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HomeMy WebLinkAbout030-2133-03-000 WisconsintDepartment of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix 'Safety and Building Division INSPECTION REPORT Sanitary Permit No: 506341 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)J. Permit Holder's Name City Village X Township Parcel Tax No: Western WI Construction I St. Joseph, Town of 030- 2133 -03 -000 CST BM Elev: Insp. BM Elev: Description: Section/Town /Range /Map No: BM ✓M Q rte, GS T 30.30.19.2003 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic r Benchmark Dosing a^ Alt. BM o OJ00 (000 41. eslI, �� o � Bldg. Sewer 9 '�J, �Z- '?Jr. 78 Holding St/Ht Inlet IT L , d TANK SETBACK INFORMATION St/Ht Outlet � TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ �� Septic 7 'SD I 7d 7 6 / Dt Bottom ��. /0.`11 S$ . `to D osing _7 5 b , J4-- 76 i . Header/Man. 04 I � , Aeration Dist. Pipe , - 4,19 16 1,01 Holding Bot. System _ 05 ✓aa , Z.S. � PUMP /SIPHON INFORMATION Final Grade 3 -1`1 l� v3 Manufacturer Demand St Cove/ GPM ` 9, �' S q���'� O E.l (�' Model Number 1 5 Z Z TDH Lift Friction Loss System Head TDH Ft VIP 3-3 /Z 37 Forcemain Length 1 Dia. .t Dist. to Well O �� Z -- - -� SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Tren es PIT DIMENSIONS No. Of Pits Inside Dia. Liqui Depth DIMENSIONS 8 57 ^-� �� .\ SETBACK SYSTEM TO I P/L BLDG TWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of stem: 5,q /t A)A- UNIT Model Number: ty) ., O r� DISTRIBUTION SYSTE Header /Manifold y Distribution i �/ / x Hole Size x Hole Spacing � Vpo Air ntake t� . 25 Pipe(s) �.f L Lf -3J Length!_ Dia Length Dia /i Spacing ` ��O SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only vttGp Depth Over 10 IDepth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center '7 8 Bed/Trench Edges Topsoil �[�"�s [] No s No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: f D / Z-f 0 - 7 �'1,Inspection #2:__/ / Ff 4-ao Location: 1378 31st Street Ho Iton Lot 3 , WI 54082 (NW 1/4 NW 1/4 30 T30N R19W) Deer Meadows Lot 3 V (� Parcel No: 30.30.19.2003 1.) Alt BM Description = ' " % � 2.) Bldg sewer length = - 72, 0 ©� 5 - amount of cover = 1 - - -- - -- — - - - -- - - u - Plan revision Required? ❑Yes o i i5 - (y � �_i - -_ _- __ - - -- - -._ - --- --- - - - -_- -_ _-- - - - - -- b Use other side for additional information. I �- SBD -6710 (R.3/97) Date Insepctor's gnature Cert. No. co11 merce.WS.gov Safety and Buildings Division County 201 W. Washington Ave., P. ox 7162 � ,� i sco n S i n Madison, WI 53707 2 Sanitary Permit Number (to be tilled in by CoJ t Oepartment of Commerce �J' a 4 3 4 Sanitary Permit Application Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm Code, submission of this form to the appropriate govenm unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are oject Ad r ss (if than maiIi / neadd ess) submittDepartment information you ed to the Depament of Commerce. Personal informa tY �! _� u oses in accordance with the Privac Law, s. I5.04(I)(m), Slats. r.F1 �� 3 Ne 1. Application Information - Please Print All Information s Property Owner's Name Parcel # ,-S o Or �� SEP 2 6 2001 036 -2133' 03 -bob Property Owner's Mailing Address A s OVA a- r ropetty Location Z. CO3 ///7 ` ST. CROiXCOUi TY J GJ !