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HomeMy WebLinkAbout040-1051-30-000 Y County: Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 420692 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID N . 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: Purfeerst, Dan Troy Townshi p C l CST BM Elev: Insp. BM Elev: scriptior� Section/Town /Rang Map No: f o o .�a � o o� � I BM ��/ See W o — j 051 - 3� . .19. TANK INFORMATION ELEVATION DAT TYPE MANUFACTURER CAPACITY STATION BS 9 HI 7FS P Septic �� / - �� Benchmark �/ /�` / Dosing D I � (O - l7• �./ Aeration d7 - -- Bldg. Sewer W Holding, = SVHt Inlet TANK SETBACK INFORMATION SVHt Outlet TANK TO Fil— WELL BLDG. Vent to Air Intake ROAD Dt Inlet Nw e� Septic / Dt Bottom 95 >100/ eLs Lzin, I G.13 Dosing lCl/Yt Header�an.2 lO Z •9 ,��Z Aeration _ -- - __ -- D Pipe T op o Holding - - —' Bot. tystem [ll. / / Final Grade PUMP /SIPHON INFORMATION �/ Manufacturer Dema St Cover GPM 7� �-1 �� Z s 0 Model Number / u ��• / , Y / /p3,' 73• ( 3 TDH Lif� l .� Fricti s System Head TD Ft Forgem in Le th ♦ Dia. Dist. to Well t 1160 > _20 D Grp I �iru� Z 05. e0 - �( SOIL ABSORPTION SYSTEM BED/TRENCH Width n gth No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth Len f DIMENSIONS 8 5 - 7 6C1, SETBACK SYSTEM TO [ P/L _ JAkLbG WELL LAKE /STREAM L CH Manufacturer: INFORMATION Type Of ystem: 11 HA R OR > 3bb - ` N A UNI Model Number: DISTRIBUTION SYSTEM ! e Header /Manifold Distribution x Hole Siz I x Hole Spacing Ven to Air Intake I k Pipe(s) .� 3 Length Dia Lengt Dia !� Spacing �(O SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only r Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bedlrrench Center -q I BedlTrench Edges Topsoil / (/ [] Yes Er, No Yes p [] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:/ �O 0 3 Location: 860 Coulee Trl Hu son, WI 54016 NW 1/ SE 1/4 2 T28N R19W) NA Lot 2 Par�cell N 12.28.1 . 1.) Alt BM Description� 2.) Bldg sewer length = �� ✓ ' �K r:GZZ - amount of cover = ��% a4lLd- Plan revision Required? I Yes No 'Jse other side for additional information. _ I _ (R.3/97) Date Insepctor's Si nature Cert. No D -6710 PLOT PLAN n,Purfeerst ADDRESS 735 Shane Park Circle #2 Prescott Wi 54021 4 SE 1 /4S 12 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX RS Shaun Bird 226900 DATE 1/31/03 BEDROOM 3 : ONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK IOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 tOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none i BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100° Filter Zabel A -100 BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 99.2' 1.5' sand lift Scale = 1/4 = 10' Alt. B.M. 400' Coulee Trail c I a r 200 a B.M. ' 10% Slope B -2 Area 15' Below System is to remain undisturbed Y u B -1 Well is to meet all B-3 setbacks found in 95' Comm. 83 Huffcutt Combo Tank 97' 99 Tank is to be properly Pro 3 Grading is to be done bedded and provided with Bedroom to divert run -off lockdown covers with House away from system approved warning labels r t Safety and Buildings Division County , W 201 W. Washington Ave. P.O. Box 7082 �scvns�n Madison, WI 53707 — 7082 Sanitary Permit Numb to be filled in by Co.) Department of Commerce (608) 261 -6546 Jam& q 2– • State Plan I.D. Number Sanitary Permit Apphcat' In accord with Comm 83.21, Wis. Adm. Code, personal inform on you E I V E D �S) 4.2 = TrwnS ' . may be used for secondary purposes Privacy Law, s 15. (1 Xm) Pro ct Address (if different than mai address) VW C � (L►411... I. Application Information - Please Print All Information