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HomeMy WebLinkAbout036-1022-10-000 rr Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix 34 ty and Building Division 0 INSPECTION REPORT Sanitary Permit No 463365 0 GENERAL INF6R119ATION (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: Salstrom, Wade & Dena I Stanton, Town of 036- 1022 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /W) r6 Nn \ GAT 10.31.17.1428 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � ` zinc Benchmark 3 �� �b3•� f� Dosing Alt. BM a �d0 0 98.8 Aeration / Bldg. Sewer f 1. 9Z S(j Holding St/Ht Inlet ��yy � A44%;, ao St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/ WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 7 -7 1 Dt Bottom 17 Dosing ,AN- `-7 1 -7 l Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade l [3 1 15 G T 9 ! q 8 , $ a PUMP /SIPHON INFORMATION 1 Manufacturer Demand St Cover r Gl GPM 4 . 1 O Model Number P& 41 1 5� t� 419 TDH Lift, Friction Loss System Head TDH t / / , Z% I a , Forcemain Len th Dia. Z t1 Dist. to Well 'vim SOIL ABSORPTION SYSTEM BEDITRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside D ia. Liquid Depth DIMENSIONS 3 Z f Q�G I `— SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: -- , IN Type Of System: CHAMBER OR ► v�J7►t 7 /6 � �� I A j - ° UNIT Model Number: J `. DISTRIBUTION SYSTEM / Q Z„ Z # - 4 Header /Manifold Distribution x Hole Size x Hole Spacing Vent to A� Intl Length Dia T Length N Dia \ Spacing SOIL COVER Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Dft Over xx Depth of Seeded /Sodded xx Mulched Bed /Trench Center Bed rench Edges '!.� Topsoil Tx No ' es No COMMENTS: discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / Location: 2247 170th Street Star Prairie, WI 54026 (NW 1/4 SW 1/ 10 T31N_ R1 7W) NA Lot Parcel No: 10.31.17.1428 1.) Alt BM Description = ` ` Cap ���� ►0 v`�`'�' � _ " � 2.) Bldg sewer length = , / (Z I zj - amount of cover = r Plan revision Required? Yes -\ -7 (4 bL � / Use other side for additional information. ✓_ Date Insepc is Si ature Cart. No. SBD -6710 (R.3/97) APR -12 -2005 16:28 FERGUSON ENT HUDSON 715 386 6144 P.01 PUMPS [R GOULDS Submersible Effluent Pump PE �• .P•7A �'il. �'Iww PUMP b�- SPECIFICATIONS MOTOR FEATURES Pump – General, General: ■ Corrosion resistant • Discharge: l'A" NPT • Single phase construction. • Temperature: 104 °F (40 °C) • 60 Hertz ■ Cast iron body. maximum, continuous when • 115 and 230 volts ■ Thermoplastic impeller and fully submerged. • Built -in thermal overload Pro- cover, • Solids handling: T/2" tection with automatic reset. ■ Upper sleeve and lower maximum sphere. • Class B insulation. heavy duty ball bearing • Automatic models include a • Oil- filled design, construction. APPLICATIONS float switch. • High strength carbon steel ■Motor is permanently Specially designed for the • Manual models available, shaft lubricated for extended following uses: • Pumping range: see PE31 Motor: service life. • Mound Systems performance chart or curve, • _33 HP, 3000 RPM ■ Powered for continuous • Effluent/Dosing Systems PE31 Pump: • 115 volts operation. • Low Pressure Pipe Systems • Maximum capacity: 53 GPM • Shaded pole design IN All ratings are within the • Basement Draining • Maximum head: 25' TDH PE41 Motor working limits of the motor. ��.._. • Heavy Duty Sump/ PE41 Pump: • .40 HP, 3400 RPM ■ Quick disconnect power