/ ..11LJlJ Govt Lot /���� City. Sta e Zip Code r y 1/, Section 11 / circle one l t- �` 'T T N; R E o W 11. Type of Building (check all that apply) Lot # N Subdivision Name J<! or 2 Gamily D,vc1ling - Number of Pcd:'ooms Oa Block # ❑ Public /Commercial - Describe Use L _ P_ _ _ - �� ❑ City of ❑ State Owned - Describe l use 4S ta.'SPr,bto y CSM Number ❑ V illage of ya Town of +Q 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' XNew System p y g P ❑ Replacement S ❑ Treatment /Holdin Tank Replacement Only ❑Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision El Chang of Plumber ❑ Permit Transfer to New , Before Expiration Owner IV. T ype of P OWTS System/Component/Device: Check all that apply ­ r ❑ Non- Pressurized In- Ground ❑ Pressurized In-Ground ❑ At -Grade WMound > 24 in ofsuitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain)___ ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: G t• Design Howl gpd) Design Soil ppltcatioyR te (gpdst) Dispersal Area Requu• (st) Dispersal Area Proposed�st) SysteElevation V1. Tank Info Capacity in Total # of Manufacturer b U Gallons Gallons Units p U � �, •,- C V New Tanks Existing Tanks f ° N y y Q O /✓ o a U rn rro iL V �. Septic or Dosing Chamber V1 1. Responsibility Statement 1, the undersigned ssu a respousibill y for ni allation of the POWTS shown on the atttached plans. Plumber's Name (Print) Plut ber's •ignature MP /MPRS / Number Bu / siness Phone Number / Plumber's Address (Street, City, State, Zip Code) I'll[. County/Dep Use Onl Permit Fee Xlued Issuing A t Signatur Approved ❑ isapp S wner n easo ial V W ' � �� IX. Condi easons for Disapproval _ t t 4,4 Mfi elterand "'"�^S ���`" t° dispersal cell must all be services, / maintained t. J( �"�' f alw..• �"' as per management plan provided by plumber. 2. AN set ack requirements must be n>eintained �/ 1 /Vd clrr s 6'� +a c{'e 60— I � Attach to complete plans for the slstem and submit to the Coln . only on paper not less than S Ii2 x I I inch �s in size SBD -6398 (R. 01/07) Valid thru 01/09 cale: NORTH (cD . sq f t�a pr ©f Q rno IAi a � 5 rav�Cf Od r'f ur nce 9''o ' . Norte more ,I # e,/9r DrOP9 � v Se Oi 11 � �lUer� � y�b � is Sys�eri► ion -jUar � � t oa6 �7'7�� n0 � f -/ A to .be re.nav Ife/ � _ eX�r�►n . ���i,LY�R v S ...,� 0 7 lI'1 �al�a�S NOTES 1. Will meet all Comm- 83 setback requirements Gallons Mfg. by Wieser Concrete Products 2. Septic Tank_Lg(&Gallons Doke Tan j 3. Benchmark #1 Elevation 100.0 Description of- rop O 3 * 3 � Description of- fo 0P PAC 2 Elevation /CJ p Benchmark # .��- - Y 4. Other- .; cal.e NORTH - frQeS `D �0` l / I {,I' -Ced I 3S.Gwi�! y j Ile — - -� �� /� c ts ,,,� ` ,Pra��'� rn�n /a►,u � 5 rvv ?� oJrfurlt2nce o pen w /.s�9�it hoIx✓ r male -/# em�i9r �'ro► -► I d Otvnrij� eAtvelbil MAO ,DroP91 �� 0� t Bing! A& ' a ° ; .