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HomeMy WebLinkAbout026-1001-90-101 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 556313 0 GENERAL INFORMATION 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: WM Derrick Const Inc Richmond, Town of 026-1001-90-100 CST BM Elev: Insp. BM Elev: IBM Description-.,, Section/Town/Range/Map No: /OZ• /n - GS 01.30.18.108 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS I FS ELEV. Septic x~,.. 5-/ Benchmark fha L sae.... ~I 4.c.`_ /DOb paw 14- Liz Z. (,Z Ae . I Alt. BM l01L S o 1,7 007. &-1 Aeration Bldg. ewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ,70 s A- z q Dt Bottom ~ Dosing Header/Man. I g,/ 9G g . 7 Aeration - Dist. Pipe /04 9 Holding Bot. System IZ13 15.9 PUMP/SIPHON INFORMATION Final Grade 7, 7 3 1d/, o/ Manufacturer Demand St Cover S 3(p /d 3 - - GPM o✓G~. Model N er ' _ - TDH Li Friction Loss Syst ad TDH Ft Forcemain Length Dia. Dist. to Well I --F----, SOIL ABSORPTION SYSTEM - BEDITRENCH Width I Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dial Liquid Depth DIMENSIONS 3 76 Z -17e^ i4_^ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: Ez INFORMATION Type Of Systerrl: 75 / CHAMBER OR UNIT Model Number: DISTRIBUTION SYSTEM 7 ~--7 :/sI ~t~Q_,, Header/M/anifo}d d~ I 1 Distribution x Hole Size x Hole Spacing lVeat to Air Intake ~O `f Pipe(s) ~ 9, Length Dia Length Dia Spacing . SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center r Bed/Trench Edges Topsoil Yes ❑ No No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1408 Cty Rd GGG~G New Richmond, WI 54017 (NW 1/4 SW 1/4 1 T30N R1 8W) NA Lot 1 Parcel No: 01.30.18.10B 1.) Alt BM Description = t-, I I L L- G Ocs (5 2.) Bldg sewer length = 40 - amount of cover o v 7 yL ' o ~ICJ~ J Plan revision Required? ❑ Yes No 75? Use other side for additional information. [ , SBD-6710 (R.3/97) Date r or's Signatu Cert. No. commerceml.goy.-`, z Safety and Buildings Division County ~V~W. Washington Ave., P.O. Box 7162 ST. CROIX i Sao n s i n Madison, WI 53702 Sanitary Permit Number (to be filled in by Co.) Department of commerco.7 1 55 Sanit ,ryff er i Application State Transaction Number in accordance with s. Comm. 83.21(2), Wis. A~t1'iQIJbt1~ { 1 ission of this form to the appropriate gov men N/® unit is required prior to obtaining a sanitary permit. ITo/C&pplication forms for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary COUNTY RD GG 1 purposes in accordance with the Privacy Law, s. 15.04 I (m), Stats. NEW RICHMOND, WI 54017 1. Application Information - Please Print All Information Property Owner's Name ~r Parcel # RYAN L. CARLSON WMl~~(G CanSiGfi 026-1001-90-100 $ Property Owner's Mailing Addr ss p Property Location 1468 20TH AVE, DEER Govt. Lot City, State Zip Code Phone Number NW V., SW V,, Section 1 DEER PARK, WI 54007 54007 30 18 (circle one) T N; R E or W II. Type of Building (check all that apply) Lot # ❑©or 2 Family Dwelling - Number of Bedrooms Subdivision Name ok t t ~ Block# CSM vol. 7, pc 1819 El Public/Commercial -Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number V, 7 ❑ Village of ~(20 0?4/ Town of RICHMOND 2- 8:c&- G?