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HomeMy WebLinkAbout022-1027-20-050 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 556302 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Nygaard, Nathan L. & Tana Kinnickinnic, Town of 022-1027-20-050 CST BM Elev: Insp. BM Elev: BM Descri lion: Section/Town/Range/Map No: I d s4e-a C"C_ dt" 09.28.18.143810 TANK INFORMATION LEVAT ON DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Z SS" L • ° yy !D° Dosing 6t1 ~/p Alt. BM .4 Ql D 5- Aeration 11 _ Bldg. Sewer Sr, ~ Holding St/Ht Inlet pi*// D l av'_ /7•Q b 2 • C) St/Ht Outlet / TANK SETBACK INFORMATION TANK TO P/ W~~ BLDG. Vent toA r Intake ROAD Dt Inlet Septic j r Dt Bottom ~ s #z a r. ~ -7 -7 3 Dosing o Heade Man. 7.,' t J V ` All 4 Aeration Dist. Pipe 03V s` RI Holding - Bot. System Z 3 g 0 .J~ Yto Final Grade PUMP/SIPHON INFO ATION Manufacturer * Demand St Cover -Z e-- GPM Vil t / 3 b 5 Model Number Co C1 e-fj r h*s 21 wt . TDH LFricti n Is Sale JTFt Forcemain Length T Dia., /i Dist. to well 0 SOIL ABSORPTION SYSTEM B DIMENSIONS Width Length No. Of Trench s PIT AIMNS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~ 'I SETBACK SYSTEM TO P/L BLDG WEL LAKE/STREAM EACHING Manufacturer- , INFORMATION CHAMBER R Ty a Of T Model Number DISTRIBUTION SYSTEM N 7-j2 a-tl r L o~ Head anifold 4,1 D' tin x Hole Size x Hole Spaci g Vent to Air Intake 1'" d Pi e(s) -u 5 r "_1iL, Length a Dia Length , n Dia Spacing r~ -so a5 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Mulched Depth Over / Depth Over xx Depth of r7eeded/Sodded T_ Bed/Trench Center Bed/Trench Edges Topsoil 0 Yes [jfl No Z Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~T Inspection #2: Location: 404 Monument Rd. River Falls, WI 54022 (SW 1/4 SE 1/4 9 T28N R11 8W) NA Lot 3 Parcel No: 09.28.18.143B10 1.) Alt BM Description= 2.) Bldg sewer length - amount of cover >~Z Plan revision Required? ❑ Yes No / s Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. PLOT PLAN PROJECT Nate Nvaaard ADDRESS P.O. Box 882 Hudson Wi 54016 SW 1/4 SE 1/4S 9 /T 28 N/R 18 W TOWN Kinnickinic COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE7/23/12 BEDROOM 4 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE765 DOSE TANK SIZE HOLDING TANK SIZE LOAD RAVE .5 ABSORPTION AREA 1220 # of chambers 60 BENCHMARK V.R.P. Top of steel fence,post ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 91.6/91.5/91.4 4'below qrade @ B-2 All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. Scale is 1„ = 40' V"I I i( 625' Property Line - Sre is--' = 40hless of e CV-k unless oth e Well is to meet all noted setbacks required by Huffcutt , pU WDNR Combo T nk Sandstone soils, not suitable for Pro 4 1120' a conventional system Bedroom • 9% Slo e House p 5 4' 1 Well Pit 1.4 W o Slope yin ild °t 5i S B-2 25' .M. B-1~ S i W45 Ca i 8' 1. yr?ac l 9% Slope 5 82' cells B_ ~ W ith >3' spacing 57 r vents 40 cc./J; Z-7 'a 2- Vent ~S N Sandstone soils, not suitable for • ~ >6» ck4 Standard aconventional system Q ~ Le ching Ch tuber of Cover wi 20.0 ft2 of Area 12" 10.2ft^2/pair of end caps 4' Long Grade at System Elevation 34" - No Please note: Upon visual inspection, the well Tested area is a gravel deposit, has been removed from this pit, it has replacement area can be original soil 300' been suggested to owner to fill in pit for code test, or at-grade system, loamy and safety reasons. sand and gravels are very loose when dug but firm in place in sidewall of boring, recommend highly using Monument Road a.5 loading rate 9EH SERIES SUMP/EFFLUENT PUMP 11.65 8.95 O CD) 0 Specifications MODEL CAT. USiIN6 SOUPS SIZE RUNNING PERFORMANCE (GPM @ NEAP) NO NO NP YOITS SNUFOFF PWA. CRP. WEIGHT DIMENSIONS (Ois.IL) AMPSIWAiIS 5' 10' 15' 20' (FL) P.S.I. 9EH CIM 509330 UUCSA 