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HomeMy WebLinkAbout026-1064-11-130 (2)Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM 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: City Village Township Jeremy & Jessica Stapel TOWN OF RICHMOND CST BM Elev: Insp. BM Elev: BM Description: 1 1 � D I.2) 1 P� r (0116C D� 6A0 Se c iu�n k � Pef�i� �y 22y� TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic r 1.��.. W 760 mot' (tS�S col I�k 525 TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIRHON INFORMATION M anafacturer Demand GPM Model Numbe TDH Lift n Loss ff Sy em Head TDH Ft Force ain ength Dia. Di . o Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 651293 State Plan ID No: Parcel Tax No: 026-1064-11-130 Section/Town/Range/Map No: 21.30.18.318B-03 STATION BS HI FS ELEV. Benchmark ,�rd N"'w, , �WJ F�I}u 2.D 8 103.33 ID(- 3 Alt. BM Bldg. Sewer 4«y "'Wodwe. 6r 1115141ad 4AL ni rns�clro S�a��� �e (�ki'L" St/Ht Inlet St/Ht Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover W U v (0*4r b sy 3w bed 4-. BED/TR idth Len No. Of Trenches PIT D NS No. Of Pits Inside Dia. Liquid De DIMENSIONS SETBAC SYST TO F,/L BLDG WELL LAKE/� T REAM ACHING Manufacture INFORMA ON 1 CHAMBE R UN Type Of System: el Number: DISTRIBUTION SYSTEM v Header/Manifold ,'Distribution x Hole Size*7 le Spacing Vent to Air take Pipe(s) L*-n� Dia gth Ua Spa p SOIL COVER x Pressure Svst sem Only xx Mound Or At -Grade Svstems Only D�d/nch th Over xx h of Vxxe_eled/Sodded xx ulched Center Be Trenc ges Topsoil \❑ Yes ❑ No Yes o COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1118 145TH AVE 1.) Alt BM Description 2.) Bldg sewer length = 25' of W; IAj ns}-,(l��( - amount of cover = � ys; s A ys° �a' A r Plan revision Required? ❑ Yes ❑ No I I 5 &�I ,❑ Use other side for additional information. 15 Date Insepcto 's Signature Cert. No. SBD-6710 (R.3/97) Sanitary Permit Application T. CROIX COUNTY WISCONSIN In accard A,11h Ghaperl 1, 2 St. Croix County Sar.il;wy ()rdiri1.,,nce PLANNING & ZONING DEPARTMENT C -Persona I into rmat i f) n you provide m a y be. used for secof 1 d dry P U rpo c T. CROIX COUNTY GOVERNMENT'CENTER ''I Llam' [Priivacy Law, S. 15,D4(l)(m)] 110 1 Carmichael Road Hudson, Wl 54016-7710 (715)386-4680 Faxj715)386-4686 C C 1) Allach com011ete plans for the system on paper not less than 8- 1 '2 X 11 jj)(.jje5 I(I Size. ji- CGunly Sanitary Permit # El Check if revision to previous applicatiGn �� Psi : 65" 2 3 .0 1, Application Information - Please Pr1rIva(14n1fp'rmatiion Location Property 0wrier,MM6 SVV 1.1,ANVV 1 A, s &c 21 JEREMY AND JESSICA STAPEL Properly Owner's Mailing Address Lot Numbt­I' Block Nup-,iber 1118 145TH STREET ---- -- City, State 70 Code Picnc Turner Subdivision Name or CSM Number NEW RICHMOND WI 4 1 L S AAT.Doe, 0 - it 23 q ll e of Building: (check one) amity El Village OTovvn of I or 2 Family Dwelling - No. of Bedrooms, 0 L1 Public/Commercial (describe, use)- RICHMOND El State-owned Nearest Road fl. Type of Permit: (Check only one box on line A. Check box q,n 11irw B 0applicable) 'A R- :Sa04-zC__ Parcel Tax Nurnbi�r(s) A) 1.0 Repair 2. ReconneTn(ctWi 1EINon-plumbing R ejuv e n a fion Sanitation 02610641"113 0 B Permit Number 1,�SL]ed V State Sanitary Permit was previously issued 642240 12/9/2021 I Tg of PO System: (Check all that apply) N on -pressurized In -ground L) Mound 4 in. si.j_ltable soil o Mound 24 in. suit -able soil 0 Mound A+ 0 Ll Sand Filter 0 Con rtrijcted Wetland El Peat Filter El Drip I irlL) L1 Pressurized Ire -ground 0 Holding Tank El Single Pass 0 Other EJ At -grade 171 Aerobic Treatment 011t El Recirculating V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispe,rsal Arp,,R 4. Soil Application Rate 5. Percolation Rate 6- System Elevation 7, Final Grzade Required Proposed (Gals,/day?'sq_tt_) (MInAnch) Elevation I. Tank Information Gapaicty In =dIIOTIS Total of Manufacturer Prefab Site Co in - steel Fit) e r plast�- Now Existing Gallons Tanks Concrete structed glass Tanks T�' anks X 750 WIESER Li El 1:1 L1 Vill. Responsibility Statement I, . the undersigned, assume responsibility for