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HomeMy WebLinkAbout034-1024-50-000 Wisconsin Departrri-at of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Civision INSPECTION REPORT sanitary Permit No: 453376 0 GENERAL INFORMATION (ATTACH T(: PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, 9.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: McConnell, Richard I Springfield Townshi 034 - 1024 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: / 0-0-0 1 107)-6 11.29.15.164A TANK INFORMATION EL13VATION DATA 2.96 jp2.96 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. /e7• Septic Benchmark Dosing Alt. BM M: MZZ ;aeration Bldg. Sew &r �c mn 3034 w - {vr 11 • � 3 q1 �Z Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION �, \ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 71CO' 7 5 6 ' 1`7 1 _ Dt Bottom ��. 1 5 • y $7. 5 Dosing IT' 7 j 1 7 , _ Header /Man. Aeration Dist. Pipe z., /65•t/5 Holding Bot. System ITO 164, Final Grade /Y,�_ PUMP /SIPHON INFORMATION Manufacturer /I ,, (((( rr Demand St Cover q q 6 GPM 5 � !T d�l_o Mc�'f"t Cs ` G • dS ✓tio • I K eti Model Number Z / (03, q T Lift Friction Loss System Head TDH V Ft ,� Z.4 z , b Forcemain Length Dia. it Dist. to Well i a' - z. 5� SOIL ABSORPTION SYSTEM BEDPTRENCH Width Length No. Of Tr nche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / I �� � "� �� \ SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR C l J Type Of System: ` ` / /�� Model Number: �o� ` ' � A UNIT \ DISTRIBUTION SYSTEM Header /Manifold Distribution \ r� x Hole Size x Hole Spacing Vent to Air Intake J 11 Pipe(s) V 64) , ( /Z ? J \14 kA- i Length 3 Dia Z Length J Dia Spacing f� —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 I Bed/Trench Edges \, Topsoil ' COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: j / Inspection #2: Location: 1060 Rustic Rd 4 Glenwood City, WI 54013 (SE 1/4 NE 1 11 T29N R1 5W, ) NA Lot T K Parcel No: 11.29.15.164A 1.) Alt BM Description = S ,kc ��k'a- ° P �L A / 2.) Bldg sewer length = 7 Y � L i vj + ' L n = !- A a_ _XU I slc . - amount of cover = t W7 � d X'` -► T° v� t U �— — - - -- Plan revision Required? Yes formation. L SBD Use other side for additional in - 6710 (R.3/97) � I Date Inse or's Si ature Cert. No. v r r ° o i 4 h o v LN 14 Jk Olt a 7 c l s Z ^ ti 4r a �� n o k w a aq t � t o � 9 91 IN S N i N 1 e . e a �> n 0. (; 0 '_n Safety and Buildings Division Cqnly n n ' ` 201 W. Washington Ave., P.O. Box 7162 (�;1�(} 1 X (� SCOT sin . Madison, WI .5376 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 4 3 3 -+(0 Sanitary Permit Application State Plan /II..D(.' Numbe In accord with Comm 83.21, Wis. Adm. Code, personal information you provide VL may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if diff (ent than mailing address) I. Application Information - Please Print All Informati - ' Pro . . I is Nal i l Parcel # Lot # Block # i �._iL l:? 6 2004 Property Owner's ailing Address Property Location a L City j;�Zip Code Phone Number ' I 21 II. Type of Building (check all at apply) T N; R E oz 0� f 1 or 2 Family Dwelling - Number of B ooms 3 , _ / ❑ Public/Commercial - Describe U 10 3'1 A* ` El State Owned - Describe Use �C - - ID City_ ❑village lTownship e - M. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ° El New System lacement System ❑ TreatmentlHolding Tank Replacement Only El 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 IV. Type of POWTS System: (Check all that apply) ❑ ' Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil oum < 24 in. of suitable so' ❑ 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. DispersalMeatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Pro ed (sf) System Elev on �� iL VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Uni 9.44 �} . /� Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank c `} Aerobic Treatment Unit (•��' I L _ Dosing Chamber �01 e!5 f VII. Responsibility Statement- I, the tdidersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plu is N me rnu) I Plumber �, re MPEA4PA&Number Business Phone Number Plumber's Addre as (Street, City e, Zip Code) VIII. Count /De artment Use Onl XA pproved ❑ Disapproved Sanitary Permit Fee includes Groundwater Date Issued Is gent Signatur (N tamps) Surcharge Fee) ❑ O rven r Denial 3 IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 3 ) c�++�- �- 16D 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained r'L��P"�►+� l t 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 i not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) Safety and Buildings 4003 N KINNEY COULEE RD commerce .Wi.+gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 I t i www commerce.state.wi.us /sb www.wisconsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary June 11, 2004 CUST ID No.3412 ATTN: POWTS Inspector HERB J PELKE ZONING OFFICE PELKE PLUMBING ST CROIX COUNTY SPIA N6298 STATE HWY 25 1101 CARMICHAEL RD DURAND WI 54736 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 06/11/2006 Transaction ID No. 1007330 Site ID No. 684839 SITE: Please refer to both identification numbers, Dick Mcconnell 1060 Rustic Rd #4 above, in all correspondence with the agency. Town of Springfield, 54027 St Croix County SE 1/4, NE 1/4, S11, T29N, RI 5W FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 962913 Maintenance required; Replacement system; 450 GPD Flow rate; 21 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), 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. C fio No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, �� ' tip stats. The following conditions shall be met during onstruction or installation and prior to occupancy or use: DEPARTMENT OF g OF F' %EY General Approval Requirements:' SEE CORRLSF • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD- 10706 -P (N.01 /01). • The manifold diameter must be reduced to 1.5 inches so that the velocity of the effluent is 2.0 ft/sec or more. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • 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. - HERB J PELKE Page 2 6/11/04 • 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. Stat • Comm 8 3.22(7) A copy of the approved plans specifications and this letter shall be on -site during construction and op en to inspection by authorized representatives of the Department which may include local inspector Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construct ion/instal lation/o perat ion. 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 Charles L Bratz POWTS Reviewer I1 , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz@commerce.state.wi.us cc: Leroy G lansky, Wastewater Specialist, (715) 726 -2544 R ECEIVED JUN ° 7 2004 SAF 8 e Wastewater Treatment System OWTS LDGtS �'V Private On -Ste Y � ) Index and Title Sheet Owner: Project Name and System Type: G/i�a /� Ce.�,� - - -6�a. �uNO �o<✓rJ C � <Ot,oeP.rs�r) Location: Street Address 31 41 Legal Description �u,✓ of .SB�ir��'.r <r, �J ��toix moo. Township /County Contents: Page 1: zly,oe-x Page 2: A o r r� Page 3: `/loss - ,��c ri.,r ,o,✓o �.✓ G/�-.✓ of /7o,i,✓o Page 4: li'i.oe 1,o rr4wA Page 5: �c - Fria ..�,� /��.,,� G /6�.0�/.Olt G /1011 • �� rm .� Page 6: E D Page 7: Aos✓rs aAlwr4 s �.i.