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HomeMy WebLinkAbout042-1076-90-150 Wisconsiri Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division ' INSPECTION REPORT Sanitary Permit No: 538780 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Parcel Tax No: Permit Holder's Name: City Village X Township Ri wald, Walter Warren, Town of 042-1076-90-150 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No / 0 c 6 161, TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic r -n Benchmark 3 1 mv ~j Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent Intake ROAD Dt Inlet Septic Dt Bottom Dosing eader an D ` q J- 'YL yl d Aeration Dist. Pip ~4r' lf<'S- Z.$ 100,93 Holding Bot. System 5 h _ 3 D0, PUMP/S HON INFORMATION Final Grade / YV!'w tvW Manufacturers ^ C errand St Cover 1-4 GPM Model Number ~U D Sf oil TDH Lift Frictio oss stem Head TDH Ft Q, S Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM Af BED/TRENCH Width Length j No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Di Liquid Depth h DIMENSIONS SETBACK SYSTEM TO P/L BLDG ELL LAKE/STREAM LEACHING Manufacturer: INFORMATION V~CHAM R Tye f S 6,2 ystem 0 t UNIT Model Number: Sa DISTRIBU N SYSTEM Se__ - 9,64- irSQe d-~ Head /Manifo d Distribution Hole Size x Hole Spacing Vent to Air Intake Length Dia „ Length Dia Spacing 'f Yb /t SOIL COVER x Pressure Systems Only xx Mound r At-Grade Systems Only Depth Over Depth Over xx Depth of / xx Seeded/Sodd d xx Mulched Bedrrrench Center Bed/Trench Edges Topsoil D s " 71 No Yes ]N,, COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: & /,7 Inspection #2: / _ Location: 743 112th Street (Twin Lakes) Roberts, WI 54023 (Gov't Lot 1 28 T29N R1 8W) NA Lot 1(( Parcel No: 28.29.18 437A10 1.) Alt BM Description = q 1~0 2.) Bldg sewer length - amount of cover Plan revision Required? Yes /No 0 Use other side for additional information. Date Insepctor's Si a e Cert. No SBD-6710 (R.3/97) commerce.wi.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ;VL. i sco n S I h Madison, WI X01 1 Sanitary Permit Number (to be filled in by Co.) Department of Commerce P g' 790 It . 53 Sanitary Permit App1i W* State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the late go ernmental 7 Nu U '7(po unit is required prior to obtaining a sanitary permit. Note: Application for ned P WTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information YIU used for ondary u ses in accordance with the Privacy Law, s. 15.04 1 m , Sta v 7- z/_3 /D / f 1. Application Information - Please Print A formati n Prop e y-Own r' Name 1 / PA Parcel # 21 J L rMY J - , ~ ~~v? _ j e Property Owner's Mailin/g Addr Y GR ~N Property Location ( U 3 /Cg 2 \ LP Govt. Lot City, ate t Zip Code Phone Number /t/ , , r vv Section oo circle one v T~N; R E 11. Type of Building (check all that apply) Lot # I or 2 Family Dwelling -Number of Bedroom Subdivision Name Block e Public/Commercial - Describe Use Tat..., ❑ City of ❑ State Owned - Describy Use CSM Number ❑ Village of 56 O J ❑ Town of i4 - 17 .r 2AJ~ 6c~ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. 