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HomeMy WebLinkAbout040-1234-60-000 Wisconsin Department of Commerce a r PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420492 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: Hewitt, Chad & Jessica Troy Township 040 - 1234 -60 -000 CST BM Elev: Insp. BM Elev: BM Description: /D , a /Da- o ^ TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY „S 9I -7 �y HI FS EL V.� Septic �a(!U Bench ark 1 0 y1 F7 0 . v Dosing p Alt. BM 5 r• gb• (> Aeration — /O B dg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P / L WELL BLDG. Vent to Air Intake ROAD Dt Inlet / p/ Septic ( C) 1 , N � J / ! Dt tto Ir Dosing 3 r ea er /Man. Aeration Dist. Pipe 'L ✓ Z, 5• IDI Holding Bo j ©f .3 /h " s /OD 6 Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM o Model Number / ! 3 3�l Z/' TDH Lift Friction Los System Head TDH Ft I Z 3 3 i Gtr • Z l Forcemairi Length I Dia. w y Dist. to well l & No _ /AI SOIL ABSORPTION SYSTEM Z BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / �r1 j /_ / ^ SETBACK SYSTE TO TO t � P/L a � BLDq EL LAKE /STREAM ACHI Manufacturer: INFORMATION CH R Ty Of System: ` y/tr .T— / Model Number: DISTRIBUTION SYS EM AidrY /i ) 5Z f?azAr eetAeA, m — Header /Manifold Distribution x Hole Size x Hole Spacing ]Vent to Air Intake � 7j /��O � a Pipe(s) (�/ n i Ij ( d ength �� Dia Z Length �O Dia 7i Spacing ' COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bch Center I BEd/Trench Edges Topsoil l Jd Yesf No Yes i No ITS: (Include code discrepencies, persons present, etc.) Inspection #1 1 5 o�� Inspection #2: 1 /10 'Trillium Lane Hudson, WI 54016 (SW 114 SE 114 3 T28N R19W) Countrywootl AllTdfi-1 Lo 5t 35 Parcel No: 03.28. 9.1172 ;on = ST. �tI V`2(/ ' NS- d ✓�1� e peC✓ Gt (�W4 _C605'ey. -(p 5- b Ld I ��.+_ trot y e( - 4pvW e -fin k f u d— 31 informatio l `r` 0 0 Date Insepctor's Signature Cert. No. f • Safety and Buildings Division County ,�/1 0 \ *i 201 W. Washington Ave.. P.O. Box 7162 S/• (. rw sconsin Madison, Wl 53707 - 7162 Site Address De artment of Commerce o -ZL_GrT_ 30 d/:7 5 - 0 ST I L.z_1(J m Sanitary Permit Application nitar PernIff Number In accord with Cotton 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision may be used for secorglary purposes Privacy Law, s15. 1 m 1. Application Information - Please Print All Information RECE IVE D ate Plan I.D. s Mme- 7A)'4040 P ny Owner's Name s "I Number 2 C xad e thissl -bd ve OCT U 4 2002 Property Owner's Mailing Address roperty Location 1 G(JC4b �/7�y1 J� Sl. �' r / ? ZC.NINGOif _ l�-A -A:S Tai N R/ W City. Stain Zip Code Phone Number Lot Number Block Number '1 I /. Subdivision Rl y er / (!!S G(Of• ?� G� / �� - �i`�J �G�y/ 0Ul�/1�/` N WOdd .L CShI Number A. Type of Building (check all that apply) ❑City 6 1 or 2 Family Dwelling - Number of Bedrooms F ❑Village ❑ Public/Commercial - Describe Use @Township ! T t o ❑ State Owned /4�`Yr4 tN/ a i l0 X �D �-C k Nearest Road T tver Ape/ M. Type of Permit: (Check only one box on line A (numbering scheme for internal trse). Complete line B If applicable) A 1 ■ New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to 7�7ty use System Tank Ord Existing System B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 ❑ Non - Pressurized In -Ground 210 Mound 47 ❑ Sand Filter SO ❑ Constructed Wetland 22 ❑ round 41 ❑ Holding Tank 48 ❑ Single Pass S1 ❑ Drip Lieu 4 5 ' s At•Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other ers tment Area Information: Design Flow (gpd)) Dispersal Are / D' jtlllsea Soil Applicapon Percolation Rate System Elevation Final Grade Required oposed Rate IDays/S q.Vt) ch) lov •T ,` Elevation r<ot�D /100 /0® e /�o h a — VI. Tank Info Capacity in Total Number 94factur Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks 00 Concrete Constructed Glass New Esistin� � 1 Tanks Tanks Septic 4 WIF:SER CONCRETE °o ' d 'a C hwsbcr K I rod PRODUCTS INC. I X VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shorn on the attached plans. Plumber's Name (Print) PI 's Signature MP/MPRS Number Business Phone Number Dennis Hewitt f 221483 ?15 - -4 Plumber's Address (Street, City, State. Zip Code) W2062 U. S. Highway 10 Maiden Rock, Wisconsin 54 ?50 -830? V111-Countv /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued is ent Signa o Stamps) Surcharge Fee) p� ❑ Owner Given Initial Adverse . ( 1 a a Determination r 0 1 IX. Conditions of Approval/Reasons for Disapproval � A �l� � ,,�� R 1-; If z � ��- ,�,� -t,�o� �;�J �,�/ /cam- �.�c� f Poles /�C�- •,/-/� Att em Plans (to tG only) ror an papa not lea than 8112 s 11 Inches to size Kzea(zv - .�.nr :scale: 1 " =,� Ft. 1IDT PLAN Page 2 of 8 000IBDo NORTH o I d9� /0 ya -t e _ ,f th CL 4 Ais rr ss(/GQl°��l�l n C 9e 13 1 L I I /00 o 3 BM ,v i o /d Fr.,r � (Af fir x I i I 1 ° a0 1. Will meet all Comm. 83..pet-tAgk, r, ujxenents –�� - fp �2wi sa- j 2. Septic Tank / O0 Gallons Dos Tank �G� Gallons Mfg. by Wieser Concrete Pros 3. Benchmark #1 Plevation -,4 -- Desogti. of- '7b� OP Iraq — Benchmark #2 Elevation /0 /5" Description of- TP or 4. Other- Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD * isconsin w ww.cornmerce.state.wi.us/sb (608) .wi.us www.commerce.state.wi. us /sb www.wisconsin.gov Department of Commerce 1 Scott McCallum, Governor c /'Ul/� 1 G 1 �1 ,nil �c +0 �i Philip Edw. Albert, Secretary h August 09, 2002 CUST ID No.221483 ATIN: POWTS Inspector DENNIS L HEWITT ZONING OFFICE HEWITT EXCAVATING INCORPORATED ST CROIX COUNTY SPIA W2062 US HWY 10 1101 CARMICHAEL RD MAIDEN ROCK WI 54750 -8307 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/09/2004 Identification Numbers Transaction ID No. 774040 SITE• Site ID No. 648659 Chad & Jessica Hewitt Please refer to both identification numbers, Tower Rd above, in all correspondence with the agenc Town of Troy St Croix County NW1 /4, SE1 /4, S3, T28N, R19W FOR: Description: Propos d Four 13edroo At -grade System Object Type: POWT System Regulated Object ID No.: 863950 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stalls. • 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. Owner Responsibilities: • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • The owner is responsible for submitting a maintenance verification re p ort p er Comm 83.55, that is acceptable to r t r r r the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. P O T S. Conditionally APPROW:n DENNIS L HEWITT Page 2 8/9/02 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 WSMART code: 7633 jswim@commerce.state.wi.us cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544 I f PACE 1 OF S Private Sewage System Plan Index RECEIVED 4 2002 PLAN I. D. N0. JU 2 ��e PROJECT TYPE lDr; /7`�' (,r4�C�'P_ �L ®GS DIV PROP. OWNER C ADDRESS PROJ . LOCATION-- COUNTY S f. C'rCrX TOWNSHIP r4 Y LECAL DES C. SEC. TILN, R-Z?