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HomeMy WebLinkAbout032-2052-50-000 F 'n Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix fQW, Building Division INSPECTION REPORT Sanitary Permit No: 399560 GENERAL INFORMATION (ATTACH TO PERMIT) S to Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 1AQ5-ZS Permit Holder's Name: City Village X Township rcel Tax No: Warman, Howard Somerset Township 032-20r5w2-50-000 CST BM Elev: Insp. BM Ele : BM Description: a 3b < , b (~`1 M .af I bb. O Z vl: ccr Qw+. 11 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~V Benchmark t 5 . I Alt. BM Dosing Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet ~ TANK SETBACK INFORMATION 10 ° W TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet . 33 Septic / 91 / Dt Bottom C11. ?S,. r > Sa (o S2- Dosing X5'0 ~ > 110 1 / Header/Man. ~'S 1 r Aeration Dist. Pipe s~ 4 ~I. 3 Z Holding Bot. System t• i(P(oI Final Grade UMP/SIPHON INFORMATION Manufacturer Demand St Cover -ZID GPM Model Number 1{ a l fa,i I~6,3 60• tj TDH Lift Friction Loss System Head TDH Ft 1 Forcemain Length s ] Dia.2 a Dist. to Well SOIL ABSORPTION SYSTEM D = 2 • bL BEDITRENCH Width 1 Length 1 NPIT DIMENSIONS No. Of Pits In ' e Dia. Liquid DIMENSIONS (z) 1 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER Number. Type Of System: lib 1 Ito r i 1 UNIT M ~j DISTRIBUTION SYSTEM ° a- L Header/Manifold Distribution I L j / x Hole Size x Hole Spacing Vent to Air Intake / I Pipe(s) 2 3 M Length 0 DiaLength V 7 Dia Spacing 2. SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded x No Wd x MulchBed/Trench Center Bed/Trench Edges Topsoil U Yes COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / D I Inspection #2: Location: 1602 County Rd I Somerset, WI 54025 (NE 1/4 NW 1/415 T30N R19W) NA Lot t. rNo: 151.) Alt BM Description = T vj 2.) Bldg sewer length = (QO i - amount of cover 3.)Contour = 91 6'~ J Plan revision Required? ❑ Yes X No 6tefrtN~oO Use other side for additional information. ~Z I r Date Insepctoes Signature .SBD-6710 (R.3197) SYS Q 'r 211 3r3 ✓ 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 iseonsin Personal information you provide may be used for secondary purposes 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 system, on paper not less than 8-1/2 x 11 inches in size. County State Sanitary Permit Number ❑ Check if revision to previous application State Plan I. D. Number . cft K 1 392 6-0 6935,Z3 1. Application Information - Please Print all Information Location: Property Owner Name Property Location -114 off 114, S 5-T ,N, R (or Property Owner's Mailing Address Lot Number Block Number /6o Q A City, State Zip Code Phone Number Subdivision Name or CSM Number N/4 II. Type of Building: (check one) ❑ City EK 1 or 2 Family Dwelling -No. of Bedrooms : 7 ❑ Village ff Town of ❑ Public/Commercial (describe use):_ i ❑ State-Owned 7J 0 C, 7 ' ot7f lF se l- ST CRQX 1 Nearest Road 3 MoQ c7 Alp czf Z ` !C b q ' ) %`D"- l( ~FF1CE. Parcel Tax Num er s III. Type of Permit: (Check only one box on line A. Check o e if a .plic }e ) A) 1. ❑ New 2. gReplacement 3. ❑ Replaceme 4t 5. 