✓ara �,o.,i�v�sirE,✓r oLi� _ oMMERr t iNGS Page 8: ONDENC Page 9: Attachments: ,� i G if'd4SN9 rio r le k0 0 0 w r 2 A,6 rc A rra /y,�i.✓ rE.✓,�,✓e �.✓fe. Plumber/Drdgner: dd Signed: Credential Number: zW - 2 yi z Date: c -z - e 5l G>'SED .SdD - lee 71 -oO , ,,o C. O/Y�ONt Nl' /�.0•✓avL a IfE�Jie„! .? O axeo , .Sea ' n u. \ w NO r :� eA ell x �l h° t � w . e o ti a • O q� a D� � _` b e n a , )t N p ° r "•1 1'1 1 fZ � • � a a IN IK 0 ° u F — o —�i +r ° p \ �► h 1 a � a n ,c A a I t ( t o g 0 In IO I��IM IM. 1 R I H • b O � F 0� • b t. Y o � 'b c7 tie K . l C O. � hSt G i th M x O t o d Oe >< t a e � • I 0n o� r w Is e z 1 0 '0 ; �7H[T:M• `C W .�• p d rrIMM•=J9d rr rT n r* x M •I t I .b I I � s � �\ m 11 Q m h h u OF CDP It N a � Fd rn ►-� M h so h N W • Zo � 0 4 I 0 Page S Of 9 SEPTIC TANK E' PUMP CHAMBER CROSS SECTION* AND SPECIFICATIONS o.t ScN. y0. 4" Cl VENT PIPE 12" MIN. ABOVE GRADE 8 WEATHERPROOF ?: /0" FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVERS W/ PADLOCK E WARNING LABEL G ,Caro —4" MIN. 18 " IN. I N INLET I► WATER TIGHT SEALS Zgart GAS- f5trr�. TIGHT 1 ► APPROVED �'Joo A SEAL JOINTS WITH APPROVED --=- ; ALM APPROVED PIPE PIPE Ot TO SOLID ' ON SOLID SOIL SOIL PUMP OFF ELEV . Ba.s FT. _+_ OFF RISER EXIT D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: �j� ��,c, L,�o,�„ NUMBER DOSES PER DAY: • TANK SIZES SEPTIC /oar GAL. DOSE VOLUME INCLUDING DOSE Goo GAL.. FLOWBACK: /67L GAL. ALARM MANUFACTURER: �. `c. "44-S CAPACITIES: A = 20 INCHES = GAL. — MODEL NUMBER: ,o�,� o0r «v T SWITCH TYPE: / Ae_,•�r B = 2 INCHES = 33 G GAL. �C. 8 PUMP MANUFACTURER: ^,`rl4 o z,14111 C = _ G..S INCHES = ia9 z GAL. MODEL NUMBER: SWITCH TYPE: D = 7s INCHES = /,?G GAL. REQUIRED DISCHARGE RATE W,111 GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . /�.8 FEET .+ MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . FEET + yso FEET FORCEMAIN'X /.,5 - FT/100 FT. FRICTION FACTOR . FEET T.OTAL DYNAMIC HEAD = aa, y FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH S3 ; WIDTH 78 _ ; DIAMETER -' LIQUID DEPTH 3 Q G • Typical Application Hi h ca ari sum /efflu Sewage -- -. Typical Application` Sewage, Dewatering Y APP P ty P Capacities to 120 GPM (7.5 Vs) _ Capacities to 140 GPM (8.8 Vs) Heads to 28 ft (8.5 m) Heads to 28 ft (8.5 m) Electrical I I 5V, le, 9.5FLA, 6OHz; 23OV, le, 4.7 6OHz Electrical 115V, Is,12FLA, 6OHz 2OOV, le, 6.8fLA, 6OHz, Motor 4 /10 HP split phase w /thermal overload protection, 23OV, le, 6.0FLA, 6OHz; 2OOV, 3e, 4.1 FLA, 60 Hz; 1750 RPM 23OV, 3e, 3.5FLA, 6OHz 46OV, 3s,1.8FLA, 6O11z; Minimum Recommended Simplex =18" (457mm); J 575V, 3e,1.4FLA, 6OHz Sump Diameter Duplex = 30" (762mm) _ _ Motor (single phase) -1 /2HP Split phase w /thermal overload Automatic Operation Diaphragm pressure switch (m anual available) protection, 1750 RPM ; (three phase) • 1 J 2HP Materials of construction doss 30 cast iron _ _ polyphase 1750 RPM _ Impeller Thermo lactic non do _ _ _ Minimum Recommended Simplex = 24" (6O9.6mm); Discharge Size 2" (5O.8mm) __ Sump Diameter Duplex = 30" (762mm) -- -) olids handling 1 1 1/ 4" (3 .8 mm) Automatic Operation Diaphragm pressure switch (single phase only) S _ Power cord 10', SIX (20' optional) (manual available) Superior Features • Carbon/Ceramic type 21 mechanical seal Materials of constru C 30 cast iro n_ • Oil filled motor w /automatic reset thermal __ _ Impeller Thermoplastic nontlog overload for maximum protection _ Discharg Size 2" (5O.8mm); 3" (76.2mm) optional • Upper and lower single row ball bearing construction S olids handling 1.1 (38.1 mm) • Piggy-bock plug available for easy maintenance _ Power cord 1 e -10' , STW -A(2O' optional); 3e - 20', STW -A and replacement Superior features • Carbon/Ceramic type 21 mechanical seat • Oil filled motor w /automatic reset thermal overload for maximum protection • Upper and lower single row ball bearing construction . , •, 0 . • Piggy -back plug available for easy maintenance c. C t -4, and replacement to eon 1 .o en tly; p romise 9 30 L SP50 SP50AB z �.