Dewatering • Maximum capacity: 61 GPM • 115 and 230 volts heavy d 16�rd length, duty • Maximum head: 29' TDH • PSC design heavy or uty volt grounding PE51 Pump: PE51 Motor: Plug • Maximum capacity: 70 GPM • .50 HP, 3400 RPM ■ . Complete unit is heavy duty, • Maximum head: 37' TDH • 115 and 230 volts portable and compact. METERS FEET ' PSC design ■ Mechanical seal is carbon, 40 i — ceramic, BUNA and stainless j I I I i MODELS: PE31, Pf 41, PEST steel. PE5i� , 35 I I I 10;33-40_ ■ Stainless steel fasteners, 30 I - ,' 2 � AGENCY LISTINGS GS i Fr i I I �� 4 I C Us 20 rested to UL 778 and I i I I i I I I i I I I C5A 22.2108 Standards 0 15 I I I I — '� - ' I I t I BY Canada SUrWhrds ASSa"on f -� I -• i � ' I Fik,#LR36509 II ` 10' I ` _ - — I i I I I Goulds Pumps is ISO 9001 Registered. ' I� I I � 1 1 ' 5 0 ` I I I ° 0 10° 20 '~ 30 40 50 6o 70 GPM 80 0 5 1 0 15 m Goulds Pumps ®2004 ITT Water Technology, Inc- CAPACrrY WeSI iveJune, zoos BpE31 {41 ITT Industries Y . RECEIVED Wisconsin Department of Commero JU 0 2 2§@L E ALUATION REPORT Page I of 3 Division of Safety and Buildings in acc4r�arwg wdh Wis. Adm. Code S ( FFtt �U X 11 0 U T Y Co ST. CROIX Attach complete site plan on pa not Ie4 QWtRjC fiches in 5ize. Plan must include, but not limited to: vertical , direction and Parcel I.D. 036 - 1022 - 10 - 000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location DONALD DuBOIS (Buyers: WADE & DENA SALSTRUM) Govt. Lot --- NW 1/4 SW 1/4 S 10 T 31 N R 17 �0 Property Owner's Mailing Address Lot # Block # Subd. Name or CSW 2268 170th STREET -- - -- -- city State Zip Code Phone Number ❑ Wage ■ own Nearest Road New Richmond, I WI 1 54017 1 ( 715 ) 248-3151 170th Street I] New Construction UseE] Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material outwash Flood Plain elevation if applicable - ft. General comments Conventional In- ground Trenches and recommendations: To Be Designed by Installer )((REVISED REPORT: ELEVATIONS RE- ESTABLISHED DUE TO BMPS DESTROYED) t g A/ a , Boring # ®�� red, o - +D f Spit Ground surface elev. 98.98 ft. Depth to limiting factor 48 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/if in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Ef1#1 I - Eff#2 1 0-8 10YR2/2 - 1 3f -mabk mvfr as 3vf -co 0.6 0.8 2 8 -13 10YR3/3 - I 2f -msbk mv­fir cs 2vf-co 0.6 0.8 3 13 -18 10YR3 /4 - I 2f- ma&sbk mfr as 2vf -co 0.6 0.8 4 18 -33 10YR3/4 — sil 2fabk mfr as 2vf -m 0.6 0.8 5 33 -38 10YR3/4 -- sl lfabk mvfr as lvf-m 0.4 0.7 6 38 -48 10YR5/6 — s Osg dl as -- 0.7 1.6 7 48 -55 10YR5 /6 f2f 10YR4 /6 s Osg dI -- — 0.6 1.6 2 Borg # Boring 99 90 52 ■ v. to limiting in. pit Ground surface elev. ft. Depth +rating Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 10YR2 /2 — I 3fabk mvfr as 3vf-co 0.6 0.8 2 4 -15 IOYR3/3 — 1 2f- ma&sbk mvfr cs Lvf-co 0.6 0.8 3 15 -34 10YR3/4 — sil 3fabk mfr aw 2vf-co 0.6 0.8 4 34 -52 10YR3 /4 - A Imabk dsh as lvf-m 0.4 0.7 5 52 -54 10YR3 /4 t2d 10YR5 /6 s l lmabk dsh -- lvf-f 0.4 0.7 (Horizons 4& 5 have some pockets of s. * Effluent #1 = BOD > 30 < 720 mg/L and TSS >30 < 150 mg/L ' Effluept #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) nature CST Number Mary Jo Hollister & 224832 Address Evaluation Condu cted Telephone Number W9875 690th Avenue, River Falls, WI 54022 12 - 21 - 04 & 05- 31 - 05 (715) 426 - 1775 l r Property Owner SALSTRUM, Wade & Dena Parcel ID # 036 - 1022 -10 -000 Page 2 of 