6. ❑ Addition to System System Tank Only Existing System B) 11 Permit Number Date Issued A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ❑ Non-pressurized In-ground XMound ❑ 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) Elevation SO Sd- f , ,j 00 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 ❑ ❑ ❑ ❑ epri 000 0,6c c- ~s ❑ ❑ ❑ ❑ C . b'oo 80© ~ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) Pl 's Signature (no stam s : MP/MPRS No. T usiness Phone Number X11 - 0, 7-7- 7 V4 Lbw is-sy - 646-1 Plumber's Address (Street, City, State, Zip Code) ~o IX. County/Departm t Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issui g Agent Signature (No stamps) V,Approved ❑ Owner Given Initial Adverse Surch e Fee) Determination 3215-, X. Conditions of Approval /Reas ons for Disapproval: In- Orvm ~1 1 SBD-6398 (R. 07/00) of Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD (608) 264-8777 onsin.gov Visconsin www.cornrnerce.state.wi.us/sb Department of Commerce www•wisconsi.gov Scott Mccallum, Governor Philip Edw. Albert,,AActtiing Secretary .r,, L.;.._... October 24, 2001 Y, CUST ID No.221741 ATTN.• POWTS Inspector . orn L ZONING OFFICE '-a r ; DONAVIN L SCHMITT ST CROIX COUNTY S L9 586 VALLEY VIEW TRL 1101 CARMICHAEL ST CAGIX ~ ODIJSiTY SOMERSET WI 54025 HUDSON WI 54016 IONNGOFFIM CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/24/2003 Identification hers Transaction ID No. 683523 SITE: Site ID No. 89066 Howard J Warman Please refer to both identification numbers, 1602 Cty Rd I above, in all correspondence with the agency. Town of Somerset St Croix County; Fire Dept ID: 5503 NEIA, NWIA, S15, T30N, R19W FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 816570 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. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.01/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.01/01). • 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 manual, and section VI of the pressure distribution component manual are complied with. A copy of this letter including instructions and information relating to proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. • Access to the filter for cleaning must be provided per Comm 84 product approval conditions. Maintenance infornation must be given to the owner of the tank explaining that periodic cleaning of the filter is required • Limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. I DONAVIN L SCHMITT Page 2 10/24/01 • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). In addition, the owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The changes made to this plan on 10/24/01 by this reviewer were acknowledged and approved by the system designer. 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 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. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 / Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789-7893 , 7:45 am - 4:30 pm Monday - Friday cbratz@commerce.state.wi.us cc: Howard J Warman • to _ + Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD (608) 264-8777 &Consin www.commerc .wis onsin.gov Department of Commerce www.wisconsi.gov Scott Mccallum, Governor Philip Edw. Albert, Acting Secretary October 24, 2001 CUST ID No.221741 ATTN: POWTS Inspector ZONING OFFICE DONAVIN L SCHMITT ST CROIX COUNTY SPIA 586 VALLEY VIEW TRL 1101 CARMICHAEL RD SOMERSET WI 54025 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/24/2003 Identification Numbers Transaction ID No. 683523 SITE: Site ID No. 89066 Howard J Warman Please refer to both identification numbers, h 1602 Cty Rd I above, in all correspondence with the a enc . Town of Somerset I„ St Croix County; Fire Dept ID: 5503 NEIA, NW1/4, S15, T30N, R19W FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 816570 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. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.01101) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.01/01). • 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 manual, and section VI of the pressure distribution component manual are complied with. A copy of this letter including instructions and information relating to proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. • Access to the filter for cleaning must be provided per Comm 84 product approval conditions. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required • Limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. DONAVIN L SCHMITT Page 2 10/24/01 • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). In addition, the owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The changes made to this plan on 10/24/01 by this reviewer were acknowledged and approved by the system designer. 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 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. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789-7893 , 7:45 am - 4:30 pm Monday - Friday cbratz@commerce.state.wi.us cc: Howard J Warman l SCHMITT & SONS EXCAVATING 586 Valley View Trail RECEIVE Somerset, 97 54025 715-549-6651 SAFE OCT 1 0 ?001 MOUND SYSTEM T, & RO A Gs oiV For: &.0 lU A R d ~ P A& 1.7 A Al Address: .16 O„ 2 /7- ~5 a mete s C r dJl s /o.2 Legal:_ UE 4 Al i & J l t-, % ao j i9 al Township: So ry" 5& r County: Sf C RD/1C Contents Page 1 Plot Plan Page 2 System Cross Section Page 3 Pipe Lateral Layout Page 4 Dosing Chamber Page 5 Pump Curve Page 6 Management Plan Attachment 1 Soil Evaluation Report Attachment 2 Mound Component Manual (Version 2.0) SBD-10691-P(N. 01/01) Pressure Distribution Component Manual (Version 2.0) SBD-1 0 706-P(N 01/01) By: - ~zc_ - MPRSW / 7 `f Date: - U COIII~~OnQ~/ APPROVED ORMUMCFCOMMM SEE CORRE ' 1 - { 1 i _ 1 - - 4-- i 111 1 ! i ; X , T r ~ u ~ I ! 1 I i I I ~ I i ~ I I I 1 I i _ I f x ' { 1 i lzr I i ~ I i cL. i + I 3 : I , co 2 O'V } yR o - - - - ~ t AeA Q I - T 1 A /000 : f 96 i ,c}-boo FtcT47; 3 i ! I i I I ' I I f : 'l t I ~ ! i j I -j ~ I 1- } L.l }.t~j~_oF- u 1 t4O- - ' - - _ ! _ I -f : , ~ r + : T- ~ ~ CIh~YCr:. _ iF4,/1 .1. t /1✓ -i. - L./Y_ ~r__ - -r T - - . Vill, _10-4 x ac } r- ; I rt r r _ - ! ,Sgr74~_Il5s Z 14,!~' l 'S1rcW, Marsh 4~,dY, Cr synthetic Covering Distfibutxary Pige ASTM C33 Medium: Sand 0 6...~opsali F Sys. ~sv. /Old C~• i , 1 'x► Slope Plowed 9:d Of Force Mol~+ Lover A09~+gott ' (~11 below PIP*) o 3 Ft. Cross Section Of A Mound Systtm Uslnp F Ft. A pad Fcr Th: Absorption Arta Ft. ~e Ft. Ft. ; . ' B ~y Ft. Signed., ! K ~ license Number: a/"7 y Ft. - - L Ft. Date: Ft. . I Ft w aC~S Ft. s dk Obiervot on Pipe im 69 B~0 ~~.rrYrw.rwr..rrw.r ..rw r..rrrrlw ~~~r ~rwl rr.Vw ..rim ~ ' Ole A Force Main ~r• rr r.r.r~rr rwrw rrr w'Iw~rrr~•r•O.r r~r•rlr w..rrr W ~...r...rr r.+.• rrr ur...wr wnr w wrw rr w.w. raw rrr r.