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HomeMy WebLinkAbout038-1039-70-200 ,Nisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division a - Sanitary Permit No: INSPECTION REPORT 430282 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 DeBruin, Tim I Star Prairie Townshi CST BM Elev: o i _ lnsp. BM Elev: BM Description: Section/Town /Range /Map No: jq �( ¢, � �� 09.31.18. trcc TANK INFOR ATION ELEVATION DATA 1 's • G 4 Z TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Rl-k- .4 t-,q- Septic e Benchmark a Dosing Alt. M or , �o 2. Aeration __ Bldg. Sewer 17 Holding St/Ht Inlet TANK SE ACK INFORMATION ►��. 3 StlHtOutlet �►� TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic SL ' tJ `,, r IhI /u v Dt Bottom ZZ. :;' Dosing11 Header /Man. Aeration __ Dist. Pipe S' 4.(– `-' t r 4 L4.4. Holding _ Bot. System y 9 Final �rade G PUMP /SIPHON INFORMATION �;, 3 Manufacturer Demand O St Cover GPM 14. 90.3 Model Number nl ` ,`ice v I 53 < Fv 5 - 3. C1 9. TDH Lift Friction Loss System Head TDQ ` Ft Al t2 lei Forcemain Length Dia. Dist. to Well 5H5 c,^ '�/ 2 .� P. ZZ SOIL ABSOI ION SY far ►r 1 S 14 4, p"" 7 v BED/TRENCH Width ► Leng No. Of Tr nc s PIT FIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS \� `- SETBACK SYSTEM TO P/L JBLDG W LL LAKE /STREAM LEACHING Manufasturer: INFORMATION CHAMBER OR Type Of System: N10 + UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake �� Pipe(s) 1 L Length Dia Z Spacin SOIL COVER x Pressu ems Only xx Mound Or At -Grade Systems Only Depth Over ° ► "^ epth Over ] xx Depth of xx Seeded /fiodded T Mul hed Bed/Trench Cent Bed/Trench Edges "� l [ Topsoil Not per'' ( =2 Z U �, �� e- 4, LJ Yes No Yes N], COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: /dR / Inspection #2:_// G� Location: 2231 100th Street Star Prairie, WI 54026 (NW 1/4 SE 1/4 9 T31N R18W) NA Lot 3 Parcel No: 09.31.18. M 1.) Alt BM Description = '%r S: e e.N �C�^ 2.) Bldg sewer length = �'� 3 G ' 5 3z - amount of cover = `' a 4- �l w� c. 1 o u etY P' Plan revision Required? Yes I No se other side for additional informati n. –� _- ` _� 1 -6710 (R.3/97) Date L (( Insepctor's Signature Cert. No. r _ I s � KWO �� �. �, • si ,,, � : �.-b �� a � � � a �► ' �" �-� r Safety and Buildings Division t uuu 201 W. Washington Ave., P.O. Box 7162 C V Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) (608) 266 -3151 430 z8 Z- Department of Commerce State Plan I.D. Number Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, personal information o rovide may be used for secondary purposes Privac s15 1)(m) Project Address (if different than mailing address) o3g - X039 �� I. Application Information — Please Print All Informatt a + + f T Parcel # Lot Block # Property Owner's Na I .. i.) operners M ailing Address j i operty cation Prty Ow 1 �i� 'k,Se( don City, State Zip Code t Phone Nttmber uc ne) T N; or W II. T pe of Building (check all that apply) G7 is e _ CSM Number 2 Family Dwelling - Number of Bedroom q � Q t s • � ll • I S of/ (/ � 16 ❑. Public /Commercial — Describe Us vt9'W'°"� Ir+'� / t _ _ I_A State Owned - Describe Use ❑City_ ❑Villa wnship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' w System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modiflcwa to Existing System B. ❑ Permit Renewal ❑ Permit Revision El 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 ound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade El Single Pass Sand Filter ❑ Constructed Wetland El Pressurized In- Ground 11 Holding Tank El Peat Filter ❑Aerobic Treatment Unit Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter El Leaching Chamber 11 Drip Line El Gravel-less Pipe Other (explain) V to V. Dispersal /Treatment Area Information: M) D si Flow (gpd) Des' n Soil A plication Rate(gpdsf) Dispersal. Area Required (sf) Dispersals ea Proposed (sf) Syst evasion Tan Concrete