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HomeMy WebLinkAbout030-1017-95-114 isconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix pr I Safety anr'BuildVg Division INSPECTION REPORT Sanitary Permit No: 405198 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: Murtha, M ark 8r Corinn I St. Joseph Township 030 - 1017 -95 -114 CST BM Elev: r Insp. BM Elev: BM Description: keo.b I co. 9 N . 14 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Bet 6 Dosing � —_ Alt. BM Aeration Bldg. Sewer 6_ � « G Holding St/Ht Inlet . P 7 f C. Z1- TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt inlet Septic � S j Dt Bottom Dosing L4 Z S Header /Man. '— 3.40 too Yo' Aeration Dist. Pipe �f 0 i� • ZO .3 Holding Bot. System 11 r� Final Grade PUMP /SIPHON INFORMATION 2.0 (D2. (a Manufacturer De [ nd Cover Model Number /QpS 1 �� 7 �° 3 S �• 0 , DH Lift Friction Loss System Head TDH Ft �O rcemain Leng Dv t; ] Dia. !t Dist. to Well 1 1 SOIL ABSORPTION SYSTEM ENCH - Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM Z SETBACK SYSTEM TO P/L JBCDG IWELL LAKE /STREAM LEACHING Manuf ct „- INFORMATION CHAMBER OR ' Type Of System: 4%. UNIT UNIT Model Number: 2 �� DISTRIBUTION SYSTEM . //Z- Header /Manifold Distribution x Hole Size Ix Hole Spacing Vent to Air Intake << Pi s) Length Dia Leng 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 Bed/Trench Center Bed/Trench Edges Topsoil yes ] No _, Yes f l No OMME S nclude code di epen �� ci s ersons present, etc.) Inspection #1:0/ 13/ C> 2- Inspection #2: (•�. 1130 ct�"'i� �2 . at[ n: 452 River Road' H54016 (SW 114 NE 114 5 T29N R19W) NA Lot 7 Parcel No: 05.29.19.76A 14 X 1.) Alt BM Description = '�(e� �- �01� �a•�t C".) 2.) Bldg sewer length = ' 3 JJ •• r n G - amount of cover = Is IV J•+er�G e -�'w� Q Plan revision Required? Yes No �4j Use other side for additional information. _7� l.W Date Insepctors Signature Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County n �� 201 W. Washington Ave., P.O. Box 7162 L� visconsin Madiso , WI 53707 -7162 Site Address Department of Commerce lei 1 1 6 2— l IVEC )&AD Sanitary Permit Application Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision Yt may be used for secondary purposes Privacy Law, s15.04(1)(m) I. Application Information - Please Print All Information State Plan 1. D. Number Property Owner's Name Parcel Number QS„ 19, 74A y MAGIC 4 OLOFMA! Atl ukTHA 030-4617- 9S- IN Property Owner's Mailing Address Property Location 23 (S A P, RF-Ln 9T IJ E 1, IVE 1� S .f T 2C' N , R 1 City, State Zip Code Phone Number Lot Number Block Number Subdivision Name CSM Number Mfr -S AA «r Ks 4 1 9 11 L (e7 S50Z a II. Type of Building (Check all that apply.) n / -� ❑ City ( - 1 or 2 Family Dwelling - Number of Bedrooms l -�,t� /� K, L ❑ Village ❑ Public /Commercial - Describe Use ft g Townshi l � Y ❑ State Owned Nearest Road 42 - kiP /?oqD III. Type of Permit: (Check only one box on line A. Numbering is for internal use.) (Complete line B, if applicable.) A. LP-New 3 ❑ Replacement of 6 11 Addition to System 2 ❑Replacement System Tank Only Existing System For County use B ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of POWT System: (Check all that apply. Numbering is for internal use.) 31. j E / 5 A- 44,9L Non - Pressurized In- Ground 21 ❑ Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line r 45 ❑ At -Grade 46 []Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑Other Zr � V. Dispersal/Treat ent Area Information: 2Z S7AU01Kt2.1r) S 1L Tk A'C 6 Design Flow (gpd) Dispersal Area Dispersal Area Soil Application- --- Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min. /Inch) Elevation 451) �0 i3 � ,7 1 �9. Ll /b2 VI. Tank Info Capacity in Total Number Manufacturer Prefab -Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks t57' Septic or Holding Tank / ^fin �b/io Dosing Chamber / lJ�( 00 00to Y At VII. Responsibility Statement- I, the undersigned, assume respon§ibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' RS ber Business Phone Number = Fr tb"4 -. 