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HomeMy WebLinkAbout032-2070-50-000 I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division • INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 463016 0 GENERAL INFORMATION to Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. = Tkfw 5. 10 6 ) Permit Holder's Name: Ly hn `jam City Village X Township Varcel Tax No: U;*f1eavn; 1Jf+MeaA+-- Somerset Township 032 - 2070 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: ) M .0 j eo- NC_ 13.30.20.770C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing w � t Alt. BM Aeration Bldg. Sewer Holding S t/Ht Inlet S t/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet. Septic , t �r t�1 -7, Dt Bottom Tb. rf i Dosing y i � } y � � 4 � Header/Man. Aeration Dist. Pipe Ali& t Z.• D b Holding Bot. System A 3 -� -� nal Grad u PUMP IPHON INFORMATION 1-� Zitl 6e act fz -r 1 Qa �- Manufacturer & CO W Demand 9t Cover GPM 1 10 o dal Number ct Jo DH Lift Friction Loss System Head TDH Ft e •�� 2 �S' 3. t • t S- • - 0 1.3 an .a Forcemain Len Dia. it Dist. to Well r lao SOIL ABSORPTION SYSTEM BED /TRENCH Width t Length No. Of Trenches I PIT DIMENSIONS No. Of Pits Inside Dia. th DIMENSIONS I 5 SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LE HING anufacturer: INFORMATION CHAMB Type Of System: U Model Number: DISTRIBUTION tYSTEM H tl Distribution x Hole Size x Hole Spacing Vent to Air Intake �Z 3 th .0 Dia Length ' Dia Z- Spacing ' /�t SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil - Yes No Yes COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 16 1 ©,4 1& Inspection #2: =/ 04 1 (Zoo . & Location: 243 Anderson Scout Camp Rd Houlton, WI 54082 (NW 1/4 NE 1/4 13 T30 R NA Lot 3 � � Parcel No: 13.30.20.7700 & 1.) Alt BM Description = y� � 2.) Bldg sewer length = ,y "' /`"` 6-n. COAD - amount of cover re�nsion Re uired? (;Yes No .��� �(�' Use other side for additional information. ��� S r — - -1 p G�a SBD -6710 (R.3/97) (fe/1 • /1 1 \ Insepctors Signature Cert No. Safety and Buildings Division County N*iSConsirn 201 W. Washington Ave., P.O. B 1 , Madison, WI 53707 - 71 Sanitary Permit Number (to be filled in by Co.) (608) 266 - 3151 D Department of Commerce Sanitary Permit Application State Plan I.D. Number 41 8 7A9 7 In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(1 xm) Project Address (if different than mailing address) I& A 1. Application Information - Please Print All Informati Property Owner's Name sEP 3 2004 Parcel # Lot # aoekdt- L N4 AN &VE& Property O er's Maili g Add ss Property Location ST CROIX COUNTY ; lM1G OFFICE _ y,, 66EY Section City, S ate Zip Code rn NumDer (circle one) now U22 Q T J,2 N; R�Q_E od) II. Type of Building (check all that apply) CSM Number III or 2 Family Dwelling- Number of Bedrooms 3 V. I / P J o5� 3 7O9 �y ❑ Public/Commercial - Describe Use ❑City ❑Village Township of ❑ State Owned - Describe Use III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System ® Replacement System ❑ Treatment/Hoiding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date issued Before Expiration Plumber Owner O IV. Type of POWTS S stem: Check all that a I K S ❑ Non - Pressurized In- Ground ❑ Mound ? 