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HomeMy WebLinkAbout032-2003-60-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division s INSPECTION REPORT Sanitary Permit No: 483985 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: Q LaMirande, Roger Somerset, Town of 032 -2003 ' 826 CST BM Elev: Insp. BM Elev: BM Description: _ Section/Town /Range /Map No: GS ( 01.30.19.475B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic y.. a.- Benchmark 3 /Z°° 41 S . �o I08•ly o qC /�O Dosing C O � 1 3' ?0 Alt. �1 C 0 • 1.7 9�� dos Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 1 Septic > /5 / Og / dz / Dt Bottom Dosing > Mr 16Z /dZ Header /Man. /a 5.5 3 d . Aeration Dist. Pipe '557 • �7 "63" Holding Bot. 6 ` System 4.31? /6 2 PUMP /SIPHON INFORMATION Final Grade q. 57 16 9 , 6 Manufacturer Zo GP and St Coyer $ 9L ', Model Number -33 TDH Lift Friction Los System Head TDH 16,58 /, l 3.3 /,f, 6_� �' P. b-3 /67.3 -7. b /0l Forcemain Length Dia. �� Dist. to Well 50 Z SOIL ABSORPTION SYSTEM BED/TRENCH Width / Lengt 7.5 No. Of TreAches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ____ SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Al Type Of System: 7 /5 /� / k S UNIT Model Number: U � �//�j" D v✓� DISTRIBUTION SYSTEM �Q Header /Manifold / , i Dissttrib tion y „ L / x Hole Size 'r I x Hole Spacing Ve��t,to Air Intake Length 4 1 Dia Z Lengt Dia Z Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /S dried xx Mulched Bed/Trench Center 1.75 Bed/Trench Edges Topsoil /";q I es ® No Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ! // W / / Inspection #2: Location: 1765 85th Street Richmoncj, WI 54017 (NE 1/4 NE 1/4 1 T30N R19W) NA Lot 1 l� Parcel No: 01.30.19.475B 1.) Alt BM Description = �� — a L 2.) Bldg sewer length = /67 '7' �j� C t,� 4 �� - amount of cover = ✓f P )OL.3 �•Z .� v....Pe fir- �..,o�.(,-e.S Plan revision Required? ❑ Yes No Use other side for additional information. L 3 J SBD -6710 (R.3/97) Date Insepctor, Si ature Cert. No. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 483985 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: 0 LaMirande, Roger Somerset, Town of 032- 2003- ;9 -9-25 -- CST BM Elev: Insp. BM Elev: 7 escription: Section/Town /Range /Map No: 01.30.19.475B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes g No Yes Q No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 1 Inspection #2: Location: 1765 85th Street New Richmond, WI 54017 (NE 1/4 NE 1/4 1 T30N R19W) NA Lot 1 Parcel No: 01.30.19.475B 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑Yes No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. commerce wl.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 M n Madison, Wl 53707 7162 Sanitary Permit Number ( to be filled in by Co.) M 1 0-1m.—I ) PA $ 5 Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental 19r /r unit is required prior to obtaining a sanitary permit_ Note: Application forms for state -owned POWTS are different than mailing addr ss) submitted to the Department of Commerce. Personal information you provide may be used for secondary p urposes in accordance with the Privacy law, s. 15.04(l Xnt), Stats. L Application Information —Please Print ormation R ECE S'4t VI A 7 Property Owner's Name / Parcel # Property s Mailing Address Property 'on Z �%f S , ST. CROIX COUNTY Govt lot C City, State Zip Code y,, 1 /a, Section le one circ R�E 11 Type of Building (check all that apply) Lot # 1 or 2 Family Dwelling — Number of Bedrooms Subdivision Name Block # ❑ Public /Commercial — Describe Use ��+� �� ❑ City of ❑State Owned — Describe U _� CSM // Nam n� Village of A-J Y Ij✓ Town of 75 IIL Type of Permit: (Check