOIL COVER x Pressure Svstems Only xx Mound Or At Grade Svstems Only
Depth Over
Depth Over
xx Depth of i 1reeded/Sodded,,,e"'xx
Mul:LYe
Bed/Trench Center
Bed/Trench Edges
Topsoil
�
Yes �❑ No
�[_] No
COMMENTS: (Include code discrepencies, gomresent, e,,tc.) Inspection #1: G�L � � Inspection #2:
Location: No Address AVAilable �,11 � 1 V )M( ' 0 C/vo I In C � `-(�,�
� 1 a �x\
41 1.) Alt BM Description = of ( ,,^^•� , J 1lJ ��y
2.) Bldg sewer length = � 1 ►��,
- amount of cover = A 4 4 2-r„, Lill fed An, �uc
9S
1
Plan revision Required? ❑Yes ❑ No
Use other side for additional information.
Date Insepctor's Signature Cert. No.
SBD-6710 (R.3/97)
C
--
D 1\ ,
,VAxrtrit,,
J - J
County
Industry Services Division
S%', CR.o 1 X
�, ill
r
JUL 15 2019
1400 E Washin ton Ave
,P.O. Box 7162
Sanitary Permit Number (to be filled in by Co.) ,
j
St. Croix County
Madison, WI 07 16
k53'5-7
ni Development
Sanitary Permit Applieptio i
State Transaction Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate govern it
0 (0 9 --� c
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are subtpitte to
the Department of Safety and Professional Services. Personal information you provide may be used for seco ry
Project Address (t t Brent than mailing address)
!Poses in accordance with the Privacy Law, s. 15.04(1)(m), Slats.
I. Application Information - Please Print All Information
Property Owner's Name t C�
Parcel #
i
Property Owner's MailingAddress
Property Location
Govt. Lot
�� '/4, S(�'/,, Slection a14
City, State
Ziitp, Code
Phone Number
`1 Agep, Pvc � elo -LTS
55d�
q
� �5 g� - a�5q
one)
1•�I�
/
1 N R lg(ciEloe
1I. Type of Building (check all that apply)
of #
Subdivision Name
❑ 1 or 2 Family Dwelling - Number of Bedr oms
�D
12 �(/Jr>w
!
Lzt t,� ua --3
rublic/Commercial - Describe Use
Block
✓ /w
__ tt
PsCity of N&W 1J� 4NCIV
❑ State Owned Describe
- Use
El Village of
CSM Number
❑ Town of j
III.
T e eck only one box on line A. Complete line B if applicable) 2 d a— j
A
X New System
❑ Replacement System
❑ Treatment/HoldingTank Replacement Only
p y
El Other Modification to Existing System (explain)
B.
❑ Permit Renewal
❑ Permit Revision
❑ Change of
❑ Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration
Plumber
Owner
IV=Non-Pressaunrized
tem/Com onent/Device: Check all that apply)
n-Ground ressurized In -Ground ❑ At -Grade ❑ Mound> 24 in. of suitable soil ❑ Mound< 24 in. of suitable soil
ispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dis ersal/Treatme Area Information:
Design Flow (gpd)
3'3.5
Design Soil AppliZ tion
Rate(gpdsf) ^(
Dispersal Area Required (so
Dispersal AreaProposed (sf)
System
CjElev, 'on
I
VI. Tank Info
Capacity in
Gallons
Total
Gallon
# of
Units
Manufacturer
New Tanks
Existing Tanks
i t ''!
Aal-
a U
cn h
Ln
i.L
Septic or Holding Tank
U.n_
tell'
C❑?