—' W This Plan has been prepared in accordance with AT -GRADE COMPONENT MANUAL SBD- 10570 -P (R .6/99) and Pressure Distribution Manual SBD - 105 -P (R.6/99) PACE ONE INDEX SHEET PACE TWO PLOT PLAN PACE THREE CROSS SECTION & PLAN VIEW PAGE FOUR LATERAL DISTRIBUTION PIPE PACE FIVE PUMP /SIPHON TANK PAGE SIX PUMP CURVE PAGE SEVEN MANAGEMENT PLAN PAGE EIGHT DESIGNER Dennis Hewitt CREDENTIAL NUMBER 221483 ADDRESS W2062 HIGHWAY 10 MAIDEN ROCK_ , WISCONSIN 5 -8307 TELEPHONE ?i5 _6 47-4682 DATE [ly /j/ SIGNATURE Ala4 DEPARTMENT OF COMMERCE DIVISION OF SAFETY AND BUILDINGS , SEE (5ORRESPYNDENCE 1 , cale: 2 "= Ft. PLOT PLATT I'age 2 of 8 �I J 1400 %U N ORTH o Iq 1 n f �iir �rP� .S PS�PC u n 'r �3 b 10 lGO � v q X - - - -- - AK �� B/1jyf1 � o/d F,,e e C/V Prrp I \ I I i A -v meet all Coffin. 83 ,SetbAQk., ,r -� -f� � � 2. Septic Tank f d() Gallons Do * Tank ?GYM Gallons Mfg. by Wkeser Concrete Pros 3. Benchmark #1 Elevation 1C1E ,0 •- DescrlgtI0A- of- - 72P o P 1 1 �i Benchmark #2 Elevation /Dyls" Description of- Tap O " 4. Other - i Page 3 of 8 FORCE MAIN L >5► B ?5. j L I a Turn -Ups A o W C OBSERVATION WELLS L— 1/613 1/6 B Design Loading Rate GPD/SQ. FT. B= 601 W- J7 / Linear Loading Rate ..5. GPD/Ln.Ft. C= 3 1/2 " -2 1/2" AGGREGATE STABILIZED Distribution in vest Observation Wet {- ---,,., / L atera 1 ejer, /00.q' APPROVED Fabric � \ � J; �2" l 6 Cover ' Nz y SLOPE PLOWED a LAYER i 1 { I ?5 A �2 C A r 2 ?5 V' Section of a Wisconsin Plan View and Cross At-grade Unit with Two g Absorption Cell With in a Single Unit on a Sloping Site Page 4 of 8 i Perforated Pipe Detail 0 End VI•ry P•rloroled o �• ,y PVC Pipe �— Lower Lateral Hots Located On Bottom. • L. S. 900 Are Equally spaced W/Threaded Plug S X = /07 l �Upper Lateral 2 /? PVC X Manifold Pips 1 Position Of Disliibulion X c �a n Force Main From Pump Pips '� 2 Lost hole Should Be Neal To turn —up / Distribution Pipe Layout Turn -Up UPPER LATERAL L OWER LATERAL P 0? C/ P R — R S r _� S X ! X v= Y_ Y= Hole Diameter ' a Inch Hole Diameter -3 Inch Lateral = Inches) Lateral _ �?_„ Inches) " Manif �Inc hes Manifold = Inches 'f Inc Force Main Inches Force Main " _ Inches HOLES PER LATERAL HOLES PER LATERAL / L INVERT EI,EV . OF LATERA 1 (G INVERT EI,EV . OF LATERA �/� -� SYSTEM ELEVATION �(�,� SYSTEM ELEVATION Page Of 8 COMBINATION SEPTIC TANK /PUMP CHAMBER 4" CI vent Pipe aitn ,.� (No Scale) Approved Cap, 15' Pproved Locking Manhole Cover From Buildings With Warning Label Attached n Weatherproof Approved Junctio gent Cap Junction Sox —� 12 Minimum 6" Minimum 4" Minimum + Final Gr } 461 Quick 18" Minimum PVC Disconnect i i 1/4" Weep Hole Baffle Approved Joint "" A �C w /C.I. Pipe abel R Extending 3' Filter Alarm B Approved Joir Onto Solid Soil On 6; w /C.I. Pipe or PVC i C Extending 3' Onto Solid Sc PUMP ' OFF ELEV . ,6 0 f f t or PVC D Conc. Block 3" of Beddinq Under Tank —j Lateral Volume /XY Gal Min. Dose. (5 X Lat. Vol.) Q Gal. Max. Dose (20% of DWF) 120 Gal. Note: Pump and Alarm Are On Separate Circuits Flowback /5"0� /6.3 2y Gal. Max. Dose W/Flowback L Gal. Tank Manufacturer: WIESER CONCRETE PRODUCTS Tank Size - Septic /Pump: 1200 806 Gallons Alarm Manufacturer: S. J. ELECTRO Model Number: 101 HIGH WATER Capacities: A 20 inches or 4 12.0 Gallons + B 2 inches or 41 .2 Gallons Pump Manufacturer: - �Zoefler - + C inches or Gall ons Model Number: + inches or _ Gallons Minimum Discharge ate: Total ... inches or 0 Gallons 0- 3 /4 /1 #016 u, G6 f ,ck�av Vertical Difference Between Pu and Distribution Pipe:�ElFeet 14-.3 1 8� 'Minimum Required Supply Pressure :.......... ................