_LL,,_S L.4 e( ` III. Type of Permit: (Check only ne box on line A. Complete line B if applicable) A. ({New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner r 1a 'Jus IV. Type of POWTS S stem/Com onent/Device: Check all that apply) EXNon-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaVTre ent Area Information: Design Flow (gpd Design Soil Application Rate pdsf) Dispersal Area Requiref~sf) Dispersal Area Proposed sf) System Elevation 450 .7 643 ✓ 700 ~ 9'6.6 y,4- VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units D ° o 'g New Tanks Existing Tanks EISER/POLYLOK 525 o = I a U in H vi W. C7 a Septic or Holding Tank 1000 1000 1 W/POLYLOK 525 X Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibili for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's lure MP/MPRS Number Business Phone Number PAUL KOEHLER 664713 15-246-2660 Plumber's Address (Street, City, State, Zip Code) 321 WISCONSIN DR, NEW RICHMOND, WI 54017 VIII. ount /De artment Use Only Approved d Permit Fee Date I sued Issuing ent Signature $ O ❑ rven Reason or ial 4D 1 IX. Condi easons for Disapproval eptic i k, effklfrnt fiher end 3) If dispersal cell must all be seryteesl•maintat~ted , 0 p ~4 ttC~a~ ~.4r1 t~~a as per rnanegelnent plan provided by plumber, W ~S 2. AN setback YequVe rne,Ots must. be.malntair*d as W gable code / t rd nances ,s G~2tJ t O V` Attach to complete plans for the system and su mit io the Count only on paper not less than 8 la x 11 inch is in size I U SBD-6398 R. 02/09 Valid thru 02/11 5 k aLL v' 1 i r i j(k r t i t } t RYAN L. CARLSON 1468 20TH AVE, DEER PARK, WI 54007 08/10/12 ® g,r'~ ScAI i "=hn BENCH MARK #1 TOP OF 1/2 PVC PIPE BENCH MARK #2 TOP OF GALV. PIPE SYSTEM ELEVATION 96.6 NW1/4 SW 1/4 SECTION 1 T 30 N R 18 W TOWN OF RICHMOND P.N. 026-1001-90-100 ¢XXX COUNTRY RD GG Pia Pv6NEW RICHMOND, WI 54017 ° 1000 GALLON SEPTIC TANK \ 20~ • WEISER TANK W/ PL 525 FILTER 2- 70' TRENCHES OF EZ-FLOWS 0 D i ,`:-i .5r alv% i C b CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: RYAN L. CARLSON Owner's Name: RYAN L. CARLSON 1468 20TH AVE DEER PARK WI 54007 Owners Address: Legal Description: NW 1/4 SW 1/4 SECTION 1 T 30 N R 18 W Township: RICHMOND County: ST. CROIX Subdivision Name: CSM vo1.7, pc 1819 Lot Number: N/A Parcel ID Number: 026-1001-90-100 Pagel Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cry Septic Tank Maintenance Form. Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: PAUL KOEHLER License Number: 664713 Date: 08/10/12 Phone Number 715-246-2660 Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page t i 4 i I t i RYAN L. CARLSON 1468 20TH AVE, DEER PARK, WI 54007 08/10/12 ti 6'M ScaT,F t "=~n 6 BENCH MARK #1 TOP OF 1/2 PVC PIPE BENCH MARK #2 TOP OF GALV. PIPE I SYSTEM ELEVATION 96.6 d~ NW1/4 SW 1/4 SECTION 1 T30N R18W TOWN OF RICHMOND P.N. 026-1001-90-100 XXX COUNTRY RD GG i Pro pv"j A®r•L i NEW RICHMOND, WI 54017 1000 GALLON SEPTIC TANK 204 WEISER TANK W/ PL 525 FILTER 2- 70' TRENCHES OF EZ-FLOWS f ~o c,p6i~~f ~~t o , 6(A1~u Q 'e C-~ Car Soh EZ_1203H trT trrt j; rtvriv '4' = ~s ~i *a;:, r vrrrTrv It lwVr TrsY 12/t 24 vrt 'ati" RTr w 4.625" » tT TvT . .W , V& V2 Ckr- 1&8'4" r !