24 in. of suitable soil * Mound < 24 in, of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation .5 r fv SO VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding. Tank 5' '✓' Aerobic Treatment Unit Dosing Chamber s"? ©O CP VII. Responsibility Statement the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plu r Signature MP NIhb Business Phone Number C Plumber's Address (Street, City, State, Zip Code) /E ' Z VIII. Count l epartmentfJse Onl Approved ❑ Sanitary Permit Fee (includes Groundwater Date issued Is uin Agent Signature o Stamps) ved Surcharge Fee) O � ❑ 7w7ne iven Reason fo nial Wo IX. Conditions of al /Reas ons for isapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced I maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x It inches in sirs SBD -6398 (R.01 /03) _ r - - -- -- i P c ,r' 1 - -' i - - p - -- -- — - !ry -8 a, r P6 L ; ) � I _ X a b_ y n cl pp ! E � � � r j�; � j j i� ' ) J4P f or a� V ® ©R� NbiES —�--- - ++ 1 9 x,75 j_ I ILL L 7-V F ; -- Li , t f I S4 7� : i P� Gar � � I P I AW N I N O 1 � i I _ � t � I T Safety and Buildings r' 4003 N KINNEY COULEE RD commerceml.gov LACROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.commerce.state.wi.us /sb Department of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary August 11, 2004 CUST ID No.223760 ATTN. POWTS Inspector JOHN F SCHMITT ZONING OFFICE SCHMITT & SONS EXCAVATING ST CROIX COUNTY SPIA 586 VALLEY VIEW TRAIL 1101 CARMICHAEL RD SOMERSET WI 54025 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 0811112006 Identification Numbers Transaction ID No. 1037265 SITE: Site ID No. 687697 Lynn Hoven Please refer to both identification numbers, 243 Anderson Scout Camp Rd above, in all correspondence with the agency. Town of Somerset St Croix County NW1A, NE1 /4, S13, T30N, R20W FOR: Description: Three Bedroom Replacement Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 974129 Maintenance required; Replacement system; 450 GPD Flow rate; 23 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD- 10691 -P (N.0 1 /0 1), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01 /01); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. 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 approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems - Version 2.0" SBD - 10691- P(N.O1 /01). • The pressure network is to be constructed in accordance with publications SBD- 10706- P(NO1 /01) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems - Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81)" • 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 existing septic tank must be inspected for structural soundness, size and baffles and must be brought into conformance with the requirements of ch. Comm 83, Wis. Adm. Code. If it does not conform, a state- approved tank must be installed. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. P•0. ..S CorIrl ;t o..1c T' _° i EAU V l ff JOHN F SCHMITT Page 2 8/11/04 • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • Comm 83.22(7) - 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 inspec tors. Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(i)(a) - 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). • 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. 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. • 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. 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. