HomeMy WebLinkAbout032-2046-20-100 r -
/* �Od �v saw
Vb; &vWn Oepartrne "t of Con'm(ce PRIVATE SEWAGE SYSTEM county:
Safety and BWkf ings Division INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) sa nRary Permit No.:
Persona) information you provice may be used for secondary purposes [Privacy Law. s.15.04 (1)(m)l. 384260
E ld 's Name: Q City p Village Town of: State Plan ID No.:
, nary Somerset Township
ev.:- Insp. BM E ev.: BM Description: Parcel Tax No.:
p J GST ctsif 1,t��ll 032- 2046 -20 -100
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic �(� Benchmark
Dosing BM - glwk 1.1 l0 /f� Jov
Aeration Bldg. Sewer t a• 7 3 ! 8 ,
Molding - - St t Inlet '1.(vZ j •��-
TANK SETBACK INFORMATION St/ Ht outlet ?.� Cji •L�
TANKTO P/L WELL BLDG. to
Air I ntake
A ir ROAD Dt Inlet
A
Septic NA Dt Bottom
Dosing NA Header / Man. 9 a t • G 3
Aeration NA Dist. Pipe
1 1 . 08
Holding Bot. System
PUMP/ SIPHON INFORMATION Final Grade qs •74
Manufacturer
emand over �� IB
Model Number GPM
EForcemain Lift Friction System TDH Ft
Loss Length Di a. 1i oi:t. To well
SOIL ABSORPTION SYSTEM
BED / TRENCH Width Length o. Of Trenches PIT
No. Of Pi Inside Dia. Liquid Depth
D IMEN S IONS $7 1 ENI N Pits
SYSTn P / L BLDG WELL LAKE /STREAM LEACHING a" rer: SETBACK CHAMBER a INFORMATION Syst m Sb� ,? / A. // OR UNIT
DISTRIBUTION SYSTEM
Header / + M + an) old 1 Distribution Pipe(s 7 O / x Hole Size x Hole Spacing Vent To Air Intake
Length 1 Z Dia. Length ��Dia. Spacing -
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Depth Over P
Bed /7rench Center Bed / Trench Edges Topsoil Q Yes Q No C] Yes C] No
/
COMMENTS: (Include code discrepancies, persons present, I3Bpection #1: to / 4 /0 Inspection #2: /
Location: 891 160th Avenue, New Richmond, WI 54017 (NE 114 NE 1/4 13 T30N 19W) - 133019662C -
Lot 2 � Nw� s �es�i ►-c �
1.) Alt BM Description = I o p �vmncu, ko�R t -wtiL- ►� fss * O ,
2.) Bldg sewer length= ?�( inn s ",, C d
.,
- amount of cover = 3( — `�8 r^ti �• v�,��, L�
3 � 1 bu.r� wuc ec� + e 6n��i 5ci ` ��
Plan revision required? )(Yes O. No �( O(
Use other side for additional information. Cert N
/ � _ inspector s Si n ure
SBO -6710 (R.V97) - ) W' r4 l tK f ► ^ �T�"vbd � / ^4 Q/ e,
1 fo0
c
I s
P�
s
' Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing this application PO Box 7302
`�SCOnS # n Personal information you provide may be used for second purposes p Madison, WI 53707 -7302
Department of Commerce (Submit completed form to county if not
[Privacy Law, s. 15.04(1)(m)] state owned.)
Attach complete plans (to the county copy only) for the s t than 8 -1/2 x 11 inches in size.
County State Sanitary Permit Number ❑ Che ion to previous fi ion State Plan I. D. Number
I. Application Information - Please Print all Information Location:
Property Owner Name f � A A Property Location f/
h e 'q /4,SJ T��1,R�E W
Property Owner's Mailing Address �' Lot Number Block Number
City, State Zip Code otle Number �.° Subdivision Name or CSM Number
Aim
II..Type of Building: (check one) ❑ City
119!�' I or 2 Family Dwelling - No. of Bedrooms: a,:15 — ❑ Village
❑ Public /Commercial (describe use):_ Alown of
❑ State -Owned
A" ��TC v, i' lam' ea o?p� C1l �t �e�f NeazestRoad
. 6e ;I� X12V
L�Gt �' G t ( (C' s rid i? /4 i� Parcel Tax Numbe rs) O d
III. Ty of Permit: (Check only one box on line A. Check box on lin B if applicable) ¢ ® �
A) 1. MQNew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
B) Permit Number Date Iss ed
Sanitary Permit was previously issued �j ��
IV .Type of POWT System: (Check all that apply) j u,7e 25 ZXf
�)on- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V. Dispersal/Treatmen Area Info rmation: Z 3 r x (o K S
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Ara 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) - (= 9,V 0 levation q',3: 7
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
VIII. Responsibility Statement
1, th undersign assume responsibility for installation of the POWTS shown on the attached plans.