repaiCreconnenction/rejuv enation..'installation of non -plumbing for the Pm OWTS shoi on the attached plans. A ficense is not required for terralift repair or the installation Ot POfl-pkimbing sanitation system. Plumber's Name (prinlplumb , Si QLMS MP/MPRS No. Business Phon-c Nijmber stam, PAUL R KOEHLER -0 W�� 225410 715'246 2660 Plumber's Address (Street, City, State, Zip Code) 321 WISCONSIN DR NEW RICHMOND 54017 V111. County Use Only D- roved Sanitary Permit Fee Date Issued Issuing Agent Signature (No stamps) Wner Initial verse Z�0 74712 L IX. Conditions o(.Appr ova 0 1: SYSTEM 0.1� L��vLdiecIre-0 0,tk et 4vok -�r 3 1. eDt,:L J -`isv�rcal celi Sc tank, effl-i ein, I I _9 4vaA aj— to r, vte c�---6> must be serviced i maintainer] pis Cer ns.lnag,em-erl, [Aai-, p-rovded by p!up'ibu. &&SSor -Art V & co 2, All setacv rec,uireme%rit5 nist be mpintqined as per appliGable code iordinprins Bm Yv Pvc pipe Benchmar6F k 105 FF Pit BM 1100 BM 2 97.18 SLOPE 3% PIT 197-42 PIT 2 98-22 50 PIT 3 95-97 75 FT sm It,.KJ I 4, L Bm Yv Pvc pipe Benchmar6F k 105 FF Pitrt BM 1100 BM 2 97.18 SLOPE 3% PIT 197-42 PIT 2 98-22 50 PIT 3 95-97 75 FT sm It,.KJ I p Lli 411( r yr s�-� �1 �� C�i�A— SEAL 4" CAST —A —SEA'! Ve f .'A 1-71LTER OR BAFFLE 1101IM114m Li r'r cn < Lj -7- IN� OUTLET 2 V) V) :c I _ ��y -" < < Lo U-)I = I r%% U 0%j CL CL - 0 M -q- k7) _1j_ Rol 21 po I —1227 Rf"­JF�EVE�'.—S TANKS ARE MANUFACTURE-DIa 7C KIEE7 10R AST�,l C 'IT'LP750-MR TANK SPECIFICATIONS. DIMENSIONS: LLI WALL. 2 1/2" al BOTTOM: 3" C 0 VE R: 5'1 MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT, 54** OUTSIDE DIAMETER: 7 —Olt BELOW INLET: 42" La LIQUID LEVEL. 37'p WEIGHT. 6,150 LBS. 0 INLET AND OUTLET- E 4 pi CAST —A —SEAL BOOT OR EQUAL GASKET 1 Cd INLET AND OUTLET BAFFLE AND FILTER: 6j WISCONSIN, SEE DETAIL #10 —1 < L-LJ (OTHER STATES SEE CHART) a c < . IDLn L� LIQUID CAPACITY: 20.28 GAL/IN Ln HOLDING TANK - OUTLET HOLE PLUGGED ACTUAL CAPACITY: 790 GALLONS af Ln LOADING DESIGN: 8'-0" UNSATURATED SOIL z co LLJ I TANK CAN BE USED AS - SEPTIC / HOLDING / PUMP OR SIPHON COVER: MIX DESIGN #8 NO FIBER) TANK. MIX DESIGN #10 STRUCTURAL FIBER) v) CUSTOMIZED TANKS - FOR CUSTOM TANKS CONTACT WIESER CONCRETE _j < CL REVIEWED BY REVIEW DATE DRAVVINGS SUBMTTTED FOR APPROVAL APPROVED SHEET NO. SHEET APPROVAL DATE: 0 FF PRODUC-i-, NFFDED BY: T� Inc. lr. Innovs6ons in Promt DrBinap Zabel* & Wastemter PmduM A C kvisim of Po�iok Inc. PL-525 Filter PL-525 Effluent Filter The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the Polylok PL-525 has an automatic shut-off ball installed with every filter. when the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. i „ Features: • Rated for 10,000 GPD (gallons per day). • 525 linear feet of 1/16" filtration. • Accepts 4" and 6" SCHD 40 pipe. • Built in gas deflector. • Automatic shut-off ball when filter is removed. • Alarm accessibility. • Accepts PVC extension handle. PL-525 Installation: Ideal for residential and commercial waste flows up to 10,000 gallons per day (GPD). 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if necessary. 3. Glue the filter housing to the 4" or 6" outlet pipe. If the filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center filter. 4. Insert the PL-525 filter into its housing. 5. Replace and secure the septic tank cover. PL-525 Maintenance: The PL-525 Effluent Filters will operate efficiently for several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped, or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. 1. Locate the outlet of the septic tank. 2. Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 4. Pull PL-525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. 6. Insert the fitter cartridge back into the housing making sure the filter is properly aligned and completely inserted. 7. Replace and secure septic tank cover. WE" Filtration Slots Accepts 4" & 6" sCHD 40 pipe Outdoor 5martTilter@ Alarm Polylok, Zabel & Best filters accept the smartFilterO switch and alarm. Alarm switch (optional) Accepts 1" PVC Extension Handle Rated for 10,000 GPD 525 Linear Ft. of 1/16" Filtration slots Certified to NSFIANSI Standard 46 Gas Deflector Automatic Shut -Off Ball Extend & Lok"'' Easily installs into existing tanks. Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com r � r Cri-.y , DeparLment of Cc mmerce PRIVATouE SEWAGE SYSTEM St. Croix a-,J 5uldmg DMspon INSPECTION REPORT Sonilary Permit No GENERAL INFORMATION (ATTACH TO PERMIT) I Stalt Plan ID Nc 642240 `"v. c. na. P.if o rTr n,, cmi pf O'Vlde M.11 j be L SL!-C 10,r se-zzmj a,ry pro- ss I P, rw,,i�, v L ;i oe S 1 0,4 (1 % rm tj pe.-Ti- %'1kaQe Townshiic Parcel Tax Nr)- CUrrahee Custom Homes TOP OF RICHMOND 026-1064-11-130 e to E e v hsp BV Ehiv P bor) -n'! in n 7owwR a n ge�?J a - NCF e��t Zr Ff� �Z�r (In jr vtl y 21.30.18.318B-03: TANK INFORMATION IF-1 VATInN n-ATA I YPE se�+c MANUPACITURER CAPA I T y Cusina r A ELI 14�1—d 1h g, TANK SETBACK JNFORMATT ON T,4 W T 0 VYT, 1 2 L Lr In At I so ... A,eratiz)n Ho 1d;n q PUMP/SIPHON INFORMATION [N—I (—ir i,.: f a c r r- r Derqand M01,11 Nunlibe., TIDIA 1 L. ih F�_uv)n Loss TY1 H e.'� 71 IL Lq�-1-jth b a SOIL 4S&)RPTION SYSTEM S FATION DS H� FS ELEV. B e r- -. lh rna rk q P2 Lv- t"ilt BM 4 Bldg, Sewer :St'Ht Inlel last EE 0.st Pipe Bol% Systern /0 Final Grade I-Ovel fi r IJK J. 10 L I i't r 1A A M tloW 04. SED-71RIENCH L e,-i -i•th No 0f TLe-nolies PIT DIMENSIONS `J- i 75LIde,bra [-�eplh SETBACK 'S YS STEM M T C F-1. \o M L Y71 WELL LLAKEF'STREAM LEACHING INFORMION 1 CH-MABER OP I- r + C, ;V51eff, . A D UN!,r '' I -.1L I 1 4 ).0 1 DISTRIBUTION SYSTEM �-t)ie 5,ze to r-1-a �-e L 1!� r+ e-%6 1 j r+.a A r— r1% 0 kj i L- %-0 V V r- M x Rressijrre SySt.OM$ C)nly T, L,ep (I Over Cepin Over �qlqrancP,- Ce-iler Be -J,Tr en -- 11 E d ge � ;7 COMMENTS: cue discrepencies. perscms prcsent. etC Location 1 ! 18 14,-)TH AVE n V,� 1-1 Aft EM 'escriptio 2.) E3 I d g s c. y%oe r I e ngth a -f c mou--,( Plan revisicn Required Yes N:) Use other side foradlclilior)al information aw S B0 - 6 71 t �.'971 xx ---W -und Or At-Gra Illy 0 P v e 15 �JQ 'Yes Inspe,_fion #1 OVA 04 YON yxmf IL I ep=F,s 519ratLi-e Cen r.- f ety nci F3 'i s oivls'�on n.- rq 201 W Washington Ave., RO, Box 7162 S P, Mad-w,n. W 53707-7162 V SaAl. T� rMit--Aopli-cation In aacurdamc wildh S PS 3 93 ', 1!7,), 'M6, A d-m, Co&,- s c �f th fom to tht Appr4matc j61QVc-.mm-cr,1 id un i rrcquirOn0121oilxirmt. kApp1l,.4 cPrL nrm fur =c 7e the Depia rn=,A or safety and Nor c*s)wK, Srrvic&- T1,!rs--ivA; ri f i ,rl YOU P. i: used for p tj rp -, sL-s in w-cmdamcc *jib 1he Frivaq- LxA, s- 1�.04i iv-'r). "-t,;;LS pficatiDn Wormation — Please Print All InformAtion Air pem't r4un-Lb-cz. (tD bc fiUrd in byQ,) T *t addriss) &cs� (Lf thy, m Pfopel'I'. CWmr's XELMC OA C�� -a Jun C I AddrrsS GovI Lot o 01 Sum Zip Ccxk Mone Numnr I dF 1 2 .2 —LOF IL Typr of Building (chc-ck Al that APP)YI L LCM V 1 S KJO AMC ;LM il Y DW C I i I I L& urnbcr of wm*r[Ls I ock r zm nu, al - 11itz, D CO3, of Cs M N, L rr D'u OUM of 49 1 111, Typ-A-tf Perrimt. 4ChtCk (OxIly OFIC bU.X (Y.111 line A. Compleft line 13 irapplicah1c.) A. ll �-.61ex W1 vIificaoa to ex Dining syst= (piain) 7 Ntw Ll Rcp1xemr-r,L1 Syst-�-m Treatmenul iol din g Tmk Rcp I 2k-,xime Sri 0I L.' Lis t prtv I ous Pamit Numbcv and Dak Issuod B Ej I - 21 L J P=h Revision U aanp of Mmbet U Pe:rmh Tfvzfcr to New .j CITT) 41 i%,tnCW Mum Expiffation of 111) V-7s S-% StejU/COmpQncn!LfDcv1cC, 'beck 911 that apply) Wpund < 21 4 ur., 4!'s u 1 �*Jc 11 L')-��OLJ)d Uj At-Gra& -Mcund > 2"' OL Of I :hi�r ��L � ri Cani;x)OCrA J. P1 Hill) I LA ing T" J -L 16r RTI- %,. o1spersav treatinCT111. Ari�,s Injormation. DCS I p R:nN f "-d) Desip Soil Apph cadon 0 VL Tank I n fa capb6ty 1.11) Gallons I. In Flo W71 —In Stptj,;� cw HoUmp Tank D -eo a g C1 *=he DispaTs4 Axca Rcquu"& (-sn /0 7 LT Wolts units Sr. ten Flevabon 4W 401 V11L CSC- Spon'sibill ty STatmen 1, thr uadtr%;ipnvd mine rcspuiwf...p r 'L U S I a] J t LJ V Uf [fat P 0'�+" FS itbown on the attached plate. LM C1 S N=r. It f 41, - ------- JI Mvmbr-r s Add("queex, C�}, SL,11Z, JAJI God 11111. Couaa!Dcp�rt-mcnt U-%c Only Dome In lnui;ig Aim Signalum A;ijjf avod Din ppro Ved S 4, lZozj &aAA EX. Conditions A 3 r- 7 21 3 _AAA&^, Mai S4 ST F 10 OW.'r