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Gerard M. Swim Balance Due $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm jswim commerce.state.wi.us WiSMART code: 7633 �r cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 SCHAHTT & SONS EXCAVATING 586 Valley View Trail Somerset, WI 54025 715- 549 -6651 M LM SY•S'TEM For: VVA) NO 1 Address: a 13 ri` ujo e e so N se c7u C , *kn, /e0 / �u c To •�/ G v1 .J S'o� Legal: W ' / L / --- /V F Vv -s /-3 ✓ 3 c DV R 0 2 © Township: J b rn Cj2SEi County: - '57. c je© /X Co ntents Page I 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 l Soil Evaluation Report Attachment 2 Mound Component Manual (Version 2.0) SBD -10691 P(M 01/01) Pressure Distribution Component Manual (Version 2.0) SBD- 10706-P(N 01/01) By: MP.RSW 0 ? 9 , 7 Date: ur1 OF CoMMERCE DtV ►5ipN S AFETY AND BUILDINGS RECEIVED SEA COR PONDENC AUG 0 5 200' { SAFETY & BLDGS DIV. i I — t ro 5tt �t2cG FT lit ' ga P � - - - :- w_►�� - -�— -- � rT, -- - — — -- -- - - -- - -- - . - -- - -- _ hIL7 SrrA) 700 4 6AL. y 'f _� — - -- - X15i n7 ��tUGl1A ��xlS7t �, _ — 1 ✓ ) 7 �� �f - , ( Po'o 1 �►. 1 � 11 0 r s Q 5CA to --d—L Pee Page Lf _ 1 Straw, Marsh Hay, Or Synthetic Covering ASYMC33 Distribution Pipe M"um Send K a 6" TopsOi► SYS ELEV. % Stapt Sod Of �— 2 force Main Plowed Aggregote Layer (6 /e Below PIPS) D . D Ft. � Cross Section Of A Mound System Using E Ft. F Ft A Bed for The Absorption Area G Ft. A 6 Ft. H /,!DQ Ft. signed: S Ft. � K q. Y Ll Ft. License ?umber: L 13. Ft. Date: Q j :!!�o63Ft. Alternate Position I Ft. of w Ft. Force Main a L -- Obeetvetion _ {p j _.. . ' t1b To 00 B Fmm'End at Bed K �r r.wr r.+ wrYrwr�• Y�w.iY rwr�rww • Force Main r +++rrYrr�. ♦� ; 1: wr..rr-r+.r - v �pistrlbution bed Of. Pips Agaregols Obseryation Pipe PerrK►cnent Moriters •. 115 To 1Ho S from End of Bad Plan view Ot Mound U s ing A Bed For The ADsorD lion Area F Page 3 of 6 Tom -UP WO Cleanout Actress B Plug or Ban V&i've �,�♦,. PVC Foroe Main plsWbution Lateral S PVC Manifold P - --}-�� �-- x �--} -- X X 1 f Xt2 Distribution Lateral Layout P 36.25 S 3.0 Ft. j X 30 InchAt. r Hole Diameter 3/1 Inch ned: Si -7 L ateral g Lateral 1' __ ,�s License ber: 223760 Mani fold " 1 y Incht�`f �c �V Force Main ,? lnche` OaLe: f of holes /fire 1...____ {. Invert Elevation of Laterals. P AGE 4 or 6 PUMP CHhMBE R CROss 5£CT�OU Awo SP[C�f►Carr�A.'S VCIaT C AP 4'C.I. VENT PIPE � AtPKO vitlk 1JL WCATSIER PR00► �MAIJhWI C COVER .tus3cTIO J BOX r h' r KnN ni,r � I�'MiLI• I .iiNUUw uK f Kf`i {� � AIK 1UTAKE GRADE I CoiJDUIT — lo•nlu. �\ `$ PROVIDE liJ4.E T AiAT�c:NT SEAL � I � I ~►•�` ✓/� APPKpVLO 40I► A�P><avco .JOIU7� A 1 I I W /C. PIPE WjC.z. PI ►G 1 I ALARM LXTC 1' e:xTCNa►I� 3' y OMTO &Q uo U O►JT17 &0610 %O IL 21.76 Gal./Inch 1 I 1 I o1J i $633 - _ LtCv #T, PUMP --.., prr � 0 COOJC aI.DC-K RiSCR EXi7 PERMI'ITEG 04JLy IF TANK MAAJUPACTURCR HAS 5UCN J►!'i'RavAL 'j BzDOi a SPECII= ICATIO!JS ! SEPTIC DOSE +or -5 Y�I.� /+►1►I�VPACT'URI`r K Week' S C . P - Wu^UER OF DOSES: - PlLfi D TAJJK WZC: ...._��..— 8.�Q trAti.UO> DOSE VOLUME g7.04 Se ptronics Tan kmate i1UCLU0114(* SACKF60w. T L���osk AL MM►uPALTUR[R. 413.44 MOQCL IJl3MDCK: TM -1 CAPACITICS.' A • 19 lue"E! OK ,...�.._.. 4A�L0► SWITCH' Type:._ Mercury _ - Z.•_ IAiCMEi 01t 4 .... 3 ..:.SG(►t.4Gi. PUMP MAMUPACTURCR: Zoeller C._.4,_..•IuCxCi OR 87.0 W►LV01 MOpCL ucJ R: 152 1 2 - Iw wEs o % 2 61 ..12 GALLOt SWiTC?i T1iPC: _ Mechanical QQTE: PUMP AN0 AI.ARM AKE TO 39-6 INSTA-.LEG 06J SEPARATE CIRCUIT& Mt1JtMl1M D{SCjAiR61E RATE.f_________G YEvmci L Dir EREMLS DETWCCW PUMP OF AIJD.D15TRIbUTIOW PIPE - - 0 FECY + MILIIKUM NETWORK SUPPi.tl PKE6$URC ....... . X 3.25 Fi.CT FKJCY{OAi FAC1044. ` � FELT + rE E T OF FoRCr MtiAIJJ x 3...2.4._. o rt TOTAL D KtAt) = �d FEET -. R S MTZ 4N 4; iIJTLRUAL. OIMLN6 ar TAWK: LEMCrTH --..