4/10 115 90 (Ur ► IR x L x W) 3/4 13.0 1000 70 64 55 41 32 13.8 20' 24 9.11 x 11.64 x 8.94 9EN-CIM 509340 UUCSA 4110 230 3/4 6.5 1000 70 64 55 41 32 13.8 20' 24 9.11 x 11.64 x 8.94 9EN-CIA-RFS 509350 UUCSA 4/ 10 115 314 13.0 1000 70 64 55 41 32 13.8 20' 27 9.11 x 11.64 x 8.94 9EN-CIA-RFS 509360 ULM 4/10 230 3/4 6.5 1000 70 64 Continuous D 55 41 32 13.8 20 27 Rated 911 x 11.64 x Duty LdUeGiant Wastewater pumps arerated contin 8.94 continuous duty as long as they are run within the published ratings forthese pumps." FLOW- LITERS/HOUR Construction 0 1000 2000 3000 Motor Housing Epoxy Coated Cast Iron Impeller Material Poly Carbonate 30 10 Impeller Type Closed Vane Volute ABS W 7.5 Power Cord STTW-A 20 Mechanical Shaft Seal Nitrile with carbon and s ceramic faces W = W Fasteners Stainless Steel 10 2 s = Shaft Stainless Steel Bearings Upper Sleeve and Lower 0 0 Ball Bearings 0 20 40 60 80 FLOW- GALLONS/MINUTE PUMP PERFORMANCE CURVE PlrltY °"'R~ 11! DV 60HZ Little Giant Pump Co. 8 a PO Box 12010.Oklahoma City, OK 73157 s fit' Phone: 405.947.2511 • Fax: 405.228.1550 WwW.LIttIeC><iantPump.COm . E-mail: customerservice@littlegiant.com A~ Form 995235 - 07/03 eommerce.wi.govg Safety and Buildings Division County c i~f_201 W. Washington Ave., P.O. Box 7162 i s eo n s i n 7O J Madison, WI 53707-7I62 ._b_ <w ne me iny Co_I epartment of Commerce 3 3 1QJ 'or 302 1 tale Transaction Number Sanitary e111,~~►~e~ication _ In accordance with s. Comm. 83.21(2), Wisr1ARIA~ICode, submission of this form to the appropriate gov&nmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Add ss (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m , Stats. / 1. Application Information - Please Print All Information Property Owner's Name Parcel # Property Owner's Mailing Address Property Location / Y3 D , Govt. Lot ( City, State Zip Code Phone Number y,/,,Section ( / ?1e on T2 N; R ( E otl`W H. Type of Building (check all that apply) Lot or 2 Family Dwelling - Number of Bedrooms Subdivision Name Qk z~ •D Block # ❑ Public/Commercial -Describe Useb0 P71- - i ! (0 ❑ City of a " ~/i ❑ State Owned - Describe Use CSM Number n ~7~6 Village of c va Z d' 3 f Town of L/2Q~ o~~ l ~ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. O!Ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV T e of POWTS System/Component/Device: Check all that apply) -Pressurized In-Ground ❑ Pressurized In-Ground ❑ t-Grade ❑ 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 Fl (gpd) Design Soil Applicat~Rate(gpdsf) Dis ersal Area Required (st) Dispersal Area Proposed (sf) ~Jsttee VI. Tank Info Capacity in Total # of Manufacturer - o 11 U Gallons Gallons Units f;J M 2 -0-2 U - New Tanks Existing Tanks 2 o N T! / a, U uo rn L c7 R Septic or Holding Tank J~ S Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume r ility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's S e MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) /-4~1 2--- ~2 VI . Coun /Department Use Only Permit Fee Date Issue uing Age t Si tore Approved ❑ Disapproved 00 7 2_10 ❑ Owner Given Reason for Denial LX,g"*#tVp0 f"ppoval/Reasons for Disapproval 3 1 l a 30 + ~p a/K- yYf/ jr(,~ 1 Septic tank, eff luent filter and V " ~14L ) 5 ~ ~ GSM ab dispersal cell must all be serviced / maintained a/Y as per management plan provided by plumber. ~,,,,,`/J~ ' s~~ s✓~~~~„. 2. All setback requirements must be maintained i T b system and sub it to the County only on paper not Jess than S in x 11 inches in siz V " - G, cr ~ t!"t~i~ fJtlJ 6 y~ G~ ~/t'Ur+ 1tii S SBB.