HomeMy WebLinkAbout002-1079-10-200 (2)Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]
Permit Holder's Name: Village Township
Kenneth C. and Karen D. Singerhouse Ciry TOWN OF BALDWIN
CST BM Elev: Insp. BM Elev: BM Description:
06 .� lop . r G1�L
TANK INFORMATION ELEVATION DATA
TYPE
MANUFACTURER
CAPACITY
Septic
/ -
Dosing
Aera
L7
w�st� e
l
Ho'g
—
TANK SETBACK INFORMATION
TANK TO
P/L
WELL
BLDG.
Vent to Air Intake
ROAD
Septic
Dosing
7
J
Ae . n
Ho 'g
PUMP/SIPHON INFORMATION
Number
().100
2NO
.0- S
IForcemain ILent * [Dia. � �• (Dist. to Well
STATION
BS
HI
FS
ELEV.
Benchmark
cc)
Alt. BM
Bldg, Sewer
St1Ht Inlet
St/HI Outlet
Dt Inlet
DtBottom
�3•�0
92•
Header/Man.
2
Dist. Pipe
2 •
1�3. yo
Bot. System
.Lo
02•�
Fi ra de
tva1�
Z `�
��04
ov
3.10
PIT DIMENSIONS
No. Of Pits
Inside Dia.
Li uid Depth
BE
ENSIONS
Width
Length I
/
J
No. q�Trenchea
L J`
SETBACK
INFORMATION
ISYSTEM TO
Type Of System:
P/L
7
G f
WELL
' CPOI
LAKE/STREAM
/
LEACHING
CHAMBER OR
cturer:
Model N r
DISTRIBUTION SYSTEM
Header/Manifgld
'J ►1
11-ength!4-- 0 Dia (r
Disln
Pipe(s)
Length_
tion 1 t
Dia Spacing
l.� O
l '
x Hole Size
3
/gO
x Hole Spacing \
f /
Vent to Air Intake
CAI[ CAVFR
— o.eee— C..ere...e not.,
vv tlmmd rb At rrndo Systems. Only
Depth Over
Depth Over
xx Depth of
m Seeded/Sodded
xx Mulched
Bed/Trench Center
Bed(rrench Edges
Topsoil
1 Yes n No
"-.-1 Yes ' No
.__
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #t1:Z177 A� `>/��spection i12: Cr 11
Location: 678 230TH ST
1.) Alt BM Description =
2.) Bldg sewer length -
amount of cover,
3) WQ0% t mac,/�uaQ i.► P� p� pew
Plan revi on Required? Yes v� Noy//
Use other side for additional information
Date Insepctor's Signature Cert. No.
SBD-6710 (R.3/97)
U? '
.90
Kevin Grabau
Subject: FINAL--644768--Bird --Singerhouse
Location: Town of Baldwin --"RED"
Start: Wed 8/24/2022 10:30 AM
End: Wed 8/24/2022 11:30 AM
Recurrence: (none)
Organizer: Kevin Grabau
Categories: POWTS
678 2301h Street
002-1079-10-200
32.29.16.465A-30
Scheduled on phone with Shaun 8-22-22—"RED"
1
< I1 - 2d ;a �— !7l 4 1
SY,
1.S
d
a
ZA
Industry Services Division
Cou
—
1?3iw
�V =�' AUG 16 2022
4822 Madison Yards Way
Madison, WI 53705
Sanitary Permit Number(to be filled in by Co.)
�s.
P.O. Box 7162
l� /ZJ_ O
o x County
Madison, WI 5 707 2
��
`•/4 � 69
eve ermlt Application
Cora
State Transaction Numb r
In accordance with SPS 383.21(2), Wis, Adm. Code, submission of this forty to the appr governmentalunit
—
Project Address (if diffe•ent than mailing address)
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to
the Department of Safety and Professional Services. Personal information you provide may be used for secondary
purposes in accordance with the PrivacyLaw, a. 15.04(I)(m), Stats. %k
C- „
I. Application Information - Please Print All Information
Property Owner's Name fr/
�0
Parcel N
00( r
^
{ 1 1
,..1(�
Property Owner's Mailing Address
Property Location
2 ��
Govt. Lot
�(// '7
Lr
F 1A,
City, S to
'
Zip Code
Phone Number
V
/ _ , S tioll
T N R E r W
JI. Type of Building (check elt.that appl))
Lot g
Subdivision NameFor—
or 2 Family Dwelling -Number of Bedrooms
FPublic/Commercial - Describe Use
Block N
❑City of
State Owned- Describe Use
illageof
CSM Numbe M— (45Tgoveritif—.
