Loading...
HomeMy WebLinkAbout030-2133-02-000 Wisconsin Deparir+.lent of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 499198 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: Green, Scott � �, St. Joseph, Town of 030 - 2133 -02 -000 CST BM Elev: Insp. BM Elev: BM Descripti n: Section/Town /Range /Map No: /" c. c +* Z oG Y0C_ i •V­e 30.30.19.2002 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark �� > a. a -c. ! c ,� e to S �� . ��. •t7 Dosing Alt. BM 6- Aeration Bldg. Sewer i3 n St/Ht ..� Inlet f t a \ 1vz 36.E St/Ht Outlet `3 TANK SETBACK INFORMATION - / s Iv TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet f Septic 4 ��, ,-- , Dt Bottom Dosing Header /Man. 3 3 Aeration Dist. Pipe Holding Bot. System :5 y. '3 !d 3, Final Grade PUMP /SIPHON INFORMATION �� r3,•� Manufacturer Demand St Cover C PC- - 4 GPM c�n1 v✓ 4 � (;.32 JIjC. � Model Number 23�, St TDH Lift , Friction Loss System Head TDH _ Ft °� ,— pY Forcemain Length Dia. 1/ Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS — 7 C ( I f SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING anufacturer: INFORMATION Type Of System: CHAMBER OR ­7 p( UNIT Model Nu rtN � DISTRIBUTION SYSTEM 5f6 -tom •,. Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length 3 Dia Length 3 Dia 1 J'f Spacing S. `3 36, 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 No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: /. 0(0/, O I L I spection #2: rr / off' Location: 304 138th Avenue Unknown NW 1/4 NW 1/4 30 T30N R19W Deer Meadows "Lot 2 `— Parcel No: 30.30.19.2002 1.) Alt BM Description = T" c 2,) Bldg sewer length r - amount of cover = S L " -I Plan revision Required? Yes No Use other side for additional information. -- Date nsepctor's Signature Cert. No. SBD -6710 (R.3/97) r � 1 Safety and Buildings Division County ; N201 W. Washington Ave., P.O. Box 7162 J t CW i sconSiin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 T / 9l 6 Sanitary ermit Application ate Plan I.D. Number 1 Y PP / 2 3 In accord with Comm 83.21, Wis. Adm. Code, personal information you p e may be used for secondary purposes Privacy Law, sl5.04(I)(m) roject'Address fdifferent than mailing ad 1. Application Information - Please Print All Information ' ?39 Propert Owner's Name arcel H Lot # k >A `3 eo G reen - /Lk_S n ' L�on�y ��� � Property Owner's Mailing Addres �r Locatio City State -?U Zip Code Phone Number �'�— A I, Section 3o 41 cir cleym� I � ` T RE9(W l Type of Building (check all that apply) RECEIVED � t� or 2 Family Dwelling - Number of Bedrooms Subdivision Name ❑ Public/Commercial -Describe Use El State Owned - Describe Use ❑City_❑Vi11a e wnshi of s� III. Type of Permit: (Check only one box on W ,_ to li Q — Z 3 3 — B — B6a • Z fJ02 A. :New System E] Replacement System reatmen olding I ank Keplacenient 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 L 1, r \ / I / IV. Type of POWTS System: Check all that appl ❑ Non - Pressurized In- Ground Mound > 24 in. of suitable so ❑ Mound 124 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) f V. Dispersal/Treatment Area Information: Design FI w (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Req - red (sf) ispersal Area Proposed (st) System Elevation � .3 ao b� yda le3.6 VI. Tank Info Capacity in Total Number Nia Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank �t / /) ! �S q �. Aerobic Treannent Unit Dosing Chamber lL VII. Responsibility Statement- I, the under assume responsibility for insta ron of the P S shown on the attached plans. Plumb is Name (Print) a Plumb s nature ^ M /MPR Business Pfsone Plumber's Add (Street, City, SlItte Zip Code) VIII. County/Department Use Onl Approved ❑ Disapprove Sanitary Permit Fee hcludes Groundwater Date Issued Issuing