�, b 20 • - Zabel A 100 R Commercl SPECIFICATIONS APPi ICATIM The A100 is used in residentlal and carimerci�l septic ►acenu. It �---�5 is effeccye in multiEnngyh tal ptoTerty, achdols, o#ficrs and everywhere waatewater M t sl>spaldld SotldS content. 3 FLOWRATI 3,000 perfilter. JnsmgtwdorcnaefilterslnafVC"conaece gxta echieve.flows of 6.000 t amore. tec$ a►ich.Zabel FILTRATION: Pe ragon. 16 Disc Danis 1 tech provide 198 lineal feet of 2 INSTALLATION: The filter tt�ar be trotalied inside the tank or insulted m a Zabel k Container Assembly aat$ she septic tank. SERVICE: Service residential installatiotu whenever you pump the tank. O . r o a. 4-W LM O i MA t•an� —I f- - Y: , V'�/ • j • 1• it • I 11 11 11 1/ t y -- 1f«318' Dill. —► ... , , , lrem: Ma ulal Specification Cases, Lida, Reducers Rigid Vinyl PVC 87371 M L 2 26 Flker US T owe Discs High Impact Polystyrene 3 i 4 3 Rad Rod, Nuts High Density Polyethylene S 3 ; 1 Nit U.S. Patent No. 4,710,295 Call 1 -800- 221 -5742 or Fax (502) 267.8801 for further information. Maintenance The interval for servicing septic tanks is set by state and local code Throughout the United. States there is a wide difference of opinion on what this interval should be, but mbst;regulatdly zlgencI 'S suggest two to five years. The Zabel"' filter, which does not increase the frequency of servicing fbr the,tatik, should be cleaned when the septic tank Is normally inspected and pumped. However, our filter is virtually self- cleaning. The continued action of -the anaerobic organisms on the Zabel filter causes lodged particles-to. disintegrate and fall to the bottom of the tank. If your filter contains a Smartpiltel'" alarm; you will be notified by an alarm when the filter needs servicing. To �§arvlde the filter: "8ervtdng any zabel filter should only be done by a certified septic tank pumper-or Installer. I,.QCate the. d(d.K.6f the s��ank. and Ide dit Remove the tank of the ;a and su to to be u 9 ft ahy $01 Cor�tac? z � M o .� escaping to hvidiss when the re '.: .• t:. gig E q, '. '•. 1 f - While holding t the access inSeit cartridge '. back t. careful to 1`16,01 , ,. sure r< Mote: n b not Co. mp ba teftonlheAhB+':: rray Replace �wwW,'' Ma`Mw' The product(s) shown are covered by one or more of the following patents: U.S. 5,762,793, 5,580,453, 5,591,331, 5,759,393, 5,683,577, 5,582,716, 5,779,896, 5,593,584,5,795,472,5,736,035, 4,710,295, 5,382,357, 5,482,621 U.S. Des. 386,241, 349067, 4605501,5098568, Des. 309007, Australia: 134440; Canada: 2,135,937; Israel: 111574; New Zealand: 264824, Other Patents Pending Call for a free ZABEL ZONE An Onsite Wastewater Magazine 1 -800- 22.1 - 5742 • Website http1 /www.zabel.com A`100/3004 M,0499 r Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 8$,11Vis. adrrS: Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must 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. ; Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). AA� .' M T Property Owner Property Location � � WE � Govt. Lot S // T c? `I N R /GiC C Go.✓nJ�'L Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 04 was ric WD 004 -- — City State Zip Code( P one Number I [3 -eity 0 pillage ® Town Nearest Road /L Son/ CJ� �W (315- 1� X 7 9 �� .