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HomeMy WebLinkAbout008-1093-10-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INF~RMA'~ION (ATTACH TO PERMIT) Personal information you provide Snay be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Gavic, Don Eau Galle Townshi CST BM Elev: Insp. BM Elev: o BM Descriptio ~~ ~~ i oo. o , d ~v - TANK INFORMATION TYPE MANUFACTURER CAPACITY Septi Z Dosir}g'~ ~ J ~bo Aerati on /j , j~ Holding ri TANK SETBACK INFORMATION TANK TO , /~ /~. ~ ~ WELL BLDG. Ve nt to Air Intake ROAD Sep' ~ ~l 77_lSt ~O 1ST ~ l ~ c"O~- / Dosing ~ 2 ~ Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number a 2~ TDH Lid ~~ Friction Loss Syste~ :~ol~ TDH Ft Forcemain Le th ~ Dia. p Dist. to Well ~~ SOIL ABSORPTION SYSTEM County: St. CrOiX Sanitary Permit No: 420542 0 State Plan ID No: Parcel Tax No: 008-1093-10-000 ELEVATION DATA STATION BS HI FS ELEV. Benchm~~l /Z~ L la5'~ ~d yt ~._~ Alt. BM sue' ~ O Z ~ 2~ Bldg. Sewer 0, ~ Z/ S7 G~-S- _! SUHt Inlet f S G I ~ b- o SUHt Outlet G„ jln., J ~ / Dt Inlet %(Y~ Dt Bottom o. . gy ~ < Header an. ~ry-~ r~ 3.2 5 f0 2- o Dist. Pipe Bot. System t -~ a/. o Final Grade - 3~ io z,5 St Cover ~2K d 3. a /o Z- ?-~S _JO ~V ri 10 ~' ~ BED/TRENCH Width f Length ~ No. Of 7ren hes PIT Q]yJFeNSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS J „ / is SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM EACHI Manufacturer: INFORMATION C M OR Type O],Syst~~ ~~ ~ ~~/ ~~7 IT Model Number: DISTRION SYSTEM ~_ ~ ~lh,~, e~.l. ,0~0~ Header Manifold Distributi on ~ x Hole Size x Hole Spacing Ven o Air I a /~ q Pipe(s) I ~ /y~ J S ~ ~ ~ L - (J / C Length Dia . Length~ Dia pacin S 9 _ SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Only /}(~ ~ OA/,( ~~3 Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulche Bed/Trench Center .~, I , Bed/Trench Edges Topsoil ~ Yes [~ No [] Yes [] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/ d 3 Inspection #2:~/~/ U~/, Location: 76 County Road BB Blaldwin, WI 54002 (NE 1/4 NE 1/4 33 T28N R16W) NA/L~ot ~~ Parcel No: 33.28.16.489~`~ 1.) Alt BM Description = ~w~ JT = C$~fy~~ (1,, ~,~~~ n p,( /~,~~~ 2.) Bldg sewer length = ~ rJ~/ ~ / ~ [~/ ,~.a C J2~ ~K ~ `~ -amount of cover = ~ ~ f _ (,~7 L C/ /~~~ _ , y 3.) Contour = ~TJ k ~rt.4 wJ Plan revision Requ~ d~/ i Yes ^~tQo ~~ h-i-~~ ` -~ Use other side for additional information. ~! ' ;"3~ _.___ ~ `~ _-_J SBD-6710 (R.3/97) Date Insepctor's ignature Cert. No. " Safety and Buildings Division County 5T GC ~ ~ 201 W. Washington Ave., P.O. Box 7162 D / t: - S~O~SIII Madison, WI 53707 - 7162 Site Address De artment. of Commerce -o z- 3 ~ ~ ~- ~~ ~ g~ Sanftary Permit Application Sat>i~ Perm;t ber ~2 0 S~Z In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ^ Check if Revision ma be used for seco ses Priva Law, s15. 1 m I. Application Information -Please Print All Information State Plan I.D. umber ~ io. 6 - ~e ., ,~tca. Property Owner's Name Parcel Number ~ ~ T c( 1 UD$ - ~o -coo Property Owner's Mailing Address ~ Property Location ~p .~. . // 1. f ~,,CL 6/ ~E.J I V G S4 lY t; '.6: S T N. R j(~ City, State Zip Code Phone Number Lot Number _ r Block Number ~/ f~ , Q ] ~. 1 ~ ~ ~~. -^ u ision N ame CSM Number II. Type of Building (check all that apply) ~ ~ ~ C `` ^Ci // 7 ~.1 or 2 Family Dwelling -Number of Bedrooms ^Vil ge e ~ ^ Public/Commercial -~esc n~ U s ' ~To lup ~'Qu ~j Ge ~ ~'~ ` f C y -~~~ ~C _ ^ State Owned - t Road III. Type of Per it: (Check only one box on line A (numbering scheme for internal use). Complete e B if applicable) A' 1 New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to For County use.. S stem Tank Onl Existin S stem B. ^ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) ajE__ -1~1b . 