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HomeMy WebLinkAbout038-1239-17-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM uu"". St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 624816 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 Township Parcel Tax No: TODD & JULIANNE BACKER TOWN OF STAR PRAIRIE 1 038-1239-17-000 CST BM Elev: Insp. BM Elev. BM Description: N �� Section/Town/Range/Map No: 17.31.18.1278 0-02 1� TANK INFORMATION ELEVATION DATA TYPE MANUFAC R � s CAPACITY Septic ; Al` LO Dosing p o 1 vi 9, 7 �7� ! 4Ja Aeration TANK SETBACK INFORMATION TANKTO PfL WELL BLDG. Vent to Air Intake ROAD Septic .5 r 3o. Dosing c1di, t at , 7� Ip( ?� N t7 3 (., Aeration Holding L— I V" PUMP/SIPHON INFORMATION Manufacturer 1-7 501L ABSORPTION SYSTEM Demand t I Ie STATION 2BF5 HI I FS ELEV. ot.5 Benchmark Alt. M 0)4r_ �uvor ,3 `i'G.5 Bldg. Sewer St/Ht Inlet � I-Z•� 1 1 1 ' St/Ht Outlet Dt Inlet Dt Bottom 16 87, HeaderlMan. l . 0 l m qs Dist. Pipe 10(.3 Bot. System Final Grade Ski Plcr Cu �.3 7 •S BED/TRENCH DIMENSIONS Width /rT 7VS Len=7 ` es 2 PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO E&r/L BLDG WELL LAKE/S EAC ING an factures INFORMATION Type System: 7(0 HAMS OR UNI Mode Nu er: DISTRIBUTION SYSTEM 11(&Ae1 Header/Manifold y' Distribution y I x Hale Size �3a x Hole Sparing Vent to Air In —r4 Length Dia Length Dia Spacing Z' l70 sin SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only f ei Depth Over Bed/Trench Center lcv I �, i1 Z Depth Over Bed/Trench Edges > „ xx Depth of �� Topsoil - 7 Z tnc Seeded/Sodded �, Yes Q No xx Mulched ,d Yes 0 Na 1 / NCI COMMENTS: (Include code discrepencies,ppersons present, etc.) Inspection #1: flo1 d N" Inspection #2: f� Location:219194THST `�1e6� t` Gksi 7/7/2 / 1.) Alt BM Description = �I TC.✓-L O�'� Ou yh� 4 `� // PLt w (Q v .J w fU 2.) Bldg sewer length = 3O'�� - amount of cover = `^ �yz Plan revision Required? Yes S No 8 / 2 /_ Use other side for additional information.7 __ � ` 7 lei Date Insepctoes Signature Cert No. Beo-e7la (R.3/97) sf-jv- 2,02 - tZ'j >=.�. MAY 2 0 TOTO Safety and Buildings Division � �4- IL9 Stmimry Panic N (ta be filled m by Co.) �` '" • ' r;. 201 W. Washington Ave., P.O. Bex 7162 n- " St. Croix County Madison, Wl 53707-7162 - ' i ommunity Development , �ry/� "'/(((nJJJ VX Sanitary Permit Application L s" 1e " q"°°� ®' QQ�-20 L� O in accotdaom with SPS 393112). Vs. Adm Code, subati&noo of this Joanto the appropnme -fah ProjectAddress (if Mierem than madmg address) a required prior to obtanalg a salary p®i- Not: Application farms for stan"wil♦d POWTS are subnated to the Depat�eut of Safety and Professional Savies. Pasnoal information you provide may be used for secondary se'in accordance with the PrivacyLaw, s. 15.04(1 m), Stus Z I L A Neutron Information — Please Print All Information A. Property Owner's NameLe /e L�t4 dne pared, Prop Owar'3MaltingAd&= , ProportyLocatlon Y—TtZ AA e,. Govt Lot �y/,, Sore "Coda Phone Number City. I - t IS D �Sediw �Q�j T eLt---N; R W Type of Building (cheek all that apply) I Lot k Family Dwelling -Number of S� Block Subdivisioa�Naint wtlQ / it 0 PubtidCommercial-Describe Uu ❑ City of CSM ❑ Sot Oared-Descnbe Use ❑ V-dwp of Number Town of i III. Type of P : (Check only one box on line A. Complete line B if applicable) A ❑ Ropiaoemeat System ❑ TreennentlHolding Tank Repiacesuem Only ❑ Other Modification to Existing- System (explain) B. ❑ Pautit Renewal l] ?