+ - - 3. - 3 Feet b / Feet of Force Main x _ Friction Factor /100 Feet. Feet 2 Inch Diameter Force Main Feet Total Dynamic Head:... --- 2.2 Internal Tank Dimensions: Gal. /Inch 20.6 Liquid Depth " Page 6 oL 8 . TOTAL DYNAMIC HEAD /CAPACITY HEAD CAPACITY CURVE PER MINUTE a: MODEL 152 153 EFFLUENT AND DEWATERING G W MODEL 152 153 50 Feet Meters Gal. Liters Gal. Liters 5 1.5 69 261 77 291 153 10 3.1 61 231 70 265 12 40. 152 15 4.6 53 201 61 231 -y 9 pr, Q ` o 20 6.1 44 167 52 197 = 25 7.6 34 129 42 159 30 30 9.1 23 87 33 125 Z 8- q�p� � 35 1 240 20 Lock Valve: 38.0 Ft. (11.6m) 44.0 FL (13.4m) ,J P 0145M 4 n �eec�e to - 0 httpJ/www.soallar.eom PlJMP !O. 20 40 60 80 100 GALLONS LITERS 0 80 160 240 320 I FLOW PER MINUTE Table 6 FRICTION LOSS (FOOT /100 FEET) IN PLASTIC PIPE' Flow in Nominal Pipe Size GPM 3/4 1 1 1 1 -1/4 1 1-1 1 2 1 3 4 6 1 2 3 324 4 3.52 5 8.34 6 11.68 2.99 Velocities in this arcs 7 15.53 3.83 are below 2 feet per -econd 8• 19.89 4.91 9 24.73 6.10 10 30.05 7.41 2.50 11 35.94 8.94 2.99 12 42.10 10.39 3.51 13 48.82 12.04 4.07 14 56.00 13.81 4.66 1.92 IS 63.62 15.69 5.30 2.18 16 71.69 17.68 3.97 2.46 17 8020 19.78 6.68 2.75 l9 21.99 7.42 3.06 19 24.30 921 328 20 26.72 9.02 3.72 25 40.39 13.63 S.62 1.39 H 30 56.57 19.10 7.97 1.94 w 25.41 10.46 J 3 3 /C3 a J 9P"7 32.53 13.40 �{ 40.45 16.66 4.11 50 49.15 2024 49,9 60 29.36 7.00 0.97 70 37.72 9J 1 129 i0 11.91 1.66 90 Velocities in this area 14.91 2.06 100 exceed 10 feet per second, which is 19.00 2.50 0.62 125 too great far 27.20 3.79 0.93 150 various flow rates and 5.30 1.31 175 pipe diameter 7.05 1.74 200 9.02 223 250 13.64 3.36 0.47 300 4.71 0.66 350 6. 0.8 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pago '�' of FILE INFORMATION SYSTEM S PECIFICATIONS Owner C'h St'iC e ` Tank Manufacturer L(Jl i?-W'' 0 ❑ NA Permit p a0 q q ■ Septic ❑ Dose ❑ Holding Vol. 16400 gal DESIGN PARAMETERS Tank Manufacturer WILeo5r c oncr-eaae O NA Number of Bedrooms - ❑ NA ❑ Septic ■Dose ❑ Holding Vol. gal Number of Public Facility Units ■ NA Effluent Filter Manufacturer 2Q/ ❑ NA Estimated (average) flow gal/day Effluent Filter Modal Design (peak) flow - (Estimated x 1.5) j6JO gal/day Pump Manufacturer In QQ/l e-r C3 NA Soil Application Rate o al /da /ftz Pump Model IS3 Standard Influent/Effluent Quality Monthly average* Pretreatment Unit i NA Fats, Oil & Grease (FOG) 530 mg /L O Sand /Gravel Filter O Peat Filter Biochemical Oxygen Demand (BOO,) 5220 mg /L ❑ NA ❑ Mechanical Aeration O Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Manufacturer Biochemical Oxygen Demand (BOD 530 mg /L Dispersal Cell(s) ❑ NA Total Suspended Solids (TSS) 530 mg /L ■ NA ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Fecal Coliform (geometric mean) 510 cfu /10Um1 E At -Grade O Mound Maximum Effluent Particle Size Y, in dia. ❑ NA O Drip -Line O Other: Other: ifs NA Other. ❑ NA • Values typical for domestic wastewater and septic tank affluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month( (Maximum 3 years) ❑ NA ■ year(s) ■ When combined sludge and scum equals one -third (, me O NA Pump out contents of tank(s) ❑ When the high water alarm is activated At least once ever ❑ month(s) (Maximum 3 years) ❑ NA inspect dispersal celllsl y' -,3 ■ ear(s) ❑ month(s) p NA Clean effluent filter �J y� At least once every: ■ year(s) Inspect pump, pump controls &alarm At least once every: ❑ month(s) ❑ NA ,3 0 year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: 11 year(s) Other: At Least once eve ❑ month(s) 1111111 NA ever ❑ 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 (pumper). 