~ OistribUtipn Bed 0•f i ~ P1pe Aggregate t Toaervet M Pipe Permanent Markers l$ M a~ 0 aE ago plan Viow Of Mound Using A Bed For She Absorption Area i Pipe Lateral Layout Plastic Valve Box Over End Cap Holes Located ❑n Bottom Are Spaced Equal( Y Perforated X S Threaded End PVC Pipe Caps X P End View Distribution Pipes Manifold ' Ft. Pipes y, ~nrcdEs PVC Force Main Y `r z- Inches. Hole Diameter 3/j 11 Inch. Lateral Diameter / %s Inch(es). Manifold Diameter / %x Inches. Sianed: - fem. Force Main Diameter 2 Inches. License Number X/711 #of Holes/Pipe I? Date: /V -D i Invert Elevation of Laterals IO/, i;2 ' • 1 , r~VC ~ tf PllMia CHA PttJCR CROSS SECT'Z) AMC) 5Pf:C(f9CATI0A:S • M ~1r'CWl' CAP '4"C.3. VEN'T PIPE -7,i ! WCATkER rROO F AP'PROVE'D LOCKIMCP j u0JCT 10k1 BOX 71AAWHOL.C COVER • M ~r wa:rl luarill, i film iuw wit ►9LbIt (1"I1s•1. I AIK 9JTAKE i I { 6RADE ! Im. ` e t ( Ib, {i~lr -7 i I CONGUI'f L =MM- PROVIDE w NLEY i AiRTic;.+iT SEAL ` I i ~ t APPROVED JOip17~ A, 1 1 I /IPIR,0VL0 JOQW S w/c.z, wore f I d~, w/c.r, fire CATEAIOIIJ& 3' I ALARM LVE401MG 3' OWYO 60410 60t. ; ONTO $0616 Wu. i ON rump off iI E CONCRETE DLOCK 3 APPRoVMD Ri5C4E rX{"1' PERMITTEG Oi~iLtI IF T'AWK MAiJtIFACTLIRCii HAS SUCH ArPitQ+lA1- ~En41~ SEPTIC SPE C.I FI C.ATI OU S DOSt T AI KS 1^ AAiUFACTUR1. 1,; WWb% rLA OF DOSES 5 PER 044 T^WK LIZC : GAI.,L01. S DOSE VOLUME y 7 Z-AA LCeT' 104C.LUDIMLo BACKFLOw: &ALLONt ALAKn MAuuF^cruRCR. ~q hlC►OCL WUM6CR: - f01 - CAPACITIES.* A ~ r.L! _IMCHES Olt ~GALLORI6 SWITCH ItIpt: )ecL/ ( gz IWCIIES OR y3 6~11.LOiLIS PUMP 1AAMUFA1CTURCR: ZoC L L Fly co IWLWE6 OR g? y GALLON: r.rr_ AODEL WUAS¢R'. Dm _ / 2- IWCMES OR 026Ica GALLOWS SWITC4 TQIPEt _ ~~('/Cell 4 NOTE: PUMP AND ALARM ARE TO GL MIMItNum DISL1,2614GE KATE FPM IAISTA.LEG ON SEPhRMTrx CIRCUITS YERTIICAL DIFfEILEAICE 6ET'WEE4{ PUMP OFF ^UD.GISTRItSUTtO►J PaPE.. /0 FEET t MtuImUM NETWORK SUPPLtl PKELSLIKC . . . . . 3•z-5 FE.ET ♦ -4LL- FEET OF FORCE MIM Y. ttFKiel 10W FACYaa,. ~cf FEE'L' TOTAL 0y1JAMIC KLA,+D L- (oS FF-ET INTERNAL 01MLWb1QWp Of TANK: LEK14TH_;WIGTH - jLIOUIO OILPTA A - - sIPr1~iE0: I tcClssE latlr~ts~ R;_ it/7y/ IRATE. /,I - U/ HEAD/CAPACITY CURVE EFFLUENT and DEWATERING A CAUTION Model 185/4185 should not be subjected to less than 30 feet TDH. MODEL 42 48 53, 55, g8 137 t 39 140, t 61, t t 65, 1 786, t 88, 189, 19 t 57 59 4140 4161 4163 4165 4185 4186 4188 4189 U) ET. - u. CAL. U-RS CAL. LT CAL. I rRS, CAL. t 9S CAL O CAL. L CAL. t JRGAL. Lliffl CAL. 1 GAL. Lt CALL. - GAL. CT CAL. CAL. 5 '1.52 15 6Y37 -121; 43 1U72 273 93 3$ 91 11; 100 3)* 61 231' 61 - !tw.t 5B 220 145 849 145 9'. 45 W W 10 3,m '42 94. 11 129' 61 231: 79 290.. 84 31$93 'W 61 1= 61 58 140 140 63Q' 45 15 37 23 757 72 45 ,47Q: 6 242 76 $68? 65 12i, 60 61 SB SS2A 134 135 5ta_ 45 20 6.10 56 128 13t 45 93 136 257; 79 299. 59 } 60 140 25 _ 3J ' 9 223 70 57 Yt 59 58 ( 122 ' 125 45 42 30 9.14. d5i n2 235 55 56 85 58 6 20 45 41 135 _ 179 _ 170; 46 55 70 58 104 109 45 75.24 . x 1 231 58 90 97 45 60 16.29 `146 56 71 tW- 85 2}, 45 40 130 7050s4iJ/ - - _ 1 k FS 675 f,,34 52 4$7 51 69 46 45 80 's 24 ~6 170 ~e 51 y 45 90 `.2),U. ,r'Al ,117: J4 45 38 125 100 -10-48 - - _ - rw n 60• 7 40 110 }100 t~ ? `.'f 1V ;15!'. 