=nit Revision ❑(]range ofMambet ❑ Permit Transfer m New Lis[ Previous Pernik Number and Doc Issued Before Expiration Owner IV. Type ofPOWTSS Com oneut/Device: Check all that apply) ❑ Nm-PreuwiuA In -Ground ❑ Pressmved InGtomd ❑ Alxxade ❑ Mmmd> 24 im of suimb <24 is of k sob /n b� O Holding Taok ❑ Otber Dispersal ) ❑ Pretreamuent Device exp am C ( � V. Dis Vlreatmeut Area InformationCP Drsi flow (gpd) Design Soil Application dsf) Dispersal Afro Required (sff DisperW Ares Proposed (sf) Systan Elevation �r a VL Tank Info Capacity in Gallons Tool Gatloos p of Units`' g U .g g New Inks Exieune Tanks/�C E A m C — a W W a SepaorHoldnsTaok Doamg Cb ba / VIL ResponsibilityItespGasibility StatementA the undersigned, poasibiliry for iusrallatiou of the POW IS sbowt on the attached plans. -- Phmaber's Lame (Print) PI Iv MRS Nuorber I Basieess Phone N ZZ6 Amber's Address (Street, City, State, Zip e e✓ Z J VDL IDe rtweat Use OaIV Approved 0 eraut 4geat Si nner El0 m eea-tr Denial DL Conditions of Approval/Ressons for Disapproval STEM OWNER: 1. Septic tank, effluent filter and s �. S�s dispersal cell must be serviced ! maintained as per management plan provided by plumber. llewta L. All Sewa(.1C name -h as per applicable code/ordinances. 51 1 i S7S- - yn � fli�-rA&A vi SBD-6398(R 11/11) JPfl�dL+T'tfr. System PLOT PLAN PROJECT Todd Backer ADDRESS 841 JOoer Dr. Somerset WI 54025 NE 1/4 NW 114S 17 /T 31 N/R .18 W TOWN Star Prairie COUNTY ST. CROIX SYSTEM ELEVATION 100.1' 1.1' sand IN 5/6/20 BEDROOM 4 ;DATE CONVENTIONAL AT -GRADE CONVENTIONAL LIFE HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255,gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD�RATE 1 .0 ABSORPTION AREA 600 # of chambers none IL BENCHMARK V.R.P. Top of 2" pvc pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL •H.g P. same as benchmark 0' 40' I- � I0 O2 Acre Lot Scale = 1/4" 10' B.M." B-1 Property Line 1600' 99' 9 8' Grading;is to be done to divert run-off away from system B-2 Property Line 96 B•3 10% Slope Area 15' below system is to remain undisturbed 258' Pro 4 Bedroom Huffoutt House Combo Tank YVell is to meet all WDNR setbacks 94th St. 10+ May 19, 2020 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2022-05-19 Plan Review: PWTS-052000870-C SHAUN R BIRD 1432 120th St New Richmond WI 54017 SITE: Todd Backer 2191 94th st. Town of Star Prairie Saint Croix County Total Amount: $250.00 FOR: DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304.5211 Contact Through Relay http:lidsps.wi.gov/pmgmms/industry-services www.wisconsin.gov Tony Evers - Governor Dawn Crim - Secretary Mound Component Manual — Ver. 2.0, SBD-10691-P (N.01/01, R 10/12) Pressure Distribution Component Manual — Ver. 2.0, SBD-10706-P (N.01/01, R 10/12) Description: 600 GPD (4 Bedrooms — New Construction) Maintenance Required The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per a.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on -site or off site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose organic material to be removed from POWTS Dispersal Area. • Divert surface water from all POWTS Areas. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Pump Floats to be set and verified per approved plan. Any changes may result in pump resizing to meet TDH and GPM Specifications. • Areas that are occupied with rock fragments, tree roots, stumps and boulder reduce the amount of soil available for proper treatment. if no other site is available, trees in the basal area of die mound must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/opemtion. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state scats 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Thanks, POWTS Plan Reviewer— Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services email: tim.vanderleestna.wisconsin.eov Cell: 608-516-6134 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 5/7/20 Owner:Todd Backer Location: NE1/4 NW1/4 S17 T31 N,R18W 2191 94th St. Star Prairie Manuals Used: Mound Component Manual Version 2.0 (N.01/01, R. 10/12) Pressure Distribution Manual Version 2.0 (N.01/01 R. 10/12) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7. Filter Specifications and cross section 8-9. Maintance and contingency plan Attachments: