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HomeMy WebLinkAbout032-2116-90-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Di�jsion INSPECTION REPORT Sanitary Permit No: . 430027 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Potting, John — _ Somerset Township 032 - 2116 -90 -000 CST BM Elev: Insp. BM Elev: BM Des I ription: Section/Town /Range /Map No: 1 lam• U 8h'1 0 � �G� / 15.31.19.1069 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic \J� U D Bench�rK, „" Dosing W�. , // /I , Alt. BM Aeration U � Bldg. Sewer & Holding St/Ht Inl� � � — _�_ L�� s� 93 TANK SETBACK INFORMATION St/Ht Outlets,,, V /0 5 93. TANK TO P/L WELL j LDG. Vent to Air Intake ROAD Dt Inlet Septic i Dt Bottom s�o Dosing eader/ an r Aeration Dist. Pipe -7'" 6 � 64 ' Holding Bot. System .7 o7 Final Grade PUMP /SIPHON INFORMATION S S• �"! S Manufacturer Demand St Cover ? n f J IO a Model Num TDH Lift Fr' System Head TDH Ft Forcema' Length Dia. I. to Well SOIL ABSORPTION SYSTEM + tt ` BEDITRENCH Width L Length No. Of Tren es PIT DIMENSIONS No its side Dia. Liquid Depth DIMENSIONS 7 1& 2 , S-+h 7 SETBACK SYSTEM TO P/L JBLDG W L LAKE /STRE LEACHING Mau urgr: - II C / INFORMATION CHAMBER OR t O lv Typ�pf System: > 3 � -F t i� / UNI Model Number: DISTRIBUTION v( � J SYSTEM Iy', � � � �►1�j Header /Mani ol Distribution ' ^ x Hole Size I x Hole Spacing Vent to Air Intake / N Pipes) lY ` 1 N . Length Dia Length Dia pacing � S ' � / � I `Y 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 �i Bed/Trench Edges Topsoil I] Yes Yes No � � No COMMENTS: (Include screpencies, persons present, etc.) Inspection #1: L7 ( / 63 Inspection #2: Location: 559 217th Ave Somerset, WI 54025 (SW 1/4 NE 1/4 15 T31N R19W) / Shadow Pines Lot 12`1 Parcel No: 15.31.19.1069 1.) Alt BM Description 2.) Bldg sewer length = 2-0' - amount of cover = 41 S Plan revision Re uired. Yes Ll No Use other side for additional information. XVt J SBD -6710 (R.3/97) / Date Insepctor's 6Sigature Cert. No. �h G�Gvr�) r1"�U7�2d ,tom �� G� =��n,, �.a� !�, • �d11OGt�.Gt! G�l.Q� -- ;�� o� /� �� y � I� 1 1 �'�'"� �, -�--- Safety and Buildings Division County i 201 W. Washington Ave., P.O. Box 7162 s1 rseonsin Madison, WI 53707 - 7162 Sanitary Permit Number ( be filled in by Co.) (608) 266 -3151 3X�- 7 �� Department of Commerce State Plan I.D. Number Sanitary Permit A PPid��;� -; ma be used for secondar Y � In accord with Comm 83.2 1, Wis. Adm. Code, persona inforre u(yo plr e c ndar purposes Privac L w, s15.04(1)(m) , Project Address (if different than mai �ng address ) Y P rP , I. Application Information - Please Print All InformatiT Property Owner's Na me Parcel k Lot 11 Block ffi / Property Owner's M ailing Address Property Location S . �W (,tJ ' / /, ' /a,Section City, tate Zip Code Phone Number (circ o e) N; R E r II. Type of Building (check all that apply) Subdivision Na e CSM Number r 2 Family Dwelling - Number of Bedroom Public/Commercial - Describe Use ❑ - �V' wnshi p ❑Cit L i_ illa e ❑State Owned - Describe Use a / l� �/ V u ` Y — g III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ew System ❑ Replacement System ❑ Treatment/ Holding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued B. ❑ Permit Renewal Permit Revision L1 Change of ❑Permit Transfer to New Before