FEB 1 1 2003 Property Owner's Par I # Lot # Block # ?L A ST. CROIX COUNTY C ZONING OFFICE Property Owner's i4a iling Address roperty Location City, State Zip Code Phone Number �`' Section 1 2tqz)2� (circle pe) II. T pe of Building (check all that apply) T N; �E qCV j c�S 5 ►� v or 2 Family Dwelling - Number of Bedr ms t_ SM Number p ❑ Public/Commercial - Describe Use trv� Q ��O t 0 L l o Q t tr ❑ State Owned - Describe Use U )c s , V \ ad 6 "= b -Tt (1 8 ❑city ❑Vill Township of' _ S III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ew System ❑ Replacement System ❑ TreatmentlHolding Tank Replacement Only ❑ 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. Type of POWTS System: Check all that apply 61 - A - too 6 Pf R I_TC-P— ❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter r ] Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design 1 w (gpd) Design Soil Application Rate(gpdso Disp al Area Required (so Dispersal Area Proposed (sf) System Elevp n VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New I Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the under g , assume responsibility for installation of the POWTS shown on the attached plans. Plumber' Name (Print) Plum ignature MPIMPRS Number Business Phone Num r 1 Plumber's Address (Street, City, State, Zi ode) VIII. County/Department Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuin Agent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Reason for Denial I Tis . l2 2ao3 IX. Conditions of Approval/Reasons for Disapproval ►A-11 �o,cxt. �r�- �.w.e.� ww•� �_ v ^°'""�n-"'r`°� . 4 (4 Wt.tc7t �e t L"J Om a, ,, t � s s� L w�a t: 4_ o e t Attach complete plans (to the County only) for the system on paper not less than 81/2 x 1 t inches in size SBD -6398 (R. 08/02) Safety and Buildings 10541N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 Nvisconsin www.commerc . v Asc o ns o v vrww.wiscnsin.gov Department of Commerce James Doyle, Governor Cory L. Nettles, Secretary February 06 2003 CUST ID No.226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 02/06/2005 Transaction ID No. 835142 SITE• Site ID No. 655572 Dan Purfeerst Please refer to both identification numbers, Coulee Trail above, in all correspondence with the agency. Town of Troy R1 St Croix County C o gl NW1 /4, SETA, S12, T28N, R19W FOR: New mound, 450 GPD Object Type: POWT System Regulated Object ID No.: 890744 :t GUPAfv7MI The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes -S 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 and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10691 -P ( N.01101) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD - 10706 -P (N.01/01). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. Note • The bottom of the distribution cell shall be level per the Mound Component Manual. • The maximum fmished slope of the mound surface shall be equal to or less than 3:1 per the Mound Component Manual. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. J SHAUN R BIRD Page 2 2/6/03 • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(i). Consult the Department of Natural Resources for well setbacks and exceptions to the setbacks. • Insulate building sewer per COMM 82.30(11)(c). 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. 