- ;WIDTH (LIQUID OfPTH 3 ... � { 9IG1.3[D: 0 LICENSE u UM@Ei ; 'DATec , F HEAD CAPACITY CURVE __ = f MODEL 1 S 2/ 15 3 — —_ — -- - �� - - - - - -- so 12 40 52 - I 1 �►� w „fir _... _,__ -... _. .._..__ _...._.. -- ............. -_.._ 4 __•: _ 014508 �.� . 20 60 80 100 D. � ^ __URNS � 80 160 .b40 3 _ ►- FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS Timed dosing panels available. mo o' Electrical alternators, for duplex systems, are available and supplied with an alarm. Variable level control switches are available for controlling single phase systems. Double piggyback variable level float switches are available for variable level long and short cycle controls. — Sealed Qwik -Box available for outdoor Installations. See FM1420. Over 130 °F. (54 °C.) special quotation required. 1521153 Series ^ 152(153 MODELS Control Selection ' ;k Model V olts-Ph '' .Mode { Amps 1 Simplex Duplex c SI ; N 152 115_ 1 Non 8.5 1 2 or 3 5N I 52 11 i Auto 8.5 Included ! 2 ar 3 SK2064 E15 230 1 Non j 4.3 1 1 2 or 3 BE152 230 1 Auto 4.3 Included 2 or 3 i N153 1 15 1 Non 10.5 1 2 or 3 1 31 SN153 115 _ 1 Auto 10.5 Included 1 2or3 SELECTION GUIDE E153 230 1` 0 5.3 - -, 1 2 or 3 BE153 230 1 i A uto I 5 .3 I Included 2 or 3 _j 1. Single piggyback variable level float switch or double piggyback variable level float — – - -- switch. Refer to FM0477. A CAUTION 2. See FM0712 for correct model of Electrical Alternator E -Pak. All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level Control switch 10 - 0225 used as a control activator specify duplex (3) ;4 licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 r 7 Louisvrlle,KY 40256 -0347 Manufacturers of SHIP T0: 3649 Cane Run Road Couisvrlle. KY 40211.1961 E p�a1�rYP�Mf 9VrE 1939 778.2731. 1(800) 928 -PUMP http: / /www:zoeller.com ! !J /Y /! - FAX (502) 774.3624 Q Copyright 2001 Zoeller, Co, All rights reserved '1 ' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page /0 of FILE INFORMATION SYSTEM SPECIFICATIONS Owner L y ivN c7 U rN Septic Tank Capacity 1000 ❑ al NA Permit # Septic Tank Manufacturer P ❑ NA Effluent Filter Manufacturer S ! �yl T h/ ❑ NA DESIGN PARAMETERS NA Number of Bedrooms ❑ NA Effluent Filter Model $'T� ~/ ��� (7 . ®NA Pump Tank Capacity $00 al ❑ NA Number of Public Facility Units Estimated flow (average) 300 al/da Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) 4 gal/da Pump Manufacturer Zoe1 ler ❑ NA Soil Application Rats (1, al/da /ft= Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit M NA Fats, Oil & Grease (FOG) 530 mgll ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD,) 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Dime ersal Cell(s) ❑ NA Pretreated Effluent Quality Monthly average P Biochemical Oxygen Demand (B00,) 530 mg /L ❑ In -Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) S30 mg /L ❑ NA ❑ At -Grade / Mound Fecal Coliform (geometric mean) 510` cfu /100ml ❑ Drip -Line ❑ Other. Other: ❑ NA Maximum Effluent Particle Size Y, in dia. ❑ NA 9 Other: ❑ NA Other. ❑ NA Other: ❑ NA 'Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency ❑ month (Maxmmum 3 years) ❑ NA Inspect condition of tank(s) At least once every: 3 q ear(s1 Pump out contents of tank(s) When combined sludge and scum equals one -third (Y,) of tank volume ❑ NA ❑ moat (Maximum 3 years) ❑ NA, I j Inspect dispersal cell(s) At least once every: 3 p years ❑ month(s) ❑ NA } Clean effluent filter At least once every: 1 M year(s) ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: 1 ■ year(s) ❑ month(s) ❑ NA'� 51 Flush laterals and pressure