Plum 's Name (print) Plumber's ature (no stamps): MP/MPRS No. Business Phone Number
1 ' .o
Plu is Address ( e City, State, Zip Code)
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued IsAing Agent S' ature (No stamps)
Approved ❑ Owner Given Initial Adverse Surcharge Fee)
Determination 5O
X.. of Approval /Reasons for Disapproval:
�cvZ �0 re C � 4 Goa j� ��(1{ -V.) (0CCCc M,
uhSYl;i,, ,
lk� u -C�fc4 �wis �hsf�Gh� -, a�c�ispe
T%e 15 -IFJ spews�blc- Ca< �7-. Pow TS
SBD -6398 (R. 07/00)
PLOT PLAN
PROJECT Gary Beraman ADDRESS 948 Coleman Dr. NewRichmond W. 54017
NE 1/4 NE 1/4S 13 /T 30 N/R 19 W TOWN Somerset COUNTY ST. CROIX
�
MPRS Byron Bird Jr. 2205 DATE 6-18 -01 BEDROOM 3
CONVENTIONAL XXX t -Grade CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gal LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE 0 LOAD RATE 1.2 ABSORPTION AREA 375 # of chambers 22
kk BENCHMARK V.R.P. top Of V steel pipe ASSUME ELEVATION 100'
❑ BOREHOLE O • WELL IH.R.P. 160 th ave NE corner of PL
Vent
SYSTEM ELEVATION T -1 =90.01 T -2 =89.1
AT' Sidewinder High
Capacity Leaching
Chamber with 17.2
6" t ^2 per chamber
Grade at Systern
Long 34' Elevation
160th ave
512'
Dri ay
60'
B4
35' B2 68.75'
2 10'
B1
70' B3
60'
10' st ob pipe
3
B PL
3 bed gage
house
182'
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page t of Z
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
�
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County G'ia
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. OZ - fj 6 �o?O -- l8 -O
Please print all information Rev' d by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
a
Govt. Lot 1/4 �1 /4 S / T .-7a N R / E
ZAW 4* Property Owner's Ndiling Address or Lot # Block # Subd. Name or CSM#
C �
� Cit State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road
aNew Construction Use;,EK'Residential / Number of bedrooms _ Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material Flood Plain elevation if applicable /y!Q ft.
General comments
and recommendations:
5y�Ae.,�
ELI Boring # [ :] Boring ql
1� Pit Ground surface elev. oZ ft. Depth to limiting factor !p in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
CA
/.
(t�
❑ Boring # ❑ Boring X
Pit Ground surface elev. ft. Depth to limiting factor 7Z -G, in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 _< 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS _< 30 mg /L
CST Name lease Print) r nature CST Number
h
Addres a Evaluation Conducted Telephone Number
SBD -8330 (R07 /00)
Property Owner Parcel ID # Page of
Ed 'R Boring # ❑ oring
Pit Ground surface elev. ft. Depth to limiting factor > / 2, p _ in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
F ❑ Boring # E] Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
❑ Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777.
SBD -8330 (R.07 /00)
• POWTS OWNER'S MANUAL 8Z MANAGEMENT PLAN Page of _
rIL� :i4FORMATiON SYSTEM SPECIFICATIONS
Septic Tank Capacity gal ❑ NA
# Septic Tank Manufacturer. ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer fi �j ❑ NA
N r:zber of Bedrooms ❑ NA, Effluent Filter. Model ❑ NA
of Commercial Units ❑ NA Pump Tank Capacity gal ❑ NA
Est;; i iated flow (average) , _5'e* gal /day Pump Tank Manufacturer ❑ NA
Design flow (peak), (Estimated x 1.5) J y gal /day Pump Manufacturer ❑ NA
So;, application Rate - gal/day/ft' Pump Model ❑ NA
Intluent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA
Fats, Oil Grease (FOG) s30 mg/L [3 Sand /Gravel Filter ❑ Peat Filter
❑ Mechanical Aeration ❑ Wetland
Biochemical Oxygen Demand (BODs) s220 mg/L
❑Disinfection ❑Other:
Total Suspended Solids (TSS) sISO mg/L
Manufacturer
Pretreated Effluent Quality ❑ NA Monthly average ** Dispersal Cell(s)
3lochemical Oxygen Demand (BODs) s30 mg/L Ain- ground (gravity) ❑ In- ground (pressurized)
Total Suspended Solids (TSS) s30 mg/L ❑ At -grade ❑ Mound
Fecal Coiiform (geometric mean) s10' cfu /100m1 LO Drip -line ❑ Other:
Maximum Effluent Particle Size A inch diameter
* Values typical for domestic (non - commercial) wastewater and septic
tank effluent.