Expiration Plumber Owner IV. Ty of POWTS System: (Check all that apply) - Pressurized In- Ground ❑Mound > 24 in. of suitable soil ❑Mound < 24 in. of suitable soil ❑ At -Grade ❑ Sing]e Pass Sand Filter ❑ Constructed Wetland ❑Pressurized In- round ❑Holding Tank ❑Peat Filter ❑Aerobic Treatment Urit ❑Recirculating and Filter ❑Recirculating Synthetic Media Fitte thing C ber ❑Drip Line Gravel -less Pipe ❑Other (explain) V. Dis ers . _ Area n D i n Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersa a P e s System Elevation D ' VI. Tank Info Capacity in Total Number Manufacturer Pre Site Seel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank J j c Aerobic Treatment Unit i Dosing Chamber I I VII. Responsibility St ent- I, the tmdersi ass responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print Plumber' re MP /M RS Nu ber Business Phone Number Plumber's Addre ss (Street, City, State, Code) VIII. County/Department Use Onl Sanitary Permit Fee (includes Groun water Dat Issued suing A in Signature tamps) pproved ❑ Disapproved Surcharge Fee} —$"* � El Owner Given Reason for Denial IX. Conditions of Approval /Reasons for Disapproval Attach complete plans (to the County only) for the system on paper not less than 8112 x 11 inches in size P OT PLAN PROJECT John Pottino ADDR s 414S. Ownee St. Stillwater Mn 55082 SW 1/4 NE 1/4S 15 /T 31 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/17/03 BEDROOM 3 CONVENTIONAL XXX IN- GROUND SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 21 BENCHMARK V.R.P. Top of Foundation ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. same as benchmark Vent SYSTEM ELEVATION Standard Biodiffuser >6" Plans Designed Using 217th Ave Leaching Chamber of Cover 31.1 ft2 of Area Conventional Powts Manual Version 2.0 6' Long 11 " 34" Grade at System Elevation 154' Property Line 60' Assumed horizontal 255' reference point Pro 3 Bedroom 50' House 30' B.M. 20' T 5% Slope 15' B -1 70' B -2 15 Vents 35' B -3 1 -3 3' ' X 69' Cell and 1 - X 63' Cell with >3' Spacing Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County � Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must j 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. Please print all information. Re awed b �n , Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). G� Y "` r CC/ Property Owner Property Location Govt. Lot 11,N 1/4 S T N E( pr) Property Owner's Mailing Address Lot # Block # Subd. Namw CSM# L ! State Zip Code Phone Number ❑ City ❑ Village wn Nearest Road CA- JF�New Construction Use esidential I Number of bedrooms c� Code derived design flow rate Ji7 GPD ❑ Replacement ❑ Public or co me�raat - Describe: Parent material �LR�27 .r /_�1 "' Flood Plain elevation if applicable /'1� / .t� ft. General continents and recommendations:,S-�1 54- EZI Bori # E] Boring Apit Ground surface elev ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. Cont. Color G j Sz. Sh. - Eff#1 I - Eff#2 2 3-3Z ^� i ®Boring # Boring / Pit Ground surface ele>✓ ✓4: ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color G . Sz. Sh. 