0 New System ~~rr ,i.Replacement System ❑ Treatment/Holding Tank Replacement Only Othe Modification to xisting tern (explain) lcC Z° i ~l~' B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New rous ermt Before Expiration Owner l IV. Type of POWTS System/Component/Device: Check all that apply) d ❑ Pressurized In-Ground ❑ At-Grade JW Mound > 24 in of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treat nt Area Information: d t Design Flow mvi~ Design Soil App ation Rate( 96.;f) Dispersal Area Requi Dispersal Area Propo sf) System Elevation VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units 2 o v o New Tanks Existing Tanks Septic or Holding Tank Wie--sw ?r, Dosing Chamber ( It VII. Responsibility Statement t, the undersigned, a me responsibility for installation of the POWTS shown ttached plans. Plum is Name (Print) Plu %rSignaature MP/ Business Phone Number AAA MRR , 'D k~0~ 1 7) 7W Plumber's Address (Street, Cit Slate, Zip Code) Jf 4 , t Uhl f,/`J,I 116) 4W VIII oun /De artment Use Only L 17 -11 Approved It7.7ven Permit FeeDate Is ed Issuing t Signature 6131 1/1 Reason for ial $ Sa IX. Cond. -M i as ms for Disapproval 1. Septic tank, efflubnt fiftor and -dispersal cell must all be services / maintained as per management plan provided by plumber, 2 /Alltbactt requ(Cements ntust.be maintaltted / ctdirlartces: low" Attach to complete plans for the system and submit to the County only on paper not less than gin x l l inches in size SBD-6398 (R. 02/09) Valid thru 02/11 ~a o 4 M Safety and Buildings commerce.wi.gov PO BOX 7162 MADISON WI 53707-7162 i Contact Through Relay s co n s i n www•commerce.wi.gov/sb/ Department of Commerce J©1 www•wisconsin.gov GUV~~pkF~G~ Scott Walker, Governor Paul F. Jadin, Secretary May 16, 2011 CUST ID No. 220673 ATTN: POWTS Inspector CHARLES L WEBSTER ZONING OFFICE WEBSTER SOIL TESTING & DESIGN ST CROIX COUNTY SPIA N5815 770TH ST 1101 CARMICHAEL RD ELLSWORTH WI 54011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/16/2013 Identification Numbers SITE: Transaction ID No. 1938960 Walter Rigwald - Dwelling Site ID No. 767155 743 112TH St Please refer to both identification numbers, Town of Warren, 54023 above, in all comes ondence with the agency, St Croix County NW1/4, SW1/4, S28, T29N, R18W FOR: Description: Mound Object Type: POWTS Component Manual Regulated Object ID No.: 1314705 Maintenance required; Replacement system; 450 GPD Flow rate; 26 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD-10691-P (N.01101), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01/01); Effluent Filter 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 the•-• component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. P No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, CPI,l 1 stats. lei A copy of the approved plans, specifications and this letter shall be on-site during construction and open to D€ AP ; qFc Drys, inspection by authorized representatives of the Department, which may include local inspectors. All permits SAI required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. Si CCE In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. CHARLES L WEBSTER Page 2 5/16/2011 ieterE Fee Requ ired $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 agel Private Sewage Plan RJewer , Integrated Services WiSMART coder 7633 (608)266-2889, M - F, 0600 - 1430 Hrs pete.pagel@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828-5902, Monday, 7:00 A.M. To 3:30 P.M. Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. "Construction business" means a trade that installs, alters or repairs any building element, component, material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the delivery of building supplies or materials, or the manufacture of a building product not on the building site. For further information, go to our website: www.commerce.wi.gov/SB/SB-BuildingContractorProgram.html Webster Soil Testing & Sewer System Design Charlie Webster, Owner _ N5815 770th Street' Ellsworth, WI 54011 W1 Licenses: MP220673, ST220673, PEI 8803 Telephoni(715) 