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HomeMy WebLinkAbout032-2103-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division e ; — . INSPECTION REPORT Sanitary Permit No: 420366 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: Vavricka, Michael I Somerset Township 032- 2103 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: /oo - 5e7l TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark (�- t..t� -•d � a-�-� 3.2 to3. boo. o Dosing �y 8o h Alt. BAa_ a ,� sstJ ,L Wit ll Z •g t oo' CA Aeration U Bldg. Sewer Holding W t Inlet p TA SETBACK INFORMATION St/Ht Outlet O �3 TANK TO _211 WELL BLDG. Vent to Air Intake ROAD Dt Inlet ? � • S � T / Septic / I Dt Bottom p al A.N 1I, y � �O•�� 0 Dosing .F' / 23 / Va45r Header /Man. Aeration Dist. Pipe T, o, �. 41 Z 7 y9, a3 ding Bot. System PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand S C v VULDS GPM Q�d Lf 3� GIS Model Number TDH Lift Frictio oss System Hea TDH Ft �i. t3 , Forcemain Len Dia. M Dist. to well 2 /JaT /.'J e"r SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length No. Of Treriahes PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS <1 -7 (]'r/ SETBACK SYSTEM TO P/L E BLDG WELL LAKE /STREAM LEACHI nufacturer. INFORMATION CHAMB R Type Of System: ��/ Z5 ` �� y S IT Model Number: DISTRIBUTION SYSTEM 7 6V , ss E r /Manifold Distribution x Hole Size x Hole Spacing Venn I Pipe(s) / / '/( /, / Dia 7i Lengt Dia Spacing / d 3 ' b4 d SOIL COVER / x Pressure Systems Only xx Mound Or At -Grade Systems Only 10 1 -imc1 •j -S Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil r Yes No � ] Yes 1 No q v COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: 1 �� 1 / Inspection #2: Location: 1525 Oak Ridge Lane HHoulton, WI 54082 (SE 1/4 SE 1/414 T30N R2 Green Acre Ctry Estates Lot 12 Parcel No: 14.30.20.974 1.) Alt BM Description =T P 0 3 Pfd Q4 0 W - 4- /in L 6Aald 0, J 2.) Bldg sewer length = �Lt?u.r•�/� l/t.S�y.B GfZ �X o•FSai' — A-a-All �Q - amount of cover = �tl f� ��,� 6,�,a( AAZA>41� 3.) Contour Plan revision Required? Yes ; No Use other side for additional information. � _ -- - - - — 4 - -� SBD -6710 (R.3/97) Date Insepctor's Signature Cent. No. Safct and Buildings llivtswn County . 201 W, Washington Ave., P,O, box 7162 - -- *is- Madison, WI 53707 - 7162 _,� Sta��ras OAK 'ej0 , �� -9 .o -� © /Q!S of Commerce a Number oll4 --JZ7 Dep Sarutuy P rudt Sanitary Permit Application yao 3� In accord with Comm 89,21, Wu. Adm. Code, personal informauon you provide O Chock if Revision may be used for secondary purposes Privacy Law. $15 04(IXm2 �.. State Plan I.D. Number 1. AppUcation IslfOrm9 - Please Print All I.nforn; 5 �� g 23 Parcel Number pr Owner's Name a i 41 Property 14c4don • �7�. Property Owner's Matting Address / -J' - 4 j - ' g N, �, C�c Phone Numlxr Lot Nam r Bleok Pfutnbcr City, Stan Subdiv_ i�Name CSM Numtgr 11. Type of usldutg (cltcck all that Apply) ry - 1 or 2 Family Dwelling - Number of 13cdrovnu �_.... ' -- OVulage (� Public)Conunercial - Uvwribc Use T ownuhi „ Z 0 Stata owned /�(ILv+'1 d ev1 fytd�ry � Nearest Road g r X �`� 70 �t� -d w ` -{`d! III. Type of PeruWt: (Check calf one b6 oD line A (nun;berusg scheme for internal