J E R - I Septic tank. effluen'., fj�ter anc ALI 16 I r1lspers-al cell mt,,st be Sc-:-Vice'o 6 e4* ps per plarl prcvjU-e�j L'Y Im 42-bf!LVCZ1-^ IT" P-40 P0, Fri -1-— un rv 6 ir�dr n I I LM per app I cat) le (-,od e o'd 5) %q SBD-6398 (F, I I I 11) 1 V- I m System PLOT PLAN PROJECT Currahee Custom Homes ADDRESS 904W Main St. Balsam Lame Wl 54810 SW 114 W 1 f 4 s 21 IT 30 Nf R 18 W TOWN Richmond COUNTY ST. CROIX ' SYSTEM ELEVATION 93.0/92.M2.6 5' below grade 11 /28/21 5 DATE BEDROOM CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/600 LOT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1093 # of chambers 54 IL BENCHMARK V-R.P. Top of 2" pvc pipe . ASSUME ELEVATION 104 Filter Lifetime �fetune Fiit+cr BOREHOLE(DWELL * H , R, P, same as benchmark 96" r.. i copy 9 8' A \ 3% Slope 3.31 x 74' cells with >3' spacing UWLNWSRXN%�����R � o � 10' 60 - 30' Hdffcutt mbo tank 30' � Pro 5 eA Bedroom House Vent > V Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 6.6ft^2/pair of end caps 4' Long Crra& at System Elevation 145th ave System PLOT PLAN PROJECT Currahee Custom Homes ADDRESS 904W Main St. Balsam Lame Wl 54810 SW 114 W 1 f 4 s 21 IT 30 Nf R 18 W TOWN Richmond COUNTY ST. CROIX ' SYSTEM ELEVATION 93.0/92.M2.6 5' below grade 11 /28/21 5 DATE BEDROOM CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/600 LOT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1093 # of chambers 54 IL BENCHMARK V-R.P. Top of 2" pvc pipe . ASSUME ELEVATION 104 Filter Lifetime �fetune Fiit+cr BOREHOLE(DWELL * H , R, P, same as benchmark 96" r.. i copy 9 8' A \ 3% Slope 3.31 x 74' cells with >3' spacing UWLNWSRXN%�����R � o � 10' 60 - 30' Hdffcutt mbo tank 30' � Pro 5 eA Bedroom House Vent > V Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 6.6ft^2/pair of end caps 4' Long Crra& at System Elevation 145th ave Cover Page Shaun Bird Bind Plumbing Inc. 1 482 1 2oth St, New Richmond Zvi 84017 718-246-4818 Date: 11 l22 1 Cwner:Currahee Custom Homes Location: SW 1 /4 NW1 /4 S 21 T30 N, R 18W 1118 148th acre Richmond Used: In -ground absorbtion system (version 2.0) Page# 1, Cover Page 2. Plot Plan 8. Chamber Cross Sect'o 4-8, Maintance and Co g nc Plan 7. Filter Cross Sectlo Signature License numb iW2 90o System PLOT PLAN PROJECT Currahee Custom Homes ADDRESS 904W Main St, Balsam Lake WI 54510 SW 1/4 NW 1I4 s 21 1T 30 NIR 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 93.0192.M2.6 5' below Grade 11 /28/21 BEDROOM5 mmmww�DATE CONVENTIONAL CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/600 LIFT TANK SITE DOSE TANK SITE HOLDING TANK SITE LOAD RATE .7 ABSORPTION AREA 1093 # of chambers 54 hk BENCHMARK V.R.P. Top of 2" pvc pipe ELEVATION Ito' Lifetime Filter ASSUME E Filter � DBOREHOLE WELL H . R . P . same as benchmark 105' do 96" 9811 0B-1 S o-- is 3 % Slope 3-3' x 74" cells with >3' spacing 0 30' Huffcutt combo tank 30' ? Pro 5 Bedroom House .Vent wr.wwwwrrw > 6 ?3 Quick4 Standard f over Leaching Chamber with 20.0 ft2 of Area *fthpair of end caps 4 Long 1 2 Grade at System Elevation 145th ave OM% ,ross Sect'ion of Quick 4 Stardard Leaching Chambet Typical cross section for 2 of 3 cells QUIck" 4 St-crtndai-d Leaching, Cliajiiber with 20.0 ft. of Area per C ft hmA)e,r 6.6 Al _. pmr- of end plates Vcn. 0' Typical Installation Grade 4' Ak-��301034, Septic Tank M �T JPO" Uad*!2 al Systcm Elevation Spacing_ 5 0 4 1 To be > 1' above grade Finish grade elevation 98.0 r &--I Gmde, at Sy.�iem Elev'& 1'( 41 34 7.1 Observation tube/Vent Same on other end To be located on end of Cells 18 chambers per cell %A B System elevations: C A93.0 B-92,8 C-92.6 ��ILE INFORMAT'i-ON Owner lurrnit# J-)F.SIGN PARAMF-TFRS !i Number of Bedrooms Number of Public Facility Unqs Estimaled flow (average) POWTS OWNER'S MANUAL. & MANAGEMENT PLAN Page I of r D W, 1 Design flow (peak). (Estimated x 1.5) ') it Applicaton Rate S c tandard InfluenVE Muent Quality Fats. Oil & Grease Bjuch-ernicaA Oxygen Demand Monthly average* (FOG) _530 mgll- (BOD-5) Total Suspended Solids (TSS) Pretreated Effiuent Quality 151=nemlcal Oxygen Dernand (BCDs) Total Suspended Solids (TSS) Fecal Cohform (georneiric mean) k4aximum Effluent P;art'Zile Size j Mont,hly avie rage S30 Trig/L ,930 rrg/L A l 0' cU100mill 16 in dia. Ei NA A 7A. *'values typlcal for donne-stic wastewater and septic tank effluew, [AINTENANCE SCHEDULE SYS71EM SPECIFICATIONS Septic Twx r,ap1 �� tv � f 1 L7�► Septic Tank Manufacturer Cj tq,4 EfflUe°nt Filter ManufaQturer 17 0 NA 1�fluect "filter Model ID NA Pump Tank Capacity NA P u,-Tip Tank Manufacturer D NA Pump ManUfacturer NA NA P-etreatment Urit NA 0 Peat Filtor [J' Mechanical Aaq-atiun 0 Wetland Lj Disinfecboil 0 Other: D'Ispersal C0(s) IJ NA • in -Ground (gravity) -Ground (Pressurd) • At Grade 11 Mouna • Drip-Liwe C' . Other. Other. 0 "NJL ether: ©CIA Other 0 t,1A I , Service Eyent Service Frequency Unspect condition of tapk(s) 0 month(s) At Fast once every: 7.#Lm I e a r (S) (Maximum' 3 years� Ir- -1 N A Pump out contents of tank(s) When wribined & ud9 o ard scum equals one-third ("A,) of tank voluni e 0 IN, illti El month(s) :lsspeat diSperSiF31 Clell(s) At I ea s I once every; (Maximum 3 yearm) --;> 5Tnyear(s) --_- Clean effluent filter At least uixe every,. Cl month(s) :1 N A Ayear(s) ----d- � risped pump, Pump CaWrols & alarm At least once ev"; El morith(s) El year(s) ]-'lush Werals and pressure test At least ame every: 0 month(s) NA yuar(s) At least once eveq.- NA -1 1 - yealks') iAher- MAINTENANCE INSTRUCTIONS Onspections of tanks and dispersal c.efls shall be made by an inn ividuM cari)-'ing or.c of the following licenses or cert'.ficaiiuns, Plumber- Master PlUmber Resed Sewe,r- POVV7S Inspector: Nlainialer, 5eptage Servicing Qperatc)r. Tank - 0 6 1 1 i %0 mspactions mubt include a visual inspection of h P ',,ank(s) to identify any m-Zsing ol. b1r,-)kC-1 - t io rdwate, Identify, any cracks or leaks, measu re the vol urne. of 1-.4mbined sludge and scum and to check for ary bac�, up or pondinV, of affluerit on trie aroind s,,jrfaCer The d1spersal ceii(s) shan be iviisualiy Inspected I d)ack tho effluent �evels in th,� a'0soi-voti.,,n to chet:k ftr ariy ponding of effiluent on the ground surface. tl'� ati of I I 't-he Por)dlng of efflueni on the ground surf�Acn M,�3.y [,-",L J17ZIL*'; �1 llr-3dirlti I I -1w fc, on cA)ridjju,i and ricaquires the the m1a I-egulalory authority. 01hen the combined zccomulafian of sludge and scum iv � a.riy equa!s one-th,;d (X) or morn of the tank volui,ne, ,he entire conte,-,tof 'he tank shall be removed 1,y a Septage ServiCirig of to accordance with ctlaoter NR 113, WisconStri ;k1d ml nii stra five Coda_ All other seivices, including but riot 11miteal to the tiG:-v!Cjr:q of eftluen't or pressuflZIF-0 coimpcnents, pretreatment unds, Nnd any s-erylaing at iii1ei-yals of :512 months, shal' be. per!' -,):A) icuol h. -r a cf,�n t f,T_ d P C? �-, !1- 6 Tor t a �1 r-, c r I- Of ;� Se';c.e report shall be. provided to the loc-al requlaWry 3cjthc_,m�-'.--A0hW 4,0 oay3 -)I coriplefiofl of any service event. Page of �. START UP AND OPERATION t For .new con-strudon, prior to use of the P01AFTS check treatment tank(s) for the pre senCe of painting produc% c>r other chemicals Uv4 may impode the treWment prcceass and/or derma ge the dispersI(s), If high mncentmUons are detected have the contenof the is rerntoved by a septage servicing operator prior to use. System start up shall not occur when soil condiUcns am frozen at the inn flVative surfiac . During power Wages pump tanks may fill above nomal hIgNmter levels, erg puwer �a restored the excess wastewiatef Mill be discharged to the dispersal celf(s) in one Large dose, overto.ding the cell(s) and may result in the backup or surhica dime of efflueat. To avoid this is�uation have the contents of tptimp tank removed by a Septage Servicing OperMor ;w`oor to restoriW per lo tt-02 effluent pump or ntad a Plumber or POVVTS Maintainer to assist in mamaUy operaUleg the pum,P WntrOls tO rt$tNe nO-rmal leve s +r ithin. the punip tank. withIn Do not dnve or park Vehidas over tanks end dispowl cells, Do not drive or park over, or oftmise disbA or ow"c� the area 15 f0t d mn slope of any mound or at-gra de sail abso rption area. Reduction m e6min-ation of the following tr(m the wastewater atfeam may irnp;ove the performance and prolong the We of the POWT' antibiotics: baby was,; 6gamfte butts: condoms: cotton swabs: (Sagremew dantW fIGGST dlapwg; disinfectants'. W.