HomeMy WebLinkAbout038-1210-00-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Buildipg Division
INSPECTION REPORT Sanitary Permit No:
488038 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:
Mielke, Earl I Star Prairie, Town of 038 - 1210 -00 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No:
GS 1 13.31.18.1138
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark �0� •
Od 3 103.35 / 5
g Alt. BM
Aeration Bldg. Sewer
(O.3 �l7 15 'S
Holding St/Ht Inlet
TANK SETBACK INFORMATION SUHt Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic ;7 � / 3 / `30 / Dt Bottom �
J > /ca Q
Dosing Header /Man.
- 7,1
Aeration Dist. Pipe 9( . ZS
� 7
Holding Bot. System � Z_
PUMP /SIPHON INFORMATION Final Grade Z.-95 AD, S
Manufacturer Demand St Cover I q 6 1 .4 1 5
7
Model Number - ° ----
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia. I Dist. to well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width f Length I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 (0 9 I Z ) re
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer.,
INFORMATION CHAMBER OR a' C
Type Of System: , v� 3d ' 5 Q ' , SO / r 1/4- UNIT Model Number: 5 ��
Cbrt�e.�' ,
DISTRIBUTION SYSTEM % r.5 // .— = L Z 'tea +e,_,
Header /Manifold /i Distribution x Hole Size x Hole Spacing Vent to Aionta
/ Pipe(s) z ftv.�
length Dia Length \� -- Dia Spacing - - Q 5
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 5 , 3S Bed/Trench Edges ._ Topsoil �, No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / $ ! O b inspection #2:
Location: 1346 212th Avenue New Richmond, WI 54017 (NE 1/4 SW 1/4 13 T31N R18W) Northgate II Lot 48� (I Parcel No: 131.18..�111[lJ38�'�
1.) Alt BM Description=
2.) Bldg sewer length = 3 0 r✓IA �� �` S �` �"� �"
- amount of cover = , ��� ��a� �I'� ✓� C�
1
Plan revision Required? Yes No / 2
Use other side for additional information
Date Insep or's Sig re Cart. No.
SBD -6710 (R.3/97)
afety and Buildings Division County
ni
Alt ME Washin
N *6co nsin di n, W D Sani Permit Number to be filled in Co. De artment of Commerce (608) � n o
Sanitary Permit p tiow C 1 9, 2005 State Plan I.D. Number
In accord with Comm 83.2 1, Wis. Adm. Code, p nal in ation you provide
may be used for secondary purposes Privacy Law, 15.04( RQIX touNTY Pr ' t Address (if different mailing address)
I. Application Information — Please Print All Information
Property Owner's Name Parcel # 1 It Block #
Property Owner's Mailing Address Property Location ol
� � m ' /., Section 1
City, State Zip Code Phone Number
� l �(
GG O W 15� V� T N; R cEcl on � //3 V
II. T e of Building (check all that a /L
Subdivision N M N
1 or2 Family Dwelling — Number ofBedrooms z4 �
❑ Public /Commercial — Describe Use o
i ❑Ci ❑Vill ownshi o
❑ State Owned — Describe Use Z � tJ � �' ( a ri a$ P C
III. Type o Permit: (Check only one box on line A. Complete line B if applicable)
A. S stem
y ❑Replacement System ❑ Treatment/Holding Tank Replacement Only 11 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. kpe of POWTS System: Check all that apply) t
— Pressurized rond ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In -Gro d [I Holding Tank 11 Peat Filter ❑ Aerobic Treatment Unit ❑ i Sand Filter v
Recirculating Synthetic Media Filter chin Chamber El Drip Line 11 Gravel-less Pipe 11 Other (explain) c �.'
V. Dis ersal/Treatment A Information:
Design Flow (gpd) Design Soil Applicatio Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed System Elevation,
6_ ✓ 7 107 o
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel fiber Plastic Qat;
Gallons Gallons of Units Concrete Constructed Glass
New Existing �/
Tanks Tanks b
Septic or Holding Tank ✓
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- 1, the undersigned, assu a e§ponsibility for installation of the POWTS shown on the attached plans.
Plu ( m ' ber' Name (Print) / Plumber's A MP/MPRS Number Business Phone Number
_4
Plumber's Address (Street, City, State, Zi
./� 2 ZRZ111j1 -�"
VIII. Coun rDe artment Use Onl
Approved re Disapprove Sanitary Permit Fe (includes Groundwater 5 Issu W
, CC Issuing t Sign
Surcharge Fee) /9
Own en Reason for ' 1 (�(J
IX. Conditions of Approval/Reasons for Disapproval
SYSTEM OWNER:
1. Septic tank, efflusM titer and
dispersal cell must all
as per menagwrterit plen prcvkled by OUMb k
2..A1 setback rQ*** items must be maintaNnd
as per appOc" code I ardinarlcae.