tae). Complete Line B if applicable) A j — FoI:CC:0":II use I New 2 O Replacement System 7 O Replacement of 6 O Add: n to S sutra Tank On! Bxis tem Date issued B, O Check if Sanitary Pcrmit Previously Issued Pcrnut Numlxr IV, Type of Permit; (Check all that apply) (numbering scheme is for internal use) 44 O Non - Pressurized in- Ground 2119 Mouncl 47 O Sand Filter 50 O Constructed Wetiarsd 22 O Pressurized In -Ground 41 O Hold" Tank 48 O Single Pass 510 Drip Litre 45 O At 46 O Aerobic Treatment Unit 49 O Rocirculatang N O Othor V, DIspersaliTreatment Area Information; Design now (8Ad) Dispersal Area Dispersal Area Soil Applicauon Pcrcolauon Rate S Elevation Final Grade Proposed Required Kate(Gals.(Day Sq.F ,) (Min./Inch) Elevaoon �Q6D (p(9U (QOM _v a S .- ,V V1, funk 1n' Capacity tit Total Numtxr Manufacturer Prefab Site Steel Fiber Plat.: Gallons Gallons or Tanks Co fircle Consiructod a ss New Eusting Tutka Tanks Scpdc or Holding Tuck _ / — Dosing Chunber VII. Rtspopsibility Statement- I, the undersigned, a res nsibalty for installatlou of the POWM shown oa the attached laps• Pltuntx 's gnu (P " ) Pltsmbcr's Sig rc MPIMPRS Number Susinass Pbotx NtsmW urrivs PI bet's Address (Street, City, State, Zip c) 'Z/"o z VIII, unt /Uc artmeut Use Oul & Approved O Disapproved Sanitary Pcrmit Fee (imiudes Groundwater Date lssued Is Agetu Siguaurt (No SUMG$, 7_ , l Surcharge Fee) _ f O Owner Given Initial Adverse 3 �5 Deter mination _ -- IX. ditioru of Ap � vaUR f& U pprov� o 1 backs' S h �. Cn . 83, —! , W r►�u a de rm'� > s' �'r''^ ^•�fc s, exA-) 411 t L xeuch comPim tt a " tr gay) rvr the om va paper ovt ;ban 414 1 t"b" *4 - S F3 D -6 3 9 8 (R. 0 S ,�0 I) � -c�c -- � �� �.�,• /�,•, o � � i J O � F h �c Al o �O � o x c � h I t � \ Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 2648777 isconsi►n www www•commerc . s hoo o nsin. ov .wiscnsin.gov Department of Commerce Scott McCallum, Govemor Philip Edw. Albert, Secretary August 22, 2002 CUST ID No.224263 A7TN: POWTS Inspector KIM A O'CONNELL ZONING OFFICE K.O. CONSTRUCTION ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/22/2004 Identification Numbers Transaction ID No. 778239 SITE• Site ID No. 649415 Michael Vavricka Please refer to both' identification: numbers, Hidden Valley Circle above, in all correspondence with the agency. Town of Somerset St Croix County SETA, SETA, S14, T30N, R20W FOR: Description: Proposed o Bedroom Residence Object Type: POWT Sys m Regulated Object ID No.: 867091 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: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans. • 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. • 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 inspectors. Note: The 2" dia. manifold chosen by the designer is permitted based on the SBD Pressure Manuals. Owner Responsibilities: • Comm 83.52(1)(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. P.O.W.T.S. Conditionally r KIM A O'CONNELL Page 2 8/22/02 Owner Responsibilities Continued: The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is 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 Balance Due $ 0.00 Oerard M. Swim POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm WSMART code: 7633 jswim @commerce.state.wi.us cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544 r � l A MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE , l Project Name: MICHAEL VAVRICKA Owner's Name: MICHAEL VAVRICKA ��o A so Owner's Address: 489 LEEWARD TRAIL /` WOODBURY MN 55129 Legal Description: SE -SE -SEC 14- T30 -R20W Township: SOMERSET County: ST. CROIX Subdivision Name: GREEN ACRE COUNTRY ESTATES Lot Number: 12 Block Number: Parcel I.D. Number: Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 PLOT PLAN Designer: KI M A OCONNEL License Number: 224263 Date: 08/11/02 hone Number: 715 - 755 -3145 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) Version 3.0 (03/01/01) r-9a 2 r b " — Page 1 of 8 DEPARTMENT OF 0 A�'B� B UILDINGS VISION OF ` SEE CORRESPO U-NCE Mound anti Pressure Distribution C,emeneett -W8190 Design Worksheet Site information �-Q,, "(0) a (r or c) i % i�$ntigi vi vvl i uil6rCi8i c�8 � s 914" ,0" IN #"6 400MO Es[irtlated wastewater Flow (gpd) cou "M of <. 39 bohn 1'64 Packing Facer to 9 1.5 =15CPA4 . 600. Design Flow (90) S. Site Sloe ( 97.80 Contour Line Elevation (ft) 2& Depth to1im- iting..Factor (ir) 8.40 In-situ Soil Application Rate (gpd/ft`) Dis 'butio Coll information v.vv viajrorool von 1..811 a rJStG'ly Corit0u I, =*att 0 Dispersal Cell Design Loading Rate (gpolfe) r _�� ..Ir.!!ze-la!es'a!s3h•�s�s'.` ::.. -� m the dis L Y � tribute Pry$ ? Ente . (c or 8) E center or End Manifold If N above, enter the elevation ft 4.00 Lateral Spacing (ft) 2 Nuf of LaWals of tl�e higkiest point. / 0.125. Orifice Diameter (in) (e.g. 0.25) t( � � ,,tim�.(e_d ixiuce a tft) _t u izgiotif+ce- 200. Forcemain Diameter (in) ���� �5...v I a 6I a r §-%,l 1"t� tl�� wyy �I �v Io. , na. ; dr., =7-1K 1 _. f $6.00 Pump Tank Elevation (ft) EAWY4orX f 7 3f1 Forcemaj6 DrWnback "(gal) 6:50 'System Fieacf (#t) x � :� t3.4 Vertical Lift (ft) 67.38 5x Void Volume (gal) r 0.43 Friction Loss (ft) 74.72 Minimum -Dose.Volura : (galY.: , :40 Total Dy namic Head (ft) 20.60 System Demand (gpm) Lateral Diameter Selectio t� ! � ani!: o ld Dia , eter selection ..mint. y� vl•:ni... nFfrr� . v ,�V11J VI it 1. 4161. V NOVO IV WIVIW 0.7 t 1.25 1 x 1.25 x 2.00 x 1.50 x x 3.00 2.00 x 3,00 x _ (optional) Treatment Tank information 1� 260.0 Total Tank Capacity (gal) SS. ' . Ctu il:' :i l:'iiS� 6.i '.3id f+'qt! i Irf , I i.vv.vv v."tic 1 c'jr tl� iluyE5vliY yy4c/1� f EKS Manufacturer 21.72 gallin (enter result in cell W Dose Tanis information Effluent futer Wonnation 800.00 Dose Tank Capacity (gal) J,Zabel FA Manufacturer 2#.7 t Tar* Vofwtte f gaft) A'fb IEEKS Manufacturer Project: MICHAEL VAVRICKA Paige 2 of 8 Mound Plan View . ............................... 1/10 0 - Obwtvation Pipe { ;� K � E ` .i a •_ ; .. ! fjT OR yY 4i .. s '.'.'.'.'. ..........'......' ............................... L Mound Component Dimensions Down sl a toe extensi made. A 8.00 E 18.54 in H 1.00 K 8.95. it t3 75. F 9 50 in z 12.00 ft L 92.91 ft D .