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HomeMy WebLinkAbout040-1134-80-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 53$$00 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)]. Permit Holder's Name: City Village X Township Parcel Tax No Manche Jr., Johnny C. I Troy, Town of 040 - 1134 -80 -100 CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No. G 35.28.19.556M10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER t ` CAPACITY STATION BS HI FS ELEV. � Septic 3 / D � Benchmark /x i • 1 , V Dosing O ��1� Alt. B TJ �O� U A Aeration Bldg. Sewer • Holding SUHt Inlet St/ tit Outlet, TANK SETBACK INF 4, 7� l TANK TO ; / WELL BLDCp. Vent to Air Intake ROAD t `/ c� �� Se tic 1 Dt Bott m �, �d � Ca3 �3 /Z •S Dgsi / 5 ' L , 5 I � I Header /Man. — Aeration � Dist. Pipe 4 ,1 1 Holding Bot. System / Final Grade PUMP /SIPHON INFORMATION 3. 16 Manufacturer n Demand St Cove A 9 Oct d/ GPM J rl S . U Model Number / 5 p6, _ O TDH L� Friction Loss System Head TDH .�! rG 7 E /Z .�j / r� bJ� Forcemain Length / i it Dist. to well $ 1 n' =rb SOIL ABSORPTION SY TEM BED/TRENCH Width / Length No. Of rench PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth 16 z � � DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Typ stem, /C, .5 7— ( 13 CHA OR G1 Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution / x Hill Siz I x Hole Spacing .. Vent to Air Intak Pipe(s)� Length � ia Length Dia Spacing ` SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of ^ 1 XX Seeded /Sodded xx Mul ed Bed/Trench Center /.7 Bed/Trench Edges Topsoil I 1—: Yes J No es Nc COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: –7 1 Z b / j - � j pection #2: Location: 36 Pine Ridge T"ce River Falls, 1 54022 (NE 1/4 SE 1/4 35 T28N R1 9W) NA Lot 4 C� Parcel o: 35.28.19.556M10 1 1.) Alt BM Description = � e ti 2.) Bldg sewer length - amount of cover =; 1 O Plan revision Required? FN Yes IN �Q `7 Use other side for additional information. �� ____ ___ _ 0 3 Date Insepct is Signal e Cert No SBD -6710 (R.3/97) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM county: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 538800 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)]. Permit Holder's Name: City Village X Township Parcel Tax No Manche Jr., Johnny C. Troy, Town of 040 - 1134 - 80 - 100 CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No. 35.28.19.556M10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St over GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits M Inside Dia. Liquid Depth LEACHI DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM CHAMBER OR anufacturer: INFORMATION Type Of System: I L I- ---L- UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched p Bed /Trench Edges Topsoil Yes No Yes No Bed/Trench Center 9 ❑ � _. � COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 36 Pine Ridge Terrace River Falls, WI 54022 (NE 1/4 SE 1/4 35 T28N R1 9W) NA Lot 4 Parcel No: 35.28.19.556M10 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes 0 No Use other side for additional information. �—�- — - - Date Insepctor's Signature Ce t No SBD -6710 (R.3/97) F ECEI COrn etee.Wi.gov Safety and Buildings Division County vD� U Q U 2 Q Z W. Washington Ave P.Q 63t SC o� Madison, W1 5 A lj Sanitary Permit Number (to be filled in by Co.) OFFICE v X COU ONING nl any erinit Application .S tate Transaction Numb' 7 In accordance with s. Comm. 83,21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary /� 9 -1.