HomeMy WebLinkAbout042-1028-10-000 visconsin Department of Commerce PRIVATE SEWAGE SYSTEM c ounty
Safety and Buildings Division St. CroiX
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) SanitarxP_erAlitNo.:
Personal information you provice may be used for secondary purposes [Privacy Law, V5.04 (1)( 3 �V3GY
❑ City ❑ Vi I� r 6TF fg S ate Plan ID No...
CST BM Elev.:- Insp. BM Elev.: B ription: arcel TdL�OID28 - -000
®'�9' m . a = c51 F. M 1 V G 1
TANK INFORMATION ELEVATION QAT
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic �1 U r Benchmark C4) 3.2 ( (o3,Z( Up • i
Alt. BM
r
Dosing �.� a'3.�3 t. }Z X02.2/
Aeration Bldg. Sewer 1O , IS C13-
Holding St/ Ht Inlet - 1.3.19 r
TANK SETBACK INFORMATION St/ Ht Outlet 0 92 -93
TANK TO P/ L WELL BLDG. Air I to ROAD Dt Inlet c
Air I ntake � 3.3 1 b 3
Septic -43r 2 NA Dt Bottom
Dosing X7-5- ( ` p / NA Header / Man.
Aeration NA Dist. Pipe
Holding Bot. System 8 ' cm. S - i
PUMP/ SIPHON INFORMATION Final Grade %W 5;_
St cover
Manufacturer Demand CA Q
Model Number (h� —Sp (96 GPM .a
0 1 0 DH Lift .off Friction a ; S stem TD ,(OCFt
8 Loss
2 �' Z.s �2
�. Forcemain Length ZS' Dia. Z " Dist.Towell 6
SOIL ABSORPTION SYSTEM
BED/TRENCH Widt_r Lenqth No. f PIT No. Of Pits Dia. Liquid Depth
DIMENSIONS 1 DIMENSION
SETBACK
SYSTEM TO P / L I BLDG WELL LAKE/STREAM LEACHING Manu actu INFORMATION Type O CHAMBEf{ Mo m er:
System: 2� 2 8 ^' ( 1 11 ' OR UNIT
DISTRIBUTION SYSTEM
-�• Ro.2 R.w•
Header / Manifold Dist ution Pipers) i u x Hole Size x Hole Spacing Vent To Air Intake
51 ^� N ) 12. -3 u a
Length oZ• Dia. oC Length ��` Dia. � Spacing � /( 2�
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil E] Yes No es N pfA
COMMENTS (Include code discrepancies, persons present, etc . l nsnection #1: to / 1 2 - lot- Insvection #2: Ib / OU aU
Location: 1088 140th Street Roberts, WI 54023 (NE 1/4 NE 1/4 11 T29N R18W) - 112918161 701
t-
1.) Alt BM Description = � k,-, g;t(,,:,N �Nf. 5 ��) � �
2.) Bldg sewer length = 26 • o I g
- amount of cov�j = ? 18
3.) contour= — ��o //
�'`vt_ 1('t� ° _"' "- ' /. �/ lortdC � PA, cckv
I�►ale f
— 111 Pfan requ�ed? ❑ Yes 3( No
U other side for additi al i f tion. 02 01 - of I :2 - 1
p� . (� i Date Inspector's Signature Cert. No.
S D -6710 (R.3197)� ��
ADDITIONAL COMMENTS AND SKETCH '
SANITARY PERMIT NUMBER:
} }
E
� .,�.m
@ey }
f �
3 's
e }
}
._ ..._ ._
-� i E
I
}
E
a
_._._
t i
7
s G AL � ���
Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.21. Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing this application PO Box 7302
N*Scons
Personal information you provide may be used for secondary purposes Madison. WI 53707 -730^
Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to comity if r
state owner
Attach com lete plans (to the county copy only).for_tbg system. on paper not less than 8 -1/2 x 1 I inches in size.