1� 223242 7rS 2Ry - 3/ 4 f r Plumber's Address (Street, City, State, Zip dod Rb X 29S h1/ S 11 q VIII. County/Department Use Onl Disapproved Date Issued Issuing Agent Si nature (No Stamps) Approved ❑ Owner Given Initial Adverse Sanitary Permit Fee (includes Groundwater _ / Determination Surcharge Fee) IX. Conditions of Approval /Reasons for Disapproval See. ✓wa-� c&idd M5 Attach complete plans (to the County o y) for the system on paper not less than 81/ x 11 inches in size ' i SBD -6398 (R. 05/01) Safety and Buildings n m County 201 W. W - -` ix 7162 � 0_Kn� i s P sin Site Address //�� Department of Commerce 53'L� �S oZ- &Ozt l6a"e S ani t ary Perm Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. (� may be used for second u o t t , El Check if Revision I. Application Information - Please Print All Il A A� 3 State Plan I.D. Numbe Property Owner's Name Parcel Number 7 o.s L: i - 76 - c 1vt N izl� 4 e ®Rl�tnf rn „t. i � ti 030- -7 9s- // Property � Owner's Mailing Address , \a � � � Pr Lo Z3 5 �r�l ELI �T �. ,V` 0��� / ya / S 5 T 2 1 q N R ) I Elk City, State Zip Code Phontj \N Lot Number Block Number S� O N Subdivision Name CSM Number MPLS. MIQ .5S4 ° "9 � 6 /l /3167 S 7d I � II. Type of Building (Check all that apply.) y ❑ City `4f-1 or 2 Family Dwelling - Number of Bedrooms ❑ Village ❑ Public /Commercial - Describe Use PR-Townshi ❑ State Owned Z - FR 4Pq/, -t� I >6 _ Nearest Road i'n,c, Rt 1/�"e �8 ) Te. III. Type of Permit: (Check only one box on line A. Numbering is for internal use.) (Complete line B, if applicable.) A. 1 New 3 11 Replacement of 6 ❑ Addition to System 2 ❑Replacement System Tank Only Existing System For County use B ' ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of POWT System: (Check all that apply. Numbering is for internal use.) tit 1. _ .SIGIQ(.UG 6ZS - � 44 $- Non - Pressurized In- Ground 21 ❑ Mound 47 11 5 0 Sand Filter ❑ Constructed Wetland 34 0 � 22 Cl Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line / 45 ❑ At -Grade 46 ❑Aerobic Treatment Unit 49 ❑ rc ating 30 [] Other 7 V. Dispersal/Treat ent Area Information: LAS I S! ANn AR-ft 1 NC LT T h0Ls Design Flow (gpd) Dispersal Area Dispersal Area Soil Applicat Percolation Rate System ElevatiotL� Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min. /Inch) /�` Elevation ZIM Lq s7 S619 ,__7 97 y ia3 VI. Tank Info Capacity in Total Number Manufacturer Prefab - Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank )Z&-) /Z5 io IV f ��F 2 [ Dosing Chamber 75(3 75o VII. Responsibility Statement I, the u e responsibility for in n of the PO TS shown on the attached plans. Plumber's Name (Print) lumber's Si tur M MP umber Business Phone Number =TEr= � I�x / , / - 2232y2 715 -29 `/ -3 /ti 1 Plumber's Address (Street, City, State, Zip Coe - 7 16'YCj /- Lo Y J L R o . 