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HomeMy WebLinkAbout032-2133-00-000 o Q d n con T .1 • Cp 1 o d v a o °�� �'OW qty- W O N CD n N O cl) .+ ►► � G !O W O W N Lf R CL O (D O p O r O OD 3 g h V OD A O v U? 2 D O. � 1 CD co D C v CD CL c o Er i C) w °° < a f3 N z ° ° C c� r to O oocu cn v+ cn I 3 Q 3 a CD 0 o o o 3 1 0 co CA (A� prq v C - 1 � e 1 0 m C a Z I 0 D D o 0 o r a I = CL A • CL O CD O j CD O CD < < c o,$c 3 a o3m fD 1 Z C A z m 3y0 Q or N 3 0 d CD �. � # cc W o m ° W CD '° z $ CD ° a a 3C $ N rn co 1 c m w� a I I 3 A '�� 3 m ° CL n m 0 w 6 • 0 0 — = M O o n Ica o o o mac ' m O d 7 ( > j tD j d O p O 'p a a y S �y 0 (n v fD F y y fD O ' CD G) �7 a 0 o w Q o _ e I ,.o � m� m• �•�v_•p1 agm3 3 ? a ID fD d C Oq n y S O. N ' ' f CL O fi O < n N . y N a a N ID N b 6>> 01 7 `< O d CD 01 0) a CD N O1 G 3 O a — (D p N p f �0 n O to O C) CD CD � I Pam Quinn r" Subject: Utgard, Rocky Ridge Lot 11, 463401 (plow) Location: Somerset Start: Wed 6/1/2005 10:00 AM End: Wed 6/1/2005 11:00 AM Recurrence: (none) 032- 2133 -00 -000 01.30.19.1 179 891 174th Avenue i l Jisconsin Department of Commgrce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: 1P INSPECTION REPORT 463401 0 rENERAL 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: Free Style Homes I Somerset, Town of 032 - 2133 -00 -000 CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No'. d ��;etin� 01.30.19.1179 TANK INFORMATION ELEVATION DATA TYPE MA,4qUFACTURER CAPACITY TATION BS HI FS ELEV. ,?/L 42b -4 CID �j.�� l0q, I CD,0 Septic Behchahark / / S Dosing Alt. BM 0.2- /Z3.0< Aeration Bldg. Sewer Holding SUHt Inlet ' 4 1 ! I �. O 5� TANK SETBACK INFORMATION St/Ht Outlet ( I7• / 0 05__ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet A> t a o,q0 /0z.3� Septic > / 11k I b 3 r Dt Botto (A) Z '0 r Dosing I Header /Man. Aeration jDist. Pipe Z5 �' IIlo.ao' Holding Bot. System Final Grade PUMP /SIPHON FORMATION . q (,( '�y ( /YU Manufacturer � Demand St Cover 1 VJC w 2(olcls GPM L w1e i7r D r 3 S Model Number t,e�L-G S ,l /� d � 1/4, M-, i OK Tf l� � 6 TDH Li Friction Loss S st m H ad TDH Ft Forcemain Lengtth, O r Dia. 2 , Dist. to Well � ky\ � ►a L � 1 /0 iC6 Z. qo /p 7 3 S� SOIL ABSORPTION SYSTEM '7L C� i� �. c �� / BEDITRENCH Width / Le Of Trenche PIT DIMENSI S No. Of Pits Inside D a. Liquid Depth DIMENSIONS ( Q� SETBACK SYSTEM TO P/L 9LDG WELL LAKE /STREAM LAP HI Manufacturer CH R OR INFORMATION Type Of System: �' fl ,' t NI Model Number .�. f \ DIST U ION SYSTEM t-uplL SSA lfiyi Heade Distribution / x Hole Size Hole Spacing Vent to Air Intake 1 Pipe(s) / 2 / i L/ 3o it L 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 No Yes No Cq�AMI=N � co a I ° screpe Iles, er on present, etc.) Inspect' n #1: / / d 4 / Inspection #2 _ � 6-)1�a1>� : F i uROI e t a � (� t,, � 'ration: 891 174th Avenue Somerset, WI 54025 (NE 1/4 SE 1/4 1 T30N R19W) Roby Ridge Estat&tot 11 Parcel o: 01.30. .117 1. Alt BM Description = �tt.G. - C A * +�. ,��� t9 � Parcel. No: Bldg sewer length = �3 r ��^�S �--.1�y"^ l S oy tAr— r � �,(�,,,_ 1414e - amount of cover vaw C�o�� Plan Use other side Required? formation. Yes o L - side for additional in - -_ O � � `�_ Date In 9�ros Signatur Cert. No. SBD -6710 (R.3/97) Pam Quinn Subject: lot 11 Rocky Ridge elevations Location: 174th Ave. - violation for non - inspection Start: Wed 8/24/2005 12:00 PM End: Wed 8/24/2005 1:00 PM L V Recurrence: (none) ` L Z A . S Z (A) p. - 5L (29'�;)_ (12 