✓� i�l1 D �uss�c �o. I New Construction use:,® Residential / Number of bedrooms -3 Code derived design flow rate f�-s - d GPD a Replacement ❑ Public or commercial - Describe: Parent material otss oud a 6L.O61i d - ji[ 4 Flood Plain elevation if applicable �iQ ft General comments r /�oaro YYS1"E.y �acJrS /lEe arrrolwO SYS. 2� , - /D Y.7 0.✓ /03. `/ ca„�rou.c� and recommendations: l D�6�/ 6.�,oss ` /L LD / AQ,o.✓eo ✓ro Ex�sri.✓c sr�ric I.o.✓.�' a Boring # Boring , rr © Pit Ground surface elev. /Da?. 9 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 Gr. Sz. Sh. `Eff#1 `Eff#2 a Y, y/3 -- s, / a .� 6.� owl . G 3 22- yB swz wy lva-/ X 0 rz z / 'F 'i' Boring # ❑ Boring r �� 0 pit Ground surface elev. /oy y ft. Depth to limiting factor �7____✓r__ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 v .G . Effluent #1 = BOD > 30 < 220 mg /L and JSS >30 < 150 mg /L ` Effluent #2 = BOD _< 30 mg/L and TSS < 30 mg/L CST Name (Please Print) i ture CST Number Address Date Evaluation Conducted Telephone Number /So3 �i�<✓.vr fir, ,Iv W ' 64 Gj sy7o S 7-o y �/S 8.�s% Se lo Property Owner z�"/- X/ G o„f.1 L Parcel ID # Page of -� -] Boring # ❑ Boring ® Pit Ground surface elev. /e..? X � 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 xe 2 a Yit s -? — n s6,F e Z 6 F-1 Boring # El Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil App lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *041 *Eff#2 I Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. F1 Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.. *Eff#1 *Eff#2 I I I I I ' Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.07/00) • � � O N c'1 ^0 b H h y .J O O n H H z r 0 Ih ti .. IN all a z 3 rd r rd ;< o I t \ o a N n N � A a 3 L �� �' ► moo! �� � �3 � 0 a a 't a o g t- N b4 a POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner cz a Septic Tank Capacity /d a o g al ❑ NA Permit # Septic Tank Manufacturer / a ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Z.oarl ❑ NA Number of Bedrooms 100 d/bedroom 3 ❑ NA Effluent Filter Model yso ❑ NA Number of Commercial Units — NA Pump Tank Capacity G'66 g al ❑ NA Estimated flow (average)* o -o g al/day Pump Tank Manufacturer /0"d-ly- ❑ NA Design flow (peak), estimated x 1.5* ys-o g al/day Pum Manufacturer yo ,.,, ❑ NA Soil Application Rate Z G gal/day Pump Model ❑ NA Pretreatment Unit �'NA Influent/Effluent Quality (NA [I) Monthly Average ** [I Sand/Gravel Filter [3 Peat Filter Fats. Oil & Grease (FOG) < 30 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BOD5) 220 mg/L ❑ Disinfection ❑ Other: Total Suspended Solids (TSS) Manufacturer: Model: S 150 m Dispersal Cell(s) Pretreated Effluent Quality ❑ Monthly Average * ** ❑ In - ground (gravity) ❑ In - ground (pressurized) Biochemical Oxygen Demand (BODO < 30 mg/L ❑ At -grade 'Mound Total Suspended Solids (TSS) < 30 mg/L ❑ Drip ❑ Other: Fecal Coliform (geometric mean) < 10 cfu/100m1 0 Leaching Chamber Manufacturer Maximum Effluent Particle Size 1/8 inch diameter Model Laying Length/Chamber� *Wastewater Flow Verification and Calculations: Soil Application Rate gp d/ft 2 Area Req. fe (Other than bedroom based) Infiltrative Surface /Chamber -ESIA Ratin fi Minimum Number of Chambers ❑ Aggregate Desi Flow/Loading Rate= if min ** Values typical for domestic (non - commercial wastewater Materials: all materials must comply with WI Adm. Code and septic tank effluent. COMM84 and be installed per manufacturers specifications ** *Values typical for pretreated wastewater. and approval letters. -- DESIGN CRITERIA ❑ "Wisconsin At -grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.al.1990) ❑ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual' Converse, J.C. and