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HomeMy WebLinkAbout012-1021-30-000Wisconsin 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: Kevin & Beth Kelly City Village Township TOWN OF ERIN PRAIRIE CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MAN CT RER CAPACITY Septic In I La N6 Dosing 3,G, C � 0*0 0 Aeration TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of s DIMENSIONS I It 1 �3 S I SETBACK SYSTEM TO P/L BLDG WELL INFORMATION Typfgf System - DISTRIBUTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 651261 State Plan ID No: Parcel Tax No: 012-1021-30-000 Section/Town/Range/Map No: 08.30.17.110 STATION BS HI FS ELEV. Benchmark ./ Alt. BM Bldg. Sewer 10� SO St/Ht Inlet O I'io;L. St/Ht Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade Cover41 IT l I l• PIT DIMENSIONS INo. Of Pits LAKE/STREAM I LEACHING CHAMBER OR NIT Inside Dia. ILiquid Depth Manufacturer: Model Number: Header/Manifold %Pipe(s) q Distribution 1 16 % k L\ x Hole Size x Hole S a�ng Vent to Air Intake Length Dia Length Dia Spacing 4 SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Onlvj0i./ e.i...w.ln../ Depth Ov Bed/Tr.Opzwl ch Center Depth Over Bed/Trench Edges xx Depth of Topsoil xx Seeded/Sodded Yes ❑ No xx Mulched Yes ❑ No 1 I—N $ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1652 165TH AVE 1.) Alt BM Description =�:Wmv owd •� 2.) Bldg sewer length -?5 1 - amount of cover = Nall Plan revision Required? ❑ Yes ❑4 No Use other side for additional informations. I A q ?3 ikb".OL I �� I ( 46 SBD-6710 (R.3/97) Date nsepctor's Signature Cert. No. 64 PIECE WEED inaustry bervices uivision 4822 Madison Yards Way i-r r (�J N. 0 .1, �r S P �UG 17 Z023 Madison W1 53705 I Sanitary Permit Number (to be filled in by Co.) 7, P.O. Box 7162 Madison, W1 53707-7162 I z 6 I Comm v r ti" *4CD it Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental tinit Project Address (if different 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 Privacy Law, s. 15.04(l)(m), Stats. 1652, 1� S, I. Application Information —Please Print,,All! Information 9 Property Owner's Name Parcel # Property Location Property Ow ePs Mailin7 Address _E Govt. Lot 41� '/4 C i �1, State t- "r Zip Code Phone Number Ca 0 1 , Section 02 T a-50 N R or Subdivision Name .11. Type of Building (check all that apply) Lot # or 2 Family Dwelling - Number of Bedrooms tI Ubl ic/Cominercial - Describe Use P"1,000, Block # 0"W"Wo ft0% E]City of ❑State Ow`iied -Describe Use - Village of Village CSM Nun er AJC- 2 ?Z_b 00*:?­ 0 no f 4g�7�- Ed 111. Type of POWTS Permit: (Check either "New" or "Replacement" and other afili;A, ble on line Check one box on line B. Complete line C it applicab s System Replacement System Elother Modification to Existing System (explain) [:]Additional Pretreatment Unit (explain) ystem El B. F�Holdlng Tank []In -Ground Evt-Grade Mound ->24 Individual Site Design Other Type (explain) (conventional) C. E] Renewal Before Revision lahange of Plumber 1'ransfer to New Owner List Previous Permit NU111hCr anti Date Issued I Expiration N,0 IV. Dispersal/Treatment Area and Tank Information: 9' mp", 00 A 0 Design Flow (gpd) Design Soil Application Rate(gpd/so Dispersal Area Required (so Dispersal A e Proposed (so System E vation 4 -5-le V 0 9 Cl Capacity in Total # of Manufacturer 4-J Tank Informati011 Gallons Gallons Units �/�,� C- 0 U CIQ New Tanks Bisting Tanks 0 a. U V) V) Septic or Holding Tank YV (f Dosing Chamber V. Responsibility Stateme ,1, the undersigned, assuniel/onsibility for installation of the POWTS shown on the attached plans. Plumb is Name (Print) Plumber" nature MP/MPRS Number Business Phone Numb r Plumber's Address (Street, City, State, Zip/ode) L/ V1. County/Department Use Only ?� Approved Disapprove Permit Fee Date Issued issuing Agent *. Signature on for Conditions o(A_pprova_L Ir. Pv4+ LUP,%- 2023 — 02q- SYSTEM OWNER. UJ _tekZ Fr0AA_+_. 1. Seplc tank, effluent filter and dispersal cell ace Pe_r�+ Ao"e P,:D� aAs- &.X�Ieoq_ ac 4) A ,, "64 must be serviced / maintained as per b) AU L4A. a64+L,;rK mina gement pIan provided by plumber. 