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HomeMy WebLinkAbout010-1034-40-000Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM County o r� St. Croix INSPECTION REPORT Sanitary Permit No GENERAL INFORMATION (ATTACH TO PERMIT) 645411 Personal information you provide may be used for secondary purposes (Privacy Law, s 15 Oa (1)(m)] State Plan ID No Permit Holder's Name James &Molly RevIT City Village Township Parcel Tax No TOWN OF EMERALD 010-103440-000 TANK INFORMATION TANK SETBACK INFORMATInN TANK TO PIL WELL BLDG. vent to Air intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION GPM .Wir M MQVr[r 11WIY 0 TO I tM ELEVATION DATA Sewer Inlet Outlet st. Pipe Grade BED/TRENCH DIMENSIONS Width Length No Of Trenches PIT DIMENSIONS No Of Pits Inside Dia Liquid Depth SETBACK INFORMATION SYSTEM TO PIL BLDG WELL ILAKEISTREAM LEACHING Manufacturer Type Of System. CHAMBER OR UNIT Model Number 1'11CTD1 QI ITIA\I eve rru Header/Mandoltl Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(sl Length Dia Length Dia Spacing snll rnvcD _ Depth Over -•---..._ _..., Depth Over _.. ........... .....-..uvc.ayarvrria xx Depth of Willy xx Seeded!Sodded Mulched BedlTrench Center Bedfrrench Edges Topsoil ,Yes � NOT _ � 'Yea - No vviaia�i. I W. (incluae code dlscrepencies. persons present. etc.) Location: No Address Available 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? . Yes _ No Use other side for additional information SBD-6710 (R.3/97) Date Inspection #1 Insepctor's Signature Inspection #2 Cart No c t 202� 4822 Madison Yards Way AEG 2 J Madison, W153705 _J, P.O. Box 7162 Croy County Madison, WI'53707-716:1 —P - - --rr_.......,.f� r to aceordance with SPS 363-21(2). Wis. Adm. Code, submission of this ram b the approp enw unit is rcquircd prior to obtaining a sanitary pernrit Note: Application farm for sMeo bmiltcd to the Department of Safety and Professional Services. Personal information yCu provide may be used for secondary pugxxm is eccordeoce with the Privacy law, s. 15.09/ 1 Nml. Sans f. r /%« r KE 'S 3 /LL r+# /1'A#Vwedo 40syoiS il. Type or Building (chectt all that apply) ✓ Lot a ©1 or 2 Family Dwelling - Number ofn6orims 3 O C 4,( E]PttblidCommacial - Ikscribe Use( Block p ISme Owned - Describe Use S j: 4'Ao cant Number (to b i1b Lis 4 1 Pam- o$ 2-.61 Project Address (if different than mailing addm isle .?SO � Sr, Pace) It 40/40-1c3y- yd- 000 Cove Lot -sGl ya -f41 Yti Section /y of 4 C- K Town of Z- rVdn id III. Type of POWTS Pffaft (Check alber "New" or "Beplacement" sad other applicable on Unit A. Check oat bm as &a S Caingl as ILe C if applicable.) A. l%'f j'7'j� •e' System I System EDOdter Modification to Existing System (explain) Additional PrWelmaut Unit (explain) a' OHold %Tank ❑ln-Oramd (convettrioml) [DU-0rade - ©Mound Individual Site Design Type yPe() C. Renewal Before ORevigon of Plumber OI':armcfer to New Previous Permit Numbs cad Date honed Expiration IV. Mperzanrea Aura sad Taak laforalatioa: pv t~ _ ,r Design Flow (gpd) ign Soil Application Ra s Dispersal Area Requi sf) Disperse Aria (so S B]evatioo Y 0, (o yso -75a ys6 937.5 9g. cs Tank Inforetation Crib Gallons Tow Gallons B of Units Man"fichullir CxF- o 3 New Tm1s ExMineTmb 8 It - 3 a - sepk e. t{atai.P.rank 000 - /000 //ffC4tT La.