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 addressce.shall provide a copy of this letter to the owner and any others who are responsible for the installation, oper on or main t nance of the POWTS. Sinc Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Patricia L POWTS Plan Revi er, , Int grated Services WiSMART Code, 7633, (715) 634 -7810, ax: (71 634-5150, M -F 7:45 am - 4:30 pm pshandorf @comme7e . te.wi.us cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 1/31/03 Owner: Dan Purfeerst Location: Coulee Trail )-W TS fitio al System type: Mound System .JV Manuals Used: Mound Component Manual version 2.0 (01/31) ` E FC M R Pressure Distribution Manual version 2.0 (01/31) DINGS j Page# ;ESPONDENCE 1. Cover Page 2. Mound Plot Plan r r '�� .�_ 3. Mound Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7 -9. Maintance and Contigency plan 10 -12 Soil test Signature License number 22900 1/31/03 PLOT PLAN PROJECT Dan Purfeerst ADDRESS 735 Shane Park Circle #2 Prescott Wi 54021 NW 1/4 SE 1/4S 12 /T 28 N/R 19 W TOWN Troy COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 1 BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none IL BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 99.2' 1.5' sand lift Scale = 1 /4 11 = 10' Alt. B.M. 400' Coulee Trail c a E 200 M.* 10% Slope B -2 ❑ Area 15' Below System is to remain undisturbed a� ❑ B -1 a Well is to meet all B-3 setbacks found in 95 Comm. 83 Huffcutt Combo Tank 97' 99' Tank is to be properly Pro 3 Bedroom Grading is to be done bedded and provided with to divert run -off lockdown covers with House away from system approved warning labels zgner No r Date Non -Woven Filter Fabric 4" Observation Pipe Perforated Below Filter Fabric r Distribution Pip A Cr-33 Sand C " Topsoil a E 11111111 pjf1;1� Slope Bed Of j 2 ? Force Main Flowed Drain Rock From Pump Layer 0 Cress Section Of A 14!ound 'System Using FC2p , A Bed For The Absorption Area F G !� A Ft, h LIE- 6 Ft. I .0 Ft.- Ft. _..- K IZ,8 Ft. - } L Ft. ` % r K 3 3,8 Ft. L 40bservotion Pipe -".,\ o A cn �° -- - ._�.. - - - - - -- --------------- - - - - -- 1 Force Main W _�_ From Pump 3 p Distribution Bed Of V-2 % Pipe Droin Roch I , 4 Observation Pipe Permonent Morker Pipe or Rods _Plan View Of Mound Using A Bed For The Absorption Arso PAGE OF Perforated Pipe DOW r 1 End Veer ) Perforated i� PVC P.pe s 140105 Located On Bottom. Are Equally Spaced tf f A S (l PVC Force Main FJ"T VA" U161CC T6 Gannet +Mk-. PVC Monifotd Pipe Lr- Sit-/Ole, Oistriaut,an Pipe 1 2 -44 - Distribution Pipe Layout P S F R Fj, X InChes YA nches Signed: Hole Diameter Inch License Number: Lateral 2 Inch Oate : Manifold - Inches_ Force Main " Z _ Inches # of holes/pip- Invert Elevation of q �, Laterals % 7 Ft. r rave v . SEPTIC TANK PUMP CHAMBER GROSS SECTION AND SPECIFICATIONS u" Cl VENT PIPE 12" MIN ABOVE GRADE 6 WEATHERPROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W/ PADLOCK B FINISHED GRADE WARNING LABEL Lp +s• t n ...... MIN. Is" INLET GAS- � ' WATER TIGHT SEALS "�" TIGHTS ED FI L TER — = A SEAL s .JOINTS WITH ,.1_ . ALM APPROVED PIPE APPROVED 3 ONTO ON PIPE 3 SOLID SOIL Onto scx.to r SOIL PUMP OFF ELEV .p ?? FT. OFF D 3" APPROVED BEDDING UNDER TANK CO CRETE PAD SPECIFICATIONS SEPTIC / DOSE ,rte TANK MANUFACTURER: NUMBER DOSES PER DAY: GAL. DOSE VOLUME INCLUDING TANK SIZES �ES DOSE / � GAL. FLOWBACK: !A S GAL. ALARM MANUFACTURER: �.