'Eff#1 'Eff #2 r �/ ✓ > •Effluent #1 = BOD > 30 < 220 n1y1L and TSS >30 < 150 ' Effluent #2 = BOD 1 30 mg& and TSS < 30 mg/L CST Name (Please Print) re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address ate Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54 17 6:�4."I- �' —�� 715 - 246 -4516 Page Property Owner _ Parcel ID # Pa e o f ❑ Boring # Boring ®/) ft Depth to limiting actor Pit Ground surface elev. y v . Depg in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell / Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Boring # ❑ Boring ❑ 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/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # ❑ Pit Boring ❑ Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2 Effluent #1 = BOD > 30 1220 mg/L and TSS >30 < 150 mgll_ ' 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 (8.6(00) stfdy8mdDMdott /J Vis conarn 241 W. W Ave., P a Box 7082 G (r MstSsoa,Wi 53707 -7082 SanetyPrrtaNmaba ftobefiftdiobyCu.) Department of Commerce (608)261 -6546 00.2� -i. Sanitary Permit Application Soft teacaad w lbCaaom83.21, WIL AduLCakporsond UMXMFAMYM PRA maybe used far seaoedery pmB— ftW-y 1xm, sI IWXm) Pmjat �ifd aeat ehsu addna) L Application Lafo —Pima PrjntAH Iatonudka -, Yo- coo haperiyow w5mme PNW# w Bar y's zip C=10 YbomNesnbac IL Type of SwIdIng (dmxk an that apply) or2Fasm7yl - NttmberafSedmams Name CSMNnmba ©PubWCbmmcrdsJ— D=*eUse - 62-C'Jd Ose.teoa�ea— DerctybeUae - ZI May PvmwX,.si Int HL Type of Perms (Cheek ody ate box an Mw A. Cb=pide Mw S fie) &L a A S ' U fl w system N� O ©T�, of is lop B. O ftn*Reaeud O PamitRevis m O Cbsuvef OPenakTonsRertoNOW BefoseEspitation Ptumber owaa IV ofPOVM an not wwvl PrwMiscd lMmea >_74e ad&a 13Mawd <24aacd' At-tusde S laPasRsSaoaFHter O vvaa.oa O Pressurized %4=md O TW& O Yost Fiba • Ti atmmt Umt O Ring Smd Fibs O HIM - Chamber use O i� O 0mer(e ) V Area Z S Dispe i �(gpd) Desert Sml Agpbcatioa R " Area Ptoposd System Ek iaa ✓/ �" �/ VL TM& Info Capay is Tuna Numbs POM Sift Mel Fibs Plastic C Cadtae efUi is _ l Canoe O m&m*d &AM _. U I�r Tentcs Tsd�s �nr t7t7b �. waa6ie 7t Uai txaeacbemba VII. fi- L � tespsty fss• boa dttx POVV'fS s6ewa oe the attached pieac PAmoba'sName{Aint) s MPiIII / Numbs PJtoesNn 1 �d v✓ ) I � Z7���J 7 1 7- r — ,?, f7� J .6 thuft'S Addteas ($tteet, UW. MIW COde) UM OAdy O DbWmvcd k Fee(mckdas c Date yea SM") ` O owaa{'AvenRea for t / 020 5 � a o DL CORMCMIM of 3 SBD� -639$ (R 08/02 2�� PL T PLAN PROJECT Johr, Pottino DDRESS 414S. Ownee St. Stillwater Mn 55082 SW 1/4 NE 1 /4S 15 /T 31 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/25/03 BEDROOM 3 CONVENTIONAL XXX IN- GROUND . SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK E HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambe s 22 BENCHMARK V.R.P. Top of 1.5" Pipe ASSUME ELEVATION loo' Filter Zabel A -100 ❑ BOREHOLE O WELL •H.R.P See Plot Plan Vent SYSTEM ELEVATION 94.5/94.6 5' Below Grade >6 „ Standard Biodiffuser plans Designed Using 217th Ave of Cover Leaching Chamber Conventional Powts with 31.1 ft2 of Area Manual Version 2.0 6' Long 11 " 34" Grade at System Elevation 154' Property Line Assumed horizontal 255' reference point Pro 3 k Will be destroyed Bedroom 17i� 50' during House 20' construction due Sy B.M. to poor location 30' B -3 tom` Vents T o c�ci'l ` 40' 30' 30' S0' AL B -2 10' B -1 10' p 20 B.M. Alt G�f 100-0 2 -3' X 69' Cells with >3' Spacing PL T PLAN PROJECT Johd Potting DDRESs 414S. Ownee St. Stillwater Mn 55082 SW . 