gent Signature ( o Stamps) Surcharge Fee) er Given son for Denial Q IX. Conditions ppro s9 f1'6Vah 3) N o 6.4 �"'"� SYSTE WNER. f �( 1 Septic tank, effluent filter and 4"_ "z, c3, � dispersal cell must all be serviced /maintained + _ A as per management plan provided by plumber. le�tr ow.o� i S St 2, All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 812 x 11 inches in size SBD -6398 (R. 01/03) Id -�cv � I $ Ilk' a � I ---� -r "1 � /lo n, e ?loafif ,o p• -p l,�,c �M 7 jO G t ✓� i ea. d. Wit., cT"'� Pirc f op e r.kctl� 7'CS i� e/ - �s J7 // p e �L'(le�T'/ �•h .:1�� / !U [ � + -67 Go Safety and Buildings PO BOX 7162 commerce.Wl.gov MADISON WI 53707 -7162 TDD #: (608) 264 -8777 i sc o n s i n www.coe.YA.gov/sbt Department of Commerce www.wiscAnsin.gov Jim Doyle, Governor Mary P. Burke, Secretary May 01, 2006 CUST ID No. 220673 ATTN. POWTS Inspector CHARLES L WEBSTER ZONING OFFICE WEBSTER EXCAVATING, INC. ST CROIX COUNTY SPIA N5815 770TH ST 1101 CARMICHAEL RD ELLSWORTH WI 54011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/01/2008 Identification Numbers Transaction ID No. 1265863 SITE: Site ID No. 696028 Scott Green - Dwelling Please refer to both identification numbers, 304 138TH Ave above, in all correspondence with the agency. Town of Saint Joseph, 54016 St Croix County NW1 /4, NW1 /4, S30, T30N, R19W Lot: 2, Subdivision: Deer Meadows FOR: Description: New Mound System / 450 gpd Object Type: POWTS Component Manual Regulated Object ID No.: 1072681 Maintenance required; 450 GPD Flow rate; 35 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 /01); Biofilter 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 the component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. P O.r No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, Condit stats. A copy of the approved p specifications g p en plans, ecifications and this letter shall be on -site during construction and o to CEP T OIV SAFET inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. SEE CORRES In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. CHARLES L WEBSTER Page 2 5/1/2006 Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 eter E Pagel Private Sewage Plan R ewer, Integrated Services WiSMART code: 7633 (608)266-2889, M - F, 0630 - 1500 Hrs pete.pagel @wisconsin.gov cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 I Webster Soi! Testing bt Sewer System Design Charlie Ft Kris Webster, Owners N5815 770 Street, Ellsworth, WI 54011 5 Telephone: (715) 273 -3430 Fax: (715) 273 -4181 �f WI Licenses: MP220673, ST220673, ST 261669, PE18803 POWTS Index Sheet Page 1 of 8 Mound System for a 3 Bedroom Residence Property Owner/Project Name: Scott Green Lot 2 Deer Meadows NW % NW'/ S30 T30 N R 19W Town of St Joseph, St Croix County, WI Co ntents Page 1 of 8 Index Sheet Page 2 of 8 Plot Plan Page 3 of 8 Plan View Cross Section Page 4 of 8 Distribution Pipe Layout Page 5 of 8 Pumping Chamber Layout Page 6 of 8 Pump Performance Curve Page 7 &8 of 8 Management Plan ISCO e' CHARLES L V WEBSTER Z O ELISIMSFiTH 4 0 Z MIS. r �. b r SO ONA . rs Component ma, nuals used; Name: Mound Component Manual for POWTS Version: 2.0 SBD- 10691 -P yAM M c Date: January 30, 2001 ING , Name: Pressure Distribution Manual for POWTS Q0 N�E F Version: 2.0 SBD 10706 -P Date: January 30, 2001 Plot �'Id ��x ��� S'e� c� o�- cl ECG 1 l ly 1• E 1 ? 4 1 � I � I 00 s • �, r + � s 4 In `,� �r - �., - ---r F.�,��. r_:• { `° ✓ w�11 !a ca'�,�y � �' 9:. 4 •� plc ��e4 /at i � - /ldt� 7,�.��,- 4�.;�,.� �, �✓. �/� vim_ O • f f �4 Y:`c cJ c�sS- Secfbg -Scut 1s re e¢I Page : }0 .. Approved Synthetic Covering R•S7"" c.3; Distribution Pipe Medium Sand G Topsoil —__ —_ __ = F Elev 1c3-0 3 E - % Slope Bed Of z -2 Force Main Plowed Aggregate From Pump Layer a Cross Section Of A Mound System Using E l I �l • �l_�.7Ff� A Bed For The Absorption Area G A 7 Ft. H Ft. Li:,ear Loading Rate =i" 8- GPD /LN FT B Ft. Design. Loading Rate= © /SQ FT I Ft. - f}ccess box d Ft. T6K ,dC1td/� K _� Ft. 7 yp.