+u, v - - — Daautsce.rabQ .. -- Goo - Lao 1 / ILa.r+to C� s .. .m.cr,groca, PqP reapaoaotuq rob Instawtion of the MIM shown oa the aasebed attests I y.Sl led '1tl Ajur. dzo y 3 ❑ Approved ❑ Disapproved Permit Fee Date Issued Issuing Agent Signature 0 Owner Given Reason for Denial Conditions of ApprovaMeasons for Disapproval 7 11 l / (v rd t I'v/t� ) n I S SYS EM OWNER: ,,/y'� . l / 1. S tic tank, effluent filter and q�( V-e jj f h eoT �T- di ersal mana emenmust pserviced/maintained / lvvl GCS Ntv ,OliV+fib St�s�h't ✓t�4+Ytf�/,4✓tGe as r management plan provided by plumber. •2. All etback requirements must be maintained as er applicable code/ordinances. Aft* to twPktu: Pal t►e s7ste sad wbmh to tee Caury aaly as P*er ear km tMe t to x l l krebn i arse / a s`�i`o S 5 S,'r�c (/un •� 5-d #1 f Aw sc r (t �� �( ✓I a1 r -rAxrs + /Yo u y Ardol - .?.4b j: •f Ei,reRiso� Sr. L.terY Co, ?.12 L� Sr. I jot Raw o,%R b a r r G %75',tocrc CELL X r/;S`'OY&LQs /edrs LFds". .StO (/Jadu) �9 9 � W g, 10" /aAtst ruo rr 0 25' A6r _ v� � = Alr5r " AcAF FAssrt Ast .SAS 313.V3 mnm4crs �rtr O Ataw�t. 4AW.C4)r3' r+st ,6E AlftiiAr" rX OEL}r!O AArsOF,ar y fez wf sflrla.•+ ,JAOr 44wo LW,4j 4t r rTsw! a5c6 orst As JAWY h �S /arlaaf Lrs�r �latA X`/w s' Alwc;ee.arr lbw4 f Lo++Ne rt•ric Fp/� S�yo facer rriiw(3e �. /d� o r �a 99.0 DWISION OF W MTRY SERVICES IN41 N RANCH RD HAYWARD WR 54843-6M2 CDfta Thmugh P41" MPA"W wl alrlr.rrlroainrl.po�I Tory Sws - 0WAKI r omm orMN - saw"" August 17, 2022 commo APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES CONDITIONAL APPROVAL DIVISION OF INDUSTRY SERVICES PLAN APPROVAL EXPIRES: 2024-8-17 Plan Review: PWTS-082201921-C Curtis Boos 6451 1601" Ave Bloomer, WI SITE: Revoir 2501" Street Town of Emerald St Croix County SW'/. SW X S14- T30N — R16W FOR: i SEE CORRESPONDENCE Description: 3 bedroom-450 GPD —12" to limiting factor- Effluent Filter - Maintenance j Mound Component Manual — Ver. 2.0, SBD- required. 10691-P (N.01/01, R 10/12) Pressure Distribution Component Manual — Ver. 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, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • The site shall be properly prepared prior to plowing. Any grasses longer than 6" shall be cut short and removed. To avoid matting, any leaves or loose organic matter shall be raked up and removed. Cut trees and shrubs flush to the ground and leave stumps. Avoid operating equipment on the Mound site. If necessary, use only tracked equipment, during dry conditions, with minimal passes, to avoid compaction. • Components and soil removed from an existing drain field shall be properly disposed of so that there is no risk to public or environmental health. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec.145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. • A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is operated and maintained in accordance with this chapter and the approved management plan under s. SPS 383.5411). 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. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Joshua Rowley POWTS Plan Reviewer, Division of Industry Services (715)634-5124 Joshua. rowlev wisconsin.sov Page j of Q Private 4nsite Wastewater Treatment System Index and Title Page Project Name: T,r"ceg✓eaedo tars Owner's Name: r� •• Owner's Address: ae ,,9//83 ="` Sr Legal Deseripfm: S w sw,1 Municipality: Town, Vgiage, try of EwrE.uso County Sr. d ceiX Lot Number Block Number. CSM Number: Subdivision Name-. .? SO Sr Parcel I.D. Number /0 3y- YO - o00 Page I Index and Title Page Page 2 Plot Plan Page 3 Cross -Section & Plan View Page 4 Pipe Lateral Layout Page S Septic Tank / Pump Chamber Cross -Section & Specification PW6 PUMP Performance Information Page 7 POWTS Owner's Manuel & Management Plan Page 8 POWTS Owner's Manual & Managemont Plan Page 9 Filter Information Name of Designer. �u c r 60o s License* r700 B f"7 770 Signature: Date: 8-Doi — nt MOM ID the following POR^, c ^rnnnr~ ?.,: Ma.,W �4 m — - - - - Mound Corot Manuel for POWTS" Vasion 2.1 (May 2022-2027) "Pmm a won Component Mantel for POWTS- Version 2.1 (May 2022-2027) Attachment Sol! EwFuadon Report r S rr, sw, iit' 30 Nr a w _ •f E/r�Reu, A L.te/r La sab i s� rr r g p 25` Sor Cr rs, f'O At<F AdttiL A[t .S/S 303. V3 s[reours sr r ,44OW: ,6. S. AwrulvAr r/A7 .tF Alfft-irro - r 10-fdW / /A4re0-.Pr iOw •4lldrrrd �L � �� -SN•J Y� -YK< .6F 4ff1 of d/W ��'�< <ew+wtres ri/r/�!t/cr uw.