❑
❑
❑
❑
Dosing Chamber
❑
❑
❑
❑
VII. Responsibility Statement- I, the undersigned, assume nsi 7 r installation of the POWTS shown on the attached plans.
Plumber's Name (Print)
Plumber's Sig
MP/MPRS Number
Business Phone Number
Todd Sinz
139462
715-235-2644
Plumber's Address (Street, City, State, Zip Code)
T. L. Sinz Plumbing, Inc. E5609 708th Ave. Menomonie WI 5475
� I
VIII ount /De artment Use ( j
Approved
Disapprov
Permit Fee
Date sued
Issu, gent Sign ure j
net Given Reason for nial
$ 660 . oe
7 ZZ �l
IX. Condi Disapproval 3, �� ti ✓ % f2 �� ;
dkpmgw cell !rust dfl e¢�►t-ISrn ! r-,iaWrgL oil
t-
�wpeIr lypin pMent plan p,o ridwi by plu,nbe . I l� f�YF�E�
2. A/Nt>ft r�rer�etals tn�trtw t-�w t:Ir.af. /� p n /
• per applarbm Cad? 1 drtlihi11Y6I1. T l /1I n .. _.,.� Ll• n� _ d (_ ,. AM.� o L l
At[ach [o complete plans for the system ands mit tot a County only on paper not less than 8 V2 x 11 inches in siz
SBD-6398 (R03/14)
WhA
I rr?
O'd,
, liii:irk �Ak '.) , I , 1" 1.) !WV1
DIVISION OF INDUSTRY SERVICES
2331 SAN LUIS PL
GREEN BAY WI 54304-5211
Contact Through Relay
http://dsps.vA.gov/programs/industry-services
www.vrisconsin.gov
Tony Evers - Governor
Dawn Crim - Secretary
June 25, 2019
CONDITIONAL APPROVAL Conditionally
PLAN APPROVAL EXPIRES: 2021-06-25 APPROVED
Plan Review: PWTS-061900919-C DEPT. OF SAFETY AND PROFESSIONAL
SERVICES
TODD L SINz DIVISION OF INDUSTRY SERVICES
E5609 708th Ave
Menomonie WI 54751
SITE: Doug Trogstad
Hanger Road J
Town of NEW RICHMOND
Saint Croix County
SEE CORRESPONDENCE
Total Amount: $250
FOR:
In -ground Component Manual - Ver. 2.0, SBD-10705-
P (N.01/01, R 10/12)
Description: 133.50 GPD-New Public In -ground
Maintenance Required
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be
constructed and located in accordance with the enclosed approved plans and with any component manual(s)
referenced above. 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:
Key Items- POWTS Design Approval
• The design included the principles and best management practices of the In -ground Soil Absorption
Component Manual for Private Onsite Wastewater Treatment Systems Version 2.0" SBD-10705-P
(N.01 /01).
• Verify west property line location.
• Provide surface water diversion around the treatment tanks and dispersal component.
• The owner is responsible for the operation and maintenance of the private onsite wastewater treatment
system (POWTS) in accordance with SPS 383 and the approved management plan
• The owner of a POWTS shall be responsible for ensuring that access opening covers remain locked or
secured except for inspection, evaluation, maintenance or servicing purposes.
• Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual
for the POWTS described in this approval.
• Provide a copy of the approved POWTS plans and this letter to the owner.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representa[ives of the Department, which ma\ include lo. al inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
constructioniinstallation, operation.
In granting this approval the Division of Industry Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state slats I111.1 ?(?). nothing in this rcti icw
shall relieve the designer of the responsibility tier designing a sate building, structure, or component.
Inquiries concerning this correspondence: may he made to me at the telephone numher listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any
others who arc responsible for the ins[allation, operation or maintenance of the POWTS.
Sincerelv,
Mark S Finger
POWTS Wastewater Specialist, Division of Indt.tstry Services
(608)5674-1189
€ii.itk i.n �'E ff:i I �(jV
._ _ �_.__.....
APPLICATION FOR REVIEW
P S -Complete all pages -
NOTE: Personal information you provide may be used for secondary purposes
[Privacy Law i. 15.04(l)(m), Stats]
Private Onsite
Wastewater Treatment
Systems
Division of Industry Services
.. . . ........ . . . - ----- -
E) Plans to be F-filed. Provide SharePoint User name below: For plan status, check our website at
Email technical code questions to
Several counties have been delegated certain authority to review plans in lieu of Division of Industry services. For
a current list of those
counties and their dt!&natjon check our website at
1. Project Informatlom.Z Fill in all known Information.
Confirmation of assignment to a reviewer.
