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HomeMy WebLinkAbout040-1243-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453019 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: Brunckhorst, Gary I Troy Township 040 - 1243 -20 -000 CST BM Elev: Insp. BM Elev: BM Descriptio // .� / Section/Town /Range /Map No: / 6 <-, a to -5 Z Q 3 -c��Y� a� .� � "mod 1 03.28.19.1241 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. /D_ Septic Benchmark q_3 / cq — :5 /IJS' U Dosing [ Alt. BM !! W 2-Wd 7 (off . A y y 16 10 y' S Bldg. Sewer Aeration GS Holding . S tInIP 16 �SCk1 �1 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake FR OAD Dt Inlet Septic � Dt Bottom �3vs (3. Z Dosing '7 , L r ,_ Header /Man. / D-7 Aeration "l �^ Dist. Pipe Holding Bot. System 2 ct << Final Grade PUMP /SIPHON INFORMATION dy 9l Manufacturer Demand St Cover GPM / /0-0 , 2- S -- ' Ia-7 - S Model Number l n , ,� 3. d 3 -Y OS TDH Lift Frictio Loss System H ad TDH Ft J 1,p 'i•7 to I /7 -'J� W Forcemain Length Dia. Dist. to Well ZY SOIL ABSORPTION SYSTEM BED /TRENCH Width f Length ,- No. Of T� n�hes PIT DIMENSIONS No_. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/ BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION C BE OR Type Of System: d , / / f em: / Model Number: DISTRIBUTION SYSTEM Hea r /Manifold Distributich x Hole Size ? x Hole Spacing e to Air InlaYe (- Pipe(s) , a' 7 z ( 7 Length Dia Length Dia 2 Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over 0 Depth Over xx Depth of xx Seeded /Sodded xx Mulc e Bed/Trench Center Bed /Trench Edges Topsoil Yes No Yes No COMMENTS: (Include c d discrepencies, persons present, etc.) Inspection #1: / / Q7 Inspection #2:/ Location: 504 Trillium Lane Hudson, WI 54016 (SW 1/4 SE 1/4 3 T28N R19W�yWo( . II of 83 Parcel No: 03.28.19.124 Q +(� C fits Sl 1. ) Alt BM Description 2.) Bldg sewer length =17['1 - amount of cover =✓ Plan revision Required? Yes No Z� Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor'49nature Cert. No. ( A > Safety and Buildings Division County . 201 W. Washington Ave., P.O. Box 7082 s . f c ons>R Madison, WI 53707 - 7082 Sanitary Permit Number (to be tilled in by Co.) (608) 261 -6546 -�5 3 (D I Del artment of Commerce to Plan I.D. Number Sanitary Permit Application # 9� +� >"e,us. gyp• In accord with Comm 93.2 1, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, aI5.04(1)(m) � dress (if different than mailing address) 712 ! t_ L I ta►� L �EtJ� I. Application Information - Please Print All Information Property wner's Name &k/ f�t # Blocr # 5 C 3 r _ Property Own � M[ / siling-Address Property Location ' ' .5, !/h ✓ , Section 'C ity Stale l Z ip Code !� Phone Number ! V ! n6) "TT N;/-,�E7r W r1L of Building (check all that apply) *4(w ^^ aolAg Subdivision Name CSM 1 ber 2 Family Dwelling - Number of B � _ � T �� � \ / ❑ Public/Commercial - Describe Use (3 State Owned - Describe Use )( ❑City, ❑villa ownship o IIL Type of Permit: (Check only one box on line A. Complete line B i applicable) 17- 3 — ZO -C G I Z 1 A. System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑erm Pit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that ap ❑ Non - Pressurized In -Ground > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At- Crrade ❑Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In-Ground ❑ Holding Tank ❑ Peat Filter C1 Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber Drip Line ❑ Gravel -less Pipe ❑ Other (e lai ) V. Dispersal/Treatment Area Information: A7 - IUD Design Flow (gpd) I Design Soil Application Rate(gpdsf) Dispersal Area Required (s!) Dispersal Area Proposed (t) System Elevation VL Tank Info parity in Total Number Manufacturer Prefab ice Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic a Holding Tait .J Aerobic Treatment Unit Dosing chamber VII. Responsibility Statement- 1, the undersign auutne re:ponaibility for iostsllatlon of the POWTS shown on the attached plans. Pi s Name (Print) Plumber' gnature MP/MPRS Number Business Phone Number Plumber's Address (Stroet, City, State, Zi poaN LZQ VIII. Coun /D epartment Use Onl .Approved ❑Disapproved Sanitary Permit Fee (dudes Groundwater Date Issued lssu g nt Signature Stamps) Surcharge Foe) ?