LqO f ISM -1q.3 /g( "f 1Z . `(n� OT Ls;t J 04, Ir L s . &T `� i Safety and Buildings Division County r" m 201 W. Washington Ave., P.O. Box 7162 J V sevnsr►n Madison, WI 53707 — 7162 itary Permit Number (to be filled in by Co.) De artment of Commerce (60 �( Sanitary Permit Ap OII S te Plan I.D. Number In accord with Comm 83.21, Wis, Adm. Code, person oyy�y'�� 'o ou r +fie 1 4 n05 Z� 2 may be used for secondary purposes Privacy Law,W15. �" Pr ect Address (if different than mailing address) I. Application Information — Please Print All Information pNING OFFICE 19 1 1 - 7q 4A, Ave_ So J�;perty Owner's N e O Parcel #2— t # Block # I le Z P!Qperty Owner's ili A �js Property Location C Zip Code Phone Number f �+�—� � Section V ci rcle on II. Type of Building (check all that a 1 ( `� N; RRc or PP y) ar �� t 100se— I or 2 Family Dwelling - Number of Bedrooms C i ' n N CSM Number 0.h.. Public/Commercial - Describe Use o ❑ State Owned - Describe Use ou C 75 ❑City Village to mshi o III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System El Replacement System El Treatment/Holding Tank Replacement Only C1 Other Modification to Existing System B. ❑ Permit Renewal El Permit Revision 11 Change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl ❑ Non — Pressurized In- Ground Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ / Constructed Wetland 11 Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter /❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ ip Lin ❑ ravel -less Pipe ❑ Other (explain) CO J h / V. Dis Dispers ersaI)T!:eatment Area Information: _ 1gn )Joyr (gpd) Desigpp 'cation Zte(ydsf) Dispersal equir (st) I Area Proposed Syst e on vati , a 2,00 LQ O Q 5 ) , VI. Tank Info / Capacity in Total Number ufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Faasting Teaks Tanks Septic or Holding Tank Z Aerobic Treatment Unit Dosing Chamber t, VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. �7 umb 's Nam ' t) Plumber's Si ature MP/MPRS Number Busin Phone Number Pumberdress ( City , Zi ode) VI . oun /De artment Use Only R :�54 pproved ❑ Di Sanitary Permit Fee (includes Groundwater Da lss Issuing nt Signature S p Surcharge Fee) 7� GO / ❑ O er Giv eas for Denial "7` �g jS IX. Conditions of Approval/Reasons for Disapproval /� SYSTEM OWNER: 13•�Co�lid %v` – P , t-e,re- uent filter and di spersal cell must all be serviced / maintained G ��- as rovided b ' lumber. 2. All setback requirements must be maintained as per applicable codelordinances. Attach complete plans (to the County only) for the system on paper not less than $1/2 x I I inches in size SBD -6398 (R. 01/03) Fytv- 5�yl f — VA&CS� &—C-- r M o C.- L? �l P/d 4 4 PIo � Pla h '• N l 4 44 Ave for i a or /] / LOT to A P hOp. :c 46d�.., s``t9� :ted / , hac•.f to f�tl\ iJ k. !/ �»,c t,.� /ehy p.,,, V, dG �Q /oC1f•6h C �C a 1. c H.fS Ci,. � i, G r �Y a S 7� J' �C C Y C � `� ev 7.SPt. l¢ • — A f, l,ZS6�7S OCo »,`��kJf %v+� takk � f �� Td,.k �y `'�•esc.- co.,�, er'e �''.. el���s�a�, �r.,w,., ���. �,� I N r v R •Y or s h I- V Lr� ` v) •r J L C i 1 / P r'P 8 •'t r �e /o � � �r °k / . � '. r d b o 7 .G J� 7 �. O 4 7� u 7� i r Safety and Buildings ov PO BOX 7162 commerceml. g MADISON WI 53707 -7162 TDD #: (608) 264 -8777 w ww.coe.W/sb/ govsb, D www.wisconsin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary March 29, 2005 CUST ID No.220673 ATTN.