Project/Site Name: 7-4-Y2
Transaction ID:
Location, Number & Street of project (if unknown, in acated nearest road)
i Previous Related Trans. ID:
Estimated Completion Date:
Assigned Reviewer:
Nu (AE
I Legal Description- A)
County
Assigned Office:
City 13 village EBTo-"- of I
—rJk�
Mail to your office of choice below:
LaCrosse, Green Bay
Z After plans are reviewed, please: (check all that apply)
Call customer 1, 2 (circle number)*
NOTE: We reserve the right to re -distribute plans to another office it
Requesting party will pick up
needed to reasonably balance turnaround times. Check
El Mail plans to customer 1, 2 (circle number)*
for next available review date
*Refers to customer number from below.
3. Complete the following designer/owner/requesting information. Utilize the check boxes when designer, owner or requesting party is the same to
avoid repeating information.
Designer Information (Customer 1) DSPS
. . . . . . . .. .............. . ...........
Other Please Specify Below (Customer 2) DSPS
First Lasj SML I rp J toer Number
0J
First Name Last Name Customer Number
Compan
rV I— V-1 AJ V'I (ZI luc
Company Name
Address
rS rb 0 -
Address
City State —Zip+4 (9 digits)
Clty� +(9 digits)
PhoneNumber E-mail address Cell phone
Phone Number E-mailaddresj--Cell phone_
(area code) i
- -Check
(area code)
Check if applicable or specify —r`eWtionship
if epplicable
Owner
El Owner El Other - speci relationship
Information and Plan Submittal Checklists. To request electronic plan review complete the appropriate application form and e-mail it,
along with your registered SharePoint usernarne to i_ "-. : I I � .- If plans are being submitted via paper, they 1
will be assigned to a reviewer after receipt at a DSPS office. Submittal checklists can be found in each applicable component manual
'Lappeattng on the PC7{NTS program page under Publications
La Crosse Area DSPS Green Bay DSPS
3824 Creekside Ln 2331 San Luis Place
Holman, WI 54636 Green Bay, Wl 54304
608-785-9334 920-492-5501
Fax: 608-785-9330 Fax 920-492-5604
Email: Email:
Make Checks Payable to: Division of Indus S rvices
heck boxX to inVoloic deli n r and sign below TOTAL AMOUNT DUE $
Review Code 7633
it
Designer Signature_
SPS-10577 (R 4/18)
5. POWTS SUITTAL (check all that dppiy -incomplete forms may result in processing delays)
---- ------
L--,rmr-vv L_J Aerobic Treatment Unit(s) D Chlorinator EJJ Tank Replacement Only
❑ REPLACEMENT ❑ Commercial System D UV Disinfection Unit E]Add Effluent Filter
SYSTEM TYPE(S) NOTE: Submit separate sheets for each system if submitting multiple systems on the same site Enter Fee
Revision to previously approved plan
$85.00
El Miscellaneous Review (i.e. replacement of a septic tank, addition of an effluent
filter or pretreatment
device to an existing system, etc.) $80/hr
D-C."ponent Manual
Design
All treatment components are previously approved
Ej At-Gracip Component Manual - Ver. 2.0, SBD-1 0854 (N.03/07, R. 1/12)
Wastewater Flow in
under s. SPS 384.10 (2) or (3),
["J<n-'ground Component Manual - Ver. 2.0, SBD-10705-P (N.01/01, R 10/12)
Gallons Per day
El Mound Component Manual-Ver. 2.0, SBD-10691-P (N.01/01, R 10112)
3 3, s-
Desigr wastewater flow of the proposed
I system:
(yam y
El Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R 10/12)
1,000
❑ Other - Please specify
GPD
gpd or less $ 250 00
1, 001 - 2,000 gpd $325.00
1411000
❑ Soil Based Individual Site Design*
One or more treatment components arenot
9 no
❑ At Grade
previously approved under s. SPS 384.2'or (3)
j
ual site design/deviation from component
r mpnent
E] Non -Pressurized In -ground
El Pressurized In -ground
Design
manuals and use of components without product
approval):
El Mound
Wastewater Flow In
Drip -line
Gallons Per day
Design wastewater flow of the proposed system
❑ Constructed wetlands
Documentation must be provided to Support treatment and dispersal claims. In a separate
GPD
1,000 gpd or less V'50.00
1,001 - 2,000 god $600.00
statement, provide rationale for the project and attach supporting documents (code sections, test
reports. technical papers, research articles. etc.)