-0 u ses in accordance with the Privacy Law, s. 15.04(1 )(m ), Scats. 2/ _ Y . I. ! I. App lication Information - Please Print nformation ✓ w Propert O ner's Name Parcel # 6I 11 64 //3# - o ^ / Prop en Owner's M ring Addrgs Property Location 554 M Govt. Lot C ht y, t — eh ate Zip Code Phone Number A 6 -5f, (` D9 ^ /., I( Section Qrl T �__- N; R � L (etrcle onc) EorW 11. Type of Building (check all that apply) Lot # �1 or 2 Family Dwelling - Number of Bedrooms Subdivi Name ,Ao Block # �� l L �etw ❑ Public /Commercial -- Describe Use Q -- ❑ City of ❑ State Owned - Describe Use CSM Nu her G ❑ Village of _ h - 75 � �(^ /1 3o A Town of III. Type of Permit: (Check only one box on line A. Complete line B if a plicable) / A ' ❑ New System 0*. placement System y p y ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS Sy stem/Component/Device: Check all that appl 5 In- Ground ❑ Pressurized In -Ground -"P -Grade ❑ Mound ? 24 in "of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain)_ _ _ ❑ Pretreatment Device (explain) V. DispersaWreat4fient Area Information: Design Flow Design Soil Application Rate(gpdsf) Dispersal &re� Required (sf) Distiewal Area Proposed System Elevajin � O Cite VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o Now 6O� Existing Tanks � A � � E / f t•+ w u to run is t� n. Septic or Holding Tank bb © h b a �. Dosing Chamber C VII. Responsibility Statement- I, the undersigned a ume responsibility for installation of the POWYS shown ttached plans. Plum is Name (Print) P s Signature MP/ Business Phone Number 111k24 �� Plumber's A et (Stre, Cit , te, Zip Code) 76 0 VHL Coun artment use Onl fA proved ❑ Di ved Permit Fee Date 1 ued Issuing t Signature ❑ Ow tven Reason Denial onditions of A rov �kR! asons for Disapproval A �� SYSTENPg%W E . 1 3) QI�Q Sysdr.�. 1. Septic tank, efflu6tlt fillr and L ✓J dispersal cell must all be servk:es / maintained as per management plant provided by pltimbor. /�' 2:: , 'tli46ack requirements "W be tnairlt hWill 'if, _ f q„� �(�. : or, b(',�, o e system and submit to the County only on paper n ess tha x I I inches In size Go le•e dl e � GN; tsf-: SBD -6398 (R. 02/09) Valid thly 02/11 s /ke At - sildLde S ' cV , Cr t y S y ea. mr a ZA �roy T.,., - sr f"r�•,j Cam. r- R, �, w 1"eFr c �_ 36 f_ { g, �I # � a = 3df #c Ce�r �4 do s '*CON d� �.ars -r.: ism jml °'T CrS`� SCF' � C r'E.l'W't*s +r i + C�fri+6.t�( ! 1d8�+f'sti� c: .sr 6 �'y LZ]"r os fiiN Pl E✓ f J � � - � �.� i ^irsz+s. lw / rear. X,.. /. /zv s 4kc..a qy 4 —e. c 7 s-x / a F �v r L+'C c- Conab�C7�6'. t �" c Er 4, i Iemr ^ 0 �p �r4r4 f � i r • 9 : c t v a++ � r r `mot 0 n �rar L „try Safety and Buildings RECEIVED t� G PO BOX 7162 commerce MADISON WI 53707 -7162 Contact Through Relay isconsin U L 0 7 2011 •commer isco g n.gov www.wisconsin.gov Department of Commerce ; . _;,�,�„A �,%,uNTY PLANNING & ZONING OFFICE Scott Walker, Governor Paul F. Jadin, Secretary July 01, 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: 07/01/2013 Identification Numbers SITE: Johnny Mancho - Dwelling Transaction ID No. 1952479 36 Pine Ridge Terr Site ID No. 768608 Town of Troy, 54022 Please refer to both identification numbers, St Croix County above, in all corres ondence with the agency. NW 1/4, SW 1/4, S35, T28N, R19W Lot: 4, Subdivision: Pine Ridge Terrace FOR: Description: At -Grade Object Type: POWTS Component Manual Regulated Object ID No.: 1321206 Maintenance required; Replacement system; 450 GPD Flow rate; 41 in Soil minimum depth to limiting factor from original grade; System(s): At -grade Component Manual, Version 2.0, SBD -10854 (N.03/07), 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. 