3 Boring ❑ Boring # Pit Ground surface elev. 98.90 ft. Depth to limiting factor >55 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 I *EM2 1 0-5 10YR2/2 -- 1 3fabk mvfr as 3vf-co 0.6 0.8 2 5 -11 1 IOYR3 /3 -- I 2fabk mvfr as 2vf-co 0.6 0.8 3 11 -19 10YR3/2 -- I 2f -mabk mfr as 2vf-co 0.6 0.8 4 19 -26 10YR3 /4 __ sl 2f -msbk mvfr cs 2vf-co 1 0.6 0.8 5 26-40 7.5YR3/4 -- is lfsbk mvfr cs lvf -m 0.7 1.6 6 40-47 7.5YR3/4 — s Osg ml cs lvf-m 0.7 1.6 7 47 -55 10YR3 /6 — s Osg dl -- -- 0.7 1.6 ❑ Boring # C] Boring Q Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff` in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring # ED Boring F Q Pit Found surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Mused Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg1L ' Effluent #2 = BOD < 30 mg& and TSS < 30 mg1L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altemate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD- 8330Test (R.07 /00) PLOr PL 3 SAISCRUM w u*u Owl t e 1#3 l N C A - `�'MnG�QS�'an'1 7 y4C1�S lu • X9a1 D83 � � ��,c� gh► Z O trove T. M _ a S ic 1 Safety and Bu' Division County 57+ C n O r 201 W, Washingto Box 7162 f� 1 visconsin Madison, WI 53 16�/j Sanitary Permit Number (to be filed in by Co.) Department of Commerce (608)266- 315 UU 33 S State Plan I.D. Number Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, personal information ou pro RECEIVE pro ec Address (if different than mailing address) may be used for secondary purposes Privacy Law, s15.04(1) (m) J I. Application Information - Please Print All Information u 5 Property Owner's Na me 11Parcel Lot N Block k Property Owner's M ailing Address I� Property Location — Z Z 6 2 7D �` t — 4 JU V/4 W /a,Section /0 City, State Zip Code / Phone Number ,A l e14 AhA)b tJ 5 �Y 71✓ Z 4?9 349 -1 cucle T REot II. Type of Building (check all that apply) 1 or. 2 Family Dwelling - Number of Bedrooms 1 � n /JW. Public /Commercial - Describe Use L &+ D� ?_Q cc �� ❑ State Owned - Describe Use - ❑City_ ❑Village KI'ownship of S +J+N III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System p y' ❑ Treatment/Holding ) y g Y ❑ Replacement System g Tank Replacement Only Other Modification to Existing System I List Previous Permit Number and Date Issued B. ❑ Permit Renewal 11 Permit Permit Revision Change of ❑ Permit Transfer to New Before Expiration Plumber Owner IV. T e of POWTS System: (Check all that apply) ® 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 ❑ Othe (explain) V. Dispersal/Treat ent Area Information: O Design Flow (gpd) Design Soil Application Rate(gpdso Dispersal Area Required (so Dispersal Area Proposed (so System levation �, y b 0 h 6-ft .s�Q���1ri X4 , ' ) VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Stec Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit / C Dosing Chamber p / VII. Responsibility Statement- I, the undersigned, assume resp lsibility for installation of the POWTS shown on the attached plans. Plumbe 's Na me (Print) Plumber's Si gnature MP /1 fHC Number Business Phone Number 2- `z 7 715 Z ZJ 10 4-�q* Plumber's Addre ss (Street, City, State, Zip Oto VIII. County/Department Use Onl Approved ❑ Dis Sanitary Permit Fee (lrcludes Groundwater Date Issued I sui Agent Signatur (No Stamps) _ Surcharge Fee) ❑ Ow ven Reason roi- - ,?V - _ LX-Conditions( Appro /R 3 6— � Z tr SYSTEM OWNER. ��� Cta -�A, 1 Septic tank, effluent filter and �,� ,� a dispersal cell must all be serviced / maintained (" �"`�`' as per management plan provided by plumber. � 2. All setback requirements must be maintained • as per applicable code /ordinances. eh r V i.J"L""'.