273-3430 POWTS Index Sheet Page 1 of 9 Mound System for a 3 Bedroom Residence Property Owner/Project: Walter Rigwald NW1/4 SW1/4 S28, T29N, R18W 743 112th St Town of Warren, St Croix County Parcel 1. D. 042-1076-90-150 Page 1 Of 9 Index Sheet Page 2 of 9 Situation Report & Construction Considerations Page 3 of 8 Plot Plan Page 4 of 9 Distribution Pipe Layout Page 5 of 9 Distribution Pipe Layout Page 6 of 9 Pump Chamber Layout Page 7 of 9 Pump Performance Curve Page 8&9 of 9 Management Plan ``~rrrrrrurrr~i q 0 -IV ZZ, It CHARLES L - WEBSTER E-18803 LC • ~~v~ W p i ELLSWORTH WIS. ~.w se , o; r ry.~ /'0 A' t'Dc CF Component Manual Used: Name: Mound Component Manual for POWTS Version: 2.0 S13D-10691-P Dated: January 30, 2001 Name: Pressure Distribution Manual for POWTS Version: 2.0 SBD-10706-P Dated: January 20, 2001 REPLACEMENT MOUND SEWER PLAN FOR WALTER RIGWALD PG OF 9 WARREN TWNP - ST CROIX COUNTY SITUATION REPORT This system was installed in 1991 and was initially designed for a three bedroom home. The original soil test and the original plan are not on file at the county. The county does have a copy of the original DILHR approval letter. The original plan was reviewed and approved by Gerald Swim. The house was constructed in 1991. The system has formed a biomat at the interface of the dispersal cell and sand lift, which is the reason for this replacement. The existing system has a 12 inch sand lift, which was code minimum at the time of installation. Per the new soil test done on April 29, 2011, 10 inches of sand lift would be sufficient. This plan keeps the system elevation at 12 inches above the contour, allowing for a two inch "cushion" above current code minimum. Elevation measurements taken in several spots on the existing system show the system elevation to be 100.4 ft. The installation contour at the upper side of the distribution cell is 99.4 ft. There are two distribution laterals in this system which are I '/z inch in diameter. The top of the distribution pipe are at elevations ranging from 100.35 to 100.45 ft. The existing dispersal cell measures about 7.5 ft. by 50 ft., which would provide 375 sq. ft. of dispersal area. This would have been the minimum dispersal area required for a three bedroom home at the time of installation. This design proposes to keep the dispersal cell at 50 ft. long and to widen the cell to 9 ft. This would provide for 450 sq_ ft. of dispersal cell area as required under current code. Per inspection of the existing system, the sand lift extends at least 15 ft. below the existing dispersal cell (the "I" dimension shown is the system cross section). Because we have 12 inches of sand lift, the maximum soil infiltrative rate allowable is 0.8 gpd per sq. & of basil area. With a 9 ft. wide dispersal cell (50 ft. long), this would mean that an I factor as small as 2.25 ft would be allowable. This design shows an I dimension of 10 ft. It is recommended that the reconstruction use the same width as the existing mound, which will be more readily measurable during construction. An I dimension of less than 10 ft., but greater than 3 ft. would be acceptable. The pump in the existing pump chamber is a Gould Model 3885 WE05HH. This pump is less than 6 months old, and can continue to be used. The design allows for a smaller pump, a Gould EP05 to be used as a replacement should it be necessary to replace a pump at a future date. CONSTRUCTION CONSIDERATIONS Note from the contours on the sketch that the surface drainage is to the southeast of the system and southward and away from the well. A filter