2. All setback requirements must be ma;ntained as per applicable Code / nrdinances,- Atkich to complete plans for the system and submit to the County only on paper not less than 8 1/2 X I I inches in size SBD-6398 (R. 03/21) PROJECT Kevin Kelly System PLOT PLANADDRESS 654 E 11 th St. Auot. B. New Richmond WI 54017 NW 1/4 NE 1 /4 S 8 /T 30 N/R 17 W 'TOWN Erin Prairie COUNTY ST. CROIX SYSTEM ELEVATION 102.5` 7/26/23 2 DAZE BEDROOM CONVENTIONAL All -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND xxx SEPTIC TANK SIZE 840 Gallons LIFT TANK SIZE DOSE TANK SIZE 508Gallon HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 304 # of ChambersNone ik BENCHMARK V.R.P. Top of 3/4" Pipe ASSUME ELEVATION 100) Filter Lifetime Owiw.r�niiiii.nm i n rri.r..r..r�irm.nno•- ..w. au— „„giro BOREHOLE WELL * I.I. R. P. same as benchmark Scale 1"=40' Well is to meet all WDNR Setbacks 102.51 a� .5' 1 1100.5' B.M.* B " 3 Area 15' Below mound is to remain undisturbed Property Line Wisconsin Department of Safety and Professional Services Division of Industry Services 4822 Madison Yards Way PO Box 7302 Madison, WI 53707 August 15, 2023 CUST ID NO.: 226900 SHAUN R BIRD 1432 120TH ST NEW RICHMOND, WI 54017 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/15/2025 MUNICIPALITY: TOWN OF ERIN PRAIRIE ST. CROIX COUNTY SITE: KEVIN KELLY 165TH AVE NEW RICHMOND, WI 54017 NW 1 /4 NE I /4 S8 T30 NA 17W FOR: Design Wastewater Flow Value: 300 Bedrooms: 2 Limiting Factor(s): 26 Inches Maintenance Required: Effluent Filter Phone: 608-266-2112 Web: http://dsps.wi, ov Email: ds s ci)wisconsin. ov Tony Evers, Governor Dan Hereth, Secretary Identification Numbers Plan Review No.: PWTS-082301707-C Application No.: DIS-072333926 Site ID No.: SIT-119362 Please refer to all identification numbers in each col: respondence with the Department. Mound Component Manual - Version 2.1 (May 2022-2027) Pressure Distribution Component Manual - Version 2.1 (May 2022-2027) SITE REOUIREMENTS • A full size 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. A Department electronic stamp and signature shall be on the plans which are used at the job site for construction. The following conditions shall be met during construction or installation and prior to occupancy or use: • 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. • Prior to the construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a '/d-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 unti 1 it dries. • 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. • 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) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacturer's recommendations. 0 Verify property line(s) prior to installation. 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 and Wis. Admin. Code SPS 383.54 1 . • 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 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 manuaI(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. 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 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. The Division does not take responsibility for the design or construction of the reviewed items. Inquiries concerning this correspondence may be made to me at the contact information listed below, or at the address on this letterhead. Sincerely, Kvorol�i pe� ei Katie Petzel Division of industry Services Phone: 608-574-1189 Email: katie.petzel@wisconsin.gov Fee Required: $250.00 Fee Received: $250.00 Balance Due: $0.00 Refund Expected: $0.00 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 07/26/2023 Owner: Kevin Kelly Location: NW1/4 NE1/4 S8 T 30 N,R 17W 165th Ave, Erin Prairie 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 Attachn Shaun Signatt Licensf Page 1 of 9 PROJECT Kevin Kelly System PLOT PLANADDRESS 654 E 11 th St. Aoot. B. New Richmond WI 54017 NW 1/4 NE 1 /4 S 8 /T 30 N/R 17 W TOWN Erin Prairie COUNTY ST. CROIX SYSTEM ELEVATION 102.5` 7/26/23 2 DAZE BEDROOM CONVENTIONAL All -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND xxx SEPTIC TANK SIZE 840 Gallons LIFT TANK SIZE DOSE TANK SIZE 508Gallon HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 304 # of ChambersNone ik BENCHMARK V.R.P. Top of 3/4" Pipe ASSUME ELEVATION 100) Filter Lifetime .