2,001 - 5,000 gpd $750.00
greater than 5,000 god S900.00
State-owned facilities:
plus $0.08 for each gallon over 5000 gpd
Holding tanks previously approved under b.
El Holding Tank Component Manual, Ver. 2.0,
Design
Wastewater Flow in.
lzro
384.10 (2)(3), Design wastewater flow of the
SBD-10855-P (N.03107, R1/12)*
proposed system:
Gallons Per day
Non -state owned Commercial and Residential Holding tanks that completely utilize this manual i
5,000 gpd or less $90.00
and have an estimated daily flow of less than 3000 gallons per day must be submitted to the
5,001 - 10,,000 gpd $150.00
appropriate governmental unit for review instead of the Department. [see SPS 383.32(3)(@)J
GPD
greater than 10,000 gpd $225.00
❑ Holding Tank Individual Site Design*, (i.e. site constructed, <5 day holding capacity, Co- I Holding tanks including site constructed tanks NOT
mingled wastewater, etc.) Design
I previously approved under s. SPS 384.10 (2) or (3). ( i
Please specify: Wastewater Flow in Design wastewater flow of the proposed system:
Gallons Per day
Documentation must be provided to support the rationale for 5,000 gpd or less $180-00
the project. in a separate statement,
5,001 - 10, 000
please Include all code sections, test reports, technical papers, research articles, etc.)
than 10gpd
GPD greater ,000 gpd $450,$300.00 00
El Soil Saturation Determination Report (using observation pipes) M Interpretive Determination -
$240.00
❑ Experimental System (One time additional fee). Submit fee for individual system as per appropriate above system type) Experiment Number $400.00
Priority Review (enter same amount as normal review fee listed above) $
Enter Total (rounded to the nearest dollar) $ 4�
SPS-10577 (R 4/18)
Construction Materials S-, Techniques
All materials must comply with Comm 84 and be installed in accordance with manufacturer's
specifications. Construction methods must comply with the hollowing Component Manual:
In -ground Absorption (�'. 2.0) - SRI) — 10705- 1)
Location: SWI/4 SWI/4 S24'131NR18W
Town of New Richmond
County: St Croix
Date: 5-22-20 19
Owner: Doug Trogstad
Address: 7331 Braden Trail
Inver Grove Heights MN 55076
Plurnber: Todd Sin7, A
Signature:
License # MP 139462
Attachments: 6748 Plan Approval Application
SPS 381-385
Page 1: Cover
22- Design criteria and sizing
3: Plot plan 6: Effuent Filter
4- drainfield cross section 7 :0-micrs ;Manual
5: Septic Tank. 8: Management Plan
C,
Yes Wastewater Contaminant Load:
Anticipated septic tank effluent
3 FTE I x 13 x 1.5
2 floor Drains 25 x I x 1.5
Min.Design Flow
Drainfield Design Flow
Page I of 7
30 rn,,/I, < BOD5 < 220 nig/L
30 nig/L <TSS < 150 mg/l...
4:7
Fecal Co 11 form > 10,000 c fu/ 100 mt.
Fats, oils, grease < 30 mg/L
58.5 gallons/day
75 gallons/day
= 133.5 gallons./day
= 133.5 Gallons/day
Design Calculations
In situ designed loading rate 150 gallons/sq. ft. per day
Depth to estimate high ground water >I 00 in.
Depth to bedrock >1 00 in,
Cross slope at system Flat%
Septic tank Huffeutt 600 gallons
New Effluent filter Lifetimei.TI/8
Septic Tank Sizing And Liftstation.
Minitnuin septic tank size required for 3 years service frequency is 313 gallons by spreadsheet
Calculation.- Using Huffcutt 600 gallon septic .