only one box on fine A. Complete line B if applicable) A ❑ New System Replacement System ❑ Tmatmen HoldingTank Replacement Only ❑ Other Modification to Existing System (explain) B • ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New X 107 Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Compoin ent/Device: Check all that app 11 Non-Pressurized In- Ground [I Pressurized In- Ground 11 y At -Grade p Mamd > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Trea0hent Area Information: Design Flow (gpd) Design Soil Application 7 gpdsl) Dispersal Area Required Dispersal ,15p- Prop (-0 System Elevation /D �� /�J ✓ VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units p m c W New Tanks Existing Tanks / O - re AvI/A.., a , v w C7 w Septic or HotdtrlgFank X Wieser X Dosing Chamber /� D / VII. Responsibility Statement -1, the ninaderaigned, asrW responsibEty for matalludoa of the POWTS shown on the attached plans. Plumber's Name (Print) Plumbips Ignatu re MP/MPRS Number Business Phone Number Dennis Hewitt 2214$3 1 715-821-4682 Plumber's Address (Street, City, State, Zip Code) 439 Sunset Drive Hudson, Wisconsin 54016 VIIL oun /De artment Use Onl Approved Permit Fee Date T Issuing Signature 3=; $ ( ao q d ben Reason Denial IX Condl ' easons for Disa 9 17 /6 app 3) 6.,. ati t,✓ 0 L.a , rG 1. Septic tank effluent filter and hj -5 �,,� �,` Sp,'( �tb�" Web dispersal cell must all be services / maintained / _ /1 � bbev5 664- L1416 Lam„ as per management plan provided by plumber, rro(` pR CAA-41- l� Z., At s*tbWk-requh`ements must.be maintained 5 r /l per otdinainceit. C C." node / W Attach to complete plans for the system and submit to the County only on paper not less than 8 V2 =11 Inches��� 16 � ��s�� 6.j_ LXJ (R. 02/09) Valid thru 02/11 I Safety and Buildings 10541N RANCH ROAD commerce.Wl.gov HAYWARD WI 54843 Contact Through Relay is c o n s i n www.commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Aaron Olver, Secretary September 15, 2010 CUST ID No. 221483 ATTN: POWTS Inspector DENNIS L HEWITT ZONING OFFICE HEWITT EXCAVATING INC ST CROIX COUNTY SPIA 439 SUNSET DRIVE 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/15/2012 Identification Numbers Transaction ID No. 1852196 SITE: Site ID No. 759955 Roger Lamirande Please refer to both identification numbers, 1761 85TH St above, in all correspondence with the agency. Town of Somerset St Croix County F SWIA, NEIA, S1, T30N, R19W COn FOR: Description: Mound, 4 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1279884 pEpAP Maintenance required; Replacement system; 600 GPD Flow rate; 31 in Soil minimum depth to limiting factor from DiVISiON original grade; System(s): Mound Component Manual -Version 2.0, SBD- 10691 -P (N..01 101), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01/01); Effluent Filter --- SEE CI The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative C es and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Key Item(s) • 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. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • Care must be taken to preserve the bench mark during construction or establish a new bench mark with the elevation set to relate to the original bench mark. • The bottom of the distribution cell shall be level per the Mound Component Manual. The "D" dimension shall be a minimum of 6 ". The maximum finished slope of the mound surface shall not have a slope ratio steeper than 3:1 per the Mound Component Manual • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. DENNIS L HEWITT Page 2 9/15/2010 Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • The existing POWTS must be.properly abandoned per s. Comm 83.33 Wis. Adm. Code. • Insulate building sewer per COMM 82.30(11)(c). 