� ,V•; tv be re.r►av t� V e de l i[Y R SMA /� -fr Q S C.,7 ...L 0 7� . � e r lV ea6lOV)S t2 OW NI P'OTES 1. Will meet all Comm. 83 setback requirements Gallons Mfg. by Wieser Concrete Products 2. Septic Tank Do Tank ,� p 3. Benchmark #1 Elevation 10 Description of- - oP 3 �' V C e scri tion of- �"o of 34 P�C Benchmark #2 Elevation /� � 4. Other- i PACE 1 OF S Private Sewage System Plan Index PLAN I. D. NO. PROJECT TYPE CA110 S' MOUND PROP. OWNER ADDRESS PROJ. LOCATION -- COUNTY �1'D /�C TOWNSHIP 7. S LEGAL DESC. / y, , SEC. Man in accordance with Mound Component Manual SBD- 10691 -P (N. 01/01) Version 2.0 and Pressure Distribution Manual ;RD- 10700 -P (N. 01/01) Version 2.0 PAGE ONE INDEX SHEET PACE TWO PLOT PLAN PACE THREE CROSS SECTION & PLAN VIEW PACE FOUR LATERAL DISTRIBUTION PIPE PACE FIVE PUMP/SIPHON TANK PACE SIX PUMP CURVE PACE SEVEN MANAGEMENT PLAN PACE EIGHT DESIGNER Dennis Hewitt CREDENTIAL NUMBER 221483 ADDRESS W2062 HIGHWAY 10 MAIDEN ROCK, WISCONSIN 54750-8307 TELEPHONE 715- 2 DATE /F?WZ2= r SIGNATURE RECEIVED rD ti. a SEP 1 0 2007 E Y COMMERCE , gNOFt 7 'LUNGS SAFETY & BUILDINGS �_ - _��`� 0PONDENC Safety and Buildings 4003 N KINNEY COULEE RD commerce.wi.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsi www.commerce.wi.gov /sb/ www.wisconsin.gov Department of Commerce Jim Doyle, Governor Co Mary P. Burke, Secretary September 12, 2007 CUST ID No. 221483 ATTN. POWTS Inspector DENNIS L HEWITT ZONING OFFICE HEWITT EXCAVATING INCORPORATED ST CROIX COUNTY SPIA W2062 US HWY 10 1101 CARMICHAEL RD MAIDEN ROCK WI 54750 -8307 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/12/2009 Identification Numbers Transaction ID No. 1457464 SITE: Site ID No. 730168 Scott Green Please refer to both identification numbers, County Road V above, in all correspondence With the agenc Town of Saint Joseph St Croix County NWI /4, NWI /4, S30, T30N, R19W Lot: 3, Subdivision: Deer Meadows FOR: Description: Mound / Three Bedroom / Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1151660 Maintenance required; 450 GPD Flow rate; 35 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 101), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 101); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. 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: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. The force main is to be installed in the down slope area, The trench for the force main may not be wider than 12 inches. Track type tractors or other equipment that will not compact the area are required. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c c _ 't4Q�> , • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. SET, C` • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat DENNIS L HEWITT Page 2 9/12/2007 • Comm 83.22(7) A copy of the approved plans specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /instal lation/operation. 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. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 (2 ' Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday charles.bratz@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. I ! age 3 of 8 Ground Contour Elevation QQ.Q Synthetic Covering System hlevation Oistribution Pipe Medium Sand Topsoil -- H ____-� F �G 3 ti °I. Stops lJ CELL 0! I- 2 % Force Main Plowed Aggregate From Pump Layer p to Cross Section Of A Mound System E F to ' G 6 „ r/ A of Ft. H LINEA? LOADING �'tATE Iv L GPD /LN F`r D Ft. DESIGN LOADING RATE o _ GPD/SQ FT ,� I Ft. BASAL AREA NEEDED SQ FT Ft. BASAL AREA AVAILABLE /L `1 S Q FT K 9 Ft. L Ft. Force Main W LFt. L Observation Pipe J g — K �r----------- - - - - -- - - -� Q '•� A f. Distribution Cell Of Pipe Aggregate 1 Observation Pipe Lateral Clean -outs Plan View Of Mound 4 LATERAL Absorption Area i Page 4 of Perforated Pipe Deloll �0 L.S. 90 End View Clean -Gut \ P.rloroted PVC Pipe at �e `--7 �.o o ce Holes Locat.d On 50110m, Are EQuolly 5poced S S x � / Q PVC Monllol0 pipe Poslllon Of 07slritaution i" ✓ wo F� ( y 'r Force Main From Pump Pipe Lail Mole Should B• Nest To End Turn — Ups oistribution Pipe Layout Graph 6 Minimum Lateral Diameter Based on orifice Spacing r 3116" iameter Orifices x _ �5 3 25 Hole Diameter 3 // Inch 300 Lateral " Inches 275 Manifold " Inches 250 Force Main _ Inches 225 Holes Per Lateral 200 r 3' 775 Invert Elev. of Lat. 150 / System Elevation 725 2' Contour Elevation 100 7s ,•vr , , 25 3l4' 0 25 1 3.5 4 4.5 5 Orifice Specinq In Feet page A `• COw6INATIO SEPTIC TANK /PUMP CH AMOLR 4" CI Vent Pipe ..;cn (No Scale) ,approved Cap, 1j - . Approved Locking Manhole Cover from du;lz;ngi With Warning Label Attached n Weatherproof Approved Junction Box Vent Cap 1. rlinim,..� 6" Min 4" Minimum 1 Gr Quick Disconnect 18" Minimum - I 1/4" keep Hole Baffle r J I Approved Joint ' A WI/C.I. Pipe Alarm �+ Extending 3' Filter B Approved Joir Onto Solid Soil 0 0 l y l a k , S � � On 6; w / C. I . P i pe or PVC I C Extending 3' Onto Solid S: PUMP - OFF ELEV. �•" Off or PVC 0 Conc. Bic:►. 3" of Beddinq Under Tank—/ Lateral V olume��q��,Y.0� `31 Min. Dose (5 X Lat. Vol.) Cal Max. Dose (20% of DWF) 90 Cal Cal dote: Pump and Alarm Are On Separate Circuits Flowba se X•165) Cal Max. Dose W/Flowback Tank Manufacturer: WIESER CONCRETE PRODUCTS Tank Size - Septic /Pump,: l000 600 G ons Alarm Manufacturer: S. J. ELECPRO Model Number 101 HYCH WATER Capacities: A 18 inches or 0�„ _ Gallons + B 2 inches or Gallons Pump Manufacturer: - <' + C i nches or Gallons Model Number: + D inches or Gallons Minimum Discharge ate: Gallons Total.....° inches or /� Feet Vertical Difference Between Pump Off and Distribution Pipe* 3^' Feet Ml mum Required Supply Pressure: ..................... +Feet _Y�Feet of Force Main x Friction Factor /100 Feet: 2 Inch Diameter Force Main Total Dynamic Head: ... = Feet Internal Tank Dimensions: Gal. /Inch 16.? Liquid Depth 3F" _ Page 6 of 3 TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE HEAD CAPACITY CURVE EFFLUENT AND DEWATERING MODEL 52 153 MODEL 152 153 W W Feet Meters Col. Liters Col. Liters 50 5 1.5 69 261 77 291 10 3.1 6 1 231 70 265 153 - 15 4.6 53 201 61 231 12 40 1 2 0 6.1 44 167 52 197 a _ 25 7.6 34 129 42 159 z z 30 9.1 23 87 33 125 ,0 c: 35 10.7 -- 22 85 z 40 12.2 - - 1 1 42 o f r Lock Valve: 38.0 Ft. (11.6m) 44.0 Ft. (13.4m) a � ousoe � r- 0 r- 4 F x'7/7 http : / /www.aoallor. com PUMP !O. 0 20 40 60 80 100 GALLONS LITERS 0 80 160 240 320 FLOW PER MINUTE Table 6 FRICTION LOSS (FOOT 1100 FEET) IN PLASTIC PIPE' Nominal Pi Size 3 4 6 Flow in 1.1/4 1-1/2 2 GPM 3/4 1 2 3 3.24 4 5.52 S 8.34 Velocities in this area 6 11.68 2.88 art below 2 feet per second 7 IS.53 3.83 81 19.89 4.91 9 24.73 6.10 10 30.05 7.41 2.50 