Trench Sizing
133.5 gpd/.7 per sq ft = 190.71 sq. ft minimum effective area for medium sands
Install 10 infiltrator, Quick 4-W shells which f— 20 sq. ft each EISA plus I x 5.8 sq ft for a pair
I 9�1
of end caps gives, 205.8 sq ft FISA. ***We are over sizing this system..***
Ell
-10
ffi
-31
O'd 1,
Soil Absorption System Cross Section
PVC Vent Pipe
With Vent Cap
Leaching
Chamber U U
ft
Soil Absorption Systern_Rlan-View
Vent OrObservation Pipe
Leachina Chamber Specifications
Manufacturer And Model
*�" w~7
E|SA Rating��/ mq ftper ohannbar Soil Application F�ote_��_�_gpd/mq M
��gpd Design Flow *%~) ` Soil Application Rote + E|SA = {} Chambers
[
Page �� 1�
WARNINGLABEL >.MBECDED IN-0
r CONCRETE COVFR READS AS FOLLOWS;
.r ' CAUTION.
DO NOT ENTER WITHOUT PROPER VENFIL.A-.iDN,
COULD CAUSE DEATH -DANGEROUS GAS
',TOP VIEW% -•: -T 29' DIAMETER CCNCRETL COVER ',TYPICAL)
!SE 'ACCESSORIES' FOR L"THE1� COVER OPTIONS
[.5'
u
�D[A'UTE
LI
THIS DRAWING REPRESEN`S A SEPTIC TANK.
SEE ACCESSCRY III FOR OPENINGS LOCATED
IN THE TOP OF A BOLDING `ANK.
f�
"IIIII
5 25" :
nfR
i
I I
4' .,
o
DIA -� IN,
a S
CIA.
.-"—
' GAL. PER INCH =
�:i LiCI.ID CAP =
[5.1y
638 641
aun-tT P[A
MAX LI➢LID CAP = 668 CAI_
1
\ :BLLI'd INLE �)
If7
— YAF F''�E
r�I
t
N
'IJ
M
SECTION
(TANK BASE, TOP, & COVER)
3' 67,
HUFFCUTT 600;I
I'
TANK LABFL_
" HIGH CONCRETE
FORME) LETTERS
OUTLET SIDE ELEVATION
(TANK BASE, TOP, & COVER)
I
Q
--- 55 - J
U9
w
2 JR
m
'8b YA:7r At W
c Dj;sV V,W; !er
^7tYs!
� C d
l <P
� to
Mcu
°
LJ
6 y
�o
c
:S"'°"`
cm
t
The Best Just Got Better
The most efficient, the lowest
i maintenance, the most economical
effluent filter!
Nearly Twice the Filtering Capacity
Estimated to go 3 Times
Longer Between Cleanings
o Cleaning Made Easy *
Does Not Retain Solids Between Plates -z
Outlam
- Eliminates the -collection: ofSOI_id_S inside, the cartridge.
- Nearly twice the filtering capacity of any other filter.
drastically reduces the need to clean.
- Cleaning made simple and efficient.
LT-1/8: 3500 GP/Residentsal Strength
3
- LT - 1/16: 3350 GPD/ Residential Strength
Filtration 1/16"
- LT - 1/32: 3000 GPD/Recommen ded for Commercial use with Residential
Strength - Filtration 1/32"
- LT - 1/64: 2500 GPD/Recornmended for Commercial usage with Residential
Strength - Filtration 1/64"
- 2700 Inches of Linear Filtoafinn (NP;3r[v Twit-,- the- CnmnPI;f;nn)
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION
Owner r'
Permit #
DESIGN PARAMETERS
Number of Bedrooms
-2-NA
Number of Public Facility Units
❑ NA
Estimated flow (average)
j gal/day
Design flow (peak), (Estimated x 1.5)
`Q (( gal/day
Soil Application Rate
t al/day/ft2
Standard Influent/Effluent Quality
Monthly average"
Fats, Oil & Grease (FOG)
<_30 mg/L
Biochemical Oxygen Demand (BODS)
5220 mg/L ❑ NA
Total Suspended Solids (TSS)
<_150 mg/L
Pretreated Effluent Quality
Monthly average
Biochemical Oxygen Demand (BOD5)
_<30 mg1L
Total Suspended Solids (TSS)
s30 mg/L ❑ NA
Fecal Coliform (geometric mean)
<_10° cfu/100ml
Maximum Effluent Particle Size
Ya in dia. ❑ NA
Other:
❑ NA
`Values typical for domestic wastewater and septic tank effluent.