* * Values typical for pretreated wastewater.
MAINTENANCE SCHEDULE
Service Event Service. Frequency
Ins conditio of tank(s) At least once every ❑ months Pyear(s) (Maxlmu .)
Pump out contents of tank(s) When combined sludge and scum equals one -third (Ys) of tank volume
Inspect dispersal cell(s) At least once every ❑ months fTyear(s) (Maxlmu .) 1
Clean effluent filter At least once every ❑ months Elyear(s)
Inspect pump, pump controls 8z:alarm At least once every , ❑ months ❑ year(s) ❑ NA
Flush laterals and pressure test At least once every. ❑ months ❑ year(s) ❑ NA
Other: At least once every ❑ months ❑ year(s) ❑ 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 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
nodflcadon of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (A) 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
;ge o€
.cart .;: shall not occur when soil conditions are frozen at the Infiltrative surface. — +-
owe, jutages pump tanks. may fill above normal highwater levels. When power Is restored the excess wastewater will be
:u .... :ed tc the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
'rtilut: To jvold this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
po" r:.j the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
resoor :ormal levels within the pump tank.
hive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
m 5 feet down slope of any mound or at - grade soil absorption area.
Keau� on o: elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POW' �: antibiotics; baby wipes; cigarette butts; condoms; 'cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
tout,::.: _ion drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
products: pesticides: sanitary napkins; tampons; and water softener brine.
ANt JNEMENT
Whet, ie POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is
pro p c 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
CUt. AGENCY PLAN
)WTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
re ient 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 soli 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.
X The site has not been evaluated to identify a suitable replacement area. upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may
be Installed as a last resort to replace the failed POWTS.
Mound and at -grade soil absorption systems may be reconstructed In place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< < wARN1NG> >
SEP i iC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT
OX i :;EN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES.
DEAT MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR
fMVriCCIRI.I`..
AD D VT I ONAL COMM ENTS
POW 11 INSTALLER POWTS MAINTAINER
N a rie / -;� �'i,� �.. , S �, Name
Phone
SEP`i,i :E SERVICING OPERATOR (PUMP LOCAL REGULATORY AUTHORITY
r4...;e �� Agency �� ����r s;L S��� '
__
Qe o
$$ I �� Sanitary Permit Application V�E ; ^ afety & But dings Division
In accord with Comm 83.2 1, Wis. Ad m. Cod ^�4YLD \, --�Q1 W. Washington Ave.
See reverse side for instructions for completing this a ` tion PO Box 7302
Nvzi; �'i ®nS�n Personal information you provide may be used for sewn urpo gg i �(� o ?_'Madison, WI 53707 -7302
Department of Commerce J17 2KrHr[ bm�llCl�d form to county if not
[Privacy Law, s. 15.04(1)(m)] �� �
T state owned.)
Attach complete plans (to the county copy only) for the system, on paper t than
County State Sanitary Permit Number ❑ Check if revision to previous i a an I. er
3� 26
I. Application Information - Please Print all Infor mation io
Property Owner Name rojierty Location
k-- V X �.- ?lf 1 7 1/4 / /4, S T C ,N, It/ E (o
Property Owner's Mailing Addres / Lot Number Block Number
:
Ci State Zip Code Phone Number Subdivision Name or CSM Number q
II. Type of Building: (check one) V Rs P 5 '"k ❑ city
1 or 2 Family Dwelling - No. of Bedrooms: V ❑ Village
•
Public /Commercial (describe use):_ � Town of S�
❑ State -Owned
Nearest Road ¢
,(WC CA 6 Parcel Tax Number(s)
III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) p ICE (
A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
B) Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
104,on- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V. Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) �y - = �3` Elevation