test At least once every: 1 m year(s) ❑ month(s) r. ❑ NA: Othe At {east once every: ❑ year(s) ❑ NA Other: MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made an individual carrying one of the following licenses or certifications. Inspector; POWTS mi ssing Maintainer, hardware, Septage Servicing Operator. ;Tank Master Plumber, Master Plumber Restricted Sewer; POWTS inspections must include a visual inspection of the tank(s) to identify any missing or broken o ei d h t ar of effluent the G round su. 0, measure t volume of combined sludge and scum and to check for any back up or p 9 g The dispersal cell(s) shall be visually inspected to check the effluen( levels s rfaca ay ndi ate a fail ng condition and resathe of effluent on the ground surface. The ponding of effluent on the g,o und r, 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 entuc contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter. NR lY3 Wisconsin Administrative Code. 1 All other services; including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatme units, and any servicln� at intervals•of 512 months, shall be performed by a certified POW7S Maintainer. t R A•service report shall be provided to the local regulatory authority within 10 days of completion of any service event. lj T Page of ; 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 shell not occur when soil conditions are frozen at the infiltrative surf ace. 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 cells) 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: i • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. d ❑ 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. i ■ 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 ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A e PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS ' MAINTAINER POWTS POWTS INSTALLER Name' John-Schmitt Name` Owners 'choice y° Phone Phone` 549 -6651 �h SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name `:CroiX Zonin Owners choice Phone Phone 715 386 �4680 r' This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Vlltsconsin Administrative Code ' ; 1 it r s. II • " 1246 ftsconsin Department of Caaxnerce SOIL EVALUATION REPORT P age t of 3 Division of Safety and Buitd)ngs 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 i'nnted to: vertical and horizontal reference point (BW), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest mad. Please print all information. Reviewed B Date Personal mbortnatim you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m))� Property Owner Property Location Fatheree, Earl Govt. Lot NW 114 NE U4 S 13 T 30 N R 20 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 243 Anderson Scout Camp Road n/a City State Zip Code Phone Number J City - f Village rg Town Nearest Road Saint Joseph i WI 54082 715 - 549 -6061 Somerset 1 Anderson Scout Camp Road J New Construction Use: 1,0/ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ✓_f Replacement J Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a mound system. System elevation is 97.83' based off of contour line established at 96.75'. Slope is i Boling # 2j Boling .Sol Pit Ground Surface elev. 96.85 ft. Depth to limiting factor 25 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtft' 'Eff#1 'Eff#2 1 0-7 1 Oyr3/3 none sl 2mgr mvfr as 2m, 2f .6 1.0 2 7 -25 1Oyr4 /4 none st 2msbk mfr gW 2m, 2f .6 1.0 3 25-58 7.5yr4/4 m2d d 1 16 sl 2msbk mfr gW 2f 6 1.0 4 58-80 1 Oyr5/6 m2d 7.5yr5/6 Ws 1 msbk mfr gW — 4 6 7.5 12 5 80-98 10yr516 none s Osg ml --- --- .7 1.6 F2 ] Bang # Boling , rli Pit Ground Surface elm 96.85 fL Depth to limiting factor 25 in. Soil Application Rate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence 8airndary Roots 'EtT#1 'Eff#2 ; • a . 