13oX Zvi S' f7 s P_ 1 1 14/1 SV C) L'1 VIII. County Department Use Onl Disapproved Date Issued suing ent Signa o Stamps) u+'Approved ❑ Owner Given Initial Adverse Sanitary Permit Fee includes Groundwater Determination Surcharge Fee) CJ O GL�✓Y IX. Conditions of Approval /Reasons for Disapproval �p Z -S' A" /I� D ^ „ "*h�� 0 �l Attach complete plans (to thd County only) for the stem on aper of less th 81/2 11 ch m size LTL- 7L� ?7d/��Gs �(�ntlrNTJrli� >�d�p /'lf SBD -6398 (R. 05101) i2op-IAW mu 5 VI/ IVE A - 6 , TZ 9 61p*11an ST. sT jOcsp I_ _ _S Ll /,G qtM ---- - - -o -- _ -- - -- — - -- __ -I ROM 6tA(ZA6& - - -- -- - - - -- -- 9ELAWAA ------ ------ -- ---- ----- . 76p 6,c L6r 5 TAI(L- jgt.H J 1 yo r �JV _ / v! { - /J 7 MAR-` C oPUAW MUPTNA 5 vv V Y NE Ay S_r 7Z9 . jJ, vv' 231s' GA &FI ELO S"t' JVE ST SOE tl TU/S M 1 t,wV- P. s AILN LOT SSLl Q.M. � otiff /p o Z "ERNS lti1[TN �l t(!GN CAD loZ.s 0 &Z' WILL &IYA+TE /e0/tfJ �_1✓1EA7T GA(?Mg °O 8ELIRW AA ,EiIO USA TANK ® fib,) BF X01. Lv r 5 TA I(& jgL= Joo Q S ©IL HDRIAJi. c S CALG �IU /uUE2 2� 030 - /01 - 7 /�llAI�IC C_o2i,�tN /rl11�7'NA 5V AY IVE� 5 -5 - TZ 23fs ST. )VE ST ibcspfl — rv/sr M 1n3LV—A P6LI S. AA �J OT - 7 SSLl f3,M. i� 4 �CA oh ce.,ti cf Lam•- -� / Z 7K�-IucNs KJITH 11 1416,K LIAP sIflEwlfjDr& loZ -S <-- Alfp,Ox 1.2c 2 „ 3=09-WAA A1 0 4z " WiLL &IYATE Rom e/ASE,✓1EIVT GA MC 0 SFD/�dD�V'� �Q Usk - TANK ® 7 BF Lvr S TAI(& jgL= !OO Q SCL ROQJA)1 c YO EIUE2 tL O AIN Wiscor.sinDepartmentofIndustry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor ard Human Relations Division of•Safety & Buildings in accord with ILHR 83.05, Wis. A,4at.. {p. COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. 4PI��nclude, but t St. Croix not limited to vertical and horizontal reference point (BM), direction and % , scalB ' ^, - CEL I.D. # kq, 101-7- qS' • </ dimensioned, north arrow, and location and distance to nearest road. P ` q pen ing ED Y DATE APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION. iY (t PROPERTY OWNER: e OPERTY-LOCATION r' - Jim Dahlb /��� M611ZT14A I f Clj�f _68 QT 1/4 NE'ua' . 5 T 29 N,R 19 )b(or) W PROPERTY OWNERS MAILING ADDRESS SUBD, - OR CSM # 399 Brookwood Dr. °. na._. ending SSD ��� CITY, STATE ZIP CODE PHONE NUMBER []�IILLAGE ' N NEAREST ROAD Hudson, WI. 54016 (719 386 -0244 St. l e ph River Road d�71 New Construction Use [ )] Residential ! Number of bedrooms [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd/ft Absorption area required 643 bed, ft2 563 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd/ft Recommended infiltration surface elevation(s) _ 99.4 _. __ft (as referred to site plan benchmark) Additional design / site considerations — alt. system el . =98.5' Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for s stem (3 o u [3 cl U I [as ❑ U RI S ❑ U fl S ❑ U [IS ® U SOIL DESCRIPTION REPORT E �?j Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tn tch Uj 2 11 - 22 10 r4 4 none is oscr mvfr qw if .7 .8 Ground 3 22 -84 7. 4 elev. 1. 02.7 ft. Depth to ��• 3 q . (� � ,(p limitin facto +4 Remarks: Boring # 1 0 -12 1 r 2 .5 .6 <...?.:.'> 2 12 10 r5 4 none sl lcsbk mfr qW 1 .4 .5 Ground 3 36 -84 7.5 r4 4 none ms oscl mvfr na na .7 .8 elev. 10 ft. R Depth to y ' - 41V limiting factor +84" Remarks: CST Name: Please Print Phone: Gary L. Steel 715 - 246 - 6200 A ddress: 1554 20 . , Ave., New ichmond, WI. 54017 Signature: Date: CST Number: 2Z 9 -13 -96 m02298 PROPERTY OWNER Jim Dahlby SOIL DESCRIPTION REPORT Page 9 of 3 PARCEL I.D. # Mending Lot #7 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundety Roots GP in. Munsell Qu. Sz. Cont Color G r. S z. Sh. 1 0 -12 10 r4 4 none sl 2m r 2 12 -84 7.5yr4/4 none ms os ml na na .7 .8 Ground elev. 10 ft. Depth to - 3 7. Z 7 3 limiting factor +84" Remarks: Boring # 1 1 0-12 10 r3 3 none 2msbk 4 € €<? 