Constructed Glass Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic VI. Tan i n Gallons Gallons of Units New Existing Tanks Tanks Septic or Holding Tank U� Aerobic Treatment Unit w Dosin- Chamber VII. Responsibility Statement- 1, the undersign assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's gnature M� � Nym��� Business Phone Number �7 2 � cS 6 — Plumber's Addre ss (Street, City, Stat l L'(s. zj) ? VIII. County/Department se Onl Approved ❑ Disapproved l 2 Sanitary Permit Fee Surcharge Fee) includes Groundwater Date Issued ssu �1` Agent Signature No Stamps) ��,� ✓^ 1103 � ❑Owner Given Reason for Denial r T/ IX. Conditions of Approval /Reasons for Disapproval SYSTEM OWNER: 3� New Se 1 Septic tank, effluent filter andQ g t dispersal cell must all be serviced / maintained 1 P as per management plan prov►ded by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) r % PLOT PLAN CT Tim Debruin ADDRESS 9953 Hamlet Lane S. Cottaae Grove Mn 55016 ,ter 1/4 SE 1/4S 9 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX 7/24!03 3 MPRS Shaun Bird 226900 DATE BEDROOM CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 454 # of chambers none IL BENCHMARK V.R.P. Top of nail in tree ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE ( DWELL . H. R P same as Benchmark SYSTEM ELEVATION 99.5 300' Property Line Scale = 1 /4 11 = 10' Well is to meet all setbacks found in Comm. 83 200' Pro 3 o Bedroo ° use Alt. B.M. B. M. Huffcutt Co B -1 ank is to be properly bedded and 14% Slope rrovided with lockdown covers with pproved warning labels Area 15' ow system is to ain undisturbed B -3 B -2 Grading is to be done to 95' divert run -off away from system 9 9' 9 7' 98.5'9go�. Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TD #: (608) 264 -8777 erc *isc,onsin www www•comm .'wisc . on s .wiscsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary August 08, 2003 CUST ID No.226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL Id N o . 8 95 7 umbers PLAN APPROVAL EXPIRES: 08/08/2005 Transaction ID No. 895762 SITE• Site ID No. 663065 Tim Debruin Please refer to both identification numbers, 2231 100th Street above, in all correspondence with the agency. Town of Star Prairie St Croix County NW 1/4, SE 1/4, S9, T3 IN, RI 8W FOR: Description: Proposed Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 914861 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: • 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 /01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD - 10706 -P (N.01 /01). • 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. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • 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. co 11 SHAUN R BIRD Page 2 8/8/03 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 and r s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or an � of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report 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 Gerard M. Swim POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm jswim @commerce.state.wi.us WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715 - 246 -4516 Date: 7/24/03 Owner:Tim Debruin Location: NW1 /4 SE1 /4 S 9 T31 N,R 18W Star Prairie 2231 100th St. System type: Mound System Manuals Used: Mound Component Manual version 2.0 (01/31) Pressure Distribution Manual version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7 -9. Maintance and Contigency plan 10 - 12 Soil test ? Signature License nu r 226900 � ,� „<<r, RECEIVED r 11EL'tSi�1� Ci _ ti c JUL 2 5 2003 . �E CUt r !V f - SAFETY SAFETY & BLDGS DIV� ��- • PLOT PLAN PROJECT Tim Debruin ADDRESS 9953 Hamlet Lane S. Cottaae Grove Mn 55016 NW 1/4 SE 1/4S 9 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 7/24/03 BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 454 # of chambers none BENCHMARK V.R.P. Top