�� G 0.50 ft J 5:0� ft W 25.fl2 ft 600.00 {et) Dispersal Ceil Area 1500.00 (e) Bas Area Av 8.00 (gpd/ft) Linear Loading Rate 7.50 (fit) 1110 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal -Area- Finished Grade 100.43 (ft) --^-► ft G t x38.63 ft — — In vert Disoessai Cetl E 11 hh, Fiievatir#1 U. �a .was x ^; 9.0 % Site Siope Geotextile Fabric Cover Shading Key v Dispersal Cell See lateral details on Topsod Cap °- t. t i _5 ft - !' Pane 4 for ss Subic. 's CL = ar a 't t t - J size, and spacing of S � k .•/ ASTV. 33 Sard '14• Y•i' w T. �tY GPiLI G� W. `W aF' iA p �:'RfL� L3jr� _ ..a • . l,S.Z . -S � xywm �biciS� :�. f .' euURy spawd from Aggr the. E�fis Yibk#t�9 c� S 4F A "/' x diStFFI'i0i`4 cell � ) Project: MICHAEL VAVRiCKA Page 3 of 8 r End Connection Lateral Layout Diagram alscenter over the A& S dimerslon s= Turm- up wtbailvalveaoiearroutplug P Alllatera is we lF X—>1 Holes &&pd oa the bottom of the lateral s Faroe maie annnent�rn uia tep nr crass to manifold at aqy paint. Lafs>sc face madr� of f�'V'C � 4ti (per C+DNW Table 84-5) Nufter of Laterals 2 Orifiel: 0 e 0.125 iA Lateral Diarneter 1.50 irk (riffs Spackv (X) 3. A Lateral Length (P) 73.44 # Orifices per Laterai 25 Lateral Spacing �S) 4.W. ft Orifice Density 12-0Q ft Lateral Flow Rate 10.30 gpm Manifold Length 4:00 ft System Flaw Rate 20 gprrk Manifold Diameter 2.00 in Total Dynamic Wend 2(3 4O Fo " rcemain Velocity 2.10 ft/sec Dose Tank lntor_m Lion LodmV cover vAh vmrrwV Wet and fo wv device and Wat EiecWxW as per NEC IN arld =0 — Comm - W2- -8'WAC j 4ap..min. Dboonned Tank camponerA is-propedy vented= f-- ^ Afternate ouf;et location Forcemain WE EKS LlreF 2 irr it .00 llor'aa' != V:2lt!!a8 21.76 ... A { tt : how OF all Dimensio Incises Gallons 8 1. 1 siphon device Y . �r .'.. L!... l;9�: µe•`3+1 �. � � -.i. B 2.001 4352' 9 Pump ff elevation ft 1 -1711 A71 r 1. ;. .�P_ � r,7 ' 1 1i 0 F 8.00 17 1 Total 1 36.76 800.00 t. .t. r x l # 2 S3Y33:7LY• lfit 3" Bedding tin&f tank- Alarm Manuafacturer J SJ ELECTRO Wi —._.__ al��i•�'it ^v. .... "u 'Y'iYW9 .rrtn Pump AMarwifa uree IGOULDS � pwnp ri,iFDw p:+i„fxrbber .wEclatIL r Pump Must De 20.6€1 gpm at 2 00 TDH Project: MICHAEL VAVRICKA Page 4 of 8 Adoundvstem Maintena and t3neration S ecificati Service Providers Name I KIM A OCONNELL sin onrc 0g..I,:,.,a,.,,l� .kI I Phone 715-755-3145 _ �+ ......... �'� ®f1LY OLf rTY ` f�k6Hk� �no 71 -5 3SM` r4l . .+ ltSte n P and Load Parameters Design Flow -Peak 600 gpd Maximum Influent Particle Size 118 in Estimated Ely- - A.verage Septic Tank C Maxim - urn SODS Capacit 1�. gal- Maximum TSS 180 L Soil Absorption Com#�onent Size Sfl0 ftr Maxi�ruirn FflO 3p T ype of Wastewater.. Domestic Maximum fecal C0Jiform >'I_OE cfuMOO ML Sel�l�e F�aixeilrcv� Septic and Pump Tank inspect and /or service once every 3 yeam Effluent Filter Sfiou#d ' . and Mclean at ,least once every 3 ears PUMP : Controls . Test once Wary 3 yew Alarm Should test m2nt . Pressure System Laterals should be flushed and Pressure tested every 1.5 years Mound i nmed for •c ones and seepage onc every 3 wars t- 3 �t�sc�:`��nei3€is :�n`�Zlru�tf��i utiv �atcr�itr`fs ��c"#�tT s I. Obsenratien Opes are slotted and flugerials MOM, to Tape C.,,,m 84.30 -1, have a wetedi�krt cap, and are secured in as shown in the mound component manuat. 