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 a check for any back up or ponding of effluent on the ground surface. The dispersal cell(sl shalt 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 1. requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one -third (Y or more of. the tank yplume, 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 tb the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 5'1,2 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 12/021 i Paga or START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals that may impede the treatment process and /or damage the soil 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 extended, 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 and may overload them resulting in the backup or surface discharge of effluent, To avoid this situation havesthe 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 ovikr, 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) discharge; 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.shail 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 aite 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 (ornate 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 absorptior'systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions pf 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 gin S �I eallt 4 Name Phone — Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY / Name Name �� /, 1. roj Phone Phone 7/3-7—n, - 3n,— This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies in compliance with no 1)1)11)%1 miwiRlf1 and 83.5401, (2) & (3), Wisconsin Administrative Code. in partment of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 xi Human Relations Division of Salety & 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 mu i 11 u S Croix not limited to vertical and horizontal reference point (BM), direction and % of slop ,t4� or I.D. # v�'J , IZ3 7 dimensioned, north arrow, and location and distance to nearest road?;' ) E ndin APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION %, rt RE Y DATE IV a/ by PROPERTY OWNER: P RTY LOCATION Richard Stout G OT 1/4, 28 AR 19 { (or) W PROPERTY OWNER':S MAILING ADDRESS LO le@t3Yjr. A SM # 1353 Awatukee Trl. 35 a t Wood CITY, STATE ZIP CODE PHONE NUMBER ❑CITY 1 Vl�l NEAREST ROAD Hudson, WI.. 54016 b15) 549 -6731 Tro ° . . Tower Rd. ] ] New Construction Use [ x] Residential ! Number of bedrooms 3 [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 4 bed, gpd /ft •5 trench, gpd /ft Absorption area required 375 bed, ft 375 trench, ft Maximum design loading rat • 4 bed, gpd /ft - 5 trench, gpd/ft Recommended infiltration surface elevation(s) 99.62 ft (as referre a plan benchmark) Additional design / site considerations systm el. based on contour line of el. 98.62 Parent material limestone uplands 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 ❑ S � a s 11 U [IS ®U ❑ S ®U ❑ S ou ❑ S [NU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxar Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -9 10 r2/2 none 1 2msbk mfr cs 2f .5 .6 1 2 9 -29 10 r4/ none sicl 2msbk mfr gw if .4 5 Ground 3 29 45 10 r5 4 none cl m na na na np .2 elev. 98 ft. Depth to limiting factor 45" Remarks: Boring # 1 0 -10 10 r2 2 none 1 2msbk mfr cs 2f .5 2 10 -27 10yr4 /4 none sicl 2msbk mfr gw if 0.5 Ground 3 27 37 10 r5 4 none cl m na qw na npl.2 elev. 4 37 -55 10 r6/4 Fractured Limestone na -- -- 98 ft. Depth to limiting factor 37" Remarks: CST Name:—Please Print Phone: Gar L. S 715 — 246- Address: 1554 0th. AVe , New Rich mond, WI. 54017 m02298 Signature: D qt e: CST Number: 5 - L PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT Page PARCEL I.D. # mending Lot #35 Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft Boring # Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 7.45 1 0 -10 10 r2 2 none mfr cs 2f 2 10 -21 10 r4 4 none sicl 2msbk mfr gw if Ground 3 21T36 10yr5 /4 none cl m ' na 9w na np .2 elev. 97. ft. 4 36 -55 10 r6/4 Fractured Limestone na na npnp Depth to limiting factor 36" Remarks: Boring # k �r v ., Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # M IR Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) l STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Richard Stout New Richmond WI 54017 MPRSW 3254 NW4SEk S3- T28N -R19W (715) 246 -6200 t town of Troy N 1 =40' BM.= top of 1 pipe C el. 100' alt. bm= top of wooden post C el. 104.15' Z� Z V . S c o- A-1 3 l b - 1 � F e - So t l4' �7 0, 5 1 oC , Gary L. Steel 5 -17 -96 1 .. „ � moo° ky a W. MOM WO n --uoor ano human noon, C(3 ny t U r ` o� � r� , ,r -2d.7 ` ai ision or Safety 6 Buildings in J in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but St. Croix �- not limited to vertical and horizontal reference point (B", direction and 96 0/ sbpa. scale or PARCEL I.D. # b_ /- ��� dimensioned, north arrow, and location and distance to nearest road. nd APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION I BY DATE PROPERTY OWNER: PROPERTY LOCATION Richard Stout GOVT. LOT NW 1/4 SE 1 / 4 -S3 T 28 ..N.R 19 :k (of) W PROPERTY OWNER'S MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # 35 na Country Wood -�- GTY, STATE ZIP CODE PHONE NUMBER QCITY OVILLAGE DOWN NEAREST ROAD Hudson WI.. 54016 (715) 549 -6731 Troy T&imx Rd.' k j New Construction Use [ A Residential/ Number of bedrooms -4 (j Addition to existing building L j Replacement [ j Pudic or commercial describe Code derived dairy low 450 gpd Recommended design bading rate • 4 bed, g • 5 trench, gpd11 Absorption area required 375 bed, n2 375 trench, ft Ma)dmum design badulg rate • 4 bed, gib • 5 Mich. gpdfft2 Recommended infiltration surface elevations) 99.62 ft (as referred to site plan benchm Additbnai design / site considerations systm el. based on contour line of el. 98.62 Parent material limestone-uplands Flood plain elevation, if applicable na ft S - Suitable for system CONVENTioNAI MOUND N�GROUNO PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U Unsuitable for tem [IS M ci S O U O S ®U O S ®U CIS 0S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft in. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. Bed Tlend 1 1 0 -9 1 r2 2 none 1 2msbk mfr cs 2f .5 .6 2 9 -29 10 r4 4 none sicl 2msbk mfr gy if .4 95 Ground 3 29-45 10 r5 4 none cl m na 'na na - n .2 e(ev. 98 ft Depth to limiting kCtDr s 45" Remarks: Boring # 1 0 -10 10 r2 2 none 1 2msbk mfr cs 2f .5.6 2 2 10 -27 10 r4/4 none sicl 2msbk mfr 9w if .4.5 Grotmd 3 27-371 10 r5 4 none cl m na qW na n i.2 98 ley 4 37 -55 1 r6 4 Fractured Limestone na - Depth to smiting factor ��— Remarks: T Name: —Please Print Phone: Gary L . Rt-ppi 719-246- Add ress: 1554 0th. AVe4f New RicYnnond WI. 54017 m02298 Signature: r R 1-Qti CST Number STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Richard stout New Richmond, W154017 MPRSW towwn n o f Troy 3254 NinT s N -ni9w (715) 246 -6200 of N 1 " =40' EI.= top of 1 pipe @ el. 100 alt. bast= top of wooden post @ el. 104.15' Z r l � S Q. �vk ,�•3 (o N So 14' 1 . 1 -1, a5 s Z Gr , 12: • Gary L. Steel 5 -17 -96 07/08/2002 16:22 6087859330 SAFETY AND BLDGS PAGE 01 Safety and Buildings ; 4003 N KINNEY COULEE RD LA CROSSE WI 54601.1831 TOD #. (608) 264 -8777 v vwvw.wisco�sin.ov Department of Commerce Scott Mccanum, Governor Philip Edw. Albert, Secretary Dennis, A note to let you know l looked over your soil test for Richard Stout. The indication of massive clay loam in each of the 3 soil borings does not disqualify the site for an at - grade system. You are correct in reporting that massive clay loam receives no soil application credit according to Table 83.44 -2. However, per Table Comm 83.44 -3, massive clay loam is identified as a soil texture and structure that can be credited towards the minimum depth of suitable soil needed between a limiting condition and the system elevation. Massive clay loam conditions only require 36" of suitable soil. The soil application rate and system size can be obtained by using the top horizon(s). The massive soil condition leads me to suggest a system as long and narrow as possible and maybe a soil loading rate that is averaged out to a lower rate also. The plot plan indicates that there's only 72 feet between borings. An additional hand boring would allow you to lengthen out the system to gain a lower linear loading rate. if you have any questions, please don't hesitate to contact me at 608 789 - 7892. Jerry i I I i = 41 _0T a . M N87'24'0I6W 498.00' ^ pr. �aIS '0.00' 278.00' Z ' 59 QA 0 M g �o N87 ° 24 0l W 230.00' Z M � , 6 35. M� M 9 AC. 2.24 AC. 52 SO. FT. . 97, 794 SO. FT. W 34 33 W � p - - o ''� 2.23 AC. 2.76 AC. ` Z 97,005 SO. FT. 120,302 SO. FT. _ . �-` - jr VIP C MVB DATA (drainage usnuts) CORY1 LO? SIDIIIS C81m C601D CHOSD ARC !Him TI111R 10. 10 L816T1 nu Bulm LBIGTS LEE om B11�1M 1 54 247.00' 02 810 10.06' 11.14' Su $09 T 53 247.10' 02 !!1.54 11.02' , 11.12' 11l�23!33'1 317 Pi 52 417.00' 01 S1 1'14.1 10.02' 11.12' 514 517 11 51 417.10' 01 $11 10.03' 11.13' 517 $19 Qi 32 433.00' 01 131 13.12' 13.12' 130 131035117.1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer � ``� X5 tJ17 Mailing Address 15 kEEr ftAk F*45 LJZ S4'o2a Property Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number 01- - /-� 3 O —OY- LEGAL DESCRIPTION Property Location k) ui v, S V,, Sec. . T a N -R-L�_W, Town of T��Y Subdivision C©U TkT woo6 - . Lot # . y Certified Survey Map # , Volume Page # Warranty Deed # & aj , Volume Page # 0 Spec house ❑ yes 0 no Lot lines identifiable ❑ yes ❑ no SYSTEM NANCE M�iINTE 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 mastcrplumber, joumeymanplumber, 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of