+c gsw..yas `�Y Afi�•.tide /sot/.�� /Ifswtr LaWLJ.t.rc �/v7 e � .e s r�rr flip or�r w: A aNeP r f /d~AArc rt G Y 7.SL,t4ur u[ L I >1 `atLea ' ttAer S. EL.- 9S.Gs`•-+ 97.7'a.,H.a y /oG Saf7� !N • srfE Sumo �V•'�u� �9 '7� �'°' /ayK \ 4/u 4L. r /�uffc•rr / Lo.rte rf w 9f.o 3 Pape of 9 D = , 7S ft CROSS-SECTION OF MOUND _ = 7S f t UPTURNED LATERAL A ACCEU BOX S = _ 9 ft L TOP am OBSERVATION PIPE i WATEItTSW CAP Ri = .5 ft GEOTEXTKA FABRIC COVERING DfSTIq VWN LATERAL ( ji In. sch. 40 PVC 02MM _ I_ ft FILL Latarel invert El.mTOP _J� SotL H O TOE F ,?: .• System El.= 1 •. Contour El.= 9 z 9 ft ♦ • • t �'r . ' ► BURFACE : , -_ _Q %SLOPE FORCE MAN (2' sch. 40 PVC WIWI) oroTRIeuTIoel cEL.L. • 6 R x _ 7r it • fa ftl (W-zx• amewo) Min. RequWW K /—O• Zo = ffo Re A=_ 6 ft B=ls_ t I = J t J = 6.S ft x = ft L = 9/.S ft N=/? ft — 4, sah. 40 PVC Observation pipe 1.5 R d 0+ O.b R .1 • Ol� pipe ( ObWwobw Ope 6.SJ 75 8.;S tox A r, it•'r' DX it DWIr bullon Cal Iy 1/813 a �. J I 131hrI r4ion R4Rm .t,S d ( ) /iS R � 7J ( A In. sch.40) OXO UpWned Labual wO Acoms Box ProhRA dial rba ce end vends bOft WNW 15 R of downslops Ros. r 4 L 4.c a Bead Area s 7gs R= W Regyhed a 'Y1O i � - Z i fo R= r Faros MMyn ME** (Alm WK 40 PVC 02W) i' .1 1- •� • .•. .� SOLI DXAHW = + `? t: in. L&TWAL DIA. _ ,Y, in. MWIIlr D D211. Iff in. (sch•'0PVC Wpe D2W6) >IosC: ao►ir Dn►. • � in. a 72 rt. Y ` �_ rt .fir y •a,. 40 D26M ��g 3 r 10 "f' xX" / FORCE MAIN (? sch.40 PVC D2eB5) y %Vp 9= pap ___Y._ of 9 HOLE LOCATED EVENLY ON BOTTOM OF PIPE. Wnlmum Number of Hobe ■ ySd R2 14 = 341 Hoke _JI HolesA stmi x 2 Labrab = 34 (3118n Holes x CM ppm / (3118') Hob - dx of GPM = 8YSMIA FLOW RATE PIPE VOLUME = /Y# fL Latsrale Golan x 0.092 paft = _ /! . x 8 = oC4,1S GAL ■ SUM D019 ypUJME PIPE INVERT ELEVATION e 99 /S R CONNNAM NN A§gWI q TANK MANHOLE RISER a (OVER FINAL GRADE OwSPaW2"at Wires WAVY Mom bd".? . aq,.a�aAVey ,0acl..wM• aMnwdye.iMw clr.ed.4oPvtTtlravWi ECTRIM band. ti moms goo a Mr' 4' M1i2 6cA r0 PVCa 1fWat JUHCTION� BOIX �D1A RIM. l Flood Bwrrts BUILDING SEWER aar..Iz.eow atr .rwePSM�e J vor wa �aa.aotI la �•• lq io - nmi 6n r.n W�e rEc Soo► momUNWIN #A06 M OF T OF SUITABLE 8®0NG SEtEATH TAN( s MAX*" BLPY DEPTH OF Or AnthwYO of to rit mWb e ra q,,' ' purr aPa as,.atMW Tank Ma►ufac ksw.. Atyc..rr %,.Uwcrr Daly Wn*wrtsr Row (DWFY S/.ra GPD SepddPump Sae: /om /coo ogNOrls Number of dolly doses: J. s /9.17.) Alarm Marwiaclumr SE/rt..rl6f Force me Model Number: Yl rT lt volume:_�D R:. /43 9.Nt =� gr Swkh Type: r4V.r mc�rc Actual dose voiu mm 45 qd poid doss volume - voNMn or top main) EllrmrltPump Maras jlyrgs Model Number: of 13 Mini nuem Diealwga Rata: 'Ps. 40.9 OPM Vwt cw aft (pimp oar to weral invent)............ Z f ft System head (distal prlesure AS x l.3 ft): 3..i ft 30 ft Farce mein x /. IV 1100 Uictlom Wor . Y It Fftw friction loss ...................................... — ft Tole! Dynamic Head (TDH): // . a ft Reserve above alarm at.; in . 3W pM (D) Alarm anal above on floo! '? 1^ : _-rd6s air (C) ONOtr abet meeaursnert 6 In - W f flat (B) Orr above tank bottom _ 8 in : AW yd (A) DOSE TANK MENNOU Length I o in OuW height W in Width 7f in GWWw rjch /�fi A# 1 1 • • .. .. ..1P.. :. \��!