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HomeMy WebLinkAbout605152Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04 (1)(m)1 Permit Holder's Name- city Village Township .Gary & Cheryl Kemling I TOWN OF CYLON CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Cj Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number Ef ) 04 TDH I Lift Friction Loss System Head TDH Ft Forcemain Length I Dia. I Dist. to Well i SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 605152 State Plan ID No: Parcel Tax No: 006-1067-95-100 Section/Town/Range/Map No: 30.31.16.466A STATION BS HI FS ELEV. Benchmark Alt. BN Bldg. Sewer St/Ht Inlet DU S. Ht Outle Dt Inlet Dt Bottom Lin Header/Man. Dist. Pipe Bot. System Final Grade St Cover BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS I I I SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR UNIT Type Of System-. I 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 Prpqqijrp SvqtPm% OnIv xx Mound Or At -Grade Svstems OnIv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No I E] Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Location: 1932 HWY 46 1.) Alt BM Description 2,) Bldg sewer length - amount of cover Inspection #11: 1 v0 gAns ection #2: 10, 4 S O►k- 3+"" 6 ;,a- �' Plan revision Required? Yes No Use other side for additional information. Date Insepctor's Signature Cert, No. SBD-6710 (R.3/97) 111111iiii0i StlrV -Do i s - Z? sy D Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 County Sanitary Permit Number (to be filled by Co.) S Madison, W1 53707-7162 it Apple - kyl JLIn S tate Transacti n umber accordance SPS W5plg de, submission of thIS forM tC) the_annrammums - ntal urUt Address (if different d= mailing address) is required pnio to Lary permit. Note: Application forms for state-owned PO'WTS are submitted to 'otoProject the Department ety and Professional Servies. Personal information you provide may be used for secondary p2!poses in accordance with the Privacy Law, s. 15.04(1)(m), Stats. I. Application Information - Please Print Allorrnation Property Owner's Name Parcel 4 c� o Property Owner's Mailing Address Property Location 1 Govt. Lot Ay 1/4, Section (C' le one) City, state Zip Code Phone Number .100 T N; R E Lot 4 H. Type of Building (check all that apply) %JA Subdivision Name 1 or 2 Family Dwelling - Number of Bedrooms Block 4 ❑ Public/Commercial - Describe Use ❑ CITY of % 0 State Owned - Describe Use CS El Village of Town of S1 Number III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. 0 System El Replacement System ❑New X14rreatment/Hol ding Tank Replacement Only Other Modification to Existing System (explain) B. 0 Permit Renewal El Permit Revision EJ Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner 14n, spo", - - = IV. Type of POWTS System/Component/Device: (Check all that app!v V El Non -Pressurized In -Ground iW Pressurized In -Ground EJ At -Grade El Mound > 24 in- of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area equired (sf) Dispersal Ar Proposed (sf) 77 SystemLion N1. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units 7; Z New Tanks Existing Tanks Cn F coo Septic or Holding Tank 47 Dosing Chamber ey leiat NM. Responsibility Statement- I, the undersigned, assume responsibility for installation of the PONATS shown on the attached plans. Plumber's Name (Print) Plumber's Signature NP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) WH. County epartment Use Only A Approved 13 11101115iri. 1 Peuiu't F e fo Date Issued Iss ng Age t Signature n easo�nf Denial IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER:. �, r 1. Septic tank, effluent filter ai is dispersal cell must be serviced /.iiaffltaiMu as per management plan pluni!)er. da ---rC4_� it.