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/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions this 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 and the POWTS management plan to the owner and any r' others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 `v Balance Due $ 0.00 �. Pa is L Shand rf V POWTS Plan Re� viewer , Integrated Services WiSMART code: 7633 (715) 634- 7810�Fa�x: (715) 634 -5150 , M -fr 8:00 - 4:45 pat.shandorf@wlscoAsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828-5902, Monday, 7:00 A.M.-To 3:30 P.M. Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. "Construction business" means a trade that installs, alters or repairs any building element, component, material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the delivery of building supplies or materials, or the manufacture of a building product not on the building site. For further information, go to our website: www. commerce. wi. Qov/ SB/ SB- BuildingContractorProoram.html PAGE 1 OF S Private Sewage System Plan Index PLAN I. D. NO. PROJECT TYPE 'W GALLON MOUND PROP. OWNER �S DL3!?(` ,L &A ADDRESS 1 0 1 e&) rflCjrng,ld Cl� /, •�* D// PROJ. LOCATION -- COUNTY ff' CrO TOWNSHIP 96 LEGAL DESC. v' SEC. �, T _N, RZW Plan in accordance with Mound Component Manual SBD- 106g1 -P (N. 01/01) Version 2.0 and Pressure Distribution Manual SBD - 10706 -p (N. 01101) Version 2.0 PAGE ONE INDEX SHEET '.O.W.T.S. PAGE TWO PLOT PLAN ditionally PAGE THREE CROSS SECTION & PLAN VIEW ' ROV ED PAGE FOUR LATERAL DISTRIBUTION PIPE )FMESAFET�YF CO PAGE FIVE PUMP/SIPHON TANK PAGE SIX PUMP CURVE �RRESP DE E PAGE SEVEN MANAGEMENT PLAN t g/ PAGE EIGHT M3r9gement Plan f � DESIGNER Dennis Hewitt CREDENTIAL NUMBER 221483 ADDRESS • 439- -Sunset Drive ' ,-Hu d$en, - "Wis . 54016. TELEPHONE . 71'5-821--468 DATE SIGNATURE Scale: 1 "= Ft. PLOT PLAN Page 2 of 8 , NORTH .,4 - M de 40 -9�4 `o 1 ,BrrP7? Ct�ady� Po o r- — � cd�ll fi Ql aCcPFg' prti✓F - -- • 98.E �. _ /7 v _ ..._..-- ._. ---- �__ e- l•eU�iah /Oc�.� 'T sic 1 1 - rjO , /) +q /GuJ L 1. Will meet all Comm. 83 setback requirements 2. Septic Tank 1d#0 Gallons Dog Tank yV Gallons Mfg. by Wieser Concrete Products 3. Benchmark #1 Elevation 1 Description of- ?ap 0 1? 1e lovc Benchmark #2 Elevation Description of- 4. Other- �Qr�/ I I, Scale: 1 " =_ A Ft. P LOT PLAN "age 2 of 3 NORTH - - -�• S Mde 0 P 5` 1 PO m S� �._.. 6 /4 / ,60 0 cow /n v ,ah fiat aces Drt v _ /5'dow rI ara IN � I �n es . s ys4em C&WWr v Ie ah �v 9 �rM 4, i sW 4� o ii es w � �i Sac 1 I I j /V, +q 0 'ES i. Will meet all Comm. 83 setback requirements 2. Septic Tank 1 d #0 Gallons Doge Tank Yj,) Gallons Mfg. by Wieser Concrete Products 3. Benchmark #1 Elevation 100.0 Description of- - rop or "pYc Benchmark #2 Elevation Description of- 4. other - c� 7 w r forre/ Page 3 of 8 Ground Contour Elevation Synthetic Covering System Elevation Distribution Pipe Medium Sand Topsoil a • % -1 /o Slope CELL Of Force Main Plowed Aggregate From Pump Layer Cross Section Of A Mound System F t of G 6 of LINEAR LOADING RATE !S GPD/LN FT A Ft. H T 22 to DESIGN LOADING RATE , ,e GPD /SQ FT 8 Ft. BASAL AREA NEEDED Z Zt) _ SQ FT j _A l, Ft . BASAL AREA AVAILABLE 4Zdo?S FT J , Ft. K ..! Ft. L Ft. W Ft. L ' 00s.ervation Pipe i3 K A �--- - T ----- - - - - =--------------------- W � ► .- _. — - -- �h D tion Cell 0 f %� -.2 z z Pipe Aggregate /Cpl t Observation Pipe Lateral Clean -Outs Plan View Of Mound LATERAL Absorption Area Page 4 of 8 Perforated Plpe Detall 0 Clean -Out End View n� Fe ire / )POrforoted �. PVC Pipe C� �7 Holes Located On 8 S Are Equally Spaced S Av,eple Distribution Pipe Lost Hole Should Be Neat To End J `S'ufn — Ups . Distribution Pipe Layout Graph 6 P _ C4 / S = 1/rD � Minimum Lateral Diameter Based on Orifice Spacing or 3118' lameter Orifices X� 350 325 .._ _ ..