County (L / State Sanitary Permit Num ,, , C Qk i iPvysion to previous application State Plan I. D. Number
U
I. Application Information - Please Print all Inf rtii lon Location:
Property Owner Name Property Location
d! �. j rr !� ` - /�" . NE I!4 Ol � ll4, S l l Tr'Zq ,N. R j� W
Property Owner's Mailing Address Lot Number Block Number
tk
10 88 NO Sfi s. V ��r ;....-' /' AIA
City, State Zip Code iN r F1 one Nutti6m j Subdivision Name or CSM Number
Ro be-," - +S CJ 6 -Y0 A . 3 (1. `' ? 33 -2 3 u0,
II Type of Building: (check one) � 4 0 i ,: " ❑ City
I2L I or 2 Family Dwelling —No. of Bedrooms: `— -�'° ❑ Village
❑ Public/Commercial (describe use): 19 Town of
❑ State -owned f�3 CL t%
III Type of Perrnit: (Check only one box on line A. Check box on line B if applicable) Nearest Road ✓ q 0
A) 1. ❑ New System 2. ; (Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s)
System Tank Only Existin S stem O 141 —
$� Permit Number Bnle-tssued
❑ A Sanitary Permit was previously issued i 29• SC • !
IV. Type of POWT System: (Check all that apply)
• Non - pressurized In- ground W Mound ❑ Sand Filter ❑ Constructed Wetland
• Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
• At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
• Dispersal/Treatment Area Information: 1=l — /nkl do ( ' 0 *(60 'q • 4-
1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed a� Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation 14, q50 fs YO' is90 .7 IVA, Qs,K� ?7, c1
VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
-wt " 5L ❑ ❑ ❑ ❑
�. e, 1 SD 1 1 �..,..�
VII Responsibility Statement
I, the under signed, assume res on ibility for install of the POWTS shown on the attached plans.
Plumber's Name (print) Plumber's Signature (no stamps): MP/MPRS No. Business Phone Number
Wca" 14c►- IV ttCl, Lz o�X - ?10 '7/5'' 9 -33a�
Plumber's Address (Street, City, State, Zip Code)
VIII County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued to Agent t
r t Signure (No stamps)
3
Approved ❑ Owner Given Initial Adverse Surcharge Fee) / >s�
Determination
IX. Conditions of Approval /Reasons for Disapproval:
51,4 , 4-
_ �k;� �s�54eww wwck 6, i'✓44i� 6�co{ G. cc orG�% �S '�1� S �e ! otrecX �LGA ^
_ � l�.e� 2 i' 1/ ' � �, �^'� Ir � 5 �('.� s wS ��n �C.� � FvCI"V L tCJY2 w iArct� h'T7n. ' inn " `�t�12 ��,p�,'Z IL r/ �1 i' t'l�N�l — Nt 1 � C
��� w� -G•^n v.Gccc�fvtnl -i!' S �G►'r/�- oci�"d�l
— 3� �vtovwi ��5 ��,�l -K, aw;ti�v vtifReva d� `f� mot \o� (WA
SBD -6398 (R. 07/00)
M�
� Safety and Buildings
10541 N RANCH ROAD
HAYWARD WI 54843
TDD #: (608) 264 -8777
Visconsin www.commerce.state.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
September 29, 2000
CUST ID No.226375 ATTN: POWTS INSPECTOR
ZONING OFFICE
ROBERT W ULBRICHT ST CROIX COUNTY SPIA
655 O'NEIL RD 1101 CARMICHAEL RD
HUDSON WI 54016 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 09/29/2002 Identification Numbers
Transaction ID No. 435640
Site ID No. 65829
SITE• Please refer to both identification numbers,
Site ID: 65829, DALE FREDERICK above, in all 'correspondence with the >agenc
ST CROIX County, Town of WARREN; Fire Dept ID: 5506; 1088 140TH ST, ROBERTS 54023
NE 1/4, NE 1/4, S11, T29N, RI 8W
FOR: REPLACEMENT MOUND, 450 GPD
Object Type: POWT System Regulated Object ID No.: 761867
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:
1. This plan action is subject to designer comments on the plan.
2. The maintenance plan for this system must be given to the owner of the POWTS.
3. 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.
4. Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual.
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..
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address cone; t
on this letterhead.
rt
Sincerely, DATE RECEIVED 09/05/2000
O f SArc1Y
FEE REQUIRED $ 175.00 01
- FEE RECEIVED $ 175.00
PATRICIA L SHE DORF , P TS PLAN REVIEWER BALANCE DUE $ 0.00 S '_E COttir��`
Integrated Services
(715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM
PSHANDORF @COMMERCE.STATE.WI.US WiSMART code: 7633
cc: DALE FREDERICK
LILBRICHT & ASSOCIATES CO.