-- ,5 CAPACITIES: A =�� INCHES :GAL. MODEL NUMBER: B = 2 INCHES a 3-4 - 7 — GAL. SWITCH TYPE: S PUMP MANUFACTURER: C = � INCHES = GAL. ---- - I S z m 1 t/ MODEL NUMBER: D = � INCHES GAL. _ SWITCH TYPE. } REQUIRED DISCHARGE RATE GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE Z FEET •' �y FEET MINIMUM NETWORK SUPPLY PRES Ob 3 . . .F FRICTION FACTOR FEET + j FEET FORCEMAIN X TOTAL DYNAMIC HEAD _ FEET DIAMETER INTERNAL DIMENSIONS O F PUMP TANK: LENGTH ': WIDTH LIQUID fftV �a SIGNED: _ L ICENSE NUMBER= DATE: :/88 TOTAL DYNAMIC HEAD /CAPACITY HEAD .CAPACITY CURVE PER MINi EFFLUENT AND DEW EWATERING MODEL 152/153 W MODEL 152 153 5 Feet Meters Got. titers Got. Liters 153 5 1.5 69 261 77 291 12 40 IK 0 10 3.1 61 231 70 265 152 15 1 4.6 53 201 61 231 0 20 - 6.1 44 167 52 197 C2 30- 25 7.6 34 129 42 159 8 30 9.1 23 87 33 125 22 85 20 0 40 12.2 -- -- 11 42 4 lock Valve: 38.0 FL (11.6m)144-0 R. (13.4m) 10 — 814506 0 20 40 60 80 100 GALLONS s 1/4 LITERS 1 0 80 160 240 320 - 3 27/32 4 5/8 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS 3 27 /32 _ • TBned dosing panels available. ® 3 27/32 • Elechical anernators, for duplex systems, are available and supplied wtih an alarm. • Variable level conbol switches are available for controlling single phase systems • Double piggyback variable Ind RM swkhes are available for variable • Sealed Qwllf available foroutdax installations. See FM1420. 1 • Over 130•F. (54°C.) special quotation required. 1 15M53 Series' 12 1/8 112H53 MODELS AAodd VoPh Made 51/8 Ni52 11 1 Non 8.5 1 2or3 BN152 115 _ :L Aldo 8.5 betided 2or3 slcrast E152 290 "1 Noe 4.3 1 2or3 BE152 230 1 Aldo 4.3 ka:kded 2or3 M53 115 1 NDo 105 1 2or3 SN153 115 1 Aub 10.5 ieduded 2or3 SELECTION GUIDE E153 230 1 Non 5 3 1 2 or 3 1. S9M w evel float teh woad verb* l m ordo" ftybad variable level fbat SE153 t 230 1 Aub 53 kit" 2or 3 switdL Refer b FM0477. A gp�npa Z See FMD712 for correct model of Eledrieai Atbmator E-Pak. Aa hota Wee of controls, p onices and wktnq sbootd be done by a quailed 3. Vwm* laud =W W swdch 10-0225 used as a conbd activator, spe* duplex (3) licensed de"tan. AN elect" and safely codes should be followed Inctadtn911re moat or (4) that system. recu tNarbnd Bectdc Code (NEC? and dw Oc�aticnal Saf*anId Heam Act (DSNAl RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller purnp. Am TD: P.O. 8DX 16347 ' Lain*, KY 4025MM7 INarlufecpre�sof.. L� WE T& 3649 Cm Run Road Li 0 lai idle. KY 4011-1961 (502} 7782731.1 92"tW � fA, e,�rr PL/MP !D F f n 77 4-W4 ® Copvri9ht 2000 Zoeller Co. All rights reserved. Maintenance and Contingency Plan for a Mound System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Dose Chamber is to be pumped at the same time as the septic tank. 3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 4. Once every 3 years the mound is to be inspected via the inspections pipes in the at- grade. The laterals are to be inspected via the cleanouts. 5. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 6. Pump and electrical components are to be checked at the time of the pumping. 7. Owner agrees to leave the area 15' below mound undisturbed. 8. The owner agrees to save this plan. 9. Trees, shrubs, and other similiar vegitation are not be planted on system. The system is not be driven over. 10. Effluent Quality is not to excede the requirements found in Comm. 83 Contingency Plan 1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if needed, then bypass pump float and try pump without float. If this works, float is bad, replace float. If pump still does not work, check power at the pump with a electrical device such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is power, then pump is bad and needs to be replaced by a plumber. 2. If mound fails, determine cause of failure, test another area or remove pipe and sewer rock, retill soil, install new mound system. 