of nail in tree ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. same as Benchmark SYSTEM ELEVATION 99.5' 300' Property Line Scale = 1/4 = 10' Well is to meet all setbacks found in Comm. 83 200' Pro 3 C) Bedroom ° House Alt. B.M. B. M. Huffcutt Combo Tank B -1 Tank is to be properly bedded and 14% Slope provided with lockdown covers with approved warning labels Area 15' below system is to remain undisturbed B -3 B -2 Grading is to be done to 95' divert run -off away from system 99 9 7' 98.5' r Designer NO Date Non -Woven Filter Fabric 4" Observation Pipe Perforated ,Distribution Pipe Below Filter Fabric ASTK C -33 Sand —\ Topsoil lope �' Force c e M.oin plowe d Be d Of { l�— 2 �2 ° \� Drain Rock From Pump Layer f E Z / Cres Section Of A Mound S ystem Using A Bed For The Absorption Area s G A Ft. g Ft. I Ft.- J ��.Ft. K Ft. _ E 77 , Ft. ` Ft. ` � /• n wk' 1n L ¢''Observation Pipe n A J 0 - ----- - - - - -- --------------- - - - - -- 1 Force MOM �, o - yy �o From Pump 3 p �oisIribuIion Bed Of % 2' Pipe Drain Rock I l„ 4 Observation Pipe Permanent Marker Pipe or Rods Pion View Of Mound Using A Bed For The Absorption Arco PAGE OF Perfora'ed Pipe Det0il r 1 End 'thew - �Ferlorofea �' �^ t' Pv% P•pe Cs \ Moles located On Bottom. Are Equ0 Sp4ce0 PvC Force Main I PtRST liof.L MIXT ra CMMAec }lcr PVC Manifold Pipe L � SF�t Ole- Oisoriout'on Pipe Disirioution Pipe Loyout Ft. 1 X , Inches Signed: Hole Diameter,,, -- :c nch License Number: Lateral r_ Inch(es) Manifold Inches Date: Force Main inches # of holes /pipe Invert Elevation of Lateral SEPTIC TANK E FUMP C{#AMB£R CROSS SECTION AND SPECKICATIONS L'= CI VENT PIPE 12" M IN . ABOV GRADE F WEATHERPRWF 2:25 FROM DOOR, OR JUNCT1 BOX APPROVED wI TH 4COND I I T MAl`MOLE 'OVER FRESH AIR INTAKE W1 PADLOCK & FINISHED GRADE WARNING LABEL =, 4" ..- 4 " MIN. zY 1s" Ijai. � * aV .1. Q�t�iLiii►t>i°t� � :- I$�•Mi#1• T = INLET ; LS !SAS_ a � f WATER TIGHT SEA — TIGHT f = s N APPROVED A SEAL _ `� , JOINTS WITH ALM APPRt3Y£D PIPE PI 3Eii ; — — _ 3' ONTO ON SOLID SO are t} S{?L IO C t ' SOIL /'f FT _ -- -- OFF Pt3MP uFF ELF _ (/. / D 3'* APpRCVED BEDDING UNDER TAAZK NCRETE PAD pz'CI F ZCATZ QNS SEPTIC / DOSE NUMBER DOS iiiK MANUEACT€lRER= — GAL. DOSE MME INCLODiN � � GAL - TANK SIZES: SEPTIC GAL. FLf)L.t$ACiC- DOSE ` �ofxO CAPACITIES= A ` �� INCHES = AL. ALARM MANUFACIVRE.R: 1�=°C° s = Z INCHES = GAL. MODEL NUMBER SWITCH TYPE: =�J INCHES =,��' GAL. J ✓ C ?UMF MANUFACTURER : y INCHES = GAL- MODEL NUMBER: SWITCH TYPE: �Cy�C��'� �1 = ; LHR 18.23 WAC: REQUIRED DISCHARGE KA,:E G PM pump - pMP � ALAR WIRING AS PER � ' E£T VERTICAL DIFFERENCE BETWEEN PUMP Q= F AND DISTRIBiSTioN gs .E.. F EET + MINIMUM NETWORK SUPT N P Tj 1D0 FT. zRiCTIdN FACI . _ - �,� FEET t � L , FEET fQRCEMA.1N - _ T0 DYNAMIC H£AI� - 1 -- DIAME !� D: �,yjSCTH :hT£RNAL DrME2 SIONS uI' Fum TAr4K: LIQUZD D AT L g MBER SIGNED: TOTAL DYNAMIC HEAD /CAPACITY PER MINUTE HEAD CAPACITY CURVE EFFLUENT AND DEWATERM co MODEL 152/153 1 ! j15 o: i MODEL 152 C al ers 50 Feet ,Meters Gal. Uters gal. 5 1.5 0 26i 77 91 153 10 3.1 61 231 70 265 12 40 152 15 4.6 53 201 61 231 I ° 1 20 6.1 44 167 52 197 30 25 7.6 34 129 42 159 Z S r 30 9. i 23 87 33 125 �35T 7 -- 22 I - 20 j -- - 40 12. -- -- 1 42 0 4 Lock Va lve 138.0 =t. (11.6 r_) 14.0 F (13.4rn Gi45W 10 0 20 40 60 80 100 GALLONS I �-- 6 I/4 —� LITERS 0 80 150 240 320 a 5/a 3 ?7/32— �- •- - - - �'" FLOW PER MINUTE d I 3 27/32 AP PLICATIONS e CONSULT FACTORY FOR SPECIAL AP _ ,e • Timed dosing panels available. C 3 27/32 • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase I systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik -Box available for outdoor installations. See F M1420 � � I • Over 130 °F. (54 °C.) special quotation required. i 1521153 Series 1 /8 152/153 MODELS control Selection / Model _Volts-Ph I Mo jnps Sim lex Du lex 5 +/S N152 115 1 Non 8.5 1 2 or 