E.J. Tyler. Publication 15.22 "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6 ❑ "Design of Conventional Soil Absorption Trenches and Beds ". R.J. Otis — ASAE Publications 5 -77 and "Design Manual — Onsite Wastewater Treatment and Disposal Systems ". EPA 625/1 -80 -012 October 1980 ❑ SBD — 10570 —P (8.6/99) "At -Grade Component Manual Using Pressure Distribution" ❑ SBD — 10567 P (8.6/99) "In Ground Absorption Component Manual" ❑ SBD — 10705 —P (N.01101) "In Ground Soil Absorption Component Manual" Version 2.0 ❑ SBD — 10628 — (N.6199) "Recirculating Sand Filter System Component Manual" ❑ SBD 10656 —P (N.6199) "Split Bed Recirculating Sand Filter System Component Manual" ❑ SBD - 10572—P (8.6/99) "Mound Component Manual" 1Ej( SBD - 10691—P (N.01 101) "Mound Component Manual' Version 2.0 SBD - 10595—P (8.6199) "Single Pass Sand Filter Component Manual" ❑ SBD - 10657 -P (8.6/99) "Drip -line Effluent Disposal Component Manual" ❑ SBD - 10573 —P (R 6/99) "Pressure Distribution Component Manual" XSBD - 10706 —P (N.01 101) "Pressure Distribution Component Manual" Version 2.0 ❑ Drip -line Effluent Dispersal Component Manual for Multi -flo Onsite Wastewater Treatment Units MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Frequenc Inspect condition of tanks At least once every ❑ months 3 a year Maximum 3 s. Pump out contents of tanks When combined sludge and scum equals one -third 1/3 of tank volume Inspect dispersal cells At least once every ❑ months 3 X year Maximum 3 s. Clean effluent filter At least once eve months ❑ year (s Inspect pump, pump controls & alarm At least once every ❑ months 319 ears ❑ NA Flush laterals and pressure test At least once every ❑ months 3 JZ year(s) ❑ NA Valves At least once every ❑ months ❑ ears 0 NA Other: At least once every ❑ months ❑ ear (s) ❑ NA Page -7—of-2— f START UP 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. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water - saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable /fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. ❑ Valves Valves shall be operated in the following manner: ❑ Alarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual Iicensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back -up of sewage into the dwelling or surfacing. INSPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). Septic Tanks Component Tank inspections must include a visual inspection of the tank 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 backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one -third (1/3) 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 NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. Pump Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of any filters. Any service needs or repairs shall be promptly taken care of ❑ In- Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Page 8 of 9 Mound, At- Grade, In- Ground Pressure The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code. All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. - The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. - After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other 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 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. PV 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 CONTIAN 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 4d Afzer Name Lo ai✓s Phone 715 <7. - ,S 1Lt Phone SEPTAGE SERVICING OPERATOR um er - �.Gve u✓ LOCAL REGULATORY AUTHORITY Name Agency Z.. Zc,✓i.