- ___.__......_..._ _. ..._.._..._..------ ...__......- ------ ___ —.— Hole Diameter 4LInch 300 .. __.......__... --- .._......... - - __._.._.. -- ... - - -- - - -- lateral "2, Inches 275 __ _.... .---.. ...................__..._._._.. __... ....._...__..._.__...._._. —.___ r, Manifold Inches 250......_ __ ....... .. ... ....._... _._-- .------ ._.- ___.._._._._ .._._._ _._..__ ...—_........ ' Force Main nehes 225 ... ...._ ._ ...- ._......_..---....._._._.. ..- ..— _...__....- --------__... LL Holes Per Lateral c 200 t 3• � J 175 ......_.._ _....... _ ................--._....._..___.. ._................____..__ -__ -- /Q Invert Elev. of Lat. 150 _........__.._..---............_.._-_._.._......_........_....... .�__._.....— ._.....___— .__..... System Elevation 125. .. .. _._ .. ................._....... - - - - -- __— ...�._- ---- ._......____ —_ 100 _...._.. ....... ..._ ___......-.-.._.._...__.--.......__ Z�.. .._.— ..---------- _..----- - -_. -- Contour Elevation so . ..... _,. .... . _._. _.. 25 . 314• 0 2.5 3.5 4 4.5 5 Orifice Spacing in Feet ' Page ` s Of 8 COMBINATIO SEPTIC TANK /PUMP CHAMBER (No Scale) 4" CI Vent Pipe wicn Approved Locking Manhole Cover Approved Cap, 15' With Warning Label Attached from Buildings n Weatherproof Approved Junction pox Yent Cap - -� 12" Ati n i Mwa 6 Min Grade ; 4" Minimum Quick 18" Minimum Disconnect -- I i 1/4" Weep Hole Baffle Approved Joint A rr /C. I . Pipe lz �/ �D/ ' Extending 3' F iter Al arm d , v � B Approved Joi ; Onto Solid Soil On 6; w /C.I. Pi'pe C or PVC I Extending 3' 1 Onto Solid S Pump - OFF ELEV. �aA Off 6 or PVC D Conc. Block 3" of Beddi n4 Under Tani( —Y Lateral Volume 140 r1 X •0qA Gal . Min. Dose. (5 X Lat. Vol'.) Gal. Max. Dose (20% of DWF) 120 Gal. Note: Pump and Alarm Are On Separate Circuits Flowback °0(�o?�y, Max. Dose W/Flowback /o�b�.� Gal. Tank Manufacturer: WIESER C ONCRETE PRODUCTS Tank Size - Septic /Pump: 1200 800 Gall ons Alarm Manufacturer: S. J. ELECTRO Model Number: 101 HIGH WATER Capacities: A inches or -/449 Gallons + B 2 inches or Gallons Pump Manufacturer: + Ltinches inches or # Gallons Model Number: + inches or allons ch Minimum Discharge Rate: Total....._ o allons Vertical Difference Between Pump Off and Distribution Pipe:)D, Feet Minimum Required Supply Pressure :...................... ....+ � Feet Feet of Force Main x 2, Friction Factor /100 Feet: +,eet Inch Diameter Force Main Total Dynamic Head:... = Feet � Internal Tank Dimensions: Gal. /Inch ,c+ Liquid Dept h Page 6 of 8 HEAD CAPACITY CURVE MODEL "98" 30 25 20 10 3� r'}'eed 5- GALLONS 10 20 30 40 50 60 70 8C 80 160 240 0 FLOW PER MINUTE Table 6 FRICTION LOSS (FOOT /100 FEET) IN PLASTIC PIPE' Flow in Nominal Pi Size GPM 3/4 1 1 -1/4 1 -1/2 2 3 4 6 t 2 3 3.24 4 5.52 5 834 6 11.68 2.88 Velocities in this arcs 7 15.53 3.83 arc below 2 feet per second 8' 19.89 4.91 9 24.73 6.10 10 30.05 7AI 2.50 11 35.94 8.94 2.99 12 42.10 10.39 3.51 13 48.82 12.04 4.07 14 56.00 13.81 4.66 1.92 IS 63.62 15.69 5.30 2.18 16 71.69 17.69 5.97 2.46 17 80.20 19.79 6.69 2.75 l 339 i 2199 7A2 3.06 19 24.30 8.21 20 26.72 3.72 A&W 40.39 13.63.6 3 5.62 1 p � 5637 19.10 7.87 1.94 �fxJu/ 3 f47�, Q/H1 f�1Tu/ ,,,,, 23.41 10.46 58 ° 32.33 13AO 3.3 °.° 4S 4 16.66 4.11 SO 49.15 20.24 4.99 60 29.36 7.00 0.97 70 37.72 9.31 129 11.91 1.66 80 rcs 14.81 2.06 90 exceed in this a 100 exceed 10 feet per second. which is 18.00 230 0.62 too um for 2720 3.78 0.93 125 125 various now rates and S a o 1.31 ISO pipe diameter 7.05 1.74 175 9.02 2.23 200 13.64 3.36 0.47 250 4.71 0. 