��/ W Ft. d I ,rObservation Pipe $ K ----------------------- - L 13 S Distribution Bed Of 2 — 2 4 j Pipe Aggregate Observation Pipe,` 1 cL (anchoz securely) 'J6sr�e�} �•��s %° /1('p s? Is .'fz e o ihe�r� 6e P } o�• °f��r k� v e 7�ir C. Po �7•o 4es'. s�e t te c � / 9 Plan View Of Mound Usilkg A B•ed For The Absorption Area (✓ s e k ck s'y _r /1?4 � Page 4' Of — Perforated Pipe detoll n End View Perforated PVC Pipe / -o P Holes Located On Bottom, Set a�e�d %� Are Equally spaced / STCrr.'ar� Ai ' Dlstrbtution A, / Pipe See defid P 63 Ft. Distribution Pipe Layou S 3 � Ft. s6T r •,•., i p .h_. y, �.a.. / rT) C +�. -.,,, U` .�' 1 �pN °�,- �. - t - A ,/ 46' Inches Y 36' Inches S' Hole Diameter 4-_z Inch Lateral VA- Inches) Manifold Inches Force Main " Inches # of holes /pipe � - at tti��(d�d I e at Ft. P � avert Elevation of Laterals L e I /1 e. j / I P ,' e,, d Q� e f" 1 i l Place lst hole /P,hc, ��oN, e�dbdste,�bwtiwice'11 With succeeding holes at 3 Cfk 4- intervals . S vt �Y e ek Page 3 Of s✓ • C O � aiA St 71 h � /�tc.,�., or Sc4'e'i 4 0 (No Scale) p /rsr.� re#r ? of' _Approved Locking Manhole Covers � � With Warning Labe1S Attached ve-,! ""iO' ° P pp Weatherproof Ap °`7r 1's -- j Junction Box Vent Cap — � o 12" Minimum 4" Minimum i i Quick 18" Minimum � l Disconnect 1/4„ Weep Hole Baffle fob � i 4 e rp i A Alarm 6 B On 6� ' p C wr" •:, /as' . A *APPROVED Off 64 9S o,'coYei- to JOINTS WITH 0 d«'J APPROVED PIPE ZD 3' ONTO Conc. Block SOLID SOIL 3" of Bedding Under Tank -� d'r,� � p / •�. 04 rep al "f e— Number of Doses: S-Y Per Day Gal 1 ons Per Day / ofi'_ : 76 9 Gal 1 ons Volume of Back fI ow:-!! 9+ ?. - ,.)- Gallons Tank Manufacturer: �iCSC. C f'�a e��cfs �c. Total Dose Volume: ........ _ 61-t- Gallons Tank Size-Septic/Pum Alarm Manufacturer: l c /d X54 r�i Model Number: p L V Capacities: A a3 inches or 371 Gallons Swi tch Type: + B z, inches or Gallons Pump Manufacturer: �� �,/ + C inches or Gallons Model Number: -"? 8 Z s P6, // + D om_ inches or 3 -6 - Gallons Minimum Discharge ate: Z3. 6 fd Total ..... = 3 g inches orGallons Vertical Difference Between Pump Off and Distrib tion Pipe: � O Feet Minimum Required Supply Pressure:. .3:s�.. C.`3° ° ......... + -7 eet S'o Feet of Force Main x l -;t-S Friction Factor /100 Feet: + Feet a Inch Diameter Force Main Total Dynamic Head: ... = 9. a. Feet Internal Tank Dimensions: Length 4,6 ;Width 19 Liquid Depth ?15 4.0. s' acv tt CQ t-e e � � _ _ _ _ ��. 6' • �� .- 38 71 EPO4 EP05 APPLICATIONS • Fasteners: 300 series Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover. Thermoplas- • Homes components. tic cover with integral handle Available for automatic and •Farms Motor and float switch attachment • Heavy duty sump manual operation. Automatic • EPO4 Single phase: 0.4 HP models include Mechanical Points. 115 or 230 V, 60 Hz, 1550 Float Switch assembled and • Water transfer ■Power Cable: Severe duty • Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant. automatic reset. ■ Bearings: Upper and lower SPECIFICATIONS • EP05 Single phase: 0.5 HP, heavy duty ball bearing 115 V, 60 Hz, 1550 RPM, FEATURES Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo- construction. • Solids handling capability: automatic reset. plastic Semi -open design /4 max imum. • Pow AGENCY LISTING • ax o er cord: l0 foot standard length, 16 3 SJT with pump out vanes for Capacities: up to 55 GPM. 9t . / O mechanical seal protection. Ca�aianSlandardsAssociadon • Total heads: up to 24 feet. with three prong grounding ■ EP05 