►~t'Ta►vT tk"T~vvr Y 24n. 12-1/2n DL4. Void Cads a +tor.1x ~ ' s2 SaEE O.D. of4" P1pe • 4.625 jmaw Sidetvall a smowaw 2♦ ~ s 3.14 Void ti9H~ttle per Na~ac k = 3.t<' ~ t2in! & } ltE = O.I i T R° gp 2-10 O.D. ofd.,. r2J TPW s~ lutwfam Arm sly Vpid toluene in of °eYb=f 3 l{ I 1• -Ifll s ` ~ .s'k~-.423 Qs ] tl l 1~/1! ♦ O-D- ofvwWft or es= r2 Void w{ outdeeyKtx.. z+z.! _ . es~ Q/~ p~ Psojeeted TeremI Aces .STS i 901 ~ 12ta/Q akwal1 HOW s Sq.P~. 12iti. `2 = 2M sqf, { $ V otbottom .00 WI Wh das 36 FR. _x " ~`IZa/Et + l is/O~a l2islk ' 0.215 EN P~~ted T.~eieek Asia S.Y? Sq,Ft; VOW "40* ttt "=We bonow on.*% (1l2. of void'Wume bu~ 1 Tetst. cyNDd"0,21312-0.108 . vwW vukmm+ 0.117 4- 0.422 4-8'.904 +0.215 * fL 103 "i 1.763 Celtic R / $ O'nom . />a f1= 1.763 Jf 7 AB 13.2 ' kWexQt6 Trench S~stern EZ1203H kn"dusW Group N 65 ~d P=*' Rd. ~Jond. TV $EiO6Q som skiin I of I Is-z7•-aii Soil Absorption System Cross Section I ' 4" Schedule 40 loo ft. PVC Vent Pipe with Vent Cap Final Grade GeoteAile Barrier Material I System Elevation ft Soil Absorption System Plan View ft ft 70 ft Trencfi 1 Trenc 2 Vent or Observation Pipe EZFtow 1 Chambers ~,y 5 Leaching Chamber Specifications Manufacturer and Model c--) IE SA Rating sq. ft. per chamber Soil Application Rate / gpd/sq. ft. y5© gpd Design Flow Soil Application Rate _ 7 EISA Chambers 2 rows of chambers each 77 r' I ma PEU: ox INSTALLATION INSTRUCTIONS °ato9n i~ranage Zabel' ( rto€PoMokI PL-525/PL-625 FILTER ~ Was.>ewa!er Mock::•.s PL-525/PL-625 FEATURES & BENEFITS Features & Benefits: k • Rated for 10,000 GPD • PL-525 = 525 Linear Feet of 1/18" Filtration PL-625 = 625 Linear Feet of 1/32" Filtration PL-525 PL-625 *Accepts 4" and 6" SCHD. 40 pipe The PL-525/625 Effluent Filter should operate efficiently s Built in Gas Deflector for several years under normal conditions before .Automatic Shut-Off Ball when Filter is Removed requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped or at least every *Alarm Accessibility three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the .Accepts PVC Extension Handle filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. RECOMMENDED PRODUCTS Polylok PVC Filter Extension Handle R D, E r Risers & Rise Covers Extend & LokTM Riser Safety Screens Filter Alarm Panel and rtFiterTM Control Sma Riser Pol lok risers bring y `I T^" PolyJok safety screens our PolyIok Extend & Lok y se cover to grade. is a simple easy to use prevent tragic accidents Switch Pfile tank This allows locating and solution that can extend from happening by children Polylok filter alarm panels servicing your filter easier the inlet or outlet pipe and and pets falling into open and switehs provid a visual and time saving by elimi- make filter and/or baffle septic tank entrances. and audible notification of nating digging to find tank installation a snap. impending filter and tank entrance. Fits 3" and 4" pipe. servicing. For a full list of Polylok products please visit our web site at: www.polylok.com W-UldN :3113 958-5Z2-008 OIOZ 'Nbf 03SIA38 Z \ aLva 09L49 IM 'NOOM N301VW Ot AMH Sn gum idnNdW 0Ild3S w O :NnOd-1SOd '31v0 OtOZ ANVnNY : LLJ :8nOd-38d .0-,I=.