- POWTS Inspector CHARLES L WEBSTER ZONING OFFICE WEBSTER EXCAVATING, INC. ST CROIX COUNTY SPIA N5815 770TH ST 1101 CARMICHAEL RD ELLSWORTH WI 54011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/29/2007 Identification Numbers SITE• Transaction ID No. 1122220 Rady g , _ s k, Hvm " L L Site ID No. 696289 85 Th St Please refer to both identification numbers, Town of Somerset, 54025 above, in all correspondence with the agency. St Croix County NEIA, SE1 /4, S1, T30N, R19W Lot: 11, Subdivision: Rocky Ridge Estates FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1010439 Maintenance required; 600 GPD Flow rate; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01101), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01101) 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. 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 s construction /installation/operation. �• ~' In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should C o Tr e 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 the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Robert Kanter POWTS Plan Reviewer, Integrated Services WiSMART'code: 7633 (608)261-7735, Monday -friday 8:OOAM - 4:45PM rkanter@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 WEBSTER EXCAVATING, INC. N5815 770th St. Ellsworth, WI 54011 (715) 273 -3430 �• POWTS Index Sheet Page 1 of 8 Mound System for a 4 Bedroom Residence Frec- 5fy loo s, Property owner/Project Name: I.ot 11 Rocky Ridge Estates NE Y Town of Somerset, St Croix County, WI Contents % :7 Page 1 of 8 Index Sleet Paue 2 of 8 Plot Plan ft me 3 of 8 Plan View Cros Sects_ ou Fa ize 4 of 8 Distribution Pipe layout p age 5 of 8 Pumviny. Chamber out . Page 6 of 8 Pump erfo ance Curve Pave 7 &8 of 8 Management Plan ���•�� �$ C O Ids �wo 4j � ARLES L r ? WEBSTER w j 9 E•181M ; It w O 't ELLSWORTH • .. WIS. •* 2.� w o I � •• .... '.•' Cb� � ate sg�3�7 C.:E Cil6V � Component manual used: - -- Name: Mound Component Manual for POWTS oNoENcE Version: 2.0 SBD- 10691 -P Date: January 30, 2001 ame: Pressure Distribution Manua[ for POWTS 'Version: 2.0 SBD 10706 -P :Date: January 30, 2001 A^ �lllp i �• � P!o � P/a � N 1-7+ -+4 Ave D oT f of l) L O? lD 5 Ga > > C- , A or le 46d••�+ 54.��e lout. i`n leH�f ✓ p ~'V•dc 1oc.►f•dti G/� d C �"�'t� rMuJ7�.t ��Cy�.l � ���• q ��wH o�2 /"���0 t-f. ` r / o �. l.Z 5 /75 co-,. ,k. �j tYr gq tank f A �. Tdtik � y w •eSCr• ca.. E'k'e N.� e�tiGfL�LtiC, �, -.,w., �� o X� �l04.o N f.IIII�1Ir•, A 2 -r 2 sa ft --2:a- . � or s t� a, tt- ry Lo JJ A r c d a- yL..h d I o 1 q,.ded i 1t4.o P r'� `! f Rld •� N 1-7 4 44 Ave LoT 1 a L ot 11 LoT l� s� o[ 4 1 Ph�p swfyeJtto/ .1. t �p,� t tvi.., Ra�.,3'e f'e �'. k �l iJ `1. u... t• G�. � l� leh�f Ph . v, alG loclf:dti i n c %ar °wts (� --•��� �aurf.r�ceY� ��� ?�� 91.w., del'^ll�� - f � eves 7,5 "Pt. !� R R6 /L �O /� " �J ri It C✓' r � Tdik �y w•esc.- C' °.,��e�`e /- '.�.1�.��C�..c -. �• �r�ti.. cl C,/. H R or I � f n Q! © n C LI) i M bwk g R °Uk did � 1 �i4.o P r-P 6Hr Imp �� (rrha/C /' ape c�/ �of csLw�I— eI= IOG-O P!p C i .r d b o 7R .Z f 7t, c> w, of I CA Pag �. Of Sc c- 7 n Approved. Synthetic Covering Distribution Pipe ST h'1 C- 3:3 Medium Sand " Topsoil - -- Elev —_� 3 E D 1 r °/a Slope � Bed Of Z— 2 2 Force Main Plowed Aggregate From Pump Layer coh +ow� e/m //4.0 p $ • r h. Cross Section Of A Mound System Using f 7. S7 A Bed For The Absorption Area /h, l G o.