��PIIIII.. P. I 11 II.IY.Y..Y..r�lnll..nnni.- �1. OBOREHOLE 0 WELL * I.I. R. P. same as benchmark Mound System Cross Section and Plan View liftMM sw a -a a--w wiw: .w. w�• r -a: ww• .ter aMom .rr. a...a. ■wn, a- .rr rrr ■.. �+ r. �. i i A w i I i i I i i i i I W a a on r fts r a wb ONi r K B L Dimension Feet A ic B Ile3 D -0 F G ,S H I,O I 3.3 is 9. L Z Slope__ 1 = Topsoil _ ASTM C-33 Clean aggregate — 4 in, sch. 40 pvc 0 Ca Material sand fill 'h; 1/2 to 2 %z in. dia. observation pipe �1r�111�ti1���►1r1�1ti�titi�ti11ti11r��.- �1�ti1�r�11�►�1��1ti1��1�1ti~11ti1�~` �►ti1ti��11�11�1ti► �1�.�.... . 1..�111►�111�ti►��1�11►`ti►11ti1r11tititi1111����1�t����ttt�t»��,. Plowed Surface Ft Contour Slope Direction 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 1/4 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 laced overhead by a backhoe. Special care must be used when placing sand of less than one foot p . thickness to minimize compaction of the plowed surface. After the topsoil cap is placed; the entire mound p is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower b inches and secured in place with rebar or a closet flange. 10/071gj Page of 1 Pressure Lateral Layout Two Laterals — End Manifold Man Force Main ` N % 's za orl[j6r OA Distribution Network S ecifleations Lateral Diameter In. Manifold Diameter . In. Orifice Diameter 3Ya6,,,_In• X__( Orifice Spacing) In. L Lateral Length)-�j �p Ft. M Manifold Length) Ft. Force Main Diameter `L\. In. Force Main Len th Ft. 03/05 lgj ded gout g rig 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. Page _9_ of 9 i • i St)ecificatiolls ose alik Cross SectiPrinancon And u m'Perfo p. erank-Mandacturer (A) '1'ank Model Jftmber Total'Fank Capacity Dopth -Filter manufticturel, Filter Model 'Number Minimum Pump Performance Required GPM, I @ _q(; Ft TDB Outlat),Vlanhole Njin. 4" Above Grade With Locking Do -vice. Inlet Maffllole < 0" Below Cn'Ode Scaled Watertight Finished Grade 41111111 pum Manufacturer pump Model Number Alarm Manufacturer Alarm Model Number Switch Type Total -Dynamic Htad (Fr.DH) - Feet-____ Elivation Plead Distal Pressure Network Loss Furce Main Loss ----------------- Total Manhole .Min. 4",Above Grade Securely Mounted Witti Locking Device, Weather-proof Junction Box Vent Min. 12" Disconnect Above Grade EN Means With Vent Cap 14 4►4 I L-O I Outlet Filter 4 :4 inlet Inlet Baffle 1::. "; .... .- ... .. � I t } , t of Owitch Settj'ngs and Reserve Capacity 'rank Volume GPI Dimension; Inches Volume Gal. (reserve) At (alarm) B �30 62 (dose) C (dead) D'. Total .4 0. Weep Hole ?loll Off Elava•timi 1 C 0 lit, 1111►Bottom Ab I pqo X110 D X1 1 evation 4 1, 4" 1 " Ft 11 :4 o I': t' 014 �'o",Y, 1 ) 114 .4 44.'t4 C4 4 1I4%44 A I A A k% A: GENERAL INSTALLATION: The septic/dose tank is bedded mid back filled in accordance with the nianufar,tarer's product approval specifications. Maximum depth of bur'y as spooffied by the manufacturer may not be exceeded without prior 4pproval. Manlwla covers exposed to grade have an offeutive locking device (padlock) installed. Piping at the hilet and'oUtlet is of approved material, cotinected to the tank with watertight fittings, and laid on st,ablc soil to prevent settling Or sagging. The force main is sleeved with 4" Sch. 40 1)VC to bridge the t-,cink QXQaVUticill glad the sleeve 'is scaled watertight. Electrictil service complies with NBC 300 and Comm 16-28, Pageof 02/05 U" 280-SERIES 1/2 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. AI(Models Feature; * Vortex style impeller permittin.g passage of solids Up to Y4" o 416 stainless steel rotor shaft @ Permanently lubricated upper and lower