Impeller: Thermo- � • Discharge size: I NPT. plug. Optional 20 foot CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in "F" or "AC ".) rotary/ceramic - stationary, three prong grounding plug improved performance. BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel 10 i j { • Capable of running d without damage to 9 { N 9 30� ! components. I Pump: EP05 $ + I • Solids handling capability: 0 25 ; S %" maximum. W • Capacities: up to 60 GPM. s 20 • Total heads: up to 31 feet. • Discharge size: 1 /2' NPT. z 5 �-- I 7 I • Mechanical seal: carbon- 0 15' i ! rotary/ceramic - stationary, a 4 I BUNA -N elastomers. o I I • Temperature: t 3 10 I 104 °F (40 °C) continuous 140 °F (60 °C) intermittent. 2 5, w.► �- �?!�r / ' T f 0 0, 10 20 30 40 ! 50 GPM L -L L 0 2 4 6 8 10 12 m /h CAPACITY ©1995 Goulds Pumps, Inc. Effective May, 1995 83871 i POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page -7 of (9 FILE INFORMATION SYSTEM SPECIFICATIONS Owner S',a it (� r e ti Septic Tank Capacity lG l' O a l ❑ NA Permit # �f j Septic Tank Manufacturer Gfi, %s r C, ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer P /o /t ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model ❑ NA N umber of Commercial Units % X NA Pump Tank Capacity gal ❑ NA Estimated flow (average) - ?o o _ gaVday Pump Tank Manufacturer C',,,,,, ❑ NA Design flow (peak), (Estimated x 1.5) 4so g al/day . Pump Manufacturer ❑ NA Soil Application Rate G?• al/da fle Pump Model C PO ❑ NA Influent(Effluent Quality Monthly average` Pretreatment Unit NA ❑ Sand/Gravel Filter ❑ Peat Filter Fats, Oil &Grease (FOG) 530 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BOD x220 mg/L ❑ Disinfection ❑ Other. Total Suspended Solids (TSS) 5150 m g/L Manufacturer Pretreated Effluent Quality ❑ NA Monthly average`* Dispersal Cell(s) ❑ Biochemical Oxygen Demand (BOD 530 mg/L In-ground (gravity) ❑ In -ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ At -grade XMound Fecal Coliform (geometric mean) 510 cfu/100m1 ❑ Drip-line ❑ Other Maximum Effluent Particle Size Y inch diameter Values typical for domestic (non- commerciao wastewater and septic tank effluent. ** Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every 3 ❑ months )Kyear(s) (Maximum 3 yrs.) Pump out contents of tanks) When combined sludge and scum equals one -third (n) of tank volume Inspect dispersal cell(s) At least once every 3 ❑ months )Kyear(s) (Maximum 3 yrs.) Clean effluent filter )r At least once every 3 ❑ months )Kyear(s) Inspect pump, pump controls & alarm At least once every ❑ months ❑ year(s) ❑ NA Flush laterals and pressure test At least once every r N,eded ❑ months El year(s) ❑ NA Other. At least once every ❑ months ❑ year(s) XNA Other. At least once every ❑ months ❑ year(s) X NA Mf' T eeoH+�c• e'Se�C1x,h�i �'i /fir ©yce- eYeP -X 3Y 't4 MAINTENANCE INSTRUCTIONS e v e eX Poll a..y Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or r Master Plumber Restricted Sewer POWTS I POWTS Maintainer, Septage certifications: Master Plumber, Pe 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 %) 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components,' pretreattment components; and any other maintenance or monitoring at intervals of 12 months or less 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 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. % Gl /'%rik y GY - C: k.. ,- Tr 13' ^ u T f GF• e P4 Page of 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 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 P ump 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. ABANDONM ENT 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 ch. Comm 83:33, Wisconsin 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 faits 