$- Ft. A Ft. H / O Ft. Linear Loading Rate =Cg OGPD /LN FT B 7 ` Ft. Design Loading Rate= 38.GPD /SQ FT I 1 3 Ft. —_ y} cccr 1 l .x J Ft. Th.c,+dedO /w,t 1 K Ft. i1fe.,1 / Ft. TyP��t t1Put/ cn W oZ 8 Ft. L • Observotion Pipe J i 8 K ---- - - - - -- -- - - - - -- -`-� s to Q A a s � w -- - T----------- - - - - -� Distribution Bed Of -I? 2 Pipe Aggregate Observation Pipe,` (Anchor securely O�sC �p // .�P.0 I`- ,b X)I - C d /Y // Jih•/07kF. (/. / P / d c.. �c r �`9 y'f c � �1(/@ fhCpa ftov. �itic � CS S�stfeo��,6G rcC'ue� dhcL.oite. d Plan View Of Mound Using A Bed For The Absorption Area Page 4 of Perforated Pipe Detail n / End View Perforoted / z w PVC Pi pe / / Holes Located On Bottom, SCt a/f7'a? Are Equally Spoced i Q ) S dtti,'I e PVC Monifold Pipe t 1 Disln.�ulion / Pi ?e Set d�fiv.l ° P 36 Ft. 3".C, Distribution Pipe Layout A7. ; r � a/ �C� s 4 Ft. X 3O Inches /lw Y 3 Inches Oft :arN,. h��- o� r�Jtc•., /o�.= �} ��_ /SJ ��_ � Hole Diameter Inch Lateral It I )�- Inch(es) Manifold Inches Force Main " oZ Inches # of holes /pipe tti��,ded Invert Elevation of Latera s Place 1st hole% from center of manifold with succeeding holes at3 intervals. / -! O 1.1 / - �0 k S 41 ,� Pa ✓ Of se 'o ! i'c rj a ��/ C! `�« c..r.or skid 90 (No Scale) P /�J7 rewr P 2 > /oft Approved Locking Manhole Covers- With Warning Labe1S Attached '% U' r I., -i r l� y 1Ke Weatherproof Approved _ Junction Box Vent Cap ~ T 12" Minimum ,f - , y � t 4.. Minimum Quick ,. 18" Minimum , Disconnect i cevv� 1/4" Weep /AO,p Baffle Hole Al arm L On Q p e : 14.0 ;, /6 1n44 -APPROVED Off LV ' 9"5-SS oFcoyor t, JOINTS WITH P`°v° APPROVED PIPE ID 3' ONTO SOLID SOIL Conc. Block 3" of Bedding Under Tank --/ Act 'PW "-"0 $ Jd r.,, oil ' r e ck"t ei �i r cs�.�'7•� Number of Doses: 6:a Per Day Gallons Per Day /i : 76-4 Volume of Backfl ow:zo °.�'!O+ — Gal 1 ons Tank Manufacturer: �iese� co, ���� Prda/�.�ts� -�4 r. Total Dose Volume ........... ix 7 Gallons Tank Size - Septic /Pump: /;tS'o 17.s0 Gallons Alarm Manufacturer: -okel a1akk" Model Number: b4,V Capacities: A 9 inches or 4& Gallons Switch Type: Sfee/ Ball + B 2 inches or 3 a. Gal Ions Pump Manufacturer: G' + C & inches or 12 q Gallons Model Number: fi.• Eo.S'ff P + D inches or /2 Gallons Minimum Discharge )date: .7-4 - 6 t Total ..... = 4. inches or 7S 7 Ga i Ions vertical Difference Between Pump Off and Distrib tion Pipe: /c3;7 Feet (�• Minimum Required Supply Pressure:. !3A.�o .... +�,, Feet .ZS Feet of Force Main x 43�" Friction Factor /100 Feet: + 1Ts5� Z. Inch Diameter Force Main w � Total Dynamic Head: ... = -Feet � /v Internal Tank Dimensions: Length /S - ; Width ; Liquid / Depth 47 C du " l L � r� — S + 1�2 j- �on� -5 �-�•— S FF.FT 1 3 �f ��i7L' �.il•: . ' . ... . ' . ... ... . ' . ... .:.`r!' < <S�'J: '. M:3 zoo P 110 : ... i0tl; ; s �'r .. 9 0; 4 iSi� • . '- - .. - • : - . - . - ' - • . • .. -- - - .. D110 • . 1;. . . . . ` . . /O ' .. G.... ..... ..... ..• �0 : 0 20 30 40 5 0 50 70 80 90 100 110 120 130 140 'ISO 1 11; L - -- J------ C--- - -L - -- -=-- - - - -- - -� - - L-----=----- J------ C----- L-------- - -1 - -- vy r � E c, Iq CANA( l Y molds i s De , ti c/ _ 2 4 --------------------- - - - - - -- TT �v%vw.gorl ' .com i i � E -��t?' I POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 7 of S I F,�c? S L� e_. FILE INFORMATION S � SYSTEM SPECIFICATIONS F al Septic Tank Capacity / -IS ❑ NA # Septic Tank Manufacturer �� ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer /�o / ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model S"�� ❑ NA Number of