� NOON■■■ memo MEMEMME 'o\NONE ■■■ manamom • . NOW.- ENNEREN■ Emmummoommom■■ .,►E■EEEEi MOMMENUMMEMOM 9.5 K332 ?AM Pik In VAA Page 7 of 9 POWTS OWNER'S MANUAL AND MANAGEMENT PLAN F(LR INFORMATION owner I rA of 10 dole Permit M �F Nneesar of Bedrooms Number of Commercial Units - FAtimeied flow (Ave) (100 Wdlbed room) Design flow (DWF) - estimated: 1.5 YSO gpd Soil Applicsfion Rita . D gpcvftl. bAnn t/EBuent Quality (O NA) Monthly Avenge Fas. Oil & Orame (FOG) :� 30 mg/L Biochemical Oxygen Demand MWs) <_ 220 mg/L Total Suspended Solids BSI <_ 150 mg/L Ptetnated Ef luem Quality (R NA) Monthly Average Biochemical Oxygen Demand W%) <_ 30 mgtL Taal Suspended Solids (W) <_ 30 mg/L Foal Colifbrm (geometric mean) S 10 efWIOOmL Maximum Effluent Particle Sim I /5 inch diatwar urpersar user Neuroses rdanmer: ia �.. .Yj _MIJ '. I:P• Septic T.dt Capacity jrL'rt1C4Qf 111110KA Seqstic'lashMinagifiectiarer W47T Q NA Effinant Filter M60u6emer {d FS r OKA Effiaeet Filter Model !-/O DNA PUMP Tank CWDCKY Sol O N Pump TnkMaradaeturar yff(enft O NA Pumls Mmafwomv F ,a 5 O NA Ndom /7! ON PeetrrsmrreM Unit (ON A) O SandlOnvel Filter O FeatFilow ❑ Mechsoical Aeration O Wadead D Disiofcetiom O Other. Mmdlecturw. Model: Soil Absorption component (O NA) O lavaund (gravity) 17 In-ground(pressurized) O At -grade 9 Mend O Drip -tins O other: Vertical Dtehmx TamtBolamp to sarvice Pad: It Iiorizapral Disaoce T s so Service Pad: fl NA Calciaiavar. soil Dispersal End Cap (Dispersal Unit EFSA) DM + Application Rate - Area Reouired - E[SA + or ffreneh Width) _ # X Inots or Total LMgh of T sl y!0 + /o - yso c' rr' O "At-C,rade componem Manual l rpovnr (pressure or Oravity. Version 3.0 (May 2022-2027) O "Design of Pressure Distribution Networks for Septic Tads -Soil Absotplioo Syatedns." Publication 9.6 (SSWMP Manuel) O "EZ Flow Mound Component Manual" Version 12I15ML7 (April 2018-2023) O -In-Ground Soil Absorption Component Mamas for POWTS" Version2.1 (May2022-2027) ® "Mound Component Manual for POWTS" Version 2. I (May 2022-2027) O "Pressure Distribution Component Manual for POWTS.- Vesion 2.1 (May 2022-202T) O Other: ......�......+- .�.n .r. v.�siu lure Service Lent I Sol 0 Frequou PMMPANP@Ct dispersal s dean filler I At lest one every. 9 13 months IS 3 YMS O bVm pump t puft cogiftols, alarm, wit At ksw ones every O months R 3 O NA Flush sad prepurs no haarsis At teat muses . O months 9 3cars O NA START UP AND OPERATM: For new construction. prior to wing the POWTS check treatment tank(s) for the pet wnce of painting products or other chemicals that may impede the treatment process and/or I ge the dispersal oell(s). If high concentrations are detected have the contents of the tank(s) reuroved by a septage servicing operator prior to are. System startupshall notocear when ssB conditions are frozen at the infiltrative surface. The property owner is responsible for the operation and maintenance of the POWTS and Submission of tegmued reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWI'S. The installation of water -saving appliances and fb acres along with prompt repair of leaks reduces the wastewater volume. Alan the brine or wtr6e from water 10f earn, two removal units, other else water iteaenent devices and foundation drains should be diachayed to the ground surface whenever ponbie Note: this does not include laundry waste, showers, dishwater, esc. This system is designed to handle domestic strength wastewater, however, the disposal of food based greucs, oils, vegetable/fruit pals, seeds. bones, and food solids such as those produocd by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. 