2: Dispersal, We e arrr►s,tQ g4.3 f} �� k Wis: �kdrrr Code. 3. All gravity and presswe,pi dials wworm to the r 4, Tillage of the basal area is e�rern�ts in Cam 84, Y1/is. Adm. Code. accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas - hill - be seeded and mulched to prevent soil erosion and help reduce frost penet LaAeral Turn -gyp oew Finished Grade \J4 +... •.. 6 -8" Diameter Lawn Threaded Cleanout RR , elve F7 ....:` istributitsn Lateral = 1 ~-- Long Sweep 90 or Two 4� �Iiif ltYY 11yf 11�1� �' - JItIY Lat UtC#4AEL VAVRIClSA page 5 Aof a Mound system Management Plan L/a 0 3 4, 6 pufauent t4 om m 83.14. W10- .:Code This system stroll be operated in accordance w Comm 822 -84 IAf Code, and shah maintained =ar �MnCe wilts ills' Component manacle [SBt� -fi 8t•P Ut OtlO'f) an6S5WMP_ Pubhcatiorr9 d {Ot/Bt�Tand local or -sue rules p � � mainteaaace reporting• /hat pc�uld rxuse death. No one should ever a septic or pump tank since' dangerous gases MV1 be present - Septt Band .pump:�k••gbandomnent.shatlbein accordance-WithZC Milt' i33, CnOsaw + a►'bnaJ as POWTS components for water 6ghVww and soundness, Access OPOO P used Septic. or pump tank manhole risers,. access risers and covers s h ou ld be inspected for and sessmet a e as t shoA-be see 0dwRWW uPon' �_ootMWdOtL Of secytoe: KnY oPecdnS deemed'tarsaa� diefect6re. oc srtilecCm 1>N4u rvice jDust be replaced. Eiposed sc 4POOings 'e tl�a 8•lad>•s1u basac�rad bYaA all � � accidental or unauthorized entry into a tank or component• maintained b an individual osfified fo servi c tanks under s. 281.48, slabs. The conter� of the septic tank The septic tank' shalt be Y condition of the septic tank and outlet fllter shatl be assessed at sha11 be disposed of in accordance with NFt 113, Wis. Adm. Code. The operating i feast once 3 The outlet fitter shall be cleaned as necessary to ensure ra er operation. The filter esr i should not a ippedved with an alarm ON Mer . me a to are so in e n may slough off the fitter when removed fro m endosurf 1 equipped alarm. shall be serviced it the alarm is activated continuously. Intermtttent titter alarms may indicate ga The septic tank stsatl have its eorrter removed when the volume of sledge and scum in the tankexoeeds 9/3 lire liquid volume otyhe tank If the contents of the tank are not removed at the time of a triennial assessrnent maintenance pw el d1all ad�ae the of when the nerd service needs to be performed to maintain less than maximum scum and sledge accumulation in the tank. The addition of bk kooi Or them" additives •to enhanoe septic'tamCpeFWmarsoe a; a"y .'W . tW,,M ff such prodsxas are used *eV shall fay appboved tru !a�` "°� by " ° o€ coaaaierce• Pam �+� arxi �pa.sgallba clad to �is� The pump (dosing) tank shall be .Inspected at least once *very 3 years. AY auuidWs. a .operation. •ff an eflkrent Flier is •instANed witfiin the tank it shall- Wwpected and serviced as • necessary. -• � - -' PressureDistritxittnn Svsbem m ound shall No trees or shrubs should be planted on the mound. Plar►tinpa may be made pro limn fio tp ge srset V6on: Tnft(Vd veyatstivc be seeded and muk�rod as necaMMY W pmat a°s °� 'to prov ide some prote m m e) on Vw mound i root reoommended since soil compaction may hinder aeratlon of tla irrflltrative surface wildln the parrund utow compaction in Hu