(-2DHF- X
/�
r
Do : �Sso58
CCU
111. Type of POWTS Permlt, heck either eiv" or "Replacement" and other applicable on fine A. Check one box of line D. Complete line C If
applicable.)
A.
Dewsystem lacement Syste
Other Modification to Existing System (explain)
[]Additional Pretreatment Unit (explain)
B'
❑Holding Tank FlIn-Ground
I__f't-Grade
Viltilattind
Individual Site Design
Other Type (explain)
(conventional)
C.
❑ Renewal Before Revision
ha a of Plumber
Dransfcr to New Owner
List Previous Permit Nuffber and Date Issued
Expiration
/
IV.
Dis ersaVTreatment Area and Tank Information
i ow (gpd)
Des Soil Application Rate(gpd/so
tspeIsJe 9 equired (so
Dispersal A Pr oscd (s0 System
Elevation
Y
�'��
Tank lilforrttalion,-
Capacity in
Gallons
Total
Gallons
N of
Units
Manufacturer -
p
Vy
y
u
New Tanks
Existing Tanks
StM
D T
V
65
u
IM
Septic or Holding Tank
Dosing Chamber
O
O
V. Responsibility Statement- the undersigned, dupiresponsibility for imtallatlomof the POWTS shown on the attached plan I
Plum 's Name (Print) PI r s Signature
MP/MPRS Number
17
Businesa Phone mber
n
rJ //
/
Plumber's Address (Street, City, St Zip Cc a
,CV1. Count /Dopartment Use Only
Approved
❑ Disa roved
Permit Fee
�t Issu d
1 ui Agent Si alum
0 0 e n n for Denial
Conditions Approv / al
EM OWN ! 1.
ptic tank, effluent filter and
r1 , 1 n _ s
persal cell must be SerViCed / Malntal� - �) -41 fie+ �t�eLnS IM 1�$� t� w. . —tut
�rrTTT
per management plan provided by plumber. .OV( •.r/
OW
setback requirements must be maintained �1-w"''
per applicable code/ordinances. J�0,
SBD-6398 (R. 03121)
At Inch to complete plans for the system and submit to the County only on•papernot tessoan s ins it mcnes m size
N
System PLOT PLAN
PROJECT Karen Sinaerhouse ADDRESS 678 230th St. Woodville Wi 54028
NE 114 NE 114s 32 /T 29 N/R 16 W TOWN Baldwin COUNTY ST. CROIX
SYSTEM ELEVATION 102.6' DATE 6/3/22 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 456 # of Chambersnone
IL BENCHMARK- V.R.P. Base of power pole ASSUME ELEVATION 100' Filter SIM TFC
BOREHOLELE�O WELL sH.R.P. same as benchmark
r n • 230th St.
R
ST is 5' from the
house
Wal
180'
ST Existing 3
Bedroom
House
DW failed
M. 6 Huffcutt Dose Tank
B-1
v
B
4% Slope
Property Line
101'
Grading is to be done
to divert run-off
away from system
Area 15' below
system is to remain
undisturbed
B-2
1 0 2'
101.6'
Scale = 1/4" = 10/
0' 40' 80'
1 1 1
'OpY
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
sbird@frontiernet.net
S/3/22
Subject: Failed Septic system
wG162W
St. Croy County
_—I� n
I have inspected to the septic system at the above property and found it to be failing and
discharging to the ground surface and heading for the neighbor to the north property. The
system needs to be replaced and is causing a public health hazard.
Shaun Bird MPRS #226900
Wisconsin Department of Safery and Professional Services
Division of Industry Services
4822 Madison Yards Way
PO Box 7302
Madison, WI 53707
August 16, 2022
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 2024-08-16
Plan Review: PWTS-082201886-C
SHAUN R BIRD
1432 120th St
New Richmond WI 54017
SITE: Kw= Singwhouse
678 230th St.
Town of BALDWIN
St. Croix County
Total Amount: $250.00
FOR:
Description: 450 GPD Q Bedrooms — Replacement)
Maintenance Required
Phone:608-266-2112
Web: hao:!/dwsmi.aov
Email: dsosfa?wisconsin.aov
Tony Evers, Governor
Dan Hereth, Secretary
condWomiy
APPROVED
DEPT. OF SAFETY AND PROFESSIONAL
SERVICES
DIVISION OF INDUSTRY SERVICES
I.- 1/...a.,. 1--t
SEE CORRESPONDENCE
Mound Component Manual - Version 2.1 (May 2022-2027)
Pressure Distribution Component Manual - Version 2.1 (May
2022-2027)
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin
Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with
the enclosed approved plans and with any component manual(s) referenced above. 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, scats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site.
• Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting
under the dispersal area. All loose organic material to be removed from POWTS Dispersal Area.
• Prior to construction of the dispersal area check the moisture content of the soil to a depth of 8 inches. Smearing and
compacting of wet soil will result in reducing the infiltration capacity of the soil Proffer soil moisture content can be determined
by rolling a soil sample between the hands If it rolls into a 1/4- inch wire, the site is too wet to prepare. If it crumbles, site
preparation can proceed. If the site is too wet to prepare, do not proceed until it dries.
• Abandon Existing System per SPS 383.33
• Pump Floats to beset and verified per approved plan. Any chances may result in pump resizing to meet TDH and GPhI
Specifications.
• Divert surface water from POWTS Area.
• All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5
• Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c)
• Tank Installation to follow all manufacture's recommendations.
• Verify property tlne(s) prior to installation.
• Well setbacks to meet chs. NR 811 & 812.
Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper
treatment. If no other site is available, trees in the basal area of the POWTS Dispersal Area must be cut off at ground level. A
larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area.
Owner Responsibilities
The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use
and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's
manual for the POWTS described in this approval SPS 383.54(1).
In the event this so0 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.
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 Industry Services rescrves 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 and the POWTS management plan to the owner and any others who are
responsible for the installation, operation or maintenance of the POWTS.
Thanks,
q
Burr 7/.a0re5e,#
POWTS Plan Reviewer— Wastewater Specialist
Department of Safety & Professional Services I Division of Industry Services
Email: tim.vanderleest(@wisconsin.eov
Cell: 608-516-6134
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 8/3/22
Owner: Karen Singerhouse
Location: NE1/4 NE1/4 S32 T 29 N,R16W 678 230th St. Baldwin
Manuals Used: Mound Component Manual Version 2.1 (May 2022-27)
Pressure Distribution Manual Version 2.1 (May 2022-27)
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
7. Filter Specifications and cross section
8-9. Maintance and contingency plan
Attachm
Shaun B
Signatu
License
Page 1 of 9
PROJECT Karen Sinaerhouse
NE 1/4 NE 1/4S 32 /T 29
System PLOT PLAN
_ ADDRESS 678 230th St. Woodville Wi 54028
N/R 16 W TOWN Baldwin COUNTY ST. CROIX
SYSTEM ELEVATION 102.6' DATE 8/3/22 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 S1ZE LOAD RATE 1.0 ABSORPTION AREA 456 # of Chambersnone
BENCHMARK V.R.P. Base of power pole ASSUME ELEVATION 100' Filter SIM TEC
BOREHOLE O WELL 0H.R.P. same as benchmark
230th St.
ST is 5' from the
house
WQI I
180 Scale = 1 /4" = 10/
ST 01 40' 80'
Existing 3
Bedroom
House
DW failed
B.M. d Huffcutt Dose Tank
B-1
I
B-
4% Slope
Property Line
101'
Grading is to be done
to divert run-off
away from system
Area 15' below
system is to remain
undisturbed
B-2
1 02'
101.6'
aoF�
Mound System Cross Section and Plan View
-I- - - - - - - - - - - - - - - - - - - ---------- - - - - --
I
= Topsoil
Cap Material
El= ASTM C-33 = Clean aggregate
and fill s1/2to 2 %, in. dia.
, 2 Ft Contour
Slope Direction
Dimension
Feet
A
$
B
S
D
t
E
F
5
G
H
K
, Z
L.
^
W
t
Z
Slope
%
= 4 in. sch. 40 pvc O
observation pipe
GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing
vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or
chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a'A inch soil wire
when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately
after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or
is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot
thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound
is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The
observation pipes are slotted in the lower 6 inches and se ured in place with rebar or a closet flange.
10/07 lgj Page , of
Man
1'Vl I.G IVIQIII
. ;
Lateral Diameter
Orifice Diameter
L
Force Main Diameter
Force Main Leneth
03/05 ]gj
Pressure Lateral Layout
Two Laterals — End Manifold
A
iI
1n.
In.
In.
In.
Ft.
Ft.
In.
Ft.
ided
lout
8
ig
Sweep
90
Bend
Pressure System Construction
Laterals are constructed of Schedule 40 PVC
pipe. Orifices are drilled perpendicular to
the pipe with a sharp drill bit and face down.
Lateral turn -ups terminate with a threaded
cleanout plug and are enclosed in a 6-8 inch
diameter lawn sprinkler valve box accessible
from finished grade.
