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038-1041-95-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sa itary Permit No sl& 552316 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)]. -/l q -7 Permit Holder's Name: City Village X Township Parcel Tax No: Severson, Glenn Star Prairie, Town of 038-1041-95-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: /60 ►J Gb T- 10.31.18.1828 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 3-7- Septic J Ff_6L_j 4+ A?- Z r /14~ Benchmark aynl~ ~Q2• 166 Dosing / AU. BM 163 . bo lOc~ o o S Aeration Bldg. Sewer Z • ~ ~a~ r Holding St/Ht Inlet 7 9 TANK SETBACK INFORMATION St/Ht Outlet TANK TO A WELL JBLDG Air Intake ROAD Dt Inlet Septic 7 CO 96 Dt Bottom ` 1.Z. • Dosing x Header/Man. '7 A14 U . ~ Aeration Dist. Pipe 3 . (0 9S . (v Holding Bot. System 14.1 ms PUMP/SIPHON INFORMATION Final Grade , cp 11a , i~ Z •3 Manufacturer r♦ I 6~,a.. GP Demand St cover Model Number 25 ►~Fc~. r TDH Lift 7, 5 Friction Los / System Heead3 TDH 4Ft Forcemain Lengtt(4 Diai 11 1 Dist. to Well /6 i SOIL ABSORPTION SYSTEM BED/TRENCH Width Length NPIT DIMENSIONS No. Of Pits Insido. Liq Depth DIMENSIONS / Z 75 SETBACK SYSTEM TO / P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Typ O Sy e~ q ~ UNIT G~ nom- - f J? Model Number: DISTRIBUTI N S TEM /,J Header/Manifold Distribution x Hole Size x Hole Spacing VPunAp o Air Intake ` Pipe(s) 3 ~!D Z //t Length Dia / \ Length~1 Dia Z Spacing a 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 / r O Bed/Trench Edges N Topsoil t 1~' Yes No ~[^]s 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 5 / /7 / 12- Inspection #2: Location: 2281 CTY RD CC New Richmond, WI 54017 (NW 1/4 NW 1/4 10 T31 N R1 8W) metes &/bounds Lot Parcel No1.1828 1.) Alt BM Description= 1 p 2.) Bldg sewer length = - amount of cover 4z p J G LC- 6% 1,, 5 YZ - Plan revision Required? 0 Yes No 5 l 1' Use other side for additional information. 1 ! SBD-6710 (R.3/97) Date Insepctor's gnature Cert. No. corramerce.wi.gOV Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 G T • (49/-k Madison, W1 53707-7162 S~t~ar~yt~Per~mi't~N mber(~ob~t~d~ yC,.) Depatiment of Commerce , I_: _ ~ W'v ~ I K5 ~i - Y ~ State Transaction Number Sanitary Permit Applicatio an -7 r- -L 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. PeTSOneI information you pro,' be used for secondary purposes in accordance with the Privac Law, s. 15.04 1 (m , Slats, yYt,2 1. Application Information - Please Print All Information Property Owner's Name Parcel # \ C=23~- All-I) Property Owner's M:av ddT. CRUi Prop I~ erty Location f I I nJ S ~C COUNTY Z Z ANPJING £I Govt. Lot _ b city, state onSection T f' N; R circiEot~ -~1 It. Type of Building (check all that apply) Lot # Subdivision Name l or 2 Family Dwelling -Number of Bedrooms I~ Block # ❑ Public/Commercial -Describe Use ❑ City of CSM Number ❑ Village of ❑ State Owned -Describe Use own of III. Type of Permit: (Check oal ox on line A. Complete line B if applicable) Trealmenalolding Tank Replacement Only ❑ Other Modification to Existing System (explain) epl A-74 ew System ramrn~ . 11 Permit Renewal ermit Revision ❑Chan a ofPlumbet ❑PermitTransfer to New List Previous Permit Number and Date Issued B Before Expiration Owner unklwwn IV. Type ofPOWTS S stem/Com onent/Device: Che -that apply) ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in, of suitable soil Non-Pressurized In-Ground ❑ Pressurized In-Grou -Grade ❑ Holding Tank ❑ Other Dispersal Component (explain)-- ❑ Pretreatment do (explain)_ V. Dispersal/Treatment Area Information: G Design Flow (gpd) Design Soil A plication Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total # of Manufacturer o Gallons Gallons Units U _ y New Tanks Existing Tanks o w U inn y rn is. c7 P, Septic or Holding Tank L Dosing Chamber 6.3 i7 VII. Responsibility Statement- 1, the undersigned, assum ponsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's re MPIMPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) VI . Coun !De artment Use Onl Permit Fee Date Issued Isstiing Agen Sign ure Approved ❑ Disapproved $ f" Z ❑ Owner Given Reason for Denial IX. Conditions of ApprovaURessons for Disapproval Ale&l sv` 1 l ~ owy(G 14i0- IMF 4C-6 ' l ~f Attach to c plete plans for the system and submit to the County only on paper not less than S In z ' ehes in size SBD-6398 (R. 02/09) i)E4 aRTb~N. Safety and Buildings 141 NW BARSTOW ST FL 4TH ~Cr WAUKESHA WI 53188-3789 3 ~ Contact Through Relay www.dsps.wi.gov/sb/ ,o www.vAsconsin.gov ~sszoxP~s~ Scott Walker, Governor Dave Ross, Secretary April 26, 2012 CUST ID No. 226900 ATTN.- POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 04/2612014 Transaction ID No. 2077972 SITE: Site ID No. 777328 Glenn Severson Please refer to both identification numbers, 2281 Cty Rd Cc above, in all correspondence with the Town of Star Prairie agency- St Croix County NWl/4, NWl/4, S10, T3 IN, R18W FOR: Description: At-Grade, 3 bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1362197 Revision; Maintenance required; Replacement system; 38 GPD Flow rate; 28 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 any 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. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and with the At-grade Component Manual, Version 2.0, SBD-10854 (N.03/07), and the Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01/01) ~ C-~, 4f" 0 In the event this soil absorption system or any of its component parts malfunctions so as create Y,the th hazard, the property owner must follow the contingency plan as described in the approve . 1' diti owner must comply with the operation, maintenance and monitoring duties as described i4ss VI j of the at-grade component manual. A copy of this information must be given to the owner upon coe the project. CQ/ Maintenance information must be given to the owner of the tank explaining that periodic leaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Slats. SHAUN R BIRD Page 2 4/26/2012 Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383 54(4) shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Si ly, Fee Required $ 85.00 Fee Received $ 85.00 Balance Due $ 0.00 Julia Lewis-Osborne POWTS Reviewer 2, Integrated Services WiSMART code: 7633 (262) 397-6005, Fax: (608) 283-7481 julia.lewis@wisconsin.gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety & Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. PLOT PLAN PROJECT Glenn Severson ADDRESS 2281 Ctv Rd CC New Richmond Wi 54017 NW 1/4 NW 1/4S 10 /T 31 N/R 18 W TOWN Star-Prairie COUNTY ST. CROIX SYSTEM ELEVATION 99.0' BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA 750 # of chambers none BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter BEST GF10-8 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Cty Rd CC 200' Property Line 1110- Scale = 1/4" = 10' B-2 100'98, 12.5 Acre Parcel Old house burned down, 96' old system is to be buried B-3 18% Slope Grading is to be done to divert run-off away from system Well O 99' Area 15' below system is to Huffcutt Combo Tank B-1 B' M' * remain undisturbed Tank is to be properly bedded and provided with lockdown covers with approve warning labels Pro 3 Bedroom House Wisconsin Departm't of Comme "770 - SOIL EVALUATION tPj!!Tj Page I of Division of Safe ands Buildin n 1 h Comm 85, Wis. Adm. Code Attach complete site plan o4a S 1/2 x 11 inches in size. Plan must ix include, but not limited to: zontal reference point (BM), direction and Parcel I.D. percent slope, scale or ~f , s, north arrow, and location and distance to nearest road. Please print all information. Reviewed b Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 7 Property Owner Property Location 'A'l cLa Govt. Lot 114jtAJ14 S/ /S T / N R (o W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City S t Zip Code Phone Number ❑ City ❑ Village ,Town Nearest Road Z4 ~ _w 5LIE)1,71 l ( ❑ New Construction Useg Residential / Number of bedrooms - Code derived design flow rate 5/0ZJ GPD Replacement / ~Jf Public or commercial - Describe: Parent material ~t~(Y o Flood Plain elevation if applicable ft. General comments endati 7 Z 3 (O ~t " (il and recommendations: r'1 System Type 6c~ System Elevation 72,0 Boring # Boring F Tl tGt Pit Ground surface elev. 2 21 t2 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Z 3-o 7,. s - 070 2, ~1)14 /7 Boring # ❑ Boring ® Pit Ground surface elev. l~ 01- Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 •Eff#2 ~s , v --3 . s ' 31< 51 4k -3 Z 70 7, ~t/ Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 11 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST N mg (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird lure 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 549;;--// 715-246-4516 f Property Owner _ Parcel ID # Page of Ong # Boring g 3 R~1. pit Ground surface elev. Depth to limiting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 31-ill 7,ZX V/4 ~A~'S F-1 F] Boring # 0 Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 F Boring Boring # 11 Ground surface elev. ft. Depth to limiting factor in. pit Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 III Effluent #1 = BOD, > 30:< 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD, < 30 mg& and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SOD-8330 (R.W00) Soil Test Plot Plan Project Name Glenn Severson shau rd Address 2281 Cty Rd CC New Richmond Wi 54017 C V1 Lot Subdivision Date 112112 NW 1/4 NW 1/4S 10 T 31 N/R18 W Township StarPrairie Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 2" pipe System Elevation 99.0 *HRpSameas Benchmark Cty Rd CC 200' Property Line Scale = 1/4" = 10' B-2 10098, 12.5 Acre Parcel 96' Old house burned down, old system is to be buried B-3 18% Slope Well O 99, B-1 B.M.* Pro 3 Bedroom House Cover Page Shaun Bird RECEIVED Bird Plumbing Inc. 1008 192nd Ave APR 1 6 2012 New Richmond Wi 54017 SAFETY & BUILDINGS 715-246-4516 Date: 4/12/12 Owner: Glenn Severson Location:NW1/4 NW1/4 S10 T31 N,R18W 2281 Cty Rd CC Star Prairie System type: At-Grade Revisin to Plan #2061620 Manuals Used: At-Grade Component Manual version 2.0 SBD 10854 (N. 03/07) Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01 /01) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-11. Soil test 12. Filter Specifications Shaun Bird F,L Signature ' License number 22 9 0 °~p F~ At-grade System Sloping Site Cross Section and Plan View r- - .-„T.... rr rr r. ■`r W .•y~.r •r ~r r rr.. 