� r ❑ Owner Given Reason for Denial 7 IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER. 1 Septic tank, effluent filter and dispersal cell must all be serviced /be serviced / and as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper no t less this $112 s 11 Inches in size SBD -6398 (R. 08/02) PLOT PLAN Gary Brunckhorst ADDRESS 16643 4th St. N. Lakeland Mn 55043 1/4 SE 1/4S 3 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX 2/29/04 BEDROOM 4 ; PRS Shaun Bird 226900 DATE CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK XXX 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 600 # of chambers none IL BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100 Filter Zabel A -100 ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 107.0' Trillium Lane Well is to meet all setbacks found in Comm. Pro 4 83 Bedroom House w� k dt,•�f' �u i 30 ) 10 0 105' 1 6' Huffcutt Combo tank 107' Well is to meet all B-2 setbacks found in Comm. 4% 83 Slope Grading is to be done to divert run -off away from system B -3 c op y Area 15' below system is to remain ndisturbed B.M. —� 342' Property Line Scale = 1/4" = 10' No �`�'� ,,� ,� � .,� ,��, Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 �scons�n www.commerm.state. /sb Department of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary March 04, 2004 CUST ID No.226900 A7TN: 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 PLAN APPROVAL EXPIRES: 03/04/2006 Identification Numbers Transaction ID No. 974400 SITE: Site ID No. 671213 Gary Brunckhorst Please refer to both identification numbers, Trillium Lane above, in all correspondence with the agency. Town of Troy St Croix County SWl /4, SE1 /4, S3, T28N, R19W Lot: 83, Subdivision: Country Wood FOR: Description: Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 944560 Maintenance required; 600 GPD Flow rate; 40 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01/01), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 /01); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, Condrtio stats. APP The following conditions shall be met during construction or installation and prior to occupancy or use: DE ARTMENT OF General Approval Requirements: 0 NO E YA • This system is to be constructed and located in accordance with the enclosed approved plans and with the SEE CORRESM "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). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. SHAUN R BIRD Page 2 3/4/04 • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of See. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A cony 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 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. 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 (O�'�� Balance Due $ 0.00 Charles L Bratz POWTS Reviewer 11 , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 Cover Page q e F Shaun Bird Bird Plumbin g Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 2/29/04 Owner: Gary Brunckhorst Location:SW1 /4 SE1 /4 S 3 T28N,R 19W Lot 83 Country Wood Troy 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 WIy 7 -8. Maintance and Con 'gency plan ED OM MERCI: 9 -11. Soil test ,v LDIIVG �NDI_N Signature License num 226900 PLOT PLAN PROJECT Ga ry Brunckhorst ADDRESS 16643 4th St. N. Lakeland Mn 55043 SW '1/4 SE 1 /4S 3 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 