needs to be installed on this system. The plan calls for a Simtech STF 100 to be added to the existing pump. Remove excess/overgrown vegetation from mound, mow and remove clippings. Pump out any standing wastewater through observation pipes. Permit dispersal area to dry out. Pump out septic and dose tanks. Remove and stockpile topsoil from mound system. Remove aggregate from absorption area and dispose of in approved manner. It cannot be reused. Remove distribution pipes and observation pipes. Dispose of properly. Remove clogged sand plus an additional 3 inches of clean sand and dispose of properly. This sand cannot be reused. Inspect remaining sand for particle size to see if it meets ASTM Specification C-33. Install replacement mound system using procedure outlined in the approved mound component manual. ATTACHMENTS New soil test report. Copy of the approval letter for the original system. A copy of an email sent to and response from Leroy Jansky, On Site Waste Specialist for the State of Wisc., with respect to the missing information on this site. A copy of the St. Croix County "Detail Sanitary Information" sheet. 4~ y CL L' Ilt 04 -0 4", lu NA $ . s 4 e w * le M z' rJ"' Page 4.Of /~/d 1/ic'w CYV9•J sec tfgy1 . Approved synthetic covering FrSTM C- 33 Distribution Pipe Medium Sand Topsoil F Elev /00- G 3 E b crH rn~ % Slope t/= 9 q 1` R Bed Of 2 %2 Force Mbin Plowed Aggregate From Pump Layer (s~~. p~;ocdcr~./ P" a I te, »d tc ~~YO~ D l~ o Ft. rh. Jiq) f Ft. E Cross Section Of A Mound System Using A Bed For The Absorption Area G ~-S Ft. G C7. S Ft. A Ft. H /.O Ft. Linear Loading Rate= 7-OGPD/LN FT B &-C? Ft. Design Loading Rate~=1097GPD/SQ FT j Ft. / J Ft. See no-ta 0'Y See n~fes eh P Per7'oe;K~+~~ 7`O . ol. .Z- d, Aieol ri ©h K Q Ft . L Ft. w 26 Ft. E1` e0bservation Pipe ; rloce - s 1 O W..=-'-- - - ~ - 4,4.s Distribution Bed Of 2 2 2 l 3-to Pipe llteh•+ fS~ Aggregate Observation Pipe Ac«rs,8c~c u.•ti iaTi>> rn - u ~ Oh I ~ (Anchbr securely) ('s~c/"~P~ det a~Jl s~tc) J~` C~brt~ y,~',eo., ~v,,P~. r-o /Z~(/e /►"'~:wr4wt 4id~..~7~'~ o r' ~itiches ~t PI-vy~~~a~ wi 7-~+ .t w.In•,. t,~, ~•f cd~:+~ hJ(~c r11G b.~'-i~», ~iitc~i~ s/R ~2 0l ~ ~ C. c/ P/q /-~~r, a✓a. / Qj Page Of - - Perforated Pipe Oetoli n End -Vie- Perforated PVC Pipe I I J as,~ Holes Located On Bottom, 5-"e Are Equally Spoced t~ s fi rt r 1 ~ ~ Distrtiiutip+ Pile de't'd,~ Ll P Ft. Distribution Pipe Layout $ 3 Ft. J9, ti . rn k c~, u. 4 a c.c C9_ 6 6"~f, Q 2, S-pf_ X 40 Inches rj = I SYO- - 6 ,z .2 7 a, Y 4 o~ Inches Hole Diameter 76 Inch Lateral Inch(es) Manifold o - Inches Force Main Inches # of holes/pipe ~o~ceesr b.x /00_ Q *b.~4 Aot pA Invert Elevation of Laterals Ft. bra( eh a( Place 1st hole -~Cleode--~ A,.a„ e..J,~d;:fi;L~tiw►cel~ with succeeding holes at 40iPcl{intervals. au 1 Ol /~7 l4 k J°c~r q I fcf t tlop Ova ~CY PAG F l G F PUMP CHAMBER CROSS SECTIOU AND SPECIFICATIONS RIP lh -tole VENT CAP oIFYM~«~.t6 G.ovcrfo p.rv+°~dccess y,. C. Z. 0hegf~0 P/dJtTC 1Ett~% a WEATHERPROOF APPROVED LOCKING >-1OFr FRO JUNCTION BOX MAWHOLE COVER -M DOOR, WftJDOW OR FRESH IZ'mlU. .Th1'7`,~/G)J~/S/MJFf AIR INTAKE I ( TF~{ bv~rr,oCe~ 91~- D GRADE I /YuInFL S j~ !o o I 4' MI►J. COWDUIT WAIN. I x t.