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. ❑ 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 mu I y must comply with the r 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 OWTS INSTALLER POWTS MAINTAINER tt E N. e, � Name e -Phone - PTAGE SERVICING OPERATOR PUMPER 6&, LOCAL REGULATORY AUTHORITY Name Agency St Ca o :,k Phone Phone — _.? ors— 6' O his document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies. This document meets e minimum requirements of ch. Comm 83.22 2 g ( )Cb)(1)(d) &(f) and 83.54(1). (2) � (3), Vlrisconsin Administrative Code. Use of this document does not iarantee the performance of the Powrs. GMW (2101) l Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings Page of in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County S include, but not limited to: vertical and horizontal reference point (BM), direction and Percent slope, scale or dimensions, north arFOw,.andlocatinn ant( nce to nearest road. Parcel I.D. v�ut1U G i Please print a l infdryn6gaij. J Rev' wed by Date I Personal information you provide may be used f r secondary purposes (Pnvacy Law, 1 15.04 (1) (m)). Property Owner 1 Q Z U ti'. "a f operty Location 1/41V LA) 1/4 S T 3 fj N R Property Owner's Mailing Address 1 l E (or W i �n , of # Block # Subd. Name or CSM# City l ` S — taste ' p Code Phone Number Z � �Uw S City Village R Town Nearest Road t►v tiv S�Ioo (Z1s) 6 &y- yt6Y S �si,�CJ (� New Construction Use: ® Residential / Number of bedrooms Code derived design flow rate _ p p Replacement GPD Public or commercial - Describe: Parent material `.DHSS / 0 V \ t ti�s Flood Plain elevation if applicable _ N General comments ft• and recommendations: �J/ q ' x Dl s`M 15' U 1n Du CqL. L c�>vhjv2 N2�'V . LOZ.p' F T] Boring # ❑ Boring ® Pit Ground surface elev. a- - 7 ft. Depth to limiting facto in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roo Soil Ap plicati GPD ft n Rate z I in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ' ff#1 'Eff #2 � D mv� 2 A 4 3 U R=2Y ��yR cl-� -z.S�2s1� si I 1cfs YL Yn — Z 3 Boring # ❑ Boring ® Pit Ground surface elev. .3 fL Depth to limiting factor 3 5 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 Z 1Z. -3S 10�231y — 6rsil �- i'►�.S� � � Ck., �� •5 ,(3 Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS _< 30 mg/L CST Name (Please Pnnt) gnature CST Number Arthur L Wegerer _ O � Z 220254 Ad W e g e r e r Soil Testing & Design S e r v 1 C e Date Evaluation Conducted . Telephone Number 421 11. Hain St. River Falls, 1•7I 54022 01 � -l6 -03 715 -425 -0165 1 Property Owner Parcel ID # V"�1N--))A) Page 7 of Boring # ❑ Boring Pit Ground surface elev. �� 3 . V ft. Depth to limiting factor 7 �'� in. Solt Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 D - 9 loH Z 3 t! z - s i b Vr rn�. c-w Z� , s 8 Z + m - (V H S �8 l03 bk vq C w — _6 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 ' Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft 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. SOD -8330 (R.6/00) h T PLOT PLAN Page 3 of 3 Scale 1 1 =5(3 ' 10 z � r �� M�1 �-, l b `''t�t���y "D1A, Svc tqe� wjLpm . g 7 '11P t.L, 31y" DIA, hl Pe W �. bDNtrcOMP T 5: 'a C� m Vzc) x-07' Z �CzO PO S�"b ZZpfl�D { I LUOMa i e., �. 6-16-O'3715-425-0165 220254 03_1 OZ- CST Signature Date Telephone I CST No. Job No. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Own uyer 7 G�J� %Ie A (Ni�S bn S ' I j( V Mailing Address Property Address R I (Verification required from Planning & Zoning Department for new construction.) City /State d � 1 it U�l t Parcel Identification Number �30 OZ -CM zao2 LEGAL DESCRIPTION Property Location '/ , '/ ,Sec. 3�7 , T 6 N R_ Town of sq . I Subdivision Q � t db lj Lot # Certified Survey Map # t , Volume , Page # Warranty Deed # k I / Q a 3 , Volume O? , Page # 531 Spec house la yes ❑ no Lot lines identifiable ❑ yes ❑ 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 a treatment 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 virtu of a warranty deed recorded in Register of Deeds Office. Number of bedroo s 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. 