01her non-biodograd" items, such as baby wipes, tampons, Sanitary napkins condoms. cigarette butts, dental floss, and conon swabs, should not enter tiro system. Chemicals, such as petrolam products, paint, disinfectants, pesticides. antibiotics, solvents, cu., abouW not be flushed into the system baciamthey can wAcoaly datmage yourPOWTS and conaminste your drinking water supply. Maintain a regular steady now by spreading )sundry washing throughout the week- Avoid vehicle traffic over all system components. Compaction ofsnow overthe dispcmi unit may cause it to flscne up. Page 9 of 9 INSPECTIONS A MAINTENANCE: Inspection W" be made by an individual carrying one of the MBowing liccum or certifications: Muter Plumber, Master Plumber Reatricted Sewer, POWTS Maintainer, or Sc~ Servicing Operator (per the attached Maintenance Schedule). Tank inspections must include a visual inspection of the task to identify any missing or broken hardware, identify any cracks or leaks, nenure the volume of combined sludge and scum and check for any backup or ponding of effluent to the ground surface and test all electrical equipment such as pumps and alarms. Any defects shall be promptly corrected. Exposed openings greater than g inches in diameter shall be segued with effective locking devices to prevent accidental or unauthorized entry the tanks. When tic combination of sludge and serum in any tank exceeds one-third (1 /3) or more of the tank volume, the entire contents of the tank shall lx removed by a Septage Servicing Operator and disposed of in accordance with Ch. NR 113, Wisconsin Admin, Coda Specific servicing rnecbartics must be provided if Yet" is >15 feet or if horizontal is > 130 feet and instruction to be provided below. the outlet tiltW s) shall be inspected and cleaned to remove soy accumulated solids according to manufacturces specifications. Solids washed from the filter shall be retained in the tank. Filter cleaning may be necessary at more frequent intervals bran stated in the maintenance schedule tokeeptbe systemoperstittg. Alarm should be tested on it regular basis by the home owner. if an ohms sounds, contact an individual licensed to service P OWTS. There is normally a 1 day reserve under regular operating condilksta, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surficing- ABANDONMENT; When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to mum that the By is properly and safely abandoned in compliance with Ch. SPS 393.33, Wisconsin Admin. Code: ' All piping to tmlta and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits Yell be excavated and removed or their covers removed and the void space filled with soil, gavel, or other inert solid material. CONTINGENCY PLAN, if the POWTS fails and cannot be repaired the following measures have ban, or must be taken. to provide a code compliant replacement system: O A suitable replacement are has been evaluated sad may be utili%ed for the locatinu of a replacement soil absorption system. The replacement area should be protected from disturbance and. compaction and should not be infringed upon by required setbacks from existing and proposed structure, la litres and wells. Failure to protect the replacement area renders it unusable. Replacement systems must comply with the rules in effect at the time of replacement. O A mutable replacement area is not available due to setback and/or soil limitations. Barring sdvwwm in POWTS technology a holding tank may be installed as a Iaat resort to replace the failed POWTS. 09 The site has not been evaluated to identify a suitable replacement arm Upon $rhos of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding task maY be install ad as a last resort to replace the failed POWTS. 