~ 93=3 IAILET PROVIDE I . AIRTIGHT SEAL ~I I I * A i~ ALARM w lNo ~ B A. At eef C *APPROVED 0tc JOINTS WITH ELEV. FT. APPROVED PIPE I _ 3' ONTO PUMP J o SOLID SOIL OFFD 70- CONCRETE BLOCK RISER EXIT PERMITTED OWLy IF TANK MANUFACTURER HAS SUCH APPROVAL S Cfp t,c .r loo oga, / by - G~✓e,sc~ C'o•.c~c*~ SPEGIFI*CATIOUS 62=1r - _ /X.. C-fSJ.r 7_ 3q~,p/ DOSE TAUKS MANUFACTURER: u/~,sl'~ car cN~~ IJUMBER OF DOSES: PER DAy TANK SIZE : 7s © GALLOIJS DOSE VOLUME ALARM MANUFACTURER: cL,1- 7 INCLUDING SACKFLOW: -.GALLONS MODEL QI.114ER: CAPACITIES: A=~`f WCHES OR z GALLONS SWITCH TYPE: B = IMCHES OR _ GALLO~JS PUMP MANUFACTURER: Cs INCHES OR (71 GALLONS MODEL IJUMBER:3~-E WfOul / Ds~INCHES OR. GALLONS SWITCH TYPE: 5Y-Q! MOTE: PUMP AMD ALARM ARE TO BE MINIMUM DISCHARGE RATE 7 GPM //INSTALLED ON SEPARATE CIRCUITS VERTICAL. DIFFERENCE DETWEEN PUMP OFF AND DISTRIBUTION PIPE.. FEET + MINSUILIM NETWORK SUPPLY PRESSURE ' ate FEET Cl3o~ / Ty- 14- + FEET OF FORCE MAIN X J F0110CFLFRICTION FACTOR. per' FEET TOTAL OtlWAMIC, HEAD FEET c4 !,t,vcry vs~2~e fps 3 `i I)JTERNAL DIMEUSIONG OF TAIJK: 'FH ;t~tt&" ;LIQUID DEPTH ,we es -Lh/~'7` ~a,nc~eSi C~~acr~y~ o2 U_ ~cf cr M d f l ~t ~2 Tay Wry ~t r a, ct /cX -7 o T? c t 117 q.4 e. e- CC.( J~ Y ~a1^ r , a cY l~tib S c c P p /'e- p u•~~O r , h C' ~u ~e 7" c e x.s f~ h p Lc ~-i/v~ / ale / 3 c~ WJ~f/ AS FFFT fu r e r cp f~ re s-h . (x 720o L jog; - • - Lr - - - - 70:-4. %.1': 4 - \..I 11 /r~•~. j• . a •r - ; , d / Q 2Q 38 40 56 60 70 80 9o Joe 110 120 130 : 1413 '45~ ~ , r /'~Q dam/ 3 6-,9- - r 9- 30 v . 8- 25 5- o is WI 3 10 Ne.nci~* 5 i 1 ( I loo c; o u 1 i 0 10 20 30 40 50 GPM 1 I , 1 1 0 2 4 6 8 10 12 DP/h CAPACr Y Effective May. 1995 ol.l. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page e or • FILE INFORMATION SYSTEM SPECIFICATIONS Owner wq~ / ea R#' w / Septic Tank Capacity /on Q al ❑ NA Permit # Septic Tank Manufacturer; escr ❑ NA DESIGN PARAMETERS Effluent Fitter Manufacturer 5,,7-ec AL ❑ NA Number of Bedrooms 3 13 NA Effluent Filter Model 57F /o0 DNA Number of Commercial Units NA Pump Tank Capacity al C03 NA 7 f' Estimated flow (average) 302 ilda Pump Tank Manufacturer Gc/; is e h ❑ NA Design flow (peak), (Estimated x 1.5) 4S- p gayday Pump Manufacturer Cso~.s /cl ❑ NA SON Application Rate 0.47 "t ; da /ftz Pump Model W a 'O S`HJq ❑ NA Influent/Effluent Quality average* Pretreatment Unit NA co* PIP O Sand/Qravel Filter ❑ Peat Filter Fats, Oil & Grease OG) Ap mg/L Biochemical Oxygen Demand (BODej ~p mg/L ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 [3 Disinfection ❑ Other. mg/L Pretr~ed Effluent Quality . ❑ NA Monthly average" Dispersal Dispersal Manufacturer Cell(s) Biochemical Oxygen Demand (BOD.) 530 mg/L ❑ In-ground (gravity) ❑ In-ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ At-grade ❑ Mound Fecal Colifam (geometric mean) 510' cfu/100m1 ❑ Drip-line ❑ Other Maximum Effluent Particle Size Ys inch diameter • values typical for darnestk (non-conmsrdaQ wastewater and septrc tank of luenL Vakws 4VIcal for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months ❑ year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume Inspect dispersal cell(s) At least once every ❑ months ❑ year(s) (Maximum 3 yrs.) Clean effluent filter At least once every 3 ❑ months year(s) Inspect pump, pump controls & alarm At least once every ❑ months ❑ year(s) ❑ NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) ❑ NA Other: At least once every ❑ months ❑ year(s) ❑ NA other: 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 Maintainer, 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 combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shah 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 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, mechanical or pressurized POWTS components, pretreatfinent components; and any other maintenance or monitoring at intervals 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 chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. Pageof System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fiA above normal hkOwAster Wets. When power is restored the excess wastewater will be discharged to the dispersSl Cep(s) in ones kwp date, overload the cell(s) and may result in the backup or surface discharge of effluent. To avoid this silitation have the contents of the plump tank removed by a Septage Servicing Operator prior to restoring power to do effluent pump or contact a Plumber or POWTS Maintainer 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 cogs. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soli absorption area Reduction or: elimination of the following from the washmater strvam rrtay Improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; tie butts; condoms; cotton fibs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; palnbng products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fail and/or is permanently taken out of service the Wowing stems shall be taken to insure that the system is properly and safety abandoned in compliance with ch. Comm 83:33, WiisoonsWAdministrative 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 wwavatsd and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized far the location 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 ex"V and primed structure, tot Iktes and wells. Failure to protect the replacement area will result In the need for a now sail and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rum M effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area Upon failure 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 tank may be installed as a last resort to replace the failed POWTS. Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biornat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT 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 POWTS MAINTAINER C4 y l (h a u- n Name ,~~q LXcQ f,`n Name Phone 7tS- Phone 9P E, E SEPTAGE SERVICING OPERATOR PUMPER ("4/ Re". LOCAL REGULATORY AUTHORrry Name n -A Phone Phone 71j*',- 7-?- 6 7 4Z 1 This document was drafted by the staffs of the Green Lake, Marqueft and Waushara County ZonkV and Satltation agencies. This document meets :he mWmum requirements of ch. Comm s322(2)(b)(1)(d)&(f) and a &54(t), (2) 3 (3), Wisconsin Adminl4 aM Code. Use of this document does not guarantee the performance of the POWTS. GMW (2/01) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address L Prope rty Address C e)'` S - J ~dc 1j, (Verification required from Planning & Zoning Department for new construction.) ~ City/State d(._ o b er j~ Paarrcel Identification Number 61- 9cl') LEGAL DESCRIPTION p ) Property Location'/4 , v, , Sec. tJ , T AL"N R~W, Town of Subdivision , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # , Volume, Page Spec house yes Lot lines identifiable (yes . no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Numb r of bed ooms SIG ATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application 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. (REV. 08/05) 1,,,i- 1635PAGE 80 i~ STATE BAR OF WISCONSIN FORM 1 - 1998 dE5. 449~$ WARRANTY DEED KATHL5EN H. WALSH REGISTER OF DEEDS Document Number ST. CROIX CO.. WI RECEIVED FOR RECORD This Deed, made between JAMES C. NELSEN 05-08-2001 10:30 AM WARRANTY DEED - Grantor, EXEMPT N and _WALTER J. RIGWALDJR. and JERI R. JENSEN-RIGWALD, CFRF COPY FEE: COPY FEE: husband and wife as survivorship marital- propertty TRA49FER FEE: 598.50 RECORDNG FEE: 10.