�` Attach complete plans (to the County only) fo the system on paper no t less than 81/2 _11 inches i size '�� v /� SBD -6398 (R. 01/03) q5 SAS ('U`'`R �''°� T 1 � &� PLO+ At arA — ujAb6 A. o C-vq 1 �e 2 A C2ES n � C a� JL �tPE M 160 w� D tuU� -w 6 COPY G , - Combinatio.n SepC;ic-',Tank and PI"1MP CHAMHER CR0S5 SECTIOW W10 51ECIFICATIOh15 VElJ7 CAP WEATHER FKOOf JLIIJCTIQ►J 60X VEMT PIPE APPROVED LOCKIWG !j0' FROM DOOR. MA?JHOLE COYER r-vi'M ` wARr�If1G 1.A.6E4. - .iiUDOW OR FRESH cor�tw�r 1tJSP�Cj101J C' lP A. p oiTAKI ' I S� ' w+w , • � b Mi�JC . .. I y' MI)J. ,• PROVIDE I - - - -- IAILET �' AIRTIGHT SEAL � - ( APPROVED JOIJQT� APPROY) =D J0IMT Z1't8� �t4 A I II W /C.T. PIPE�P�c W /C.T. PIPEOK Tank construction I II ALARM shall comply with I II ILHR ()3.15 and 33.20 ° 1 j I I o►J C • I 1 PUMP -� OFF D CQtJGRETE 5LOCK 3 APPSN >: RISER EXIT PF- R.M1TED OIJL� IF TAWK MAUUFACTLJRE.R HAS SUCH APPROVAL BEDDING SEPTIC F 5PECIFICATIOKIS DOSE Wl� CUiC eZ Tom. tjI-LmSER OF DOSES: PEK DAy TA►JK IAQUFACTLJRCR: TAfJK fdZC *.. GALLOKIS DO5E VOLUME ALARM AMUFACTUR.CR: S.� C� ICCQ S�1S `�l IAJCLU01mca OAGKF GALLONS M MQDEL ►JUM6EK: 0 Nw CAPACITIES: A= 23, d IUC14C5 OK lam— CALLOUS SWITCH TJPL: ? - i 8 = � IUCHES'OR G�LLOU5 PUMP MAIJUFACTUREK: -S C = OR L, MODEL MUMBER: ��n �'T�J DF IAif,HES OR F .-=� GALLOIJS 5WI7CH TYPE: w»z IJOTF: PUMP AMD ALAKIn ARE TO dL MWIMUM D15CKARGE RATE -- GPM INSTALIEO Ohl SEP1,Rt,TE GIRCL11T5 VEKTICAL DIFFEIII DETWCEU PUMP OFF AIJO..DI5TRI5IJTIOQ PIPE.. 'Z IrE ET t KIWMUM METW ORK SUPPLY PR� C E$SURE .. ... , ... V FE + � � FEET OF FORCE MIM X . ` L�..__ F/ IOarL FKICTIOU FALTOR..- --/ ' FEET TOTAL Cy JAMIC. HEAD 1 FEET As per .rianufacturer gal /in. W M E40 series "M® 4/10 IMP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 N 30 L H 25 8 C.] M I1 20 = 6 F- �5 J O F 4 1-- 10 5 2 0 0 10 20 30 40 50 60 70 80 90 100 0 CAPACITY GALLONS PER MJ NUTE r. E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 K3326 7/91 Printed in U.S.A. CONVENTIONAL SYSTEM CROSS SECTION i NO SCALE I r - ---� -- I L ;`•F `� r ��z 11 " J.i 12 COVER 12 COVER , I CO , I 12 COVER MON U` ?i'ian l� .. ..:. ..t <.l. ....... E�.... .... .... ..:... I .. t ,..,5 .... .. ..: •,... ... .. , . ..1, . ..t ,. . k. jJ x�ii•.' f .: <:F. � t 4'� -�� � ` ^,. .H .. ....,..., .I .. I :.. t..,. .....: .,.. ,. .,,.. . >. "L. J. ° .'' • €:v �;i`t:i .3.;'. .: i7i .t ,s'.... :., .t�...: ,,. ..: >s. , .�... n .t k. {.i ..,:, .l,,, Il.,..n.. q...:. •., .... .., 1., .. . >.. ;•':..; .! .. .. lJ l: •k•Is'4« : ,. ")C ..c:..�l. 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I. .... .: 1..,1 i 11.. , > ... ... ,.: . 1 '$• >. ;,. �. , :,. .....:4:'.:' ::i•; , ::�l; tlal yl, yr.