44 ^ Non -Pressurized In-Ground 21~ Mound 47 ^ Sand Filter 50 ^ Constructed Wetland 22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other V. Dis ersal/Treatment Area Informat ion: Design Flow (gpd) Dispersal Area Required ~(~tlo ~) Dispersal Area Proposed ~62~{ e~t) Soil Application q. ) Rate(Gals./Days/ Percolation Rate (Min./Inch) System Elevation Final Grade Elevation roaa i~ ~g.~ X518-`( ~ ~ , 3Q C~,,°,,,~ ----- ~v~, ~ ~v 3 , ~ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks 2 _ S~j,d ~ ~yL7~L! Concrete Consttucted Glass New Tanks Existing Tanks ~ ~ -/U~ ~ ~•~/' ~ ~~ Septic or Holding Tank ,/_~ ~P ~~ ! ~ ~ ~ •~ ~ ~ ?( Dosing Chamber ._ Oo ~ ~? !.J x VII. Responsibility Statement- I, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) ,~v ~ ~ ;mot w-- Plumber's Signature ~,~,.~ MP/MPRS Ntunber Zz ro ~ z Business Phone Number ~i ~- ~7z - 3 z~y Pittmber' A/ddress (Street~,JCity, State, ZipC/o~de) I Z~ /5 ~~~' /~`l/`e KJ L l~t%Yl CKJ ~/ S~(~ Z 7 VIII. Coun /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) ^ Owner Given Initurl Adverse . Surcharge Fee 325 lll~j/O2 Determination ppfoval IX. Conditio of Approval/Reas ns for D' , Attach complete plans (to we t:onaq omyl for me ryscem on papa ~ ws Luau oai.: u iucaes m sme SBD-6398 (R. 05!01) _t Q LL t J- ~~~ 1 M; M G+ Z r Ip ~' a ~-- -- ~/~ I S i ...I^ 0 J s d 1 a ~G a ,L ~~ ~~ ~ 3 3 ~ s ~ ~* .~ ~ ~ J ' ~ r ~~ ~~ j~; ~ 1 • ~ s ~ ~+ 9 ~~ ,_ 1 i '' " c® ~/ /1 a -s ~r 9 0 s ~~ w t i N vim, J N J ~ ~` ~ J ~~ d-~ ~~ °~ ~~ ~. •„ J J ~ ~ ~ ~o f ~ ~ ~ ~ . o ~~ ~ d s ..~ ^ ~ 9 ~ 3 ~ , p 4 V j d ' ~ ' O ~ , ~ J ` J ,~ ~ ~# s ~' yy d f ~ ~ w t/1 ~ .~ ~ * qn J .~ ~ aC~ z ~ ,~ 1 3~ -r ~(a J 9 ~~ ~~ do ~. 3 7 ~ ~ a~ ~ -~, 3 ~~ ~~\ ~~ ~~~ ~~ ~~~ i rJ0 L ~ w ~ ~ ~ v~ ,~ ;~ 3 ~ ~~ .. ~ ~ ~~-o j ~ fl ~~/ ~ ~ ~t N ~~~ ~~ _~~ ~~.~ ~ ~~~ ~ \. ~ -~ ~ ~ ' ``_~ :'f a ~-~ ~ $ .. ;, ~~ V V ~. t ~' ,~i ~=1 a '~~~~= ~~~ fy»_ --, :_ %~~~~: »~=_ 1 ~sconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi. us/sb www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary October 14, 2002 CUST 1D No.226524 ROGER L TIMM TIMM EXCAVATING 3128 20TH AVE WILSON WI 54027 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/14/2004 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Don & Diane Gavic CTH BB Town of Eau Galle St Croix County NE1/4, NE1/4, S33, T28N, R16W FOR: Description: Proposed Four Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 873980 Identification Numbers Transaction ID No. 794671 Site ID No. 651497 Please refer to both identification numbers, above, in all corres ondence with the a enc . The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans. • 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. • Comm 83.22(7) - 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. Owner Responsibilities: • Comm 83.52(1)(a) -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. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • The owner is responsible for submitting a maintenanc eJJ{{fication report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Re she~ll~s~b~ltted at intervals appropriate for the component(s) utilized in the POWTS. OIZL~ItIOIZLIlIy A~PR~VE® l:r~ ROGER L TIMM Page 2 10/14/02 In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm j swim@commerce.state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky ,Wastewater Specialist, (715) 726-2544 Henry F Grote ,Certified Soil Testing f. Don & Diane Gavic -Mound Transaction # Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manuals: Mound, SBD-10691-P (01 /01) Pressure Distribution, SBD-10706-P (O1/O1) Location: NE 1/4, NE 1/4, Sec. 33, T 28 N, R 16 W Town: Eau Galle County: St. Croix Date: October 18, 2002 Owner: Don & Diane Gavic Address: S. 306 Church Ave. Spring Valley, WI 54767 Plumber: Roger Timm Signature: License # MPRS 226524 Attachments: 6748-Plan Approval Application SBD-8330 page 1: cover 2: design criteria & calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve 8: system management RECEIVED SEP 2 6 2002 SAFETY & BLDGS DIV. DIVISION 0 FE7 ND BUILDINGS SEE CORRE ONDENCE page 1 of 8 I .~ Design Criteria ~ `~~ Residential Wastewater Contaminant Load: 30 mg/L < BODS < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg/L Bedrooms x 100 gal/bedroom day x 1.5 ~' "'° gallons/day hydraulic load In situ designed loading rate Depth to estimated high ground water Depth to bedrock Cross slope at system Force mar .nark Manifold/header length Drain-back Lateral length 4' Lateral elevation Lateral hole size SJ~b in. ~ 3 holes/lateral Design Calculations ~•3g gallons/sq. ft. per day ~~ ~ in. ~ ~~ 3.~ 3a ~ ~. 3. ~s' @ s~,° l o~.s~ @ ~-g.o S' Z ,~ Lateral volume ~ g,4 Total lateral discharge rate 3~+•3t Network pressure compensation losses °'~'~ Elevation difference 7 2~/ - -, b'~ Friction losses `~ •~ Z- Total dynamic head iy~3~i ~ °'Z~ Pump/slprhon 31o gpm @ ~~ Manufacturer ~'' °"'~ ~'~ ~~ ~' ~ Dose volume ~~'~ ~ Lift/si~on tank ~ ~-~-~ tn. ,,.... ft. of z in. - ft. of z in. gallons ft. of ~`! z ~ in. ft. @ bottom of lateral in. ( ¢• ° ft.) Spacing holes total gallons gallons/minute @ ~'~ ft. head ft. ft. i ft. @ 3 ~ gallons/minute ft. ft. of head Model # t ~' o ~'' gallons ~ `rO gallons t L `~'° gallons o~ ~<<~ o~ s~ ~~ Septic tank ~• - `^' ~-4-~K ~ ~ ~ ~-~ Effluent filter ~ °~~ ~'`"``~'~ ;~- Measurement pump on and off g'•S Height alarm from tank bottom ~ Z•~~ Reserve capacity S3~-~' specs.calcs.res tn. m. gallons Page Z of $ ,~ ~„~ ~~ 1 ~I~i J' a iy 0 J~ 9 rJ , t~ M; M f Z r rp f d 0 .~ a d 1 n6 (!r d S 9 ~ J ~ ~~ 9 q J a ~s r a ~ _ p ~ f ~~r~ Y d'~ i J~ ~ d ~ • ~ a . ~ y~ ;~ ~~ 0 x ' ~~ ~~ 9 ~- ~ , Y- M J ~i- N k 1 i~ d~ ~t .~ ~ ~ ~ ~ ° f ~~ ~ ~ ~ ~~ o ~ °~ ~ ~ d ~ ~ ^ s ~ ~ ~ ~~ 0 0 ~ ~ ~ ~~~ f ~~ '~ ~ y S ~, '~ XJ ~ w J ~ + ~ ;~/ + ~ Z ~~ 'S 1 .. ~ dC~ Z ~ r l~ a ~~: a ~~ s ~ !. ~ i ~"~ ,/^~ -^{i ""~, V 1~ ff o ~~ ~ ~ s a •d' ; ~ ~, ~ ~~ a~ 3 J ~~ 1 ~• v~3 ~ M ~ ~~ ~ -~ ~ fl ~! ,. t 00 f ~b M~ ~:, `~s~` >~> ^»>.= .;~:-~:- __,m o~, J^000." `» ____________-- __ V .. ~~, 101. aX ~,~, . ~ o ~ . o ~ 3 -r 11 11 M oe.~ tia t-di 0. O~a! a~~ (y'' ~ps~ ow Zu ~p 0„v t t9 r ~~n.TV .' 1 N ~ ~ to Sl+~oco: ~° ° "" Q„~a.v o.r a.~.. ~ t}~ . ~ 3~ ---___._ .--__ - - 1 C ,1. ~ ~ L tw~e-1..~ a ~e.~, t Q.'~.c~' O~ •~ ~_ ~ i ~.3` ~--- ~ ~ ~ --~~ .t, ' Zo•4 Z.o~ 1.Y~ Q i _~ ' .wl ~' +. l 1. ~ -~_ ~,g 1 ~ 4.~ g g' i. 12 ~. ~' I' ~ 1 ( 1 ~.'J ~, ~ o ~•.. Q w W S O l v-e c. ~~ b orh I V o -'c- e '. 1 u ~ P~ c~ ` S ~ Pte. ~.. `, h a ~ c - O'. Qc~ ~- a. xa ~p ~ P u C o `o S ~r v ~ ~-: o h ~,.. a,1 ~ i-~ b e ~ •~ o .., O ~ r o c. K Z. PAC ~e.~ ~O ~•. a.a. .w .'.r s\o~..St 5.-0 ~..,_ 1-e i....t~ L~ Pic s~ 40 ....., ~~ ~~ '' l ` 's ~ V ~ ~ c.h 4-J `..~o......\S I / 3.0' it ~ I I ~.~~ I I ~.~~ ~Z.a~ ZA, ~ 4.0~ ~ ~ 4.~' ~~ ,.