655 O'Neil Road • Hudson, WI 54016 Reg. Designers of Engineering Systems
715 -386 -8185 Private Sewage Consullants
.
PROJECT INDEX
Plan I.D. # Date 3 O • 2,0r
Owner �/}LE �ipL Phone 7/,5. 7Y 7 . 33 L3
Address /o /yOJ'C S,T. R AOQ& I V/ S 1 0 2-3
Legal Description jl� Dy2 • /U2 /p-aU
TfOA�
N9 ry ti6 y S,e , 2 y,V tP lof 40
Town of IN,4/Q/ 6AI County ST G t x
C.S.T. R&& XhX1? r 2 2.63 -75 Installer # IVX a/ /&'
Local Authority/ Supervision Sr. CAW)( C 7 - Y. 20iU /•vG� �E PT .
PROJECT DESCRIPTION
&Pt 14C" ,E,v s Sr & - y 3 f
/ •
y
SST -�- is �/�o�os� • � 0 1 s
J14. ROBW W.
ULBRI
�til FCC O 01160
HUDSON, W1
z �
4 S' G�� @0
P 1 PLOT PLAN VIEWS �Ojr�u�unum,gn ► + + +�����
Pg. 2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS
Pg. 3 PIPE LATERAL LAYOUT
Pg. 4 DOSING CHAMBER CROSS SECTION & SPECS.
Pg. 5 PUMP PERFORMANCE SPECS
Pg. 6 OPERATION, MAINTENANCE, AND PERFORMANCE REQUIREMENTS
This design for installation is based entirely on measurements, elevations,
j landscape conditions (slopes etc.) and soil suitability provided by CSTK
L The accuracy of his specs, as reported, shall remain the sole responsibility
of the CSTM.
Any use of this POWTS design ky any licensed plumber, or any
related unlicensed parties or persons (excavaters, laborers)
shall not be construed as an assumption of responsibility by
the designer for the workmanship, construction, placement,
substitution or selection of any components not specified, or
any assumptions by the plumber that any unspecified components �
are state approved or proper, or the effects of poor judgement
if working under adverse damaging weather conditions
soils) by any such parties ox persons. (wet /frozen
I
A p • iP��o� PER PLUMBING P R DUCT APPRO AL
CODES E VC
0 pr1 ALL AB 0 GROUND to�t�� �a�l PIPING (FROM TANKS SYSTEM ARE S
f � ���,� MUST BE SCH.40 PV MEETI )
AS M
�0 ' D1185 NG OR D2665 STAN ARDS.
�3t ' 25
I '
95.E
e
---
J
or
!� o �- 7 ��C m
I /
f3M
b�
Tar. ..
/0a .o
j 0--c-0 OJ �-
5f p7_i c 1 2>
zti
z 2
ASS O�
N Le
r" o
0 f%Aj
c CALF : / - 3 0 MENT to SHAl
_._..,..._._ - r A r REpT NEp aOPER{.Y
T5 BE ABANDO P l R
('le U" 7 - % av S
_J
CR OSS SECTIoAJ e F MoUuD -' wi rti T3ED
13 It. n 6 F % " ro
Ai3et -SATE
'DI ST Iti(3uT� o,V
Cs' Tl+i PI P fN Cr
of T° P S o i L TE
w/ �h /loy- s ys r e o
elo is. \ EIEvArioo
Ou; FoRM 1'o E • '
E
3)
RR i0 Mao. -
T
A
///
U&3 FOR
R
(p % 510pE FORCE" EIr% VATAOO UNDER
MAW f3ED �f 7'• � '
.17 / � F r• — ELEV 5 --" �
Fr. IN VE Rr OF / Z, 1ATERM S
Top o Rock 9� • Z
•Top °F Z IATERA IS
FT
PLAN VI ELV vF MouK)D - wlr+t 13Eo
CC x-STR A I_ >
FvPm MAW A 3 FT•
(3 90 F r
Fr
1 •- - - -- 13 - - -• I i /io
w
F T
- -
a
w
\9 I Fr
To 1 y"
PVc cAppEp A 9�RE514TE
09SERVATI00
'D Ai� lUhSrE' l ow �Jd
R EC.2ui12ED (3,g5AL hReA;
XCI t- ,a-'; IrrtATltlE
C A?Aci Ty
PRop05F -v BASM APeN = B ( A t z
��. 3o�s�
L�4yp(�7
C�
P �
• � y
F �/Z
Fr
R Fr
n X 2� INc
CE►JTR�4t� � 12cE MAi►`1 NES
3 S Fr. o Pvc y lucH�g
T V (91D U01UME S75 GA15. 'PisT ^acs
" To TEL 1/0/0.y,--
INCN65 D� /�7�alpj(�
LhTERAL
Z INc µis
C EuTR h L MAM %r - o ,D 2 ��°•l G''�' 99
FAIN 2 I;
or HoIE5/piPE 2 Iu�l{ES
ZruvERr ELEVATIOKj
or- L ATEg A15
SEA � U�PSE SIDE Fop, --� /- �-
TIE i"AL coo bt!T _ PER
y
R�Mou� All T)Ri11 f3uRR5 Y
No1� s I act
TEb o,v t3 oTi'oM G'g UA11Y SpAcrp
�i SrRi (3uT'IOry 'v�SchAR �� RATS � _
( R �Ach LArERI L
GAL
TOTAL ( STRMOTIoO 'DiScti^ GATE r-OR
6'A / M 1 * 1V. a•5 MI *101*MUAA
ID /40&
S.