300 _6 0.87 330 POWTS OWNER'S MANUAL & MANAGEN:` dT PLAN Page __ of __Z_ FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity gal ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer V li l y bk ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Commercial Units K NA Pump Tank Capacity gal ❑ NA Estimated flow (average) gal /day Pump Tank Manufacturer r— ❑ NA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer �� o�j��- ❑ NA Soil Application Rate gal /day /ft' Pump Model ❑ NA Influent /Effluent Quality K':onthly average* Pretreatment Unit J'NA Fats, Oil & Grease (FOG) <30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BQD <220 mg /L ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <1 50 mg /L ❑ Disinfection ❑ Other: Manufacturer Pretreated Effluent Quality 10 NA Monthly average ** Dispersal Cell(s) Biochemical Oxygen Demand (BOD <30 mg /L ❑ In- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) :530 mg /L ❑ At -grade Mound mean < a Fecal Coliform (geometric ) _10 cfu /100m1 ❑ Drip -line ❑ Other: Maximum Effluent Particle Size %$ inch diameter * Values typical for domestic (non-commercial) 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 Uyear(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 ❑ months JR year(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ months 10 year(s) Inspect pump, pump controls & alarm At least once every ❑ months ® year(s) ❑ NA Flush laterals and pressure test At least once every ❑ months JO year(s) ❑ NA Other: At least once every ❑ months ❑ year(s) Ig NA Other: 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 Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any combined sludge and scum and to check leaks, measure the volume of comb g missing r broken hardware, identify any cracks or ea 9 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, pretreatement 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. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Page P .of 8 , During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. 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: • 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. TEL Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS: POWTS INSTALLER POWTS MAINTAINER Name S Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Agency ' Q Phone Phone 4 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies. This document meets the minimum requirements of ch. Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not n, ­rq ^.tre the nerfnrmence of the POINTS. r ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer 116 N L a 1-cm ( e_ Mailing Address Property Address I �o� O ff ' �7� 'Xey - 'elCA ma"7 (Verification required from Planning & Zoning Department for new constniction.) City /State i / Parcel Identification Number LEGAL DESCRIPTION Property Location �,S 4 , '/4 , Sec. , T 3Q N R /�' W, Town of DI7l P,/ SP� Subdivision Lot # _ Certified Survey Map # , Volume , Page # Warranty Deed # -_? o! ZW , Volume -, Page # Spec house yes no Lot lines identifiable 4s> 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 virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms — T 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) i ' 0 "1G1 RECEIVED $; EA ID SEP 2.:3 2009 Wisconsin Department of Commerce ti SOIL EVALUATION REPORT Page _ of Division of Safety and Buildings NInce NG QFFICk- PLANA��y� with Comm 85, Wis. Adm. Code County c Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must v X include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Q , j 02 — yrrO