3. Replace any other failing components as needed. Important Phone Numbers Plumber: Shaun Bird 715 - 246 -4516 Pumper: Tom Mondor 715 - 246 -5148 St. Croix County Zoning 715 - 386 -4680 Shaun Bird #226900 POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Pa ge or IF INFORMATION SYSTEM SPECIFICATIONS Owner c3� F . Sepf Tank Capac4 at O NA Penint T Septic Tank MWAOIa boast 13 NA NA DESt�N PAR�tM� Effluent FMar Manufacturer ,( � D Number of Bedrooms DNA Effluent Filter Model 0 NA Number of Commercial Units PumP-Tank CaPadty 6 ga l 13 NA flow O .�? PmnP Tank Manufacturer 0 NA x 1.5) �f s0 Manumocturer' 0 NA Design lbw (F_sdnnated , d alf Pump Model 3,✓ / Z 0 NA Sol Apprt Rate � Pretreatment unit A hilluentEttfuent OUSKY Monmo vera g e, Cl SandlCrqvel Flit 0 Peat Filter Fats, 01 & Grease (FOG) 50 mgI- D Mechaicat AerAon D Wand Biochemical Oxygen Demand (BOD s220 mgll D Disinfection 0 Other_ Total aded Solids (TSS) 5150 mqAL Manufacturer Pretreated Effluent Quality > <NA Mon" fie.. l persai Cis) Biochemical Oxygen Demand (BOD,) 530 mg1L 0 lnlround (gravity) In (pressurized Total Suspended Solids USS) S30 mgiL D At -grade D Ottrer Fecal COMM (geometric mean) 510 c u looml 0 Maximum Effluent Particle Size fa inch diameter Vskm tA*W for domestic (non adaA wastewater and :spec taNc eue"t Vatuas typed for preueaw wastewater. MAINTENANCE SCHEDULE Service Frequency Service Event At least once every .3 O months '�ar(s) (Maximum 3 yrs.) inspect t�rnd "lion of tanks) of tank volume Pump out contents of tank(s) When combined sludge and scum equals one -third (f;) At least once every O months �year(s) (Maximum 3 yrs.) Inspect dnspefsad cell(S) 0 months - J*wr(s) Clean efftrenttitter At least once every Inspect pump. Pump controls & alarm At least once every � 0 months s) O NA At least once euray O months s) 0 NA Flush laterals and test ❑ months 0 year(s) 0 NA oO: At least once every o t At least once every ❑ months a year(s) (3 NA MAMTENANCE INSTRUCTIONS i cells shah be made by an Mdtvkivad casrying one of the foQowing or Inspections of tanks and �r Plumber Restricted Sewer; POWTS Irk. �� W Mahtailw.. Sedge cerdfbdions. Master plumber, must incuxfe a visual doh of the U19s) to identify any missing or broken Ser vicing Operator. Tank re the volume of combined sludge and scum and to check for any bads up hardware. identify any ashes cu teaks. measu . The dispersal eefl(s) shaft be visually inspected to check the effluent levels or p Of effluent on the ground surface- of effluent on the ground surface- The Posndm9 of effluent on the in the observation I and to check for any Pig of the local regtlatory authority ground surface may indicate a fang condition surd requires the lmmed"le noTif�n or more al the tank volume. the When the combined accumulation of sludge and scum in any tank squats one third ( of er accordance with ch_ NR di entire contents of the tank shall be removed by a SePtage Servicing Ope r ator 113. Wisconsin Administrative Code_ t components, and any The servicing of effluent filters. mecha NOWTS Maintainer. nhcal or pressurized POWTS comporerhts. Pre at intervals of 12 months or less shad be performed by a cerfifred other maintenance o' monitoring witthln 10 days of completion of any service event A servxge repot shall be provided to the local regulatory aut hority START UP AND OPERATION s for the presence of Painting products or other For new construction. to use of the POVYTS check treatment tank() s ' h concentrations are chemicals that may impede the treatnent process and/or carriage 1fie dnspersat cell() if N9 detected have the contents of the tanks) removed by a septage servicing operator Pdor to use. r ' Page _ of _ System start up shalt not occur when sot'l'conditm are frozen at the infiltrative surface. Dig pMW outages PUMP W