••••• Grade ••••••
6-8 Inch Lawn
Sprinkler Valve
Box
r�
Page Iof
Dose Tank Cross Section And Pump Performance Specifications
Tank Manufacturer
Tank Model Number
U
Total Tank Capacity
3 v
Max. Bury Depth
Pump Manufacturer
Pump Model Number
Alarm Manufacturer /iie.LJ C..e/._.
I Alarm Model Number 1 7), 1
Switch
ft� — .
Inlet
Vent Min. 12"
Above Grade
With Cap
Finished Grade
Switch Settings and Reserve Capacity
Tank Volume = GPI
Dimension
Inches
Volume Gal.
(reserve) A
(alarm) B
2
(dose) C
6,.j
2 7, J-
(dead) D
Total
Z
3
tm p Performance Required
GP Ft TDH
c
Total Dynamic Head - Feet
Elevation Head
Distal Head
Network Head Loss
Force Main Head Loss
Filter Head Loss
,
Total
Weather-proof
Junction Box
Tee,
Manhole Min. 4" Above Grade
With Locking Device
1
I`
Disconnect
Means
X.
'°` V�1,
B W cep
Hole
Off Elev. C
Ft
Bottom of Tank Elev. 9n•
Ft D
GENERAL INSTALLATION: The dose tank is bedded and back filled in accordance with the
manufacturer's product approval specifications. Maximum depth of bury as specified by the
manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have
an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved
material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or
sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the excavation and is sealed
watertight. Electrical servicecomplies with NEC 300 and Comm 16.28.
10107 Igj Page S of
t5�
280=SERIES
112 hp Submersible Effluent/Sump Pumps
The Liberty 280-Series provides a cost effective "mid-
range" pump for on -site waste water systems, liquid
waste transfer and commercial heavy-duty sump pump
applications that require higher head or more flow.
Designed around Liberty's unique "Uni-Body" casting,
the 280-Series will provide years of reliable performance.
All Models Feature:
• Vortex style Impeller permitting passage of solids
up to %" I( l
• 416 stainless steel rotor shaft
• Permanently lubricated upper and lower ball bearing
• Epoxy powder coat finish
• All fasteners - corrosion -resistant stainless steel
• 1 yt" Discharge
it Stainless steel bottom screen - easily removable
It Maximum fluid temperature: 140' F.
280-Series Cord Lengths
_Model 10' 25'(-2) 35'(-3)
50'(-5)
280 Standard Optional Optional
Optional
281 Standard Optional Optional
Optional
283 Standard Optional Optional
N/A
287 Standard Optional N/A
WA
10' cord length standard on all modols. For optional lengths,
add "-2, -3 or -5" suffix to model number.
Example: for model 280 with 35' cord, order 200-3
Motor Specifications
y: hp 60 Hz 3450 RPM
Oil filled, thermally protected
(PSC) Permanent Split Capacitor
8.0 amps (115V)
4.0 amps (208/230V)
•V
•�.............����■ SEE .....
25
LL 20
� 15
= 10
11
9
8
6
5
3
2
5 10 15 20 25 30 35 40
U.S. Gallons Per
0 38 78 114 158 192 228 270
Liters Per Minute
Dimensional Data:
Weight: 29 lbs.
Height:13"
Major Width: 10" (model 287)
Minimum Sump Diameters:
Model 281, 283... 14"
Model 287 VMF...10"
rIA
a)
v
Factory switch
Model 281, 283
Model 287
I
settings
VMF
Turn on level
131.
9.5"
Turn off level
7"
4.011
The Model 283 features a fully adjustable wide-angle float. Ufforential
adjustments can be made easily by tethering the float to the dis-
charge pipe or other mounting point. Vertical float model 287 is not
adjustable.
Ino
odel 280 Model 281 Model 283
anual, Wide angle Wide angle
switch float switch float switch
with quick- with series
disconnect (piggy -back)
plug
SSPM✓-� s �.
CE�TpIED
c us Certified
epecllle•Ii�en,eubieel l• chOng Mlhoul notice.
Model 287
VMF-Series
Vertical mag-
netic float for
smaller pits -
will operate in
a 10" diameter
sump
Liberty Pumps it 7000 Apple Tree Avenue • Bergen, New York 14416 • Phone 800-543-2550 Fax (585) 494-1839
www.flbertypumps.com Copyright* Liberty Pumps. Inc. 2017
All rights reserved. LUT 2000 Ra5r17
GAG SIM/TECH FILTER
065% SIGN [MY OTH 20
WYFE CITY, MI 49712
1-NB-W3290 FAX 1231-�82 9324
SIM/TECH FILTER ASS'Y LETAII ?AT415DBQ-
J HONERY S7F-1�100 00 �1127
_._ .--
GARY KpTEky L"R j WrOG2
SB/7,0 39tid 03 dwnd a38 aa6 0(///
89BLOL85TL L6:01 TTBL/90/L0
\: POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page�er
FILE INFORMATION
Owner J
Permit 9
nRClf.rd PAPAMFTFRS
Number of Bedrooms
3 Cl NA
Number of Commercial Units
NA
Estimated flow (average)
( al/da
Design flow (peak), (Estimated x 1.5)
41-1V gaVda
Soil AppOcation Rate
r U aVda /W
Influent/Effluent Quality
Monthly average'
Fats, Oil & Grease (FOG)
S30 mg/L
Biochemical Oxygen Demand (BOO.)