1/4 NE 1/4S 15 /T 31 19 :' W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE5 /25/03 BEDROOM 3 CONVENTIONAL XXX IN-GROUND, 4ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK E HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambe s 22 BENCHMARK V.R.P. Top of 1.5 Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P See Plot Plan SYSTEM ELEVATION 94.5/94.6 5' Below Grade jjL Leaching Chamber Standard Biodiffuser plans Designed Using 217th Ave with 31.1 ft2 of Area Conventional Powts Manual Version 2.0 34 y Grade at System Elevation 154' Property Lin p rty e Assumed horizontal 255' reference point Pro 3 ' j Will be destroyed � J Bedroom 50 , during House S 20' construction due B.M. to poor location 30' B -3 '7 Vents T 40' 30' 30' S0' B -2 10' B -1 10, 44 20 I S ��. B.M. Alt Pic T o " C� L (0, a 2-3'X 69' Cells with >3' Spacing bd, a -v 1641 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8'/ x 11 inches in size. Plan St. Croon include, but not limited to: vertical and horizontal reference pant (BM), directio CEI percent slope, scale or dimensions, north arrow, and location and distance to Parcel I.D. / 2- 2116 -90 -000 Y Please print all information. v 2 B �e Personal information you provide may be used for secondary purposes (Privacy Law, s. 1 Y Property Owner Pr pe rtyl h John Potting t. Lot ZONING FILE 9 S 15 T 31 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 414 S. Ownes Street 12 Plat Of Shadow Pines City State Zip Code Phone Number J City J Village a Town Nearest Road Stillwater I MN 1 55082 612 275 - 1752 1 Somerset 1 559 217Th Ave. 0 New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD I Replacement _f Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install two trenches at elev = 94.50' sing 22 leaching chambers. FT1 Boring # Boring ✓_f Pit Ground Surface elev. 99.55 ft. Depth to limiting factor >105" 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 -5 10yr3/3 none sl 2fsbk mvfr as 2fm,1c 0.5 0.9 2 5 -21 7.5yr3/4 none Is 1msbk mvfr gs 2fm,1c 0.7 1.2 3 21 -39 7.5yr4/6 none Is 0 sg ml cw 1fm 0.7 1.2 4 39-47 10yr4/4 none Ifs 1 msbk mvfr cw 1fm 0.4 0.6 5 47 -58 7.5yr4/6 none Is 0 sg ml gw 1fm 0.7 1.2 6 58 -86 10yr4J6 none s 0 sg ml gs - 0.7 1.2 7 86 -105 10yr6/4 none s 0 sg ml - - 0.7 1.2 M Boring # Boring 1/ Pit Ground Surface elev. 99.27 ft. Depth to limiting factor >102" 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 1 0 -5 10yr3/2 none sl 2fsbk mvfr as 2fm,1 c 0.5 0.9 2 5 - 16 10yr4/4 none Ifs 1 msbk mvfr gs 2fm,1 c 0.4 0.6 3 16 -23 10yr5/4 none Is 0 sg ml cw 1fm 0.7 1.2 4 23 -29 10yr4/4 none Ifs 1msbk mvfr cw 1fm 0.4 0.6 5 29-40 7.5yr4/6 none Is 0 sg ml gw 1fm 0.7 1.2 6 40 -71 10yr4/6 none s 0 sg ml gs - 0.7 1.2 7 71 -102 10yr6/4 non s 0 sg ml - - 0.7 1.2 * Effluent #1 = BOD ? 30 < 220 mg/L a TSS, >30 < 1 mg /L Effluent #2 = BOD < 30 mg/L and TSS < 30 mg /L CST Name (Please Print) Signat CST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 5202003 715 - 248 -7767 Property Owner ' John Potting Parcel ID # 032 - 2116 -90 -000 Page 2 of 3 F3 I Boring # 0 Boring 11 Pit Ground Surface elev. 99.73 ft. Depth to limiting factor > 107' in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -4 10 Y r3/2 none sl 2fsbk mvfr as 2f,1 m 0.5 0.9 2 4 -17 10yr4/4 none sl 2msbk