soil test Shaun Bird License Page 1 of 9 System PLOT PLAN PROJECT Todd Backer ADDRESS 841 Juniper Dr. Somerset Wi 54025 NE 1/4 NW 1/4S 17 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST.CROIX SYSTEM ELEVATION 100.1' 1.1' Sand lift! DATE5/6/20 BEDROOM 4 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 If of chambers none BENCHMARK V.R.P. Top of 2" pvc pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL "H.R.P. same as benchmark 0' 40' Ip, 2 Acre Lot Property Line Scale = 1/40 = 10' Grading is to be done to divert run-off away from system B.M.B-1 B-2 Property Line 160 0, 99 96' B-3 10% Slope Area 15' below system is to remain undisturbed 258' Pro 4 Bedroom rFHuffcHouseTank Well is to meet all WDNR setbacks 94th St. 1,9+ / Mound System Cross Section and Plan View 1 — 71 = Topsoil � = ASTM C-33 = Clean aggregate t a Ca Material 1 _ P sand fill Vito 2 /a in. dia. Geotextile G Fabric D. q-E--a. Ft Contour H F t Slope Direction 0 M ly N a O = 4 in. sch. 40 pvc observation pipe S, GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a 1/. inch soil wire when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/07 lgj Page -S 02 Pressure Lateral Layout Two Laterals — End Manifold Man t'VIUU Wimu ;,.1: .3-7 o r,n- I Lateral Diameter Force Main Force Main 03/051gj In. In. Ft. ded out 9 19 Sweep 90 Bend Pressure System Construction Laterals are constructed of Schedule 40 PVC pipe. Orifices are drilled perpendicular to the pipe with a sharp drill bit and face down. Lateral turn -ups terminate with a threaded cleanout plug and are enclosed in a 6-8 inch diameter lawn sprinkler valve box accessible from finished grade. ••••• Grade •••••• 6-8 Inch Lawn Sprinkler Valve Box Page 4 of/ Septic -Dose Wank Cross Section And Pump Performance Specifications i�NOW. �: tl 1/ � 1. \ Ill � -� . •1 m�� 53"M 71I\'/foil b / .I L1i►r,R,t*!� - — Mmimnm Pttmp ferformance Requhvd y O GPMj @I Ft TDH Nutlet Manhole Min. 4" Above Grade With Locking Device, Inlet Manhole < 6" Below Grade Sealed Watertight J Il • U I 11: MR lM I� /� RR • \I V... � Rl h_� � it r Total Dynamic Head (TDH) - Feet Elevation Head / Dlrtal Pressure Network Loss Force Main Loss 3 Total Manhole Min. 4" Above Grade 3.3 ttx� GENERAL INSTALLATION: The . sepdridose tank is bedded and back filled in accordance with the manufacturer's product,approval specifications. Maximum depth of bury as speoified by the manufacturer may not be exceeded without Prior OPMNIl. Manhole covers exposed to grade have an effective locking device (padlock) installed Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4 Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. ElectAcall vice compli" withNEC300 and Comm 16.28. Page L °f 02I05 IJ 29OmSERIES 314 hp Submersible Effluent(Sump Pumps The Liberty 290 series provides a cost effective "mid- range" pump for on -site waste water systems, liquid waste transfer and commercial heavy-duty sump pump applications that require higher head or more flow. Designed around Liberty's unique "Uni-Body" casting, the 290-Series will provide years of reliable performance. All Models Feature: • Semi -Open impeller permitting passage of solids Up to Y4" • 416 stainless steel rotor shaft • Permanently lubricated upper and lower ball bearing • Epoxy powder coat finish • All fasteners - corrosion -resistant stainless steel • 1 Y2" Discharge • Stainless steel bottom screen - easily removable • Maximum fluid temperature: 140° F. • 290-Series Cord Lengths Model 10' 25'(-2) 35'(-3) 50'(5) 290 Standard Optional Optional Optional 291 Standard Optional Optional Optional 293 Standard Optional Optional WA 297 Standard Optional N/A WA 10' cord length standard on all models. For optional lengths, add "-2, -3 or -5" suffix to model number. Example: for model 290 with 35' cord. Order 290-3 Motor Specifications; % hp 60 Hz 3450 RPM Oil filled, thermally protected 115 V. Models 10.4 amps 208/230 V. Models 5.3 amps Performance Curve: 290-Series 16 12 9 63 Flow (GAR 38 76 114 151 IN221 266 303 all Liters Per Minute Dimensional Data: Weight: 31 lbs. Height 13" Major Width:10" (model 297) Minimum Sump Diameters: Model 291, 293... 