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete strutted
Tanks Tanks
❑ ❑ ❑ ❑
❑ ❑ ❑ ❑ ❑
VIII. Responsibility Statement
I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber' a (print) r Plumber's Si nature (no stam MP/MPRS No. Business Phone Number
Plum s Address (Street, City, State, Zip Code)
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued I ui Agent Sig na (No stamps)
K Approved ❑ Owner Given Initial Adverse Surch e Fee) off. `
Determination 225, u 2< -
X. Conditions of Approval /Reasons for Disapproval: ,
1e m t Sv t ry s hna� 4's. e2/ Case - I
SBD -6398 (R. 07/00)
PLOT PLAN
PROJ19CT Gary Beraman ADDRESS 948 Coleman Dr. NewRichmond Wi. 540
NE 1/4 NE 1145 13 /T 30 N/R 19 W TOWN Somerset COUNTY ST. CROIX
MPRS Byron Bird Jr . 220527' —�"'` DATE 6-18 - BEDROOM 3
CONVENTIONAL XXX Grade CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gal LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE 0 LOAD RATE 1.2 ABSORPTION AREA 375 # of chambers 22
BENCHMARK V.R.P. top of 1 steel pipe ASSUME ELEVATION 100'
❑ BOREHOLE (DWELL - H.R.P. 160th ave NE corner of PL
AT" t SYSTEM ELEVATION T -1 =95' T -2 =94.8
Sidewinder High
Capacity Leaching
Chamber with 17.2
t ^2 per chamber
Long 34 Elevation
160th ave
512'
ve ay
B 36, 42'
26' B4
68.75'
38'
42
10'
I IT
B5
10 ob pipe
st
1
PL
3 bed gage
house
182'
r -
PLOT PLAN
PROJ19CT Gary Beraman ADDRESS 948 Coleman Dr. NewRichmond Wi. 54017
NE 1/4 NE 1/4S 13 /T 30 N/R 19 W TOWN Somerset COUNTY ST. CROIX
t �
f � 1, 6 -18 -01 3
BEDROOM
MFRS Byron Bird Jr. 220528- DATE
CONVENTIONAL XXX Grade CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gal LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE o LOAD RATE 1.2 ABSORPTION AREA 375 # of chambers 22
BENCHMARK V.R.P. top Of 1 steel pipe ASSUME ELEVATION 100'
❑ BOREHOLE O WELL IH.R.P 160 th ave NE corner of PL
Vent SYSTEM ELEVATION T -1 =95 T - =94.8
>12" Sidewinder High
° Capacity Leaching
Cov Chamber with 17.2
6 t ^2 per chamber
No Grade nt. System
Long 34" Elevation
160th ave
512'
Dri veway
B 36' 42'
26' B4
B 68.75'
38'
42
10'
B5_
10 ob pipe
st
1
PL
3 bed gage
house
182'
Wisconsin, ' Department of Commerce SOIL AND SITE EVALUATION
Diviapn of. S„ety and Buildings Page of
Bureau of Integrated Services r ce with s. ILHR 83.09, Wis. Adm. Code
Attach complete site plan on paper not hes in s z6,Plan must County
include, but not limited to: vertical and (BM), diree�tion and �5k
percen slope, scale or dimensions, no distance ta road. par I I. . #
APPLICANT INFORMATION - iRation.Y iewed by Date
Personal information you provide may be use vacy Law, s. 1 .04 (1) (m)). Z Cam
Property Owner ZONING OFPCF_ Property Location
Govt. Lot 1/4 ;- 1/4,S T D ,N,R (or
Property Ow Ws Mailing Address Lot # 1 Block Subd. Name or CSM#
Ci Sta Zip Code Phone Number ❑ City ❑ Village Town Nearest Roa
I I . ATI d
-- ( ) a
New Construction Use: ® Residential / Number of bedrooms Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow gpd Recommended design loading rate ; � bed, gpd/ft . trench, gpd/ft
Absorption area required Z- X? bed, ft SAY trench, ft Maximum design loading rate ! bed, gpd/ft gpd/ft
Recommended infiltration surface elevation(s) 9e, ft (as referred to site plan benchmark)
Additional design /site considers lions
Parent material �' ,m� 5'ac�i�t/��n., Flood plain elevation, if applicable ft
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for system ® S El q�l S❑ U 0 S ❑ U ® S ❑ U ❑ S 0 U ❑ S ® U
SOIL DESCRIPTION REPORT
Boring Horizon Depth Dominant Color Mottles Structure GPD /ft
g in. Munsell Gu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench c�
5
Ground
elev.
Depth to
limiting ct s , o
fac tor
>_in. 5�•`1/ 1z.
Remarks:
Boring #
z Al s
.s
Ground 01 Lj '
elev. _
Depth to
limiting
factor
din. Remarks:
CST Name (Pi ase P ' t) Sign Telephone No.
Address CST Number
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C ER ' T .I E I ED S UR V E Y MA P
Located in the Northeast quarter of the Northeast quarter and the Northwest quarter
of the Northeast quarter of Section 13, Township 30 North,
NE Corner Range 19 West, Town of Somerset, St.Croix Coun ty.
Section 13
Barry Boardman
3 869 160th Ave.
o New Richmond, Wi. 54017
0
IV) 1 1 0 UN_ PLATTED - LANDS
I I S 00'09'19 "W 73 1.41'
1 t 694.00'
I
137.41' lL ® T 1
I 1, 169,561 S.F. (3.893 Ac.)