mfr gw 1fm 0.5 0.9 3 17 -32 7.5yr4/6 none Is 2msbk mfr cw 1fm 0.7 1.2 4 32 -53 10yr4/6 none s 0 sg ml cw - 0.7 1.2 5 53 -10 10yr5/6 none s 0 sg ml - - 0.7 1.2 �r F—I 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 P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F—I Boring # J Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPD 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 _ - BOD < 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. ♦ E!e ✓cz �o •� . /oGated prop. Stalee b e �o O a gencS►maxe C: T p of P J. c. P ipc, f}SS krn Lcl el /O,00. I03�G' wcode.d uvoal ail n 3 b� drean /�� r't5�da.nce g /s /oi o $I 49.0' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner - �d�7 Septic Tank Capacity al ❑ NA Permit # Z O ­7 Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model A ❑ NA Number of Public Facility Units NA Pump Tank Capacity al �� A Estimated flow (average) gal /day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer NA - App#catJi e (� , '7 gal/day/ft' Pump Model ❑ NA Standard Influent /Efflue Quality Monthly average* Pretreatment Unit A ats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (B0D :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 (B0D :530 mg /L )5jn- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L )(NA ❑ ❑ Mound Fecal Coliform (geometric mean) :510 u /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in di a ❑ 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: ❑ o j l(s) (Maximum 3 years) ❑ NA 2 -3 Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA ❑ month(s) Inspect dispersal cell(s) At least once every: 2� 3 years) (Maximum 3 years) ❑ NA 5 p� — '1� At least once every: I months) p NA Clean effluent filter �'(}� Z I g ❑ year(s) Inspect pump, pump controls & alarm At least once eve ❑ mo year(s) ❑ NA Ins P every: ❑ years) ' ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) Other: ❑ month(s) ❑ NA At least once every: ❑ year(s) 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. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, 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. Page Z of 2 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other'chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. 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. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter 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: `gyp A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. �� T alua ' a o ing ttank '� T11� �0� H/�✓ CANS M(JC - ON b e a� a RO+II'e ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 15t- c ( (7V ZOrJl�tl Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &If) and 83.54(1). (2) & (3), Wisconsin Administrative Code. # 1306 1­7 Maintenance and Contingency Plan for a Septic System Maintenance Plan _ 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -4516 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715- 246 -5148 Shaun Bird #226900 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM i owner/Buyer Q� � r ✓t�'L Mailing Address / 7 - • �Lc>n s '�i G /�'"`�o Property Address 5 5 (Verification required from Planning Department for new construction) City /State Parcel Identification Number LEGAL DESCRIPTION , Property Location '/4, �i / <, Sec � T�N W, Town