1 0-8 1Oyr3 /4 none sl 2mgr mfr cs 2m, 2f .6 1.0i 2 8-25 10yr4/6 none sl 2fsbk mfr 9W 2f .6 1.0 3 25-43 5yr4/4 m2d 7.5y,6 16 7.5yr6/2 scl 2msbk mfi 9W 8 1.0 I 4 43-65 5yr4/4 rn .5 2 sci 2msbk mfr --- -- .6 1.0 l i t ' Effluent #1 = SOD y > 30 < 220 mg1L and TSS >30 < 150 mg1L • Effluent #2 = BOD <_30 mgrL and TSS t�0 mgiL CST Name (Please Print) Signature: 4 f .CST Number j 71 Thomas J.'Sctiinitt `' ` 227429 " Address Tom $chrndt Deb Evaluation Conducted . 715 24 2941 4 ! 1595 72nd St., New Richmond, WI 54017 V 3i �� Y 3ynr d } Property Owner Fa L Earl Parcel ID # Page 2 of 3 Boring # J B0f1n fo Pit Ground Surface elev. 94.47 ft- Depth to limiting factor 23 in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'Eff#1 'Eff#2 1 0-9 10yt3/3 none I 2mgr mfr gw 2m, 2f .6 .8 2 9 -23 1Oyr4/4 none SI 2msbk mfr gw 2f .6 1.0 3 23 -39 5yr4/4 m2d r6/2 7.Syr62 SI 1 msbk mfi gw — .4 .7 4 39-62 5yr4/4 m2d 7.5yr6/6 St Om mfi — --- .2 .6 7.5 /2 F—I Boring # -- 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 'Eff#1 'Eff#2 Boring F-I # J Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'EtT#1 'Eff#2 ' Effuerd #1= BOD.30 < 220 mg/L and TSS >30 < 150 mglL • Effluent #2 = BOD <30 mg& and TSS <_30 mglL The De}iam=t of Comnm a is an equal opportunity service provider and employer. Ifyou need assistance to access services or need material in an alternate format, phase contact the department at 608-260-3151 or TTY 608 264 -8777. Page 3 of 3 Conducted try: Conducted For. Schmitt Soil and Site Evahlatiow Name: Esd Fadtbecee Thomas J:- SChMitt, CST 227429 Address: 243 Anderson Scout Camp Road 1595 72nd St. - City, State, .Tap: Hoolton, WI 54082 New Rich== WI. 54017 Phone: 715-247-2941 Subd.Name: N/A 11 acre parcel Lot No.: N/A Legal option_ NW 1/4 NE 1/4 S13 T30N R20W Township ofi Somerset Bench Mark EL 100.00' Top of 2" pvc pipe next to 24" red oak tree. Alternate Bench Mark EL 96.55' Top of 2" pvc pipe next to 14" birch tree. Slope= �' /o Contour Line EL 96.7 _ \ S 1 " =40` A&tf e saA 5 7 A ' C i a i 1246 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 she plan on paper not less than 8% x 11 inches in size. Plan Plan must St Croix include, W not limited to: vertical and horizontal reference point (BM), direction percent slope, scale or danems' o t M^ Parcel I.D. Please T ierJ VE RAID y Date Persons information you provide sed for secondary purposes (Privacy t aw s. 1. (1) (m)1. d'T Property Owner A G 3 1 2004 Property Location T Fatheree, Earl Govt. Lot NW 19 NE 19 S 13 T 30 N R 20 W Property Ovimer's Mailing Address ZONING OFFICE Lot # Block # I Subd. Name or CSM# 243 Anderson Scout Camp Ro n/a City State Zip Code Phone Number City Village !g Town Nearest Road Saint Joseph i WI 1 54082 715 - 549 Somerset Anderson Scout Camp Road New Construction Use: ig Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD OM Replacement J Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a mound system. System elevation is 97.83' based off of contour line established at 96.75'. Slope is 9 %. a Boring # Boring 16 Pit Ground Surface elev. 96.85 ft. Depth to limiting factor __ - in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft *Eff#1 *E 1 0-7 1 Oyr3/3 none $l 2mgr mvfr as 2m, 2f .6 1.0 2 