1 V IN including right - of -way
160,680 S.F. (3 .689 Ac
N I N excluding right -of -way. N
I
o
LIJ S. 00' 09' 19 "W 733.31' I�
, 594.00'
6 6'
QI I :m
U_ 0 T 2
(0 I v IN :W 170,002 S.F. (3.903 Ac.) 3
Q � to 1 io �' including right -of -way Ln
160,680 S.F. (3.689 Ac.) p�
Q! I Im IN �, N > 1
_..1; I exclua�::d __o^: - - �tiay". -
1 (D Q i
� 3 o Ji
S 00'09'19 "W 735.22'
N m :�
694.00' 03
CUI
LOT 3 cn
tit :0 170,443 S.F. (3.913 Ac.)
W tr). to including right -of -way
160,680 S.F. (3 .689 Ac
0 cu 0j excluding right -of -way. N
M �I , - - - 737.12' -
M - 43.12 3/2.98' . ... 6 - 94. 00
CY) m 356 oo'• N 00 381.12'
z
I Bearings referenced to the
0) North line of the Northeast
quarter of Section 13,
- c l assumed to be N89 0 35'05 "E
C) ;1 l iv 3
v v UJ
,
LOT 4 to
m Q
J; • indicates 1"X24" Iron pipe
CD Z; weighing 1,.68 pounds per ' "n.
I ]� foot set.
1 46.69'
L ... 309,32' 154,487 S.F. (3.547 Ac.)
N 00' 09 19 356.00 including right -of -way
1 I I UNPLATTED LANDS 135,001 S.F. (3.099 Ac.)-
___________ ________ excluding right -of -way.
SCALE IN FEET l'= /50'
0 /00 200 300 400
This instrument drafted bV 4972524
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uotiduosaQ
POWTS OWNER'S MANUAL at MANAGEMENT PLAN Pa of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner -
f^ Septic Tank Capacity Wi gal ❑ NA i
Permit # Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS
Effluent Filter Manufacturer ��� �/- [3 NA
Number of Bedrooms ❑ NA- Effluent Fliter,Model _ ❑ NA
Number of Commercial Units ❑ NA Pump Tank Capacity gal [3 NA ,
Estimated flow (average) gal /day Pump Tank Manufacturer ❑ NA
Design flow (peak), (Estimated x 1.5) 2 j --gai /day Pump Manufacturer ❑ NA
Soil Application Rate Z gal/day/ft' Pump Model ❑ NA
Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA
Fats Oil & Grease (FOG) s30 mg/L ❑Sand /Gravel Filter 13 Peat Filter
Biochemical Oxygen Demand (BODs) x220 mg/L ❑Mechanical Aeration D Wetland
Total Suspended Solids (TSS) -150 mg/L ❑Disinfection ❑Other:
Manufacturer
Pretreated Effluent Quality ❑ NA Monthly average **
Dispersal Cell(s)
Biochemical Oxygen Demand (BODs) s30 mg/L j WIn- ground (gravity) ❑ In- ground (pressurized)
Total Suspended Solids (TSS) -30 mg/L ❑ At - grade ❑ Mound
Fecal Coliform (geometric mean) s10' cfu /I00ml ❑ Drip ❑ Other:
Maximum Effluent Particle Size 'li 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 P-�year(s) (Maximo -)
Pump out contents of tank(s) When combined sludge and scum equals one -third (A) of tank volume
Inspect dispersal cell(s) At least once every ❑ months 15 year(s) (Maxima .)
Clean effluent fliter At least once every ❑ months _,El::�year(s)
Inspect pump, pump controls 8t:alarm At least once every D months ❑ year(s) C3 NA
Flush laterals and pressure test At least once every , ❑ months ❑ year(s) O NA
Other At least once every ❑ months ❑ year(s) ❑ 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 certiflcations: 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
nodflcadon of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (A) 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 cerdfled 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 constructlon, 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
Page of
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks, may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the 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 W'establlsh a suitable replacement area. Replacement systems must
comply with the rules In effect at that time.
• A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology
a holding tank may be installed as a last resort to replace the failed POWTS.
• The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area Is available a holding tank may
be installed as a last resort to replace the failed POWTS.
• Mound and at -grade soil absorption systems may be'reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems 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
iMPnscIRi.F.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name
Name
�� ��� ��� � t-�
Phone �i s �2 �' l.� Phoned
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Agency 2e' 1'1, , n �1s3 �' <K 6
ST CROIX
COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer 'A
Mailing Address ��j, � � '07< u'( .
Property Address �r°I
(Verification required from Planning Department for new construction)
'('
A*'
City /State i�rc9 C4�22d i `5 a
P el Identification N umber
LE GAL DESCRIPTION
Property Location A ' / <, e '/4, Sec., T�N -RW, Town of �o`an p rs
Subdivision , Lot #_.
Certified Survey Map # Volume _ Page #
Warranty Deed # Volume )42o Page # �
Spec house ❑ yes�no Lot lines identifiable .Byes ❑ 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 property owner 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 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 Zoning Office within 30
days of he three year expiration date.