th year expiration date. MM APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of rho property criibed above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGMA OF APPLICANT DATE « « « « «« Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed STATE BAR OF WISCONSIN FORM 2 - 1998 K6HU669 H WARRANTY DEED REGISTER OF DEEDS Q ST. CROIX CO., WI oocumenl Number 401 1 449PAGE 304 _. RECEIVED FOR RECORD This Deed, made between - - - - -- OA-16 -1999 12:50 PH — - -- - -- -- VARRAIM DEED — -- - - -- EXEMPT 0 - - - -- Grantor. CERT COPT FEE: — — COPT FEE: and ____.SBD_,I and TERR C HEWITT, - -.— TRANSFER FEE: 149.70 RECDRDING FEE: 10.00 PAGES: I -- -- — — — Grantee. Grantor. for a valuable consideration. conveys and warrants to Grantee the following described estate in County. State of Wisconsin: L t 35, Plat of Country Wood First Addition, Name and Return dress T tun o Troy, St. Croix County, Wisconsin, i�63 G�� ✓t�� / S ao a.1- 040 1 2 �a fif1 - Parcel Identification Number (P IN) This-L4_aot -- homestead property. (is) (Is not) Exceptions to warranties: easements, restrictions, rights -of -way and covenants of record. Deed this 1 1 th day of . Allgl)Gt 1999, ' (SEAL) (SEAL) (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT signature(s) __ -_ _.___._— -._ -- State of Wisconsin, ss. St. Croix County. Personally came before me this 7 1 tI day of authenticated this day of , the above named to TITLE MEMBER STATE BAR OF WISCONSIN me know to be the p n who executed the foregoing (If not. — -- instrum nt and ackno dge the same. authorized by 5706.06, Wis. Stars.) Q THIS INSTRUMENT WAS DRAFTED BYO`,J�y .,,CO Janet p. Stout to o { - -- Notary Public, Stat of Wis onsin ---3353 Awatilkee Hudson, Wi . 54016 My commission s per anent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary) 'Names of persons signing in any capacity mast be typed or printed below their signature. Wesconsm legal Blank Co.. Inc. STATE BAR OF WISCONSIN Ww"kee. was. WARRAN'T'Y DEED FORM No. 2 - 1998 Safety and Buildings 4003 N COULEE RD LACROSSE SSE W WI 54601 -1831 TDD #: (608) 264 -8777 R E C ? C r, www.commerce.state.wi.us /sb �sconsin www.wisconsin.gov Department of Commerce F I I- 0 9 2002 Scott McCallum, Governor Philip Edw. Albert, Secretary S l ..o .. .,...�� pj August 09 2002 u g , CUST ID No.221483 ATTN: POWTS Inspector DENNIS L HEWITT ZONING OFFICE HEWITT EXCAVATING INCORPORATED ST CROIX COUNTY SPIA W2062 US HWY 10 1101 CARMICHAEL RD MAIDEN ROCK WI 54750 -8307 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/09/2004 Identification Numbers Transaction ID No. 774040 SITE: Site ID No. 648659 Chad & Jessica Hewitt Please refer to both identification Tower Rd numbers, above, in all Town of Troy correspondence with the agency. St Croix County NW1 /4, SE1 /4, S3, T28N, R19W FOR: Description: Proposed Four Bedroom At -grade System Object Type: POWT System Regulated Object ID No.: 863950 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. DENIMS L HEWITT Page 2 8/9/02 • Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101. 12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Gerard M. Swim Balance Due $ 0.00 POWTS Plan Reviewer - Integrated Services (608) - 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm jswim @commerce.state.wi.us WiSMART code: 7633 cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544