tg may fig above normal highwater levels. When power Is restored the exces wastewater wA be discimiged to the dWpersW GeRS) in one large dose. overloading the aeks) and may re* in the backup or surface discharge of eietd- To avoid this situation have the oortberHs of the pcirrp tank removed by a Se~ Ser Aclog Operator priorto, testorug power b the eMuent pump or contact a Plumber or POWTS Maintainer to ! assist In manualy opmft um pump controls to restore normal levels wWdn the plump tank. Do not drive or park vehicles o vw tanks and dispersal ce ls. Do not drive or park over, or othenrise disturb or compact. the area wittin 15 feet down slope of any mound or at -grade soil absorpdon area. ReductI n or-S&dnaWn of the f aMV ftom the wastewater stream may improve do periocmatwe and prolong the Ire . of the POW M auntibiodw baby w%xK-cl9 butti; condomw. cotton swabs: degreasers; derrtel floss: dtapers; dam; fat; fourida w dtaln (sump punW) water; Ault and vegetWft purge: grease, hetbiddes; meat s=W. medicellonc. 011; PMductK pestiddes; sautes► naPI*W bmPOns: - mid water softener brine. ABANDONIANW When the POWTS falls and/or is permanently taken out of service the follm" steps sW h5 taken to Insure that the system Is property and safely abandoned In comptlanos with ch. Comm 83 33. Wisconsin Administrradve Code: • Ab piping to tanks and pits shall be domed and the abandoned pipe openings sealed. • The contents of all tarots and pits shah be removed and property disposed of by a Septage Servicing Operator. • After pumping. an tanks and pits shall be excavated and removed or their covers reproved and the volo space figed with soil, gravel or another Inert solid material. CONTINGENCY PLAN if the POWTS fags and cannot be repaired the following measures have been, or must be taken, to provide a code compliant reptacernent system: Cl A suitable repiaoanent am has been evaluated and may be utfized for the location of a replacement sod 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 weds. Failure to prated the replacement area will result in the need for a new sod and site evaluation to estabRsh a suitable n4 area. Replacement systems must comply with the rules in effect at that time. ❑ A sudabie replacement area is not available due to setback and/or sod limitations. Batting advances in POWTS technology a hoidmg tank may be installed as a last resort to replace the faded POWTS. The sle has scot been "raged to identify a suuTable replacement area Upon failure of the POWTS a sal and evaluation must be perforrned to locate a suitable r eplace ment area If no replacement area Is available a holdetg tank may be kn9aged as a last resort to repiaee the failed POWTS. Mound and ate soil absorption systems may be recons t r ucted in place following removal of the biomat at surface. Reeonshucdons of such systems must comply with the rules in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE QTR OF A TANK MAY 13E DIFFICULT OR IMPOSSMLE. ADD ITI ONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name LA i r ) Phone 1 -- - 52 Phone — L �! SEPTAGE SERVICING OPERATOR PUMP LOCAL REGULATORY AUTHORITY _ Name / All Y �- Ptmr►e t .i [ 1' ` y� Phone 7) j p This do not was dratted by the shaft of the Queen Lmm. Matgaelte and Waushata CoiariY zo turd Satttadon agettdes. This doe "� Me m *nurn ot rep W mils d � dL •° 83.22M(bX and 83 -Wl). (2) & (3). Whoonsin [af(se Cade. Use of iOft i not guarantee dte peftm cm of the POWTS. GMW (it) P� Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County C L P plan paper n p / Attach complete site Ian