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Existing vegetation is mowed and raked off the site, The basal area (L x W) is staked out and plowed with a moldboard or chisel plow. Plowing may not proceed it the soil is wet enough at the plow depth. to form a '/4 inch soil wire when a sample is rolled between the palms of the hands. The A x B area is covered by clean aggregate deposited overhead by a backhoe. Special care must be used when placing the aggregate to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire at-grade is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are perforated in the lower 6 inches and secured in place. 03/051gj Page of Pressure Lateral Layout One Lateral - End Manifold 4 Threaded Cleanout l Lateral Turn-up - P. Plug Force Main X L Long Sweep 90 Bend Pressure System Construction Distribution Network Specifications Lateral Diameter In. Laterals are constructed of Schedule 40 PVC Orifice Diameter 3 J 1 In. pipe. Orifices are drilled perpendicular to X Orifice Spacing) In. the pipe with a sharp drill bit and face down. L Lateral Length) 7 Ft. Lateral turn-ups terminate with a threaded Force Main Diameter In. cleariout plug and are enclosed in a 6-8 inch Force Main Length Ft. diameter lawn sprinkler valve box accessible from finished grade. • Grade :Q 6-8 Inch Lawn Sprinkler Valve Box 03/051gi Page of Septic-Dose ` 'aiank Cross Section And. Pump Performance Specifications Tank l'vli aacturer ~ Ct P!!Tp Manufacturer 1."ank Model N'mrtbar tic so Q Pump Model Number ~ Total Tank Capacity mitt> 3;D Alarm Manufacturer - ~je L (v S~ 5¢P~,~ c? Max. Bury Dcptlr --r - _ Alarm Muriel plumber. _ Switch Type /77 CA~_ Itre t,4' r, Filter Manufacturer C 'Total Dynamic Head (TD14) w feet Fitter Model :Num err I ;F Elevation _Reacl Distal Pressure o?. _ _ 'N'etwork T~c►ss _ MinimYUn Pump lerformanae Required Force Main L gs , 02 GPM: Ft 3'DH Total . Outlet Manhole Min. 4" Above Grade With ' Lucking De~iice. Inlet Manhole Manhole Min. 4" Above Gracie b„ Below GrWe Sealed Watertight Securely Mounted With Looking Device Weather-proof .lunc:tion Brix i.W imp W- Finished Grade ~ YrL11 YIIIf wr rl ..1. ~ ~ Vent Min. 12„ Disconnect " Above Grade Means With "Went Cap i { i > >I{ >ai > itL ! l~i~> 1 {/i 1•tit) )IL>>irt•,ia•1. Y,la•lit) rti,ll>r )fir/rt r)a• 1,{ •1~l; `t•Y !1)"! Y•1 Y`Y iafa} 1 f } YIrt1 ! i r / ! Y`/ / L L l L 1 ':•1 1 `1 Outlet Filter Inlet 1, iitY ;!1{ .1! Switch Settings and Reserve Capacity A y~yy Tank `lrolunaeOPx Weep Dimension, Inches 'V`oluutne Gal. B Hole 1•r (reserve) A: -06 - 7 11 L`{ (alarm) B: 2 3 j Off Elevation 1 i t t:t --L---•- tl:i yi~y C"-_ r I l t !i 1YI`, (don) ~Ly{. (({y~ YI ! r Y Bottoin (dead) D - - l) Elevation _Total `02 _ .5 it{ j 1• . Yl•Ii.YV iii, lifitltil>: 7 l-~i. S,')t ,~rrrc~`crrcrcz-a-~~~-ra-rrY- ,t~.L i~ •1 . 1 ,1 1• t a r > t l ter a i~~ i~r ti-t i i iiis~flt > t a 1 1 a, t. t. t t. 1 e, r t i + i t>r • r,t t r r~i '•YYh ,i!>r)`. ))•`)Yr>i />3>{>>>Y>>1>~111 YZ}Y IYIY`I `I•}hY 1!}`!}rL YI YY`I `{`Yir `{i`I )1 YI i>r 1 1 1.1>t•},. { r r ,it f/ t i t a f l t t l tit r t T I/ f i t t f f Y a l t, t l t t 1• i•/ i.,, t i r I f i i 1/ t{ i f [ { i t i l t,{ i t 1 i t i l r 1 1. t r r I• GENERAL INSTALLATION: The mptic/dose tank is be¢Wed and back tilled in accordance with the manatachucr's prodwt approval 51mitications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers expoBW to grade have art efli dive locking device (padlock) installed. :Piping at the inlet and OUdOt is 0f approved material conneeW to the tank with watertight fittings, and lard on stable soil to prevent settling or sagging. The force main is s1mvved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is scaled watertight. Electrical service complies with NBC 300 and Comm 16.2n, 02!05 U 'Page of 1 /lb.75"L tltliC/ ~ may-a-vv Ap, LsserJet 3100; • „R'' H SERIES STUMP/EFFLUENT PUMPI 9E 8.95 d 0 $paCif lCatiOnS 1mllgym tw 111,1 x ~ Wma M UfgLm Nt WA mie.lat A P t~ t+i t3.0 2l1 24 9.11 x1i.b4xB.94 13A 1000 70 64 55 4t 32 5083aQ UtIC54 y;0 tt5 65 1000 70 66 5$ dry 32 Wo 21 24 9.11 x11.64x8.84 8@t tytl t9.B 28 9.11 i 11,64x8.$4 qM 609340 141454 W Alto M 4h r~g~8 IMIC84 4Mo 0 115 94 13.0 1g30 78 84 55 4t 32 t 27 27 9.11 Y 1.61% .84 "-tlatk$ 1 are nmw18d1t1h18nb1~4►►4d~6~rttnse patffp4 Got:tinaeu6 OutyitMed -"Lmr GiaNVVasrewetn'Pbr4Pe~i4 raudeolaitalaesde111as IenY>~sY►4Y Con6triICt10l_.~- FLUW- L1rERS/Hn1lR Motor Houbin $ xy coated Cast Iron 0 lOQO 2000 3e0a eller Matl:tial Poly Carbonatc Imp Closed Vaoi% ADS 30 Volute Power Cord _ SJTW-AA 7.5 w Mec)n>tuic nl Shaft cut l~ifii a with carbon and ~ ceratiUC faces 20 a Rtainlesc.Steel Shah Upper Sleeve and Lower = 10 2.5 ~eaCffi~b Ball H_em ings _ O 0 0 20 40 60 00 r4ttV' GALLONS/1.4INU7E Little Giant PUMP Co. PUMP PERFORMANCE CURVE f pp Now Lzets+old&%-* dy,OK13157 L15V 60HZ ! p4ame:409.947J511409.233.1550 E-aerM: cwiotpeteN~ttL~eot +~oo • ;rt Fam 946235 07103 Www LjttleG1antPamp.carm rce wi4pv Buildings Division county n gton Ave., P.O. Box 7162 of , 1 f ~j l thnsi;ef ~ son, WI53707-7162 S=w Permit Numbor(to be tilled in by Co.) 5z Sanitary Permit Appff-canhal state Tramaetion Number in accordance with s. Comm. 63.21(2), Wis. Adm. Code, aubmisaioa of Chia rm to governmental ZO~ p Zb unit is required prior to obtaining a sanitary permit. Note. Applicatio forme POWTS are Project Address (if different than mailing submitted to the Dopardt►ent of Commerce. Personal information yo pmvide may ZZQ t in accordance with the Privacy Law, a. 15. 