5220 mg/L
Total Suspended Solids (TSS)
5150 mg/L
Pretreated Effluent Quality /<NA
Monthly average"
Biochemical Oxygen Demand (BOD.)
530 mg&
Total Suspended Solids (TSS)
530 mg/L
Fecal Coliform (geometric mean)
510' efu/100m1
Maximum Effluent Particle Size
Y. Inch diameter
MAINTENANCE SCHEDULE
evercu coCCIFICATIr1NSi
Septic Tank Capacity
al
O NA
Septic Tank Manufacturer
eye`
NA
Effluent Filter Manufacturer
=
G NA
Effluent Filter Model
O NA
Pump Tank Capacity
al
13 NA
Pump Tank Manufacturer
NA
Pump Manufacturer
O N.A.
Pump Model
O
p NA
Pretreatment Unit
A
O Sand/Gnivel Filter
❑ Peat Filter
❑ Mechanical Aeration
❑ Welland
❑ Disinfection
❑ Other.
Manufacturer
Dispersal Cell(s)
O In ground (gravity)
❑ I -ground (pressurized)
❑ At -grade
ound
C1 Drip4ine
O Other.
• Values typIcal for domestic (ran-cortxnerdal) wastewater and
septic tank of erc
.•• Valuas tyWA1 for pretreated wastewater.
Service Event
Service Frequency
Inspect condition of tank(s)
At least once every
When combined sludge and,,scum
O months ar(s) (Maximum 3 yra.)
equals on hard (Y,) of tank volume
Pump out contents of tank(s)
Inspect dispersal cell(s)
At least once every J d months
ear(s)
(Maximum 3 ym.)
Clean effluent fitter
At least once every
O months
years)
Inspect pump, pump controls & alarm
At least once every
❑ months
years)
❑ NA
Flush laterals and pressure test
At least once every U
❑ months
ars)
P NA
t)tlrx:
At least once every
O months
O years)
NA
Omer:
At least once every
❑ months
❑ year(s)
NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an Individual carrying one of the following licenses or
certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintalner Septage
Servicing Operator. Tank inspections must Include a visual inspection of the tank(s) to identify any missing or broken
hardware, Identify any cracks or leaks, measure the volume of oombined sludge and scum and to check for any back up
or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels
in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the
ground surface may indicate a failing condition and requires the Immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third (Y.) or more of the tank volume, the
entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR
113, Wisconsin Administrative Code. ,
The servicing of effluent filters, m nical or pressurized POWTS components, pretreatfinent components, and any
other maintenance or monitoring at Irliervals of 12 months or less shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other
chemlcats that may Impede the treatment process and/or damage the dispersal calks). If high concentrations are
detected have the contents of the tank(s) removed by a septage servicing operator prior to use.
0'0 �
Page — of , ,
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that
may Impede the treatment process and/or damage the dispersal Cell(s). N high coricentrations are detected have the contents of the
lank(s) removed by a septage eervicing operator prior to use.
System sign up shall not occur when soil conditlons we frozen at the Infiltrative surface.
During power outages pump tanks may fill above normal hlghwater levels. When power is restored the excess wastewater will by
discharged to the dispersal call(s) In one large dose, overloading the call(s) and may result in the backup or surface discharge of eHluerg.
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to this
effluent pump or contact a Plumber or POWTS Melntalner to assist In manually operating the pump controls to restore normal levels
within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area wilhln
15 feet down slope of any mound or at -grade soil absorption area.
Reduction or eliminallon of the folloWing $'OM the wastewater stream may Improve the performance and prolong the life of the POWI43:
antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental fices; diapers; disinfectents; fat; foundation dralln
(sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; most scraps; medications; oil; painting product's;
pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS falls and/or Is permanently taken out of service the following steps shell betaken to Insure that the system is props fly
and safely abandoned In compliance with chapter Cann 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space fkfled with sail,
gravel or another Inert solid material.
CONTINGENCY PLAN
If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code complir)tnt
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelm.