OF 6
�i,��S �1o U�vp
1,44 6'
P Ro
U
/U / /9
T
/RUC 13411 v41aE
��v /�'I/lvl�oLf
PUMP CHAMBER CROSS SECTION AND SPECIFICATIOUS P,4 J E
5a, 4 3 ? /D
pvG -VEUT CAP ( PI PE
VENT PIPE WEATHER PROOF APPROVED LOCKING
JUNCTIOU BOX MANHOLE COVER
/ W/ 4V,4,(M/N6- IA13EI
9 G . � 12 "MW. I •
I
V,A r �4:Ur1 7_40 Al GRADE
9/ 0
r COIJDUIT -- ---- - - - - --
IE UAr, ti
PROVIDE I - -- --
��_ INLET AIRTIGHT SEAL I I
n I III
APPROVED JOIIMT A INh 1 V � K I I i l APPROVE JOI
1J PIPE r (� v ( II EXTENDING 3'
EXTENDING 3' 0 � ALARM
O SOLID SOIL r1D I II ONTO SOLID SOIL
5CI4 , 40 POG B �j I I 1 15C4 fa PSG
�� 33 I oN
ELEV. � FL PUMP- - -1
1 � OFF 2/SE' 3 O�Q
' r. �lOiPE �
D D
BLOCK
I•
SANK 'g�D01ti' !� 51f"P
lE VA f i o d G-
n�
RISER EXIT PERMITTED dUL4 IF TANK MANUFACTURER HAS SUCH APPROVAL
SEPTIC E 1*gi PkJE 571 ffR N SPEC.IFI'CATIOAJS
DOSE
' pAE41'57 _ C.
TAAIKS MANUFACTURER: c IJLIMBER OF DOSES: PER DAy
TAMK SIZE: -7 O ✓ 0 GALLOMS DOSE VOLUME io
U
ALARM MANFACTURE /
R: `^'EU� �17RM INCLUDING BACKFLOW: GALLONS
MODEL DUMBER: y CAPACITIES: A= & INCHES OR GALLONS
SWITCH TYPE: + B = INCHES OR /n GALLONS
PUMP MANUFACTURER: MaP? -5 C= ' 5 INCHES OR /"'� GALLONS
MODEL IJUMBFR.'. f W 5 �,/ 0 / D A ' S INCHES OR 2 Z• �GALLOIJS
,L
SWITCH TYPE: JIY4 �-- �/ NOTE: PUMP AMD ALARM ARE TO BE
MIUIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS
VERTICAL DIFFERENCE BETWEEN PUMP OFF ARID DISTRIBUTION PIPE.. FEET - 'AA* S PE C S
3.25 ,.s '`— � '
-I- MIUIMUM UETWORK SUPPLY P // .. . . . .. .. FEET 6ACCA- I O� { P
-} 3S FEET OF FORCE MA X ° F /oo r T FRICTION FACTOR.. —L— FEET ('S I Q•1s
Ads'
= TOTAL DyUAMIC HEAP = ( � FEET
z
INTERNAL DIMEIJSIOUS OF TAUK: LEtJGTH ;WIDTH ;LIQUID DEPTH
PER PLUMBING PRODUCT APPROVAL
ICODES, ALL ABOVE- GROUND PVC
PIPING (FROM TANKS & SYSTEM AREAS)
MUST BE SCH.40 PVC MEETING ASTM
D1785 OR D2665 STANDARDS.
ti
- SEPTIC TANK, per Comm.83.44 (2) (c) shall be equipped with an
outlet attached approved filter device (Zabel
fliter). Tank shall have an approved above
ground locking manhole cover for regular (every
12 months or less) inspection & servicing by a
licensdd service pumper.