2/29/04 BEDROOM 4 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 600 # of chambers none IL BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H,R.P. SameasBenchmark SYSTEM ELEVATION 107.0' Trillium Lane Well is to meet all setbacks found in Comm. Pro 4 83 Bedroom House 105' 106' Huffcutt Combo tank 107' Well is to meet all B-2 setbacks found in Comm. 4% 83 Slope Grading is to be done to divert run -off away from system B -3 Area 15' below system is to remain ndisturbed B.M. 342' Property Line Scale = 1/4" = 10' p Y "Designer No Date Non -Woven Filter Fabric 4" Observation Pipe Perforated < ,Distribul ion Pipe Below Filter Fabric ASTW C -33 S a n d --\ -�` G iH " Topsoil ` - - - -_- = - o �_ E ` . r � 1 1� % slope ,• Force Main ��Fiawed Bed Of t��- 2 Y From Pump �n er Drain Rock ' D E Cress Section Of A Mound System Usin F � A Bed For The Absorption Area G A Ft- s ��_ t. t- d Z,_2 Ft. x./'G� Ft. Ft. l' W, �, ' Ft. L 4'Observolion PiPe­ _K r _----------------------- ---- A a Force Main . -------------- --------------------- ------- - - - - -- ------------ - - - - -- From PU W to r ° Distribution Bed Of f Pipe Drain ROCK I 4Obse / rvotion Pipe'PCc Permonent Marker P' i pe or Rods Pion View Of Mound Using A Bed For The Absorption Area PAGE OF' Perforated Pip! Detoit End View �Perforotea �, • Pvc P,pe Mates EquG11 O BattOm. Art Equal}p Spacea id Y a PVC Force Main .� >+ 7 �ftRST 1lOt.L NLXf ro CaAAtf: }�of PVC / Manifold Pipe j;'4 Old oist. out�on Pipe l`ex.F ., Distribution Pipe Lay P 1 2 0, Ft. X 4> n h es I c Y Inches Signed: Note Diameter J �o�Inch Lateral Inch (es) License Number: Manifold inches Date:, Force Main Inches # of holes /pipe Invert Elevation of Lateral Ft. i SEPTIC TANK FUM? CHAMfi CROSS S£ C TiON AND SPECL3ICATIOnS wEAFHERPRWF APPROVED ., tAZN . � GRADE JUNCTION BOX C` VENT PZPE I2 WITH CONDUIT MANHOLE COVER y_ FRO Doolt , WI NI? OS� 4R w / P i, x s FRESH AIR INTAKE F or,t / WARtiI�tG LA$EL GRADE to �r�r'" g +' MI�1. 2Y� INLET GAS � `. ED iiAT£R TIGHT SEAS � joINT5 VITH A i AppoygD PIPE 3 ql + A N 8 �,IID SOIL APPROVED - i • PIPE 3` C I OFF SMID 9 jsFT. A— SOIL PUMP OFF ELEV - D APPROVED BEDDING UNDER 'TA ONCRE PAD c� SPECIFICATI 3'iB�R DOSES NLJ PER DAY SEPTIC ! DOSE RER: VO YNCDING Tu TANK nAFAC� .GAi.. DOSE F LaWgpC1C j- SEPTIC ,,_�..��-- - AI„ TANX SIZES: DOSE taj- ` INCHES CAPACITIE A INCHES = GAL. y AgH 1 , SA FAC11iRER • !1�' 8 = A rssER : / : /o� 71S MpDEL ��'� " C ?� f ;ACHES SWI TCH TYPE: �/ I GAL PUMP HA9UFAC'URER = 16.23 "c m NUMBER : " Lv/` A S PER I LHR MOD TYPE: M WIRI SW2TCH G PcTISP s ALAR FEET REQU .RED DISCHARGE RATE DISTIRIBO'T'ON PIP£ - y _ FEET pUMp OFF AND .' FEET VERTICAL DIFFERENCE sETwEEN . � FT/ 1 O D � FT - ICTION FACTOR - gg FEET + MIN tai NETWORK SUPPL PRESSURE T OTAL DYN�IC HW FEET FOR �j COWN X ---"" WIDV _. ......' DIAMETER ? TANK: INTERNAL DISENSTONS 4F PUM LIQUID DA:£= LICENSE SIGNED- _ : /g8 TOTAL DYNAMIC HEAD /CAPACITY • - PER MINUTE HEAD CAPACITY CURVE EFFLUENT AND DEWATERING Ln MODEL 152/153 I MODEL 152 153 LJ g 50 Feet Meters Gai. Liters Gol. Liters 5 1.5 I 69 261 77 291 153 10 3.1 61 231 70 265 12 40- 152 15 4.6 53 201 61 1 231 ° a 20 - 61 44 167 52 197 w 30 25 7.6 34 129 42 159 z 8 30 9.1 23 87 33 125 35 10.7 - -- — 22 85 0 20 40 12.2 -- -- 1 t 42 4 l L ock Valv 38.0 Ft. (11_6m) 44.0 Ft. (13.4m) 10 wa5oa 0 20 0 60 80 100 GALLONS 6 1/4 LITERS 0 80 160 240 320 1 a 5/8 —� 3 2%j32 FLOW PER MINUTE I I �__ _ 3 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. 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 FM 1420. • Over 130 °F. (54 °C.) special quotation required. 