- foundation drain (sump pump) water; fruit and vegeWbte peelings; gawline;. grease; herUcides,, meat saam rnedkcns; oil; paindng products', pestickles; sanhary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is panne nentJly taken OtA of SvVica the foljowtng steps shall be taken to insure that the system is pro it and safety abandoned in oompliance with chaptbe Comm 83,33. Wsun!wln Administmbve Croda: • All piping to tars and pits stizll be diaconnected and the aLbandoned pO o ngs isealed. Pe" 6 The contents cf all tanks and pits shall be removed and prope ay d1tposed of by a SePtage Servicing Operator. After pumping, all tanks and pits shall be excavated and removed or their c;over5 rerncyed and the void space filled With sail, gravel or another inert solid material, CONTINGENCY PLAN If the POVVTS IaUs and cannot be repaired the following nwasures have been, or musi be WWI, to provide a code comPlAnt replacement system. - AL -suitable repLacernent area has been evaluated and utilized for the U of a replacement sod ebscrpboP, Syr T The rep kKwnent area shoo td be protected from dlsWrbence and compaction and should not be tarring ed upon by FeqU]W setba*s fmm fisting and proposes structure, lot fives and welis. Faflum to prolect ft replece"rt &MA'will result in t,v nod 1br a now sail and site evaluation to establish a suit replacement area- Replacement systems must oarnply wfth the rules In gffW at that firre , El A SuftWe Mosoement area is nol available d-je to setback andlor soil limitations. Barring aMnoes in P0VVTS technoio-gy 2 holding tank may twi haWfled as a IaW resort to replace the failed POVV78. 10 The 09 has not been evaluated to identify a adtaNe replaoement area. Upon failupe of the POVV7'S 8 soil and site evolusfor mW be I r ed to kxate a a ultable re pia comeat a rea. I f n ci re piece -a ent area is ave us ble a howl rig tw* "y be insW led a, a Is at resod to rep I ace th e fai led P 0WTS - 1:1 Mound and at -grade soil absorpton systems may be tewnstructed in p4roAa fol]&Mng removel of the bicmat at the infiltraciv( surfa0e. Rewn:structons of such systems must comply with the rules In effed at that time. SEPTIC, PUMP AND OTHER TREATMENT TANKS WAY CONTAIN LETHAL GASSES ANEVOR INSUFFICIENT OXYGEN, DO I ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES, DF.ATH MAY RESULT, RESCUE OP: PERSON FROMTHE INTERIOR OF A TANK MAY 13E C&FICULT OR IMPOSSIBLE- FU Q 87 V 9- 111 [1 -9 TIT 1 F . J111F71111 Narne Phone POWrS MAINTAINER Nam a I Phcnel 7/-X jV0, 1 ` j S E PTAGE 8 E RVII CIN G OP ERATO R (P)PER) LGCAL REGULATORY AUTHORITY oil Nsnw Name j( -Z- z 60 -,7L 1;7 1-11 Phone Phone This dooumergt-mndread iricornp,Ua,noewthchopWiSPS3M.22(2)(t)'-'i)td)&(and 383.54(l),(2) & (5), VVLscoresin AAmInktrMNe Goft- 00 .01 Gap t>eh++cen Case and Serwrne MMI' M w• yr � f, 91 SECTION A -A i.ivli 59 le Sir. CR�NTY. `� SANITARY,§4,YSTEM Floffi" use only 6WNERSHIP/ADDRESS FORM ��++ Community Development Department will utilize this information to provide the property owner with information regarding operation and Maintenance of your new;or replacement sanity eml This � � p �� information will be provided as part 4'. our ongoing efforts to protect public health, your well, groundwater,. surface water, property values, and county resources. Once ap�roved, this completed form and educational information will be sent to you by ernsl, e Phone Dumber Parcel Identification lumber (found on the property tax WO _ w Property Locatio /4 �&A4 , . T 3_JQN Town of rit 141Am Su bd ivision plate Lot # _ Certifled Survey Map # I L2 306 L 149 'volume � � Page # 1A Warranty "Dd # q"� 5 before 2 � Volume � Pa { 3 e # 9 Number of bedrooms Spec hou C3 po Lot lines identifiab M0 no New Property Address 7 �- ff&. �1lenf cation of r'w address required from Comrnuruty Deve#opmem Depmtrnent fbr new co ) = i e (Staff 166*) (Date) This form must he submitted with all