of . Subdivision �� �'/ st, , Lot # . Certified Survey Map # . Volume . Page # Warranty Deed # S� S - 7 �� , Volume 3 . Page # Spec house ❑ yeno Lot lines identifiable Xyes ❑ 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 masterplumber, journeymanplumber, restrictedplumber 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 113 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 your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days f the thr xpiration date. A" 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 p o rty =ve, by virtue of a warranty deed recorded in Register of Deeds Office. ATURE OF APPLICANT 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 /0 HL 139' %499 !' STATE BAR OF WISCONSIN FORM 2 — 1982 595744 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS DOCUMENT NO. $T. CRDIX CO., WI - -7- REfEIIlE2 FOR. RECORR RICHARD O. STOUT and JANET P. STOUT, 01 -14 -1999 2:45 PH NARRANTY DEED !; EXEMPT N li CERT COPY FEE: JOHN W:. POTTING and MARIT W. j COPY FEE: conveys and warrants to TRANSFER FEE: 144.00 POTTING, husband and wife survivorship mar2ta RECORDING FEE: 10.00 property, I! PAGES: 1 II �; THIS SPACE RESERVED FOR RECORDING DATA St. Croix I -- Ir1 AZi AND RETURN ADDRESS v I the following described real estate in COp °t y , 1First National Bank of New Richmond 7Sotl2 sin: PO Box C , Plat of Shadow Pines, Town of Somersethew Richmond, WI 54017 oix County, Wisconsin. CJC.J�' 032-1042-10-000 Z / PARC0.nh9!EI"2%A3VEF000(t O 032 - 1042 -40 -00011 I 032- 1042 -50 -000 032 - 1042 -70 -000 Ii �I II it I 'i Ii I i� I, i This i s not homestead property. (is) (is not) Exception towarranties: easements, restrictions, rights -of -way and covenants i of record. I Dated this 12th day of January AD 19 99 ' I Richard O. Stout Janet P. Stout (SEAL) (SEAL) (SEAL) (SEAL) I 'i AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, lI r. } ss. .I St. Croix J l County. r authenticated this day of 19_ Personally came before me this 12th day of January 19 99 , the above named Richard -O. Stout and Janet _ Stout f TITLE: MEMBER STATE BAR OF WISCONSIN (IE not, �! authorized by §706.06, Wis. Slats.) S to me known to be the person s who executed the foregoing instru� nt and ack ledge the same. THIS INSTRUMENT WAS DRAFTED BY Janet P. Stout !�' L I — 1-353 Aoa�azukea Tr. Hudson, Wi. 54016 No Public, j' County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If st ex iration dale: necessary.) � • Names of persons signing in any tapacuy should by typed or primed below their signatures. WARRANTY DEED STATE BAR OF WISCONSIN Wwonsin Legal Blar*Co" Inc. Furm No. 2 -1982 mowetk". Wis. - 1 61 f� Z 1 0 r LaJ N oar 1 N ,� v �n 1 S2'12 5�p.4o CID W \ Z o of u �. �= 2 1 ; Z 00 1 OI \ 1 1aJ M ^ oD 1_ 9 � �, M Z O II Ckf ok 1 1 . 00 z I M„ 8k LLS I 1 I O •o I / 1 / !_ r ♦ � L r W tnj '19 S6 3 3 40e ?``9x�s' 'S' Z� 9 zN W s� � I o ro N / {o Z X O K � � N ) ul OD LL- x MC),` ��! \ tea ?! `2c � o < cv .- 0 Q 00 in XL °�� c °s r%� i �o `p, z H X ,o s 2 1 L,u-)�< °; o LLI CID w his •ti z rl ga o r, r j� N d• Q 00 i M„8Z, b0J N =b co 69'Z22 -- - ,61'lL9Z M.99,11. - NOI11SOd 83N800 431(1&400 NON I I _ - - -- , l91 3„ 80,Ltr.68N SI (1Oa N08I „l ON3 11.00N------- - - - - -- I i cn I - - - -- o °cq o 7HI 30 3N17 IS3M I Z i I LLII I Of -- U) I of ZI I Z F �I Lo: i Li Qi JI I wil7�OW 01 (� 1 i 001 I I I ' z N' I p� I I 0m \ 1 I � Z t,_ .