~ o trc. 02/09) v Cover Page Shaun Bird ; Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 7/22/12 Owner: Nate Nygaard Location: SW1/4 SE1/4 S9 T28 N,R18W 404 Monument Road Kinnicikinic System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Pressure Distribution Manual (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet ' 8. Dose Tank Cross Section 9. Pump Curve Signature License n er #226900 PLOT PLAN PROJECT Nate Nvaaard ADDRESS P.O. Box 882 Hudson Wi 54016 SW 1/4 SE 1/4S 9 /T 28 N/R 18 W TOWN Kinnickinic COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 7/23/12 BEDROOM 4 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT XXXX HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE765 DOSE TANK SIZE HOLDING TANK SIZE LOAD RAVE .5 ABSORPTION AREA 1220 # of chambers 60 BENCHMARK V.R.P. Top of steel fence post ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 91.6/91.5/91.4 4'below qrade @ B-2 All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. ~ ~ Scale is 1„ = 40, Scale is 1" = 40hless otherwise 62s' Property Line unless otherwisnoted Well is to meet all noted setbacks required by Huffcutt WDNR Combo Tank Sandstone soils, not suitable for Pro 4 20' a conventional system Bedroom House 9% Slope a-rdQ~ 40' 10' ell Pit 'e hLw, o Slope Ca. I a B-2 B 15 B.M.*t WQS CQp~ 8' Zyrs' a~a ' 9% Slope 5 ~X 2-3' X 82' cells B-3 35 Wl with >3' spacing 5 vents Vent Sandstone soils, not suitable for a conventional system >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 12„ 10.2ft^2/pair of end caps 4' Long 34" Grade at System Elevation Please note: Upon visual inspection, the well Tested area is a gravel deposit, has been removed from this pit, it has replacement area can be original soil 300' been suggested to owner to fill in pit for code test, or at-grade system, loamy and safety reasons. sand and gravels are very loose when dug but firm in place in sidewall of Monument Road boring, recommend highly using a.5 loading rate Cross Section of Quick 4 Standard Leaching Chamber Typical cross section for 2 of 3 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 10.1ft^2 pair of end plates To be >1' above grade Finish grade elevation Vent Typical Installation ~ 96.0 Grade Vent X30/34 Se tic Tank p ALo 4" 4 1 5' 4' Long 1 f) 3 4" Grade at System Elevation 34" Grade at System Elevation Spacing 5' 3-3' X 82' Cells Observation tubeNent Same on other end To be located on end of Cells %A B System elevations: C A-91.6 B-_91.5 20 chambers per cell C___91.4 Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer ' Pump Manufacturer Tank Model Number ! Pump Model Number Total Tank Capacity Alarm Manufacturer V l! S 5 Max. Bury Depth Alarm Model Number L-- ✓ Switch Type G. Filter Manufacturer C a Total Dynamic Head (TDH) - Feet Filter Model Number T Elevation Head Distai Pressure Network Loss Minimum Pump ~erf~onmance Required Force Main Loss fj GP'NI, Ft TDH Total outlet Manhole *n. 41f Above Grade With Manhole Min. 4" Above Grade Locking Device- Inlet Manhole With Locking Device Securely Mounted < 6" Below Grade Sealed Watertight Weatherproof Junction Box - Finished Grade ~ ~ t ~ .Y. Vent Min. IT, Disconnect Above Grade Means with Vag Cap • r Y; :'i !i I;: (;i /;Y;/':i (tY:~!'V :.;(:~Y~a;,Y('YlYY( . Outlet Filter Xnlee Baffle inlet .r - _ Switch Sotqugs and Reserve Capacity Weep Tank Volume = GPI B Hole 'Volume Gal. . ` ' Dimension- Inches _ (reserve) A off Elevation C ' . Y (gym B ~ 2. Ft (dose) C 7. Bottom Elevation (dead) D X Total ':~a'(/ta, attt Yar to t,ataa <t,rs <a a<s tea as a, as t((<t(t,Y Ya.., ts< << Y a t Y I r> Y, Y a Y Y! Y ! Y Sa:, :Y<► Y! r> Y r Y r Y Y> Y Y a r ar Y a, r aa>•> a.; a 1> i<Y r Y Y 1 r r r r r! r r Y: Y Y Y , a: 1 Y a f, a a t< a i V 4, V< V a V a (t I t a a t i, V t ((t Y V V V: t Y (Y't t:' tyt << a, :a a< a, a♦ a<< V V t ,.