3 BN152 115 1 Auto 8.5 Included 2o 3 I _L sxmes E152 230 1 Non 4.3 1 2 or 3 r BE152 230 1 Auto 4.3 Included 2or3 N153 115 1 Non 10.5 1 2 or 3 BN153 115 1 Auto 10.5 Included 2or3 SELECTION GUIDE E153 230 1 Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float Et 3 230 1 Auto 5 3 Included 2 0 r3 B 5 switch. Refer to FM0477. o caurioN 2. See FM0712 for correct model of Electrical Alternator E -Pak. All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10 -0225 used as a control activator specify duplex (3) licensed electrician. All electrical and safety codes should be followed including the most Or (4) float system. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL 70: P.O. BOX 16347 K Louisville, KY 40256 -0347 Manufacturersof. . Z y SHIP v K Cane Run Road p7p Louisisville, le, KY 40211 -1961 Q�gUTYP2/MP9 SiYCE �di/iJ p (502) 778 - 2731.1(800) 928 -PUMP http.lAvww.zoeller.com �L� �Q- FAX(502)774 -3624 n r nrnrrintit 2nnn Zoeller Co. All rights reserved. Maintenance and Contingency Plan for a Mound System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Dose Chamber is to be pumped at the same time as the septic tank. 3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 4. Once every 3 years the mound is to be inspected via the inspections pipes in the at- grade. The laterals are to be inspected via the cleanouts. 5. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 6. Pump and electrical components are to be checked at the time of the pumping. 7. Owner agrees to leave the area 15' below mound undisturbed. 8. The owner agrees to save this plan. 9. Trees, shrubs, and other similiar vegitation are not be planted on system. The system is not be driven over. 10. Effluent Quality is not to excede the requirements found in Comm. 83 Contingency Plan 1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if needed, then bypass pump float and try pump without float. If this works, float is bad, replace float. If pump still does not work, check power at the pump with a electrical - device such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is power, then pump is bad and needs to be replaced by a plumber. 2. If mound fails, determine cause of failure, test another area or remove pipe and sewer rock, retill soil, install new mound system. 3. Replace any other failing components as needed. Important Phone Numbers Plumber: Shaun Bird 715- 246 -4516 Pumper: Tom Mondor 715 - 246 -5148 St.Croix County Zoning 715 - 386 -4680 1 • - POWTS OWNER MANUAL & MANAGEMENT PLAN Pa ge of SYSTEM SPECIFICATIONS FILE INFORMATION - Septic Tank Capacity al CO3 NA owner tz.=•t.� Permit #. Septic Tank Manufacturer ❑ NA Effluent Filter Manufacturer _ ❑ NA pESIGN PARAMETERS Effluent Filter Model ' ❑ NA Number of Bedrooms - ❑ Number of Commercial Units Pump Tank Capacity al ❑ NA Estimated now (average) :' al/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1 -5) ,S�J aVd Pump Manufacturer / ❑ NA • Rate 1, i aVda /fe Pump Model /tr .�� ❑ NA Soil Application Monthly average- pretreatment Unit t Influent/Effluent Quality ❑ S Filter ❑ Peat Filter Fats, Oil & Grease (FOG) S30 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BOD 920 mg/L ❑ Disinfection ❑ Other. Total Suspended Solids (TSS) 5150 m /L Manufacturer Pretreated Effluent Quality NA Monthly average" Dispersal Cell(s) i0 mg/L ❑ In -ground (gravity) ❑ In -ground (pressurized) Biochemical Oxygen Demand (BOD5) ❑ At- grade Total Suspended Solids (TSS) 530 mgt ❑Other Fecal Coliform (geometric mean) 510' cfu /100m1 ❑ Dri ine , Maximum Effluent Particle Size Y inch diameter Values typical for domestic (non oommerdaq wastewater and septic tank effluent. •• Values typical for pretreated wastewater_ MAINTENANCE SCHEDULE Service Frequency Service Event Inspect condition of tank(s) At feast once every ❑ months, ear(s) (Maximum 3 yrs.) When combined sludge and scum