1521153 Series 12 1 1521153 MODELS Control Selection Model VOlts•P Mode Am s Simplex Duplex 5 1/8 N152 115 1 Non 8.5 1 2or3 BN152 115 1 Auto 8.5 Included 2 or 3 _L sKZOSa E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2or3 SELECTION GUIDE BN153 115 1 Auto 10.5 Included 2 or 3 153 E 230 1 Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float BE153 230 1 Auto 5.3 Included 2 or 3 switch. Refer to FM0477. A CAUTION 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 TO: P.O. BOX 16347 Louisville, KY 40256 -0347 Manufacturers of. . [ SHIP TO: 3649 Care Run Road c�� o Louisville, KY 40211 -1961 Q!/AUTY )OUMP9 ,SINCE 9, & �. PUMP !O. f 502J 77 8 - 2731 FAX (502) 7743624 PUMP http: / /www.zoell er. corn © Copyright 2000 Zoeller Co. All rights reserved. Page of WTS OWNER'S MANUAL & MANAGEME l PO L SPECIFICA SYSTEM Septic Tank Capacity Sal ❑ NA FILE 1NFORNIATION j ❑ NA E Fe rmit Septic Tank Manufacturer #. Effluent Filter Manufacturer ❑ NA DESIGN PARAMETERS 0 NA Effluent Filter Model ��" ❑ NA Number of Sedro Prns Tank Capacity ' � al G NA Pump Number of Commercial Units aUda Pump Tank Manufacturer N Estimated flow (average) Manufacturer �Pi�.' NA D c al/day . Rump 0esign flow (Peak)) (Estimated �� M j,J' ❑ NA lftz Manufacturer son Application ' tion Rate Pretreatment Unit Monthly average O Sand/GrBvel Filter ❑Peat Filter Inftuent/Etffuent Quality 530 mg/L echanical Aeration ❑Wetland G M Grease (FOG) O Grea ( r Oil 8� ❑ Other Fats,. 5220 mg/L Biochemical Oxygen Demand (ROD [3 Disinfection Total Sust�_d olids SS) 515 0 m �L ManufacbufeNA Monthly average" Dispersal Ceil(s) ❑ 1 .ground (pressurized) Pretreated Effluent Q - _ mg/L ❑ In -ground (gravity) -Mound Biochemical Oxygen Demand (SODS) s30 mglL ❑ At -grade ❑Other. Total Suspended Solids (TSS) 510 cfu /10pm1 ❑ Dri ine Fecal Coliform (geometric mean) • Values typical for domestic (non- commerd waa ao stewater and Y inch diameter septic tank effluent Maximum Effluent Particle Size Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Frequency Service Event �❑ months�ear(s) (Maximum 3 yrs.) Inspect condition of tank(s) At least once every ...5 y of tank volume When combined sludge an' scum equals one- s Maximum 3 yrs.) Pump out contents of tank(s) At least once every ❑ months -'I MKS) K ) ❑ months�7ear(s) Inspect dspersal At least once every er(s) p NA Clean effluent filter �' ❑ months con controls � alarm At least once every --� ear(s) O NA inspect P� m P P ump ❑ month At least once every ❑ NA Flush laterals and pressure test At least once every c3 months [I year(s) Other ❑ months ❑ year(s) ❑ NA At least once every otter. MAI�ENANCE INSTRUCTIONS n one of the following licenses or ks and dispersal cells shall be made by an ind'ivldual cafrYi 9 ctor POWTS Maintainer, Septage Inspections of tan to identify any missing or broken certif cations: Master Plumber, Ma ns must inG d�a `^su insi>ecdo the th for an back up Servicing O Tank inspectio meas ure the volume of combined sludge and scum and to check Y an sacks or leaks, ed to effluent levels hardware. identify y round surface. The dispersal cell(s) shall be visually if check the e nding of effluent on the or he observation g of effluent on the g for any ponding of effluent on the ground surface. The po regu authority. in the observation pipes and to check r eq uires the immediate notification of the focal reg ground surface may indicate a failing condition and um uals one -third (X,) of more of the tank volume, the Se a Servicing Operator and disposed of in accordance with ch. NR When the combined accumulation of mo by and a s P�9 in any tank eq entire contents of the tank shall tie re and any 113 ' a certified POWTS Maintainer. other maintenance or monitoring at i n ter vals Wisconsin Administrative Code- retreat ment components The servicing of effluent filters, mechanical cal op pressur the or shall be Pe "ed ulatory a utho r ity within 10 days of completion of any service event. A