- 1 - < J ! I La 1 —,99 = 1 I - -- I I L ` �I �' S31 S�1`d0 N6 H 3 1 ON 1`dld N 1 I 1 I I a do � 7• M Wisconsin Department of Commerce SOIL AND SITE EVALUATION Divtision of Safety and Buildings Page 1 of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size P m - ' pqnty include, but not limited to: vertical and horizontal reference point (BM), dir tiQmand St. Croix percent slope, scale or dimensions, north arrow, and location and distan a+earesp ; ri Parcel I. . # r .., APPLICANT INFORMATION - Please print all info a6 M , t eviewed by Date Personal information you provide may be used for secondary purposes (Privacy s -15.04 (1) Property Owner Properl?QW& 6n Richard Stout ` GP*t& SW 114 114 : 1/4,S15 T31 N,R 19 E (o rgW Property Owner's Mailing Address Lot `j Lk# : Subd: Name or CSM# 1353 Awatukee Trail ?S a ow 'Pine — 3 City State Zip Code Phone Number City ❑ Village own ea est Road Hudson Wi 1 54016 Somerset 160th Ave ® New Construction Use: ® Residential / Number of bedrooms a Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd/ft gpd/ft Absorption area required 858 bed, ft 2 _7 5 f) trench, ft 2 Maximum design loading rate - 7 bed, gpd /ft trench, gpd/tt Recommended infiltration surface elevation(s) See Qlot plan l t (as referred to site plan benchmark) Additional design /site considerations Parent material COC2 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 51 S El E s ❑ u [j7 S U ❑ S [X U ❑ S U SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD /ft Boring Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 1 ` 1 0 -3 10yr2/1 -- sil 2)i,4 3, mfr cs if .5' .6 2 1 3-1E 10yr4/3 -- si1 2. mcahK mfr cs -- .5; .6 Ground 3 18-!1 7 . 5yr4/ -- sil 2 M k6F. mfr cs -- . 5 , .6 elev. 194 4 51-101 10yr4/E ms osg ml cs -- .7'.8 Depth to limiting factor 1 01 in. Remarks: Boring # 1 0 -1 1 0yr2 /1 -- sil 2."Y � mfr cs if .5 ;.6 2 2 10-_':0 10yr4/3 -- sil 2 rs,4j2,4, mfr cs -- .5 .6 3 30-41 7.5yr4/6 sil 2 ma-bK mfr cs -- .5 :.6 Ground 4 41 -100 10 r4/ -- ms os ml cs -- elev. 96 ft. Depth to limiting 1 :fa�t or U in. Remarks: CST Name (Please Print) Signature Telephone No. Address Date CST Number Sc:c, / !c' 7 9 9 11 SOIL DESCRIPTION REPORT PROPERTYOWNER Richard Stout Page 2 cif PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 1 0 -8 1 Oyr2 /1 -- sil 2 ry)4(5(-, mfr cs 1 f . 5'. 6 2 8 -4 1 Oyr3 /6 -- is 2m mfr cs -- .7 .8 Ground 3 41- 00 1 Oyr4/ -- ms osg ml cs .7 ; .8 elev. 9 5 — .-9-0-ft- to limiting factor 1 ' Remarks: Boring # 1 0 -10 10yr2/1 -- sil 2 M 4 r-, mfr cs if .5 ;.6 4 2 10 -24 10yr4/3 sil 2 f)A-V mfr cs -- .5 ,.6 3 24 -48 7.5yr4/6 sil 2rga -Pbi; mfr cs Ground 48 -96 10yr4 6 __ s osg ml cs -- .7 ;.8 elev. 96 ft. Depth to limiting factor 9 6 in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # 1 _ _� 0 -6 10yr2/1 sil 2 n'1 mfr cs if .5 .6 5 2 6-42 7.5yr4/6 -- sil 2rO mfr cs -- .5 .6 3 42-99 1Oyr4/6 Ms osg ml cs -- 7 8 Ground 96. e 8 o' ft. Depth to limiting factor 9 9 in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) S"To ccT xoT a r9g 3 0� 1' - 6D' I �1r7/ /`� �� Ch�vyv 7`r�r � Aiu,.� /6✓.�77�,iP,'G6ra.✓ t�ce tJ /D�J, p 4 /,y, F th r l t i 3,0 ,Q.0 T QL9 �3 y yes ' r y 8� c 'Sm1 •