2 12 - 7.5 r4/4 none sl lcsbk mfi Ground 3 1 30-80 7.5 r4 4 none ms elev. 1 Depth to limiting factor +80 Remarks: "�-� -- Boring # 1 1 0-13 1 5 =< 2 13 -37 10yr5/4 non sil 2msbk mfr Qw if .5 .6 Ground 3 37 -76 7.5 r4 4 none ms 0sci ml na na .7 i .8 elev. 10 ft. Depth to limiting facto 7 6 Remarks: ° - Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) r— v STEEL'S SOIL SERVICE Gary L. Steel Jim Dahlby 1554 200th Ave. CSTM2298 SW4NE4 S5- T29N -R19W New Richmond, WI 54017 MPRSW 3254 town of St. Joseph (715) 246 -6200 lot #7 -csm 1 =40' IN.= top of NW lot stake @ el. 100' r � � 3(� r� I Gary L. Steel 9 -13 -96 Page Of COMB NATION TANK TIC E PUMP CHAMBER S P / h% (No Scale) 4 " Ci Vent Pipe with -"� Approved Locking Manhole Cover Approved Cap, +25' With Warning Label Attached From Buildings Weatherproof Approved _ abe Junction Box . Vent Cap 12" mum 6" Minimum i — ' Final Grade ; 4 " Minimum 6" Maximum -- T 4 C.I. Quick 18" Minimum T Insp. Pipe Disconnect 1/4" Weep ' Hole Baffles ' Approved Joint w /C.I. Pipe �re� I A r ' Extending 3' Alarm Onto Solid Soil On B Approved Joint w /C,I. Pipe CeGI� C , Extending 3' ' Onto Solid Soil Off d" D Conc. Block 3" of Bedding Under Tank—/ Note: Pump and Alarm Are On Separate Circuits Number of Doses•Per Day Gallons Per Day/f o Doses: 11 2.i5 Gallons Volume of Backflow: ..... ..+ 7- Gallons Tank Manufacturer: VIfIES� Total Dose Volume: ...... .. = 20.1 Gallons Tank Size - Septic /Pump: ItI27n allons Alarm Manufacturer: 'T N AIEk'l Model Number: }b! ✓' Capacities: A if inches or 317,3Gal Ions Switch Type: £ UC 2y + B - 7 — inches or Gallons Pump Manufacturer: + C inches or .Gallons Model Number: £ pp g + D _ 7 inches o Gallons Minimum Discharge ate: 3 71 Total .....= 3�( _ inches o I.2 Gallons Vertical Difference Between Pump Of nd Distribution Pipe: Feet Minimum Required Supply Pressure : .......................... -- Feet 12; Feet of Force Main x Friction Factor /100 Feet: + / ` Feet ��- Z Inch Diameter Force Main Total Dynamic Head: ... = 6.g Feet Internal Tank Dimensions: Length Width Liquid DepthqZa IV Signatu License Number zyZ 12 /D2 '_;4 a� METERS FEET Q., s MODEL: 3871 9 Dtscfge�s�ze T 2 � ttSQ�idS .m -�,� ��� 6 r k 1111 i ,� $ :. - h -. 25 ij- Smgle =phase 115V - 6 Materials of;Construction =h Brass/thermoplast* 5 ,5 Features and Benefits r ' epos • Top- suction eliminates a 3 10 impeller clogging. 2 5 • Corrosion resistant 1 construction. ° 0 10 20 30 40 50 US6PM • Float actuated switch`. ° 2 , 6 8 ,° 12 mN. CAPACITY MUMS 5 H IT 7 Pump Specifications Features and Benefits MODEL DVP03 0 6 4 /10 and V2 HP • EPO4 impeller- semi -open design 5 Up to 60 GPM pump out vanes to protect t5 Maximum head to 32' mechanical seal. ` Discharge size 1 NPT • EP05 impeller - enclosed design 3 10 Solids: 1 /4" maximum for improved performance. • Rugged glass- filled thermoplastic S M otor motors feature ball casing and base design provides ° 0 bearing construction. superior strength and corrosion 0 5 10. 15 20 25 30 35 40 U.S.GPM resistance. Single phase: 115V 0 z 4CAPACITY 6 6 10m0Mr Materials of Construction • Cast iron motor housing for Cast iron efficient heat transfer, strength, Thermoplastic and durability. Stainless steel • Corrosion resistant threaded stainless steel shaft. • Available for automatic and manual operation. • GSA listed models available. All Models are designed for continuous operation and feature stainless steel hardware. Page Of COMBINATION SEPTIC TANK /PUMP CHAMBER (No Scale) 4" Ci Vent Pipe with ,Approved Locking Manhole Cover Approved Cap, +251 With Warning Label Attached From Buildings Weatherproof Approved _ rning Label Junction Box Vent Cap — T 12" Minimum 6" Minimum i — Final rade -� i 4 Minimum 6" Maximum 4 C.I. Quick Insp. 18" Minimum Pipe Disconnect ..