14" Model 297 VMF... 10" Factory switch Model 291,203 Model 297 settings VMF Turn on level 13" 9.5" Turn off level 7" 4.0" The Model 293 features a fully adjustable wide-angle float. Differential adjustments can be made easily by tethering the float to the discharge pipe or other mounting point. Vertical float model 297 is not adjustable. Model 290 E=15 Model 291 JModel 293 Manual, Wide angle Wide angle no switch float switch float switch with quick- with series disconnect (piggy -back) plug Cn �' s !• ® c $ c us Certified SPeciScetione she eubiect to change without notice. Model 297 VMFSeries Vertical mag- netic float for smaller pits - will operate in a 10" diameter sump i Llbergr Pumps • 7000 Apple Thee Avenue • Bergen, New York 14416 • Phone 800-543-2550 Fax (585) 494-1839 www.libertypumps.com Copyright ® Liberty Pumps, Inc. 2011 All rights reserved. LLIT 6661 R09/11 80-SERIES khp Submersible Effluent(Sump Pumps •- ,. - - •' • •• " Ott■/////////////try///tt/t/ //r���rOA�/�►:cq�tt//■ttt■ ' up to ■ttt/t/1/t/t//tl/tt►\//tt/t■ rotor416 stainless steel ,//tt/►1ttt/t///1/tttt.ttt/t■ ttttir//ttt////�tt//tt.�ttt■ ■tt►.r//t/ttt///�/ttt/ttt�//■ Epoxy..wder coat finishrt/t/tttttttt/ttt/t//ttt/�a r 1 Y." Discharge Stainless steel ..removable Maximum fluid temperature: 140* F._ 280Serles Cord Lengths Model 10' 25' - 35' 5 280 Standard Optional tional tional 281 Standard Optional O tional 0 anal 283 Standard Optional ti WA 287 Standard O ional A WA 10' cord length standard on all mode add "-2, 3 or -5" suffix to model n Example: for model 280 with 35' or optional length$, er. . order 2803 Motor Spec" ions %hp 60Hz RPM Oil filled, therm protected (PSG) Permanent Split Capacitor 8.0 amps (115V) 4.0 amps (208/230V) Data: Weight: s. Height:l3" Major Width:l ' (ml Minimum SO Model 281, 283... 14" Model 287 VMF... 10' 1287) Diameters: Factory switch Mode1281, 283 Model 287 settin s VMF Turn on level 13" 9.5" Turn oft level 7" 4.0" The Model 283 features a fully adjustable wide-angle Boat. Differential adjustments can be made easily by tethering the float to the dis- charge PiPe or other mounting point. Vertical float model 287 is not adjustable. I J ■ Model 280 del 281 Model 283 =U Wde angle..tch 11 �•e angle I tno ••Manual, • • r I.' � - �• •• le.r■sA ►1�i���pluglaarr`� lw� fp Certifiedus Model 287 VMFSerfes Vertical mag- netic float for smaller pits - will operate in a 10" diameter sump Liberty Pumps • 7000 APP/e Tree Avenue • Bergen, New York 14416 • Phone 800-543-25M Fax (585) 494-18" www.liberfypumps.com Copyright o Ubwty anroa lna M7 A■d"rewwd. WT200a RWA7 20140O48A 0+3200 19mm I8A000 I ` _ J N 1.1921 \ G `awwwwa i 98164 9.3759 .01Gop bef een Cow a Serpen(M 9.4356 n � -+1 C -�J SECTION A -A I' POWTS OWNER'S MANUAL & MANAGEMENT PLAN page —of FIt ETNFORMATION SVCTFM CDFrlPlrATMNC Owner Septic Tank Capacity i al NA Permit 0 Septic Tank Manufacturer L NA DESIGN PARAMETERS • VaWU typlal t« domes4c (roMwnmerUaq wastewater aM septic tank eMuent Values typkal for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months ear(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y) of tank volume Inspect dispersal cell(s) At least once every ❑ months ar(s) (Maximum 3 yrs.) Clean effluent filter At least once every O months years) Inspect pwnp, pump controls & ala n At least once every ❑ months r(s) ❑ NA Fhtslh ljrals and pressure test At least once every O months r(s) ❑ NA ar °f At least once every O months ❑ year(s) ❑ NA oehw: At least once every ❑ months ❑ year(s) ❑ 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 