11 3544 8.84 2.99 12 42.10 10.39 4,07 13 48.82 12.04 4.66 1.92 14 56.00 13.81 1 2' 18 is 63.62 15.69 5'70 2,46 16 71.69 17.68 6.68 2.75 17 80.20 19.78 21.99 7.42 7.06 19 821 3.78 19 24.70 26.72 9.02 3.72 139 40.38 13.63 5.62 2S 19.10 7.87 -1'.94 _ 56.51 2.58 35 25.41 c 32.53 13.40 3.30 40 40.45 16.66 4.11 45 49.15 20.24 4.99 50 28.36 7.00 129 .97 60 77.72 9.31 1 70 11.91 1.66 80 14.81 2.06 0.62 90 2.50 in this area 2.50 exceed 10 feet per second. which is 18.00 3 .50 0.93 100 too &mat for 27.20 1.31 125 5.30 various now rates and 7.05 1.74 150 pipe diameter 9.02 2.23 175 13.64 3.36 0.47 200 4. 0.66 250 6.217 0 97 300 -_ POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORN1ATION SYSTEM SPECIFICATIONS Ovmer Septic Tank Capacity /Q gal C3 NA Permit N Septic Tank Manufacturer ❑ NA 1 Effluent Filter Manufacturer — ❑ NA DESIGN PARAMETERS ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model Number of Commercial Units NA pump Tank Capacity gal ❑ NA Estimated flow (average) gal /day Pump Tank Manufacturer ❑ NA CQesign flow (peak), (Estimated x 1-5) gal /day pump Manufacturer 2 e Ile r ❑ NA Soil Application Rate gal/day/ft' Pump Model ❑ NA {'nfluent / Effluent Quality Monthly average' Pretreatment Unit ,Jig NA ❑ Sand /Gravel Filter ❑ Peat Filter Fats, Oil & Grease (FOG) :530 mg /L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODJ 5 _220 mg /L ❑ Disinfection ❑ Other: Total Suspended Solids (TSS) 5150 mg /L Manuf —; Pretreated Effluent Quality j8[ NA Monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (BOD 5_30 mg /L C3 in-ground (gravity) ❑ In ground (pressurized) Total Suspended Solids (TSS) 5530 mg /L ❑ At. grade ❑Mound p Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -line ❑Other: Maximum Effluent Particle Size % inch diameter Values typical for domestic (non- commercial) wastewater ano septic tank effluent. * * values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Frequency Service Event inspect condition of tank(s) At least once every 3 ❑ months X year(s) (Maximum 3 yrs.) 'Pump out contents of tank(s) When combined sludge and scum equals one -third (% of tank volume Inspect dispersal cell(s) At least once every 3 ❑ months 9 year(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ months 9 year(s) Inspect pump, pump controls & alarm At least once every ❑months :9 year(s) ❑ NA Flush laterals and pressure test At least once every ❑ months ® year(s) ❑ NA Other: At least once every ❑ months ❑ year(s) ONA Other: At least once every ❑ months ❑ year(s) X 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 vi -s-ual 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 chac for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check th, 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 ( % 3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretr b t a certified POWTS Mai and ntann r. o ther maintenance or monitoring at intervals of 12 months or less shall be performe d y A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. the START UP AND OPERATION: For new construction, de the treatment process and /or damage the d s ( persa r l cell(s)e h of painting products or other chemicals that may imp concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. Syste rt st, tip shall not nccur when Boil conditions are frozen at the infiltrative surface. r f�' PJ1.111 l •,;1 During power outages pump tanks may fill above normal highwater levels. When power is re tired the excess or s r ste er s %iil be discharged to the dispersal cell(s) in one large dose, overloading the c and Y 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 cor trots 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. im rove the performance and prolong the lite Reduction or elimination of the following from the wastewater stream may p 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. ABANDONEMENT: 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 Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN: If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ion ❑ A suitable replacement area has been evaluated protected f a d be isturbance dazed and compaction f and e should not be b nged P� system. The replacement area shou by required setbacks from existing t and propo evaluauonuto establish bush a able replacement area. Raplapement will result in the need for a new so must comply with the rules in effect at that time. ❑ A suitable replacement area is not availa due t s ort to replace soil li itationPOWTSng advances in POWTS technology a holding tank may be insta and site ❑ The site has not been evaluated to identify as ble be replacement area. lf no peplacementfarea s able a tank t evaluation must be performed to locate a suitable P may be installed as a last resort to replace the failed POWTS. if Mound and at -grade soil absorption systems rs place he in effect atlt of at th at the infiltrative surface. Reconstructions of suc h systems must comply < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS M C LETHAL UNDER GA AND/OR CIRCUMSTANCES. MAY ' DO NOT ENTER A SEPTIC, PUMP OR OTHER TREA RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS: POWTS INSTALLER POWTS MAINTAINER Name CUl! Name Jr) Phone Phone LOCAL REGULATORY AUTHORITY SEPTAGE SERVICING OPERATOR (PUMPER) off/ . Agency >T 1 a E Phone mees Th s document was drafted by the staffs of the Green Lake, Marquette and W2� & +3' fl rons;n ntlsuativetCodegeUse of t h s document 11) . ,,, ,;,»um n�nuirrr ^ants of I rnmm 83.22(2)(h111)(rl) &(f) and 8. 5"'(1), Dii nsin 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 v CEO, percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Y G r Please print all information Rev ad by Date Personal information you provide may be ed for s�gonClagr $Path (privacy aw, s. 75.04 (1) (m)). Property Owner Property Location I " -GeA. Lot — N l� 1/4 M I.�j 1/4 S Z T 3 N R L E (o w Property Owner "s Mailing Address Lot # Block # Subd. Name or CSM# me Clty State Zip Co - -° El City ❑ Village [S� Town Nearest Road �►•� hJ S�f 68 _ _ ow L , CT1 y v ($� New Construction Use: ® Residential 1 Number of bedrooms 3 Code derived design flow rate GPD I ❑ Replacement ❑ Public or commercial - Describe: Parent material `n.Lt. Flood Plain elevation if applicable General comments - ft and recommendations: G x S O lS'TYZ - 1 61, P 1 �. l V ltrt (� `` O1= SPM'tl Ft LL , 0 "j f E Boring # ❑ Boring c ® Pit Ground surface elev. Q 1 - 3 ft• Depth to limiting factor Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil A pplicatio n Rate j in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff #2 1 0- 10 X12 31 - S I ) Z`�b`tz, h'1`[�r C ZJ Z `� - , $ � L R - 5 toy 2-310 — 3 3 S 4 Boring # ❑ Boring i 9 IrSI Pit Ground surface elev. � � O. Q ft. Depth to limiting factor.. 