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. Df Livid F„ A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of SEE ;;ql construction /installation/operation. 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 7/1/2011 r Since e Fee Required $ 250.00 Fee Received $ 250.00 f' Balance Due $ 0.00 eter V Pagel Private Sewage Plan Re ie er , Integrated Services WiSMART code: 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.izov/SB/SB-BuildinjzCo tractorProgram.htmi Webster Soil Testing &t Sewer System Design Charlie 8t Kris Webster, Owners N5815 770 Street, Ellsworth, WI 54011 Telephone: (715) 273 -3430 Fax: (715) 273 -4181 WI Licenses: MP220673, ST220673, ST 261669, PE18803 POWTS Index Sheet Page 1 of 8 At -Grade Svstem Designed for a 3 Bedroom Residence Property Owner/Project Name: Johnny Manche 36 Pine Ridge Terrace Lot 4 Pine Ridge Terrace NW 1/4 SW 1/4 S35 T28 N R19 Town of Tray -St Croix County Contents Paae 1 of 8 Index Sheet Page 2 of 8 Plot Plan Page 3 of 8 Plan View Cross Section Pate 4 of 8 Distribution Pipe Layout Page _5 of 8 Pumyint Chamber Layout Page 6 of 8 Pump Performance Curve Paae 7 &8 of 8 Manasement Plan • .. sp - co 'fir WESWO HA .� wrr. Component manual used: ND� Name: At -Grade Component Manual for POWTS Version 2.0 SBD 10854 Date: 03/07 Name: Pressure Distribution Manual for POWTS Version 2.0 SBD 10706 Date 01 /0 2 1 C. To►- At ,Sao -- de, sct,4 r y sty— #vA- 1 p a T.IG� M c T T•«,,. - s c'rr,;� e Ph' rt, c t I 1 _ / ! 34 dry. �ortia s t ; ® I AL S*d C + ti;IIr.s c�> jf % 44 0 7 . 1 r �• ; l 7 cx J SC� IC �►iFMS f!,„�¢ Mtrf -- 16 owlat, k A. Le 1 C c.., <i ,'h q„t. a„ �EA/i� I✓i '7'� ,` ' { l�iac+� /.c. /c r.y ' p ti )'' a+4 ,` r, ♦a G 7' "X 0092, �'t, ho v . It 4LJ T � a- aL � ig T'+�i r LvCL.SCJ- Ce•oahCl"�°- i 1 J'kl4 4( 1♦4�.. S Clwyp OM6.e �' 4 MiZV„_ dP o �►°� r � of A 0 S �.r rw .�► I N ¢. mcx EC 7'/ oN 4r 5 A■ 1( Feet - �_ ��Feet • Linear Loading Rate 6_.O GPD /LN FT L= (J Feet Design Loading Rate = C G?D /SQ • FT W= Feet ' Distribution - Late di Observation- ---_�v Well 12„ .3 �/� S�oPE e►ww�p >Jr � A t2� >_ r li j- t e.p fe- /r1 *�� a'� Pe�sal �� r�+d IC rG yO d rc , -70 Lj co tek 7)'/C 1`d ��.'c r WA .., ��� "4 y- 0 . c � �,,.�, 4 . 3v 651 e MC C .! cC. a� �.X ��• oa t o I'p'e �� -"- i sPdcc� 6�� ds ri � � � Pi � n►cfic.- (j .�wc% 7 X Jffdles `e,}c. 3 7 s4.cc e �d.ti� �� /mss a7` � " ' �_.�� :Kt / e.rJ /s. La s7` �• /� t� `� o �'t Page H of -1<., C -l.00- s�,c d40 (No Scale) P / -'sr : rerf P.Pe��jo�* Approved Locking Manhole Covers With Warning Labe15 Attached /� Is ylke Weatherproof Approved d 7r 0 Junction Box Vent Cap � T r -� C77, T 12" Minimum 6 ; murn tt 4" Minimum Quick 18" Minimum , Disconnect t � 1/4" Weep Baffle Hole z _ fo� C �{� IG.e+.f r /•��IP i A ar 4 Pf N've d Alarm 6q B eP� ,• v. /e v t On 6, t t 8 .1.V.P�e C w, "KiB:..0b *APPROVED j Off lr E1J 7 G, OA C.yak- -t JOINTS WITH 'e itle APPROVED PIPE p 3' ONTO SOLID SOIL 3" of Bedding Under Tank -f Pc�� fswnrJ,� �dtls�r�rr oij s8�e► �.