ResWctgd 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, identity 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, m"nical or pressurtted POWTS components, prebeatfinenl components, and any other maintenance or monitoring at irlervals 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 concectrabons are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. '-. <Z5IDIr-9 Page _ of _, START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals thelt 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 calls) in one large dose, overloading the call(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 Saptage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Malntalner 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 ceps. 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 fife of the POWT$: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental aces; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting produc*; 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 prope(ly and safety abandoned in compliance with chapter Comm 83.33, Wlsconsln Administrative Code' • M 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 property 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 filed with sell, gravel or anofftar 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 compilpnt replacement system: O A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelm. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requided setbacks from existing and proposed structure, lot lines and wells. Failure to protect tine replacement area will result in the need for a crew 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. Baring advances In POWTS lerhnology 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 fits POWTS a soil and site evaluation Cr hust 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. 1d Mound and at -grade soil absorption systems may be reconstructed in place following removal of the blomat at the infiltrative J----surfaca. 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 AN DIOR INSUFFICIENT OXYGEN, DO OT ENTER ASEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER p POWTS MAINTAINER /) NMI SEPTAGE SERVICING OPERATD PUMPER LOCAL REGULATORY AUTHORITY Name fLY�� —, Name S , Phone /J'—ia�� S/( Phone e —EL9d . This document Was drafted in compliance with chapter SPS 383.22(2)(bK1)(d)&(f) end 383.54(1), (2) & (3), Wisconsin A6nYdNCMNs Gods. SEPTAGE SERVICING OPERATD PUMPER LOCAL REGULATORY AUTHORITY Name fLY�� —, Name S , Phone /J'—ia�� S/( Phone e —EL9d . This document Was drafted in compliance with chapter SPS 383.22(2)(bK1)(d)&(f) end 383.54(1), (2) & (3), Wisconsin A6nYdNCMNs Gods. Wisconsin Department ofCarcreme SOIL EVALUATION REPORT gvldatd8�elyatdBuidmge i,,,,.,,,�,.r,,,,bwrr.r.,,m a.ee. 1273 Peps 1 d 3 Tan SCIVA Adedi earipete cle an pFw nd lew aces 8%a 11 tides In Nan miaiEC — edicts a4 not reKed vwicM and Eonea rvwjn e : fii- 4 pwantabpe,aabadinwE"Wo snow, and boal(on end bn�43oa�.7 Pease PdMall lydonnatlon. r 8 200 PeeoeaMsrsroon you poddema/bound for wads paposw tots, a3d6CNRQ GUUNi' St Crohr P I.D.—/a39���—�� Raul ed By Dole �} o / Propany Ownw Grand Properties, LP E Owl Lai M P1W 1/4 S 17 T 31 N R t8 W Property Owners Wing Address 712 Rivard Streeet, Suite 3D0 Lot IF 17 Block 9 1 Subd. Name or CSW 1 Squaw Lake Estates City SMe Zip Code Phone Number Somerset I WI 1 54025 715-247-5800 City 0 Village M Town Near@* Road Star Prairie I 94Th at New Construction Use: Ia Residential / Number of bedrooms 3 Code dwNed design flow note 450 OPD Replacement ■ Public or commercial - Describe: Parent material Glacial Tii Road plekt elevation, if applicable not General comments and woommendeeone: Area Is suitable for a mound system. System elevation Is 100.40' based oft of oontour One established at 