9 Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltimtve surface Re000suucuoms ofauch systems must comply with the rules in effect at that time. WARNji GIIII SEPTIC, PUMP, AND OTHER TREATMENT TANKS MAY CON IAN I UMAL GA88tS AN OR INSUFFICIENT OXYGEN. DO NOT ENTER A SKMC. PUMP. OR OTHER TREATMW4If TANK UNDER ANY C ULCUM TANCE& DEATH MAY RESULT. R=CUE OPA PERSON FROM THE INTERIOR OFATANIE MAYBE DIFFICULT OR OLIO SSIRLE. ys Una .. a:a.„ t..Ia.kF:3i POWTS DWALltlt POWPB MAINTARM Name: 4/-&Ar 44as 1W. esro,5 Phone: 7 9d - WWTAGE LOCAL REGULATORY AUTHORITY Name: NomaSr. [ieoi �T Phone: Phone: 7/S s — yt,111e a' Installation Instructions for the GF10 Filter CAI T�.l -- —:I o I• Step 1: Loan and remove the septic tent cover, on the outlet stdref rank. SMp2: Before MWilMbn, place the Mar can on to the outlet pipe. taka aura the cam is positioned so the filler can be removed from the tank for metnte- nance and service I�GUFSM--1C Step 4: Glue the filter case onto the outlet pipe. Insert the fitter cartridge Into the cam (Make sun the filter Is co nipately Inserted Into "case.) mzzom TECHNOLOGYBEST Stop ]: For Installations that require or desire adslhlo id support (If additional strppM b not needed, go to Step ) us* sectlon of V Sch. all plpe to see two hubs looted on the bottom of the case and the hub located on the side of the use. 0 Step S: For Installations where it will be difficult to reach the handle, dace I -Schedule 40 pipe into the tee on the handle and extend It to height that wtk make it my to remove the Aker. ,.� as ;w w ere. r leer ter r ea r r r r r yea s m4 teal 1 Installation of an sewteaeanewaydv ordythesepuclank i A existing system. must be panped prior to instatladon. 1 e r r year Y. a rNo ass r ter rea r ter rerr r;.a Maintenance of the GF10 Filter A time frame In dadr septic Lana as serviced Is set by rants and kcal ads. Aa wi0 o" may be dW&wt6 mat requbtoryap nds ou"ex wm to tM years We no rimpto dye GFI C ibw be droved %4 wt the sapdc tmk b valued timed and ptngwl or as needed WARNING: If the liquid level in the tank is above the top of the filter, pump the tank prior to removing the filter cartridge. OCAUTION: USE RUBBER GLOVES WHEN HANDLING F ILTERSI Stop 1: INmove site optic tank corer eyed pump the tank di eceaary to parent arty sokds horn escaping to the INd when their Mae Is removed 0 d. Sap 2. pull Ito filter handle and tilde the deter otst of the case. Stepp. Whilehoklksgdse fitter cartridge ova; the access opening of the unk, Ante the cartridge off with fresh avatar. Take tre b nuke sue all solid m Will falls hack Into the tank OFW` TICIN04=T S 1'~ wvd. Wass n jord, Cr OW2 i-M-M-SM Far. 1l3.ae4e14 Stop 4. Insert the cartridge bark Into the case raektrp Sure that It Is property allgrsed and tortpkdaly Insarted Into the car& B Step 4: Glue the filter case onto the outlet pipe. Insert the fitter cartridge Into the cam (Make sun the filter Is co nipately Inserted Into "case.) mzzom TECHNOLOGYBEST Stop ]: For Installations that require or desire adslhlo id support (If additional strppM b not needed, go to Step ) us* sectlon of V Sch. all plpe to see two hubs looted on the bottom of the case and the hub located on the side of the use. 0 Step S: For Installations where it will be difficult to reach the handle, dace I -Schedule 40 pipe into the tee on the handle and extend It to height that wtk make it my to remove the Aker. ,.� as ;w w ere. r leer ter r ea r r r r r yea s m4 teal 1 Installation of an sewteaeanewaydv ordythesepuclank i A existing system. must be panped prior to instatladon. 