not less than 8 1/2 x 11 inches in size. Plan must (� include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). .1 'M03 Property Owner Property Location Govt. Lot Ayj 1/4S- 1/4 S12 T .ZIN R / E (o W Property wner's Mailing Address Lot # Block # Subd. Name or CSM# au 3s Al/ City 7 Zip Code Phone Number ❑ City ❑ Village own Neapest Road New Construction Use: Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material -6e2z Flood Plain elevation if applicable ft. General comments / - f *' and recommendations: S �f �� I ~' IVE +, ✓� J ou lj Boring / " ' F/-1 Boring# �S CYtrrt<S�'�Ftef �" Pit Ground surface elev/ ' ft. Depth to limiting factor r ir►: Soil AppGt:ation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2 e - 3 " , 6 Z ZQ� S - N, • ® Boring # ❑ Boring pit Ground surface elev Depth to limiting factor ' . Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 4`! z -_—' �- c , S z21 - � ' 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) Signature CST Address Date Evaluation Conducted Telephone Number SBD -8330 (R07 /00) 1 Property Owner Parcel ID # Page - of © 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/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 - a Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 F 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/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2 Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.07/00) Soil Test Plot Plan Project Name Dan Purfeerst Shaun ' Address s�` 110 Young St. N Prescott Wi 54021 C #226900 Lot Subdivision - ------ Date 2/25/02 NW 1/4 SE 1/4S 1 2 T 28 N /R W Township Troy Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevatio 0 ft. -Jo of Steel Fence Post System Elevation 99.2 *HRPSame as Benchmark Alt. BM — Top of Sign in Power Pole 113.9' Coulee Trail Alt 400' 200 B.M. 10' B -2 10% Slope 45 -3 r 6 B -1 95' a� 97', 0 99' I I _ I ST CROIX COUNTY SEPTIC TANK M� NCE AGRER ,AND. OWNERSHIP CERTIFICATION FORM i Owner/Buyer Mailing Address Property Address - ��e �X�-s� (Verification required from Planning Department for new construction) City /State Parcel Identification Numbe I LEGAL DESCRIPTION J Property Location y +, '/4, Sec./ , 'I N -g�—W, Town of� .--- Lot # Subdivision Certified Survey Map # t � :� Volume rage # 3 5� . Volume , Page # Warranty Deed Vl # � Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE couldresattin its premature failureto handlewastes. propermarntenance I use and maintenanceofYour septic system consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What yon Put into the system can affect the fanction 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 lumber restrictedplumber or a licensedpumper verifYmg that (1) the on4te wastewaterdisposal system is in p open operating i is in proper operating condition and/or (2) after inspection and pumping (f necessary), the septic tank is less than 1/3 full of sludge. � Uwe, the undersigned have read the above requirements and a gree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Comm � Departm ent of Natural Resources, State of Wisconsin. Certification Office within 30 stating that your septic system has been maintained completed and returned to the St. Croix County Zoning da o e three iration date. g A / / DATE 0- PLICANT OWNER CEi RTLFICATION the owner(s) of I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the described above, by virtue of a warranty deed recorded in Register of Deeds Office. — DATE SIG OF APPLICANT * *sss* Any information that is rots- 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 