> IZILti 2. All setback requirements must be iflaintalried It as per applicable Coe @00#j0-fgM*Vft plans for the system and submit to the County only on paper not less than 8 112 x 11 inches in size SBD-6398 (R- 11/11) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: JEFF ARNESON Owners Name- JEFF ARNESON Owner's Address: 1932 HWYT 46 Legal Description: NE1/4 SE1/4 SEC30T31R16W Township.- CYLON County- ST CROIX Subdivision Name: Lot Number: Parcel ID Number: 006-1067-95-100 Designer/Plumber-, Date- Signature Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross -Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty SeEtic .Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments- Soil Test & House Plans PAUL R KOE_HLER 08/17/2018 License Number, Phone Number M P 225410 (715) 246-2660 Designed pursuant to the In -Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 12X 117 FT BED 10 FT OF THE HIGHWAY RIGHT OF WAY. WIESER 1200 GALLON T I f I 4 BEDROOM HOME j I � i f I TO BE REMOVED I I I I ONCE NEW HOME IS I I IN PLACE. I ----- 2 PUMP LINE I I I I APPROXMENTLY I I 140 FT f I I r r I I NOTE .WATCH DISTANCE FROM Fa WIESER 1000/600 COMBO TANK TO THE WELL 25FT MIN 101 TANK POLY LOCK 525 FILTER SET BOTOOM OF TANK 6 FT. VERIFY ELEVTIONS ON SITE. WELL 3 BEDROOM HOME JEFF ARNESON 1932 HWY 46 NEW RICHMOND WI SEC 30 T 31 R 16 W CYLON TOWNSHIP PARCEL ID 006-1067-95-100 INLE 0) Lo A 4" CAST —A —SEAL 02 0� / l� Ill �� / FILTER OR BAFFLE -JlJL TOP VIE W SIDE VIEW 4" CAST —A —SEAL ,A " VLN T OU TILE T ) PAD TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS W1000/600-MR TANK SPECIFICATIONS DIMENSIONS: WALL: 2 1/2w BOTTOM: 3" COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 69 1/2" O.D. LENGTH: 114 7/8" O.D. WIDTH: 93" O.D. BELOW INLET: 57* O.D. LIQUID LEVEL: 51" WEIGHT: 12,380 LBS. INLET AND OUTLET: 4" CAST —A —SEAL BOOT OR EQUAL GASKET, CAST —A —SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 19.61 GAL/IN (SEPTIC) 11-82 GAL/IN (PUMP) LOADING DESIGN: 89 0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC/SEPTIC, SEPTIC/PUMP OR SEPTIC/SIPHON COVER: MIX DESIGN #8 NO FIBER) TANK: MIX DESIGN #10 STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WESER CONCRETE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: 0 m l C u'- (3 § C C3 0 L" ul rl-- Id, U) (.c) o L0 z 00 LLJ U) �© 0 X 00 SHEET NO. joF POINTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION Owner JEFF ARNESON Permit # DESIGN PARAMETERS Number of Bedrooms 3 0 NA Number of Public Facility Units 1XNA Estimated flow (average) 300 gal/day Design flow (peak), (Estimated x 1.5) 450 gal/day Soil Application Rate 3.2 gal/day/ft' Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) :!;30 mg/L Biochemical Oxygen Demand (BOD.) 5220 mg/L 13 NA Total Suspended Solids (TSS) --Sl 50 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD.) 530 mg/L Total Suspended Solids (TSS) 530 mg/L 0 NA Fecal Coliform (geometric mean) :510* cfu/1 00ml Maximum Effluent Particle Size Ye in dia. 0 NA Other: 11 NA *Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity 1000 gal 0 NA Septic Tank Manufacturer WIESER 0 NA Effluent Filter Manufacturer POLY LOCK 0 NA Effluent Filter Model 525 11 NA Pump Tank Capacity 600 2al 0 NA Pump Tank Manufacturer WIESER 0 NA Pump Manufacturer GOULDS 13 NA Pump Model EP04 [I NA Pretreatment Unit 13 NA 0 Sand/Gravel Filter 13 Peat Filter 0 Mechanical Aeration 0 Wetland 0 Disinfection 0 Other: Dispersal Call(s) 0 NA 0 In -Ground {gravity) 0 In -Ground (pressurized) 0 At -Grade 0 Mound 0 Drip -Line CKDther: Other: EXSISTING BED 0 NA Other. 