Attach complete plans (to the County only) for the system on paper not less than 81/2 x I1 inches in size
SBD -6398 (R. 01/03)
I
.�
• •
'.
4i:�.., , �,� 8 +••.
�fi�t!'JbT _ 3:1L: •. •it,: iiT. �,✓U: .. .. >•Cjn!'
,1*Ik!'tt Q .., i s; � + nr > ✓y '�'�9b .: i!sit r+C
AiI1M1f%'F,itl 9 , !!: ':' ?iF1i itg ': t ��. w ;�!�� ,,,� ;
�,ti'tyn . �(p7 •: >Kfb.:'titCo ,;+ts !R
PLOT PLAN
PROJECT Earl Mielke lOeverina Homesl DRESS 838 Summer Pines Circle Hudson Wi 54016
NE 1/4 SW 1/4S 13 /T 31 18 W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 12/17/05 BEDROOM 3
CONVENTIONAL XXX IN-GROUN CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22
BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL * H.R.P. Same as Benchmark
B. . * SYSTEM ELEVATION 96.7/96.6 4' below qrade
28' 29' 21' 21' A1t.B.M. 167'
No
10' 10' Well is to meet all
Vents B -4 setbacks required by
B -1 5' WDNR
2 -3' X 69' Cells with >3' Spacing
81' B -3
81' Plans Designed Using
Conventional Powts
Manual Version 2.0
-5
B -2
30'
S
25'
220' Pro 3 Bedroom
Property House
Line
Vent
>6 » Standard Biodiffuser
of Cover Leaching Chamber
with 31.1 ft2 of Area
6' Long 11 "
3 4" Grade at System Elevation
212th Ave
PLOT PLAN
PROJECT Earl Mielke (Oeverina Homes) , DRESS 838 Summer Pines Circle Hudson Wi 54016
NE 114 SW 1 /4S 13 /T 31 ,/ 18 W TOWN Star Prairie COUNTY ST. CROIX
t °r 12/17/05 3
MPRS Shaun Bird 226900 f ' DATE BEDROOM
CONVENTIONAL XXX IN -GROUN ESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22
BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 100' Filter Zabel A -100
❑BOREHOLE O WELL *H. R. P. Same as Benchmark
B. SYSTEM ELEVATION 96.7/96.6 4' below qrade
28' 29' 21' 21' A1t.B.M. 167'
10' 10' Well is to meet all
Vents B -q. setbacks required by
B -1 5' WDNR
2 -3' X 69' Cells with >3' Spacing
81' B -3
81' Plans Designed Using
Conventional Powts
Manual Version 2.0
-5
B -2
30'
S
25'
220' Pro 3 Bedroom
Property House
Line
Vent
ALong Standard Biodiffuser
Leaching Chamber
with 3 1. 1 ft2 of Area
1 "
3411 Grade at System Elevation
212th Ave
Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, 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 St. Croix
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. 038- 1055 -10
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R VIRyVEDBY DATE
l' / a •8 1 91
PROPERTY OWNER: PROPERTY LOCATION
Greenwood Enterprises, Inc. GOVT. LOT NE 1/4 SW 1 /4,S 13T 31 N,R 18 kor) W
PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
1416 Third St. 48 na or ate
CITY, STATE ZIP CODE PHONE NUMBER [:]CITY [ ®TOWN NEAREST ROAD
Hudson, WI. 54016 (715 386 -3674 1 Star Prairie 214th Ave.
[xl New Construction Use [) Residential / Number of bedrooms 4 [) Addition to existing building
j I Replacement [ ) Public or commercial describe
Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd /ft .8 trench, gpd /ft
Absorption area required 858 bed, ft 750 trench, 111 Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd /ft
Recommended infiltration surface elevation(s) 96.65 ft (as referred to site plan benchmark)
Additional design / site considerations na
Parent material outwash Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem :E S ❑ U [2 ❑ U ZI S ❑ U ® S ❑ U RI S ❑ U ❑ S RU
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
..................
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer>ch
.................
..................
.................
..................
_..1...'y 1 0 - 12 10 r 3/3 none 1 2msbk mfr QW if .5 I .6
2 12 -26 10 r 4 4 none sicl 2msbk mfr qW if .4 1.5
Ground 3 126-84 7, M1 na n .7 1.8
elev.