1 m , Stats. I. Application Information - Now Print All Info don All h Property Owner's Natoe s 3 Parcel # le- 10 Property Owners Mailing Addowas Property Location Z Z ' Ar Govt" Lot 1 s5z City, state Zip Code Phone Number /(f ~v yti y won U 21 t J l /trcle T _.1[N; R _ E 0[ - It. Type of Building (check A that apply) Lot # ~ ❑ 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name :*t4vw. C*J Block# ❑ Public/Commercial - Describe Use ❑ City of _ ❑ State Owned - Describe Use CSM Number ❑ Village of I/ ( Townof tJl !u" III. Type of Pert: (Check only one box on line A. Complete But B N applicable) A. ❑ New System Replacement System ❑ TreatmeuMolding Tank Replacement Only ❑ Other Modification to Exining System (explain) a B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Phrmber ❑ Permit Tranafer to Now Lrst Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS 3 stem/Co1n oaent/Device: Check all that apply) D ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade Mound ? 24 ia. of suitable soil ❑ Mound < 24 in. of suitable soil _ ❑ Holding Tank ❑ Other Disperse! Component (explain) ❑ Pretreaunent Device (expiaim) 4 Al V. Die rem (ent Area Information: Design Flow (gPd) Design soil Applicatio Dispersal Aron Rsq ' Dispersal Area (sf) System z v o. ) 2 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tanks Septic or Holding Teak.. nosing Chamber S , VII. Responsibility Statement I, the heelers asst adbility for Installation of the POWTS abown on tits attached plans. Apo Plumber' Name (Print) Plumbs ' taro MP/M PRS Number Business Phone Nurser Plumber's Address (Street, City, State, Zip Code - i / ,2 lot VIII oan /De ent U only Perot Fee Date I ued issuing t Signature Approved $ tQwrG-vc-n Reason for e i WG f 1 IX. Condit, ds for Ditlapproval Gati~:~-;on~- a~ f1 Jog 1. $eptic tank; effluent finer and 3 dspersol cell must all be services !maintained. w ` Ro as per management plan provided by plumber. a e e. C Pr 2.. A*so6*ckiequrcemenis trust be tnair>tairred Ansch to complete pWs %sr the oyster and submit to the Comply only on p*w not lees than a rn x 11 incises in des t~t~ SBD-6398 (R. 01/07) Valid tliru 01/09 -5 PA., .16, ~ f , o PLOT PLAN PROJECT Glenn Severson ADDRESS 2281 Ctv Rd CC New Richmond Wi 54017 NW 1/4 NW 1/4S 10 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX SYSTEM ELEVATION 101.0 3 BEDROOM CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of wood corner post ASSUME ELEVATION 100' Filter BEST GF10-8 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark 400' Pro ert Line 12.5 acre Parcel Scale is 1" = 40' unless otherwise 100' -Scale = 1/411 = 101 noted 'thee I I 0 0 M house burnt Area 15' below Down system is to remain undisturbed 6 slope 200' 8- 3 13 98, -1 99' 120' 10 10 0' 8- 2 Grading is to be done to divert run-off away from system Tank is to be properly bedded and provided with Huffcutt Combo Tank lockdown covers with approved warning labels vty Rd CC pro 3 bed roo m house ~,.PARTn T Safety and Buildings 51 os 141 NW BARSTOW ST FL 4TH c`am' @ WAUKESHA WI 53188-3789 4 Contact Through Relay wm.commerce.wi.gov/sb/ www.wisconsin.gov °sszoNtLS~ Scott Walker, Governor Dave Ross, Secretary March 13, 2012 CUST ID No. 226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/13/2014 Identification Numbers Transaction ID No. 2061620 SITE: Site ID No. 777328 Glenn Severson Please refer to both identification numbers, 2281 Cry Rd Cc above, in all correspondence with the Town of Star Prairie agency. St Croix County NWl/4, NWl/4, S10, T31N, R18W FOR: Description: Mound, 3 bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1362197 Maintenance required; Replacement system; 450 GPD Flow rate; 28 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD-10691-P (N.01/01), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01101); 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 any 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. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.01101) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.01/01). The building sewer and distribution network piping shall be of material liste Vso6crea,te ,38,,1r 0-3 and 384.30-5, Wis. Adm. Code. In the event this soil absorption system or any of its component parts malfunctiona health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must comply with the operation, maintenance and monitoring duties as described in section VIII of the mound component manual. A copy of this information must be given to the owner upon completion of the project. All holding/treatment tanks are to comply with SPS 384.25(7)(a). SHAUN R BIRD Page 2 3/13/2012 Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. rely_ , Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Julia Lewis-Osborne POWTS Reviewer 2, Integrated Services WiSMART code: 7633 (262) 397-6005, Fax: (608) 283-7481 j ulia.lewis@wisconsin. gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety & Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. Cover Page Shaun Bird Bird Plumbing Inc. RECEIVED 1008 192nd Ave MAR - 8 2012 New Richmond Wi 54017 715-246-4516 SAFETY & BUILDINGS Date: 3/ 6/12 Owner:Glenn Severson Location:NW1/4 