<<, a l a< t< t: 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 n=ufacturer may not exceeded without pl for $pprovil> Manhole covers exposed to grade have an effective locking device (padlock) fiffings and be installed. Piping at the inlet outlet is of approved material, connected to the PVC to1bridge the, tank laid on stable soil to prevent setding or sagging. The force imam-is sleeved with " Uh. 40 excavation and the .sleeve, is sealed watertight.. Electrical :service complies with NEC 300 and Comm 16.23. Page of 02/05 L7 TOTAL DYNAMIC H_-,AL'/CAPACITY w HEAD CAPACITY CURVE PER VINUTE MODELS 53, 55/57/59 EFFLUENT` AND WA-'ER NG 25 r----- - 59 53/55/57/59 IVodel 6 20 -t. Meters CUT. I tr a ~ - 5 1 43 '.63 s 5 - t5- - _ G t 34 129 5 q `1 J L z 4- iC ghat-off Hecd 19.25 ft. (5.9rrj e- 2- 5 - - - --{3 15/16 6 5/32 I i .I 4 5/a I,- - '/'2-11 NFT U.S. GALLONS 10 20 30 40 50 __T / LITERS - --r~\ 15/16 80 160 FLOW P R MINUTE 009897 \P 4 1/ 16 r-- - --f i Variable level float switches available. ; Variable level long cycle systems available. Available with special cord lengths of 15' 25` 35' and 50'. I - Alarm systems available. 0 1/16 Duplex systems available. _-_i- i t 3 3/Q2 SKe58 9 . 51n le Seat _ Control Selection LisunU 1 2 . Single Integral float i back operated -variable levei mechantcai float switchswitch no external oexternal control required. Model Volts Phase Mode Ampa Simplex Duplex CSA L M53155 & M57/59 115 1 Auto 9.7 1 Y Y p ggy piggyback variable level N53155 & N57159 115 1 on 99 2 3 or F4 & 5 Y Y float switch. Refer to FM0477. BN53 115 1 Auto 9.7 - Y Y - + - 3. Mechanical alternator W-Pak" 10-0072 or 10.0075. BN57 1 115 I 1 Auto 9.7 N -Y BE53/57 230 1 Auto 4.8 4. See FM0712 for correct model of Electrical Alternator. f € Y Y D53/55 & D57/59 230 1 Auto 4.8 1 -Y Y- 5. Variable level control switch 10-0225 used as a control activator, with Electrical _E53155 & E57/59 230 t Non 4.8 3 or 4 & 5 Y Y-11 Alternator (3) or (4) float system. 'Single piggyback switch included. O CAUTION Forinformation on additional Zoellerproducts referto catalog on Piggyback Variable Level Float Switches, FM0477; Electrical Alternator, FM0486; Mechanical Alternator, FM0495; i;ump/Sewage Basins, FM0487; and Single Phase Simplex Pump Control/Alarm Systems, FM0732. 3 E For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO, P.O. BOX . 8947 Louisville, KY 40256-:,w Manufacturers of. . SHIP T0; 3649 Cane Run Road e Louisvik KY 40211.1961 QUgL/TY PUMP6 ~NCE ~~✓9' ® s (502) 778-2731 1 (800) 928-PUMP http://Www.zoeller.com PLJ P ~O FAX (502) 774-3624 - 0 Copyright 2002 Zoeller Co. All rights reserved. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity al ❑ NA Permit # Septic Tank Manufacturer NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units -;!f;JA Pump Tank Capacity j al ❑ NA Estimated flow (average) '~/,070 gal/day Pump Tank Manufacturer ❑ NA YA4 Design flow (peak), (Estimated x 1.5) Pump Manufacturer Q al/da ❑ NA Soil Application Rate al/da /ft2 Pump Model e-7) ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ~9~c1A Fats, Oil & Grease (FOG) <30 mg/L V ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODE) 5220 mgIL 091, ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) A Biochemical Oxygen Demand (BOD5) 530 mg/L In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ;1kNA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) <104 cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size 36 in dia. ❑ NA Other: ❑ NA Other: NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ onth(s) (Maximum 3 years) ❑ NA ear s Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ ean(s(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑ emonth ar(h(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ nth(s) ❑ NA ~ arts) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other. ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) 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 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 no# limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 51'? months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the 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 POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over ranks 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 p*irmanently 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 properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot t,e repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement ar,;a has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area sh wld be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing ana 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 instalied as a last resort to replace the failed POWTS. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone Phone 7 0 -7 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Name Phone °7) v = Phone g This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. i' 0JV I PR LTL CARTRIDGE INSTRUCTIONS Installation STEP I Dry fit the filter ease onto the and of the outlet pipe to ensure it is l centered under the access opening. It not, then either Insert more pipe into the tank through the outlet or ;oIlvent weld (glue pipe, ) additional pipe onto the nutlet S T EP 2 While the case is still dry fitted on the outlet pipe, measure the length of %-inch pipe needed to btare the filter to the tank end wall if utilizing the optional supplemental side _mpport, If side support method is not utilized, proceed to step four. 7 EP For installations utilizing the optional supplemental side su _ solvent weld the °S'.-inch pips onto the filter case. If side su pportutilized, proceed to step fou.: pport method is not YR ' . i.,> . Solvent weld the fiicer case onto the outlet pipe. Insert the filter Cartridge into the case, pressing dawn until the filter locks into the bottom of the case. If a VRS switch is utilized: insert into the filter and lock by turning clockwise 90o. Mr. t. y".,„ Maintenance 1. The effluent filter should i,e cleaned every time the septic tank Is serviced. f 2. Open the outlet access op:arting to inspect the tank and filter I 3. Pump the septic tank completely, snaking sure to remove the sludge A ~ layer on the bottom of the tank and not just the scum and effluent, 4. once the effluent level has been lowered below the invert of the ~ outlet pipe, firmly pull up on the filter handle to dislodge the cartridge from the case. 5, Slide the cartridge up and ;tut of the case for cleaning, 6. If a VRS switch connected ao an alarm is present, the switch fig should be removed by turning counterclockwise 90, and cleaned " a with water only. 7. While holding the cartridge on its side (large flat surface facing down) over the access opening, rinse off the cartridge with water only, making sure all septatg, a material is rinsed back into the tank- $ I a. If VRS switch is utilized, replace by inserting into filter and turning clockwise 901. 9. Insert the filter cartridge ba:.k into the case, pressing down until the filter locks into the bottom of the case, 'n f a, tu. Replace and secure the access opening on the tank, -:r.':-.<- ; ; a_ •-~e; t Sao->:a•,irr' . ~u www beam sitexom 877-MLPILTERS (653-4583) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner Buver Mailing Address Yerloi ~p2 Property Address ~~d r (Verification required from Planning & Zoning Depar ment for new con , uction.) City!'State Grl Parcel Identification Number Cep? - 2 fob 7-act 05Z2~? LEGAL DESCRIPTION Property Location'; Sec.--- T p~~N RTown of ~it Subdivision Plat: , Lot # ' . Certified Survey Map # b , Volume , Page # Warranty Deed # 97 (before 2007)Volume Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Connn. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or after inspection and pumping (if necessary), the septic tank is less than 1.3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural. Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. [/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms SR ATURE OF APPLICANT(S ~ 5ATE ) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division ilf Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete siqft on paper not less 'ha 8 11 inches in size. Plan must include, but ~~QQt vertical and horizon refer int (BM) , direction and Parcel I.D. percen pnsions, north arr and stance to nearest road. Please pri/tf.rl. information !7e;; ~s d f Date 1anon you provide may be s eeonFu rpes (Privacy , s. 15 (1) (m)). / Mter Owner p Pr erty Location Aft. ZI _ Z. Lot ,510 1145,E 1/4 S T N R E (or CW) Property Owners Mailing Address of Block # Subd. Name or CSM# n' ~o~ GoFF, At 's) - ~Y / v 220 City State Zip Code Phone Number "Btity ❑ ViII ge gTown N r t Road i S D ( ) /li o u /vt New Constructi Llse~Residential /Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial -Des Abe: Parent material L! / ft• General canxnents and reCORIRIBndatlOrlS:/~~GZ4,~~ System Type System Elevation/} 7 ~ 6A7? Boring # Boring I pit Ground surface elev. ft. Depth to limiting factor &Z- in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. //'Munsell 1 Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff##1 •Eff#2 t" z- Boring # 0 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 Z /1 ell~ • Effluent #1 = BOO > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 130 mg/L and TSS < 30 mg/L CST Name (please print) Sigr a a CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address 'Alp ~ate Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 7 = a/ / Z 715-246-4516 Y } Property Owner _ Parcel ID # Page of Boring # ❑ Boring a 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 1 o f J U C'ill, Z /r' , 0 I F-1 Boring # ❑ 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 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 < 150 mg/L ' Effluent #2 = BODS < 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 altemate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD4330 (8.60)) . Soil Test Plot Plan Project Name Nate Nygaard Shaun ~rd Address P.O. Box 882 Hudson Wi 54016 C #226900 Lot 3 Subdivision Date 4/26/12 S W 1/4 SE 1/4S 9 T 28 N/R18 W Township 1Cnnidcinnic Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of steel fence post System Elevation 91.6/91.5/91.4 *HRPSameasBenchmark Scale is 1" = 40' unless otherwise 625' Property Line Tested area is a gravel deposit, noted replacement area can be original soil test, or at-grade system, loamy Sandstone soils, not suitable for sand and gravels are very loose when a conventional system dug but firm in place in sidewall of boring, recommend highly using 9% Slope a.5 loading rate 10' elf Pit B- 2% Slope Dug a hole, no sand stone soil 15'B 15' B.M.* observed down to 90", house location 70' g 9% Slope 15' ____~B-3 35' 5' Sandstone soils, not suitable for a conventional system Please note: Upon visual inspection, the well has been removed from this pit, it has 300' been suggested to owner to fill in pit for code and safety reasons. Monument Road .MW Over /KiG 0711r r' 01 or dw µ y~ QG~!' ,~99.Jt IC~~ „~•L C~ ~D~,2~46 ~9aG ~G~~jy ,Lsl`".3L,r/Jt L4/~?o6 508283 CERTIFIED SURVEY MAP Located in part of the Southwest Quarter of the Southeast Quarter of Section 9, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin. Prepared for and by request of: LEGEND Larry Stoppelmoor St. Croix County Section Corner Monument 408 Monument Road River Falls, WI 54022 0 Set a 1" x 24" iron pipe weighing 1.68 OWNER - Menden-Dederick Partnership pounds per linear foot. R= recorded bearings and distances SCALE 1 =200 UNPLATTED LANDSCENTERLINE 100 0 200 R/W 111 I 6 -1NW N890 20'48"E 757.90' R- N89-04'00"E 765.26' ~ 724.63' 0 c m I :0 m i 33.07' 8Z SEPTIC 1 0 m i ~z ~Z a °VENT p ~ 10 to iZ ~m~ I~ D QGARAOE- -1- -^001 ?I r 1Z ~r 'o m I 0 ~ D6NIiWAY N.4 UI^ i I~ ID M LOT 2 / O r-I ~ m I~ I~ N'm m ~m rn 2 HOUSE! o W J m 0n I I-I lr~ F Url -4 Im iz Im ,y v m in m Ir D v iZ O ° EL? Z'39.85'- ;,I 0 In J> f it7 I N89°43'12"W 695. 