MAINTENANCE SCHEDULE
SYSTEM SPECIFICATIONS
Septic Tank Capacity
tp p
al ❑ NA
Septic Tank Manufacturer
jjquJ rF
❑ NA
Effluent Filter Manufacturer
bF,?_1ayC
❑ NA
Effluent Filter Model LT— tj$
❑ NA
Pump Tank Capacity
al-B-tdf4
Pump Tank Manufacturer
'®"MA
Pump Manufacturer
`07TA
Pump Model
- NA
Pretreatment Unit
❑ Sand/Gravel Filter
❑ Mechanical Aeration
❑ Disinfection
❑ Peat Filter
❑ Wetland
❑ Other:
15-NA
Dispersal Cell(s)
(t-Ground (gravity)
❑ At -Grade
❑ Drip -Line
❑ NA
❑ In -Ground (pressurized)
❑ Mound
❑ Other:
Other:
❑ NA
Other:
❑ NA
Other:
❑ NA
Service Event
Service Frequency
Inspect condition of tank(s)
At least once every:
❑ month(s) (Maximum 3 years)
ear(s)
❑ NA
Pump out contents of tank(s)
When combined sludge and scum equals one-third (Y3) of tank volume
❑ NA
Inspect dispersal cell(s)
At least once every:
a"Z. ❑ month(s) (Maximum 3 years)
years) _
❑ NA
Clean effluent filter
At least once every:
/
t
❑ month(s) Ak
year(s)
❑ NA
Inspect pump, pump controls & alarm
At least once every:
❑ month ❑ yeaarr((ss) ) )
NA
_
Flush laterals and pressure test
At least once every:
❑ month(s)❑
❑ year(s)
NA
Other:
At least once every:
❑ month(s)
❑ 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 (Y3) 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 <12 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. ��(
Page — Of —
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other
chemicals or sediment that may impede the treatment process and/or damage the soil 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 extended 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 and may overload them resulting 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) discharge; 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 falls 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 SPS 383.33, Wisconsin Administrative Code:
• All piping to tanks, pits and other soil absorption systems 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 falls and cannot be repaired the following measures have been, or must be taken, to provide the opportunity to obtain a
sanitary permit for a code compliant replacement system:
0 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 the time of their permit issuance.
171 A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be
rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort.
604—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.
El 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: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT
OXYGEN TO SUPPORT LIFE. NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY
CIRCUMSTANCE. DEATH MAY RESULT- ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY
DIFFICULT.
ADDITIONAL INFORMATION:
POWTS INSTALLER POWTS MAINTAINER
,Name:G.��,�Nam
Phone: Phone:
ho0
ne:
SEPTAGE SERVICING OPERATO ( UMPE!!) LOCAL REGULATORY AUTHORITY
gr PP
Name: Name: oef - /7
-y
Phone: Phone:'�O)Ar- M --. ,
This document is intended to meet minimum requirements of Ch. SPS 383.22(2)(b)(1)(d)&(Q and 383.54(t), (2) & (3), Wisconsin Administrative Code. Use
of this document does not guarantee the performance of the POWTS.
1�9/1% (Rev. 3/13)
'ViAsconsin Department of Safety and PFdossional Services
SOIL IE-VALUATION REPORT
P COunt%< ' "
In accordance villih SF S 3H, Ali& Adm. Code
t•omplete. site plan on paper not less than a 112 x 11 in-�i''eu itj "Le plaj-, T-iusl include,
bu° tict!'rnited in, vertical and horizontal reference point �Sfvl), direction and permnt slope, Parceii.D,
saaio or d"Friensions, north arrow, and jocatloa and distance m no,:irast rwad
Please print all Information. i Reviewed by
i'vlor"natim Yoj Rrovide may usq
Property Location
(vlq Govt' Lot
T 11 R F
P malilg z�Zj';� # B!Ock •Subd. Name or CRA W
State Zip Code r Ohone Number I V14290 To Neareut Road
We,
Construction Use: Resk-lemiali Numbe r of bed aorris CoJr- def"'Jud des.igri flow rime -�O GPD
Public or coo - metal- Describe. op � C.�
R300 'Plan el:evkon I; apoltuble ft.