NW1/4 S10 T31 N,R18 W 2281 Cty RD CC Star Prairie System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-12. Soil test 13. Filter Specifications and cros tion Shaun Bird Signature License number 226900 7, f 10 C F PLOT PLAN PROJECT Glenn Severson ADDRESS 2281 Ctv Rd CC New Richmond Wi 54017 ,NW 1/4 NW 1/4S 10 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX SYSTEM ELEVATION 101.0 BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of wood corner post ASSUME ELEVATION 1009 Filter BEST GF10-8 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark I 400' Pro er# Line Scale is 1" = 40' 12.5 Acre Parcel unless otherwise 100, kale = 1/4° = 101 noted Well ?0- M house burnt Area 15' below Down system is to remain undisturbed p B% slope 200' 8-3 13 98' 120' -1 99, 100, Grading is to be done to divert 8-2 run-off away from system Tank is to be properly bedded and provided with Huffcutt Combo Tank lockdown covers with approved warning labels wty Rd CC pro 3 bed roo m ho use Mound System Cross Section and Plan View Dimension Feet A r _ r B i R r D i A E r W r € i r F r lJ r s J .Z. r r H a r - r I I r a r r J r K r ILI K B Z L Slo e % r -'1 = Topsoil = ASTM C-33 = Clean aggregate Cap Material sand fill O = 4 in. sch. 40 pvc a %2 to 2 '/2 in. dia. observation pipe Geotextile Fabric G" H F Ft D E Ft Contour Plowed Surface ' Slope Direction GENERAL INSTALLATION: vegetation is mowed The mound area is staked out along the design contour. Existing chisel plow. and raked off the site. The mound basal area (L x W) is plowed with a moldboard or Plowing may of proceed if the soil is wet enough at the plow depth to farm a'/4 inch soil wire when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks is placed overhead by a backhoe. Special care must be used when Ph icing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 1.0/071gj Page of Pressure Lateral Layout Two Laterals - End Manifold o 'Threaded Cleanout Lateral Turn-up Plug Manifold M L - Long Force Main Sweep 90 Bend Distribution Network S ecii eations Pressure System Construction Lateral Diameter _ In. Manifold Diameter In. Laterals are constructed of Schedule 40 PVC Orifice Diameter In. pipe. Orifices are drilled perpendicular to X Orifice Spacing) In. the pipe with a sharp drill bit and face down. L Lateral Length) Ft. Lateral turn-ups terminate with a threaded M Manifold Length) Ft. ceanout plug and are enclosed in a 6-8 inch Force Main Diameter In. diameter lawn sprinkler valve box accessible Force Main Length Ft. from finished grade. • Grade :Cj 6-8 Inch Lawn Sprinkler Valve Box Page of 03/05 lgj Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer u- P!m Manufacturer _ . Tank Model Number 0 Pump Model Number Total Tank Capacity 30 Alarm Manufacturer Max. Bury Depth Ahmn Model Number v Switch Type ~ [filter Manufacturer Total Dynamic Head (TDH) - Feet. T Filter Model Number G d - - - 1Jlevatton Head Distal Pressure Network Loss Minimum Pump'erformanee Required Force Main Lass ~T Zz -7 0 GPM' @ 5-, h Ft TDH Total Outlet manhole min. 4" Above Grade With Locking De~uice. Inlet Manhole Manhole Min. 4" Above Grade < 6" Below Grade Sealed `~V'atertiaht Securely Mounted With Locking Device Weather-proof Junction Box s " r r Fi4ished Grade " r s r. Vent Min. 12" Disconnect Above Grade Means With Vent Cap t./+ rY/:rt:. Outlet Filter - - - :t Wet met $affle - - - - - - Switch Settings and Reserve Capacity A y Tank Volume = GPI Weep Dimension. Inches Volume Gal. g Hole (reserve) A! (alarm) B 2 Off Elevation C (dose) C s Ft Bottom (dead) D - Elevation Total C7 ' ' ~/y/p + +r +f+r s+,r 1~ L r t• 'CTi-t'i~l-f'FT'~1?-i'T'.. a f e a t t{ a t f i l { t{ a r{ 1 I/ i 1 t r t. c r. t t 1/ t t r 1 i t i t 5'. 1 f t s t t a 1 1 i t t 1/ t l t t/ a t l i a t l{ 1{ a t 1 1 a a t I t 1: I• ,Y + + Y,.,Y ! f s r,{s iii :.f tYay tri tYa Y<YaY.Y{Yi {yaf lY.Y.Y.iY.YaYtYI{i {Y.rt•:.+i i i ttaYataYal stirs i~t r.iY.Yi {ra{.Y.tat Y{Ytf.r{+tY/ttit {•rf tYtYlflYr•tr1 {tt•i i Tfs GENERAL INSTALLATION; The septictdon tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be, exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is, of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The farce main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28. 02/0511 Page of V LaserJet 3100; y 716 npe~ ; may-O-uo 00 9EH SERIES SUMP/EFFLUEN'T' Foump 11.85 0 i i ~ip~i#iea~i+ons Alllll m I Ili 11114 J99p9aE "=a$ Mt81 Al am 14'1t,1911 am ft K 1k.iri 4MaNR11 V ti l9 >dI Ou MI Mal 024 r 94 901-Itlt S119n9 wo 41+0 115 3" 132 1000 70 94 5s 41 32 13.8 20 24 9.11 x1tUx&94 043M 509340 WW V11 290 3N 6.5 1000 70 64 55 41 32 Ito 20 24 9.11 01.944/1 904-MIND 58&160 WO 400 115 34 Ito 1000 70 64 55 41 V 13.8 20' 27 8.11 r1t04x9.94 WHG W 698 0 OU;SII 41^0 280 3!4 65 1000 74 64 55 41 32 In 210 V 911 x 1181W! ~i011d114094 G9{pRrOd-"UI81 rtj9~N911tplNrylf>INi~9dt011`IIIIBIKtllltll>SIa9~i9yMY>IPlfY1x14i~9~M~AMIW!'♦Nf11~911Of~Mp 9191M1.' FLOW-- LITERS/HOUR c4metnurtien 9 1000 2000 3000 Motor Housing 1prxy Costad Cast Iron Impeller Material Poly Carbonatc 30 to [m er' c Closed Vane Volute ABS >.3 Power Cord _ WTW-A 20 Mechanical Shag S41a1 Nitrile with earbm and ceramic faces W s Fasteners StainlM Mt401 10- Shaft Stainlem Steel Hearings ( Upper Sleeve and Lower I Ball Bearings pill tilt[ Tr~ 0 20 40 60 80 FLOW- GALLONVAINUTE P,UW PERF URMANCE CURVE SMH Little !slant Plump Co. Iisv 60HZ ?