1 e r r year Y. a rNo ass r ter rea r ter rerr r;.a Maintenance of the GF10 Filter A time frame In dadr septic Lana as serviced Is set by rants and kcal ads. Aa wi0 o" may be dW&wt6 mat requbtoryap nds ou"ex wm to tM years We no rimpto dye GFI C ibw be droved %4 wt the sapdc tmk b valued timed and ptngwl or as needed WARNING: If the liquid level in the tank is above the top of the filter, pump the tank prior to removing the filter cartridge. OCAUTION: USE RUBBER GLOVES WHEN HANDLING F ILTERSI Stop 1: INmove site optic tank corer eyed pump the tank di eceaary to parent arty sokds horn escaping to the INd when their Mae Is removed 0 d. Sap 2. pull Ito filter handle and tilde the deter otst of the case. Stepp. Whilehoklksgdse fitter cartridge ova; the access opening of the unk, Ante the cartridge off with fresh avatar. Take tre b nuke sue all solid m Will falls hack Into the tank OFW` TICIN04=T S 1'~ wvd. Wass n jord, Cr OW2 i-M-M-SM Far. 1l3.ae4e14 Stop 4. Insert the cartridge bark Into the case raektrp Sure that It Is property allgrsed and tortpkdaly Insarted Into the car& B File #: ST CR NTY SANITARY SYSTEM Office use o,fty OWNERSHIP/ADDRESS FORM Created212021 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. OWNER/BUYER INFORMATION Owner/Buyer Ja vy\e s e Vy� Mailing Address 6193 I L, (el`' S City/State/Zip 1-6 YO mavLoi_( �� N o /,S_ Phone Number (required) (0-S Cl W ' ?02 � Email Address (required) i'2Ut 1 r , c� a Parcel Identification Number 6/0 - / 4 - L4 - 0 J (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location _ ` 1/4 ,,�W_ 1/4 , Sec. T T 3N R / �P W, Town of EM e r­u l d Subdivision Plat: , Lot # Certified Survey Map # , Volume . Page # Warranty Deed # 1122 G 22, (before 2006)Volume Page # Number of bedrooms _? Spec house O yes �L no Lot lines identifiable W-yes O no L l, /I OFFICE USE ONLY New Property Address �J /l 2-J`O� j f, e r ct (/ L (Verification of new address required from C mmunity Development / 9 12622 (Staff Initials) (Date) 5ZIA 7V for new construction.) 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.00v 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.aov F1 1 30 DESIGN LLC (715)248-3010 C ❑ = _ - ED M:l NOTICE, Z' 71�-' i -Jim Revoir li ELEVATIONS II t d.1 Il IL 7 .4 t BRACED WALL LINE PANEL DETAILS Zo i 30 OESIGN LLC (715)248-3010 NOTICE. Jim Re%oow Gmage FLOOR PLANS • A2 ® m m m m m m m no SIDE ELEVATION REAR ELEVATION SIDE ELEVATION LEI !. ; _l _ _ FRONT ELEVATION fe GENERAL NOTES JJLIYf �C CC ':':�Of JLIN L'.ClYM YfQ. W y�LlN�C'Wf �ifY4M �O url Ml. rA— iL e7 V Ilk\ GENERAL NOTES FOUNDATION A-2 --* _ t I V c 1 02- i GENERAL NOTES -.. ems• >c .R _ _ +M run l�hl K R�r _ '✓fAllbr iC MM� � fs�n _ +u ""f. •c'.O[ uc Jhl� rO..aA ran MAIN FLOOR PLAN- A-3 ROOF PLAN WALL BRACING DATA PORTAL FRAMING DETAIL I I SECTION A94 St. Croix County Accessory Structure Affidavit James Revoir Name — (Owner) Typed or printed He/she is the legal owner of the following parcel of land located in St. Croix County, Wisconsin, with their deed or document of ownership interest recorded as Document Number 1122642 St. Croix County Register of Deeds Office. Record n Name and This property is described as follows (include lot no. and subdivision/CSM ` -"M ' or detailed legal description): i f 3 Parcel The Southwest Quarter of the Southwest Quarter (SW Y4 of SW Y4) of Section Fourteen (14), Township Thirty North (T30N), Range 16 010-11 West (R16W), St. Croix County, Wisconsin. OR: _ See attached deed copy for legal description ImL11111111111111 1158556 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 