0 NA Other: El NA Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 ❑13 month(s) (Maximum 3 years) [Xyear(s) 0 NA I Pump out contents of tank(s) When combined sludge and scum equals one-third %) of tank volume 0 NA Inspect dispersal cell(s) At least once every: 0 month(s) (Maximum 3 ears) 3 IR year y 0 NA Clean effluent filter At least once every: month(s) 1 &Yea(s) 0 NA Inspect pump, pump controls & alarm At least once every: 0 month(s) 3 [1 year(s) 0 NA Flush laterals and pressure test At least once every: 0 month(s) 13 year(s) E�(NA Other: At least once every: ❑0 month(s) 1-3 year(s) BxNA Other: 0 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; POVVTS Inspector, POVVTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tanks) 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) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local 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 chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent fitters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <l 2 months, shall be performed by a certified POVVTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page _?.-of S___ START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankis) 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. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwatar levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(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 P0VV7S 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 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination 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. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, 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 property 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: 13 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. tcr Wu F-7b_U I L taVeTTMIL Upw; failwe aloe '170- Mpliscericilt 31 ea IS a o rng ank 1>441 15 rFEI�1- 9=b,4e__ Xjg�Aj C.0&157 LICIn 0 ❑ 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 Name COUNTRYSIDE PLUMBING Phone 715-246-2660 1 M POWTS MAINTAINER EName PAUL R KOEHLER Phone 9d 715-246-2660 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY 2Z1 �j Name BERENDS Name � Phone 715-265-4623 Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&ffi and 83.540), (2) & (3), Wisconsin Administrative Code. Septic -Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer WIESER Tank Model Number 1000/600 Total Tank Capacity 1,600.00 Max. Bury Depth - 18.00 Filter Manufacturer Filter Model Number i ip!-7t" --I Mini&m Pump Performance Required GPM J75 Ft TDH W UF -- Outlet Manhole Min. 4" Above Grade With Locking Device. Inlet Manhole < 6" Below Grade Sealed Watertight •@MOWN Finished Grade Inlet Depth of Cover Ft It - 19 - It - 4 - 94 - 4 . 44 le- 4- C - 4 , .9 Outlet Filter I 4F--.--- Inlet Baffle Pump Manufacturer GOULDS -.Pump Model Number EP04 -Alarm Manufacturer SJ ROMBUS Alarm Model Number Switch Type Total Dynamic Head (TDH) - Feet Elevation Head 0 tao �0_ 0 Distal Pressure A) P Network Loss PC Force Main Loss - 1311460 -0 Total .37w- Securely Mounted Weather-proof Junction Box ow ON am own Vent Min. 12" Above Grade With Vent Cap 13 Manhole Min. 4" Above Grade With Locking Device 1 3� I Xss, Disconnect il Means K00,00" 000 so t b -C 3% 01 A P16 �: Switch Settings and Reserve Capac 81 It I ity 4 '44 1/45 11 .4 Tank Volume GPI it 34 Weep Ic Dimension Inches Volume Gal. -C Hole �Ibqvl -C T B �It sk P .9 IRV Ica, (reserve) A 26 307.00 moor= M1 (alarm) B 2 24.00 Off Elevation C P% .4be (dose,) C 10 118.00 4 30 Ft A it — 04 31 —01. .10 4C 3% (dead) D 1 3. Bottom 111cp 2 142.00 .4014 D 30 $1 .4 1.41 Elevation ),It T L— Total 50 =59 1. 