___ � 1/4" Weep ' Hole Baffles ' Approved Joint wt Pipe A r Extending 3' Alarm L Onto Solid Soil On B Approved Joint i� �r w /C. I . Pipe C i , Extending 3' Onto Solid Soil Off 6' D Conc. Block 3" of Bedding Under Tank -� Note: Pump and Alar Are On Separate Circuits Number of Doses: 9 Per Day Gallons Per Day /fot 11 Gallons Tank Manufactu er • iiUf ES�2 '' Volume of Backfl ow:.......+ 7 (� Gal 1 on Total Dose Volume: ........ = ZD,/ a11ons Tank Size -Se is /Pump: 2 SCE 75 c Gallons Alarm Manuf cturer: fi tvr �ILF'le Model Numb r: Jb Capa;cities: A 7 inches or �fG Gallons Switch Ty e: 9� 2 U �l + B i nches or Gallons Pump Man facturer: ©LI Lral + Cinches or %Gallons Model Nu ber: Q s + D winches or /Gallons Minimum Discharge ate: Total \..= w inches or = Gallons Vertical Difference Betwe 6 p and Distribution Pipe: \ B Feet Minimum Required Supply Pressure:. .. .... . .. Pipe: )�ZO Feet of Force Main x 1.5`1 Friction Factor /IOOFeet: + eet Inch Diameter Force Main �, Total Dynamic Head: .. = I y � eet 1 X0.1 Z /J)• Internal Tank Dimensions: Length Width Liquid Dep a , Signature License Number Date I _ r z _411 METERS FEET r * r FlpkaEkP]G ,T ,° MODEL: 3871 Discharge suer <' �[RT 9 30 �i Solids: 3 `rnaximum. 8 Motor 25 , Single phase: 115V Materials of Construction = Brass /thermoplastic < 5 15 EP05 Features and Benefits o 4 *Top suction eliminates / a 3 '° impeller clogging. / 2- 5 EPOq • Corrosion resistant / , construction. • Float actuated switch. % ° '0 2° mot" a z a s a ,o ,z Cana CAPACITY METERS FEET Pump Specifications Features and Benefits 0 5 MODEL DVP03 '\ ;and 1 /2 HP • EPO4 impeller- semi -open design 5- Upto 60 GPM with pump out vanes to protect 15 Maxim head to 32' mechanical seal. 4 + ° • EP05 impeller - enclosed design Z Discharge size 1 h NPT n P 9 a 3 10 3 for i p erformance. C2 Solids. /. maxir>'inm p P s 2 5 Motor • Rugged glass- filled thermoplastic + All motors feature ball casing and base design provides o ° bearing construction. superior strength and corrosion 0 5 10 5 20 25 30 35 40 U.S.GPM resistance. Single phase: 115V 0 2 4 CAPACITY 6 8 ,owfi. Materials of Construction • Cast iron motor housing for Cast iron efficient heat transfer, strength, Thermoplastic and durability. Stainless steel • Corrosion resistant threaded stainless steel shaft. • Available for automatic and manual operation. • CSA listed models available. All Models are designed for continuous operation and feature stainless steel hardware. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner ltjlg2l,� L'flAelA.I Itidk 7W Septic Tank Capacity 1 2 g al ❑ NA Permit # D5- Septic Tank Manufacturer GlJ.c�a.e.4, ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA ffluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) Qa al /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) (00U g al/day Pump Manufacturer vam ❑ NA Soil Application Rate gal /day /ft2 Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD :5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispe I Cellls) ❑ NA Biochemical Oxygen Demand (BOD :_30 mg /L � Grcund (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) :_30 mg /L A ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /1 OOml ❑ 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: Z- "j ❑month(s) (Maximum 3 years) ❑ NA 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) 0 month(s) (Maximum 3 years) ❑ NA Z 93-fear(g) Clean effluent