(` ;.1.x;4`: �:, I ELEVATION TI IN SITU SOIL T2 l liL; z5 i i I QUICK 4 STANDARD 1NFILTRATO.R DIMENSIONS: HEIGHT 12” LAYING LENGTH 40" WIDTH 34" I I I i i � I POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of Z FILE INFORMATION SYSTEM SPECIFICATIONS Owner 4J R-dC- d__ 5,41- s /ZOM Septic Tank Capacity — Z al ❑ NA Permit # q 4 9 Septic Tank Manufacturer WI S -f-ft ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 'Z 1 IF i5—L ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model d-v ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity 6 al ❑ NA Estimated flow (average) g al/day Tank Manufacturer ❑ NA al /da W(>r 3��- Design flow (peak), (Estimated x 1.5) 6 ©'q g al/day Pump Manufacturer 1 &Y6-k- S ❑ NA Soil Application Rate • al /da /ft2 Pump Model /yfLc ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ 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: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L JIL In Ground (gravity) ❑ In Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 51W cfu /100ml ❑ Drip -line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once ever ❑ month(s) (Maximum 3 ears) ❑ NA p y' 13 year(s) y Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect ever dispersal cell(s) At least once ❑ month(s) (Maximum 3 ears) ❑ NA p Y' y • year(s) Clean effluent filter At least once every: ❑ yea • month (s) ) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Page Z 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 shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: • A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. • A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. • 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 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 AJ6-j,f B --N Name Phone ��5:, z 7 3- Phone i SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY E e Name + GA I C� L(� V ne Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �� 20 de v !> / - ?,A - SCC '/r0 /_h Mailing Address Z z- b g 17 O -�' A Property Address 2 Z T l�� 0 S (Verification required from Planning Department for new construction.) City /State Parcel Identification Number Z _ z _ LEGAL DESCRIPTION gl Property Location U J %4 , S 1 / 4 , Sec. T _]�LN R�ZW, Town of u « Subdivision re Uj Lot # Certified Survey Map # , Volume Page # Warranty Deed # ZY 9 Z , Volume z 73 Page # Spec house yes no 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 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. Owner maintenance responsibilities are specified in § Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County 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. 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 Department within 30 days of the three year expiration date. r SIGNA OF APPLICANT DATE OWNER CERTIFICATION I/we certify that all statements o this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property esc�bed ab e, by a of war ty deed recorded in Register of Deeds Office SIGNATURE OF APPLICANT DATE * * * * ** Any information that is misrepresented 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 and a copy of the certified survey map if reference is made in the warranty deed. U 2 7 3 OF 1 8 0 7ErS `3 �-7 STATE BAR OF WISCONSIN FORM 3 - 1998 KATHLEEN H. MALSH F DEEDS Document Number QUIT CLAIM DEED ST. CROIX , W1 This Deed, made between Donald F. DuBois, a single man, RECEIVED FOR RECORD 01/27/2005 10 :00AM QUIT CLAIM DEED Grantor, and Wade A. Salsh'om and Dena A. Salstrom, husband and wife kXEPipl 9 e as survivorship marital property, NEC FEE: 11.00 TRANS FEE: COPY FEE: CC FEE: Grantee. PAGES: 1 Grantor, quit claims to Grantee the following described real estate in St. Croix County, State of Wisconsin- Recording Area _. Na and Retu Addoas _,�..