The replacement area should be protected from disturbance and compaction and should not be Infringed upon by requited
setbacks from existing and proposed structure, lot lines and wells. Failure to proted the replacement area will result In the nded
for a new soil and she evaluation to establish a suitable replacement area. Replacement systems must comply with the ruler/ In
effect at that time.
❑ A suitable replacement area Is not available due to setback and/or will IknlWk)ns. Barring advances In POWTS technology a
holding tank may be Installed as a last resort to replace the felled POWTS.
The site has not been evalusted.to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluajon
/ mt1st be performed to locate a suitable replacement area. If no replacement area Is available a holding tank may be Installed as
a lent resort to replace the failed POWTS.
XMound and et -grade soil absorption systems may be reconstructed in place following removal of the blomet at the Infiltrative
�rface. Reconstructions of such systems must comply with the rubs In effect at that time.
<<WARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GA88ES AND/OR INSUFFICIENT OXYGEN. DO NPT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER
Name %
Phone r -
P0Wrf3 MAINTAINER
Name
/{r1� t 1
Phone
_
_ 1j_ r
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHOPM
Name Name
_ �- -
Phone /J = d a Phone %l j— (�
This doeumerit was drafted In compliance with chapter SPS 383.22(2)(bx1)(d)&(f) and 383.Kl), (2) d (3), Wisconsin AdmYriNrdNe Coda.
wl.00nsln Dpair ere or Corrvrwca SOIL EVALUATION REPORT Pape _ a
DYMM of Safetyand Bt"Vs
k, sxadanu vMh Comm 85, Wb. Adm. cad. Caudy
i a�
eah oemplW "a plan on W« tntom
pnot leas &an b V2 x 11 dw In . Plan mud '
In", bu not united to: wrtical and horizontw maraca pot (13M), diredon rid Perm I.D.
percent dope. scale or dknanslons, north arrow, and location and distance to nearer road. Q
Pleas• print all Information. ReviwYed M Dab
Perso" Wormeeon yw prwie• maybe wed la eeoordary purport (Pr"q low. a. i5M (1) (m))•
�/ l ) q
�� Owner Y �..1,, i �. �.r �/,..�, t fn 0, Ci�a4. lal 1/1//� 1H S� T �i9 N R / E ( W
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CST Name (Please Print) CST Number
Blyd Plumbing, Inc. Shaun Bird tun 2269W
Address DW uctod TeNphae Ntarber
1432 120th St, New Richmond, WI 5 Eraku �'— 715-246-4516
Property Owner _
Boning # ❑ Boring
Pit
Parcel lD #
Ground surface elee . . L f. Depth to limitip factor in.
Page of
Sn1�P.t.
Wool
rMMM.
fll.�
WAMROM.�Ci!,/w7OM[li1
RAWAIM
Boring # ❑ fang
❑ pit Ground surface elev. ft. Depth to IkWWg factor In. Sol Application Rate
❑ Borsp # ❑Bork ❑ Pit ft. i. Ground surface elev. Depth to Wnbv factor Sol Application Rate
' Effluent #1 • BOO, > 30 < 220 nVL and TSS >30 1150 n & ' Effluent #2 a BODr 130 nV& and TSS < 30 nlp(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 fortnat, please contact the department at 608-266-3151 or TTY 608-264-8777.
SOD 9330 (aA=)
Soil Test Plot PI
Project Name Karen Singerhouse
Address 678 230th st.
Woodville Wi 54028
Lot 2 Subdivision -------
NE 114 NE 1/4S 32 T 29 N/R16 W
[:]Boring Q Well PL Property Line
RM or VRP Assume Elevation 100 ft
I
Bird
TM #226900
8/3/22
Township Baldwin
County ST. CROIX
Base of power pole
System Elevation 102.6' •HRPSame as Benchmark
230th St.
ST- CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
I'I,iti is to certi.f
Y that I(ha
:.cve inspected t
rying the he septic tank
Present-J.y
resi
section 7� `-- a ce located
�=` , TZ7 N' R W J'Owll Upon inspection -- 'f
the tank and baffles to ' I certify that I
be in good condition have PouncJ
Functioning Properly. and it a
. PPears tQ be
""st time serviced:
back occur -
from absorption system?
_---- Yes No
---- (If.no, skip next line).