deed a copy of the certified survey map if reference is made in the warranty 707465 VOL 17 PAGE 4448 KATIE H. WMSH REGISTER OF DEEDS ST. CROIK CO. NI RECEIVED FOR WORD 01/29/2003 09:00AN REC FEE: 13.00 COPY FEE: 3.00 PAGES: 2 CERTIFIED SURVEY MAP Patricia Purfeerst Located in the Northwest 1/4 of the Southeast 1/4 of Section 12 APPROVED T 28 N, R 19 W, Town of Troy, St. Croix County, Wisconsin. ST, CROIX COUNTY Pla_j_ oow4 committee , 4N 2 9 2003 11 no: sec:�:'ue' ­-'In au uays of approval date approval Shall be null and void NOTE: This parcel is created pursuant to Section 17.14(1)(b), St. Crouc County Zoning Ordinance, and may not be reconnreyed by irrtial grandee without compliance with OWNER' ADDRESS this section. 864 Coulee Trail Hudson, WL North Quarter Cane Section 12, T 28 N, R 19 W `GZ Found Bantam Alwninum Monumert SJ�PLgTJEt� MA o I � 4��► N 66 St `✓0 \,� 1 01— _ • � PRO � aLW / LOT I � tAn 5' —.— ...... —.� —• —• —• — �:� DRIVEWAY 1 W `� / ZI z ; � 12Acrosor2575445q. ft. 6. 39 / A ^ 1 5245 ,4a1°sor 228478Sq. ft. t; 's ti1e� of � � i ,• -• � ,��1/ W OQ/ �: m �` 9 zi / Q zl 3 VA SW { RIVER moo � •° FALLS. ; to 2 Sarah Quarter er coer DATED - Roo L/ Nv $J 9/Z7/Ol Section 12, T 28 N. R 19 W Farad flentaen Aluminum Momunet N LEGEND 0 Indicates 1 "O.D. x 18" iron Pipe Set (Min. Wt .1.13 IbsAk R) E • Found 1" Iron Pipe Section Corner Monument aS to (as noted) le in Feet —x -- Indicates Ferree Ao 6 1 Bearings are referenced to the North - South ® Indicates Soil Boring quarter W1t� W 12, recorded bearing This Instnunent Drafted by Mark W. Peavey SHEET I OF 2 Vol. 17 Page 4448 J 2 13 9" `{ 0 0 ?Q)9325 3 �\ KATHLEEN H. WALSH DOCUMENT NUMBER REGISTER OF DEEDS - WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD Patricia J. Purfeerst, a single woman, Grantor, conveys and warrants to 02/12/2003 12:15PM Daniel S. Purfeerst and Laura A. Purfeerst, husband and wife holding as EXERT # survivors nip mari a property, Grantee, t e following described real estate in St. Croix County, State of Wisconsin: REC FEE: 11.00 ` PJA11.0W'6 I- r rJ D� /J �' TRANS FEE: 105.00 COPY FEE% iQ� Two (2) of Certified Survey M ap as recorded_in Volume 17, Page CERT COPY FEE: 4448, as Documen min the St. Croix County Register oi• PAGES 1 Deeds Office as located in the Northwest Quarter of the Southeast Quarter (NW 1/4 of SE 1/4) of Section Twelve (12), Township Twenty Eight (28) North, Range Nineteen (19) West, Town of Troy, St. Croix County, Wisconsin. Subject to Coulee 'Nail right of way NAME AND RETURN ADDRESS �0.r1 pV(t' 735 Sane Pdc+c c:scle Z 040- 10 51 -30 -000 g Parcel dentification Numbe (� i This is not homestead property. Exception to warranties: All easements, restrictions and rights -of -way of record, if any. Dated this My , day of February, 2003. _ (SEAL) (SEAL) Patricia J. Purf® at (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature STATE OF WISCONSIN ) UU ) ss. 1eP COUNTY ) f authenticated this day of 2003 Personally came before me this ! day of February, 2003, the above named Patricia J. Purfoerst to me known to be the person who executed the foregoing instrumennp and ackn TITLE: MEMBER STATE BAR OF WISCONSIN i11(D_ !l ` /{�Gll H (Signature) (If not, CHARLUE A.LARSON authorized by §706.06, Wis. Stats.) Iy Pubhc r (Nam Printed or Typed) State of INISCOB5 ; THIS INSTRUMENT WAS DRAFTED BY: M )feg pZ/Q % J a 3* Notary Public County, Wis. Leo A. Beekar, Attorney y Comm. 6W My commission is permanent. (If not, expiration date:) RODLI, SESKAR, BOLES & KRUEGER, S.C. �/G / 219 North Main Street, P.O. Box 138 River Falls, WI 54022