00 19 4 Ft 4A wwm� 4 4 4 4 4 4 4 4 4 4 4 4 A ►-qq 9 4 4 4 4 4 4 4 4 4 4 4 4 4 4 q 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 2 - - - J% - 4* -► $I s 31 * ► ► $ b * $ & b * 3, 3, > I). > 30 k > > * b 3. 30 b J% ► GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) in•stalled. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16-28 WAC. 02/05 LJ Page of GOULDS PUMPS Submersible Effluent Pum .j � z �:� MaaF�. �s�� P EP04 & EP05 Series APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling -capability: 1/4 U maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet • Discharge size: 11/2" NPT • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 1 04'D F (401 continuous 1400 F (60" intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset • EP05 Single phase: 0.5 HP, 115 V or 230V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length, 16/3 SYTW with three prong grounding plug. Optional 20 foot length, 16/3 SJTW with three prong grounding plug (standard on EP05). • Fully submerged in high grade turbine oil for lubrication and efficient heat t Far14 Sfe Available for automatic and manual operation. Automatic models include Mechanical Float Switch assembled and preset at the factory. FEATURES N EP04 Impeller. Thermo- plastic semi -open design with pump out vanes for mechanical seal protection. METERS 101 LU Z 0 9 8 7 FEET ­ 0 EP05 Impeller. Thermo- plastic enclosed design for improved performance. E Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. E Motor Housing: Cast iron for effident heat transfer, strength, and durability. 0 Motor Cover: Thermoplastic cover with integral handle and float switch attachment points. 0 Power Cable: Severe duty rated oil and water resistant. N Bearings: Upper and lower heavy duty ball bearing con- struction. AGENCY LISTING ccoCanadian Standards Association us File # LR38549 Goulds Pumps is ISO 9001 Registered. 30 77 5 GPM ' 2.5 FT 25--- - 6r 20 0 0 0 10 20 30 40 50 GPM 0 2 4 6 8 10 12 ml/h CAPACITY Goulds Pumps 2005 ITT Water Technology, Inc. ITT Industries Effective January, 2005 63871 1v0QAtj�q#astrrQrXWW us49. 31 . 16 . 4 6M I&JtE�tPjMt ,Labor and Human Relations 5*M Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) PermLI�Hol er's Name: ❑ City ❑ Village own of: leor Insp. BM E ev_: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic D .�� SIC �— Aeration Holding TANK SETBACK INFORMATION TANK TO P / L WELL BLDG. Vent to Air Intake ROAD Septic -L. j ,/ 'fiA- NA NA Aeration Holding PUMP / SIPHON INFORMATION Mjjj rer Demand Model Number GPM TDH Lift Frictan ion S m TDH Ft e a Forcemain Length Dia. Dist. To Well f SOIL ABSORPTION SYSTEM ELEVATION DATA ou my Sanitary Permit No.: 18000 State Pan ID No.: Parcel Tax No.: — 7— — U0 A 9 2 0 0 3 8 1 �O/..� /9,-,9 STATION BS HI FS ELEV. Benchmark ,6 + Bldg. Sewer St /)Of In l et r? ' St /�K Outlet I Dt Inlet,---, Dt Bottom-- Header /,.AAert. Dist. Pipe p Z.