print all information. Review Date Personal information you provide may be used for secondary purposes (Privacy taw, s. 15.04 (1) (m)). y .Z Q P Owner Property Location f A Govt. Lot S& 114 1/4 S T 3 () N R/ E (o W Property Owner ailing Address Lot # I Block # Subd. Name or CSM# �e r - city State Zip Code Phone Number ❑ city ❑ village Town Nearest Road �o i ❑ New Construction Usa` Z Residential / Number of bedr Code derived design flow rate _ GPD ;EfReplacement ❑ Public or commercial - Descri Parent material Flood Plain elevation if applicable General comments �`` x '� a /1 y '� j "�— :CYI fz 2 L'L � ` r / p , — mm and recoendations: J i System Type —,M © 4 System Elevation Boring # ❑ Boring l L fJ ;34it Ground surface elev. ' / ft. Depth to limiting factor 21 7" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 fl I/ ^ ,' a v�.✓ V ; 7. S _57 S A/ v2 Boring # ❑ Boring p pit Ground surface elev. � ft. Depth to limiting factor 3 1 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 3 - S -, - Nib Q ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 1 150 mg/L ' Effluent #2 = BOD 1 30 mg/L and TSS < 30 mg/L CST Name (Please Print) SignAW CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 _ 715 - 246 -4516 Property Owner _ Parcel ID # Page of �# E] Boring F31 Pit Ground surface elev. Q� ft. Depth to limiting factor in. Soil lication 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 3 - 7 �� 5 n� — N1 P i 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 GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 ❑Boring Boring # Ground surface elev. ft. Depth to limiting factor in. El Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/Ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 ` Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA_ ` Effluent #2 = BOD < 30 mg& 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 (8.6/00) Soil Test Plot PlVBi Project Name Roger LaMirande S Address 1761 85th St. New Richmond Wi 54017 ( M' #226900 Lot 1 Subdivision -------- Date /4/09 SW 1/4 NE 1/4S 1 T 30 N /1119 W Township Somerset Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 2" pipe System Elevation TBI *HRPSame as Benchmark 85th St. Scale is 1" = 40' unless otherwise 100' noted xisting 5 ftedr 0' house 30' 20' ST 100' 15' Well 150' Overflow 17% Slope 100' B -1 B.M. 15' B -2 35' 98' 100' B -3 50' Property Line 102' 100' Property Line .f: er o o N � O M C-3 M M - N 00 Lj 1 L s co CD _ p ti ll'> Z ° O , F Cl Z c X v° W cn LU � W w z_ V J w Z: ccf) 0- xa m o m O w " Uj O Z W CI- J O v C> CD LO =) LCD Z I 1 o O = L) F = O cfl Ln O f C14 L? ~ ' � Q CL J I �I11 11u�rruii Ili R��l� IIIIIIIIIIIII11 01 101 1 ' 19 'I'lllllllll'I'llllllllllll ��� Illllliillllllllllll'' Illflllllll9111' DIIIIIIIIIIIIIJIIIII 'IIIIIIIIIIIIIIIDII �! I'111'�!I'111 1 1'I'I' ICI 'I'I'I'llI'I'1 1 'I'I!I!��!�!�������'I'I'i'I' lull' I' I' lll! IIPI 'I'I'I'I'I'I'I'I'I'I'���'�!I' lull' I' lillll' I! IIIIIIIIIII! IIIIIIIIIII' lllil' I' lllllllllll! 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IIi. i. i. i. il. i. i. i. i. i, I .I.I,I.I.I.I.I.i.I.1.1.1.i.I.i. i.I.I.I.I.I,I.I.I.1.l.i. 1.1 1 I - iliii � I�,I I lil I ! ICI r �, ll r,,L�lrl,,r �,� r ; , ,, •��;���wwvvvywvv \AVO��_.�A, �.'�, • ��� j � , fi r,; ,,,, �; �� ;; iy � � / / / / / / / / / / / /// i / l j��/ //� , — � /i /i %; % „/ iii; ��%',; �/;%% � �, \��������������������������►�� �/ / a�1�Ui\\\ \lUl \\1 \llllllllL wtpo � � � � , • • • l i / , / l rl � ! � r ll �l � • 111 � �� �l � // � l�, �” �� ,, �,� .