Commercial Units J Q NA Pump Tank Capacity 7S a l ❑ NA Estimated flow (average) 4 auda Pump Tank Manufacturer w j 'ese. - Concj 4� ;Q NA Design flow (peak), (Estimated x 1.5) Cc d g al/day . Pump Manufacturer {�" w / c/ ❑ NA Soil Application Rate d_ gal/day/1`12 Pump Model ��'p S /S�jF� ❑ NA Influent/Effluent Quality Monthly average* Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand/Qravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD s220 mg /L ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 m /L ❑ Disinfection ❑ Other. Effluent Quality anufacturer Pretreated E ty � � NA Monthly average** Dispersal Cell(s) Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ At -grade Amound Fecal Coliform (geometric mean) 510 cfu/100ml ❑ Drip ❑ Other Maximum Effluent Particle Size Y 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 ❑ months 14 year(s) (Maximum 3 ym.) 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 jqyear(s) (Maximum 3 yrs.) Clean effluent filter N01 R1LV`15 42 ast once every (IQ months . ❑ year(s) Inspect pump, pump controls & alarm At least once every ❑ months ❑ year(s)' ❑ NA /6 e`o d Flush laterals and pressure test At least once every ❑ months ❑ year(s) ❑ NA s ,� eeder/ Other. At least once every ❑ months ❑ year(s) PdNA O t 1 er At least once every 0 ❑ year(s) JdNA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer, Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third %) 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, pretreat #ment 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 4p 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 cells) 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 Septege 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 :eliminaUon of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONM TENT When the POWTS falls and/or is permanently t out chiCOmm fol lowin g PS Wisconshn ! Admnistrative Codethat the system is property and safely abandoned in complia • 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: O 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. D A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS S. technology a holding tank may be installed a suitableee rep lacement are a. Upon fai a of the POWTS a soil and . D The site has not been evaluated to identify P If no replacement area is available a . lacement area. p a suitable replacement P mu be .,, site evaluation mu performed to loca P holding tank may be installed as a last resort to replace the failed POWT_S. 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 ER TREATMENT TANK UNDER ANY C RCUMS DEATH MAY GEN. . DO NOT ENTER A SEPTIC, PUMP OR OTHER RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY DIFFICULT OR IMPOSSIBLE. AY ADDITIONAL COMMENTS POWTS MAINTAINER POVIITS INSTALLER Name Name , // -d / /' �w^,A S3 3 6 Phone Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY CC » k,.o.c�.cr Agency St Cc o: � t 7Z Name Phone 7 ' 3 its. - 4 8 Phone This document was drafted by the staffs of the Green lake, Man 83. and 2 b vvis cou nty n nistrathre g Use of this documentt does not the MWmum requirements of ch. Comm 83.22(2)(b)(1)(d)�(f) and 83.54(1), () (). GMW (2/01) guarantee the Performance of the POWTS. CZ Page s Qt + System start tip shall not occur when soil conditions are frozen at the infiltrative surface. y . ' During,p'ower outages pump tanks mayfill above normal highwater levels. When power Is restored