Pa to Onsite doter Treotm fnt System (POW S) applications. t New System. Include with this form a rea)rd�ed warranty deed from the �eg�.ster of Heeds Office and o copy of the ceftifted survey mop if reference is made in the warrpgty deed. CommuniV Development Department Land Use Division 715-386 80 St. Croix County Governrnen�, Center 715-245-4250 Fax 1100 .Carmichael Road, Hudson, Wl 54016 Document Number I Document Title St. Croix County Accessor Structure Affidavit I�5407 e /t plsi�� Name — (Own 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 I nterest recorded as Document Number St. Croix County Register of Deeds Office. This property is described as follows (include lot no. and subdivision/CSM or detailed legal description): OR: ❑ See attached deed copy for legal description Recording Area Name and Return Address Parcel identification Number (PIN) AS owner of the above described property, I 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 (_) bedroom home, with a design flow of gpd. This accessory building may not be used as a second residence on this parcel. I also acknowledge that I will disclose this infon nation and Stipulation to any future parties interested in purchasing this property. Dated thistk day of "♦ AUTHENTICATION Signature(s) authenticated this day of , TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706,06, Wis. Stats. ) THIS INSTRUMENT WAS DRAFTED BY: St. Croix County Community Development ACKNOWLEDGMENT STATE OF WISCONSN_} )ss. St. Croix County. } Personally came before me this day of &af aa th above named to me known to be the person(s) who executed the foregoing instrument and acknowledge the Notary Public, State of Wisconsin My Commis ion is germane t. If not, state (Signatures may be authenticated or acknowledged. Both are not necessary.) Date: d � ■ r e ate: �Kti. t r♦��ss OF SO �6}}w AL AV ownF 40 � �1 TW ONUAWWV .1 IN IM ------------ x I x Nor 0 OWINIP ;=Wtmx be" Ur -A A HCKOMMIMM" VNFNpf OMMOVOW bow 47P. m It CA J4vjL9m 10 M FF"PW Uppi apwhcm PVFAIFmt OP OM APIZA HOM WOOM Aug aw AM me 44EL.D m 11 ftcM KLM lfi tiv*L -0 rWAKPWU PRM 00 "eA%&* 40 0. WCO Pow= OF lldkLATk:h 0 P-% &4rT FVAW A& OUT&M PAL'X 0 4�-MAr44 NO CVtr&-UD, 6RADEJ OW VOAK BOAPP m ps PCdM NOAPO P*kJLATKh &- a wrowm Moog e"j *7 Arm i , iA *PLc 4P C.3 +tNFT JLL Pq6r- 6CX4504 r*450doo w *Ar- " x�Ario &A&wL"rm ow-umTo� IL Nil o6 -- ------- - FIX All r SULT Im wa �aa�+w �r. �w ron rrrr�►�r� ww�crr w'7st7fi-A#!7 wsww�r► ►� ppr+� stY �rr r�air •rr �n �e Hoe 76LM.� wa r+wp tr twltwwv Owtrvr I Ecg:= ARi wl�+ti ► NOT � wv i� IIIOilyF� IIMfJvn► +�Cp� *� rw •+ M was i R � arrw Ow ,xA 1� Y 404PP 'vd,* Idr4w °F i ._ L h Y �i•k��r led^" - ' r TCAWWT lb F. i F LMN i k •II i C EEE i r may' t yy ' .a - � pia �' - i• !• a- i i 4 �'- • 41 ! .+ te" mow%° it # 01, ad� try �rj 9 I ? I A !±6 4 ro 7 ice .6 i j! I TRAY ^t T � .. err_ , ��� � •• % apamt P%Xw - m - �,lt -®dig i FW-4• h. . it &dr- Tyr .P ice, FVK All ] { lbciQA To tw l it Fyn p r ti A] RH� E VIA M, S. Deot.orSaf N Sefvi s SOIL EVALUATION REPORT Page 3 Division f Safety uldilk= in ccordanoe with SPS 385. WS Adm. Cow t Dourr + T 1 Attar plet �? s than 8 1 a x 11 lnc•h in size. Plan must in G . .nxaI fer+en pos�I t ��), crtion artid � I.C�,V-4- percent scale of dimensions. n rth arrow, and location and drstanc;e to nearest road.Z> 7 . - — Ple8Se grin f all information. Ftcoiewed by Date Penal Wormai&w Y6u PFOWI7 fn r �-? t-se_ t,�• sraondarY pugxmot (Prtvacy LMW. •. 15.04 (1� �M)) - . Prnperty Owner Property Locaton 7/ B RON D E R R I� K GOVI. Lot 114 M ILA 1 /4 S Z i T 3L N R 18 E (or) Proj>erty Owner's Mailing Address Lot 0 a Ns�ne or CShW 1462- 11 2TH ST 3 1 PeW r-3 Slate ZV Cod Phone Number Lyfty []VlKage Uwrest Rom New C onstruchon use fl ResidenuaI f Nurnber of bed rooms 4 C*de do � des 19 n fFow rate � PD 1(3Rq*We"n1 Pubtio or i- rerciaI - C soibe, Pamirt mateI LOESS E L+AMD,RIET-OVER SANDYFvd erratpon ale At Gomm n-wm 54 and recomn-wndations SUITABLE FOR IN GROUWDV 11 °. 