SIGNATTJR F APPLIC T A
DATE
OWNER CERTIFICATION
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.
SIGNA OF AP ICANT
DATE
* * * * ** Any 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
l
/D
V4. 1420PAsE433 6o IL 7vo
STATE BAR OF WISCONSIN FORM 2 -1998 KATHLEEN H. WALSH
REGISTER OF DEEDS
Document Number WARRANTY DEED ST. CROIX CO., WI
This Deed, made between Barry A. Boardman, Grantor, and Gary D. RECEIVED FOR RECORD
Bergman and Jeanne L. Bergman, husband and wife as survivorship marital 04-21 -1999 9:30 AM
property, Grantee.
Grantor, for a valuable consideration, conveys and warrants to Grantee WARRANTY DEED
the following described real estate in St. Croix County, State of Wisconsin (The EXEMPT 1
"Property "): CUT COPY FEE:
COPY FEE:
TRAMSFER FEE: %.00
Part of the Northeast Quarter of the Northeast Quarter (NE 1/4 of NE 1/4) of RECORDING FEE: 10.00
Section Thirteen (13), T�o hip Thirty (30) North, Range Nineteen (19) West,
described as follows: Q +of Certified Survey Map filed July 7, 1997, in
Volume "12 ", page 3295, as Document No. 561969.
Recordins Arcs
Name and Return Address
VAN DYK, O'BOYLE 5 SILER, S.C.
Post Office Box 127
New Richmond, WI 54017
032.2046.10-100
Parcel identification Number (PIN)
This Is not homestead property.
Exceptions to warranties: Subject to all easements, restrictions and covenants of record.
Dated this L day of Y , 1999.
��� *Barry
((��
AUTHENTICATION ACKNOWLEDGMENT
Signamre(s) &""' �• 6 0'7'Jona n STATE OF WISCONSIN )
) 8s.
County )
authenticated this /S 14�. Personally came before this day of
19 the above named
1 I to me known to be the persons) who executed the foregoing
* !) on a L 5 t le' instrument and acknowledge the same.
TITLE: MEMBER STATE BAR OF WISCONSIN
(if n0-,
authorized by § 706.06, Wis. Slats.)
s
THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wisconsin
Ronald L. Siler My Commission is permanent. (if not, state expiration date:
VAN DYK, O'BOYLE & SELER, S.C. - )
Post Office Box 127
New Richmond. W1 7
(Signatures may be authenticated or acknowledged. Both are not
necessary.)
i
. — Ta>< Pctv ( 4- 0,3-)- Q0410 -ao- 160
FILED 9
JUL 0 7 1997 ► r 17 SLCMkCO3.1A
51969
CEP T -T F -TED SUP V E Y 14A P
Located in the Northeast quarter of the Northeast quarter and the Northwest quarter
of the Northeast quarter of Section 13, Township 30 North,
NE Corner Range 19 West, Town of Somerset, St. Croix Coun ty.
Section 13
(St. Croix 3 Barry Boardman
Count m _
on
Y h 869 160th Ave.
ument.) ° New, Richmond, Wi. 54017
h
Co N
1'n 'o U_NPLATTED LANDS
I I S 00' 09' 19" _ _ - - -- -
I W 731.41'
t - L I 13741' - 694.00'
!L ® 7T 1
I I 169,561 S.F. (3.893 Ac.)
I to including right -of -way i•
I Im
160,680 S.F. (3.689 Ac.) in
I cu IN excluding right -of -way. ci
i cu
I r-
Lj S 00'09'19'W 733.31' 0
Q 1 6 6' I . v 694.00' n
r4 !L ® T 2 , aK
C) . I I� 170, 002 S.F. (3.903 Ac.) ��"� to
Z� I� including right -of -way 3 ,
�bc, 6a0 s. F . U) �
excluding right -of -way. CU ;r Z�
In :3 M Q
F 0 J �
APPROV N /.22 5 00'09' i9 "W 735.22' •
N of :� 694.00' �
.-�
1111 0 3 '97 '� � L IL ® 7T 3 `°
i :o to
W ' •o . 3 S.F. (3.913 Ac.)
" vw 170,41
to including right -of -way
!3T roh c;,U ,� Ty 0 "�I" 160, 680 S.F. 3.68 A 0 C:ump Flenninp. ( 9 C .) tn
Z0 and to N pI N excluding ri ht -of -wa . M
Pa rs, cu
g y
s Committee
m1: ' - 737.12'- -
If nut rocorded Q 312.88' •• 694.00'
within 10 days of m • • • • • 356.00 '
hl�arovaldate Z I I N 00'09' 19 "E 381.12'
OPWOral shall be
null and void I I EJ -
I I N Bearings referenced to the
North line of the Northeast
I 1 A7 quarter of Section 13,
m assumed to be N89 ° 35'05 "E
�I
� I N r o 3
Uj
Q ' v 0 W
_j I i LL ® TT' 4 In
m Q;
rr rr
J 1 0) ,I, indicates 1 X24 I
M a Iron pipe
weighing 1.68 pounds nds
p er lin
foot set.