1 .
ME Series MVWW
1/3 through 1 -1/2 HP
Effluent Pumps
Performance Curve
CAPACITY LITERS PER MINUTE
0 50 100 150 200 250 300 350 400 450
100
90 2.8
80 24
MF /SO w
70
W
W /Q 20 2
' 60 _ Z
Z_ C)
M F j 1.6 w
Q 50 S z
W J
= Q
Ir-
40 M�SO 12 O
O
H
30
I\ N
8
20
-� 4
10
0 0
0 10 20 30 40 50 60 70 80 90 100 110 120 130
CAPACITY GALLONS PER MINUTE
F.E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805 -1923
419/289 -1144 FAX 419/289 -6658 Telex 98 -7443
K3327 7/91 Printed in U.S.A.
Pg. 6 of 6
Mound System Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the
septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and
outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to
ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that
may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if
the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 16 the liquid volume of
the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise
the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in
the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required.
However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and
Buildings Division.
Pump Tank
The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to
verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary.
Mound and Pressure Distribution System
No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound
shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic
(other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the
infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather
installations (Octobbr- February) dictate that the mound be heavily mulched for frost protection.
Influent quality into the mound system may not exceed 220 mg /L BOD5, 150 mg /L TSS, and 30 mg /L FOG. Influent flow may
not exceed maximum design flow specified in the permit for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each
lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be
compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is
required to maintain equal distribution within the dispersal cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner,
and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
General
This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its'
component manual [SBD- 10572 -P (R. 6/99)] and local or state rules pertaining to system maintenance and maintenance
reporting.
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and
pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks a re no longer used as
POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access
openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed
unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall
be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition.
If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be
immediately repaired or replaced with a component of the same or equal performance.
If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired
or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption
and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper
operating condition.
Questions on the operation or maintenance of this system should be directed to your county zoning or health inspector.
I
SEE REVERSE SIDE Pg.6 FOR MAINTENANCE REQUIREMENTS SPECIFIC
TO THIS SITE, DESIGN, AND COMPONENTS
� l
Pg. 6 Con£in'uFd.,'
POWTS (landowner) is reponsible for proper operation and
maintenance of this system. Regular periodic inspections and
servicing is necessary for the safe healthy operation of this
system. The owner is required by code to submit all necessary
maintenance /inspection reports to the controlling authorities.
SPECIFIC CONTACT AGENTS .S� C/eo /•X GT�
* Governmental authority/ inspectors:
* Licensed installer, responsible for providing an operation/
maintenance "Users" manual:
33 2,2-
* Licensed service / inspection agent other than installer:
Oy SIIIVI,W-le-A-�
3�•�13
* Electrician, for pump, electric controls, wiring units:
IMPORTANT OWNER MAINTENANCE REQUIREMENTS
1. Winter traffic (sledding, shoveiring, etc.) across the mound
area shall not be permitted, or frost can /will penetrate into
the cell, freezing up the system. Discontinuos use in the
winter (a vacaction trip, resulting in no water use) can also
lead to freeze ups.
2. Water conservation needs to be exercised! Or system can be
hydrolically overloaded and destroyed. This system was
designed for a maximum wastewater flow of ,!Y5 0 gals. daily.
3. POWTS are not designed to accomodate wastes from a garbage
disposal unit, or any other unnatural sources of waste.
Any introduction of such waste materials will overload and
destroy this system.
4. If a power outage occurs, or a pump fails, it may result
in a temporary overload of effluent being pumped into the '
cell, which may adversely impact the cell (leakkge). It is
recommended that a licensed pumper empty the dosing tank,
allowing the pump to return to dosing the correct amounts.
Consult your installer immediately for advice.
5. Neglect of the vegetative cover (the cells insulation &
erosion preventive) can lead to failure. Compaction or heavy
traffic also can destroy t he system. It IS NECESSARY TO
REGULARLY WATER THE VEGETATION OVER A SYSTEM!! Effluent in
the system beneath IS NOT sufficient alone tO maintain a
grass cover.