90,31'. Slope Is 10%. Depth to Ilmitlng factor la 23. Boring a 0 Sow Fin Grand Surface elov. 99.98 R. Depth to emRing factor 23 in. SdPppiceiut Rale Haynes Dgdh Durr"MColo; Redmc Conniption Tedue Struatre Cana4Mn Baundery Rnob 1 0-8 login none at 2mgr mfr 9w 2f .8 1,0 2 B-18 10yr4/3 none sl 2febk mfr gw if .B 1.0 3 18-23 10yr4/4 none Of2fsbk m6 gw .e 1.0 4 2352 7.5yr4/8 m1d7.Sy3eyi v al lmabk mfl gw — .4 .7 5 62-71 1Dw418 m3d t 1 loyfBoring .aow" tmebk mfr — — .2 .3 s d Borng J1 PR Ground Surface Nev. 99.81 tt Depth to ibnibq facts 28_in. Sd Appiafim Rsle Har®n Depth I Do nirwd Cobr Reads Description TeAn Sbuck" Caaikece Boondey Rode 1 0-8 1Dyr= none si 2mgr mfr cw 2f .8 .8 2 8-20 7.5yr4/3 none Oil 2msbk mfr gw 1f .a .8 3 2D-28 10yr4/4 none aicl 3msbk mfl gw — .4 .8 4 28-36 10yr5/4 c2d 7.5 6 aid lmsbk mg 9w — .2 .3 5 3652 5yr4/8 n jots s ad lmsbk mfr •Effluent pl< BOO a 30< 220 MWI, and TSS>30<150 MOIL •EtRwnt e2•BOD <30 mglL not TS3 <�o m9rl CST Nems (Plesss Paint) Spnelua: �.J/ / /J / T_ CST Number 29 Thomas J. Schmitt `'�'+^+Y`•�/`"� 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 169572nd St., New Richmond WI 541317 7/30/04 718.247-2941 Picpedy owner Grand Properties, LP Parcel ID 0 Page 2 of 3 © wPit Ground Surface elev. 96w46 ft. Depth ■ 1 ■■��■�■�■■■ `Effluent 01•SOD e 30< 220 mg1L and TSS>30<150 np11. ' Effluent #2•BODa<30 m91L aM TSS 4;0 mpIL The Department of Commerce b an equal opportunity service provider and employer. If you need assurance to accew serviw a need material in an alternate forrna4 please contact the department at 608-266.3151 or TIT 608-264-9777. Conducted For: Nacre: Address: City, State, Zip: Subd.Name: Lot No.: Legal Description: Township of Bench Mark EL 100.00' Top of 2" pvc pipe Alternate Bench Mark EL "?/9 Top of 2" pvc pipe Slopes Y Contour Line EL 9,9-71' Conducted by: Schmitt Soil and Site Evaluations Thomas J. Schmitt, CST 227429 1595 72nd St. New Richmond, Wl. 54017 Phone: 715-247-2941 7 3o-oY kContour Line Length AO' Scale 1" = 40' This sell report was conducted. The area in which It was done may or may not be suitable for your use, or in the location shown. Page 3 of 3 Ref. No. Id 73 Grand Properties, LP. 712 Rivard St. Suitel00 Somerset, M. 54025 Squaw Lake Estates _/L /Y 1/4/YA/114S17T31NR18W Star Prairie, St. Croix County REAR ELEVA➢ON Iff - V- 9-I IM'UIUNG®4WNIEVft error �.r'wrv�ww �eru�.w'w �ON IN 10 e« S IoW3 Orauing Roo .- p Todd 6 Julianne Docker 9 fit" 55Ee' 219194thltrmt,%ge ,W154025 € u�f- � m ` L • r%%duyY �e uwn um ''0"P00 xwa uuo ��••, $6 mrn wa .Ion 0 A� .o ------------- ,....,. ...,,,r -onn I --------------- PUEp9N1[ i I U co ocTT---. -�� ii II I i -1W ii i IB u 0 mc. i ii li ' ' S7 SIG 1.1 � 11 I 4 „— _II 1_lAid >. a I _ c c dv F E MNNIMI MN IM'� I'Q y awa�� 9-I 1.0'��M/JN{N6 0 '.wrr�w�+rw"".s'usu+'.m R(Flll 3 P ® Wide O..nq Room, LLC Flit I�LYS� a j I a Ip 1IR 1g99 i'0Q & / loin's ara rg Roam.. q 9 Todd 6 Julianne Backer 51� 219194thfWW-ramerxt, VI 54025 1 � ;, „ Z-f /7 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 7O'D/O 4' -:ZuANNE &Ck6e Mailing Address �7 r—�UN1PE4 DQ .SO�i762SF%� W�025 Property Address 2��1 9y V STAeF , . SomErLrFj SyO a s new construction.) City/State %41'?r& rie r wT Parcel Identification Number 0 S$- W9 - 17-�Doo LEGAL DESCRIPTION Property Location 'A/E'/. 0-44, Sec. J-1. T _3LN R_W, Town of S„tamyl e- Subdivision Certified Survey Map # Volume , Page # Warranty Deed # II DZ -4o (before 2007)Volume , Page # Spec house ❑yes�o Lot lines identifiable kyes❑no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Lot # L7—. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less titan 1 /3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Itwe 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 warranty deed recorded in Register of Deeds Office. Number i o iris 7 �_ SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) E ft. 7' UNPLATTED LANDS North tine of the NW-1/4 S88036'02"E 2569.13' 162.72' 377.31' —1468.481——1468.48'— N f� o LOT IS `D 136,699 sq. ft. o\�`, o• 3.14 acres m N6��( L.B.0.