1 00. 1 15
Depth to
limiting
factor
+ 84"
�n
Remarks:
Boring #
1 - .6
2 12 -28 10 r 4/4 none sicl 2msbk mfr Qw if .4 ':.5
Ground 3 28-84 7.5 r 4 6 none ms 0SQ ml na na 1 .7 .8
F
t+
10 \
Depth to
r LT
L �
limiting
factor -
+84 �tr - t . s 998 I
-_
COUNTY r
Remarks: zONrfvGOFs ►cE ;
CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200
Address: 1554 200th. Ave ew Richmond I 54017 -
Signature: Date: 11 -5 -98 CST Number: m02298
PROPERTY OWNER Greenwood Enterpris SOIL DESCRIPTION REPORT Page 2 of 3
PARCEL I.D. # 038 - 1055 -10 ,
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bmrdry Roots GPD /ft
..................
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
3
1 0 -9 10 r 3/3 none 1 2msbk mfr gw if .5 .6
2 9 -26 10 r 4/4 none sicl 2msbk mfr gw if .4 .5
Ground 3 26 -84 7.5 r 4/6 none ms 0sq ml na na .7 .8
elev.
10
Depth to
limiting
factor
+84
�n
Remarks:
Boring #
1 0 -12 10 r 3/3 none 1 2msbk mfr gw if .5 .6
2 12 -30 10 r 4/4 none sicl 2msbk mfr gw if .4 .5
Ground 3 30 -84 7.5 r 4/6 none ms osg ml na na .7 .8
elev.
100.65ft. —
Depth to --
limiting
factor
+84"
Remarks:
Boring #
1 0-10 10 3/3 none 1 2msbk mfr 9w if .5 .6
2 10-25 10 r 4/4 none sicl 2msbk mfr gw if .4 .5
Ground 3 25-84 7.5 r 4/6 none ms osg ml na na .7 .8
elev.
1 00.6 5
Depth to
limiting
fact +
Remarks:
Boring #
13
Ground
I
elev.
ft.
Depth to
limiting
factor
Remarks:
S13D- 8330(8.05/92)
PROPEWYOWNER Greenwood Enterpris SOIL DESCRIPTION REPORT Page 2 of 3
PARCEL I.DA .038-1055-10
Depth Dominant Color Mottles Structure GPD /ft
Boring # Horizon Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0 -9 10 r 3/3 none 1 2msbk mfr gw if .5 .6
3 .'
2 9 -26 10 r 4/4 none sicl 2msbk mfr gw if .4 .5
Ground 3 26 -84 7.5 r 4/6 none ms 0s g ml na na .7 .8
elev.
10
Depth to
limiting
factor
+84
Remarks:
Boring #
I ., <;:::_< 1 0 -12 10 r 3/3 none 1 2msbk mfr gw if .5 .6
4 2 12 -30 10 r 4 4 none sici 2msbk mfr gw if A .5
Ground 3 30 -84 7.5 r 4 6 none ms osq ml na na .7 .8
elev.
10 65 (t.
Depth to _
limiting
factor
+84"
Remarks:
Boring #
1 0-10 10y 3/3 none 1 2msbk mfr gy if .5 .6
tth: ::ii
2 10-25 10 r 4/4 none sicl 2msbk mfr if A .5
Ground 3 25-84 7.5 r 4/ 6 none ms osg mi na na .7 .8
elev.
1
Depth to
limiting
fa'tor
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
SBD- 8330(8.05/92)
f
STEEL'S SOIL SERVICE
Gary L. Steel 1 1554 200th Ave.
GSTM2298 Greenwood Enterprises, Inc. New Richmond, WI 54017
MPRSW -3254 NEgSW4 S13- T31N - (715) 246 -6200
town of Star Prarie
lot #48- NorthGate
This soil evaluation was conducted to satisfy a zoning requirement, it may or may
not be suitable for your use. The location of the test may or may not be as shown
as permanent lot lines were not established at the time the test was conducted.
N
1 =40'
BM.= top of 1 pvc pipe C el. 100'
Alt. Bm.= top of 1" pvc pipe C el. 101.10'
2 1 ,
' � fk
bA
y :
N �•
Gary L. Steel
11 -5 -98
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer -r
Mailing Address �- J . ✓ J
Property Address s (Verification required from Planning & Zoning Department for new construction.)
City /State Parcel Identification Numb
LEGAL DESCRIPT /
Property Location 1 /4- t/a , Sec. /3 , T — N 1� W, Town of
Subdivision &_0 rw (7� , Lot # .