6. Periodic inspections by the owner, or his agents, is
necessary. Inspection pipes and ports have been incorporated
into the system: on the mound basal area (effluent level
inspection pipes), cleanout terminals on the pressurized
laterals, at each tip - for flushing and cleaning the laterals
out. The filter system in the tanks (via a locked above
ground cover /manhole). Only a licensed properly quali6ied
person should be performing this work which involves health
& severe safety risks. Evidence of effluent ponding in the
system's treatment cell shall also be regularly inspected.
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
,sT; CE /•aC
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
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 fin�,1ist4nceignearest road 0 0 • ���
''�
Please print all inform ,:. ' Reviewed b ., y Date
Personal information you provide may be used for secondapfipulpeses (Privacy ew, s. 15.04 (4 n)).
Property Owner t �� V CE.r_ roperty Lo tion
ov .Lot, 114N9114 S T ' � N R 1 (f E (or
Property Owner's Mailing Address -- Blo k # Subd. Name or CSM#
/Ogg �[�p �-t., ST • a �. sr caul
City State Zip Code Phon user ZQNING Of: IC 9 []Village 0 Town Nearest Road
�o WRTS 015 3 33
❑' New Construction use:,j Residential / Number of bedroom§ - derived design flow rate GPD
M - Replacement ❑ Public or commercial - Describe:
Parent material DU'J'W,+C� D(1,(,,,, j1jVJVSA -R - Flood Plain elevation if applicable ft.
General comments (Iq0 ffGa� )
and recommendations: /J
GO,v(1- �/�/�G1> �- l�U�Vv s�cf•� k'� / oL ii S'rl�.v� 7�'//
F-/] Boring # ❑ Boring �, / � Z / s, SX ,
Pit Ground surface elev. 1 1 7 " o ft. Depth to limiting factor & in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 •Eff#2
0 '12- /oYR 3 13 Ls /A v7� w - . -? ( - z
y
/.X -10 /o GS V — •1 l• z
3 .2 10 yR 4/ S / c . 14
G•
7X t2- M ors VF.< / M ID
a Boring # ❑ Boring �� 2-7 GC�•S
Q L Pit Ground surface elev. / • ft. Depth to limiting factor in. 7
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 I `Eff#2
/ 013 /oyR 3/3 /.S 14" M w Zf
2 -2• 2 l R 0
Syk S/�
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 _< 150 mg /L ` Effluent #2 = BOO < 30 mg /L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
RoQ T litLBR ii6e 315
Address Date Evaluation Conducted Telephone Number
• o7D -7! g6 •$l85
•� S 3
Private Sewage Consultartla
655 O'Neil Rd.
Hudson, Wis. 54018
ORIGINAL
Property Owner Parcel ID # Page Z of 3
[-31 Boring # ❑Boring 7 0& S SS
® pit Ground surface elev. 7 ft. Depth to limiting factor Z in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
o• /oye 313 L /M f %) z
��
R s
Zs •y /D 17 C
s NR -5161
F-1 Boring # [3 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 /ftz
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
F-1 Boring # ❑ Boring
El Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
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.6/00)
ilk
' S ,
I
r
I� rz
a�
o '
s.
2
�I1 �
130 dap
P
/ 00-0
9y,go
v
zB
2
13 0 7 V`
A�ssol2 ylP of
p�
/02,
O
o
S CAL E ' / = 30
l i o C�c P i T5
Private Onsite Wastewater Treatment System Management Plan
Septic Tank And Gravity In- Ground Soil Absorption Component
Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment
System (POWTS) shall include information and procedures for maintaining the system within
the parameters of Comm 83 and 84, and the conditions of approval by the department, agent,
or governmental unit. The approved plans and permits for system are on file at the county
zoning or health department.
This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground
Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD-
10567-P (R.6/99).
Table 1: System Design Specifications
Sanitary Permit Number
Number of Bedrooms
Design Flow - Peak (gpd) �a
Estimated Flow - Average (gpd) k S o
Septic Tank Capacity (gal) __ 1000
Soil Absorption Component Size (W) / 9 10
Type of Wastewater Domestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd) q6-0
Maximum Influent Particle Size (in) 1/8
Maximum BOD (mg /L) 220
Maximum TSS (mg /L) 150
Table 3: Maintenance Schedule
Septic Tank Inspect and /or service once every 3 years
Outlet Filter Inspect once a year and clean at least once every 3 years
Soil Absorption Component Inspect once every 3 years
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks
under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with
NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease
Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable
Restrooms).