08/05) 11 7 4 9 6 2 3 U; 2 4 7 7 P 5 3 KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 3 - 1998 REGISTER OF DEEDS ST. CROIX Go., MI ()I nor ci Aim nipwn RECEIVED FOR RECORD 12/19/2003 10:30AN Stuart T. Green and Laurie A. Green, quit - claims to Western Wisc. Constr. & Design, Inc. the following described real estate in St. Croix County, State of QUIT CLAIM DEED EXEMPT i Wisconsin: REC FEE: 11.00 02, .4 and 8 of Deer Meadows in the Township of St. Joseph. TRANS FEE: 750.00 COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Address 030-1086 -20-ON and 030- 1086-30-000 Parcel Identification Number (PIN) This Is not homestead property. Dated this day of , 2003. *Stuart T. Green *Laurie A. Green * s AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) )Ss. County ) Pere rally came before me this , day authenticated this day of M of , 3 above named 2003. RO6 ItT T_. Notary PUbiic � i�A o�oti — to me known to be the person(s) who executed the $ (� foregoi nstru n acknowledge the same. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) Notary Public , State of Wisconsin THIS INSTRUMENT WAS DRAFTED BY Y Commission is permanent. (If not, state expiration date: _ Ronald L. Slier 20 .) VAN DYK, O'BOYLE At SILER, S.C. Post Office Box 118, New Richmond, WI 54017 (Signatures may be authenticated or acknowledge. Both are not necessary.) *Names of persons signing in any capacity should be typed or printed below their Signatures QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM No. 3 -19" INFORMATION PROFESSIONALS COMPANY FOND W LAC. WI 8004L552027 y u - W r Sf sfa, s I 100' co do M � QO � ^ 2 o I LL: S cn ¢ !� .� .s ? N o ti 3l f I Go N I N L Q c� a0 C� O� L r'1 � oI'oo wl W 3 3 C mO O N cV N ��,� 2 � v °� _^ w I a u�i N N o f p N I �� 0 O 1 Q o N I W 3 I i00 r O p M 0 .-- m g Z6 9 1 z 1- � � op W m N O f M m Z N sSZ� N Q� a w iA iA o N Vn Q N a $� Z = ��p z �� W� M M 100' I (n O O r,� Q o Z po CD W J � I <W� co � m ( c \ $' I =� W I NSW 10, o N Z M W O _ I a N Q w.� cv� O=ff 3 GWw< N 00^ i I 1 N^ ,,9a h N cn Q�'' o c0 3 ° �kn z c ci \ Z e ' ,��� o It � M 2 oA Via \ 9/° h^ 4 W a I o I rn I : m O : Z N 3 _ NE I m N � S 08'17' 52 > Z �� W Z. m Z W 8 7.3 4 — (V ow c Z o - ,,� 00'00 04 � ° « ` d O z o M _ V 123.9 zo o w 0 I o� _ _ t O N 00'00'04" W N > I _ RO D 0 co ►� 129.22 wN NW \ TD Q N 08~17'5 N 3 2" W 4 2 87.34 I I n � Q h N m ♦— I N I W a gi I ti90o N $A I N, x ch ��= W � r � I u t V) I 0 4i� m 0 �.°' co �- 0 000 E W 451.9 �� W N N .^° 1 I h .- 331.43 Gj a • Q S cn �O �` N E" 0 0 ''� m Z / co to < I O p (7) Z M . E (7) co N -7 O N o �,'` ,�� `ti I ^ O 4 vi II 1 3.5$ a:,: � M 0 N cli n N � o s 82.02 N N E� rn 0) S 00'01'05" E . e m W Z 41 < M N I •pNp 3 ,I �- to V) Q S 01 E `�' `s's�' 100 iA O N / �"r 79.85' e N S ^i h g I 0o N p to co CD C 6 Z Z I N 00'00'32" W 329.96' � a `�' N N 00'29'39 W 11K z zs p,q,, R.A. NORTH 330.00' 1135s k ?til I Z O 0 41 F 34" W Q O � O 'te < ,r S CQ L` C4 r7 ►pj Z C:) N a 66 00' O �3 Q W� a N C [~ too N N OD 3 � p � = O �N F— N s z / cD O N N it cOl (V Q � 4 W / Z w I W N 0 co N 15 2 0 N N X6.20 O / s z I 04 O) Z z� �0) O oF5 O 00 Q :D Q 00 �/ N O O z (n — 258.48' I 'Q`h, N 00 C ) n )0 0) S 00'00'04" E 278.49' z "� o of _ Lo i•7 50.0 COUNTY TRUNK HWY. "V " N 00'00'04 W 324.64' Lo Ln R. N ORT H 32 4.61' S 0 0'02'44" E 4 THWEST 1/4 WEST LINE OF THE NORTHWEST 1 4 CSM V OL. 7 P 2066 �1NPLA LA z 0