Certified Survey Map # , Volume , Page #
Warranty Deed # Z — ,Volume 2 2 7 / ,Page#
Spec hous yes no Lot lines identifiable ye no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
consists of um in out the s tank eve three ears or sooner, if needed, b a licensed aintenance p umping g p every y Y p umper. What you put into
P P
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 Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site
wastewater disposal system is in proper operating condition and /or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
Uwe certify that all state en on th' form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the
property d iibed above, by ' ue of a w anty deed recorded in Register of Deeds Office. -7
IG TURE OF APPLICANT(S) DATE
* ** Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * **
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
I
J 2271 P 36 i 7 542
STATE BAR OF WISCONSIN FORM 1 - 1998 I KATHLEEN H. WALSH
WARRANTY DEED i REGISTER OF DEEDS
ST. CROIX CO., WI
Document Number _ -_ RECEIVED FOR RECORD
" 06/11/2003 01:40PN
This Deed made between Green-rod Enterz ri cae Ind a
'I
Wi sconsin n Cormrati on WARRANTY DEED
EXEMPT #
Grantor. REC FEE: 11.00
' and Marl T.- vii el kP - - TRANSFFEE: 69.90
COPY CC FEE:
PAGES: 1
- - _ - Grantee.
Grantor, for a valuable consideration, conveys to Grantee the following
1 described real estate in St f x _ - -__ County. State of Wisconsin
jj R ecording Area
(the - Property"):
Name and Return Address
Lot 48 of the Plat of NorthGate II, recorded in the Return to:
!j Office of the Register of Deeds for St. Croix County, Edina Realty Title
Wisconsin, on June 20, 2001, in Volume 8 of Plats, % 400 South 2nd Street
at Page 55, as Document Number 648882. Suite #115
Hudson, WI 54016
038-121 0-- Oo-000
�! Parcel Identification Number (PIN)
This is not homestead property.
I' (is) (is not)
I�
i
�I
i
�' I1
i
I I
Together with all appurtenant rights, title and interests.
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except �I
easements, restrictions, and reservations, if any, of record.
Dated this day of _ May 2003
D
INC. �
(SEAL) (SEAL)
i
ames E. Rusch, President
ii
(SEAL) (SEAL)
R ■
i
AUTHENTICATION ACKNOWLEDGMENT
Signature (s)
State of Wisconsin, j
St. Croi County.
authenticated this day of Personally came before me this T' day of
may _2()J33 , the above named
,Tama-_ 1F RiiSC •t _ i t-_ President, and Maras R
Riisr -h f it Snn -
*
TITLE: MEMBER STATE BAR OF WISCONSIN to
((f not, me known to be the person whp* , the{rf + Egging
authorized by §706.06. Wis. Stats.) instru t and acknowledge the am `�. P �•;� r t
• J ii
THIS INSTRUMENT WAS DRAFTED BY �/� .7a/1
Mary R. Rusch -- Sandra Gehrk y�eF • Z J � 3: :I
Notary Public, State of Wisconsin '•. C
New Richmond, W1 54017 My commission is permanent. (If uow,.Ar fun ,date
(Signatures may be authenticated or acknowledged. Both are not Sad tamhaY` 1
necessary)
Names of persons signing in any capacity must be typed or printed below their signature-
STATE BAR OF WISCONSIN Wisconsin Legal Bunk Co., Inc.
WARRANTY DEED FORM No. 1 - 1998 Milwaukee. Wis.
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner , /L Septic Tank Capacity ga l ❑ NA
Permit # Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacture ❑ NA
Number of Bedrooms 3 ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units A Pump Tank Capacity gal A
Estimated flow (average) al /day Pump Tank Manufacturer] NA
Design flow (peak), (Estimated x 1.5) J� al /day Pump Manufacturer NA
Soil Application Rate al /day /W Pump Model 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) _ :150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD 530 mg /L > < Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L �,NA ❑ At -Grade ❑ Mound
Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA
Other: Irf NA Other: ❑ NA
* Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank years) s) At least once every: ❑ on(s) y
(Maximum 3 ears) ❑ NA
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: Q Tonth(s) (Maximum 3 ears) E3 NA
ar(s) y
Clean effluent filter At least once ever / / ❑ mo
ye ar(s) ) ❑ NA
Inspect pump, pump controls & alarm At least once every: ❑ mo ❑ yeaarr((s) s) ) ❑ NA
Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA
• year(s)
Other: ❑ month(s)
At least once every: • year(s) 13 NA
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 ' 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
replace system:
- suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
I X 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 - Name Qty
Phone — 62 b _ j Phone 7 /,J 1O2 J l
SEPTAGE SERVICING OPERATOR (P PER) LOCAL REGULATORY AUTHORITY
Name Name
Phone ��� �a �� 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.