30 120 06.56 r [ .:+t tm `t:, f 20 1 20 130 • 79 62 1 Y v 'i+ - r6 10 36 191 LOCH VALVE: 9' 9' 9.25 23' 26' 46' S6' 66' 66.5 73' 114' 91' 10 13Y 115- 34 110 32 105 30 1100- 95- 28- 90 186, 26 85 4186 - N -4 1 24 80 165, 416 75 0 22- 7 0 T V 20 65 a 0 18 60 163, 4163 189, 4189 0 55- N 16- 14- 45 12 40 188, 140, 35 4140 4188 10- 30- , 185 8 137, 25 139 4185 g 20- 4- 15 42 10 161, 2 5 48 4161 53,55 98 57,59 0 U.S. GALLONS 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 LITERS 80 160 240 320 400 480 560 640 0 FLOW PER MINUTE 009922a hIANA MRNT PLAN Page Lof-L This Private Onsite Wastewater Treatment System (POWTS) has been designed and is to be installed and maintained in according to Comm 83, Wis. Admin. Code, the in-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems (SBD-10567-P; June 11,1999), 1. This POWTS has been designed to accommodate a maximum daily flow of '9 SQ gallons of domestic wastewater-per day. The quality of influent discharged into the POWTS treatment or disposal component shall be equal to or less than all of the following: a monthly average of 30 mg/L fats, oil and grease a monthly average of 220 mg/L BOD 5 a monthly average of 159 mg/L TSS. Wastewater shall not be discharged to the POWTS in quantities or qualities that exceed these limits or that result in exceeding the enforcement standards and preventative action limits specified in ch. NR 140 Tables 1 & 2 at a point of standards application, except as provided in Comm. 83.03 (4)m Wis. Admin. Code. 2. The owner of this POWTS is responsible for system operation and maintenance. The following maintenance shall occur within three (3) years of the date of installation and at least once every three years thereafter: 1. The septic tank shall be pumped be a certified septage servicing operator, licensed under s2.81.48, Wis. Stats, unless inspection by a licensed master plumber or other person authorized to make such inspection, finds less than (1/3) of the tank volume occupied be sludge and scum. More frequent pumping may be necessary to prevent solids from exceeding one-third (1/3) if the volume of the tank.. Wastes shall be disposed of by the pumper in accordance with ch. NR. 113 Wis. Admin. Code. At each pumping the pumper must visually inspect the condition of the tank, baffles, rizers, and manhole cover and verify that any required locks are present. 2. The soil absorption component(s) shall be visually inspected by a licensed master plumber, certified septage servicing operator or POWTS inspector. Inspection shall check for evidence of discharge of sewage to the ground surface and for ponding of effluent in the distribution cell. 3. The tank filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. The filter cartridge shall not be removed unless provisions are made to retain solids in the tank. Cleaning of the filter at more frequent intervals may be necessary. a. Any pump, alarm or related electrical connections shall be visually checlmc. for defects and tested to confirm that they are operating properly. 5. 1leports for all system maintenance shall be submitte. to St.Croix ountF 7ontng ir;.. a=rdancc vdtl. Comm 83.5; Wis. Adnnin. c>de. I i 3. Defects or malfunctions identified during maintenance described in item #2 above shall be repaired in conformance with Comm 83, Wis. Admin. Code. 4. Anytime a failure or malfunction occurs, it shall be reported to the owner of this POWTS. Repair or connection of such failure or malfunction shall comply with Comm 83, Wis. Admin. Code. 5. No one should enter a septic or other treatment tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases and rescue of a person from the interior of the tank may be difficult or impossible. 