winter wil•promote trost:penetration. Cold weather i oWlaborn (1)cWW- Fsbn+ary� •diotabe Wet tl�s mound f» Aseviy rnvtohed as •protectlon from freezing• cwt exceed 220 BODY. T8fs, and 3Ek srpR F04 fps aeplia bank eft"tt 0 Wknent * M" intro /tie mound system may 30 mg/L BODS 30 mglL TSS, 1.0 mg/L FOG, and' f 0" cfu/t00 mL for highly treated effluent. Influent flow may not exceed maximum design flour specified in the permit for this installation. e end of each lateral, and n is recommended that each lateral The pressure detribution system is provided with flushing point at tfi the flushed .of .accumulated solids at -feast once awry 18 months. When .a pressure .test.is.performed -it should be VOMParsd to zo om test when .the system was installed to determine If orifice dogging has occurred and it orifice cleaning, le required to maintain ec&W &Ulbutkin wi t>frt itte disperse{ call. . s y , _. •. parsat.�ett.shell be.eheeked_for. eF� PondktA:bvele a)eu:br.M 1 .0 . . . a!!d:> fir 1e., . above -s Jaches considered as an impending Jvydcautic #a"4 1equIrkV additlo aL amm ,try oxitm Elan U the septic trdnk or an y ot't!s cocnponenbs become detective the tr+rnk or compora&t shalt be repaired or reps W keep tt to system in-proper opem*V con tf the twtk, PunW, pumP VOf&Oh, al�rm or miiated waMg be'x�raes•defacdive tfia• dafectiye•compoc►srt�s) sttallUe depaired or replaced with a Oomparw t of the sauce or aqual f erfor4la1w' � 111e ground surface, it wlb fepalFOd or in the mound cxwonent fafs to accept wastewater or bO9i ns to discharge vrast a vM.b -Yap* d or ja its' pr d pi � g, and by rep l a c cing s i d co basal areal s as 10 8"90 t r� necessary re the Web" robs IX opm" lated pipkg, nd lak><i said rnponersb See Page $ of this plan for the name and telephone number of your local pOW -S reyulstor and ar*e pic*W, project: WHAEL VAVRICKA Page 6 of 8 Performance Submersible Effluent Curves P METERS FEET 90 MODEL 3885 SIZE 3 /4" Solids WE15H O ' w i = 20 E10H 60 0 WE07H 5 �0 — — WE05 10 30 WE03M -- 20 WE03L 5 - 0 C 10 20 30 40 5C 60 70 60 90 100 110 120 GPM I , � 0 10 20 30 m CAPACITY �G0ULDS PUMPS,'NC' sr ► FA" ntw YcA METERS FEET 120 NSHH MODEL 3885 35 - SIZE 1 /4 " Solids 110 1�. 25 80 1 z 2C 60 0 15 50 WE05HH nn 1j 20 10 1 —14L 1 0 120 GPM t 1 0 " ?.Ci 30 m'7h CAPACITY �a�, Ge)uios n mna inr • l I 4 j £ h \ 4 h \ i L Relatio ns IndusVy SOIL AND SITE E V A L U AT 1 O r O R T Page 1 of 3 Division of S4ety & euildings in accord with ILHR 83.05, COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in siz m but St. Croix not limited to vertical and horizontal reference point (BM), direction and lope A CEL I.D. # a ?? - 0 ?1 6 3 !V dimensioned, north arrow, and location and distance to nearest road. 5 ,gg� -' pending APPLICANT INFORMATION- PLEASE PRINT ALL INFORMAT ON VA � WED Y DATE 1 PROPERTY OWNER: NOPERTYC6 C. Leroy Urhammer S 1/4,S14 T AR 20 1(or) W PROPERTY OWNERS MAILING ADDRESS # CJ Wre e n NAME OR CSM # 1501 Scout Camp Rd. Acre Ct . Es. First Addn. CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE MOWN NEAREST ROAD Houlton, WI. 54082 (715) 549 -6497 Somerset g idden Valley Cr. [x] New Construction Use [ x] Residential ! Number of bedrooms 