__ -- _ Judith A. Remington REMINGTON LAW OFFICES Two acres in the northwest corner of the Northwest Quarter of the Southwest P.O. Box 177 Quarter (NW 1/4 of SW I/4) of Section 10, Township 31 North, Range 17 West. New Richmond, WI 54017 036 - 1072 -10-M Parcel Idemtficatton Number (PIN) This is not homestead property. I((is) (is not) l w ` I Together with all appurtenant rights, title and interests. c Dated this day of January 2009 ` . DONALD F. DuBOIS Y i AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ) a& ST. CROIX County ) Personally came before me this _ � #Ad authenticated this day of January , 2005 the above named Donald F. DuBois, a single person, TITLE: MEMBER STATE BAR OF WISCONSIN of m r to me known to be the person(s) who cx uted 046^1mrgoing�i r 1 t and acknowled c th authorized by § 706.06, Wis- Stats.) e same THIS INSTRUMENT was DRAFTED BY - Jndith A. Remington, Remington Law Office, Judith A. Remington = O f 4) P.O. Box 177, New Richmond, WI 54017 Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are not My Commission is pertnanenL trot, state cap new ate: necessary.) -Names of persons signing in any capacity should be typed or printed below their signatures QUIT CI AIM DEED STATE BAR OF wIBCONSIN FORM Na 3- 1"S INFORMATION PROFESSIONALS COMPANY FOND DU LAr- WI 3e0- 653-2021 St. Croix County Map Output Page Page 1 of 1 St. Croix Count Ma in 7 ti . e.2t +o f t� fi ar t^ s 2; kv 7U y " �4 4 ¢ A x;;„ N�tf 11+x► % � �" } K , A /' Legend MarticlP.IDr @aartdales St. Croix County Planning Department 1101 Carmichael Road 'Cerl d arvey Maps Hudson, WI 54016 Parcels V Phone: (715) 386 -4674 P° 0 P Mra d Arai wage 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 Dam prepared. It is not intended as a substitute for an accurate field survey. Permrdaf feam nWrml I1en1 :=)heam AERIAL PHOTOS : Aerial photography is date - sensitive. Features that exist presently in the County may not be present in the photos. http: / /69.5 8.147.26/ servlet /com. esri. esrimap. Esrimap? ServiceName= StCroixOV &ClientV ... 3/30/2005 s � ,';M r� -�,�. � ,fi N >., ✓° � ;!' o rz '`�x' #✓ f ,#,✓'�✓'' y ✓ ��''' � �,.a t J� ✓' t � V ;,r .5 ��`a x # � �!� ;'a� s�,^" 1 ✓ =r" af'� ,#' ✓ J . �,r ,r' �y y, � ',�,} J# # •: ,t � �� ,��«r � /' ° , 'Y ,f �r+ ,�` ,✓ '� # ' x x" , T r i,•° ��'.J V } 1' ° ' '` �� y ^r f "��p r�r+'� { l' / F +' r � •�'� :.�. k , ✓ � ` �,� ' x � � /` s✓ , �, ` T , , r J ' v ' Y v " f t'A' 'T s Y � f � . ...# ` ? 6- :/x # yI ,J' F d` g �.r" s A"F..r s ��' ° Y x ` f � ✓ f ' „ _ d ye � �.. pw.. ;i ✓ #' ''' �, x 4 r3 e 5� • ; _ 'wiz � � ��� f oft rtw. xb�.r L A t tit I V c,%-- ? 1 . Co M gaa P y � Dtilutw- �O� Wisconsin Departrrlen of IL ALUATION REPORT P age of 3 Division of Safety and Buildings ) 5 _� ti, canoe vdtr cornet code Attach complete site plan on pa not Ie thehes my ST. CROIX include, but not limited to: vertical tats r(i�, d. parcel LD Percent slope, scale or d'xrv� rrorttr a ovation and distance to 036 -1022 -10 -000 Please print all information. r Date Personal information you provkle may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). properly Owner Property I.ocalan DONALD DUBOIS (Buyers: WADE & DENA SALSTRUM) Govt Lot —NW 114 SW IM S 10 T 31 N R 17 Property Owner's Mang Address Lot # Block Subd. Name or CSW 2268 170th STREET - — - Cdty State Zip Code Phone Number oCity []lldiage IDTown Nearest Road New Richmond, I WI 1 54017 1 ( 715 248-3151 170th Street E] New Construction L)seE) Residual I Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material outwash Flood Plain elevation if applicable A R General : [ "(� t� S r� Ak Conventional In- ground Trenches - o.b Law W& RA't C A/&*- /► _ _ _ To Be Designed by Installer � - P yyS� f E �loW`' (4„ �) . ct ut F i l' s tr ` # Q pit Ground surface elev. 99.25 ft. t Depth tCrl TOV f Sod Application Rate TT Horizon Depth Dominant Redox Description Texture Structure Consistence Boundary Roots GPDIff In. Msell Qu. Sz. Cont Color Gr. Sz. Sh. *0M - Etta un 1 0-8 10YR2/2 — 1 3f-m6k mvfr as 3vf-co 0.6 0.8 2 8 -13 10YR3/3 — 1 2f -msbk mvlr cs 2vf-c o 0.6 0.8 3 13 -18 10YR3/4 - I 2f- ma&sbk mfr as 2vf-co 0.6 0.8 g 4 18 -33 10YR3 /4 - sil 2fabk mfr as 2vf-m 0.6 0.8 5 33 -38 10YR3 /4 - sl 1fabk mvfr as lvf-m 0.4 0.7 6 1 38-48 10YR5 /6 — s Osg dl as — 0.7 1.6 7 48 10YR5 /6 t2f 10YR4/6 , s Osg dl — — 0.6 1.6 11 2 Boring 9 # 99.15 52 1 � " ❑ Pit Ground surface elev. ft Depth to Ming factor in. Soi Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rods GpDAF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Etllt'I -Efla 1 0-4 10YR2/2 - 1 3fabk mvfr as 3vf-co 0.6 0.8 _N1 2 4-15 1 10YR3/3 - 1 2f-ma&sbk mvfr cs 2vf-co 0.6 0.8 3 15 -34 10YR3 /4 - sil 3fabk mfr aw 2vf-co 0.6 0.8 4 34-52 10YR3 /4 - s1 lmabk dsh as lvf-m 0.4 0.7 1�p 5 52 -54 10YR3 /4 Oct l0YR5i6 sl lmabk dsh - lvf-f 0.4 0.7 (Horizons 4& 5 have some pockets of s. g - Eft ent #1 = BOD > 30 < 220 ffq L and TSS >30 150 mg& ' Eftm t 42 = BOO < 30 mg& and TSS < 30 mg& CST Name (Please Print) - - Sigruature CST Nunber M Jo Hollister 224832 Address Dale Evaluation Conducted Telephone Nunber W9875 690th Avenue, River Falls, WI 54022 12-21-04 (715) 426 -1775 Property Owner SALSTRUK wade 8t. Dena Parcel 1D # 036- 1022 - 10-000 page 2 of 3 3 Boring # Boring 0 Pit Ground surface elev. 98.85 fL Depth to limiting factor >55 in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rods GPDffF in. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. - MI 'Ef #2 1 0-5 10YR2/2 — 1 3fabk mvfr as 3vf-co 0.6 0.8 2 5 -11 1 OYR3/3 — 1 2f tbk mvfr as 2vf-co 0.6 0.8 3 11 -19 1OYR3/2 — I 2f -mabk mfr as 2vf-co 0.6 0.8 4 19 -26 10YR3 /4 — sl 2f-msbk mvfr cs 2vf-c o 0.6 0.8 5 26-40 7.5YR3/4 — is ISM mvfr cs lvf-m 0.7 1.6 6 40-47 7.5YR3/4 — s 099 ml cs 1vf-m 0.7 1.6 7 47 -55 10YR3 /6 — s Osg dl — — 0.7 1.6 F-1 Ong # Boring Pit Ground surface elev. ft. Depth to limiting factor in. 7 §R Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rods GPQIfF in. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etff1 '0102 F-1 �g # Boring Pit Ground stnrface elev. ft. Depth to CKrpting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Tiewure %u Lure Consistence Bour dary Roots in. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. TIM 'E1f/2 ' 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 609-266 -3151 or TTY 609-264 -8777. SHM330Tcst (1 07/00) PI.,Of MAN PA W,�-; Ma 4m - 70P ®RDGUYoe lop, 6t' OoMw/ Ohm" Ix Z e)3 X9g• 45. EL- -Rl'" � R -o u�1E E�`�S *2 � r 4 jC NvJ � o tto P A cttt• H l n N O E - 0 n b rte. a d f! c 1 o C 7 O (D O S • CD n O N O O O N !' O W • W � j Q N N p CD o n fD O U1 3 7 n CD CD i CD N H 9 (n Z D 4 CD I co D N o. n N W N O W V O V O � ''i K tr CD O O O °:• z CD y (D t0 N < U CD N Z r z O D CD o O m \ \\ 3 3 j �• O y (D S y C N CD Q Cl CD fD (° p 2 m R N C: A K A z CL .. W 9 z o CL c\ 0 3 z 3 c V � Z 41 A li CL l o - v o a m N ft A ! O N O CD A N CD fp ti O f