service report shall be provided to the local reg for the presence of painting products or other START UP AND OPERATION disp ersal cell(s). if high con of the POV1fi S check treatment tank(s) centrations are For new construction, prior to u s and/or damage the disp m im" a the treatment Proces rotor prior to use. chemicals that y P� removed by a septage servicing ope ra tor detected have the contents of the tank(s) v - Page of s oil-oonditions are frozen at the infiltrative surface System start up shall not occur when ` i restored the excess tanks may till above normal h"tghwater level over l oa ding the ceti(s} and may result in the During power outag Pump rsal celt(s) in one large dose, um tank removed by a wastewater will be discharged to the dispe of effluent To �tor av to th e this th ua have o nco ntac t a Plumber or POWTS Maintainer to backup or surface discharg iing Power e effl ent pum Septage Servicing l prior .t6- to r r re normal levels within the P ump . P tank . assist in manually operating the p 00 n Ws p over, or otherwise disturb or compact, es over tanks and dispersal cells. Do not Do not drive or Park vehrd drive or Use area within pa feet down slope of any mound or at -grade soil absorption area. �rmance and prolong the rife Reduction or elimination of the following from the wastewater stream may improve the pe dental Ross; diapers; Of the POWi(i S: and baby VAPOS; cigarette butts; condo ) water, fruit and Cotton efin s� aso final �; gee; hetblcides; meat disinfectants; fat; fouridation drain (sump Pump d vegetable pe 9 . g scraps; medications; oil; painting products; Pesticides; sanitary napkins, ta mpons; - and water softener brine. ABANDONWMENT taken out of service the following steps shall lie taken to insure that the When the POWTS fails and/or is p ermanently system is property and safety abandon abandoned ed in compliance with ch_ Comm 83.33, ��n Ad ministra tive We e: • All piping to tanks and pits shall be disconnected and the disp e p�gecing Operator. The contents of all tanks and pits shall be removed and properly 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 aired the following measures have been, or must be taken, to provide a code If the POWTS fails and cannot be rep compliant replacement system: soil 0 A suitable replacement' re has beet rrea be protected ted f disturbance loca nd compa a d should not absorption system. The replacement proposed S tructure, lot lines and wells_ Failure to be infringed upon by required setbacks from existing and propo protect the replacement area will result insoil and n ite evaluation to effect at that time �blrsh a suitable area. Replacement syste must comply with t O A suitable replacement area is not availabl s etb ack ort to replace s I the failed POWTSng advances in POWT technology a holding tank. may be install as a last n failure of the POWTS a soil and f =-The site has not been evaluated to identify a suitable replacement area. U n o replacement area is available a site evaluation must be performed to locate a suitable replacement area_ i f n holding tank may be installed as a lastres to ms y Pbe �n tructed i p l ac e following removal of the biomat at e Mound and at -grade soil absorption sy I with the rules in effect at that time. the infiltrative surface. Reconstructions of such systems must comp y <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TR TREATMI =NT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY GEN. PUMP OR OTHER ICULT OR IMPOSSIBLE. C FF A SEPT( E DI O NOT ENTER ANK tHAY B D AT T. RESCUE OF A PERSON FROM THE INTERIOR OF RESULT. COMMENTS POWTS MAINTAINER POWTS INSTALLER Name Name ll �/ Phone �ZY J SEPTAGE SERVICING OPERATOR PUMPER 7 en AL REGULATORY AUTHORITY cy Name hone /�— Phone do cument meets This document was drafted by the staffs of the Green lake Marquette and Waushara County Zoning and Sanitation age ncies. This document does not requirements of ch. Comm 83.22(2)(b)(t)(d)&(f) and 83.54 1 , ) & (3), W*Lsconsin AdminisL - atnre Code. Use of this docu GMW (2/0 1 ) the minimum guarantee the performance of the POWTS_ Wisconsin Dspartment of Industry SOIL AND SITE EVALUATION REPORT Page ? of 3 Latrr and Human Relations - D'vision„ofSafety & Buildings in accord with IL HR 83.05, ..