Approximate volume ar length g h of time;
''npacity: /�' --- gallons
C'(rostruction: Prefab Concrete _44,,— Steel Other
t'i;_intifacturer: (If known) :4r�O-
�OZ-ate]
h Je of nk (If known)ryQyCd/��
// C
nature)
(Name) �Please print -
(J it]-e}
Q (L1 ense Number)
I)n to
('utm to be completed by licensed plumber
Statutes) or Licensed Disposer (NR 113 WisconsinAdministrative
Code) Wisconsin
haumber (applying for sanitary
-
y permit) Certification:
[11 accepting the above statemeAre. axis'
sc'pt1C talk
c:onditianr T certify that the taconform to the requirements oee31: of my knowledge wil..l
�r)snect.ion openin f I. Adm. Code (exce Lg er outlet P' fNamSignat — /A�
MP/MPRS�p
ST. CKo uNTYOffic. SANITARY SYSTEM Filec
( }. rr . � e Use Only
OWNERSHIP/ADDRESS FORM Created212027
Community Development Department will utilize this information to provide the property owner with
information regarding operation and maintenance of your new or replacement sanitary system! This
information will be provided as part of our ongoing efforts to protect public health, your well, groundwater,
surface water, property values, and county resources. Once approved, this completed form and educational
information will be sent to you by email. If you would like to view your issued sanitary permit online, you can
do so by using the Property Files Scanned weblink.
Owner/Buyer
Mailing Address
City/State/Zip
Phone Number (required)
Email Address (required)
Parcel Identification Num
(found on the property tax bill)
OWNER/BUYER INFORMATION
NEW SYSTEM: LEGAL DESCRIPTION
Property Locatioryl 1/41,�C— 1/4 , Sec Z' T ZZN R/W, Town of L4v
Subdivision Plat: /, Lot #
Certified Survey Map # �oS�o Volume Page # ` l Y—.
Warranty Deed # 4Y `f (before 2006)Volume Page #
Number of bedrooms —:? Spec house 0 yesko Lot lines identifiable yes 0 no
OFFICE USE ONLY
New Property Address
(Verification of new address required from Community Development Department for new construction.)
(Staff Initials) (Date)
This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications.
New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified
survey map if reference is made in the warranty deed.
Community Development Department — Land Use Division
715-386-4680 St. Croix County Government Center 715-245-4250 Fax
cdd(@sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.gov
Parcel #: 002-1079-10-200
Valid as of 08/18/2022 09:11 AM
Alt. Parcel #: 32.29.16.465A-30
TOWN OF BALDWIN
ST. CROIX COUNTY, WISCONSIN
Owner and Mailing Address:
KENNETH C & KAREN D SINGERHOUSE
678 230TH ST
WOODVILLE WI 54028
Co-Owner(s):
Physical Property Address(es):
* 678 230TH ST
Districts:
Dist* Description
Parcel History:
Date Doc # vol/Page Type
0231
SCH D BALDWIN-WDVILLE
NORTHWOOD TECH
06/26/2001 1649457 1668/550 1 AFF
1700
Abbreviated Acres: 2.737
Description:
SEC 32 T29N R16W PT NE NE BEING CSM
15/4155 LOT 2 2.737AC
Plat
Tract (s-T-R 401A 1602/4 GL) Block/Cando Bldg
* 4155-CSM 15-4155 002-2001
132-29N-16W NE NE LOT 02
2022 Valuations:
Class and Description Acres
Values Last Changed on 03/05/2020
Land Improvement Total
G1-RESIDENTIAL 1 2.7371
28,900.001 177,600.00 1 206,500.00
Totals for 2022
General Property
1 2.7371
28,900.001
177 600.00
206 500.00
Woodland
1 0.0001
0.001
0
Totals for 2021
General Property
2.737
28,900.001
177.600.00
206 500.00
Woodland
1 0.0001
0.001
0.001
0.00
2022 Taxes
Taxes have not yet been calculated.
Key
* - Primary
,Q
C sf -, C:30--
AUG
wtaayn r ; of Ccrrneme SDIL t: RT Pape _ 04
Dnnsar o' Satety anc undinc Ct� �.