�t� a I^Caa.�'7S Number of DQs*S- ,�- 8 Per Day Gall ons Per JR"i e- 7 7 mS - .1 10- Tank Manufacturer: CV C °hC � - Pru����� Total Dose Volume: ........ ank Size-Septic/Pump: 100 c)l 6 00 Gallons Alarm Manufacturer: t.. -ere/ Model Number: P ' -l' Capacities: A 34 inches or ¢v.. GaF logs Swi Type: .$� Te / - + B a inches or 2 +�Ga' ions Pump Manufacturer: �u + C 7 inches or6.3Ga i 1 ons Model Number: + D — inches or 7s Gal lofts Minimum Discharge bate: ^ — TX. Z?_ CPR Total.....= S' inches 0r .,!5'0 Gal Ions `vertical Difference BetKeen Pump Off and Distribut'on Pipe: 8 ®/ Feet ^!i nimum Required Supply Pressu e .. S��?. C !3c? +�>�,` Feet 6__ Feet of Force Main x �_ riction Factor /100 Feet: + % Inch Diameter Force Main Total Dynamic Head: ... = /J. Feet gnrernal Tank Dimensions: Lengt Width `3�tj Liquid Depth S I�f c S 7'•b�� ��'ua� / / sue /� C4a S "uzZ,. �i p �1 �u n-r� / Cl I h c cc" e` g 13871 EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover. Thermoplas- • Homes components. Avallatile for auhnnatic and tic cover with integral handle • Farms Motor: mail " Antic and float switch attachment • EPO4 Single phase: 0.4 HP, points. • Heavy duty sump models Include Merlaaical • 115 or 230 V, 60 Hz, 1550 ■ Power Cafe: Severe d Water transfer RPM, built in overload. with Float Swileh and � • Dewatering automatic reset. p at the btory. rated oil and water resistant. • EP05 Single phase: 0.5 HP, In �� Upper and lower SPECIFICATHIILS 115 V, in 60 Hz,155 : RPM, FEATURES heavy duty ball bearing construction. Pump: EPO4 built in overload with • Solids handling capability: automatic reset. pl ripe: Thermo- 9 dY� plastic Semi -open design AOEII>CY i1STN16 3 /a" maximum. • Power cord: 10 foot with pump out vanes for • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. • Total heads: up to 24 feet. with three prong grounding 0 " • Discharge size: 1 1 /2* NPT. plug. Optional 20 foot Is EP0 I close Thermo- (CSA listed model numbers end in "F" or "A length, 16/3 SJTW with p� enclosed design for C. • Mechanical seal: carbon- improved performance. ) rotary/ceramic - stationary, three prong grounding plug BUNA -N elastomers. (standard on EP05). ■ Casio and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METM Fr stainless steel. 10 i • Capable of running dry without damage to 9 30 components. i Pump: EP05 8 • Solids handling capability: c � 3 /4" maximum. a • Capacities: up to 60 GPM. = i_ •Total heads: up to 31 feet. � 6 20 ��- • Discharge size: 1 NPT. z 5 • Mechanical seal: carbon- rotary/ceramic - stationary, a 4 BUNA -N elastomers. • Temperature: 3 10 ! i 104 °F (40 °C) continuous i 140 °F (60. °C) intermittent. 2 5 1 I C'!y/ ct �✓ ��-j , ,p yr� Q 0- 0 0 10 20 30 40 50 GPM 0 2 4 6 8 10 12 IWIh CAPACITY 0 1995 Goulds Pumps, Inc. Eftw1we May, 1995 R9R71 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 7 of FILE INFORMATION SYSTEM SPECIFICATIONS Owner �o h r /t9Q h ��/ Septic Tank Capacity 1 C, a l ❑ NA Permit # Septic Tank Manufacturer w Co.