3 [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow 450 g pd Recommended design loading rate .4 bed, gpd /ft .5 trench, gpd /ft Absorption area required 375 bed, ft 375 trench, ft Maximum design loading rate .4 bed, gpd /ft .5 trench, gpd/ft Recommended infiltration surface elevation(s) 98.80 ft (as referred to site plan benchma ) Additional design / site considerations system el. based on contour line of e14 97.80' Parent material glacial drift Flood plain elevation, if a)p bl na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem EIS ®U 13S U ❑ S ®U ❑ S ®U El F& ❑ S 9111 SOIL. DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Elcurxiary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 _ 1 0 -9 10 r4 3 none sil 2msbk mfr cs 2f .5 .6 2 9 -26 10yr5 /4 none sicl 2msbk mfr gw if .4 .5 Ground 3 26 -50 5 r4 6 none scl m na na na n .2 elev. 9 9.2 ft. Depth to limiting factor 26" Remarks: Boring # 1 0 -12 10 r3 3 none sil 2msbk mfr cs 2f .5 1.6 2 12 -41 0 r4 6 none sicl 2msbk mfr C1W if Ground 3 41 -60 5 r4 6 none sl m na na na n .2 elev. 98.7 ft. Depth to limiting factor 41" Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200t19 Ave., Ne R44mon4 WI 54017 Signature: n f Date: 10 -23 96 CST Number: m02298 Gv PROPERTY OWNER Leroy Urharrmer SOIL DESCRIPTION REPORT Page 2 of PARCEL I.D. endin D. # Lot #12 _ Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -13 10 r3 3 none sil 2msbk mfr cs 2f .5 .6 2 13 - 10yr5 /4 none sicl 2msbk mfr gw if .4 .5 Ground 3 38 -57 7.5 r4 4 none s1 2mcFr mvfr crw na .5 .6 elev. 95.2 ft. 4 57 -70 5 r4 4 none sl m na na na n � .2 Depth to limiting factor 57" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel Leroy Urhammer 1554 200th Ave. CSTM2298 SE4SE4 S14- T30N - R20W New Richmond, WI 54017 MPRSW 3254 town of \Somerset (715) 246 -6200 lot #12 -Green Acre Cty. Es. First Addn. 1 =40' BM.= top of SE lot Stake el. 100' �Y 1 /a Po , 2-1 Y AW Gary L. Steel 10 -23 -96 Safety and Buildings y RECEIVED 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 �sconsin AUG www.wis co nsin.gov 2 2 2002 www'commerc ns Department of Commerce wis ST. CROIX COUN - 1 Scott McCallum, Governor ZONING OFFICE Philip Edw. Albert, Secretary August 22, 2002 CUST ID No.224263 ATTN: POWTS Inspector KIM A O'CONNELL ZONING OFFICE K.O. CONSTRUCTION ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA Wl 54020 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/22/2004 Identification Numbers Transaction ID No. 778239 SITE: Site ID No. 649415 Michael Vavricka Please refer to both identification Hidden Valley Circle numbers, above, in all Town of Somerset correspondence with the agency. St Croix County SE1 /4, SE1 /4, S14, T30N, R20W FOR: Description: Proposed Four Bedroom Residence Object Type: POWT System Regulated Object ID No.: 867091 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: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans. • 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. - KIM A O'CONNELL Page 2 8/22/02 • 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 inspectors. Note: The 2" dia. manifold chosen by the designer is permitted based on the SBD Pressure Manuals. Owner Responsibilities: • Comm 83.52(1)(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. Owner Responsibilities Continued: • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is 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 @ 'swim commerce.state.wi.us J WiSMART code: 7633 cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM w e � oc 0 nerBu er ! hP P �d VNt'C �0.