filter At least once every: ❑ year(s) on � �� ❑ NA l 2 s) S Inspect pump, pump controls &alarm At least once every: ❑monthlsl ❑ NA 13-year(s) ' ❑ month(s) Ig.OA Flush laterals and pressure test At least once every: ❑ year(s) Other: At least once ever ❑ month(s) ❑ NA Y: ❑ year(s) 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. l Page 2 of 2 ' START UP AND OPERATION For new construction, prior'to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POW fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacem t system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ 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 Namet— Name Phone 7 (� —,)_1 - 3 (.,� 1 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY r Name Name ST G(e0! Co. ZOIJI/i Phone Phone - 7/ S - _ & This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.5411), (2) & (3), Wisconsin Administrative Code. • .71 I,KViX I;VUIV l Y SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer i4i i9/L K ,-4, c&.2. / /vv ryr e ,,e 7 Mailing Address Z315 6,111 1rorz7y CAS ,n i�vFA.Oe Gi s isy,v Ss ��$ Property Address - 0 (Verification required from Planning Department for new construction) City /State Parcel Identification Number - /O / 7- - q' 5 -11 'V LEGAL DESCRIPTION Property Location 5 V '/4, JJ L '/4, Sec. S , T 2q N -R J W, Town of -TT SOfS Pi . Subdivision Lot # 7 Certified Survey Map # S 5 bZ-7 0 Volume Page # Warranty Deed # S , Volume Page # Spec house ❑ yes $4 no Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restrictedplumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, 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 Zoning Office within 30 days of the a year expiration date. iAA.A (e /Zc� a - z- SIG A APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed V OL 1? S PACE n - 4 571.207 STATE BAR OF WISCONSIN FORM 2 - 1982 WARRANTY DEED h DOCUMENT NO. 8 j Tames F. Dah1b EGI�TER'S 6FFICE V. CROIX CO., WI ru'd Apr Rscsnl conveys and warrants to ,~l J Murtha — — JAN t 3 1998 A THIS SPACE RESERVED FOR RECORDING DATA _ J NAME .NO HETURN ADDRESS R the following described reel estate in S CX-Q -- County X r" y State of Wisconsin: ) G ' I } ;� [ 030- 1017 -95 -1 , PARCEL IOENTIF CATION NUMISER .- I E,= Part of the SW1 /4 of NE1 /4 of Section 5, Township 29 North, Rang follows: Lot 19 West, St. Croix County, Wisconsin, described as 7 o rtified Survey Map filed October 2, 1996, in Vol. "11 ", Page 3167, Doc. No. 5502 i F SUBJECT TO the right of ingress and egress over Private Road Easemenc as shown on said Certified Survey Map. f_ T �SFER This i s not homestead property- )&XX (is not) Exception to warranties: Easements, restrictions and rights -of -way of record, if any. 9 day of Dated this. y January 98 f (SEAL) (SEAL) `Y ames E. Dahlby ZT (SEAL) I I 8MVBYOR' S CBRTIFTCM 1•, . Allen. C.. Nyhagen, registered Wisconsin Land Surveyor., hereby certify that by the direction of Jim Dahlby, I -have surveyed,. mapped and described the land parcel which is represented by this Certified Survey Map; that the exterior boundary of the land parcel surveyed and mapped is described as follows: A . parcel of. land located.. in. .part ...of the SW3. /4 of the N8]. /.4..,of Section 5, T29N, R19W, Town. of St. Joseph, St. Croix County, Wisconsin; further described as follows: Commencing at the $1/4 corner of said Section 5;. thence N89 "W, along the east -west 1/4 line of said section,,. 