* /t :31VOS 3NS :.18 NMd80 3131BUID V3HIm aW_OOOtdnu► N ~ W J Z w a' W V) 0: Q 0 O W O ~ = J Or z LLJ O U U p Q~ N N ~ 0 2 w w U) V) 0 Or O Z 00 O° U a (n LA- m W in V) rohm F- Q Q. ° m° Q z ~ z a to Q Z W z J= \ oo Q 0 m w w w a Q v W~'n 0 OW QQU Q °wo z a r0 0 o z w U aao: 0 mN twJ~ww 0 0 4ZJ 3 0 \ Z U m v~i m z> a LL. vi -i I V) C) O f7 C9 ° 0 0° N to m Q Q li ° N o0 J ° > F N C B Y V - w CC O Q- Of CL O UZ -UUOp* MJ w~ MLU n aV 0 W4,1 Q° coo Q M Q ¢ O W Nao c~v 0F :W i~Q ~~Q N ~0- co o>Q ~pO =1zk a s- \(nxe OgOe J>^ aU W~ZN =V Z l+1 fnx o Z~ ' LL ° o~OO z w co F.- v> Y 0 > 0\ W N Q O C-4 o:o~ ..3p= O<Y oow a Qwa w mF °D 052 a (n a CL C, C3 (L x w z Nam ° w:c CZ ED2 Qa0 a ° Zoa z z a <m ~o LLJ_ D Q ~ z z Na ° ? Z _ H U H U w 0 z Q x U wx > w a °UO~ w LL > N -i O Q M W (n aJ0 w F- O>° „6£ o w F= Qa x Q CL O O 0- 0(n w a tr m 5 o w a a 1 n N svo .-V Of w O J J w9£ do N J a W > X w l < J a a / Sb wt, W / 1 LU 0 ~ 04 W W ~ J Z_ U LL- Z Q „98 „l9 w o! Q V) x z Q F- ST. CROIX COUN'T'Y SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Q7--, - ~141 , Mailing Address 1 ~OS~ Property Address COUNTY RD GG, NEW RICHMOND, WI 54017 r2e (Verification required from Planning & "Zoning Department for new construction.) City/StateNEW RICHMOND, WI Parcel Identification Number 026-1001-90-100 0 13 LEGAL DESCRIPTION Property Location NW Y4 , SW 'l , Sec. 1 , T 50 N R 18 W, Town of RICHMOND Subdivision CSM vol. 7, pc 1819 , Lot # Certified Survey Map # , Volume , Page # W r n ~fSCE i 2 Volume a 61 my eed # 7& S Page # (O Spec house 0 yes Lot lines identifiable es 0 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result' in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statemen on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue o fa warranty deed recorded in Register of Deeds Office. Number 4 ,edrp os s _ 3 16%, F 1 if' 1__ OF PLICANT(S) DATE ***Any information thatis 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. 48/05) -77 -PT T. i V"QO 8 ( c RASE A)[ 1 yS7AT'E OF WISCONSIN 5T. CROIX. COUNTY, CIRCUIT COURT PROBATE-BRANCH . Stai_F Dr- R>E_,4L ESTATE OF PERSONS UNDER - LEGAL DISABILITY-DEED BY GUARMAN t.ounry; Wlscon5an, - WHEREAS, On appticaUon to-the Grcult court of _b x r _ to'sell all -right, title and interest of Leo T. ©otttk.e, also kr_own as'` Leo 'Doittke - ran 1 Stiendthrift in and to. the real estate hereinattitroescrihad, such proccedings were z {~g~qc$ AA+agr- er taeow,¢eFe.>t-=►- _ _ - t Mr A~ _7L M71 r8`♦ ri.a♦ r{,e 1 defslgned was r illy aUth0ri~ad 3c Y'a OI18f(118r1 to proceed in said matter, - 44.MwyC[wlr^11~LT'1•FfrlrEM'i~'•~' and whereas -the undersigned. as such guardian, has done or caused to be done all things necessary and required to be lone by law n.such cases made and firovided, before conveyance of such real estate may be made; and whereas, the undersigned Lrii 'AanP`rahan`, 'forme T:n:_q F~ L1t11C~ , as such guardian', was ,aA f. 16th riav of December nn Oho - -.