&!2Z eot. System �f • Final Grade ,��r9!, �17 ;► BED / TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO P / L BLD G WELL LAKE / STREAM-EACHING Manufacturer: INFORMATION CHAMBER Type CC,-e)v • , Moe er: System: Z5 -,,� t: OR UNIT DISTRIBUTION SYSTEM Hea er / Length z5a� Dia Distribution Pipe(s) Length /�� Dia. � x Hoe Size x Hoe Spacing Vent To Air Intake > Spacing 5C7 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 Bed / Trench Center " q Bed / Trench Edges - Topsoil ❑ Yes [] No [j Yes ❑ No COMMENTS: (include code discrepancies, persons present, etc.) LOCATION: CYLON 30.31.16.466A,NE,SE,HWY, 46 Plan revision required? ❑ Yes No Use other side for additional information. yl/ SBD-6710 (R 05/9 1) Date Insnectnr's Sinnstilrp rort Mn 14 r AS BUILT SANITARY SYSTEIyi REPORT 0WNER,,�_� h ��� TOWNSHIP SECTION � N-R..�W ADDRESS ,�9- ST, CROIX COUNTY, WISCONSIN SUBDIVISION_ LOTLOT SIZE. PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM wµ. /L .o e INDICATE NORTH ARROW 1-1 BEN :Elevation and description: ' /at Alternate benchmark SEPTIC TANK:Manufacturer:+ ! Liquid Cap. i It R i 1" 1 ey n 1 i a Q A ! "T- m h r, r+ r, ! ®,.. a A R f . / ` ld I %i 0 "'t I a No J04:4.".1 Manufacturer: - Liquid capacity: I��IIlwwwwwww�ww�Iwlwl�i��Mill wllw� Pump Model: Pump/Siphon Manufact.: Pump Size Elevation of inlet: Bottoms of tank elevation Pump on elev.. Pump off elev.: Gallons/cycle: Alarm: Man.: Switch Type: Location Distance from nearest prop. line: Front...,-, Side..., Rear.Ft . Distance from: Well Building SOIL ABSORPTION SYS'TEK Bed: X Trench: Seepage Pit: Width: Length Number of Lines: Area Built )-ZL/ '`Y'Ayo? Exist. Grade Elev. ` Proposed Final Grade Elev. .-,�?9 Fill depth to top of pipe: No. feet from nearest prop. line: Front Side, Rear.,.Ft.' I/ No. feet from well:- - 1 No. feet from buildin .-3e HOLDING TANK Manuf acturer . Capacity: No. of rings used: Elevation of bottom tank: Elevation of inlet: No. feet from nearest prop. 1 ine : Front , Side.., Rear...Ft . Noe feet from: Well , building nearest road Alarm Manufacturer: INSPECTOR: DATE: PLUMBER ON JOB: 40mmmorom -=% �DILHR SANITARY PERMIT APPLICATION In accord with ILHR 83-05, Wis. Adm. Code -Attaqh complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches In size. -6ft reverse side for Instructions for completing this application. I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. 'PROPMTY OWNER PROPERTY LOCATION �'Off tnena &r,% 'I A LX Y46A % S —33 T3 - -.12 . TY OWNER'S MAILING ADDRESS iJ,,,, -7 F1 CITY, ZIP CODE PHONE NUMBER U. TYPE OF BUILDING: (Check one) ❑ state Owned ❑ Public 1 or 2 Fam. Dwelling -dot bedrooms�L W. BUILDING USE: (If building type Is public, check all that apply) 1 0 Apt/Condo LOT # SU W W 11 ..... .................... .................... 1 STATE PLAN I.D. NUMBER N, R�6 Xror)W Bt OCK A )KNAME OR CSM NUMBER ,0z 11 wig I NEAREST ROAD VILLAGE CY, ICEL T UMSER(, 7 60(0 —7 ?�' ICYO 2 LJ Assembly Hall 6 ❑Medical Facility/Nursing Home 3 ❑Campground 7 ❑Merchandise: Sales/Repairs 4 ❑Church/School 8 El Mobile Home Park 5 ❑Hotel/Motel 9 11 Office/Factory 10 ❑Outdoor Recreational Facility 11 El Restaurant/Bar/Dining 12 ❑Service Station/Car Wash 13 ❑Other: Specify 1IV. TYPE OF PERMIT: (Che ,��only one In line A. Check line B If applicable) A) 1. E]New 2. eplacemE] ent 3-Replacement of 4.E] Reconnecti on of 5.0 Repair of an System ,Ystem Tank Only Existing System 13) 10A Sanitary Existing System Permit was previously Issued. Permit # Date Issued V V. TYPE TYPEOFSYSTEM: (Check only one) Non -Pressurized Distribution Pressurized Distribution Experimental Other 11 Vq Seepage Bed 21 El Mound 30 1-1 Specify Type 41 El Holding Tank 12 Seepage Trench 22 13 In -Ground 420 Pit Privy 13 ❑ Seepage Pit Pressure 43 0 Vault Privy 14 System -I n-f I 11. ABSORPTION VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ASSORP. AREA 4. LOADING RATE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) 5. PERC. RATE 6. (Min./inch) SYSTEM ELEV. 7. FINAL GRADE Ox ELEVATION V11. TANK CAPACITY Feet Feet INFORMATION In galIons Total Ga lions, # of Tanks I Manufacturer's Name Prefab concrete Site Con- Steel Fiber- glass Plastic xpe Er. App. Now Tanks Tan strutted _§Wfig Tank or Holdina Tank W Lift Pum TaWNWM Chamber VIN. RESPONSIBRM STATEMENT 10 the undersigned, assume responsibility for installation of the onsite "wage system shown on the attached plans. Plumber's N rint): 0101�P ber's Sig re (No rnpe) /MPRSW No.: Business Phone Number: CCt 10 1 4477, u.