(Ion 13110. Uld1lkl C3% ON 73157 mm) Plu mm 40S.N7.33t1 • Fast 405.221 LIMO • P~aaax eaa/erwrr~loa~ittl4tlrrt-4ea4 Www.LlttleG1aNt.Pump.COm 43 Fam 996286-07)03 OWNER'S MANUAL & MANAG ENT PLAN POWY'S SYVt"BM gp GATIONB 17 pit,..E It~IPOWMR't'lPH geptlcTanlC Ca> ©NU1 Owner SwprloTauNt Msett FA R a # Irfltttent f 1ltfafl ~ a NA a OVA 0001 PMA Mi~'IW d OVA M inbrr of B ' A CNPM* O Q NA r l Units M~ OVA .etpnded !loon (af~!fape) rtaefjr usWn x t7rete [ APP ' ►t U - 0 Past FII wr ~ Few S I= m9n' C3 ~nAsaftn Q Other. 21 afot~twMbM prgvont oartnard TOW Tog ~w t' so 1L a do prebawAsd ensci r ~NA ~ mg/L g" Sin-g= ws) fay nd (g?WAW a JaVound Cmeowfte ) nand t Tdrd (MIR Cwwkmn .00 FnWL a at- S Bci1Qw :sfra sine cdioornl 17 Oct a t7 Other= Foam a1 vskrs r~rpra~ t~ dseas~e~s trroneorexaeed~flv+sslsreso~r anQ . Ma)*m n ENtUW t PadM Stn! K kwhdiametsr MAtNTt`NiMiCE 9CH t.E gar~ Fraqueney 9lrtrtce event At feast once every "-1? 13 months A yew(*) (Ma3darum 3 res.) tnsped: condition of tank(s) ~ Pump out contents of tank(s) When contbtned sludge and sc ur n Squab ons-thiAd (K) of tanK volume At least once every mo r(s) (Mwximurn 3 yrs.) g irtspea disporaw Cott(a) dean n t< wg f fiber At least once every 0 months cnsp~w t pump, pump oontrats & alarm At toast onus, every II trlotttl'~~y~s) D MA At leash once ever ❑ rnont o Cl NSA Flush tltseats and prel+wme tit At least once every f3 months a year(s) 0 NA on,.r At M" tam every Q months a Yews) C1 NA neAfstTaNA@dGE !NS>Ttu,►GTIOIH8 tnapece" of bmb and dbp~ coo ahalt be trngd! by on bdi *kM ouTyitAg flea of 00 ftOVA" 110011M Or moons:, Aber Plumbw. hgm r Ptam*W Rasbiaesd aa"r. POWTS ffwposor. y Tangy ?bru~pldbn! tmrat (ttdudw a visual inspetatlwn of trio tartk{s) m t~aty any rNeebnp or txvta.n trarefwa% fdwffy any tancb* or I@Ww, trommule'the volume of mobbed atudge artd OMM end to chtw c for any beck B ~r Porrding of ~lSft on ft are d ! The 60P~ erWB) shalt be ,t ~ ~ ;n the gbsda mftn pkw and to dfeek for any po ndkv of sffkxvd an ft 9fl717ld a<ttSM Mo P0=0f +orriY ,gt*uW swft A! n" inditmfe s fll ft COMMM +aW mgtair+ss the Immed~9 t~ of the termfl exurA*ftn d MLWg* acrd Scum to sny lank equate on&4*d (V or none of to twdc , the ~,nf ~ ~+OVd bat s ~ ~9 r so c mrpand at fi with ch- NR bM 00101110 13, Wlaoonsin Admi d ratim Code. - Te he r<g of enmrti flf6 mwfttnkMi or pf*Mrtmd POWrS components, pm t oDaip°neft' and any Msintil~ meoolmmm or mortf wmg at Intefab of.12 monpl; orleas sheaf be pWfbrffW a oel'SAtrd Powys a rent A xr~ MpoFt SW to pM*Iod b VW tonal rtegUbtXY autluu'ItSf Wffhln I() &p of caarnp I of any sffV re st ARr UP AM OPgMTICW ~ t~ ~ Far a!wOxwkUdft pdor to tare &the POWM r wk.treatrrlent tarlk{s)forft p p c~rptrt4!!re ear rrery knpwd! 1170 tr,pt Mwg prtm!!s Sr Wor tfiarf*ge tins dispwvg ceff(s). If ft h Wn=Ab MMM SIN tm ON amtonts of true to Ks) removed by 8 Sepmge servicing apeteW pdo to tw& s' Sys start up shaft not occur vAisn soil'conditions are frozen at the infiltrative surface_ Page °t-- Durling power outages purnp tanks tn8y IiR above normal Ngt water levels. When power is rested the exoeu fir wN be discharged to the di spend cell(s) in one large dose. overloading the cetl(s) and may fftult in the bac kW or sarfaoe discharge of e"t To avoid this sftmt ion have the contents of the pump tank rarnoved by a Septr#ge g OpeKtor Pr10rWnW0XflV 'Power to tfte emuent pump or contact a Plumber or POWT S Meintairw to assist N fl=l iy opesaingr 00 PUMP ConttVI5 tra restore namlal levels within the pump tank Do not drive or park vahk*is ova Unb and &ISpQSW Cells. Do not drive or park Over Or oi#Iww se drsiurb yr=npact, the area wltwo 15 feet down a4w of ally mound or at-grade soft absorption area Reduction or-eGtninatkur of Me fb9aAV from the wastewater stiearn may improve the perfonranpe and prolong the ge of the PC)VYI'S. =Wb&.-5; bgbyW4 t .-dgamM9 butts; condoms, ovtfun swabs; degreatsem; dental liose, drapes; dam; tats fourkWon dtuln (sump pump) mater. frw't and vegetable peelings: 9 8: Q herbicides, meat saw ff fflocatims: t* pakiting priladuas: Pesticides; sanitary napkins: tampons; .and water softener brine- ASANDONIMENT When the POWTS fags artdlor is pM94Manently.taken out of service the fbilowing steps shall to taken to Insure that the system is property and saf+aly abandoned In comprrance with ch. Comm 83.33. ItWwoonsin Admire t etWe Code. All piping to tanks and pits shall be disconnected and the abandoned pipe openings seated. The contents of;all tanks and pits shad be removed and property disposed of by a Septage Servicing Operator_ ` Aner pumping, all tanks land pis shag be excavated and removed or thelr covers ramowed-end the void space lNed with soil, gravel or another Inert solid material. CONTINGENCY PLAN if the POWTS fads and cannot be tepa had tyre foltowing measures have been. or must be taken, to provide a code compliant repboarnent system Q A suitable replacement-area has been evaluated and maybe utilized for the tocettion of a reptacaement soil absorption system- The replacement area should be protected from disturbance and Compaction and should not be infringed upon by requited setbacks from e3 sting and proposed structure, tot tines and