ball bearing * Epoxy powder coat finish * All fasteners - corrosion -resistant stainless steel * 1 1/2" Discharge 9 Stainless steel bottom screen - easily removable * Maximum fluid temperature: 140" F. 280-Series Cord Lengths Model 101 - 251(-2) 351(-3) 501(-5) 280 Standard 0 al Optional Optional 281 Standard Optional Optional Optional 283 Standard Optional Optional N/A 287 Standard Optional_ N/A N/A 10' cord length standard on all models. For optional lengths, add "-2,-3 or -5" suffix to model number. Example: for model 280 with 35' cord, order 280-3 Motor Specifications 1/2 hp 60 Hz 3450 RPM Oil filled, thermally protected (PSC) Permanent Split Capacitor 8.0 amps (11 5V) 4.0 amps (208/230V) Model 280 Manual, no switch Model 281 Wide angle float switch with quick - disconnect Performance Curve: 280-Series 40r f I i I i - I i - -__r_T_T_f - I J I I I I F.TTI-71 I I 1 -1- 12 35 30 25 LL 15 10 5 11 9 8 3 2 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 U.S. Gallons Per Minute 0 38 78 114 156 192 228 270 Liters Per Minute Dimensional Data: Weight: 29 lbs. Height: 13" Major Width: 10" (model 287) Minimum Sump Diameters: Model 281, 283...14" Model 287 VM F.. .1011 Factory switch Model 281, 283 Model 287 settings VMF Turn on level 1311 9.511 Turn off level 711 4.011 A The Model 283 features a fully adjustable wide-angle float. Differential adjustments can be made easily by tathering the float to the dis- charge pipe or other mounting point. Vertical float model 287 is not adjustable. Model 283 Wide angle float switch with series (piggy -back) plug Model 287 VNIF-Series. Vertical mag- netic float for smaller pits - will operate in a 10" diameter sump Sis CERjIFIED icp C us Certified q Specifications are subjoct to chongo without notico, Liberty PUI77PS 9 7000 Apple Tree Avenue s Bergen, New York 14416,p Phone 800-543-2550 Fax (585) 494-1839 www.libertypLitnps.com Copyright Q L.1horty Pumps, Inc. 2017 All rights reserved. LLIT 2000 R05/17 0 .0 1 Gap between Case and Sepenfine SiECTION A -A )CO 29 50 ti Pep ----_____ of ._ START UP AND OPERATION . check treatr�lent tank(S) for the presence of painting products or other chemicals t � � For new construction, prior to use of the POWTS c;h ersal cells l, may impede the treatment process and/or damage the dlsP (, if high concentrations are detected have the contents of th } P tank(s) removed by a septage servicing operator prior to use. System start u shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal hi hwater levels. When power is restored the excess wastewater will hp close, overloading the cell(s) and may result In the backup or surface discharge of efflueriIt. discharged to the dispersal cell(s) (n one largeg over to tl ,e To avoid this situation have the co ntents of the pump tan removed by a Septage Servicing Operator prior to restoring p r power levees effluent pump or contac t a Plumber or POV'JTS Maintainer to assist in manually operating the pump controls to restore nor within the pump tank. and dis ersal cells. too not drive or park over, or otherwise disturb or compact, the area within Do not drive or park vehicles over tanks P 15 feet down slope of any mound or at -grade soil absorption area. he life of the POW113: the following from the wastewater stream may Improve the performance and prolong t Reduction or ellm�na#ion of � disinfectants', fat; f�oundatian ra n antibiotics; baby wipes; cigarette butts; condotns�; cotton swabs; degreasers; dental floss, diapers; rodue:l s !e peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting P ; (sump pump) water; fruit and vegetable p g 9 . pesticides; sanitary napkins, tampons, and water softener brine. ABANDONMENT When the POWTS falls and/or is ermanentl taken out of service the following steps shall be taka:�� to Insure that the system is propF:l �1 P and safely abandoned In compliance with chapter Coma► 83.33, Wisconsin Administrative Code: Ail 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 properly disposed of by a Septage Servicing Operator. After pumping, all tanks and pi ts shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN d cannot be aired the following measures have been, or must ho taken, to provide a code compililint If the POWTS falls an rep replacement system:. replacement area has been evsiriated and may be utilized for the location of a replacement soil absorption systom. 