-,~,T~ +Ln ~o.~ F n ('nnrt huroln r+atarl I 19;_fi, to execute acknowledge and deliver,to Derrick Construction, Inc. Spendthrift deed of conveyance of all the right, title and interest of said --in and J (~nsert~'tvltnat~"vr~tntvmpeTetiG"') W 17 ~,bto~sald real estate;. NOw THEREFORE, I the said T.ni G Handra.han fnrmer1 V Lni s Aan1 bind , by authority of the - - - - - - - - - - - - - - - - ru0llri above n_a`med and in my capacity as such guardian, in consideration of the premises and of SiXtThrLUsanH - _ _ - Dollars ~t0me in hand Derrick: Construction, Inc. , do. hereby grant.and conoay'unto:the~sai& Derrick Construction, Inc. ali the.right, title and interest of the said Leo T. Domke,. al So known as Leo Domke . t ar~r3f hri_f _ , in and to the following described real estate in ('rg~ .~t trrsL~'rf~'1V~ria~ ""2Sr = ~rS~Sm"~~t~"n'f'"•f - Gclunty ',Wisconsin, to•wit: The-"Northwest Quarter of the Sotzthwe5 Quarter (NWk of"SWh) Of `Section One-(1), Township Thirty (30) North, of Range Eighteen (=18) West: xw n 414 .~id~!.~.~^Iy • W>•s, 1} ~~}!~l ~J/ Y 211. 1 _00[x CO., wro. 'rya'6. Tor ftecorci fits 2nd 4 71 A. D. 1 Ian 1 ~-,y4 • g. ~n n .~.y A -File No. i i 1LO: 75P SALE OF REAL ESTATE GF PERSONS UNDER LEGAL DISABILITY. DEED BY GUARDIAN. Chaptcr 296. ~ 161 77 and _ _ ay. fi n~ Asplurc~ WITNESS the hand and seal of said of ; . Ha rahan , formed~,_ .di G / uardian afore,said,.thi's De6ember~,_ t9 5~._ _ day of._ Id Presence of {SEAT? 7 ]u d- Lois Handrahan, fc, mAr1y Lair, _p _ GpTt~ras Guardian of = _ !Itiscrr~txie34+'-a*~~e*amF~'~- ~ - Leo T. Domke, also known. as Leo. Domke , Speendthr s. f t - ...:r£ ft 2-- ~7"(tef'1•'S~~/hf10r ti 1i1 ~kli6M11QNfCA L".1~ x STATE OF WISCONSIN, St. Croix county. ers-c-ally c.qmq before a 22nd .kk --.d0.y o. _December A. D,19 the above rained ~O 5 Handrlhari fOrmerlY C s' ' tispyuna a-oian A "d g by -T- I --771M to.-me known-to be the person who executed the foretgoinq instrument and aqknowiedged tha~S.ha exeCtau] ~ - virtue,of the authority aforesaid. p, ht:c St. Croix : CrE 1& t `w•~ i MY `V11UU17Slon IJ Al./ia ¢u ~ o, ~ 6T9T GROd L amnToA ru ssr'a sa+ww ~~rino~ xloa~ 'is S 3 r' ~ //y 11H N d N M 1 S LS ~ V//y[ V lkvw C 2 L L1') ~ ll') tL9 u r c ° ,Q Y O v v v v c u-, Io ~ -r m r> r o ° s z~ M m > N i+ u C/~ o m rn c-, s s 1 .--I N E C d W- "'1 L ti ~O C 3 O .r ~ W O O Z L . ' U X i r L 2 u LL - Di CO U Y W N O n~~l.."~..• ~~.:w. L-Li L-Li u a Y M1 m M^ u +i o o c o v J J 4 4 N v ~ d N Q 2 Y - 1 - v~ E ~ y ? ~ C U• N t° m Of .r C7 1 N 1 1 1 T. N 2 ✓•F N C'l ~t CO c~ y L' L q G X O ` en O W =o J O m 2 1 s' v t •I #II N ~'1 1 d 1 - _ T V 0 ~ Y Y Y Y C I N J J ,L 1 N d I o Y I m CI v 1 s.,a44d ~q pauno spueT pa44eTdun 669•6Z9 M„90117£000N I - ,00'h6S IMS a44 30 }MN a43 30 OUTT 3sea 169-SE is 9 ? O I C co O H • ~ d O °i I L C O. I U > d l O d O N d O O N L O H ZO•£6S ° L A 1ET'6Z9 3„ZT,'7Eo00S > > i x d o > 2 N L O Y i - - r, > E N O m I L ~ -O H U H GI o O I O: Ti C ~n O N O 1 W N Y W La V) z I S S C O 1 O O O ~I w u d; ,h9'9£ ~i r O [J o I ,-70'Z65 3 1 3 W > I 3 °i ,89'BZ9 3uLT1h£oOOS - 1 N I N-~ N I C 1 3. 