welts- F'a#ure to protect the replacement area will r+asult in the need for anew soil and site evaluation to establish a suitable replacement area- Replacement systems must comply with the rules in effect at that time- 0 A suitable rgpfaoement area is not available due to setback and/or suit limitations- flaming advances in POWTS technology a holding tank may be instilled as a last resort to replace the tailed POWTS. f The sloe has not been evaluated W identify a suitable replacement area Upon faiYune of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If na replacement area is available a holding tank may be ftstatted as a last resort to replace the failed POWI"S. i Mound and at-grade sop absorption systems may be deconstructed in place following rernoval of the biomat at the infiltrative sunfa a ReConStructions of such Systems must comply with the rules in effect at that time.. <<WARNING>> SEPTIC, PUMP AND OTHER TRFA MIwNT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN, DO NOT ENTERA SEPTIC„ PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT:. RESCUE-OF A PERSON FROM THE INTERIOR OF A TANK MAYBE DIFFICULT OR I111IPOSSIt3LE. ADDITIONAL. COMMENTS POWTS INSTALLER pOWTS MAINTAINER Name Name ,r A--- Phorre ?1 - a j Phone - ~Z Y-1,6_11~J4, :__j L SEPTAGE SERVICING OPERATOR PUMP LOCAL REGULATORYAUTHOMY Name r7" ,4 Agency rk ~ a,t4' Phone !/v rot Phone ;;7/ g lba daa.srar+t ass draded by &a sftft of the am m t.aM, Marquette and Waushara County ZonhV and Sand om agMtMS_ This do=wel meets me ffskd UM myuTreroer s of cd. Comm ts3 zz{2xbKtx~a{f) and 83_Sd{7), (2) & Cll. Wisconsin Adrtthllstr tfm Code, Use of rbk decumentttoes cot guarantee the pedom=nce of the POWTS. C:4tW(M1 ) Wisconsin Department of Commerce ~vVw OIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with omm 85, Wis. Adm. Code -y~ Attach complete site pla on paper not leis `r~~\x 11 in es in size. Plan must County` ` t include, but not limited to. vertical a co Ire j (BM), direction and Parcel I.D. percent slope, scale or di nsion==rr nd distance to nearest road. Q r- s Z BJ Pl se p►glG ation. Reviewiab~ Date Personal information you provide ay ~N secondary purposes (Privacy law, s. 15.04 (1) (m)). Property Owner C PropertyLocatio►►, - 6 w~ e,s Govt. Lot N44> 1/414,,)1/4 S T j N R E r) W Property Owner's Mailing Address Lot # Block # ESubX;: CSM# ycl~ccl 22 City to Zip Code Phone Number ❑ C. ❑ village Town Nearest Road KPa Construction Us Residential / Number of bedrooms - Code derived design flow rate IV40 GPD placement Public or commercial - Describe: t ma terial Flood Plain elevation if applicable f/ ft. General comments /~pu J~- and recommendations: p - fi 't rs System Type© System Elevation /L,)/ o 71 Boring # ring Zit Ground surface elev. Ag, Depth to limiting factor a in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 a ~ 24 - 3-Zr3 ,~r - Boring # Boring Pit Ground surface ele/t. Depth to limiting factor in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 3 0- b L S -rn_ Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) S' CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715-246-4516 f z Property Owner _ Parcel ID # Page of Boring # Boring I pit Ground surface elev. 0 Depth to limiting factor in. 131 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 z sA 1 f _I L - 3 b t rr,_ 7/ J-7 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil -Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring # ❑ Boring F-1 ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30:5 150 mg/_ ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. see-8330 (R.61oo) P r-^-l Boring it E) Boring Ov roperty owner _ Parcel ID # Page of Pit Ground surface elev. ft. Depth to ftffing factor V in. Horizon Depth Dominant Color Rettox Description Texture soil Rate In. Munsell 5tnxx ttre Consistence Boundary Rook GPDfti= Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'EN#2 ~31t~ ~ ~C r Zee 190-70 Q F3Wng # ❑ Boring ❑ Pit around surface elev. ft. Depth to tlrnlting factor in. Horizon Depth Dominant Color Redox Description Sol tion Rate ipti Textwa Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Q Boring # ❑ Boring ❑ Pit Ground surface elev. _ ft. Depth to *W ft factor _ In. 71n. Dominant Color Redox Qescxiption. Texture, Sol! Application Rate Structure Consistence Sow dory Roots PD btu. Sz. Cant, Color Gr. Sz. Sh. 'Eff#1 'EtM2 it i i " Effluent #1 = BODE >,m < 22o KVL and TSS >.30.c 150 mgr- ' Effluent #2 @ BM, :s 30 rrgL and TSS S 30 mg& The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-2663151 or TTY 608-264-8777. 9NDQ370 (R.6N0) . Soil Test Plot Plan Project Name Glenn Severson ShauJBir Address 2281 Cty Rd CC New Richmond Wi 54017 1, CST 26900 Lot Subdivision Date 9l e NW 1/4 NW 1/4S 10 T 31 N/R18 W Township StarPrairie r-J Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of wood corner post System Elevation 101.0' *HRpSame as Benchmark 400' Property Line Scale is 1" = 40'12.5 Acre Parcel unless otherwise boo, Scale = 1/4" = 10' noted Well 201- 0 Old house burnt down B.M.