I g
I to j p
46.68'
309.32'
N 00 19 "E 356.00' 154,487 S.F. (3.547 Ac.)
I including right -of -way
I UNPLATTE•D LANDS 135,001 S.F. (3.099 Ac.)
N1 /4 Corner ---- - - - - - -- -- -___ excluding right -of -way.
Section 13 ro CD
(Pk nail) . SCALE IN FEET �'- 150
0
100 200 300 400
This instrument drafted by. 4972524
VOL. 12 PAGE 3295
Description
17 Continued.
A parcel of land located in the Northeast quarter of the Northeast quarter and the Northwest quarter of the
Northeast quarter of Section 13, Township 30 North, Range 19 West, Town of Somerset, St. Croix County, Wis-
consin, described as follows:
Commencing at the Northeast corner of Section 13; thence South 89 degrees 35 minutes 05 seconds West
629.13 feet along the North line of Section 13 to the Point of Beginning: (bearings referenced to said North line,
assumed to bear North 89 degrees 35 minutes 05 seconds East); thence South 00 degrees 09 minutes 19 seconds
West 731.41 feet; thence South 89 degrees 06 minutes 49 seconds West 694.70 feet to the West line of the North-
east quarter of the Northeast quarter of Section 13; thence North 00 degrees 09 minutes 19 seconds East 381.12
feet along said West line; thence South 89 degrees 35 minutes 05 seconds West 433.97 feet; thence North 00 de-
grees 09 minutes 19 seconds East 356.00 feet to the North line of the Northeast quarter of said Section 13; thence
North 89 degrees 35 minutes 05 seconds East 1128.59 feet along said North line to the Point of Beginning, contain-
ing 664,493 square feet (15.255 acres) more or less, and being subject to all easements, restrictions and covenants
of record.
I, Harvey G. Johnson, registered Wisconsin Land Surveyor, hereby certify that under direction of Barry Board-
man, owner, I have surveyed and mapped the above described property; that such plat is a true and correct repre-
sentation of the exterior boundaries of the land surveyed and that I have fully complied with the provisions of Sec-
tion 236.34 of the Wisconsin Statutes, the St. Croix County Subdivision Ordinance, and the Town of Somerset sub-
division ordinance to the best of my professional knowledge, understanding and belief.
,Ntllllltp��
Harv G-1899 2
Hary Johnson Si eying, Inc. :� 1 C 216 Meadow Drive North • Hudson, Wisconsin 54016 9 7 /Q N 0 '� .�
r� �.
Each parcel shown on this map is subject to state, county, and township laws, rules and regulations (i.e. wet-
lands, minimum lot size, access to parcel, etc.) Before purchasing or developing any parcel contact the St. Croix
County Zoning Office and the appropriate town board for advice.
I�
155 DEPARTMENT OF COMMERCE Comm 83.22
Unofficial Text (See Printed Volume). Current through date and Register shown on Title Page.
(d) Plans for the types of POWTS delineated in Table 83.22 -3 mance will conform with chs. Comm 82 to 84 including, but not
shall be submitted for review to the appropriate governmental unit limited to all of the following:
where the POWTS is located or will be located. a. A plan review application form specified by the depart-
ment.
Table 83.22 -1 Note: See appendix for an example of the plan review application form.
Plan Submissions to Depart b. The minimum and maximum wastewater flow and load of
Type of Installation the proposed project and the method or rationale for determining
1. POWTS owned by the state. the flow and load.
2. Facilities owned by the state and served by POWTS. c. Documentation to support treatment and dispersal claims.
d. A management plan for the proposed design reflecting con -
3. POWTS that will not completely utilize treatment formance to subch. V.
and dispersal technologies or methods either e. A soil and site evaluation report in accordance with s.
approved under s. Comm 84.10 (2) or (3) or recog- Comm 85.40 for those POWTS components that consist in part of
nized under s. Comm 83.61. in situ soil.
4. POWTS treating domestic wastewater combined f. A description of a contingency plan in the event the pro -
with industrial wastes.a posed POWTS fails and cannot be repaired.
5. Experiments under s. Comm 83.27. 2. In addition to the information required under subd. 1., plans
a See s. Comm 83.32 (3) (a). for one or more holding tanks serving a large commercial, indus-
trial, recreational or residential development with an estimated
Table 83.22 -2 daily wastewater flow of 3,000 gallons or more shall include
Plan Submissions to Department or Des Ag information pursuant to s. NR 113.07 (1) (e).