3 SS ln. Horizon Depth Dominant Color / Soil Application Rate Redox Description Texture Structure Consistence Boundary Roots GPD1ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 0 'Eff#1 'Eff#2 t-Oy �Z-�16 S i f Z -`� h2'F cw l� • S , - 0 - si) 7sn sbk Yr,�r ew - , S •9 Effluent #1 = BOD > 30 _< 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS _< 30 mg& CST Name (please Print) Signatur Arthur L. We g e r e r 0 3 �� _ 3 22 CST Number �Z Address 0254 !de g e r e r Soil Testing & Design. S e r v i c e Date Evaluation Conducted Telephone Number 421 d. Bain St. diver Falls, 17I 54022 6- L 6- D 3 715 -425 -0165 �P'rroo'pe�rty Owner G`Z� Parcel ID # 7 �1�iN Page Z of M 1 I Boring # E] Boring - 1 --' I a Pit Ground surface elev. it. Depth to limiting factor 7 6 3 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 s t. J Z Yn 3 qq 30 -),S ��3i y — L . `esblz h, +h c� - - 4 R -b 3 s�f I23` y - s 1 0 rwo F-1 oring # ❑ 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 fn. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 L . ...................... F-1 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. SBD -8770 (R.6/00) PLOT PLAIT Pane 3 of Scale 1` =S0' �i✓1 ?�-I - fit.- .. l 00 , 0 � � a r �h�.�. , 3l y` 'D! A PVC P L PL _w / L 0 its 8.'s g, Ns` �N 10 0 , p' �' z g boo �- �_ k 9 : 7 • I �I , I {I - - - - -- r 715-425-01 5 22 254 03_102 3 CST Signature Date Telephone No. CST No. Job NO. ft- 71/70/9 ex's o1+1xs ST. CRODC CO WM s� �e e.., zo .;nz 4i s ON ttyrw.re.r NORTHWEST CORNER OF SECTION 30 , awAwl tw OF 1 W SET IRON SPIKEI ��EO �� L 3 VO L. NORTH LINE OF THE NW 1/4 - NW 1/4 FROM COUNTY R.A. S 8922'19' E 1244.04' L� 4 CSM TIES VO 1 1 t P PAGE 3251 S 89'22'20' E 1244.09' VOL. 12 PAGE 3255 9.94 5o.w• 79.97. - J 461.13 2487155• 33 50 i ?rte- -- x9e' 4► 4 4 x' I 484.87' - � I E lH0 - 971.50• N miJgt' L4 1 - Z Z Lt9t[ t m g g 1 saw a'� sH LOT 4 > S7p2 - w 13 5249 S.F. LOT 5 p - to7.9e' 3.10 Ac. m A E t +' 1 ^LOT 1 v \ 93157 130747 S.F. Z w I z 161803 S.F. d c ° 1. A 0 U m O ° 700' i 3.71 Ac. \~ N U O N.B.. 92534 54 FL u h 2 O Q I y N.B.. 96747 S% N.B. 212 Ac. p A'°� N.B. 2.22 A. �y N.B.. 130747 S% F4 N I - il .Y t I I N.B. 7.00 t 1 89 1 119E - \ �, j LOT 6 D 80.05 130790 S.F. \ l+ \ I �• I 1 f N 89'22'20' W 330.04' 27 3 CSM VOLUME 2, AGE 549 I iIC R.A. N 8922'19' W 330.00' ° t y ?J ' trlr LOT I /P 3.00 Ac. p I ( I Z a 1 w euv. la y r /4• f ` tH0 . 94E..00' pp 9 ri4 �.I yea nr[ - tl►p' L__`\// N.B.. 12923! SF Ft. I I2 .'O O y "� �. N.9. 2968 Pt. 0 1N I I I UNPLATTED LANDS Po N a S J * �4• : / V - - -- - s enc�1 c tLJ157 t � ~ E y \E ?g \ SHED d E D m 7• 0q-� to r to 1349 S,F. ' }9 E 392.2 x'4•'14 •7k• O ' m 3.10 Ac. 4 ."0 pl 78 �' ? ��. O y O a R.A. S 8922'19 E 330.00' LBO - 91757 •'J jq to o $ 89'22'12" E 330.09' ; N.B.. 123782 sq. Ft f M 2V48'29' E YP E CA 7115 999 : K N.B. 2.84 A L N � e541 • W 1 . i = 9.65 �• c i $ LOT ! ' .,ta' V �' r•1 y I - e r 4� 1 � , � 0 1 6 �1 1 932.77 3 '?' a 011 130676 S.F. f ;0Z to e0.1 +' •, e•' 8 \ �I I+ 's + E BO - Z 00 33 AC. r O g 1' •�- tcsl `1 1 • - - LBO - a40.002'� u " r N O7 J.'