umurienis and recommendations:
Boring
Pit "?"ond surlace ele- Dopth to limiting racier
a.s iron: Soil Al-
Redox Description Texture SIructure
Depth r)omjqarjT Color , i " 'jj
Gomvstence Bounda ots
In. NlUnSell 'Qu. Az. Cont, Colo, Gr. Sz. Sh
7- 1 j
cz�
V
01 Pit Ground 2'urfaw elev. it.
Depth to limiting Lfact'.>i
liepth RedoxDescription 'I'eY*,L;`a Structui& C(ABJ Tence Boundary
In. Manse,
Q�t� Az. Cont Crdor Roots,
Gr. Sz, Sh
. . ......... - -
---------------
t ;7—
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`754tv iIi
It
7 7�1
... . . .....
t--ffluent'W1 130D. '30 2 . . . .......
...... .. . . .20!q2.'L orid TOO 3C �i 15f? m Ii6
OD, 30 22
Nam (Please Print)
CST Number
t
mate rolvation Cinducinc, Taisphidle Number
V,! "'Vi
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ABA� ALL DCOPS THUS ALL UIT LCORS -- A L RE FQIJINPE,
WTH STANDARD TTPE 111T—(I EA CP RLE FROM ME IRSIDE WTTCJT ME .IF
'1IT
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OF E . FEY 'R BILT U PIT 'OHRS ARE EN 4CCE5SELE RCUTE
EIJI DOERS
ILI L I
-HALL MAINTAIN K' v BO' ','LEAR A- TMEC 'MIL BE PIROVIDED — A —ER EAEELiF
L0 CNSET NET YCEE THAN 4F ABWt FI-4aHED FL— VAINTAIN —L ALPA�AEIE: 0
EX IT DOIJES
11AINTAI. LEIF: —RCACII" TO Ell 1.110
EMT LIGHT & SIGN
11'11DINP, NOT LESS THAN If 100TIAIDUS OF ILLUMINATION WT, A CONTRAS'
RA73 NOT LESS THAN OS HALL BE IILUVIIIATI-' At AN I1VE5 ME BUIL,11, 13
GO 11PIEND CDNN=P 70 AN ElAERGEHM -L—RGA; THAT PPO, DES
ILLOWI FOR A PERIOD O. NOT LESS MAI� fflljTE` AFTER PO%fF
MEANS OF EGRESS LGHTN,
ME IN IENSITV OF FLOOR 01 A-L NOT BE LESS MAN 1 F. TGANNLF OF
A- THE WALKINI SURFACE LI
J I,d TF, HET!. HT Ivl X I',l - M (J'F
T,A"_ P—
P T —A�--,'T
:_:_
STATEMENT
CITY D,7NEVVRCH0OND
158E1STSTREET —/
NEW R|CHK4OND.VV| 34817 '
715-248-4268
6/7/20'D
SECOND NOTICE 70/2019
Douglas Trogstod
dtrog2uf,a-)comcast, net
LOT3. ROW 16 640,00
LEASED PROPERTY OF8.4O0SQUARE FEET
TOTAL DUE 640.00
DUE DATE: JULY1'2U18
Owner/Buyer
Doug Trogstad
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Mailing Address 7331 Braden Trail
Property Address New Richmond Airport Hanger 16-3
(Verification required from Planning & Zoning Department for new construction.)
&S,
ate New Richmond WI
LEGAL DESCRIPTION
Parcel Identification Number %(D 1 " 1 Z1 I — ab — 600
y
G-4-Y
Property Location ✓ G1i '/4 , (4) '/4 , Sec. Z� T ✓ I N R�W, T of
Subdivision Plat: New Richmond Airport 16-3
Certified Survey Map #
Warranty Deed #
Spec house Dyes❑no
A) e ,tj 4J_-, "',
Volume Page #
(before 2007)Volume , Page #
Lot lines identifiable ❑yes❑no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
, Lot #
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. Owner maintenance
responsibilities are specified in §SPS. 383.52(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 Safety And Professional Services 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 yarranty deed recorded in Register of Deeds Office.