29' m; o v~ A IQ 0 ;0 3 ~ O M= 2 NO -II .N_ 1)8 01 M O , m 0 D N- Ol °p A N O 2 W Np LOT 3 x, o m m o N m \m f I I m~ A R= N90400'00"E 700. 14' 44,70' - S89.43'12"E 547,58' 71.53656.44' 1319.25 `-~N89043'12"W 771,67' R=WEST 772.07' - - I I - - - - - - - SOUTH LINE OF THE SE 1/4 S89°43' 12"E 2638.50' SOUTH QUARTER CORNER SOUTHEAST CORNER SECTION 9, T2SN, R18W 5' SLY OF FENCE SEC. 9, T28N, RISW UNPLATTED LANDS AREA OF LOT 2 INCLUDING ROAD.R/W = 243,486 Sq. Ft. (5.590 Acres) AREA OF LOT 2 EXCLUDING ROAD R/W = 232,363 Sq. Ft. (5.334 Acres) QF W/s AREA OF LOT 3 INCLUDING ROAD R/W = 152,438 Sq. Ft. (3.500 Acres) •t~ COQ AREA OF LOT3 EXCLUDING ROAD R/W = 143,202 Sq. Ft. (3.288 Acres) DOUGLAS J. iP ZAHLER z Drafted by Doug Zahler < HINDS Ni COUNTY GENERAL NOTICE sv~N~ Each parcel shown on this map is subject to State and County laws, rules and regulations (i.e., wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel contact the St. Croix County Zoning Office for advise. CV FI ® -APPROVED ll NOV 2 1993- 5 Nor o 2131 JAMES O'CONNELL Q Register 0i Doeds SL Croix Co., Wl ST. CROIX COUNTY Cp Ca nprehensive PLvu* Co Zoning and Park* Conwittee If not recorded within 30 days of approval date `%pproval Shah bo nap & void lu Vol.10 Page 2706 04/13/2012 18:18 17157493055 HOVER WELL DRILLIN PAGE 01/01 State of Wisconsin Department Of Natural Resources Well / Drillhole / Borehole Filling & Sealing PO Box 7921, Madison WI 53707-7921 Form $300-005 (R 6/07) paged of 2 dnr,wi,gov Notice: Completion of this report is required by chs, 160, 281, 283, 289, 291-293,295, and 299, Wis. Slats., and oh. NR 141, Wis. Adm. Code. In accordance with chs. 281, 289, 291-293, 295, and 299, Wis. Stats., failure to file this form may result in a forfelture of between $10-25,000, or imprisonment for up to one year, dspending on the program and conduct involved. 'Personally identifiable information on this form is not intended to be used for any other purpose. Return form to the appropriate DNR office and bureau. See instructions on reverse for mare information. Route to: 0 Drinking Water ❑ Watershed/Wastewater ❑ Waste Management ❑ Remedlatlon/Redevelopment © Other: 1.'t~il~I,' QaxIOYY :,~vz'.;; s P .~t§:~ » -»a+ •,Y',x. , .My,,~•:....~..,r,~ Z' 4 ~,rr-~ r . County ni que Well #of icap aoili Name, 4 r2l' moved Well ty Latfitude / Longitude (Degrees and Minutes) Method Code (See Instructions) acillky ID (FID or PWS) icense/Pemtit/Monitoring # s z2 ''/4 Y4 /s Icz clion ownship ange ❑ E riginal Well Owner or Gov't Lot # N W Present V}fell Owner Well Street Address A c4/ f 4 Well City, :Village or Town Well ZIP Code Mailing Address of Present Owner f ? ,r1;,%i -'1 •t:-;+~. } l ~C7•;~l~ox` C"'%,J F i:. .1~2'r`L•'f,;.. .j. :'kar./ Subdivision -Name of # City present Owner 4 t tats IP Code Reason For Removal From Service I Unique Well # of Replacement Well Pump and piping removed? Yes ❑ No ❑ N/A 3. W¢EI / tyl'7i(hol~ /'$oreti4fp;ln "moon' f' K}',°">% Liner(a) removed? ❑Yes ❑ No ❑ NIA Monitoring Well riginal Construction' Date (mmldd/yyyy) Screen removed? CIYes 0 No 13N/A ❑ t1 Casing left in oleae? X~Yes 11 No ❑ N/A ' Water Wall If a Well Construction Report Is available, Was casing cut oft below surface? ❑Yes 1:1 No ❑ NIA ❑ Borehole / Drillhole please attach, Did seating