0 A suitable re p area should be rotected from disturbance and compaction and should not be infringed upon by requtrled The replacement p setbacks from existing an proposed osed structure, lot lines and wells. Failure to protect the replacement area will result In the need p for a new soil and site evaluation to establish a suitable replacement area, 'replacement systems must comply with the VE.',(i in effect at that time, El A suitable replacement area Is not available due to setback and/or soil limitations. Barring advances In POVVTS technolo(jl( a holding tank may be Installed as a last resort to replace the failed POVVTS. The site has not been evaluated .to identify a suitable replacement area. Upon f'aiiure of the POVVTS a soil and site evaluailion must be performed to locate a suitable replacement area. if no replacement area is available a holding lank may be installed) as a last resort to replace the failed POWTS. at -grade soil absor tiotl systems may be reconstructed in place following removal of the biomat at the Inflitraive Mound and at- g p surface, reconstructions of such systems must comply with the rules In effect at that tirno. «WARNING>> SEPTIC PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN, DO NJOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES, DEATH MAY RESULT. RESCUE ca = A PERSON FROM THE INTERIOR OF A TANK MAY 13E DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name ) hi�A� Phone POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR PUMPER_ LOCAL, REGULATORY AOTHORITY Name T M Nari7 e .X » � _� _. __..__�-___.._. �..,. Phone Phon© Tl is document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(0 and 383.54(l), (2) & (3), Wisconsin Administrative Code. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _. of FILE INFORMATION Owner Permit # )ESIGN PARAMETERS Number of Bedrooms 0 NA Number of Public Facility Units XjNA Estimated flow (average) gal/day I Design flow (peak), (Estimated x 1.5) gal/day Soil Application Rate gal/da Y/ft2 Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (80D,5) s220 mg/L El NA Total Suspended Solids (TSS) Sl 50 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD5) �30 mg/L Total Suspended Solids (TSS) :530 rng/L ANA Fecal Coliform (geometric mean) �j 04 CfU/1 00MI Waximum Effluent Particle Size in dia, 0 NA '10ther: 0 NA *Values typical for domestic wastewatel, and septic tank effluent. MAINTENANCE SCHEDULE Service Event linspect condition of tank(s) 1Pump out contents of tank(s) lInspect dispersal cell(s) I."/lean effluent filter Inspect pump, pump controls & alarm 1::Iush laterals and pressure test lather: ether: SYSTEM SPECIFICATIONS Septic Tank Capacity �qo al a NA Septic Tank Manufacturer �j I M f El NA Effluent Filter Manufacturer 0 NA Effluent Filter Model 0 NA Pump Tank Capacity 9 - al 0 NA Pump Tank Manufacturer 0 NA Pump Manufacturer 0 NA Pump Model 0 NA Pretreatment Unit NA 0 Sand/Gravel Filter ® Peat Filter 11 Mechanical Aeration 0 Wetland EJ Disinfection Cl Other: Dispersal Cell(s) 0 NA 0 In -Ground (gravity) El In -Ground (pressurized) 0 At -Grade -4mound 0 Drip -Line 0 Other: Other: 13 NA Other: El NA Other: C1 NA Service Frequency At least once 3- every: El month(s) V�year(sy (Maximum 3 years) 0 NA When combined sludge and scum equals one-third (X) of tank volume © NA At least once every: 0 month(s) (Maximum 3 ears13 NA �year(s) y) At least once every-, 0 month(s) Vyears) At least once every: month(s) ears At least once every: 0 month(s) 11 year(s) At least once every: 0 month(s) 0 year(s) 0 NA El NA 11 NA 0 NA EJ NA MAINTENANCE INSTRUCTIONS !Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following Ilcenses or certifications: Master (Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator, Tank inspections must linclude a visual inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure the Volume of i.-.ombined 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 I-egulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (X) or more of the tank volume, the entire contents of j-he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. NI other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, lind any servicing at intervals of :512 months, shall be performed by a certified P0VVTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. 10fq File #: ST. CRb.': w �. TY, SANITARY SYSTEM office use Only OWNERSHIP/ADDRESS FORM Created2/2021 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 ProQerty Files Scanned weblink. l- OWN'E- ABUYER `I N F0Rf1 ' .' ' 'O`N. Owner/Buyer Mailing Address City/State/Zip Phone Number (required) Email Address (required) 011-7 -4. Parcel Identification Number 01*_� I L/O'*- I —j Lr= Z (found on the property tax bill) NE V SYSTEM. L CAS: I .SCRIP '1O.N / PropertyLocate V114 �I4 ,Sec. T dN W Town of //�_..� Subdivision Plat: , Lot # Certified SurveyMa #D 3 p ,Volume Pa e # 3 . g _ Warranty Deed #_ `(before 2006 Volume Page # Number of bedrooms Spec house 13 ye no Lot lines identifiable es 0 no o.:tc .aus°E� ��N�.Y N52, (obew Property Address �� (Staff Initials) (Ver' i ation of new address required from Community Development Department for new construction.) 2�5 Z� (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 wrap 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 ,dd2sccwi. v 1101 Carmichael Road, Hudson, WI 54016 wmsccw� Gov Document Number State Bar of Wisconsin Form 3-2003 QUIT CLAIM DEED Document Name THIS DEED, made between Beth L. Kelly, a married person, ("Grantor," whether one or more), and Kevin J. Kelly and Beth L. Kelly, husband and wife as survivorship marital property, ("Grantee," whether one or more). Grantor quit claims to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Located in part of the NW 1/4 of the NE 1/4, SW 1/4 of the NE %4 and SE 1/4 of the NE %4, all in Section 8, Township 30 North, Range 17 West, Town of Erin Prairie, St. Croix County, Wisconsin, being Lot 1 of Certified Survey Map recorded September 26, 1997, in Volume 12 at page 3354 as Document No. 565930. r Together with an easement for ingress and egress, ---to Lot 1 as described above, said easement as described in Vol. 896, page 105 of Deeds. Dated May 19, 2022 AUTHENTICATION Signature(s) authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: L h B R L Offs LLC SEAL)_ SEAL)_ 1154818 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 06/ 20/ 2022 12:35 PM EXEMPT#: SM REC FEE 30.00 PAGES: 1 **The above recording information verifies that this document has been electronically recorded & returned to the submitter Recording Area Name and Return Address Leah E. Boeve Remington Law Offices, LLC 126 S. Knowles Avenue New Richmond, WI 54017 012-1021 -30-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) ACKNOWLEDGMENT STATE OF WISCONSIN } )Ss. ST. CROIX COUNTY } (SEAL) (SEAL) Personally came before me on the above -named Beth L. Kelly to me known to be the person(s) who executed the *�... �•,�, ins ent and acknowle ed the same. ,,.•......, ''�•, ��� �10 ea E. oeve emvn on aw ces qsA- - r r l' �11 :� *C.OtIF 1 0 go 126 South Knowles Ave., New Richmond, WI 54017 Nota Public State of Wisebnsin M Commission expires: P8���' Z Y p � ti (Signatures may be authenticated or acknowledged. Both are not necessary.) �'�,� %•'•••......••'' G NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIL+, ���w`� QUIT CLAIM DEED C 2003 STATE BAR OF WISCONSIN FORM lr��!Q� �►s�► * Type name below signatures. St. Croix County 1154818 Page 1 of 1 -� "� MAY 0 3 2023 � � (2,7 A%tLaoh =mpietf. site ;>ian cc Pape!, -iv, iess tear, 6 x inz�,es if- st,,Ze. Pian nus, in�ude, b€,ff no: fi.