the excess wastewater will be discharged to the dispersal cell(s) large overloading the one l dose, overlo the oell(s) and may result in the baO P `or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a SePfe9 e Servicing op rvicin O rator to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to I • 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 orrellmination 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 soaps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS falls and/or is permanently compl f� ch,COmm 83'.33n Wisc:ons n'' Code to Insure the system is property and safely abandoned in co p ce • 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 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 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: Q 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. O 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. O The site has not been evaluated to identify a rep lacement area. I o replacement area P OWT S available a a suitable e site evaluation must be performed to locate P „ holding tank may be Installed as a last resort to replace the failed POWTS. Mound and at -grade soil absorption t of such systemsmust p lace the rules in removal of the effect at that bme at at the Infiltrative surface. Reconstructions <<WARNING>> GASSES AND/OR SEPTIC, PUMP AND OTHER TREATMENT T MAY CONT OTH DO NOT ENTER A SEPTIC, PUMP OR TANK UNDER ANY CIRCUMSTANCES. DEAT MAY OXY GE N . RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS OWTS MAINTAINER POWTS INSTALLER Name - g, //. �d� / /u,».,6 �:, Name -Phone R CG..kno u� LOCAL REGULATORY AUTHORITY SEPTAGE SERVICING OPERATOR PUMPE Agency St �'��� 3 7 t Name Phone 7/S - Phone This document was drafted by the staffs of the Green take, Marquette and Waushara County zo�9 and Sanitation agencies. This document meats um requiroments 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 (2/ot) the mWm . guarantee the performance of the POWTS. 1 Wisconsin' Department of Commerce SOIL AND SITE EVALUATION 3 Dil :sion of Safety and Buildings °'- Page of Bureau of Integrated Services in Ordance with s.' ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than $'1/2 x 11 inched -ya ST�e. Plan must County , 1 r include, but not limited to: vertical and horizontal refefence poinf ($M� ,i�irction and percent slope, scale or dimensions, north arrow,.ani loca ' n and distance to nearest t ad. �, - - � Parcel I.D. # `r1 006-lU APPLICANT INFORMATION - Please n i! all ij;A ' Reviewed by Date Personal information you provide may be used for secondary piirpoz�sJP,' C,. w s. 15.04' 1 Property Owner J �?' erty Location q C(s f�/ / c �P/f 0� `v ovt. Lot 1145,E 1 /4,S T 3Q ,N ,R / E (or)G Propert Owner's Mailing Address " °' "' Lot # Block# Subd. Name or CS , # City State Zip Code Phone Number Road Nearest r, ����� �/ / ❑ ify El Village [z� Town t � S'yQ /J (T ) 2s�6s �� e „ S "le 7 �1" sf New Construction Use: ® Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow � 60 gpd Recommended design loading rate �' 2 bed, gpd /ft /•;Z trench, gpd /ft Absorption area required SOO bed, ft2 Sop trench, ft Maximum design loading rate �' bed, gpd /ft 0 trench, gpd /ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design /site considerations Parent material l��GtC /4 07 X P2 0 Me er -�4'� � Flood plain �y ,l / ft j � elevation, if applicable S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S 0 U Jo s ❑ U EIS OC U I ❑ S ®U EIS ©U ❑ S S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench YY � 1 © -8” /L�f,�� �� S� f�1Sb� /7ivF✓ C� 2h'► e � �.S Ground Air w I kft. Depth to limiting factor 2 Q in. Remarks: Boring # 1 04 jots' 1,&;4t A "F- cw 21 . Y s xt 5 ho 5 &7 Ground y 2 sQ >?