�-up Co. -j, v Plumber's Address (Street, City State, Zip Code): J0011- oz� W. C2YNTYMEPARTMElff USE ONLY Disapproved Sanitar­y Permit Orwfudu Groundwater- Uate Issued Issuing nt SI No Sta fps) Approved Surchage I") 5 AB Owner Given Initial 64.00-. Adverselft lallg= X. CONDMONS OF APPRO REA 8 FOR DISAPPROVAL 4r _11 81313-O9B (10rMOdy PIWM (R. 11/88) DISTRIBUTION: Original to County. One Conv Tn- SAMN R R1111dintM Mwle6%n MamaLr Oh arv%"v STC-100 This application form is to be completed in full and signed the owner s of t q • by he property being developed, An inadequacies Will one. resin Y g Y t in delays of the permit issuance. Should this development be intended for resale b contractor Y owner %� , (spec hou se), then a second form should be retained and completed when the property is sold p and submitted to this office with the appropriate deed recording, ! � !! i! M!!!! �!l�� �f i! it!!!! !!! i■r'! !!`!A fr. i*! �r.!!!��!!!!!!! �!!! !lilies!!!! "!!!! ! wAs ! !! �� A Owner of property r'o ► y___ [,4 , Location of property N /4 SS 1/4 , Section T_aL.N-Rj.(p W TownshipLV(Orl".1 Mailing address __ I Q 3 c)N '4wV '--#-4,(o � ►v.or�1 w� s coo r 7 Address of site Scx w.Q Subdivision name A?=O/ Lot no. Other homes on property? yes XNo Previous owner of property iJ,p� Total size of parcel Date parcel was created Are all corners and lot lines identifiable? Y__Yes e No Is this property being developed for (spec house)? Yes No Volume,, 9 (OLand Page Number �_ as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Surveyp Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owners of the property described in this information form, b virtue of a warranty deed recorded �. Y n the office f i ce of the County Register of Deeds as Document No, and that I (we) presently own the proposed site for P y p the sewage disposal system or I (we) STC--105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER k--J eA� �eh Q RSp,.� ROUTE/BOX NUMBER N.3 Q ,V ��L FIRE NO. CITY/STATE ZIP - +D / PROPERTY LOCATION: 0�—: 1/4 � 1 / , S e c t i on 3 o , T_. J N, R W Town of ��o „ , St. Croix County, Subdivision s� SDI Lot No. �. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping se out the tic P tank every three years or sooner, if needed, by a LICENSED SEPTIC TIC PUMPSR. What you put into the system can affect the function of the septic tank as a al p system. treatment stage in the waste disposal p St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix P County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained, '� p The property owner agrees to submit to St. Croix County Zoninga certification form, signed b the Y owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately30 days prior to three year expiration. Y I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix Count Zoning Office within year ration Y p date 30 days of the three expiration Y g . I Ow oil A$ St. Croix County Zoning Office P.O. Box 98 Hammond, WI 54015 (715) 796-2239 or (715) 425-8363 Sign, Hate, and Return to above address DEPARTMENT OF INDUSTRY, REPORT ON SOIL BORINGS AND LABOR AND PERCOLATION TESTS (115) HUMAN RELATIONS ill 41R 127 (1Q111 A. f`I6sn►er 1dC.1 SAFETY & BUILD1 DIVI; P.O. BOX MADISON, WI 5 . P OCATv�.