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, Slate of Wisconsin (the 'Property-): cor; ;:nc; A:;ea Name and Return Address Part of Government Lot 1 of Section 28, Township 29 North, Range 18 West, St. Croix County, Wisconsin described as follows: Lot 1 of Certified Survey Map filed October 22, 1991 in Volume 9, Page 2418, Document Number 474961. 042--1076-90 Parcel Identification Number (PIN) This is homestead property. (is) (is not) .j Together with all appurtenant rights, title and Interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except - none. Dated this 7th day of May _ 2001 (SEAL) (SEAL) JAMES C. NELSEN (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, Pmtr1da r ateS-Krutson 55. Notary St. Croix County authenticated this dy oaf Personally came before me this 7th day of state of VVIsconSin May 2001_, the above named James C. Nelsen TITLE: MEMBER STATE BAR OF WISCONSIN to (If not, me known to be the person who executed the foregoing authorized by §706.06, Wis..StaLs.) instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Attorney. Barry C. Lundeen , f MUDGE, PORTER, LUNDE'EN & SEGU N, _ Notary Public. State of Wisconsin 110 Second_ Street, Hudson, Wisconsin 54016 My commission is )errr I. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) 7 ` Names of perso t signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal 9IWk Co., Inc. FORM No. 1 - 1998 Milwaukee, Wis. 4'74961 CERTIFIED SURVEY MAP Located in part of Government Lot 1 of section 28, T29N, R18W, Town of Warren, St. Croix County, Wisconsin. +°7 LEGEND Ni` d u a7 Aluminum County Section Monument Found _ ■ 0 V x 2411 Iron Pipe Set, weighing 1.68 lbs. per linear foot m~ Existing Water's Edge V N Meander Line OWNER L, 0 d „ Roadway Setback Line and Water Setback Line David Coyer y 1069 70th Avenue - W Roberts, WI 54023 0 e O O r- . . O r) -4 O L O N ,t O m x East-west 1/4 line of Section 28 M90°00'00"E N90°Op'00"E 900.72' 4384..1.3' W} Corner of , E} Corner of Section 28 Section 28 o w r w rn n` L h11V1J`~ ~~11rr) L 1 nTrrQ l_ ylVNI 1 ~U r 14 6' S8601514911W 251.421 26 218.30' - 33.1121 S0804313111E S08043' 3111E Ql 55.00' N~ . 57.881 100'x"` LQ.T 1 75 1 1.53 Acres. Inc.,.•R/W l 66,455 Sq.: Ft.:' 1 ~ 7I 1.22 Acres Ex c. R/W Imo,, ~I 53,308 Sq. F-t. Q7 If i 17 l~ 1~ J:A m 1 1 + - ,**h a C.N4'tiii~C v 7`~ tt 7 1 : R AVED 1L} I1 1 ~I .y a.. p ICr1 1 ~ ~ 7 r. ~ { •f .y O CT 2 2 1991 ✓ 21 ST. CROIX COUNTY ' q,,; ~ ~ N4704012311E YY}1yp~NE~151JE PARKS PLANNING Q 4 14.701 e~` a' r ! g; r *'V 1 t1A i" Wisconsin Department of ommerY O 9 Z 0 OIL EVALUATION REPORT P ge of Division of Safety and Buil ings i CR044 W ce i Comm 85, Wis. Adm. Code PLANNING & ZONING OFFlC~E County S Attach complete site pia Inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. I percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. eviewed / , Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).//V v(/r✓ I L / Property Owner Property Location qdtCr 1 t t 4 ,w c>` ~CL Govt. Lot A/W 1/4 S"1114 S -cp T crZ~ N R `00 G4or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 74-? /l -t4 Vol t X4/(7 City State Zip Code Phone Number ❑ City ❑ Village ;I Town Nearest Road ❑ New Construction Use:' Residential / Number of bedrooms Code derived design flow rate AS-0 GPD Replacement ❑ Public or commercial - Describe: _ *-A Parent material t a rA `q„ T ; Flood Plain elevation if applicable NA ft. General comments -Z ,V r Ar e r t At /+y agn / ~lr~stn a 7` ~r ✓ i*. e f s-q r p°., and recommendations: ~ '011C °'~/iliir,~. rC~'Gt~. d.`S /G~ ~CleGi 4hs`~~,..tirt a~•r•e.- d y'Y tJ/ ✓.Z. fit. Ike ct t.«►rr °j~ r'ristEt✓/~f.ce~, C 9 9l?