09/09/2022 03:54 PM EXEMPT #: REC FEE 30.00 PAGES: 2 lea turn Address ?if, 41- fication Number (PIN) -000 a As owner of the above described property, 1 acknowledge that the Private Onsite Wastewater Treatment System (POWTS) services both an existing principal dwelling and an accessory building on this lot and is sized for a L3, bedroom home with a design flow of 450 gpd. This accessory building may not be used as a second residence on this parcel. I also acknowledge that [ will disclose this information and stipulation to any future parties interested in purchasing this property. Dated this day of se -el 2,02-2 AUTHENTICATION Signature(s) authenticated this day of it TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY'. ACKNOWLEDGMENT STATE OF W ISCONSIN ) js Croix County. I , Personally came before me this day of - the above n_yd/ha r �7 Jta.Ci tJC t f— to me known to be the person(s) who executed the foregoing instrument and acknowledge the same ".aaaaaaa� V JUUE PET R A. ERSON Notap/Public, State of Wisconain My Commission is permanent. If not, stale (Signatures may be authenticated or acknowledged. Both are not _ necessary.) Date: 4 I�Ir"I. CST-aoaa ao a' CD pUG 26 Z�22 l) Nlleearrle Selaty"pffl eaelenel 9w+w un tcp veloP SOIL EVALUATION REPORT m ecconLlme *M SPS aft Ma. AdK Cme Cou" St. Crab( N� �� W* � On papal rnoa lees elan 6 t? x t I �dYeceon prord dope• bd not Ted a vr" and hWWNdM Mkrm a PON IMF a.cr La 0104034-40.000 saee «daMIMMLL. Ilarel e"ow, en0 baMc� erle dlelwloe d eeereel road ArAporw M 0w Preee pslne as Inl«medm Paea1M Oft "Weon;Revoir beneed kc op e. tacme 10 Plomiroww PnlpelyLceefonw x 014 T 30 N R 16 Efell w James And Mo°oK"1� SWPleperty owner. &4s&V 86 AAerae or CM and L«!963 16M S 250s+ ve.oe ■TowNerMl Randzip Code Phan NLP%W Clq 2501hHammond 54015 > E11°f°b If 3 code d.d.ee deelp,aew rs" 1C NwC«wrJAW Um ReeideltiOl/Nunberofeeboome nwdPYnele`ellonYePdloetl' ~ � RePlamermV ❑Pubes «mnnrrd.l - oaeube: Pelenl aelr�i Laemv D^i► (llrwr t n�mv TIII a.w.l ealelwde end I.oennlydY�an,_ �t�oornn rtd A 9' Sand Fill Mound On Contour 97.90 With 0% Slope 127 OpI41q v..w 1 solrw I r oldew arhu elev. ti Devd+ aen+ne each'—.e� � d^c--- sae eoeeal Rde Fblmon 08ph In. Dallnert Color Mulnee Redo: DeeolpYon Ou. Az Coe. Dolor Tgbn 9. 2L 3h. 6rT CoIMManee aelaldery Hoer OPCYF'R 1 2 3 0-61 5.14 14-M 1 7. 4 None None Nora L L SL brAft 2mebk de ds mfl cs ip 21.2vf 20 2f 1f 8 8 .8 8 8 1.0 4 32-42 71YA14 c2f 7 -"— aw tee SIN Grould a1rMa Wv.97.95 � Depth to �� eol APOCS1106 Rre Fbneon 0@00l In DawrM Color I W~ Rodo. Deeodperl Ou Az OOK Color Teabn sevdM or. aL elt. owwkwme kw drr Reeft 01o'" vw1 I 4M 1 0.4 loyfm None L 2W de ca 1i'm .6 8 2 4-12 I&f&4 None L 2hbk d.gs 2o-2f .e 8 3 12-24 7. None L 2mebk mfr ps 114vf .8 8 4 24-27 7. None 9SL 2mebk mh 98 1v( .8 1.0 5 2740 7. r2d 7. -- —' CST Neew Q%w Ppd) curt BOOS On fallow $42370 Adb.ea 8481 16ft Ave Bbo W. Wi. 54724 Does Evdua&m calduoftd 7131=22 Taboa a }amber 715-933-2443 •Rkw*elaSO0s30s220rnplLWATSS>30SIWM&-ESWR$2aBMs30ROIL MdTSSc3DGV&SB04=St) ■p BerYg A pa Pw o,4 amum wftm w.98.05 a 0� n M aao►2 ►taAmn 1 D�pei K 0.6 Ooidws Cator �nrr.4 1 u. 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CRopccauN 3 ' rvo. 645411 STAT SANaAR� PERMIT r I sn 2sa sr. PREVIOUS NO.NOW OWNER PLUMBER CMALr goo S LIC.# &2S?0 TOWN OFJ SEC_,T N, R_% q AND/OR LOT BLOCK AI, PERMIT 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 ■ 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. (f) 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. ORIZED ISSUING OFFICER - DATE Z UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI1/20)