The operating condition of the septic tank and outlet filter shall be assessed at least
once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure
proper operation. The filter cartridge should not be removed unless provisions are made to
retain solids in the tank that may slough off the filter when removed from its enclosure. If the
Management Plan for a Septic Tank and Soil Absorption Component
filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously.
Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of scum and sludge in the tank
exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the
time of an assessment, maintenance personnel shall advise the owner of when the next service
needs to be performed to maintain less than maximum scum and sludge accumulation in the
tank.
Manhole risers, access risers and covers should be inspected for water tightness and
soundness. Access openings used for service and assessment shall be sealed watertight upon
the completion of service. Any opening deemed unsound, defective, or subject to failure must
be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by
an effective locking device to prevent accidental or unauthorized entry into the tank.
No one should enter a septic or other treatment or holding tank for
any reason without being in full compliance with OSHA standards for
entering a confined space. The atmosphere within the septic or other
treatment of holding tank may contain lethal gases, and rescue of a
person from the interior of the tank may be difficult or impossible.
Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the
tank is no longer used as a POWTS component.
Soil Absorption Component
The soil absorption component serving this structure is designed to accept domestic
wastewater from a residential facility. The limits of operation of this component are shown in
Table 2.
The longevity of a soil absorption component depends greatly on proper and timely
maintenance, and system use within or below the limits of reliable operation. Good water
conservation practices by all occupants and the installation of water conserving plumbing
fixtures are key factors in extending the useful life of this component.
The soil absorption component's operation must be assessed by inspection at feast
once every three years. The inspection shall include recording the levels of ponding, if any, in
the observation pipes, and a visual inspection for any evidence of surface seepage or discharge
from the component. On steeply sloping sites, areas of erosion should be identified and
reported to the owner for repair. The surface discharge of domestic wastewater or sewage
from the system is prohibited and considered a human health hazard.
Traffic around or over the soil absorption component should be avoided particularly
during winter months. The compaction or removal of snow cover over the component may lead
to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or
impossible to repair until weather conditions improve. In general, soil compaction over this
component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to
more intense, and earlier, organic clogging of the soil.
2
• Management Plan for a Septic Tank and Soil Absorption Component
Plantings of deep- rooted trees and shrubs directly over or within ten feet of the
component should be avoided since root intrusion into the component may obstruct wastewater
flow.
a__A.
�o
3
" ST CROIX COUNTY
J ^ SEPTIC TANK MAINTENANCE AGREEMENT
r AND
OWNERSHIP CERTIFICATION FORM
r/Buyer
Ads JO 88 /190- St. �
Address
(Verification required from Planning Department for new construction)
tate r Parcel Ident' 0 2 y 8 o
n ification Number W 0 0 l A
DO — C RIPTIO
X.ation r /., /� ' /., Sec. T `l N -R S . W, Town of
'vision Lot #
ed S> rvey Map # Volume _ . Page #
my d a 7 Volume y / 6 Page # P2
x
house Yes 64 no Lot lines identifiable Q yes 0 no
`M1�j�INTENANCE
ImPriet use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
µ of Priming but the septic tank every three years or sooner, if needed by licensed pumper. What you put into the system
the fitwadtion of the septic tank as a treatment stage in the waste disposal system.
1 The pro
perty owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
plumber, journeymanplumber, restricted plumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal system
pt+Opar operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
tike undemigned have read the above requirements and agree to maintain the private sewage system with the standards
herein, as set by the Dep ent of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
that your septic system has We maintained must be completed and returned to the St. Croix County Zoning Office within 30
the throe year expiration date.
k
TURF OF APPLICANT DATE
E
OWU CERTIFICATION
1(we) certio that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
I orty dc=rx' bed above, by virtue of a warranty deed recorded in Register of Deeds Office.
r
TURF 4P APPLICANT DATE
" Arty information that is mis- represented may result in the sanitary permit being revoked by the Zoning Departr4
de with th
applicatio a stamped warranty deed from the Register of Deeds office
copy of the certified survey map if reference is made in the warranty deed
M
$ � k
s
No. 260 Warranty Deed —To Husband and Wife na Joint Tenor 416 PAGE 28 Published by Rau Claire Bmk k Bt.Qonery Co.