• T'✓l~ or.R.~,.~ sue.'/ tee'' i1 dCagf(~`/ qg/r. a Boring # Boring 9 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 It' tiA' AIV I-k (;L 6- 0. F3 Boring # El Boring ❑ E Pit Ground surface elev. ft. Depth to limiting factor °t in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 /032B io yorI3 SO .2,ftc4k A" o.,6 ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number chi - /Irs We stele' "C dwt .~-Z O C 73' Address Date E uation Conducted Telephone Number 7 70 tl -s`~ Aw 73- 3430 Property Owner W'- /*ti - `S r Q' Way rC~ parcel ID # Page of Boring # ❑ Boring q ❑ Q Pit Ground surface elev. / ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. *Eff#1 *Eff#2 ~G=4 /oAg S- AO xsyfS 8 r `k #s? - 111P e5. G, 6 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 *Eff#2 ❑ Boring Boring # F-1 ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlff2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ' Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (&.07/00) OVA/ _ ° ~ t3 rr) o o ~ ~ a a Page 1 of 2 Charlie/Kris Webster From: "Jansky, Leroy G - COMMERCE" <Leroy.Jansky@Wisconsin.gov> Date: Sunday, April 24, 20112:41 PM To: Charlie/Kris Webster" <ckwebster80@yahoo.co1/pleted Cc: "Ryan„ <ryany@co.saint-croix.wi.us> Subject: RE: Redo Unfortunately, a new soil and site evaluation needs to be and the mound repair or replacement based on those new results. Hand dug pits should be adequate. Hopefully, there won't be much change. Remember that the old mound yore sized at 1.2 opd/ft^2 and since 2000 we have used 1.0. Making the mound longer is usually easier if you plan to just core the rock and some sand out for the replacement/repair. Leroy G. Jansky, CPSS POWTS Wastewater Specialist Wisconsin Dept. of Commerce Safety and Buildings Division PO Box 517 Chippewa Falls, W154729-0517 (715) 828-5902 - Cell (608) 283-7459 - Fax From: Charlie/Kris Webster [ckwebster80@yahoo.com] Sent: Friday, April 22, 201115:01 To: Jansky, Leroy G - COMMERCE Cc: Ryan; Webster Charlie/Kris Subject: Redo Leroy, I had Ryans' email address wrong on the email I just sent to you. Chas W Leroy, I have a customer by the name of Walt Rigwald in St Croix Cty, Warren Twnp. He is having some issues with his mound sewer and it looks like he will need to redo the rock bed and some of the sand. Tom Wang did the original plan and installed the system. We have a copy of the original approval letter, signed by Gerry Swim, for the system approved on Oct. 14th, 1991. The Plan Number was S91-40875. St Croix County records show the permit being issued on 11/26/1991 and the system being installed on 11/26/1991. There records show that this was a three bedroom mound as does the approval letter. Unfortunately, there are no other records. There is no soil test, no old plans to look at and no inspection report. Apparently, this system was installed during Tom Nelsons' era as Zoning administrator. It appears that Tom had a habit of taking files home with him and when he and St Croix Cty parted ways, some of the files never got back to the county. I can probably make a good estimate as to the elevation of the existing system, erring on the side of keeping the distribution cell high in elevation. Of course, they will need a filter and the system will need to be resized to the current code. Do we need a new soil test? Or maybe just one or two borings would be adequate. I will have to make an estimate as to the dimensions of the existing distribution cell. Any other thoughts you have on this would be appreciated. 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