� V, o : /T3i N/RMLor.) W TOWNSHIPiI ITY: OT NO.: rn/a BLK. NO.: SUBDIVISION NAME - NE NE 3o Clon n/a n/a COUNTY: R AME: MA : Ste Croix,-, Neff & Kim Arneson 11932 Hy. #46, New Richmond, Wi . 54017 USE DATES OBSERVATIONS MADE F-ilkesicience NO. B : O n/a r DES I"i I O_ N_ : clew KReplace YES! 7--23--92 n/a HATING: So Site suitable for system k:caNir €f .: WS 1:1Ui EDS EJU U= Site unsuitable for system IN-GR("6 EWA: SYSTEM_jN FALL 4OLUING TAI'tittK: fiEC�OMMENDED SYSTEM:(npliollaI) HS EJU E4 IS convent Tonal It f Percolation Tests ere NOT required DESIGN RATE: If any portion of the tested area is In the"ider s. ILHR 83.09(5)(b), Indicate: Class 2 Fioodplain, indicate Floodplain elevation: na/ PROFILE DESCRIPTIONS rnern 99 Arun 130I1ING NUMBED TOTAL D'EPI"H IN. ELEVATION PTH-TQ QRQUNU ATER-INCISES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEP TQ BEDROCK IF OBSERVED ISEE ABBRV. ON BACK.) 013SE13VED EST. 141GPrST B- 1 96 99.70 none ?9 L. ; 10-26, 1QyL , s • ; - 1 0-10, 0yr3/2-I , 10vr5j4__,__1s*;, 44- 1 r4 4 Co. S. Q,- � �4 9� . �� none �'�►� �D-14 , 1(�yr4 2 , Imo. ; 1 - ! yr � �+ S 33-84 r5 B+ 3 90 J'Q 9.30 none one >9u , 14yr3 2 , L. ; -'- , yr , Sl . � .. d ! 2-9010yr4/4 Is. & S. stratified B- B- Q` PERCOLATION TESTS `I I_SI NUM13ER P- DEPTH WATER IN HOLE TEST TIME DROP IN WATIEH LEVEL -INCHES RATE MINUTES INCHES AFTER SWELLING INTERVAL -MIN. P Ejff 1 S212 t PER INCH P_ P- W161 P P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the h+ zontel and vertical elevation reference points and show their location on the plot plan. Shown the surface elevation at all borings and the direction and perc, of land slope. SYSTEM ELEVATION 95.2O _ � � looll�_ J0v o, I 0� O.S 74 lip fig �r i t J r r V., r r f Cam► 0 I i �• Q, , l.roSS at n • 193� .t�..,� �i�� 0 2" OF AGGRIE6AlE L C V. 0 F 00,0, F E T o A -IS y (A Ff 4 6 h AIr Ift.1 Arid Ob at Ira 110A p1p Cap 12" Above Geode 2 0 4 Z' Above pjpx 4* Coal lrom To final 014611 Vaml Plot Hay Of Sr AIK41k Cover$ 1wrm 2 11 ova( Pip$ PIP$ T 60 AjqrSj*j@ Bonsai& pip# o patieferod Ptp® below 0 TafinlAsIlfso Al sollogn 01 Slifem A,ppmovcc S49PACTIC CO AT E Rp�j- 0 R 9'0 of OK MAKSM s4A,%j- r --7 STR I � 'J T 11.) W PirE To ISE AT L�EAS'T W ACHES BELOW ORIGIUAL &R,&nr kJU AT LENST1.0 WCHE.S. BUT kjo Morkr - a THA)--J 42. IMCIJES 15ELM-1 FIMAL M11MM Deprvi OF EXCAVAT100 FeXom 0AIttWAL 6�ADF- VJ I L L is r- I U C H E S nN'nVM ffPrli OF EACAVATlc�J r-ROJv\ �164JAL GRAVE WILL BC MicHr-S LIC [jiSr WUMBE H: . ..................... D AT 9 ::2 DEPARTMENT OF �I�VDUSTRY, LABOR AND HUMAN RELATIONS REPORT ON SOIL BORINGS AND PERCOLATION TESTS (115) (ILHR 83.09(7) &Chapter 145) SAFETY & BUILDINGS DIVISION P.O. BOX 7969 MADISON, WI 53707 LOCATION: !/4 �� SECTION: /T31 N/R w TOWNSHIP/�ITY: OT NO.: BILK NO.: SUBDIVISION NAME: NE SE 30 16140r) Cylon n/a n/a n/a COUNTY: WNER`S18jbb~AME: MAADDRESS: St. Croix Jeff &Kim Arneson 11932 Hy. #46, New Richmond, Wi. 54017 USE NO. B COMMERCIAL E T C) esidence 4 n/a OD11ew EDReplece RATING: Sm Site suitable for system U= Site unsuitable for system DATES OBSERVATION'S MADE 7-23-92 n/a ONVENTMOUND: E�4 E:7i][x� ❑� IN-GROUN FSSURE: [�S ❑U ___r❑ M-IN-FILL S �� OLDING TANK: ❑ S �]U RECOMMENDED SYSTEM: (optional) conventional If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: class 2 1 Floodplain, indicate Floodplain elevation: ric3/ PROFILE DESCRIPTIONS page 22 AOB BORING NUMBER TOTAL DEPTH IN, ELEVATION QEPTH TO QRQUND ATER-INCHES EST. HIGHTS CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) —OBSERVED �- 1 9b 99.70 none >9b si . ; 0-10, 1pyr3/2, L• ; 10-2�►, lUyr -- ,- 1 4 ls•• - 10-14, 9Le;b 1 4/4, Cv. S. B. 2 V'T J� . �7V none ��� 10yr4/2,+4 siJL,;— Ll4 • 33_,,,Q1� 1 5 /42 so B. 3 90 99.30 none >90 TS $_ 10yr3/2, 2-90, 1 4/4, is . & S. stratified B- B- B- PERCOLATION TESTS NUMBER DEPTH INCHES WATER IN HOLE AFTERSWELLING TEST TIME INTERVAL -MIN. ® V -1 H RATE MINUTES PER INCH PERIOD 1 p P- P- P- W:= iUs3JLr:yL1 JLCMIte P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 9 5 . 2fl +fY1 t i yn V 7 _ r I I � C � � j}" �+ i � t ytl I i +l " _ -- _ __ _ _ __ - -T4 - 6_4mll tN N ;'.0 j _ I t i ( 6 ► i ! `IJ t " � i i i 1 ! I .. _ .Jr. _ �. .��-� ._ r�.� _..... — _ d. �..._..._ __ .._ l-- — ... _ �� I i i E t I t Mailing Address Property Address ST. CROI:X COUNTY SEPTIC TAI\TK MA2NT=ANCE ACRE AND CERTIFICATION FORM 4� 193a (Verificarion required m Planning & Zoning Department for new construction-) City/State { w Parcel Identification Number 00(v 10&�]:,qS.joo LEGAL DESCRIPTION Property Location V , V4 . Sec.. 0 , T 31 N R�W, Town of),o . P rty' - ---- Subdivision Plat: , Lot ## Certified Survey Map # Voe , Page 4 WwTanty Deed # Spec house [3 yes Q no (before 2007)Volume ,Page.# Lot lines identffiable 0 yes 0 no SYSTEM ALkINTENANCE AND OWNER CERTM CATI ON Improper use and maintenance of your septic system could result in its premature faflure to handle wastes. Proper aiamtenance 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 tenance respo"b lities are specified in §SPS. 3 83.52(l) 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, j omneyman 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 113 M of sludge. I1we, 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 Safety And Professional Services and the Depmtment of Nataral Resources, State of Visconsin. Certification stating that your septic system has been maintained must be completed and retied to the St Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this fog are true to the best of myIota knowledge. Uwe am/are the owner(s) of the property descnbed above, by virtue of a waaa=.y deed recorded in Register of Deeds Office. Number of bedroo 0 �IA - - e-IZ2-12t SI TURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the smaitazy 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 rn if reference is made m the warranty d3.eed. (REV. 04M) J4 '-11' —U- WATER - -----__------�_W — — — — — ----4-8* —__- ��-- - - - - - - - - - - - - - - - - - - - - - - - - - - - - + ! ELECT `D t I 1 r I 1 t�2" I I MV DROP I 1 r I � I � f IEl F1 n F1 I I I I +� -- •__• ---- -- _ _ -..- --- -^ - --- _ - .--. ----- _-.. ..- ----.-. - ..-. ..... .. - ---. -- - -..... - - -.-.. - ..-. ----.._._... I r ❑ ❑ ❑ ❑ ❑ p ❑ I f Ll I I I I I ! I t I I I I I t I ! I I I 1 I l f L. _— — --- --- -------r— — t,— —_-- — ----- ---- -- -- — — -- — --J — 461=0- 42'-0" 34'-0` 261-01 lfl,_0� 10._0, SERVICE £PlUMCE LEGEND I L [3 r EC� EL£CTRICfIL DROP S � ----�— W� a WRTER INLET D= DWV PLLUIBING DROP NOTE. REFER TO INSTALLATION MANUAL FOR PIER LOADS ALL LOCATIONS FIRE FIPPROKIMRTE CrMf+PAC[ VEWI1LAI10r1 13?0 50. FT. OF CAIWSPACE ABTA NOM TIE FOLD0110N UIDTH SON 2i'-B' VEHTILflT am IS va ar 144 50. IN. OF VENT FOR EVERY 3pD Sp. FT. GM 50. Ill. of VENT REQUIRED 15 IDWIOX TO TrE OVERALL F10OR N101H OF THE f". Of 0ftL6 HCE OKA WITH OPPRNEB VAPOR RETORDER KRIERIAE. ONE SUCH TTVENTS WaEg 0 S2 SO. IN. EFILH THE FOW01ION MY BE CONSTRUCTED UP 10 1 IR' 111DER VENT KET iE H1THIN 3 FT. OF EADI ONMIER 176 SO. IN. 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