equals one -third (Y,) of tank volume Pump out contents of tank(s) Inspect dispersal cell(s) At least once every ❑ months ear(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ months ar(s) Inspect pump, pump controls & alarm At least once every �� [I months �year(s) ❑ NA Flush laterals and pressure test At least once every ❑ months ear(s) ❑ NA Other At least once every ❑ months ❑ year(s) ❑ NA Oth At least once every ❑ months ❑ year(s) ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following Licenses or cert Master Plumber, Master Plumber Restricted Sewer, POWIrS 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 d f effluent on the round surface. cel shall be visually �Th�e Ponding k of effluen on the s in the observation pipes and to check for any pond g 9 n t on ty ground surface may indicate a failing condition and requires the immediate notification of the local regulatory When the combined accumulation of sludge and scum in tank equals one -third (4) or more of the tank volume, the Y g an entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch- NR 113, Wisconsin Administrative p rovided tot e9 Code- components. and any The servicing of effluent filters, mechanical or pressurized PO WTS components, pretrb a a�certified POWTS Maintainer- A servloe report shall be other maintenance or monitoring at intervals of 12 months or less shall be performed y he local regulatory authority within 10 days of completion of any service event_ START UP AND OPERATION For new construction, prior to use of the POVVTS check treatment tanks) 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 v b a se to n of the tank (s) removed y a servicing operator prior to use_ P 9 detected have the conte Page of �^ 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 call(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of eff Vent To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior.to*restodng 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 soft absorption area. Reduction or-elimination of the following from the wastewater stream may improve the performance and prolong the fife 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; off; painting products; p sanitary napkins; tampons; and water softener brine. ABAND04MENT When the POWTS falls and/or is permanently taken out of service the following steps shall be taken to Insure that the system is property and safety 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 211 tanks and pits shall be removed and property 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. O 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. 1e 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 ,bo lding tank may be installed as a last resort to replace the failed POWTS. d and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE- ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name , lra �� ✓`�d Phone / ✓�� °� �' Phone �-' .- ,J�` SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORrrY Name fJ�� ��!., , �.�.� Agency Phone Phone This document was drafted by the staffs of the Clem lake, Marquette and Waushara County Zoning and Sanitation agencies. This document meets the minimum requirements of ch. Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1). (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POVVrS. GMW ( 210 1) IL' consin Department of Commerce SOIL EVALUATION REPORT Page of sion of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County �� , Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must 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. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location r/ a 41 2 1 1 . / f Govt. Lot l el 114 14 S T N R/ E Pro erty Owner- Alailinq A- ss / Lot # Block # Subd. Name or CSM# City . L, Code Phone Number (:1 City C1 Village town Nearest Road // New Construction Use: [(Residential / Number of bedrooms — t de deriv *design flow rate GPD ❑ Replacement Public or commercial - Describe: �f`rS� C i Parent material � c � Z j >. ,0 0d Plain elevation if applicable General comments and recommendations: D C OUNTY t '\ zONtiIGi1FFICE ❑ Boring Boring # Ga- t� pit Ground surface elev. /��— ft. Depth to Il ' � r ��_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 c c o f a"i �� r /77�� .I� Al Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor & — in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 Effluent #1 = BOD > 30 < < 220 mg/L and TSS >30 150 ' Effluent #2 = BOD < 30 /L and TSS < 30 _ _ mgn' "'r9 mg/L CST Name (Please rint) Sig re , � CST Number Address Date Eva uation Conducted Telephone Number { ri Property Owner _A� u- e,q Parcel ID # Page of F'-7 Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor r S in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. / Munsell Qu. Sz. Cont. Color f Gr. Sz. Sh. J� `Eff#1 `Eff#2 O , y F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. go 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 F Boring # ❑ Boring El 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 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. S1313-8330 (RAW) A � Soil Test Plot Plan Project Name Kevin Medchill Byron Bird Jr. Address 2245 100th st. r New Richmond Wi. 54017 CSTA #220527 Lot Subdivision csm Date 12/ NW 1 /4 1/4S T 31 N /R W Township Prairie ❑ Boring Q Well PL Property Line County S T. CROIX ,BM or VRP Assume Elevation 100 ft top of white stake =Alt Mop of white stake100' System Elevation 94.3 H.R.P. #SW corner of 1 00s & Easm. Rd 95 94' 2 93' 2 44 ' B3 8 slope 100th st. , # Alt BMA BM 60' 10' S0' B 1 402' Easment Rd r A s Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County �• • f Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. ( PAID ) percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all irrforMiAltion. a ewed by D Personal information you provide may be used foj secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location �'►�' yC ` n,/ Govt. Lot 1 / , 1/4 S T 3 ) N R E (or W Property Owners Mailing Address Lot # 616ck # Subd. Name or tSNW City State Zip Code 'FhMe'Number-° - Cit El ❑ Vil wn Nearest Ro Construction Use - _ idential I Number of bedrooms Code derived design flow rate 1 GPD ❑ Replacement D Public or commercial - Describe: __— Parent material Flood Plain elevation if applicable xe� General comments n / and recommendations: 1 -w1 a y % S M ng # Boring J Pit Ground surface elev. ft. Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I 'Eff#1 'Eff#2 l a Ors - ' Boring # Boring �— �, pit Ground surface elev. J` Depth to limiting facto Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 1 'Eff#1 'Eff#2 O jIz' --Z �' s - Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 �� 715- 246 -4516 y Property Owner _ Parcel ID # Page of F3-1 Boring # Boring �it Ground surface elev. ft. Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 a Boring # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 •Eff#2 Effluent #1 = BOD. > 30 < 220 mg1L and TSS >30 < 150 mgA- ' Effluent #2 = BOD 130 mglL 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. SOD -8330 (8.6/00) M • Soil Test Plot Plan Project Name Tim Debruin Sha Address 9953 Hamlet Lane S. / Cottage Grove Mn 55016 C M #226900 Lot 3 Subdivision - ------ Date 7/24/03 N W 1/4 SE 1/4S 9 T 31 N /R W Township Star Prairie ❑ Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of nail in tree System Elevation 99.5' *HRPSame as Benchmark Alt. BM Top of 1/2" pipe @ 98.0' 300' Property Line Scale = 1/4" = 10' 200' Pro 3 o Bedroom ° House Cn Cn Alt. B.M. B. M. B -1 14% Slope B -3 B-2 95' 99, 97' ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ���` Mailing Address Property Address d D (Verification required from Planning Department for new