Number of bedrooms 0 J
SIGNATURE"OF APPLICANT(S) 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. 04/12)
Wisconsin Department of Safety and Professional Services -� Page / of "I —
Division of Industry Services _
JUL 15 2019 SOIL EVALUATION REPO
In accordance with SPS 385, Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include,
Parcel I.D.
dd —
but not limited to: vertical and horizontal reference point (BM), direction and percent slope,
scale or dimensions, north arrow, and location and distance to nearest road.
Revie by
Dat
Please print all information.
Personal information you provide may be used for secondary purposes Priva Law, s. 15.04 1 m
7 Z /ci
Pro pe Owner c
t�e� /oCu
Property Location
Govt. Lot.s����'/4
❑
L)U_ r D S fw(� try
SVV/%4 S T
J N R 1� E (or) W
Property Owne ilinooc
.1 _ g Addss
Lot #
Block #
Subd. ame or CSM#
City State Zip Code one Number
r
�'ty ❑ Village Tow
Nearest Road
® New Construction Use: ❑ Residential / Numberof bedrooms Code derived design flow rateGPD
lI
❑ Replacement M Public or commercial — Describe: �•"' 411� 0..`r` �0.�"f/ /'
Parent material 6 cl� Flood Plan elevation if applicable/' Q ft.
General comments and recommendations:
Sad��igt. �v�V2py�1t�WyL`c
I 7t Boring #
❑ Boring G
�] Pit Ground surface elev.
Depth to limiting factor "O'a in.
Horizon
Depth
In.
Dominant Color
I Munsell
Redox Description
'Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
—1. -Ppl..OMUII r ato
GPD/Ftz
*Eff#1
'Eff#2
D-1.3
15 V -s /
E
3
02 33
73`tYt y /
6C
5c (
a
1 c-e.
,ti►.,
z
6- 3
0,5-
33=Y
Ys /o6
25Yn,, Y
�;5rn s7,A-
—
6_7
F�il
Boring ��
Pit Ground surfacA elev v (ft. Depth to limiting factor /0 b in.
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description '
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
Jun I1 10.7aGUF1 male
GPD/Fe
"Eff#1
*Eff#2
45`k
ovs�
5
/s t c(
71�3
s I
a;, Y_ 3 r—
—`iY"L Y
s�
5-
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s`�n q/
* Ffflneni lil
= ann , Qn a 1313n
..,..n
-- ------ -
CST Name (Please Print)
c11uentsX=ovu,-AV5LGUm
Sjgnstur _
/Lana 155>305150m 1L
CST Number nag%Z
Addreglill HeidtOt 8S inc.
�3503 Hemlock } �,
Date Evaluation Conducted
a moo/
Telephone Number
�� 9_9'
I%Annrinwi Vill
SHU-5330 (R04/15)
715-5�79-95$4� t/
B� Boring #
W Boring
❑ Pit Ground surface elev. 4-0ft.
Depth to limiting factor l66 in.
Sill AmIlratfnn Rate I
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az, Cont Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Fe
*Eff#1
*Eff#2
(
0-34
5Y K
5
3-
51?2 31A
1s�
r S
1
v
I
I
11,�
❑ Boring #
❑ Boring
❑ Pit Ground surface elev. ft.
Depth to limiting factor _ , in.
Snil Annlieation Rate
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/Ft2
*Eff#1
*Eff#2
w
❑ Boring #
❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Spill Ann lnatlnn Rate I
Horizon
Depth
In.
Dominant Color
Munsell
Redox Description
Qu. Az. Cont. Color
Texture
Structure
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPD/F?
*Eff#1
"Eff#2
* Effluent #1 = BOD, > 30 s 220 mg/L and TSS > 30 5150 mg/L * Effluent #2 = BOD, > 30 s 220 mg/L and TSS > 30 5 150 mg/L
Will Heldt Soil Testing
W3503 Hemlock Road
Mondovi, Wl 5475'-�
71 5-579-Q`
a
5 63
l�
lP1L gyp, � c..�-qq•o
i3.arn = 60,0
� t- fp .
l I�
Go
� JIv
o LL Tr,, g'tt
L/
i ,
Will Heidt Soil Testinc
W3503 Hemlock Road
Mondovi. Wl 547-