■ / �l � � ll� �1���/ j' %� /�� • • • • f: co FILED FES 1 JAJ►ES O' CONNELL R"bter of 1)6*4 �. Sb Croix Casty, Wbomb 4 ST. CROIX COUNTY CERTIFIED SURVEY MAP LOCATED - - -1N PART OF THE SW-1/4—NE-1/4 OF SEC. 1, T. 30 N., R. 19.W., TOWN OF SOMERSET, ST. CROIX COUNTY, WISCONSIN N ORTH SECTION LINE S. 89 24 39' W. N 1/4 CORNER, SEC. 1 -30 -19 VW CO 30 R. 5.37' SCALE I INCH =100 FEET SEC. I - 30 -19 P 100' 50' 0 IOU 200` 300' om O i ro w LEGEND , 0 3/4 "X24 "IRON RE -BAR SET, WEIGHING 1.50 LBS. /LIN. FT. O wao z 4 _ fa COUNTY MONUMENT m m - 1 � r 0 m m UNPLATTED LANDS OWNED BY PLATTER cn gz 0 C 1 (0 W = 66.00' 1 N. 89 36' 16' ' E. 418.78` 0 N.89 36' 16 E. 9� O h N cp z O p° Ir- m I O' 0 win Z 00% p�0 O Im D m IZ 0 0 X0° N (n -•1 r 0 I Z W C m N r m LAI IZ p Z Iv LOT / `r m IS O A 3.000 ACRES (o O S m �1 O t ,t Im Ir 33' 33 m Z 10 IZ I O I IN � L N (' o U� 0 LL" '9 A I S. 89 36' 16" W. 418.78' I m T UNPLATTEQ LANDS OWNEQ BY PLATTER r r 'z z r , } m , APPROVED C .,RTIF ICAT.E OF THE `i'U�giN OF SUP FEB 1 1 1941 I, do hereby certify that this Certified Survey Map has been approved by the Toirn ST, czoix of Somerset This day of ;AKK PLANNING 1981 ANa z0j -4l,-jG COMMITTEE To +., Clerk of 'omerset ` t= a •� :,' 1 C. z VOLUME 4 PAGE 10 SIGNED 0-agow C. DATED I O 8 CERTIFIED SURVEY MAPS ALLEN C- NYH GE R.L.S. 1407 n1...,r / ": \i lnl'I^V \Aril (` ^�.^I�1 . y -.:.. �.,: 1rrr.,, .,. ♦ ..,.. , A. , ,f+: ,1 1.. 1 1 1 1 , 1 ' , 1'l C1 110 fin .nn °�` ttir5 5 *+SCE F6taeED FOII r1ES9s41i1G t7W�A , 0 7�ti1 ifils M1EFD, ria.± -lletrm" Jos e r 11is _ _ and EQ!gak 32th :; :ajj - A?� : F'a>. in.� l -n _ F-- 7utLtlltlrf - w a [ ns s s+eft TW Like. Wjid Gr"tor (Or a V*lnable c- onsviar�atioo CC,,Kvtys to 413r00teeY cl ow►isg described rc>s1.e Csie in � Cir olst.. - - 5'bac Kay Ho 1A part of the Sir' 1/4 of t:be. NE 1/:4 of Section 1: T 30 F R 19 �i 'lroti,rn, a� Sosoerset, "St C�Ctux CoUnty i+liscoi;s3it, furthex_,- described- as follows Commencing at the North 114 car - her ol- - a_aid Section _ice. thence �_ 89 324 391' la (asswnee3 b+'arirtg) along tYte _Dlorti3 line of tine iYfni -3,19 , 537 feet;. tezrce 5 S C' - 23' -44 R along the, We, R/PI : S ne' o£: a Towns .19 yet, �entze IN 89 -36- X, 66.06 feet to the East R/W line Of sand Tflwn road aril Ehe' ' point of I�eglnnfng of this descr ption; thence cant- as�uinq N - 8g 36' �6" $, 418.78 feet; thence S (r - 23' -49" k, 312.05 feet; thence _S 83 36 "x-16' :W 418.78 feet; thence N D - 23'_44.. W alone the East R/W lime of Sax. Tgwn =_ road 312..05 feet to the ppo±mt of beginning. - _ Above described parcel contains 3.00 acres and is subject to all 4a se e_ ents` of record. Thi- t•►0J ,homestc2d Property. (la) (is trot) ToggetLer with _alt and singular the he,editsinents and appustena ces thereunto belonging; '$ • And i saraiss that the title is good, indefeasible in fee simple and free aald clear of encumbrences except - arA wail warrant and defend the same. Dated this - ! ''ZLtb day of (SEAR.) - - -- (SE.ALIt • J La.Mlr.a nde (SEAL) ( SEAT.) �sHtiD�"1�LaM,lT�ind� — • AUTHENTICATION ACKNOWLEDGMENT Sigrtaturess. authenticated thj# % A. p of STATE OF WISCONSIN 0 4 County- ))) Au _ _ Personally came before me, this day of e .G t he above named TITLE: MEMBER STATE BAR OF WISCONSIN Os (If not. - authorized by g 706.0$, Wis. Stats.) Q This instrameat was drafted by T it ` to me known to be the person 2 who executed the fore - HOgerLd lrarz a going instrument and acknowledged �6 !�••,�� • :� 1 .9p (Signatures may be authenticated or acknowledged. Both are not necessary.) Notary Public _ 6�irity, �is. My Commission is p Ipg 'Pot, sts a expir_et�ffo� date:_ - J 1 ii lS�r') •Names at persona signing in any capacity must be typed or printed below their signatures. ;. •�,, , , �iy �• ti ' WARRAFTY nEF.n- STATP_ DAR of Wiscorsgm, FoRAt NO. 1 -1977