�c�e�¢ ❑ DESIGN PARAMETERS Effluent Filter Manufacturer k ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model ❑ NA Number of Commercial Units NA Pump Tank Capacity C a l ❑ NA Estimated flow (average) 3 v ga l/day Pump Tank Manufacturer &&tire, NA Design flow (peak), (Estimated x 1.5) 4 g al/day Pump Manufacturer ❑ NA Soil Application Rate 0, ( ga Ud ay ge Pump Model ❑ NA Influent(Effluent Quality Monthly average` Pretreatment Unit �KNA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Czravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg/L ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 m ❑ Disinfection ❑ Other. Manufacturer Pretreated Effluent Quality /X NA Monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (BOD 530 mg /L ❑ in- ground (gravity) ❑ In -ground (pressurized) Total Suspended Solids (TSS) 530 mg/L `XAt -grade ❑ Mound Fecal Coliform (geometric mean) I 510 cfu/100m1 1 ❑ Drip-line ❑ Other Maximum Effluent Particle Size Y. inch diameter - Values typical for domestic (non- oommerclaR wastewater and septic tank effluent •* Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ,�' ❑ months 'Wyear(s) (Maximum 3 yrs.) Pump out contents of tanks) When combined sludge and scum equals one -third (!S) of tank volume Inspect dispersal cell(s) At l east once every 3 ❑ months frlyear(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ months )Kyear(s) Inspect pump, pump controls & alarm At least once every ❑ months ❑ year(s) ❑ NA Sl�c�e nje Flush laterals and pressure test At least once every ❑ months ❑ year(s) ❑ NA Ale e n% Other At least once every ❑ months ❑ year(s) ❑ NA Other At least once every O' months ❑ year(s) ❑ NA O 14 -P L co /h A7 e� %,,,r cled. 1"1�f'Pr OhGG VNry 3y��LS. L[.�G�f eolN�r, d t� /t MAINTENANCE INSTRUCTIONS y o /ejH ftllrr every Ao ll to W v a^ P - -G /.w..0 dL.rApl fhe .4 ier'- 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) shalt be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y,) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment 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. Page e System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the oell(s) and may result in the backup or surface discharge of effluent To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the 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 cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 Beet down slope of any mound or at -grade soil absorption area. Reduction orelimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONM ENS' When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to Insure that the system is property and safely abandoned in compliance with ch. Comm 53:33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space 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 for 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 existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules In 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 biomat 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 Name �, yn L Go r .�, h Name Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY G Name Agency C`a � ajs Phone Phone �ji o ? 7 /s 35n. his document was drafted by the staffs of the Green Lake, Mamuette and Waushata County Zones and Sanitation agencies. This document meets A;(p$d ;he minimum requirements of ch. Comm 83.22(2)(b)(1)(d)&M and 83.54(l),(2) & (3), W'aoonsin Adminitrative Code. Use of this document does not guarantee the performance of the POWTS. 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O ! 