� 'e COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in �� n must include but St. Croix not limited to vertical and horizontal reference point (BM), direction a f s4e, sdale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest roa .� pending APPLICANT INFORMATION PLEASE PRINT ALL INFOR `ON `,_, E EWEDBY DATE p PROPERTY OWNER: PROPER'TYLOCATION .� Y Richard Stout GOV -r-L -6 _!,s 14 E 1 /4,S T N,R or)W PROPERTY OWNER':S MAILING ADDRESS L ^ # BLOCK # NAME OR CSM # 1.353 Awatukee Trl. r1i ountrZ Wood Second A d . CITY, STATE ZIP CODE PHONE NUMBER _ MOWN NEAREST ROAD Hudson, WI. 54016 (715 549 -6731 Troy Tower Rd. New Construction Use [ Residential / Number of bedrooms 3 [ ] Addition to existing building j ] 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 rate .4 bed, gpd /ft .5 trench, gpd/ft Recommended infiltration surface elevation(s) 107.00 ft (as referred to site plan benchmark) Additional design / site considerations - system el. bsed oncontour line of el. 106.00' Parent material limestone uplands Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem El S C3 U ®S ❑ U ❑ S K] U ❑ S 9] U E] S 9:1 U ❑ S 1 ] U SOIL DESCRIPTION REPORT J/9t'U . Z-w Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tierch 1 0 -10 10yr3Z3 none s i l 2m (� 2 10 -29 1.0yr4/4 none sici 2msbk mfr g if .4 .5 Ground 3 29 -40 7.5 r4 4 none sl lesbk mfr Qw na .4 .5 elev. 106 ft. 4 40 -55 10 r7/3 none Fractured Lime tong -- -- -- -- -- Depth to limiting factor 40" Remarks: Boring # 1 0 -12 10 r3/3 none sil 2msbk mfr cs if .5 .6 2 2 12 -28 10yr4 /4 none sicl 2msb1c mfr qw if .4 .5 Ground 3 28 -48 7.5 r4 4 none sl lcsb mfr .4 `.5 elev. 4 48 760 10yr7 /3 none Fract re Lime one -- -- -- -- 10 ft. Depth to limiting factor 48" Remarks: CST Name:— Please Print Phone: Gary L. Steel ddress: 1554 200th. Ave. New Richmond WI. 54017 m02298 Signature: Date: CST Number: 8 -13 -96 f PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT Page 9 of _ PARCEL I.D. # pending Lot #83 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GP57 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 1 +12-34 12 10 r2 2 none cs if .5 3 2 10yr4 /4 none sicl 2msbk mfr Ground 3 134-40 7.5 r4 4 none elev. 1 4 140-50 1.0 r7 3 none Fract red. Limestone -- -- -- -- Depth to limiting factor 40 Remarks: Boring # Ground elev. h. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) i PROPERTY OWNER Kicnara tout J V I L U C 7 V n I r 1 1 V I' n c r %w" i PhRCELI,D,# pending Lot #83 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence , Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench .(o n : >{ 1 0 -12 10 r2 2 none cs if 3 i h 2 12 -34 10yr4 /4 none sicl 2msbk Ground 3 1 3 4-40 7.5 r4 4 none elev. 1 4 1 40-501 10 r7 3 none Fract ed Limes one -- -- -- -- Depth to limiting factor 40" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # k:,'..:,.'�'S.C4k: .=. Tn' G Ground elev. ft. Depth to limiting factor FT Remarks: Boring # Ground elev. ft. Depth to Gmifi factor Remarks: SBD- 8330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel Richard Stout 1554 200th Ave. CSTM2298 SW4SEy S3- T28N -R19W New Richmond, WI 54017 MPRSW 3254 town of Troy (715) 246 -6200 lot #83- Country Wood Second Addn. l N i 1 =40' BM.