1 C I 1° N I O ~O w E- m O. • ~ m H=> i o o N z o ,n { a+ m N O NI m °c H {90'I65 2 a ,EZ'9Z 3,,ZZ1h o OS N W o LL- x d W v _ Is Z u E+ EI oo ° o - °o U] r-1 I • I i W o J m O A N 2 A I Q ed E-1 1s9•Le g LL 6 S o 04 ,LL'LZ9 3.,LZlh£oOOS I Ni e F-l asg7eTd q pauno spueT p033eTdun L L LL W O m N N L C ti Y E', N V Y E U 0 U Z N O = N Y u o rn y 1..{V..t O O Y N I-I F 16Z'6IET N I MuIZISCOOON 'I 10143as 40 }MS ay} }o auTl asap r OPMO AD MOO" a u3*1 vvr rir vv a.~u a.w. vv rsata. , iv vv~, :vv„ Ol Vi~A VV GV1Y 11Yh u VV4 ~ I D r POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of FILE INFORMATION SYSTEM SPECIFICATIONS Owner RYAN L. CARLSON Septic Tank Capacity 1000 al ❑ NA Permit # Septic Tank Manufacturer WEISER O NA DESIGN PARAMETERS Effluent Filter Manufacturer POLYLOK ❑ NA Number of Bedrooms 3 El NA Effluent Filter Model 525 ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity gal A3 NA. Estimated flow (average) 300 gal/day Pump Tank Manufacturer C'R NA Design flow (peak), (Estimated x 1,5) 450____gal/day Pump Manufacturer -7 N,4 Soil Application Rate al/day/ftz Pump Model )b NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit aN,% Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection O Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NT Biochemical Oxygen Demand (BOD5) 530 mg/L M In-Ground (gravityl ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) S70" cfu110Om1 O Drip-Line 17 Other: Maximum Effluent Particle Size Ye in dia. ❑ NA Other: ❑ NA Other: Other. ❑ NA ❑ NA I r_ *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 eve : ❑ month(s) every: mont yearls) (Maximum 3 years) E3 NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y.) of tank volume ❑ NEB Inspect dispersal cell(s) At least once every: 3 0 mo month(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once even'= ❑ month(s) L7 NA 1.1 O ear(s) Inspect pump, pump controls & alarm At least once every: ID month(s) N/, ❑ yearlsl Flush laterals and pressure test At least once every: ❑ month(s) N~. ❑ year(s) Other: At least once every: ❑ month(s) ❑ N~ ❑ year(s) Other: a 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 surfaCB, The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pondirig 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 (Y3) 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 11:3, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 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. VO/L1/VV iuz is;Av rAA do Job 4tioti JT UKA UU GUINIAU l¢1 UU5 Page [i of Zi ' 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 ehemicils 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 tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fiat; foundation drain (sump pump) water; fruit, and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; ail; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed, • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or, must be taken, to provide a code