0 o LO O co Cl) � O N M 00 LIB CID CO O lf� Z o O b� Z L L U co ld w 2 Z LU C7 w L1J i— J z - o, U w n ? c xo m °v O CL w w w U u:) o O 2 L L U _ LO CD M ® O w � _ "' m � O=D Un O co O ze LAD z � N F- LO c Q , KA THC VI H, WALSH r Register of 53688 sc, Croix co., wi CERTIFIED SURVEY MAP LORIN AND JUNE SATFER Part of the Northeast 1/4 of the Southeast 114 of Section 35, Township 28 North, Range 19 West, Town of Troy, St. Croix County, Wisconsin. FENCE UN TI L ROAD SETBACK L /NE S 89 50' 10 "E 498.63' y� o W Z Q LOT 3 — ; a % Q O 2.657 ACRES t Q I Q J N \ 113, 728 SO. OCT, T/N SHED TO BE REMOVED O tu; S 89 "£ 275.00' I M O tu IF ll 1 � LO T_4 -- 1.010 ACRES I p W �I Q - • 44, 000 SO. FT, 11 3 (7I -j t C)I aPo Z o n Q� O Z OW J I �1 2 J h O SEPT /C Q I h ( O Q. O O y, WEL L b • I Z O O • b DRIVEWAY O � . 224.67' 2 275.00' t 1 N 89.50'10 "W 499.67' R 1 WEST 501. 10', 301.70'1 -- E114 COR. SEC. 35, T28N, 1.52' p R 19 W, !COUNTY SURVEYOR'S O M0NJ L 0 T /, C. S M., VOL 6, h PA 1645 This instrument drafted by Laurence W. Ci ? M N Murphy w W ALL BEARINGS REF. TO TN£ EAST LINE OF THE SE1 14 „ S 4INN£NE1 14 SE 114 b OF SEC. 3S, T2BN, RISW, ASSUMED NOD - 00'00 "E J O lam O O 0 Indicates 1" x 24" iron pipe weighing 1.13 o 15s. /lin. ft. set. S 89 • 57'15 "W 810. 22' O 6 Indicates 1" iron pipe found. R/N89'55'48 "W 813.09 Owner's Address 3S Pine Ridce Terrace M W Rivar Falls, WI �` w q 440?? SCALE /°= /00' h J O 25'50' 100' 150' 200' 300' SE COR. SEC. 35, T 28 N, R 19 W, f COUNTY SURVEYOR'S MON.) Dated: September 25, 1995 _� �����t�,.,Wig,, .U. 2 7 13 P 5 9 6 _7aaaS c\ STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER F DEEDS This Deed, made between John O. Putzier and Shelly Putzier RECEIVED FOR RECORD husband and wife Grantor, 12/13/2004 01:00PK and-, Johnny C. Manche, Jr. and Kathy W. Ma nche, WARRANTY DEED Husband and Wife Grantee. EXEMPT # Grantor, for a valu le consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin REC FEE: 11.00 (if more space is needed, please attach addendum): TRANS FEE: 705.00 COPY FEE: Part of the NE 114 of SE 1/4 of Section 35, Township 28 North, Range 19 CC FEE: / West, St. Croix County, Wisconsin described as follows: Lot 4 of PAGES: 1 ✓/ Certified Survey Map filed November 29, 1985 in Vol. 11, Page 3019, Doc. No. 536868. Recording Area Name and Return Address 040-1134- 80-000 Parcel Identification Number (PIN) This is homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights - of - way of record, if any. Dated this "" '- day of December _ ' 2004 er AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF A - #10 ) ss. - - - - - -- , (.4K/ "7 County ) authenticated this __R%W D Bevers Notary Public Personally came before me this �� day of December , 2004 the above named l John O. Putzier and Shelly Putzier, husband and wife * TITLE: MEMBER STATE BAR OF WISCONSIN (If not, _ _ to me known to be the persons) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknewiedged the same. THIS INSTRUMENT WAS DRAFTED BY A tto r ney Kristina Oglan _ Hud WI 54016 Nota Public, State of My fission i ermane(If not, state expiration : ) (Signatures may be authenticated or acknowledged. Both are not necessary.) l ��A ' * Names of persons signing in any capacity must be typed or printed below their signature. Infomnation Professionals Co., Fond du Lac, WI STATE BAR OF WISCONSIN 800 -655 -2021 WARRANTY DEED FORM No. 2 -1999 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND ;7 IP H CERTIFICATION FORM Owner/Buyer �1b� ° Mailing Address Property Address a (Verification required from Planning & Zoning Department for new construction.) City /State Ft iA A), �. Parcel Identification Number LEGAL DESCRIPTION Property Location A '/4, S'C(.1 '/4 Sec. T 09� N R W, Town of Subdivision 6 ? f - rmee _ , Lot # �. Certified Survey Map # �.