=970.0' V 9 iYc AL O N CO < od to j\ N O 1 O i 1i n�' 7\H LOT n q. tt. 2.06 acres L.B.O.=970.0' 90. 81• 1 \ u •• K KW.L= 953.2' i H.W.L.= . 958.2' 248.58 \ AL 3 m � M O N 0 Z LOT ff 96, 643 sq. ft. 2.22 acres L.B.O.=960.2' 1 LOT 16i 76,317 sq. " 1.75 acre s6. y� 7?0 ?3A, 4 ' U i / AL ( AL � H. W.L= �� 950.7' /� AL Wisconsin Department atCommerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Corn85, C Attach complete site plan on paper not less than 8% x 1 t inches in size. Plan must C include, but not limited to: vertical and horizontal reference point (BM), lion and percent slope, scale or dimemsiors, northarrow, and location and ' to [ r oeParc 200 Please print all information. Revi Personal information You provide may be used for secondary purposes ( Lac, s.,W00Z1R1ry)A CO, N7 Property Owner E 1273 Pape li of 3 Tan Schmitt /-7-�� Date Grand Properties, LP Govt. Lot /4 NW 19 S 17 T 31 N R 18 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSW 712 Rivard Streeet, Suite 300 17 1 1 Squaw Lake Estates Clly Stale 7Jp Cale Phone Number ' City , VlNage I Town Nearest Road Somerset ! WI 1 54025 715-247-5900 Star Prairie I 94Th SL �f New Construction Use: IM Residential / Number of bedrooms 3 Cade derived design flow rate 450 GPD Replacement _J Public or commercial - Describe: Parent material _Glacial Till Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a mound system. System elevation is 100.40' based off of contour line established at 99.31'. Slope is 10%. Depth to limiting factor is 23'. Boring # -j Boring 16 Pit Ground Surface elev. 99.98 it. Depth to limiting factor 23 in. Sall Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDHF •Eff#1 I •Eff#2 1 0-8 10yr3/3 none sl 2mgr mfr gw 2f .6 1.0 2 8-18 1Oyr4/3 none sl 2febk mfr gW 1f .6 1.0 3 18-23 10yr4/4 none 81 2fabk mfi gw .6 1.0 4 2352 7.5yr4f6 1°75Y�S sl lmabk Mill9W 4 7 5 52-71 10yr4/6 m jd 1 f Sol 1 msbk mf r — — .2 .3 Boring # I Boring e Pit Ground Surface elev. 99.81 It Depth to limning factor 28 in. Soil AWicalbn Raw Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/@' •Emit 'Ef142 1 0-8 10y132 none ell 2mgr mfr cw 2f .6 .8 2 B-20 7.5yr4l3 none sil 2msbk mfr gw I .6 .8 3 20-28 10yr4/4 none Sid 3msbk mfi 9W — .4 .6 4 28-36 10yr5/4 `.yr6/2/6 7.5P2 I Sid 1msbk mfi 9W — .2 .3 5 36-52 5yr4/6 m �d5 8 Sid 1 msbk mfr — — .2 .3 Effluerd #1 = SOD? 30 < 22D mgfL and TSS >30 < 150 mg(L ' Effluent #2 = BODs< 30 mall- and TSS <-p mgfL CST Name (Skate Prier) Signature: CST Number Thomas J. Schmitt ./� ' 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 159572udSt.,New Richmond, W154017 MOM 715-247-2941 Property Owner Grand Properties, LP Parcel ID# Page 2 of 3 Ong # —j Boring Z,{I' Pit Ground Surface elev. 96.46 ft. Depth to limiting factor 24 in. Shc Applicalson Rate Honzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary RootsGPDfiF •ER#1 'Eft#2 1 0-10 10yr3/3 none 1 2mgr mvfr as 2f .6 .8 2 10-24 10yr4/4 none 81 2fsbk MFr gw 1f .6 1.0 3 24-36 7.5yr4/6 old 8 at 2msbk mfr cw — 6 1.0 4 36-67 5yr4/4 m2p 7.5yr6/8 all2csbk mfi — 6 1.0 ng# 1 Boring Pit Ground Surface elev. ft. Depth to lirtilig factor in. � p�loy� Rate Florian Depth Dominant Color Redox Desaphon Texture Structure Consistence Boundary RootsGPOM •EfT#1 'Eff#2 g # aBori�PitGround Surface elev. ft. Depth to limiting factor in. Soil Application Rate ❑� P Hadzon Depth Dominant Color Redoc Des Tbon Texture Structure Consistence Boundary Roots GPDfff 'Efr#1 'Eff#2 ' Effluent #1 = SOD? 30 < 220 mgA. and TSS >30 < 150 MWL • Effluent #2 = BOD54 30 mg& and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. ff you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TCY 