2337.96-feet to the Qf beg nins thence continuing N89 0 37 1 47 "W, along said east -west 1/4 line, 306.47 feet, to the west line of the SW1 %4 of the N$1 /4 of said section; thence N00 0 57 1 24 "B, along. said west - line and the east line of Lots 2 and 3 of Certified Survey Map recorded in Volume 1, Page 256 at the St. Croix County Register of Deeds Office, 1319.25 feet to the north line of the SW1 /4 of the =I /4; thence S89 0 39 1 18 11 B, along -said north . line and the south line. .of Lot 1 of Certified Survey Map recorded in Volume 9, Page' "2676 said off ibe, 782.14 'feet;'thence S01 11"W, along the west line - of Lot 1 of Certified Survey • Map recorded in Volume 8, Page 2297 at said Office, 647.12 feet to the north line of said Lot 2; ,thence N89 0 45'19 "W, along said north line, 91.27 feet, to the NW corner of said Lot 2• thence S01 ° 13'11 "W, along the west line of said Lot 2 and Lot 4 of said Certified - Survey Map, 285.02 feet to the north line of said Lot 4; thence N89 along the north line'of said Lot 4 and Lot I of Certified Survey'Map recorded in Volume 2, page 586 at said Office, 380.13 feet, to the NW corner of* said Lot "1� thence S00 0 57 1 24 "W, along the west line of said Lot 1, 386.48 feet to the; noinf" of gaiii WIUCT. Described parcel coiitaias 18.82 Acres • (819, 840 Sq. tFt.) Above described parcel is subject -to rid ,ht -of -way for Town Road (River Road) and all easements of record. also certify that thin Certified Survey Map is a correct representation to scale of the exterior boundary surveyed an& described; that I have fully complied with the current provisions of Chapter 236.34 Of the Wisconsin Statutes and the Ordinance of the County of St. Croix in surveying and mapping svision - Bach parcel shorn or: this map (plat) is subject to State ,County anand Township lad s =rules anc 'regulations : U e . , `wetlands, min3,ml lot :size_, access 'to parcel, etc.) .. Before purchasing or' develoj i.j any parcel contact the St.. Croix County Zoning:Office and. appropriate Town Board for advice. TOWN OF ST_ CSRTTFTCn'rr$ I hereby certify that this Certified Survey Map is approved by the St. 7b T Bo a ti ' S 9 FILED OCT 0 2 1996 ► 10 KATHLEEN H. WALM Register of Heeds SL Croix Co.,Vd 1r 5502 :�0 v CERTIFIED SURVEY MAP Located in part of the SW} of the NEJ of Section 5, T29N, R19W, Town of st. Joseph, St. Croix County, Wisconsin. N Le end Aluminum County Section Monument Found m OWNER • 1 Iron Pipe Found 4j C 3; Jim Dahlby 0 1 "x24" Iron Pipe set, weighing 1.13lbs c 0 0= 399 Brookwood Drive per linear foot .o o ? Hudson, WI 54016 100' Roadway Setback Line c N o -0 It Existing Fencel i ne 00 ( ) Previously recorded bearing and /or distance w „Z LOT I UNPL��TTEC Lr -VJGS I C g M IN NORTH LINE OF THE SW 1/4 OF THE NE 1/4 V 9, 2G.76 N y W N S89 °39'18 "E 782.14' c s d 391.07' 391.07' . > 1" IRON PIPE FO11PD L i> �^ t 0 w N55 °50'13 "Wi&62' 3.0' a °i CO (D A FROM COMPUTED POSITION, UNPL LOT 6 LOT 5 LANDS .o 6.01 Acres Li 8.81 Acres 261,966 Sq. Ft. w 383,765 Sq, Ft. ' i . E' - 4 V1 W - N 0 LC I 3 .. C; 0 N O NI 01 y LO I N. N o S.M. � Q. IN M Z or 0 r w _ I �r w c m S T . Gs"1oix COUNTY �' •• �- ; :t - (s8 45 18 c N omgr-gjensive>'18rxtiir N89 045'19 "W N ^ r Zo+s:r�g ilSYd 0 o O �� Park CocTrrrrtt 3 91.27' c 589 45 18 E 306.47 14 ?! Z 240.47' 66.00' - LOT c If not recorded c^ LOT_ 2 a z.o' W m v: 3 days of w W LOT 7 - 6 . a�pt 4ate C4 0 �I Ir iw Q provat shah be V 1 co ;3 v �, N82 8 'W 380.13' N i . 