V. aou roente CCX'1 r 85 1NIs Aor,: Cooe
Community ACeC �mpiete site an o- paper na less Man E '.:. x - in hes ir. size. Plar r-ius: Ji I '
include. bLA not knitec tc veticai and hozonta re'erenx ac+tr y8N dlrecLx, anc P
percent mope, scale a dimensions, norm afro" anc locator an. distance tc nearest roac
Please print all information. Re ewec ey Data
Pa inf m wr roe yr *e ma. be Usec Ia ",pas" (P+rvsc) LJ a '.E.Od'.';
� • 11 KJK
Property CWW i Properly Locatlor
kin CAI'h,�S` 77
� � Govt. L.a � q � - q S3L T 2 n' R
Property Owners Mehl. c Address i Lot R Bloex R i $<lbf.'. Name or
C7l r%/J Y
State Lc Cooe Pna a Mi—Inar C ty C vrdve earest Rcad j
�i�rl��
New Conso-ucdfr, i:seX,Gesloenta , N.an; er o` t> soxns 5 -0 GPD
Dade derived design. flow ate 1
Areplaoemeni Public 31 r-
n,er,aa: -- Desctbe
Pa-ent matena ��5 ��,d:/ 1 V n SOlt�S Fhoa Plain elevation r applicable
Genera axrtrnerrts
and raccrfrnsndabons
System Type S✓stern Elevation
Banng
Gl
MD
IN®R
AIMNIVWAMWAS
lAM"
S
' E1l wit /1 • BOD. > 30 < 220 mglk and TSS >30 1 1XIC& Eftiuertt S2 = BOD. < 30 nV& and TSS < 30 nvk
CST Name (Please Print) natur CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluatio C,4"ucted Telephone Number
1432 120th St, New Richmond, WI 5 �' — � 715-246-4516
Property Owner _
aBoring #
Parcel ID #
Page of
❑ Boring
1 z Pit Ground surface ele r ft. Depth to uniting factor in.
Sol Aooliration Ratw
v�4D/D
WAV�WNMMRMW
W
mi
VAR!�i�i�i!�/w7C%ifi[/��Iair
Bing # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Aoolication Rate
Effkiwd #1 - BOD, > 30 < 220 ngtL and TSS >30 < 150 mg1L ' Effluent 02 : BODE < 30 nglL and TSS 130 rrVL
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.
SaP8370 (RAW)
Property Owner
Boning # ❑ Boring
iRZ Pit
Parcel ID #
Ground surface eley�(Lp— ft.
Depth to lirniting factor 0_— in.
Page of
Soil Amlirntvv, Rafo
v�I,r,�J,
l�AV����
M
NMI
W-PRO
WMM.NM
❑ Boring # ❑ Boring ❑ —
Pit Ground surface elev. ft. Depth to limiting factor in Soil Application Rate
Horizon
Depth
in.
Dominant Color
Munsell
Radox Description
Qu. Sz. Cont. Color
Texture
Stnx ture
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPDM
'Efl#1
'Eft#2
Boring ❑ Boring
#
❑Ground surface elev. It. Depth to limiting factor in.
Pit W7 Amrd,.v Rafe
Horizon
')epth
m.
Dominant Color
Munsell
Redox Description.
Qu. Sz. Cont. Color
Taxhre
Struch"
Gr. Sz. Sh.
Consistence
Boundary
Roots
GPDMF
'Eff#1
I 'Efl#2
Ef k;aM #1 = BODE > 30 < 220 mglL and TSS >30 < 150 mglL ' Effluent #2 = BOD, < 30 mglL 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.
SSD-1330 Or &W)
Soil Test Plot P
Project Name Karen Singerhouse
Address 678 230th st.
Woodville Wi 54028 TM #226900
D to 8/3/22
Lot 2 Subdivision -------
NE 1/4 NE 1/4S 32 T 29 N/R16 W Township Baldwin
Boring Well PL Property Line County ST. CROIX
M or VRP Assume Elevation 100 ft. Base of power pole
System Elevation 102.6' *HRPSame as Benchmark
"ST is 5' from the
house
ginth qt
Scale = 1/4" = 10'
0, 40' 80,
1 1 1
F*f tw
0/X couNnr 'W&�� 1�No. 644768
STATE SANITARY PERMIT
QnvmsFrwRrmr**L PREVIOUS NO.
OWNER
PLUMBERSAAQ#j %lob LIC.# 2 74clgo
TOWN OF %A&w&2iU
SEC 322 9T ZR N,
AND/OR LOT 2
,%ACls-14KO Die:
BLOCK
SUBDIVISION
CHAPTER 145.135(2) WISCONSIN STATUTES
(a) The purpose of the sanitary permit is to allow installation
of the private sewage system described In the permit.
(b) The approval of the sanitary permit is based on
regulations in force on the date of approval.
(c) The sanitary permit is valid and may be renewed for a
specified period.
(d) Changed regulations will not impair the validity of a
sanitary permit.
(e) Renewal of the sanitary permit will be based on
regulations in force at the time renewal is sought, and that
changed regulations may Impede renewal
(I) The sanitary permit is transferable.
History: 1977 c.168; 1979 c. 34,221; 1981 c. 314
Note: If you wish to renew the permit, or transfer ownership of
the permit, please contact the county authority.
:M O1yZED ISSUING OFFICER - DATE "/M?A%P7
S PERMIT EXPIRES -*10/03. UNLESS RENEWED BEFORE THAT DATE
POST IN PLAIN VIEW
VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION
SBD-06499 (RI1/20)