✓� Of/ Phone Phone 7 1,S .48c - jV K: \WPDATA \EH\POWTS OWNER'S MANUAL.doc Page 9 of `� ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND , OWNERSHIP CERTIFICATION FORM Owner/Buyer !' �-� I'\fl� ( I Mailing ddress o (a� �L1S f� I k;►CJC � r Property Address �- (Verification required from Planning Department for new construction) City/Stat " T! �- Parcel Identification Number . . 165'►) LEGAL DESCRIPTION Property Location '5� %a, % a, Sec. 1 , T N -R rS W, 'Town of r) � . Subdivision , Lot # Certified Survey Map # Volume Page # Warranty Deed # , Volume Page It S '1g Spec house ❑ yes1kno Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper' verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of theffiree year expiration date. ,fc / Z F9 U SIGNATURE OF AP1 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 pro rty described above, b virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APl'L' ICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed DOCUMENT NO. WARRANTY DEED 575971 nL 1.309 parf'578 REGIS R'. Fi T �� . C THIS DEED, made between James L. OOv cue L. � !er 'ecorel • Ov It h d and wife, Grantor, an 'chard H. McConnel and La A. McConnel , usband and wife, Grantee, MAR 3 U 1998 SS , That the said Grantor, for a valuable consideration of 8:00 A. one dollar and other valuable consideration conveys to Grantee the following _ \� i'+/t described real estate in St. Croix County, State of Wisconsin: `5( Re gister of De e ds The South 1/2 of the Southeast 1/4 of the Northeast 1/4 of Section 11 RECORDING INFORMATION Township 29 North, Range 15 West EXCEPT the South 350 feet of the • • • • • • • • • • • • • • • • . • • • West 350 feet thereof AND the North 1/2 of the Southeast 1/4 of the NAME AND RETURN ADDRESS Northeast 1/4 of Section 11, Township 29 North, Range 15 West. Thomas A. McCormack 740 Main Street Baldwin, V1 54P P2 T ANS o 034- 1024 -50 3 , (Parcel Identification Number) This is homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; and Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, highways, utility rights and reservations of record, and will warrant and defend the same. Dated this 13 day of March , 1998 4 • (SEAL) (SEAL) James L. Overholt • (SEAL) (SEAL) * acaue L. Overholt AUTHENTICATION ACKNOWLEDGEMENT Signature(s) of James L. Overholt and Jacque L. Overholt STATE OF WISCONSIN } } as. ST. CROIX COUNTY } authenticated this lAk day of March , 1998 Personally came before me this day of 19_, the above named * Tim AV J. Scott TITLE MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person who authorized by § 706.06, Wis. Stats.) executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY: Timothy J. Scott BAIUM NORMAN, S.C. NEW RICHMOND, WISCONSIN Notary Public, County, Wisconsin *Names of persons signing in any capacity should be typed or printed below their My Commission is permanent. (If not, state expiration date: signatures. , 19 St. Croix County Map Output Page Page 1 of 1 St. Croix Count Ma in a � Ji x? y .. 1 . r F , ,yr'�a3 C�4 s � y q "< # 5R' M��YGpa� 6o«ida4s St. Croix County Planning Department 1101 Carmichael Road .=erase d a.rvey Maps Hudson, WI 54016 0 P�Cwcb" Phone: (715) 386 -4674 P01 Orai rage DISCLAIMER: The information contained on this map is advisory. Map Streams accuracy is limited by the quality of the public records from which it was pa ,,, prepared. It is not intended as a substitute for an accurate field survey. nerrerdal beam nrerm rreni ,^..ream AERIAL PHOTOS : Aerial photography is date - sensitive. Features that exist x '�` presently in the County may not be present in the photos. http: / /stcrxdmz/servlet/com. esri.esrimap. Esrimap? ServiceName= StCroixOV &ClientVersio... 7/12/2004