� b �� g , Volume , Page # Warranty Deed # 9 , Volume C9 � , Page # Spec house ys & 4e • 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. Uwe 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 arranty deed recorded in Register of Deeds Office. Number of bedr oms SIGNATURE OF APPLICANTS) 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) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following r side ce: (Street address) ? � P, Ille / t located at: '/4, S '/4, Section ,Town o2 N, Range J 7 W Town of , , St. Croix County Wisconsin. Upon inspectio , I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service o l Did flow back occur from absorption system. Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 006 Construction: Prefab Concrete `k Steel Other Manufacturer (if known): Age of Tank (if known): Pe 't number (if known) (Licensed Plumber Si nature) (Print Name) (Title) (License Number) MP/MPRS (Date) Form to be completed by licensed plumber (Dept of Commerce Chapter 5 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 9/2008 RECEIVED wieoonsin of cc ^ ' SOIL EVALUATION S M P R D P of 3 Division of Safety and Build' s �1UL � 3 z -: =11 � s .. in acooniariba with '5, vv. Adm. code Attach torrnpietesite plan PLANNING& 2Gt�it4GOFFICE• in size County indude, but not limited to vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or danensions, north arrow, and location and distance to nearest road. ® D-- / - FD -Dew Please print ail information. Reviewed by Date Paraorral Ghforr obw you Provide uray be used forsecwWwy Purposes (Privacy Law. s 15.04 (1) (m)). Property Owner Property t ocadon 4 . 6%roeli Govt. trot d/W 1/4 Jw /4 S S- ,2 f N R / E P s MOV Address Lot ` # Block # Subd. Nana or A i G t cr e 7 R, City State Zp Code Phone Number ❑ City ❑ Village BTawn . Nearest Road ❑ New Construction Use: Mr"R / Nunlwof be*mm 3 Code derived design flaw rate S/SU GPO (IRsplacement ❑ Public or cornmerdal - Describe: Parent material ,4 / /f*iood Plain e levation If appicable eflE fL General comments or r and Boring a# �Boring Q p Ground surface elev. fL Depth to Inviting factor �— in. J Sol Applicstion Rate Horizon Depth Don*wvtCdor Redox Description Tw&re Structure Consistence Boundary In. Muhsel Chi. Sz Cori Color Gr. Sz. Sh. fXZ 'Eif#1 'Effl/2 — JC 2 -22.. 3 s 3 - z . /31s C- �-►[ _ _ ._ z S G ,S -5•z s Ls — a #0 Boring F2-] 7 r [a Pit Ground surface elev. � fL Depth to lin sting factor � —- in. Sol Application Rate Horizon Depth Dominant Color Radon Description Texture Structure Consistence Boundary Roots GPD/ffr in. Mknsel Qu. Sz Cont. Color Gr. Sz Sh. 'Etf#1 I TOM 2 S fG- M L c s -- 7 `Effluent #1 - = l3OD > 30 < 22D mg& and TSS >30 < 150 nVL ' Mani #2 = BOD a 3D mgL and TSS < 3D mg& CST Nerve meow PMQ - - CST Number Address s y� Evaluatbn Conducted Telephone Number • / / / {� � [ � Jam/ ro WOM �M. ri mGTL1! ;, /i m mmm� /� MmmM PIMP �,Mmmm mmmmm Iola � ~ � • 3ii;f • •.. ® � �` ® © ® � icy, ll rr A t W ,5ne � 3 " om / C"IX,4 4 Y � n -ere 4,= 7l "Vey- 0 glsKme �8, 2 9q' 1 v W NJf� `Ot ell t ne'rS vend Xr i L. 3