= top f 1SW lot stake C el. 100 k v 2 F" � a , ''RR 3Rz YJ � Gary L. Steel 8 -13 -96 I� J ST CROIX COUNTY SEPTIC 'TANK iVIAINTENANCE AGREEMENT AND pJEgSHI P CERTIFICATION FORM owner/Buyer v 3 Mailing Address 5 0 Property Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number LEGAL DESCRIPTION Q �� ' /,, _ V -9 Sec. . T "W N -R /, W, Town of Property Location 3 Subdivision Volume Page # Certified Survey Map # //_ o— KJ Volume L Page # Warranty Deed # � � Lot lines identifia yes ❑ no Spec house ❑ yesXno SYSTEM MAINTENANC Improper use and maintenance of your septic system could result is its pr ema tur e a lice nsed pumper. W fail to ehat you put Pro b into the system consists of pumping out the septic tank every three years or sooner, if needed b a lice 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 ourneymanplumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system masterplumbm j in if necessary), the septic tank is less than 1/3 full of sludge. is is proper operating condition and/or (2) after inspection ection and pump g C Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards t of Commerce and the Department of Natural Resources, State of Wiscons in. set forth, Certification a in, as set by the has been Zoning Office within 30 stating our se tics ystem has been maintains must be completed and returned to the St. Croix County g days o e y expiration date. DATE F APPLICANT OWNER CERTIFICATION we) certify tbovc, t all statements on this form a d eed true to th in Register of Deeds Offi dge. I (we) am (are) the owner(s) of the p rty cribed by virtue of a warranty i DATE SIGNA OF APPLICANT Any information that is mis- representedmay 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 58 2306 STATE BAR OF WISCONSIN FORM 2 – 1982 WARRANTY DEED DOCUMENT NO. vft -- -37p?5 El 19TER 3 OFFICE 5T. CROIX CO., 1NI _ Rev � to I!NCOM JUL 0 81888 conveys and warrants 1:30 P M ; of 0"4110 THIS SPACE RESERVED FOR RECORDING DATA ` NAME AND RETURN ADDRESS the following described real estate in St Cro County, State of Wisconsin: (— Lot 83, Plat of Country Wood Second Addition, I. F n of Troy, St. Croix County, Wisconsin. 040- 1234 - - 000 -i PARCEL IDEN7IFICATION NU48ER RANSFER s This _l no homestead property. (is) (is not) ` Eztzeptiontotvarranties: easements, restrictions, rights -of -way and covenants I of record, if any. �i i Dated this _ I S t — _ day of , A.D., 19 9 3 . a _ (SEAL) (SEAL) Hich 4d Q- tn (SEAL) (SEAL) AUTHENTICATION ACKNOWLE ^GMENT Signature(s) State of Wisconsin, Ss. St. Croix County. �I authenticated this __ day of ' 19— Personally came before me this 1St _ day of Ju - _ 19�Q, the above named i Richard O Stout d TITLE: MEMBER STATE BAR OF WISCONSIN (if not Brenda Poulin I authorized by $706.06, Wis. Stats.) to me own to be the per n who executed the foregoing �i Notary Public ' State of WisconSb*n+me' d t an acknowle a the same. I THIS INSTRUMENT WAS DRAFTED BY I Janet P. Stout LL �i 1353 Awatukee Tr. Hudson Wi . 54016 Nota Public, ' County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (Ii not, ate xpiration datj 1w necessary) (�j • Names of persons signing in any capacity should by typed or printed below their signatures. STATE BAR OF WISCONSIN wiscansn Legal 8�tk A" trio. ' Wa� WARRANTY DEED Form No. 2 — 1982 w � O n v �, f - x4 S vv / S9 0 /6 Og 82 / 24 ACRES 1, 237 SO. FT. 12 AC. EXC. ESMT. 5,773 SO. FT. / / c ON � /® 0 o 8 _ � 84 ® / M� AC � RES o � 2.75 ACRES 87,639 SQ. FT. p N 119,679 SQ. FT. ' ESMT. 1.92 AG EXC. ESMT Q. FT. $7,639 SQ. FT. / /t` S6 4o 4 6 Qp , �� 00, I t� i 3n 9 � b •, / _N to/ 8O 150.00' v 25.40' 240.00' 34 5.40' 2.15 ACRES S85025 52"E 230.0( 30\ / 93,866 SQ. FT. 495.40' 2.03 AC. EXC. ESMT. 381 SQ. FT. 79 / W N n 2.24 'ACRES 78 ` op M 97,481. SQ. FT ® _ 0 2.51 ACRE. \ 22 365 0 2 W 109,130 SO. 0' O f) 2.13 AC. EX �1. u4s, so ro 92,758 SQ °'� 19 33 3g, 0