6. No product for chemical or physical restoration or chemical or physical procedures for POWTS may be used unless approved by the Department of Commerce in accordance with Comm 84, Wis. Admin. Code. 7. In the event that this POWTS or a component of this POWTS fails and cannot be repaired, the following contingency plan is proposed: The failing component shall be replaced. This may require a new soil evaluation to determine where a new soil absorption c component can be. 8. If this POWTS is replaced, or its use is discontinued, it shall be abandoned in accordance with Comm 83.33, Wis. Admin.. Code. 9. Name and number of local health agency: St. Croix County Z' oning - 715-386-4680. 10. Name of service contractor in case of failure or malfunction: Schmitt & Sons Excavating 715-549-6651 1085 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and - percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 032-2052-50-000 Please print all information. Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Warman, Howard Govt. Lot NE 1/4 NW 1/4 S 15 T 30 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1602 Cty. RD. I na na 120 Acre Parcel City State Zip Code Phone Number f City _ ; Village Town Nearest Road Somerset WI 54025 715-247-5516 Somerset Cty.Rd.I New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ✓l Replacement Public or commercial - Describe: Parent material Pitted lacial drift Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a mound system. System elevation to be based off of contour line established at 99.79'. Area is on a 3% slope. Boring # Boring ✓i Pit Ground Surface elev. 99.59 ft. Depth to limiting factor 28 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots -----G 2 D/ftin. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 1 0-8 10yr4/3 none I 2mgr mvfr cw 2f .5 .8 2 8-28 10yr3/4 none sl 2msbk mfr gw 1f .5 .9 - - 3 28-46 7.5yr3/4 c2d 10yr5/8 grvsl 2msbk mfr gw .5 .9 10yr /1 4 46-55 7.5yr4/6 rn 7d7.5 18 grcos Osg ml cw .7 1.6 5 55-63 - --10yr5/6 m3~'OY0 /1 /8 cos Osg ml gw .7 1.6 m3p l 0yr5/8 6 63-84 7.5yr5/3 5yr672 sil 2msbk mfr .5 .8 a Boring # Boring Vi Pit Ground Surface elev. 99.97 ft. Depth to limiting factor 28 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 1 0-8 10yr4/3 none I 2csbk mfr gw 2f .5 .8 2 8-28 10yr4/4 none grsl 2msbk mfr gw if .5 .9 3 28-43 7.5yr4/6 c21006/I/8 grvsl 1msbk mfr c%` .4 .6 - - - - - - m yyrr - 4 43-68 10yr5/4 7. r6/15/8 firms Osg ml gw .7 1.2 5 68-82 10yr5/6 m T5yr6/ 5yr l /8 Is 1 msbk mfr .7 1.2 " Effluent #1 = BOD e> 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD5 <30 mg/L and TSS <.30 mg/L III CST Name (Please Print) Signature: CST Number Thomas J. Schmitt u•, 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 586 Valle View Trail, Somerset, WI 54025 9/14/01 715-549-6651 i Property Owner Warmanr-Howard Parcel ID # 032-2052-50-000 Page 2 of 3 3 ] F Boring # Boring Pit Ground Surface elev. 98.90 ft. Depth to limiting factor 26 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Eff#1 'Eff#2 1 0-9 10yr4/3 none I 2mgr mfr cs 2f .5 .8 2 9-26 10yr4/4 none grsl 2msbk mfr gw 1f .5 .9 3 26-43 