construction) City /State Parcel Identification Number b3Sr ! o3 9' _ WD LEGAL DESCRIPTION Property Locatiop� s 1/s, Sec /---, T - r W, Town of ,. iTG// � Subdivision , Lot # Certified Survey Map # Volume 15 . Page # D Warranty Deed # 2 ° 1 3 U . Volume 2 �' . Page # o Spec house ❑ yes Lot lines identifiabl 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 mastor plumber. journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 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 th y expiration date. GNA F APPLICANT DA 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 th rty d 'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGMA OF APPLICANT DATE « « « « «« A 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 J% J 2307P 0?? 72977 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between Joshua J. Pingel and Jennifer R. Pingel, husband and wife, 07/09/2003 11:20AH - -- WARRANTY DEED EXEMPT # Grantor, and Timothy R. DeBruin and Sarah Strot:dt REC FEE: ' 11.00 as join_ tenant TRANS FEE: 138.00 COPY FEE: - CC FEE: PAGES: 1 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 That part of NW 1/4 SW I/4 Sec. 9- T31N -R18W described as follows: Lot 3 Name and RetuE \ of Certified Survey Map recorded in Vol. 15 of Certified Survey Maps, page SUITE 200 4044, as Doc. No. 639821. 1000 SILVER LAKE ROAD NEW B - � ttZ Subject to and together with a joint driveway easement as indicated on the F" N0. _ subject Certified Survey Map. ' 038 - 1039 -70 -00 Parcel Identificati t mber (PIl This is not homestead property. CK) (is not) Exceptions to warranties: Easements, restriction and rights -of -way of record, if any. Dated this 9tt/� day of June 2003 • shua J. Pi * Jennifer R. Pingel AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. County ) authenticated this day of Personally came before me this �_ day of June 1 2003 the above named Joshua J. Pingel and Jennifer R. Pingel, husband and wife, TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be he pe on(s) who executed the foregoing instrument and ac w ed the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY e Attorney Kristina Ogland Notary Public, State of Wisconsin Hudson, WI 54016 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) ' Names of persons signing in any capacity must be typed or printed below their signature. eATHEfflNfa#v b —Parn, fad a, it wt STATE BAR OF WISCONSIN aoo 655 -: •2t WARRANTY DEED �: NOTARY PUBLIC— MINNESOTA FORM No. 2 - 1999 M ©omro. t'xpirea Jan. 31, 2005 ■ } RONALD F. t? N, WALS14 It, S OF DEEDS JOH "iS'�N ST. CROIX CO., WI S+ AM F *Y. � RECEIVED FOR RECORD WIS. r . '� 03 -05 -2001 4:00 PM Iv ° s" R�� � E R T I F I E D SURVEY MAP E XE M PT #v F SURVEY MAP RlttliNg� Located in part of the Northwest Quarter of the Southwest Quarter of Section 9, Township 31 Nor FEE: 3.00 Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin. SFER FEE: RECORDING FEE: 12.00 Prepared for and a PAGES: 2 P t the request of: 4 OWNER: Kevin and Diane Medchill EAST 114 CORNER WEST 114 CORNER 2245 100th Street SECTION 9 -31 -18 SECAON 9- 31 - -18 New Richmond, WI 54017 (FOUND ALUM /NUM (FOUND ALUM /NUM COUNTY MONUMENT) COUNTY MONUMENT) Drafted by. Ty R. Dodge U _N_P i_ A T T E D L A ND_S N89'51'18 "E� 33 f — OVERALL E —W 1/4 UNE: N89'51'18 "E 5277.69' -- 3949.77 __— J N89'51'18 "E 998.41' 1 4/N89*51 329.51 , �/ ` 965.41' EAST —WEST 114 LIN / ' N00'00'00 "E<'� `� N 141.39' ��\ I ��— 'NOO'00'00"E i , 141.47' l� 2 LOT 4 Ol 3 py TOTAL AREA MP' F ��2 �v/ 1,283,106 SQ. FT. pArk Q, . P ' f 29.46 ACRES 6 K ` ° �� 1�'� AREA EXC. R —O —W: $a 0o rn Q / R CI ol4r 1,253,354 SQ. FT. 28.77 ACRES Q S # o f E (r) r l N ; I ( n a 'h I / O> Q I -' rs ; y�0 cli Z-0 / APP ROVED �q O w l N % 4? HII PROVED 3� ST. CROIX COUNTY g ~� •— / Planning Zoninn and Parks Commilt-e 3 '0<1 Z O wl o! C MM 5 200 $ V) ZI a� � O 2 I A ` 7 3r 3 4 44 i I U)! ! r-