compliant replacement system: Q A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorptkm system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells- Failure to protect the replacement area to ill result in the need for s new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. _1 P alua inn rn,ICt ~,tv i *I~is..n.ynstinn~I,~.a~~ ~r~ww,--~~ to G IG~IIVGGIIIGIIL QIGD 11 IIV IGFJI4laGI1iGIIL mce w avanav/o a nulunlb w►k be a at ti - ~IZ>)I-!I'fi TTF~ i>~le- A/~ CaA1STRtlG7'Ll~~ ❑ 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 NCT 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 4J Name Phone 7/ _ y b Z(o(- Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name )dame s-r. C2o ~ zo~~N Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54171. (2l & (3), Wisconsin Administrative Code. R ~ Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 % x 11 inches in size. St. Croix Include but not limited to: vertical and horizontal reference point (BM), zimttio Parcel I.D. 6-1001-90-100 Percent slope, scale or dimensions, north arrow, and BM referenced to neareE dd. Please pr %rmation R revved C Personal information you provide may be used f`sE jblM (Privacy Law, s. 15.04 (1) (m)) ` PDate Property Owner A 1 Property Location Wm Derrick Construction Inc. A UG 06 Govt. Lot NW SW v, S 01 T 30 N R 18 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1505 Hwy 65; P.O. Box 445 ``~G 2chyn,~ 1 CSM vol. 7, pc 1819 City State Zip Code Phone 0 City 0 Village Town Nearest Road New Richmond WI 54017 715-246-2320 Richmond JQ CTH GG 0 New Construction Use: 0 Residential / Number of Bedrooms 3 Code derived design flow rate 450 GPD 0 Replacement 0 Public or Commercial - Describe: Parent Material Loess over Till Flood Plain elevation if applicable N/A ft. General comments and recommendations: 1 Bor Boring ing # 0 Pit Ground Surface Elevation 100.0 ft. Depth to Limiting factor > 120 in. Soil ADolication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f in. Munsell u. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-14 10YR3/2 - SIL 2-f-gr mfr CS 2f 0.6 0.8 2 14-38 10YR3/4 - CL 2-m-bk mfr gs 1f 0.4 0.6 3 38-120+ 10YR4/4 - S 0-sg ml - - 0.7 1.6 a Boring 0 Boring g # OPit Ground Surface Elevation 102.6 ft. Depth to Limiting factor >144 in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2 1 0-12 10YR3/2 - SIL 2-f-bk mfr Cs 2f 0.6 0.8 2 12-27 7.5YR3/4 - CL 2-m-bk mfr Cs 2f 0.4 0.8 3 27-41 7.5YR3/4 - S 0-sg ml CS if 0.7 1.6 4 41-144+ 10YR4/4 - S 0-sg ml - - 0.7 1.6 ' Effluent #I = BOD5> 30 220 mg/L and TSS > 30 150 mg/L " r-muent #2 = BOD5 5 30 mg/L and TSS 30 mg/L -1 -j CST Name (Please Print) Signature CST Number Mark Iverson 46672 Address Date Evaluation Conducted Telephone Number P.O. Box 155 Hammond, WI 54015 August 1, 2012 715-796-5664 i r ~ Property Owner Wm Derrick Construction Inc. Parcel ID# 026-1001-90-100 page --2 -of 3 3] Boring # 0 Boring g Elpit Ground Surface Elevation 100.6 ft. Depth to Limiting factor >130 in. Soil A licati n Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 1 0-14 10YR3/2 - SIL 2-m-bk