4tm. +fie �, li-S. 4Nk S� C- r 14_�-eivl 60", V %^4) bc 1J2 �2 57\j< �e ^7 f, L-e ve'a �;b BOON* D&Kiv i f— r". - - -A - __ff_ __ - IL-. ri 17 10 �1 Ing HorLzon A Depth In. 0-20 t 1'% _'__"_ ___-�q-„ :.:� � r --� ra %W P"tAn,li.�f irk. Sod A Abon Rate 2 Dominant Co4or Redox Des motion Texlufe Structure n €i nd a ry Rocks GM Muns►otl Qu, Sz- Cunt, Dolor r_ Sz- Shy, 1 f1*2 10 NrR 3 1 2 M GR MVFR C 'A' 2 F .6-- 1-0 20-26 7.54,14 SL 2 NIBK M FR CA .6 C 26-108 10 I} + --- — ------- f U Boning Bofing 98.22108 ElP Ground rt s u rfa eev - ft . Depth to ImKing factor S AV Horizon DWh Dominant COor Redox art T"ure Structure stste oundary Rcots G I ' ,A 0-10 10 YR 3!3 ..------_-��®��- - _L 2 � i GR CA 1 � 4 B 10- 0 7.5 YR 4A L 2 X1.ABA, MFI CA 2F -4 . ri �f 4, 5 dE " Effluent 01 BOD > 30 0 rn9k and TS S >30 < 150 rn ' E fiuenl 02 = B O D < 30 mgA. and TSS � 30 rn CST N(Pioase ) Siva#urn CST Numbw 25410 Address "Cate Evaluate Canducled Telephcme Number i PrOwner RON DERRICK Parcel ID * I 01- 3 Page Of Bonng 0 U Boring 95.9,7 108 pil GroM usurfooe eley, Depth to limoing facloT in. scil ! Rats Hofizo-n UeVh in. DorninaM C040f Mun-sell I Desorption Qu, Sz. Coat_ CC40( Texture Strom re Gr, Sz. Sh. nsistence Boundary R its GPDM ff#1 2 A 0-16 10 YR 30.13 S T L 2 M, B K f IV' I A 2 M 4: 16-32 10YR4/4 CL 2MBK UA 1) .4 .6 10 YR `4 --------------------- S (mist; 11TI I CA Lo Cl 46-64 10 YR 6/3 0> S 0 its(, NIL CA .7 C2 64-70 5 YR 5/4 S OMS6 M L CA .7 1.6 C3 '0­ 108 r R 4.14 CX;F S OSSG M1, CA 1-6 F1 BonnV4 # Q &nn"� LJ Fit w.aruviru ZhUrIgMAM VICv. TL LMFIPI I I tv ffir I I PLJI Py I MmAul UL Soil A;pkafion Rale Honz on Eke pg. f in, —min ant Cyr Munsefi Re'dox Desc* j -0 QU, Sz, Cont, C*Ior Texl tru a re Gr, Sz., Sh. onsislence uWarye Roots GPM :ff#1 -7 i492 Boning Ground surfs eilev Depth to kmKIN factor in. - ------- Pit I Soil Afm4catenn, Rate Horizon inant Color Munse,11 Redox DescrPtion Qu. Sz. Cont- Color T'exture Structure Gr.. Sz- Sh- onsistence undary Roots ff*i ff*2 ' Effluent #1 = BOO 5 > 30 1220 rngA_ and TS-S >30 � 150 m91L 0 Effluen 102 = 500 r f 30 mp%k and TSS � 30 mt Sof e'vY and Pr(-) ional Sery 1 ces is an equal opportun i ty scr%, icc prow Wir grid em p] o% cr. I f you need assi-sl ance to . N w TTY i hrc-p u gh Re I ay. BOCAXSS A` Or T1.CCJ material in an altemate format. conucT ihc depariment at 608-266-3 151 t S Bb-A 3 MTol OR 119 1) Foam tOIXCOUNTY o _N NOO MAV ii�� STA SANI Y R_-&V__1 I T� � u I ITIRAN R/RENE WY, AL PREVIOUS NO, r OWNE fLjt R tA *�ef PLUMBE A) TOWN OF SEC 9T Nq R WE R 14 5.135 (2) N% - IS CO N N I N STAT I FF S ;1 r P (R) 11 A 1le rpose of thy: sanftiiry p-prinit is to allow ivita ll.ifluti of the private sewage sN-stem clesciibcd in the permit. (b) The approval, of the sanitary permit is har-ed on rey,u lati a ns in force- on t h r date nf approval. ic) The sanitary mmil is ','and and maybe rene"ed fora spt7dfivd period. (d) Changed regulatinni, will not Impair the va Ild1tv ref a �.rl n i ta 1-y Permit. (e) l0n IWal of the sanilan- perralt will be bawd on re�ulatinns in force at the time rcnewmJ Is mught. and chat diatiRcd rMulaliuns may impede renewal. f f) 'I'h e sa n i to ry permit is t r a ns rerab Le. Note,- If you wIs h to renew The permic, or troessfer OWILersliip of Aft M, miiencip con mi No the n1v Authority. e 6 1XISION f, psk AL sh D ISSUING OFFICER DATE, 4 "LESS RENEWED BEFOREIS PERMIT 1­XP1ATE lqjllpp� Now- III SBD-06499 (RI 1/20) CRoi; UUUN7rV �No. 65129 3— % OWNER ��... ..fW... ...� �_�S�ESS t�fA Sq}PEL........ -W r M -%C-lr7- ]L d-*%. I BD L dkY AND/1-Oxx 3 SU101 1) a I V I t S10 a . ... .......... ........ .............. ....... . . . . .... . ................ ......... . ......... ......... AUTnkiRIZED ISSUING OFFICER ............. .... ....... ....... . ..... . .... . . ................ .... ....... ... . . . .. .. ... ......... ?p �3E X CHAPTER 145.135 (2) WISCONSIN STATUTES oaf The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval.. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (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 # ca authority. t e erm�t lease contact he uu h permit, P ty DATE q/2g/26zs IF T U "'SS RENT"W'", " """RE T'"A'- Y%A1r-j T111S NLT-j xx ..... ..... SBD-06499 (RI 1/20)