7 -25 1 Oyr4 /4 none sl 2msbk mfr gw 2m, 2f .6 1.0 3 25-58 7.5yr4/4 m,2 1 /6 /2 sl 2msbk mfr gW 2f .6 1.0 4 58-80 10yr5/6 r ` � /6 ivfs 1 msbk mfr gW --- .4 .6 5 80 -98 10yr5/6 none s Osg ml — .7 1.6 a Boring # Boring Pit Ground Surface elev. 96.85 ft. Depth to limiting factor 25 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots t3PD/fF *Efl#1 *Eff#2 1 0-8 10yr3/4 none sl 2mgr mfr cs 2m, 2f .6 1.0 2 8-25 1Oyr4/6 none sl 2fsbk mfr gW 2f .6 1.0 3 _?5,-43 5yr4/4 m 7d5 . � /6 scl 2msbk mfi gW — .6 1.0 m2d 7.5 /2 4 43-65 5yr4/4 7 /6 sci 2msbk mfr — ----- .6 1.0 * Effluent #1 = SOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD . 30 mg/L and TSS <-X mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, W154017 6/22104 715- 247 -2941 Prr4eerttyO� Fdtheree, Earl Parcel ID # Page 2 of 3 IE g ang # j Boring ( Pit Ground Surface elev. 94.47 ft. Depth to limiting factor — n, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *091 *Eff#2 1 0-9 10yr3/3 none I 2mgr mfr gw 2m, 2f .6 .8 2 9-23 1Oyr4 /4 none sl 2msbk mfr 9w 2f .6 1.0 3 2�' 39 5yr4/4 m2d5.5yr26/6 sl 1 msbk mfi gw ---- -- .4 .7 4 39-62 5yr4/4 m2d 7.5yr6/6 sl Om mfi — — 2 6 7.5 /2 F—I Boring # Boring f Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff *EtT#1 *Eff#2 F 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 *Eft#1 *Eff#2 * Effluent #1 = BOD s > 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. Page 3 of 3 Ckoimi aW b*-. Cored Far: _ Sit Sail and Site Eve Neap: EadF Thomas J -Schmitt, CST 227424 Add 243 Anderson Scout Ceap Road 1595 72nd SL citY, Staw zip= HOUUM WI 54482 New RiAmov4 VL- 54017 Phlnsw 715- 247.2941. Subd.Name: N/A 1 I am pa vd _ Lot No.: N/A,_ r Legal Dwmip n: NW 1/4 NE 1/4 S13 T30N RZQW Township of Somerset , Bench 44.04' Tog oft" pvc Pipe next to 24" red oak tree. Pkmich EL 9 6.55 Top of 2" pvc Pipe nod to 14" birch tree. t - ,� � ► SioPe Co�onr Lime EL 96 T.._,,.,,,,. -, r „� 1 1 " 4W lit A� �7 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the Q residence located at: _Na /,, me Sec. T _30 N, R _,g_o _ W, Town of cSr? Ek SST St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced 17A Did flow back occur from absorption system? Yes No (if no, skip next line. Approximate volume or length of time: gallons minutes Capacity: /10190 Construction: Prefab Concrete Steel Other Manufacturer (if known) : f jJee Age of Tank (if known) : 12 - - � ©awAOZAI &C'6V-y1Tr (Signature) (Name) Please Print (Title) (License Number) (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle) . Name D,0A1A",,v Sign re '0' MP PR Z Af 7YI ST CROIX COUN'T'Y SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer 4 D V E7AZ -- Mailing Address Property Address ' ' A&0,6E/2 Soy Sao (Verification required from Planning Department for new constriction) • City /State Ji wt_ Parcel Identification Number 03 — 907a -3�0 C. LEGAL DESCRIPTION Property Location' /,, NF %,, Sec. /_3 ,, T_ <2 - N -R, JQW, Town of Subdivision AIA , Lot # ted Survey Ma # 0 Volume , Page # iasZ� Cerhf y p 37 9S9 Warranty Deed # _ 262223 , Volume elf -. Page # X j Spec house ❑ yes 00 no Lot lines identifiable CK yes ❑ no SYSTEM MAINTENANCE , Improper use and maintenanceof 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 caa 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 muster 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. 