608-264-8777. Conducted by: Conducted For. Schmitt Soil and Site Evaluations Name: Thomas I Schmitt, CST 227429 Address: 1595 72nd St. City, State, Zip: New Richmond, WL 54017 Phone: 715-247-2941 Subd.Name: S, Lot No.: Legal Description: Township of Bench Mark EL 100.W Top of 2" pvc pipe Alternate Bench Mark EL Px'/9'Top of 2" pvc pipe Slope= /O9a Contour LineEL Contour Line Length 4 Scale I" = 40' �1 Ob Page 3 of 3 ReE No. Id 7.3 Grand Properties, LP. 712 Rivard St. Suitel0o Somerset, WL 54025 Squaw Lake Estates 1 NF114 IYA1114 S17 T31N R18W Star Prairie, St. Croix County W qy�a 5� Gwl 64 sax This will report was done to fuMAl a zoning requ No permanent lot markers were in at the time the test was conducted. The area in which t was done may or may not be suitable for your use, or in the location shown. SOUAW LAKE ESTATES (A OOUNTY Pun Located m the Northport 1/4 of Me NMheest 1/4, Me NwMeoe( 1/4 of the NrcMI%st 1/A Me Mathwest 7/4 of the Northeast 114 meo' port of the Nn✓Meost 1/4 of the ft Merit 1/4, 0 he section 17. Tpwaahp JI Na , RoegO 18 M 4 Town of stw RuZr* St Gar County, Rtecopvn LEGEND: UNPLATTED LANDS p�•J¢y s %watz- „�mL`e«.I.r�n+.xe x�. w-r:K'. l 0 ooeo oeoer w me or Rorer! m. ne-r/f s.L r-I/r . te' Irn RN> e➢Y.se !HB'3B'bYE Y!lB.13' r �..i wMw.m..r (wym.v +.Sw N. va sA wos7 _rXeN'- -INn+l- r • i I! me. , P. Iwp LOIN ^'�, \— m. rye w... w n..M n.a➢msirv.�M m �r was r DeINwNC eeY C wm ), W e, ft f r'ti �w" e� ^w'r n ¢'O BUBJF9 S.e. LNe .77'w'ry ,.� A e ue'�s mx(J ¢nxv Lora N tl �wT x Gen Wemi'Me U�x K pee . R-o-w - cdl.omr Slane. a ew rmv .. ... M nex R-n-w - love) Soeeu, n..one— ._vnveveEf-e Lamao. \ i a' 9ra �.'. • LOTS mn. bMr NeFw]Mnnt IY uNRr ¢e..m.ni M+III-. n ,R'8 Lsa.ama' 942f ep rz 96Es —x-41KF9force eof Im acw i __\ F LOTA y � p t6a-%aS LOTffi — OmfolW W I. .,I a LB.A-➢)AYi, r e S IM. M9 ap II T.\`� x@ ceml., Im-mr1 Lo f L9M une a ni it °Ox¢ �lm , Leo NFu.xm zxw<wR el wml eMmx9 avw¢p � yr wtiz'C I ¢ tsa-ema' d Yn F �>, r r \ s sl n] ..L oecuoiw 10frcr H10 X4r. Lml omuen '-•, _9Evp¢': '7p➢Ae' S �S\ �xe.- ipp ammmon - To, or Im, eu .. $ z!r mw n R ;' xm w e" L4''�91 1. l�f �: a %S] � • _AI Ir, (tl Corn w•,e'^� \`� .:,� i .. +\ �\'� i" .1.d. CURVE TRBLE ggVE RAum om'. MC t]IOIO [IdfO KMLIXL iM!(HI oRms ae fel.Y Yis9' mu' Ana • n WW msm nXe nx u, �' nm• uK p. Ayp Sq. ss }Y91v2 I+IYYQ p! )m NY A➢2 m3r MM7)V]S Mr+eSTe NN'mAS qeI pJ u)m 7.+ IV TZe' wLw T¢u'+' iYMx 'xJ ryv NN'ev9e2 Mrm'NN 10, X s11l9' M. XKq l' N me,,, W] I] BOm Mg I�e]C M IJN Lm �e w S]H SS maw cm p mm mm] m•u+r w,R � ➢z9r fi LX' urzwex s]o'.o'z _ smYrvc tl2 LUR' . w vsa as!•c arm sreo-N• n nv¢ r M7. io] C@ J e61W 4'¢] r s m msacr 1>].LY siworu�x L''01'+ XI¢•N'¢I'[ XN'N'N'[ LR N rz9 Im9J�m IVIYN' + E9 zmA.+°' owls' sxo-m•av 'N•v nx•orzry Lm n rm M¢¢] Is]m 9•N'm• ]v, n.x+' eem' s,;, r sommly urlr.Rav mrorzly sa•xe'ory A ¢ ¢IY]9• 9M• 9BMJ' 9]➢'T'01YV SNSrm� SNV]']9'v • N.9J' 9m' m+'mN I.OL• pyxm u ez'H axN• i9sv sry MI'S "J+'v x lam )ur )sK' Rr+veM w me m nor mm0 w: oKRR ymee�M. M.S`]m¢f r SHEET 2 OF 4 SHEETS XIAXR ME WUtlI® XIr 1/¢ . 6rtJ3911m 10 eW 54'N'OxT p �k \ _ LH AHm avNmm • i� _ 1 ➢' Z.••• W .. I ras I \ I I i NH!%K a +� � Av 11 r r r �.. �) • '., M'� '''°. `r]MT e.aa.➢uY ' �/ —p£ � � ,' I/ (+• .. 3➢)�° ���\i r� Fez �'' /� m.u`. �>e. `J'" •�.�ry� 114t11n rt twit �, x - 8.11 s3' `° " •pE 'a`ep'd�/ ,:izm+�v iL. 1I epM ..._............/ '. y. x I tv.• E+ y' F d oxAwe 3 �, � ;�za+pf \ y t7, Cae worm $A Cs�et rcwL..%99'.p '4u'�y �u L /d'� •y' .y k..... n '\ i /\sM'+�. o�d' n7 N......... MOM, 8't wor n o. K➢ r3Hlm wz a T➢.u.y �„" i rt -L z%oo.. ]�oLr=,� Lo,ae Rr¢�8' .•" '�,�"o Lno.ever s. taa-Aw°' . r Y o'-lo 1✓y. iva.➢n e•'.. \� y.y➢ /HL0 X'r ( m.la ' GHa-ay I ) 1 u N7RAn'_give'_ 2 y UNPLATTED LANDS N..r-ija a � Avm. l7-Jhr➢ 'forty" °io w Idpa '+ ( (4tMrel LTVI)r ew.Hwn