-nited tc - ve ti: al and nonzanta,i rvferenoe Domt ;ISVI, direction and RPa Percent slope, scaie or dimensions, notrt. arro*, an location and' distance tc newesi road. )� Please print all informatior. Revie tv oat Flefsom& intormatior, vck: orovioe rriev be uses fcx E, an urposes Pnvacy L-8%4: u E.04 Govt. Lot ` � � B b A&4..l A AAr i L? E Prapeft-,,° 0*-* s Walfi-t- 7,+1,-14 f Lot Block subd. NaTw or CSN# t Zip, Code P-crirz Ahjn r �Ikage Owrl �/Nearest Road cuMate- t < .377. Z 7 Code denved design how rate Ei R e P a n i PubliC. x oxnrnel-,-�a- Desvibe- P'are rft c i cioo,-i Pima, eievabor, ff applicabie f and Amer tiaras: Svstem, Type Svster,,,-, Eleva-tion. Iv pit Ground surface eie�,, ft. Depth to limiting factor Soil Applicabor. Rate Dep4h in. Re Dorn; nt O�on jox Descripbon 0;.: Sz. Cont C-Na I "'extxe Stucture G%,. S; Sh Consistence Boundary' l Roots *Eff#1 *E f f 121 Z- Oudi /-Z- yI^- 'rg Boeing It "0' Pit Ground surr*a,,-,-c eiev. ft. Depth to limiting factor I Soit' Apofic;ation Rate Horizon Depth in. irant Coio- Munsell Redox Desaription Ou. Sz. Cont. C.Nor Texture Structire i, i Gr. Sz. Sh, Consistence Boundary' Roots G ff 4� k.) Eft -.mot #1 = BOO, > 30 < 22f, mt:OL an 7SS >Y0 & * Effluent #2 = BOD. < 30 r-�gfL and TSS < 30 mgr"L CST Name (Please Print) tu re CST Number Bird Plumbing, 'Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number ,11LOO, . .... .... 1432 120th St, New Richmond. Vv"I 5 715-246-4516 .ew Property Ovmer Parcel ID # Page ?Z,"- of , Bonn # E Boring -1 Pit Ground surface eiev//-"�j ft. Depth to limiting factor Z' in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ff Eff# 1 2 Eff#2 /01 1)4 o" '40i Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil ADDiication Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ff *Eff#1 *Eff$* Bohng # [] Boring Ground surface elev. ft. Depth to limiting factor in. 0 pit I Soil Annfination Rate Horizon ')epth in. Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Gr- Sz. Sh. Consistence Boundary Roots GPD/ff *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5.< 30 nxYL and TSS < 30 nxYL 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-83.30 (R.6/00) .% qWW rt Soil Test Plot Pl Pig-,oject Name Kevin Kelly Address 654 E 11 th St. Appt. B New Richmond, WI 54017 C Bird 'TM #226900 Lot I Subdivision V01. 12 Fg. ��54 D&e Wd/zd N W 1/4 NE 1/4S 8 T 30 N/R1 7 W Township Erin Prairie Boring G) Well PL Property Line County ST. CROIX BN1 or VIP' Assume Elevation 100 ft. Top of 3/4" Pipe System Elevation TBID * H R pSame as Benchmark Scale = 1/4" - 10' iytsco,n,,wn Depe.trient of Cornmciroc- SOIL EVALUATION REPORT Page - of Divisiori of Sats�, 8nd Buildii-)0s jr, v&� Comm Vklis. Adm. Cci�e %.11 C0^1 i,ttac, C*Mplate site purl or, papcst not lesc. than 6 )12 x 11 Inches in size. Plan must - lnc:lude, bVt no'. 1i.mJt&d ic- vetcal and honzonts-! referen--* pint (Sty/), direction and Parma' I D. t7UZ) peq�arjt slope, sc216 or dimensions, nortin. arrow, ;end10c;at'jor and distance tc nearest road. 0/�-- LO)- 22 Q� Date Reviewed by p;ease print an Inform tio , Pemonsi intownstlon you P,,0066 ryie), be utt-6 for 66-oNoaf)- purpzrs&i; (Pfivzacy Lvv,, 1, lt,04 (1) (M)). pmPert), Owner Fro pert , Location 114/�r--�,14 S- 9 T N R GnM. Lot Lot Bloc�, # Scud, Nanv 0,11 M4 PM Owner's Ma Addr C3 Village- '�ZjTown �7f4ewes( Road State Zip Code L7 C�y 11UA L2�Ll.z�,,-�2LS-�3 zg- 7 CCnSVVb)n Us 67 Residential 1 NUM Of bedrooMF�Code derived design fjow rate P D Public Or Parent Material Fbod Plain elevation ff applicable fi G,enwsi 00Mnents and ro=mrr*rKizUa-w system Type Systern Elevation Boring pit Ground surface elev. ft Hortm Depth Dominant CNor Risdw: Descnpvon I in. Qu. Sz. Cart. C.