Note: Section NR 113.07 (1) (e) reads as follows: Large commercial, industrial,
Type of Installation recreational or residential development holding tank systems that singly or when
1. POWTS that will completely utilize treatment and added to together or increased by successive additions generate 3000 gallons of sep-
tage per day or greater shall contract with a wastewater treatment facility for treat -
dispersal technologies or methods either approved ment of the septage. The contract terms shall provide assurance that the septage from
under s. Comm 84.10 (2) or (3) or recognized under the system will continually be conveyed to, and accepted, at the wastewater treatment
S. Comm 83.61. facility. If a service area designation exists, the wastewater treatment facility shall
amend the service area to include the commercial, industrial, recreational or restden-
2. POWTS that Collect and hold all wastewater of the tial development. The department may not indicate sufficient disposal capacity to the
facilities served and utilize holding components department of industry, labor and human relations, or department of commerce, until
g p the service area adjustments have been completed and approved.
either recognized under s. Comm 84.10 (2) or (3) or 3. In addition to the information required under subd. 1., plans
recognized under s. Comm 83.61. for a POWTS that is to serve a dwelling where the design of the
Note: Pursuant to s. 145.19 (2), Stars., governmental units may require separate POWTS is not based upon the number of bedrooms within the
plan examination fees or include these fees in the cost of the sanitary permit. dwelling shall be accompanied by information documenting that
Table 83.22 -3 design condition on the deed for the property.
Plan Submissions to Government U ni t 4. In addition to the information required under subd. 1., plans
for an experimental POWTS shall be accompanied by informa-
Type of Installation tion required under s. Comm 83.27 (3).
1. POWTS that will serve a single one- or 2- family 5. In addition to the information required under subd. 1., plans
dwelling utilizing technologies or methods either for a POWTS which is to serve more than one structure or building
recognized under s. Comm 84.10 (2) or (3) or recog- shall be accompanied by information that does all of the follow -
nized under s. Comm 83.61, and using gravity dis- ing:
tribution of the effluent to an in- ground distribution a. Describes the legal entity, public or private, that has respon-
cell. sibility for the operation and maintenance of the POWTS.
Note: Pursuant to s. 145.19 (2), Stats., governmental units may require separate b. Includes a copy of a recorded legal document that identifies
plan examination fees or include these fees in the cost of the sanitary permit. all the parties that have ownership rights and are responsible for
(2) PLANS AND SPECIFICATIONS. (a) 1. When plans are sub- the operation and maintenance of the POWTS.
mitted to the department or designated agent for review, at least 6. a. In addition to the information required under subd. 1.,
3 sets of plans and one set of specifications shall be provided. plans for a POWTS with a design wastewater flow exceeding
Note: Specifications for a project do not have to be a separate document but may pp
be delineated on the plans. per 12,000 gallons day shall be not be approved until documenta-
2. Plans and specifications submitted for review shall be tion has been submitted to the department indicating that the
clear, legible and permanent copies. department of natural resources has issued a WPDES permit for
the project under ch. 283, Slats.
3. Plans submitted for review shall include all of the follow- b. Solely for the purpose of determining the applicability of
ing: subpar. a., the design wastewater flow of 12,000 gpd shall be
a. Details and configuration layouts depicting how the design deemed equivalent to 85 bedrooms for residential dwellings,
is to be constructed and how the design is to accomplish the treat- including one- and 2- family dwellings, multi - family dwellings
ment in accordance with ss. Comm 83.43 and 83.44 and dispersal and mobile homes.
that is claimed or the holding of wastewater. c. Solely for the purpose of determining the applicability of
b. Specifications, including a description of the materials for subpar. a., the design wastewater flow of 12,000 gpd for corllmer-
the project and the installation or construction practices and meth- cial facilities shall be calculated using the estimated wastewater
ods to be employed. flows specified in s. A -83.43 (6) of the appendix.
c. A site plan with a bench mark either scaled or dimensioned, d. Solely for the purpose of determining the applicability of
delineating all treatment and dispersal components and their rela- subpar. a., for residential dwellings combined with commercial
tionship to any items listed in Table 83.43 -1. facilities the design wastewater flow of 12,000 gpd shall be calcu-
(b) 1. All plans submitted for review shall be accompanied by lated by prorating the number of bedrooms on the basis of 85 bed -
sufficient data and information to determine if the proposed rooms equaling 12,000 gpd for the residential dwellings and using
POWTS or modification of an existing POWTS and their perfor- the estimated flow under s. Comm 83.43 (3) (a) and s. A -83.43 (6)
Register, April, 2000, No. 532
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