START UP AND OPERATION Page of
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
replace nt system:
itable 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 /` Name 2� `
Phone _j Phone
SEPTAGE SERVICING OPERATOR (P PER) LOCAL REGULATORY AUTHORITY
Name Name
Phone 7 Phone /,� =� — d
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.
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Parcel #: 038- 1210 -00 -000 12/19/2005 04:07 PM
PAGE 1 OF 1
Alt. Parcel #: 13.31.18.1138 038 - TOWN OF STAR PRAIRIE
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
EARL L MIELKE O - MIELKE, EARL L
865 CHARLIE RYAN RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description " 1346 212TH AVE
SC 3962 NEW RICHMOND
SP 1700 WITC
Legal Description: Acres: 1.187 Plat: 2228 - NORTHGATE II 038/01
SEC 13 T31 N R1 8W NE SW LOT 48 NORTHGATE Block/Condo Bldg: LOT 48
I I
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
13- 31N -18W NE SW
Notes: Parcel History:
Date Doc # Vol /Page Type
06/11/2003 725402 2271/364 WD
06/02/2003
2005 SUMMARY Bill #: Fair Market Value: Assessed with:
120373 26,800
Valuations: Last Changed: 10/13/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.187 26,300 0 26,300 NO
I
Totals for 2005:
General Property 1.187 26,300 0 26,300
Woodland 0.000 0 0
Totals for 2004:
General Property 1.187 26,300 0 26,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: 12/04/1998 Batch #: PRGRM
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
RECEIVED
Wisconsin Department ofComme J/�I�' 21901L VALUATION REPORT Page of
Division of Safety and Buildings
�c fp r w�h Comm 5, Wis. Adm. Code
s�' VnV�X l:l1UNTV county.
Attach complete site plan on pa than 8 lit x 11 inches size. Plan must t J
include, but not limited to: vertical and horizontal re erence porn ), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. R y Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner _ Property Location
�,✓ /� ' Govt. Lot �� 1/4f 4 S T J N R E (o W
Property Owner's Mailing Address , Lot # I Block # Subd. Namd or P / 1�1X
City State Zip Code Phone Number ❑ City ❑ Village wn Nearest Roa
New Construction Us esidential / Number of bedrooms �:S Code derived design flow rate GPD
❑ keplacement ❑ Public or co rcial - Describe:
Parent material Flood Plain elevation if applicAle
General comments t� 'r ab
and recommendations:��` 2
/�T J J ✓
Boring # ' RBonng ,
Pit Ground surface elev. _ _ ft. Depth to limiting facto —_ 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
s 2 2
F-1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
F - soiiApplication 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
CST Name (Please Print) – – Sign , CST Number
Bird Plumbing, Inc. Shaun Bird �/ 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 — 0 715- 246 -4516
dP
Property Owner _ Parcel ID # Page of
a Boring # El 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
F-1 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 I •Eff#2
I
❑ Boring # ❑ Boring
Ground surface elev. ft. Depth to limiting factor in.
El Pit
Sal Applicati on 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
Effluent #1 = BOD > 30 < 220 mg1L and TSS >30:5 150 mgA_ ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mglL
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 -9330 .6/00)
SOT PLAN
PROJECT Earl Mielke (Oeverina Homed ADDRESS 838 Summer Pines Circle Hudson Wi 54016
NE 1,4 SW 1/4S 13 /T 3; N/R 1118 W TOWN Star Prairie COUNTY ST. CROIX
MPRS Shaun Bird 226900 f DATE 1/6/06 BEDROOM 3
CONVENTIONAL XXX IN -GR ND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22
BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 100' Filter ZabelA -100
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
B. SYSTEM ELEVATION 95.5/95.4 5' below qrade
28' 29' 21' 21' AIt.B.M. 167'
10' 10' Well is to meet all
Vents B -4 setbacks required by
B -1 5' WDNR
2 -3' X 69' Cells with >3' Spacing
81' B -3
81'
Pro 3
Bedroom
10' ST - House Plans Designed Using
B 2 Conventional Powts
30' Manual Version 2.0
B -6
220'
Property
Line
jL Standard Biodiffuser
Leaching Chamber
with 31.1 ft2 of Area
3 Grade at System Elevation
212th Ave