% C2 �' S 3� �L I���, U in .� NP I v. `T q Depth to limiting ��ta� ,�_ in. Remarks: CST ame (Please Print) -Ss ionatur Telephone No. reap Fa✓i -ell Cf, - � 7 /s- ? /7 -32 ©3 Address Date CST Number a P l� ? 9� z /yZu �S ®n����,�- w ry Z� Z7- �Y 2s 13 t i �� I //Yi 4wQ �•F' 1 ' ' ' � I 1 } , roCA Imo` k'� To��G�'r. S'o4�Y/�cr� d ,•,,c+ , / �- r -- - -- - i Ch ar 2 1 S d 1P.2.3 I I__ Y__ ._ {_.. ...._ -�___} _ -1. . -. -� -- .� -. _.._..2. ..- �_._ -' - i _- _.__ - __f -- - ___ -• 1 t 1 , r , G l lei �� S f le uT I , t bt- i • i j , I - �t -- - - f I , t III t I i i i i i i I i , I j t t i , I , r � ; a ' k -- r ! t t ! — ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP Ci"RTIFICATION FORM Owner/Buyer �� Gam- S GL-C -- Mailing Address ? �` k,T �� +�-S R 1,4, t `� 1_501 Property Address �� ' e y wl Ar (Verification required from Planning Department for new construction) City /State 612 Parcel Identification Number 3Z ' 2133 — 0 LEGAL DESCRIPTION Property Location %4, 6 V Sec. T 3� N -R_LLW, Town of c!'' Subdivision zlS'rlAS Lot # H__ Certified Survey Map # Volume . Page # Warranty Deed # 713 8 2 89 Volume ;2 , Page # 3 Spec house ❑ yes Ono Lot lines identifiable P(yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The proper"wner agrees to submit to St. Croix 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 wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that ur septic s stem has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of a xp' tion date. C'« / S NA OF APPLICANT DATE OWNER CEATIFICATION 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 e above, by virtue of aw deed recorded in Register of Deeds Office. S A OF APPLICANT f DATE * * ** * y information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed illl POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity Id s"� al ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model 5 ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity C) al ❑ NA Estimated flow (average) Q g al /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.51 6 ® 0 g al/day Pump Manufacturer ❑ NA Soil Application Rate r Y gal/day/ft' Pump Model j o r, /� ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD S30 mg /L ❑ In Ground (gravity) ❑ In Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510` cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once eve ry' 13 month(s) 3 month(s) ears) ❑ NA 0 year(s) y Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: a ❑ month(sl (Maximum 3 y ears) ❑ NA year(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA ,K ear(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ month(s) At least once every: ❑yearls) ❑ NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. 