- �'FE: Q O A o $ o LOT 2 : IIL� s so•\ 9410 f, I 75 t, 11wE - g N i II $• 7 , ' ORAMAM cAso 131767 S.F. °' • -LQT 2 CSM 75 e VOLUME 2, 4 PAGE 549 z -+ a rn a 3.02 Ac. .A 4L+ ---�- f m I + N ( \ s42p0' d 1E q" 5 30 Z N.B.. 97400 sq. F _ I w Z aN my : N o �•- �.�s• g �! I N.B. 2.24 �Pa mwal4Rr 5 224.56 0 A O A twugL 4 N.I. 102839 S% Ft. I + d ° to tia W Av N to W I � O N.B. 278 Ac. �I-I I AoroMr. `� L _ _ L O d 20.07' - _ rn s 8972'59' E 74212 - - - - - E 11388' S 8934 S' E 288 7 a 14 $ � TO1YN ROAD S as77'21• w 18238' N 89`5415' w 2 66 .2 ° A m N e9 do '32' E ,6.73 N 89 59 W 792.10 21 ATiON N R. ,A. N 89'34'15' W 792.00' . X > � 93&97 S 50 33' 33.28' 1 Z � t �a . 47' w o s tossroe 86. s1 @'W OR LO-T- CSM VOL. 2,_PAGE 511 A g , L +St eA1++ • �+ �S 00 E I OWNED BY OTHERS r c 1881.41T 0 WEST 1/4 CORNER OF LOT 8 % mw SECTION 30, FOUND ca 153074 S.F. 'G + BERNTSEN CAP. �� �N wo 3.51 Ac. ^ 1 O LBO - 941.110' 6 1 a >a N.B. 725M Sq. Ft j9• 33' 33 M1 I - + N.& 2.89 Ao M 1 I 8.2188 � 11L. 6 CPAMACE $ P z 9274' Mo suit t N 89'3424 W 446.69UNPLA (Qtil `03 Ylu ti R.A. N 89'34 W TIED LANDS SOUTH LINE OF THE NW 1 /4_NW 1/4 ' I 6s ES .AFM BY. BRIAN PUMA SHEET 1 OF 2 ST. CROIX COUN'T'Y SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer SGo# Mailing Address Property Address (Verification required from Plarming &Z.oning Department for new construction.) City /State y Parcel Identification Number Z13�3, r 03 " LEGAL DESCRIPTION ' Z YJ-3 J Property Location //'* '/4 , / �1 '/4 , Sec. &0 , T .. N R /y W, Town of Subdivision _ � , Lot # . Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house yes no Lot lines identifiable vex 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. Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number f bedr oms 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) 7- 4'623 V 2 4 7 7 P 5 3 KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 3 - 1998 REGISTER OF DEEDS sT. cROIx Co., xI RECEIVED FOR RECORD 12/19/2003 10:30AM 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 CLAI" DEED EXEMPT i Wisconsin: REC TRANS 75 00 Lots 2, 3, 4 and 8 of Deer Meadows in the Township of St. Joseph. COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Address 030 -1086- 20 -OW and 030 - 1086-30 -000 Parcel Identification Number <PIN) This is not homestead property. Dated this l� -- day of , 2003. X Z -'&_ ul�' A/ *Stuart T. Green *Laurie A. Green s * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) )ss. Jy County ) Pers Wally came before me this '� day authenticated this day of �_ of , 2gQ � abov named , 2003. Roger 4�IlA /tT T f�� Notary PUblic - l,��r! 4V to me known to be the person(s) who executed the Of VViseensi tae foregoi nstru n d 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 & SILER, S.C. Post Office Box 118, New Richmond, WI 54017 (Signatures may be authenticated or acknowledge. 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