material rise to surface? ®Yes ❑ No r❑r---1t N/A Construction Type: Did material settle after 24 hours? ElYes ® No U N/A Drilled ❑ Driven (Sandpoint) ❑ bug If yes, was hole retopped? ❑Yes ❑ No ❑ N/A ❑ Other (specify): If bentonite chips were used, were they hydrated No © NIA with water from a known safe source? IYes 11 Formation Type: Required Method of Placing Sealing Material ❑ Unconsolidated Formation Bedrock ❑ Conductor Pipe-Gravity El Conductor Pipe-Pumped 2 Screened & Poured ❑ Total Well Depth From Ground Surface (ft.) sing Diameter (in.) (Bentonite Chips) Other (Explain): r Sealing Materials Lower Drillhole Diameter (in.) sing Depth (ft.) L_l Neat Cement Grout r, L~f Clay-sand Slurry (11 lb./gal. wt.) r u Sand-Cement (Conorete) Grout ❑ BentoniteSand Slurry 13 Was well annular space grouted? ❑ Yes Q No ® Unknown 1:1 Concrete Bentonita Chips For Monitoring Wells and Monitoring Well Borvholas Only., If yes, to what depth (feet)? Depth to Water (feet) ❑ gantonits Chips © Bentonile • Cement Grout ❑ Granular Bentonite ❑ B@n"tq-„Sgnd Slurry 5. Material' lJsrid'To l=tll' Wolf l lfi~illTtiyli ; a:( .0. Mlic' Ratio: r apP m . tGl`' .Y6, hf Surfwc ^ ✓!~C ' .7777 6. Comments p of'Work...i;' 7. Su ervrsiort Name of Person or Firm Doing Filling & Sealing ILicense # ate of Fillirpg & Sealing (mm/dd/yyyy) 00b 0'", ;t90sr4.:% ;;y'r,•'•, ' ".7 a, .1•,m:'`• ' 'r Ji.! 1 f ` i..~ I"t,J •,:r };".a!~ r: ~ 's~ " -,5 , 1{',A Street or Route eleplione Number ' YH K k'..• ~'4 City;, fate P Code ignature~- arson Doing Wor* ate Signed PERSON COMPLETING FILLING & SEALING 11111!1111111 !1111115111111111111111111111111111 * 8 8 5 4 1 878554 STATE BAR OF WISCONSIN FORM 1 - 2000 KATHLEEN H. WALSH WARRANTY DEED 1 REGISTER OF DEEDS Document Number ST. CROIX CO., WI This Deed, made between Jeremy Cudd, a married person as RECEIVED FOR RECORD individual property and Oranzo Oevering a married person as individual 07/17/2008 11:40AM pMpgrty Grantor, and Nathan L Nygaard and Tanya L. Nygaard, husband and WARRANTY DEED EXENPT 0 wife, as survivorship marital propertv Grantee. REC FEE: 11.00 Grantor, for a valuable consideration, conveys to Grantee the following TRANS FEE: 240.00 described real estate in St. Croix County, State of Wisconsin (the "Property") (if PAGES: 1 more space is needed, please attach addendum): Lot 3 of Certified Survey Map filed in Volume 10 on page 2706 as Document No. 508283, being a part of the Southwest Quarter of the Southeast Quarter (SW 1/4 SW 1/4), Section 9, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin. Recordin Area Return to: 0% U w- La Real Source Title 12 Long Lake Road, Ste 19 Matttomedi, MN 55115 Together with all appurtenant rights, title and interests. 022-1027-20-050 Parcel Identification Number (PIN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasib] fee simple and free and clear of encumbrances except Roadways, Easements, Restrictions and Rights of Way of Record. Dated this 27th day of June, 2008. ' * *Jeremy Cudd + *Oranzo Oeve ng AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) authenticated this day of ) ss. St. Croix County ) Personally came before me this 27th day of June, 2008, * the above named Jeremy Cudd a married ers dividual TITLE: MEMBER STATE BAR OF WISCONSIN roe and Oranzo Oeverin a married erso ivi (If not, authorized by § 706.06, Wis. Stats.) roe to me known to be the person s wh egvWd*t t"' A-eknowledged the same.. ' ' Q instru n w THIS INSTRUMENT WAS DRAFTED BY Oranzo J. Overine m f' p C PO Box 179, New Richmond. WI 54017 *Kell s . (Signatures may be authenticated or acknowledged. Both are not necessary.) Notary llC, S~ate of W15COtlSln %C ~ My Com is erman nt. (If not, state Lff aU 2010. *Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. I - 2000 1 of 1