� Y �� Mailing Address 0 77, /' j )Adaot4 rV /x711/ Property Address �k4 3�dje ZU1'1 k ��o r1 (.�J (Verification required from Planning Depa ent for new construction) City /State 42 k 14t in 1A J Parcel Identification Number 0302. 210.E - A) -- Wo LE GAL DESCRIPTION Property Locatior4K '! <, �r '/4, Sec. -- 4_, T__N -R,2&W, Town of Qm � Subdivision !/ 4 ,v � Lot # /0 . Certified Survey Map # , Volume , Page # Warranty Deed # Volume , Page # - -- Spec house ❑ yes no Lot lines identifiable 1Xyes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 of the three year expiration date. / 0& SIGNA 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 ro described above b P Pe ITY y virtue of a warranty deed recorded in Register of Deeds Office. 4 A_4Y4� � D(a / D SIGNTURE 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 ''7 I • STATE BAR OF WISCONSIN FORM 2- 1999 657545 WARRANTY DEED KATHLEEN H. WALSH Document Number REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Justin J. O'Brien and Traci A. O'Brien, RECEIVED FOR RECORD husband and wife 10- 0I-2001 9:45 AM WARRANTY DEED Grantor, and Michael Vavricka and Rochelle Vavricka, husband and EXEMPT M wife CERT COPY FEE: COPY FEE: TRANSFER FEE: 187.50 RECORDING FEE: 11.00 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Name and Retum Address Dot1 Acre Country Estate First Addition. St. Croix County, . Dam a ESftm Hudson. WI Uole 032 - 2103 -10 -000 Parcel Identification Number (PIN) This is not homestead property. 0() (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this C2E 7W day of September 2001 ` + Justin J. O'E ie \ 4/1.1. 4 ". • Traci A. O'Brien AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ¢r q� ) ss. County ) authenticated this day of Personally came before me this _�5 - V day of September 2001 the above named Justin J. O'Brien and Traci A. O'Brien, husband and wife + TITLIME I I ONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by b 706.06, Wis. Stats.) instrument and acknowledged the same. ti THIS INSTRUMENT WAS DRAFTED BY + �Aevz / Attorney Kristina Ogland Notary Public, State of Wisconsin Hudson, WI 54016 My Commission is permanent not state expiration date: (Signatures may be authenticated or acknowledged, Both are not necessary.) _ . a ; 2 2o / :), J + Names of persons signing in any capacity must be typed or printed below their signature. Wormatwo Professwnau company, Fond du Lac, wi STATE BAR OF WISCONSIN 800-655.2021 WARRANTY DEED FORM No. 2 -1999 1 \� �N �'jC• Q�� lO m 1 0 Iry < C7 . r � � O Q I� o G 44 _ ` � M ° � � I O 0 m O In . ° ..� I ;o / �'4ti fD . n 10 ' 00 , F: r 4 I Z i .0 rn OD � w A� O 10 Irn P1 ti 11 I D D N i U) N 36o % Q Js • � ......... 9 S3 S1. F ca � O n Z O m x OD oZ IC ® o� - z m IZ --� m so I r I CD m ID U) N o N m I z ID m m ,� N cn i ((n I—I x :� �^ Irn � 0 O -4 x WO m