-Nix 1 0 - L7 ------ 2L 7-- Bodnq #Boring Y Z/ 0 Pit Ground surface elev.; 1, Effluent #1 a BOO,'> 335 220 M21 &na 1, >JU < I 211 Depth to lirnibng factor C� Soil Application Rate Twtire Stricture consistenoe gOundary Roots GPDff Gr, Sz. Sh. Eff#1 'Eff#2 C)rr,r, Y I T, Depth to limiting tactor C)- t in. , I:ffii iAnt � r. SOD- < 30 rWL and TSS -< 30 a-191 Property Oymer Parcel ID # Page — of Boring # Boring factor In. Pit Ground surface ele4�11 ft. Depth to limiting 11 licafion Rate Horizon Depth Dominant Color Redox Desctiptlon Texture Structure— Consistence Boundary Roots GPD/ff in. Munsell tau. Sz. Cont, Color Gr, Sz. S11. *Eff#1 *E"2 lot 24-41 �� 1,0W '0 Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor In. Soil LElication Rate Horizon Depth I Dominant Colorl Redox Description Texture Structure Consistence Boundary Roots GPDff I OEff#1 Eff#2 in. Munsell Qu. Sz, Cont, Color I I Gr, Sz. Sh Boring Bodng # Ground surface elev. ft. Depth to limiting factor In. pit I —Soil Application Rate Horizon ')epth Dominant Color Redox Desaipdon. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell flu. Sz. Cont, Color Gr. Sz, Sh. *Eff#1 Eff#2 I Effluent 01 = BOD6 > 30 < 220 n,4L and TSS >30 < 150 m9k * Effluent #2 = BOD,:S 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, SOD-8330 (RAM) Project Name Kevin Kelly Address 654 E 11 th St. Appt. B New Richmond, WI 54017 - ------- - -- - . . Lot 1 Subdivision Vol. 12 Pg. 3354 NW 1/4 NE 1/4S $ T 30 N/1317 W Boring Q Well PL Property Dine LBMorUp Assume Elevation 100ft System Elevation TBD Scale = 1/4" = 10' Soil Test Plot Plan Shaun Bird CSTM #226900 Date 5/3/23 Township Erin Prairie County ST. CROIX Top of 3/4" Pipe *HRPSame as Benchmark IFILIED SEP 2 6 1997 �► jj.ate H Registerot S. Cloix CO.. 561593 0 A I NIA Corner of Section one CERTIFIED SURVEY MAP CD Located in part of the NW1/4 of the NEI/4 SWI/4 of the NEI/4 and SE1/4 of the NEI/4, all in 0 T­ Section 8, CD T30Nr R17W. Town of Erin Pralrie, St. Croix County, Wisconsin. SCALE IN FEET 200 100 0 1-100 Bearings are referenced to thecNorth- South Quarter line of Section 8 assumed to bear 501042117"W. E Prepared For: Pat MeNumara I 1351 Griffin Ave. ZE: '_r Mahtomedi-, MN 55115 I F_ Owner: Culver Anderson P.O. Box 3 F I ME: New Richmond W1 54017 G RIVER ELEVATION ON 1/27/97 97.4 o < NW1/4 - NE1/4 SW1/4 - NEl/4\\ RIVER L W e < > LOT I Area to Meander line: 758,880 Sq. Ft. (17.4 Ln Ln H Q) 0 CID cv 0 1017.22' r.6.061 951..16t N89v11 14211E 1975.501 L-South line of the N1/2 of the NEI A UNPLATTF--n LANDS CD1 0--Iiii ------- sue! LL-1 C/')l CxDl "--,I U-11 C—) I & Found Aluminum County Monument LLJ I � I P-i Found 211 1 ron Pipe 0 C--> Lij I LJLJ I C-31 LLJ C/:> Found 111 iron Pipe rn CLJ Set 110 x 2411 Iron Pipe weighing LLJ i :---I 1.68 Pounds per linear foot. LLJ I Shoreline of Willow River r7_)l C,/'D I CD-) I —1 C/D I C)o I Centerline of Main Channel of River oI oCl -� - - - - 75 foot Building Setback from River I QVD I I I C> V> C_o I � I C-Z) I See Curve Data Table (0 165TH AVE, S1/4 Corner of Section 8 SHEET IL OF 2 SHEETS Vol .12 Page 3354 N i. 0 Q ao E o7r .9 — P x X,0-6 "I-- C- 11 p-jr - -�l � 1'� -- ---- -- ----- -27 'd ? i - -3N I -)-J- 1 vs 04 Go'd -9 N A f - — ---- - - - - - ------- . . ...... lr,cw C�l I I . lc �,�JL 1,oco � " � <� - ( s---3 & A.-7 - - -------- Lj i a ,LH 4 '--`I . Y '..--- � 71 .i � I I F-H - - -------------------- ii i 1! ��.', M UL-- d:7 4 <j r-LLS : b —J-rl.7-3�Cj UUUNTY 4'"" 454 ilo5 11 XQ _V1 a" r,YL 1; ►J X/ft-rarm OWNER 4-evir').0 �� ��'LL oil AV L 1 Uff-'r M I E' 5h R GilF L,-#VW L tA/u P W N F woo ................ ...... .................. ... .... . ....... .. . NO. .................. BSI 7 � I ...... . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fri 46 Aftie,. MAI NO:: Ir "V"I q0j' U 226 b o „F6>c 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. f c The sanitary permit is valid and may be renewedor a s � � Y ]P Y 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. (f) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: 1f you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. 1 IWWI . _ ini- THIS PERMIT EXPIRES �f L �/ 2Dzs' ..... ..... ........ . . ... VISI FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION � L �n5 VA SBD-06499 (R.�d,P—`m23 � D2,',fo ore vh l 1