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(s)Ilao lesiadslp 941 of poBieyaslp aq lllnn iaiemalsem ssaoxa 841 p9iolsoi si i9Mod uayM •slanai iazeMyBly lewiou enoge Ill; Aew sluel dwnd saBelno iannod Bwina •93e ;ins aAlieillgui 0 41 le uozoi; eie suoll!puoo Hos uayM in000 iou Heys do iiels wa1sAS •esn of solid ioleiedo Bwowes oBeides a Aq panowai (sMuel 0 41 JO slualuoo 041 aney paloelop ale suolleiluoouoo 4B14 11 (s)lloo lesiadslp ayi 98ewep io /pue ss000id luawleoii ayi apedw! Aew leyj slealwa43 ieylo io sionpoid Bugu!ed ;o eouesoid ayi io; (s)jue1 wawleeil 10043 SIMOd 0 411 0 asn of ioud 'uoponilsuoo Mau sod NOIIVa3d0 aNV do 1liV1S 2 ;0 Z . aged U 2 7 S S P 355 �$8� KATHLBEH H. WALSH Stete Bat pf Wisconsin Form 2 -2003 AT STI >F . wARuANTY DEED RECEIM FOR W MO Dommeo Nomber Dowmem None 02/25121IiD5 01:4SiPtt WARRANTY DIMfl ak?Rf i THIS DELL, made, betvim 10gft.,a 91mmaeSaMtE and WW Skegluod " wkiber ens or nwm),. BRA FE E% 1 ("tiraRt4t,. TRANS .F � 156.00. '. and _F.I C m. LC tQPY vggr t"`Ci rantee." whetltaroneormore). C I nC. -, ----- PAGKS: 2 Grantor, for a valuable consideration, conveys and warroa s to Orm0e the fbtkswing describer) real estate, together with dw rents, profits, fixtures and other appurtenant ltec v*q Ara interests in U C;Mh County, Stateof W€seondn ("Property") (it'.ntore space is NmtigaM i2st+anAddress needed, please attach addendum}: Lot 11 9 ky Ridge H9tet06. St. Croix C=Ity t W1sEx>tiSin. T' < r �, ri r ` � � :r AT LAW P.O. SOX 359 H UDSON, VNl 54015 g}� - :t3 Pool Metuifimm Nwnber (PIN) This R howAftwi . Excoptiom:to Warranties: Fase:aents, rssbietim aad ribs.of way of rnord, ffaay. Dated i? - z — zo {$EAL) (SEAL) e"I'iatothy A. MemeRlCll r {SEAL tlCId (SEAM) • #X21 -1 swgtund AUTHENTICATION ACKNOW LEDGMtNT Signatures) Kad &Wd rnd , a di enticeted on STATE OF ss. COUNTY la * Kriidw i E a BER.STATE BAR.OF W=NSIN Pally came before me on z — Z (If not, theabove -named fund authprized by Wis. Stat § 706.06) to be the person(j) who .executed the foregoing acknowledged the saute. THIS INSTRUMENT. DRAFTED BY. Hudson, W1 §4M - �e hRY v>! : stew of 9 on (is pemunew) (expired: (Slpamm my bt sothod . Roth are eot0owsuy.) NOTE:' THIS IS A.STANOARD (FORM. Amy-m in Td'THIS FORM SHOULD BE CLEARLY 1DEN MI) WA1tRANTY DEED O 2903 STAMBAR OF WISCONSIN FORM.. NO. 2-2m Type name bdow sipstures. INFO- PFtD'"I:pw F0ns SOMW2021 www.bfaptbWm Wn • 04/18/2005 03:18 PM Parcel #: - 032 -2133- -000 PAGE 1 OF 1 Alt. Parcel #: 1.30.1 .1179 032 - TOWN OF SOMERSET Current X', ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner RIEMENSCHNEIDER, TIMOTHY A TIMOTHY A RIEMENSCHNEIDER SKOGLUND KARL SKOGLUND KARL 775 150TH AVE NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ` 891 174TH AVE SC 5432 SCH D OF SOMERSET SP 1700 WITC Legal Description: Acres: 3.140 Plat: 2409 -ROCKY RIDGE ESTATES 2000 SEC 1 T30N R1 9W PT SE1 /4 LOT 11 ROCKY Block/Condo Bldg: LOT 11 RIDGE ESTATES Tract(s): (Sec- Twn -Rng 401/4 1601/4) 01- 30N -19W SE Notes: Parcel History: Date Doc # Vol /Page Type 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 11573 61,000 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.140 51,700 0 51,700 NO Totals for 2004: General Property 3.140 51 ,700 0 51,700 Woodland 0.000 0 0 Totals for 2003: General Property 3.140 51,700 0 51,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 — I M \ W O h \\ \\ I �LLI ^►rid \\ �� V 1 I i N W 0 S LOON m \\ 1 W r M !_ /7 L � sI In I ; I I ,66'6L* M „80,5 1.00 N s o \\ \ , �, I I \� _ .OL'LL \ f \ ZO -- ,68'ZOb - - -- ?� z ` rn ` \ ` �r I w 6 I w + m l Ln NI _ o _I (1 W II U { O I 00 I I M V W w \\ \\ I Z N bL'6bZ 3_OS,OZ.00S _ ,\ O tell (10 I j 1 1 1 I I •� o \ 1 50 I O cn \ \ ON I ' 3 S£S M „80,51.00 N I - �� 00 ,££ a h I r cJ ".V �+ Z �D� S h \\� n rn LC) \ L'SL M I �— w O • M,. . 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