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 septictsystem has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 davm jWthe three vearexpiration date. r g-'1231 ° `( jj NnQW OFAPPUC OWNER CERTIFICATION I (we) certifykhat all statements on this form are true to the best of my (our) knowledge. 1 (we) am (are) the owner(s) of the erty describco above; by virtue of a warranty deed re ded in Register of Deeds Office. R lz3l a y ` . OF & LICANT � �t s « «•4« « « « « «« . Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. i •• Include with this xppliCRtion: 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 U 2 6 0 7 P 2 3 0 7 E, -74 7 3 STATE BAR OF WISCONSIN FORM 2 - 1999 WARRANTY DEED REG KATHLEEN O DEEDS �� Number REGSTE OF DEEDS ST. CROIX CO., DI This Deed, made between Earl C Fatheree and Susan Fathere , RECEIVED FOR RECORD husband od wife Grantor, 07/01/2004 09:30AN and Lynn G. Hovers and Marilyn A Rilev Grantee, WARRANTY DEED Grantor, for a valuable consideration, conveys and warrants to Grantee EXEMPT # the following described real estate in St. Croix County, State of REC FEE: 11.00 Wisconsin (if more space is needed, please attach addendum): TRANS FEE: 1354.50 Part of the NW 1 /4 of NE 1 /4 of Section 13, Township 30 Nom}, Range 20 CCpFEE; West, St. Croix County, Wisconsin described as follow Lot of PAGES: 1 Certified Survey Map Riled May 20, 1981 In Vol. 4, P age 1059 Doc. No. 370959 EXCEPT part to State of Wisconsin, Department of Transportation in ol. 1435, page 577, Doc. No. 605354. St. Croix County, Wisconsin. Recording Area Name and Return Address The First National Bank V\ PO Box 89 New Richmond, WI 54017 622-2070 -50 Parcel Identification Number (FIN) This is homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this 25th day of June 2004 - - - -• - _ ... .................. _ - *_ 1 C. atheree * _ * Susan Father AUTHENTICATION ACKNOWLEDGMENT Signatures) _�— _ _ STATE OF - Wisco nsin ) ) ss. St. Croix County ) authenticated this day of Personally came before me this 25th day of Jun e_ --------- .... -- _ - - -- , 2004 the above named Earl C. Fatheree and Susan Fatheree, husband and wife - - -- - - •---- - - - - -- --- • - -• - -- - - ----•---- -• ............ ... ....... - - ------ - . TITLE: MEMBER STATE BAR OF WISCONSIN (If n I� rson ( s ) to me known to be the who executed the - - ---------------- - - - - -- authorized by § 7t)d.t)6, Wis. Stats.) instrument and acknowledged the same. T0,9 c THIS INSTRUMENT WAS DRAFTED BY - - - - - - - -•--- - - - - -- M. TOstiUa .... ... - __ -- -_ - -- - - -- - - - -- - - -- — -- -- - Hu dson, WI 54016 Notary Public, State of _ _..._ ....._. _ . - ._....._ ...__..._..... - -• - -- - My Commission is permanent. (If not, state ex ' dite: (Signatures may be authenticated or acknowledged. Both are not necessary,) (OP s * Names of persons signing in any capacity must be typed or printed below their signature. information Professionals Co., Fond du Lac, wt STATE BAR OF WISCONSIN 800-655 -202 t WARRANTY DEED FORM No. 2 - 1999 Jessie Nye Subject: #463016 Schmitt - Hoven - Final Location: Somerset Start: Wed 10/6/2004 9:00 AM End: Wed 10/6/2004 10:00 AM Recurrence: (none) 032- 2070 -50 -000 �V, 13.30.20.770C Also do onsite Jerry Sandal right down the roa i 1 Kevin GrAbau From: Monica Lucht Sent: Tuesday, January 04, 2005 2 :12 PM To: Kevin Grabau Subject: Tom Schmitt Tom called with some numbers for you: Concerning the Lynn Hoven mound: Septic tank outlet height = 99.46 Septic manhole height = 102.26 Monica Lucht Administrative Assistant - Zoning St. Croix County monica/ @co. 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