* 8% slope 200' B-3 98' B-1 99, 120' 100' 0 B-2 Pro 3 bedroom Cty Rd CC house w I-FA - Ci 1111111 Fill PI-11,1111,11" 21 7 , - - - a ST. CROIX COUNTY SEPTIC TANK MAMENANCE A~&Nr AND oWNnSIig' cwLTianCATION FORM r - owner/Buyer C~ ~9 ewe ~s nn Address c c~ , MAil n8 Propaty .Addtuss far new coa►~ruati=) ~'V'erif~xti~ required from Plaamrg & Zomag Dapaftant City/State Pw=1 Idmtification Number L At . ntr.SCi1~YP'1'ION property Location 1 !4 , V,, Sec. T NR W, Town of ta - Lot # Subdivision Certi w Survey Map # Volume , Page # Warrsuty Deed # Volume Page # ' Spec bouse yes I of irnos ideootiSabls O ie fiihue to ~a wastes' > Iaq~sapmr use and msinmm~md:e of your BV= system could result in m F if needed, W a Hoamsed P=Pw What you put into Ma0enj=X =00 ofpamepi* out the septic tank awasy three yours or sooner, iiee syatmn can affect t#ae of flea S * teak as a tseaftwt in the watt ft06811875"®' r spansxbilities use Veoffied in §Conim 83.52(1) and in Chapter 12 - St. Croix C0=1Y S"iffiy fie' owner agrees tD submit to St, Cron County Plainung 8t Zoning Dqmwmant a cart ons form. signed by the os a licensed tint (1) *6 DeptLo tank is owner and by & masW phrmbet; ~ P P (if wasoawaw disposal ey5wM is inpsapw opwat~mg condition and/or (2) after ins~ and p lees than 113 full of Sludge- itwe, the vadatsignied bx" seed tba above requiresaoals and agree'to maiataano the sysum with the as set by the Derwu m►t of Como and the Depa~em# RMOMMOS, State of Wisconsin. C has been main#ained must ba .Ml~ end teWmed to the St. Croix County Piamang & ° ' ' b ~ steling that ~ SqYdc item' Zorb8 Dqxwnnent widm 30 days of the lose year eaTiradon date I1we *a dtify that au StdMMZts on fawn are ew to the beat of mMy/rna k wlWSL L*e antlers the ownm(s) of the Prop' described above, by virtue of a dead recorded is Register of Doods Officx. N ISION-A:- ro~1os'lIz DATE OF AppI,ICANT(S) ***Any inforrotiontint is ~pa+e9cmiDed may rawlt in the sanitary permit being rev oke d by go planning & Z4ni°g Deparlintnt a recorded deed ftomn the Register of DeedS Ofte aced a copy of the eeadflad savoy MP if Inctnde witiCtiaas I . refer is made in iha warranty deed. (REV. 08/05 U 1958F 2 9 7 6 8 8 I. 4 7 HATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO.. WI DOCUMENT NO. RECEIVED FOR RECORD 08-26-2002 9:00 AN This Deed made between ON TRACK WARRWJTy DEED PROPERTIES, LLC, a Wisconsin limited liability EXERT * 3 company, Grantor and GLENN A. SEVERSON and REC FEE: 11.00 VALERIE K. SEVERSON, husband and wife as TRANS FEE: survivorship marital property, Grantees, CERT COPY FEE: PAGES: 1 Witnesseth, That the said Grantor conveys to Grantees the following described real estate in St. Croix County, State of Wisconsin: Part of the Northwest Quarter of the Northwest Quarter of Section 10, Township 31 North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin, described as follows: Commencing at the Northwest Tax Parcel Corner of said Section 10; thence, on an assumed bearing along the west RETURN TO: line ofsaidNorthwest Quarter, South 00°26'46" East a distanceof683.32 feet to the point of beginning of the parcel to be described; thence South 89°06'01" East a distance of 447.13 feet; thence North 49o02'10" East a distance of 197.24 feet to the easterly line ofthat property described in a Warranty Deed recorded in Volume 1102 Page 265 in the Register of Deeds Office for said County; thence along last said easterly line, South 00°26'46" East a distance of 152.75 feet; to the southerly line of last said property; thence, along last said southerly line and the northerly line of that property described in a Warranty Deed recorded in Volume 1102, Page 266 in said Register of Deeds Office, South 8$°49'37" West a distance of 597.00 feet to the west line of the said Northwest Quarter; thence, along last said west line, North 00°26'46" West a distance of 42.68 feet to the point of beginning. Containing 0.66 acres. Subject to County Trunk Highway "CC" along the most westerly line of the above described parcel, also subject to all easements, restrictions, and covenants of record. This is not homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances, and will warrant and defend same. Dated this ZZ day of 2002. ON TRACK PROPERTIES, LLC s , . (SEAL) By: Its: ~c s. STATE OF WISCONSIN )SS ST. CROIX COUNTY AU r rsly came ~j;fore ~3e t is 2Z day of 2002, the above named On Track Properties, LLC, by /~D)I Rr`~ -S • Beyo al SALJ is Q''~?1'~ to me known to be the person o e~xe/c~,tt foregoing instrument and acknowledged th same, being authorized so to do. C~6,x ran RQGER D. Notary Publi S t of isco sin My Commission (expires) ~ THIS INSTRUMENT DRAFTED BY: Attorney Barry C. Lundeen OF MUDGE, PORTER, LUNDEEN & SEGUIN, S.C. 110 Second Street, P.O. Box 469 Hudson, Wisconsin 54016 r f P . r + ~ 4 - - oil ~t - ti Ii . ow "No 4 R w w p M I g a N Rt4 A►S CLM" r - - - - - - - - - - r ' a i i~ pa, Q o oo Q O 6) oc H a) o r E cc N I o. a~i o; u) ~ I I a m c_ W o E ry -0 0 0 2 0 Co c v 3 co a3 ° (D 0 v Z c a) 0 m 0 LL o a av 7 3 v 02 a Q sO a 0 E g ' aii o I z" co E c z = 00 E z ~ ~ v v o cn ~ ICI a m a F- z I 0 rn c O Z v o N a d z ~ c l v) I--~ a) E .C a1 _ N N N O co .a O ct 0 z z z Ili i.) E CL c N D o Q d 0 E O N H H c jR CL (L (L _o 0000 a= N a (D ~i Z 0 o m U U m Z p o o O ° 5 a) v ) ¢ .rn _ ¢zco O N N c N N N v ~ 00 p C tl) C O 'O 'O IV O m a) w a) a) LO N ~ 0 C C O ~ O 00 0 N . N 7 0 N E € ~O ao 'm o ~ w w o v a ~ y o o I H 00 M > 0) 7 0 (A az O co cn O z N z z O N CC ` 2. CD a r r A V a 0 (j) U