00 - Op 1" IRON PIPE FOUND ko co NO2 6 01'33 "W, 0.92' Ln ,� c 1 n L I I FROM COMPUTED POSITION. N o= o �. .5. M. 1N LOT 4 J N V.2, PG. 580 �oefyr 40 C L!N89 306.48' v a C o t n 240.47' _ a 66.00' 1 En o " Ek Corn s� ' N89 37 47 lY -- N89 37 47 W 24046 66.01 _ Section 2619.27' - 306 23 7: N89 °37'47i7W- 1x5263 -- 1 >; Wk Corner A�ROXMwIATE = EAST - WEST 1/4 LINE �IIJDSON, t ORNEWAY d y Q Section 5 LOCATION RIVER ROAD WIS. •r O O ka SUR 'j' AREA LOT 7 Scale in Feet 4.00 Acres Inc. R/W 174,101 Sq. Ft. 0 50 100 200 300 3.00 Acres Exc. R/W & Road Easement 130,681 Sq. Ft. This instrument drafted by Michael Erickson Job No. 96 -80 Vol. 11 Page 3167 r i �o� ,� o i Labor and Human Relations v v a a� n a v v iv a a. r v v a a v a• a s a. a v a a a N = v' Division of Safety & Buildings in accord with ILHR 83.05, Ws. Adm. Code COUNTY , Attach complete site plan on paper not less th in size. Plan must include, but St. Croix not limited to vertical and horizontal refere I( d /o of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location rice to earesff�' o W — 4 "I APPLICANT INFORMATION —PLE RItiT A'ORIYIAFQN REVIEWED BY DATE PROPERTY OWNER: x < _.. ` PROPERTY LOCATION Jim Dahlb ; j': GOVT. LOT SW 114 EVE 1/4,S 5 T 29 AR 19 f&) W PROPERTY OWNERS MAILING ADDRE � ``� � � ° ° LOT# BLOCK # SUBBD. NA OR SMM # 399 Brookwood Dr. CITY, STATE ZIP C PH UMBER []CITY QVILLAGE ®TOWN NEAREST ROAD Hudson WI. 54016 St. Joseph River Road New Construction Use [ xJ Residential / Number o drowns 3 [ ] Addition to existing building Replacement [ j Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate .7 bed, gpdtft . a_ trench, gpdtft Absorption area required 643 bed, fl2 563 trench, ft Maximum design loading rate . 7 bed, gpd/0 .8 trench, gpo1f1 Recommended infiltration surface elevation(s) 99.4 ft (as referred to site plan benchmark) Additional design/ site considerations alt. system el . =98.5' Parent material outwash Flood plain elevation, if applicable nor it S - Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT-GRADE SYSTEM IN FILL HOLDING TANK U- Unsuitable fors stem LAS O U CaS ED US 0 U ®S ED fr7 S O U 0S au SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Colo, Texture Structure Consistence Boundary Roots GPDIft in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Tnatdh 51 2Mar mvfr 2f .5 A — 2 11 -22 10 r4 4 none is I 0sa mvfr C1W if .7 .8 Ground 3 22 -8 elev. 1 02.7 ft. Depth to limiting fac'% � Remarks: Boring # L . 2 12 - 5/4 , sb r .4 1 .5 a i — mvfr ! nor nor .7 .. 8 Ground 3 36 84 '7.5 r4 4 none ms os elev. 10 Depth to limiting factor + 84" Remarks: T Name: — Please Print Phone: Gar , L. Steel 715- 246 -6200 erg. -- - 1554 20Qtjp. , Ave., New Alichmond, WI. 54017 Signature: Dale: CST Number: . z� 9 -13 -96 m02298 AUPwi i Y UWNEH y iuu ,-- u Ii L" i' V ti a rdy� �_ JI j_ PARCEL i.D. # pending Lot #7 4. Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistenoe Boundmry Roots GPD /ft in. Munsell tau. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 1 0 - 12 10 r4 4 none 81 2 12 -84 7.5 r4/4 none ms MCI ml na na .7 .8 Ground dev. 10 ft Depth to limiting factor +84" . Remarks: Boring # 1 1 0-12 10 r 3 L 4 2 1 12-30 7.5 r4 4 none sl lcsbk m i Cry if Ground 3 30 -80 7.5 r4 4 none ; elev.;° 1 i Depth to limiting facts +80 Remarks: Boring # 1 � - 1 3 v� p 2 1 13-37 10 r5/4 none sil 2msbk mfr Qw if .5 .6 Ground 3 7-76 7.5 r4 4 none ms osa ml elev. 10 ft. Depth to limiting factor + 7611 Remarks: Boring # .. U.- Ground elev. ft. Depth to limiting �� factor Remarks: www wwwn.� Klfpf\ STEEL'S SOIL SERVICE Gary L. Steel Jim Dahlby 1554 200th Ave. CSTM2298 SW4NE4 S5- T29N -R19W New Richmond, WI 54017 MPRSW 3254 town of St. Joseph (715) 246 -6200 lot #7 -csm 1 " =40' ffiK.= top of NW lot stake C el. 100' IMP oh �J �b I_IO n ' Gary L. Steel 9 -13 -96