281274
This Indenture, Made this 3rd day of August ,19 65,
between George E. Frederick and Josephine Frederick, his wife
• part i e s of the first part, and
Dale E. Frederick and Virginia Frederick
husband and wife, as joint tenants, parties of the second part.
Ulftnroortb, That the said part i es of the first part, for and in consideration of the sum of
— Seventeen Thousand Seven Hundred Thirty ($17,73$.00) - - -- -Dollars,
to them in hand paid by the said parties of the second part, the receipt whereof is hereby
confessed and acknowledged, ha ve given, granted, bargained, sold remised, released, aliened, conveyed
and confirmed, and by these presents do give, grant, bargain, sell, remise, release, alien, convey and
confirm unto the said parties of the second part, as joint tenants, the following described real estate
situated in the County of St. Croix , Wisconsin, to -wit:
The Fast Half of the Southwest Quarter (EJ of SW') of
Section Two (2); and the North Half of the Northeast
Quarter (N� of NEI) of Section Eleven (11), all in
Township Twenty -nine (29) North of Range Eighteen (18)
ilest, St. Croix County, Wisconsin. Subject to easements
and rights of way of record.
This conveyance is given pursuant to the terms of that
certain land contract between the parties hereto, which
contract is dated February 3, 1 and recorded
on February 7, 1=61 in the office of the Re of
Deeds, St. Croix County, Wisconsin, in Volume 374 of
:'records on page 500.
i
a
Z:ogetbrc, with all and singular the hereditaments and appurtenances thereunto belonging or in anywise
appertaining; and all the estate, right, title, interest, claim or demand whatsoever, of the said part ies
of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained
premises, and their hereditaments and appurtenances.
Z0 1 2abe anb t0 1201b, the said premises as above described with the hereditaments and appurtenances,
unto the said parties of the second part, as joint tenants.
Znb the %afb, Geor r. Frederick and Josephine Frederick, his wife
parties of the first part, for theriselves, their heirs, executors and administrators,
do covenant, grant, bargain and agree to and with the said parties of the second part, and to and
with the survivor of them, his or her heirs and assigns, that at the time of the ensealing and delivery of
these presents they are well seized of the premises above described,
f
i
ds of a ood, sure, ,perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and
that the same are free and clear from all incumbrances whatever.
and that the above bargained premises, in the quiet and peaceable possession of the said parties of the
second part, as joint tenants, against all and every person or persons lawfully claiming the whole or any
part thereof they will forever WARRANT AND DEFEND.
31n WitntOO Wbtre0t, the said part i e s of the first part ha V e hereunto set th e i r hand r and
seal s this 3rd day of " Uf"U st ,19 65.
, Sealed and Delivered in Presence of , 1 [.G 2 5 .... ..,.,. .x! i........... .... (Sell)
........... fir, Xl�... _ ............ _ ....... ................
l Josephine. re(j er' -c }
John. -F. - Clarke_
-- .. ..... ..... _...... .._
_ ...... ........._...............__..._ _...... _.. _._ .............. (seal)
Patricia Waalen ........... .. .................................... _..._......__....._......_..... .._......._.......__.....(Seal)
%tate of as ioranoin,
ss.
St. Croix County.
On this the 3rd day of I, "ust , 19!:5 , before
me, John. E, Clarke �y unoer�i ,� Ricer, personally
appeared George E. Frederick and J us er hine :,, nown r `s'atf' Fact y proven) to be the
person s whose name s subscribed to the within instrument and acknowledged that the executed
the same for the purposes therein contained,
C ,
In witness whereof I hereunt se my hand and oHi ial #eal
Notary Public, ")t . C rc i f: CO No" 'Wiscnnsin.
My Commissi eagrmel 4 S F (, T ": <:1 ri e ri t
(To be filled In It ei¢ned by a Notary public.)
Drafted by Hughes & Hughes, Attorneys at Law, New : ich::cn, '.;isccns n.
(N.H. --Ch. 69 W4. Btats. Prs+idaa that all Instruments to be recorded shall have Plainly Printed or typewritten thereon the names of the araatore
Mats". witnesses and notary.)
O
tr� p O
b
A � y A
A qJ
[`m
CM T,
p
o 4 e c? .a
bi
H q)
p v
VOL 416 PAGu E 29
MENEM