7.5yr4/4 c2f l 0yr5/8 IOyr6/I ms Osg ml cw 7 1.2 4 43-51 7.5yr4/6 m2d 7.5yr5/8 sl 2msbk mfr gw .5 .9 7_5yr6/ 1 5 51-72 10yr5/4 e3p 7.5yr5/8 7.5y 6/1 ms Osg ml 7 1.2 ❑ 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 GPM' 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 I Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 ' Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD5 < 30 mg/L and TSS -s-30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or n-I rhP TTV Fn9-'1AA_R'777 ' tky ~e J u ~ !7 K L~ k x %Sb x OLt►u n Y~ ` 1~' (o ,3 ?f' lS u,N~D~ ~p x x ~ ~ 3~7~sc,~ r8. ~r p Al 11114 P" r~.w,L ~ i /-~z~..Jr~rr~ G✓~r~~-.. pr-G..~,~~ y - Th,,~. ~..S~ti.y„~ s-) sus=KG's IY,-.Iy L/ -71 r 1085 Wisconsin Department of Commerce SOIL EVALUATION REPORT page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix 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. 032-2052-50-000 Please print all information. Iewed Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Warman, Howard Govt. Lot NE 1/4 NW 1/4 g 15 T 30 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1602 Cty. RD. I na na 120 Acre Parcel City State Zip Code Phone Number City ~j Village a Town Nearest Road Somerset W! 54025 715-247-5516 Somerset - Cty Rd. I _j New Construction Use: e Residential / Number of bedrooms 3 Code derived dlssiig6A6w rat450" GPD J Replacement J Public or commercial - Describe: ! v,- Parent Parent material Pitted glacial drift Flood PI nq eovation, N applicable r General comments and recommendations: Area is suitable for a mound system. System elevation to be base offolp COW i ltnO blish 99.79'. Area is on a 3% slope.'; Boring # Boring ;a wrl Pit Ground Surface elev. 99.59 ft. Depth to limiting factor \2 in'.,,' i l Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD in. Mumdl Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *E 2 1 0-8 1Oyr4/3 none I 2mgr mvfr cw 2f .5 .8 2 8-28 1Oyr3/4 none sl 2msbk mfr gw 1f .5 .9 3 28-46 7.5yr3/4 c2d 10 /1 /8 grvsl 2msbk mfr gw .5 .9 4 46-55 7.5yr4/6 m2 75yr /8 grcos Osg ml Cw .7 1.6 5 55-63 10yr516 m3pOyr6/i /8 Cos Osg ml 9`N .7 1.6 6 63-84 7.5yr5/3 m3o5yr612 y~r5/8 sit 2msbk mfr .5 .8 Boring # 1 Boring 46 Pit Ground Surface elev. 99.97 ft. Depth to limiting factor - 28 _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 1 0-8 1Oyr4/3 none I 2csbk mfr gw 2f .5 .8 2 8-28 1Oyr4/4 none grsl 2msbk mfr gw 1f .5 .9 3 28-43 7.5yr4/6 c2f 10r6 1/8 grvsl 1 msbk mfr Cw .4 .6 m2d 7.5 r /1 /8 grms Osg ml gw .7 1.2 4 43-68 10yr5/4 5 68-82 10yr5/67.5y ji/8 Is 1msbk mfr .7 1.2 I * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD <.30 mg/L and TSS S.30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 586 Valle View Trail, Somerset, WI 54025 9/14/01 715-549-6651 Property Owner Warman, Howard Parcel ID # 032-2052-50-000 Page 2 of 3 Boring # Boring r Pit Ground Surface elev. 98.90 ft. Depth to limiting factor 26 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD& in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10yr4/3 none I 2mgr mfr Cs 2f .5 .8 2 9-26 10yr4/4 none grsl 2msbk mfr gw 1f .5 .9 3 26-43 7.5yr4/4 c2 10yr1/8 ms Osg Ml Cw .7 1.2 4 43-51 7.5yr4/6 m2d 7.5yr5/8 SI 2msbk mfr gw .5 .9 7.5 /1 5 51-72 10 r5/4 c3p 7.5yr5/8 ms Os ml .7 1.2 Y 7.5yr6 /1 g ❑ 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh, *Eff#1 *Eff#2 F-1 Boring # I Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Con. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 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 -A -.+.A.1 ;n o,. olrc.r,.orA F-t- „1-- 4.,t ti.P .ter 1 ,i - 7'TV Ann-71.A _R777 3,~ f3 f~ qO ' ~ s k U / i x x /s8' x ~X k~~~,~W{r' f - U- 3 y w~,t l g N o ; ~r A x ` X9.0 Q7= d a" Pr/c~, tea' Ar64AJA.y 1-sJ , /~+/bL.Jc-,~-O~ Grl 4~+ G.J►ik~ b~% % ~/lcw►ms Ti SGlrml~ /!/e Nv y 73v N X,,14 j-1 ~715~ ~ CAS"/ 9/IY16i r - ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer t74WAP Q U!4 g tZA A! Mailing Address /4001 e-- 7 k Properly Address ~ (Verification requireA from Planning Department for new construction) City/State L 64-r "-,c A= rParcel Identification Number _/132 n,no LEGAL DESCRIPTION - / Property Location '/4, AUL '/4, Sec. , T , 3D N-R_Lf_W, Town of Sor7eg s- 7-, Subdivision 4A . Lot # Certified Survey Map # Volume Page # Warranty Deed # Volume - 7 -2 - Page # Spec house ❑ yes tN no Lot lines identifiable E4 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 property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a maw 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. Itwe, 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 the three year expiration date. L&A,-~ //i l30 /D/ SIGNATURE OF APPLICANT 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. ~ l3n lD / PLICANT /,0 DATE S NATURE O *Lr.- 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 DOCUMENT NO. WARRANTY DEED STATE OF WISCONSIN-FORM 9 THIS SPACE RESIERVPD FOR RECORDING DATA THIS INDENTURE, Made b ..Helen Plourde,-..Mary- -Frey,-.____. Louise J. Adam Eyizabeth M-. Adam and_.Theres_a F?PC'c1 tt, M Adam I _ _ day C" grantor $ Q(: yj~gpa~7~}KggQ~{t}{ hereby conveys and warrants t to.... Howard..J . Warman. and. Edna .C._.. Warman-,... husband- ~ and...wife as joint tenants it grantees RETURN TO of-Washington County, Minnesota OGOIXDkW'XXXIO, f„r the,um of i, Nineteen Thousand Five Hundred ($1,500.00) , Dollars the following tr::, i of land in. St. Croix - 'opnt}', Mate of '~Ai-cnn,in; iI r West One-half of Northeast Quarter (W2NE.10 and North One-half of Northwest Quarter (NINW 0 , Section Fifteen (15), and Southeast Quarter of Northeast Quarter (SEINE0 Section Twenty- two (22), and Southwest Wuarter of Northwest Quarter (SWANW;), Section Twenty- three (23), all in Township Thirty (30) North, Range Nineteen s, (19) West,' r. I a 1-~ I ~ I I rl`I:~' I I I 1„14' '1' ? 1 I ~ !r ~ n rr.,I t' I[~Q s ve r their I s s 6th Apr i1 61 jj IN I'i. F.Si;\C% !il' Helen Plourde Hugh F. Gwin ` lary Frey A L. Oe Louise J. Adam Edward J. Plourde r Eliz- .}~eth--hlti..~dam I / `(SEAL) , -STATT 0' St. Croix- ',tlnt:.~ Theresa M. Adam 6th April v ;61 11e1 e F1ou2~de,' Ma-iy' Fray toui~CV J.' Adam' ftizabekh M-. -rldt}m and u.'InO,l. Theresa M. Adam o luc Linen to be r / «f. Hugh F. Gwin l~ F>.L r 'I'Lis in=trument dr;,fte.l by i Noory Public..._ St., Croix „LUj,1Vis. tl ; ermane _ My Commieron ~IyRrXe} p ii Hugh .F;_. Gwin..._ nt I p I ~ ente to be recorded shad have p{alnly printed or typApritWu thereon the 1I- --.-(Section 59.51 1) of the Wlecrnnetn Statutes Provides 11i'all tasthtm rd r names of the grantors, grantees, wltnese",and^netary)r-• I ~ II WARRANTY DEED-STATE OF WISCONSIN, FORM NO. 9 N. YLLlLk CC . AIL*-rt