mfr gs 3 f-c 0.6 0.8 2 14-25 7.5YR4/3 - CL 1-m-bk mfr gs 2 f-c 0.2 0.3 3 25-38 7.5YR4/3 - GRSL 1-m-bk mfr cs 1f 0.4 0.7 4 38-130+ 10YR4/4 - S 0-sg ml - - 0.7 1.6 17 ❑ Boring 4 Boring # pipit Ground Surface Elevation ft. Depth to Limiting factor in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Boring # 0 Boring Clpit Ground Surface Elevation ft. Depth to Limiting factor in. Soil ADDlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Etf#1 *Eff#2 * Effluent # 1 = BOD5> 30 220 mg/L and TSS > 30:5 150 mg/L * Effluent #2 = BOD5 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. r ~ 0 ft. 24 ft. 40 ft. 80 ft. N a~ c J a- CL B-2 s 102.6' y c~ ~O~ ~0 obi ~0~, B-3 100.6' ~p0 O~ ~S Proposed house B-1 30 100.0' 0 w 1 p0 PVC 0 pf e Bnn# s Description . Bench Marie B-1 - Boring Location & Elevation Elevation 100' - Owner: Wm Derrick Construction Inc. Site Information: Completed By: Mark Iverson, PSS #197 1505 Hwy. 64; P.O. Box 445 NW 1/4, SW 1/4, S 1, T30N, R1 8W 680 Larcom Street New Richmond, WI 54017 Town of Richmond Hammond, WI 54015 St. Croix County 715-796-5664 Phone: 715-246-2320 CST# 46672 1 LED l (lMAN.261987 JAM 01 COMMU O42CO74 cm ftemw CMk west line of the SW,'; of section 1, N00038'2111W r• 1319.29' -3 w w 100 w N ~F- H ti c r N z rt C, c' ° 0 00 M a rt rn co r• o In ~o O• O N N N .Z7 0 rt ~ = O N I-] IT1 fD C _ LO co r• •7 O t7j -Tl O_ m unplatted lands owned by platter m d = Cn o_ co I H Z v o' S000 34 1 2 711E 627.77' x b C N I 590.09' O Cn I~ S O z 37.68' Z I- 3- I v Z I C7 N W I Cl f N N M _v to I vrti rl- O O o 00 o o° ° H H z s - I- - x tTl C) F71 S0003412211E 628.23' 0 Z O z o 591.06' H A`v 37.17' is O z 1 - n h] O N N N co I N L9 Cn 0) CD ~ 110 o~ o o t r ~ r O y rv Gn I N z x N t0 t0 O t0 O N 1 d 10 o i C~ O c0 O O (y l O. - I y LTA Ir O w rnI w~~ N I = t _ 1 3 N N E I a_ ~y "2 L o M ZE S00034' 1711E 628.68' o H Z) CIO a 36.64' 592.04' r O z ID o o I Cl- i I w o 0 o I O r N ;T I V 1W0 N O I O" rZ N O I G v Ln rn (n CM 01 c0 O O O O I'O H I rn O W N C I o _ , O 1 r+ z y w I oo c0 C 1,% o I rt M 1< i I , _j < N i- M 3 < a CD 3 S000 34 1 1 211E 629.13' o o - I 593.021 N o ~ rt - K36.11' w I--' C S N rrCy • ~ O N I N p 4 N VI Ot W 0- tD C IU < O _ 0 C-) t0 O m I LP . , C) co w - 3 CC) co 16 ' 35.59' east line of the NWJ of the SW1 :5~ 594.001 - - - I N00034108"W 629.59' = unplatted lands owned by-others In :2! 1 ~ I ~ I rt o D Q1 1 -h m I 0 0 0 0 rn w 1 0 0 0 o ry = rt rt rt rt n = O r pt F W N i--• (n H o• to C C-) f " - C7 ,do-' I • t-• w r fD o r r+ fD 1~ ~ F I S O) O QI O '7 C -3 C )j~l `Y • ~ ~i _y I w w w w m o ~ ~ x = [m v ~ LO (D to M d w w w w w O r _ --h o r• rt o z p 0 L" Ul ° - r v a rr -7Z ~"n rn C-) CD 0 rT1 o w r n rt C, co ' TI m = s 0 ~`1' rt~ m z m a x n ro 0 0 0 3 fo O_ cp ,n C C7 i0 O S O W to .A N- W f 1' r• = co rt 3 7 -3 C= 1~ W W fD In r+ CI AP No~L,-r,z~ ~ I LO co W m cl rt m o• --j W co .4 M Ot CT1 = rt co -h o _ O O h O H A 'O C w w w w tv o = rt Ln cn cn cn -s :U ~ ,p MAY 22 "14987 ~ c ~ ~ W N f0 \ O_ u f rl-• ST, I,.,ROIX COUNTY ~za.srPkrairr~SSVE PAMS AAW Ei0c Volume 7 Page 1819