~.o 5~, n 5 1~ o F /, `\ t\ ` ~• i i ' a a o~ $ ~~ l~fa QvL cam`, 1 e, t a r e.` S y ~' `i~ C.I, vE"JT PIPE' ~ 2~ = R0:^1 DOOR, WIIJpOW OR FRESH AIR 11JTgKE h~ \ ~~ ; ~~ 1J a.} 0.,~ VEIJT CAP WEATHER PROOF JUtJCTIOIJ bOX 1 Z1 x ~~ s~o ~~ T1 o w, ~~ -4- 2. l ~~~~~ ~,.~, `c Z" - ~o •.. ; h APPROVED LOCKING MAIJHOLE COVE F. ~~ wARN~N I LAQ~I... GRADE ~ m\e,,, , ..,.~e1.3 4u I _ COAJDUIT ~-- ~~ ~.;~ \~~~~ ~~ ', 11~ PROVIpE _-_--_-_- AIRTIGHT SEAL I I ~ I ~32.e c,-~,~s, ~es~7a~~T z4.5" ~ III I APPROVED JOIuTS I III w/ PIPE I II ALARM EXTEA1DIUG 3' ~~~ I I ~ 0-JTO SOLID SOIL ~- i I ~, ~ a I I O IJ . ~2„~" ~ I I I PUMP -~ --~ OFF a'la'"• ~tS, o ~. w ~1\ DLOCK _.--, ~~ ~ ala.v . q4,3 Z ~ Off} .`'t" .~C 1t w~ ..7t~ ~" . `i~ ~..~~°~~ Submersible Effluent Pump 3871 EP05 ,I`Ilf I ~ ~~~ual APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: 3/a" maximum, • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1'!z" NPT. • Mechanical seal: carbon- rota ry/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. •EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length, 16/3 SJTOW with three prong grounding plug. Optional 20 foot length, 16/3 S1TW with three prong grounding plug (standard on EP05). • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- maticmodels include Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller: Thermoplas- tic Semi-open design with pump out vanes for mechanical seal protection. ^EP05 Impeller: Thermoplas- ticenclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover: Thermoplastic cover with integral handle and float switch attachment points, ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING ~" Canadian Standards Assodation (CSA listed model numbers end in "F" or "C".) Goulds Pumps is ISO 9001 Registered. © 2000 Goulds Pumps rr.~~~\/Q~ ~- a ~ g ~ ITT Industries Effective February, 2000 ~I J( 83871 ~~ u >a •Y ' System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, Roger Timm, 715-772-3214, or the St. Croix County Zoning Office, 715-386-4680, should be contacted for assistance. General Proper functioning of an on-site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1 . [f the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2 Install water-saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly. 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or pump tanks are no longer used, they must be properly abandoned. 11. If construction timing and weather could create a frozen infiltration system, weather-proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back-washed into the septic tank to remove accumulated material. 4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in-situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. [f this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down-slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system area. 1 1. Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 "r '~RIG91~ ~ ~~ SOIL EVALUATION REPORT Wisconsin Department of Commerce Division of Safety and Buildings in ~renrrhnrp with Cnmm R5 Wis Adm Code 1488 Page 1 of 3 CeR~ed Soil Testing County Attach complete site plan on paper not less than 8'/: x 11 inches in s¢e. Plan must St. Cr01X include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I D percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. . . Please pri l i f id P i b s ~Al (P~r Law d f 04 (1) (m)) 5 Reviewed By Date e may ersona n ormat on you prov e , . se or . . Property Owner roperty Location Gavic, Don & Diane AR 1 2 ovt. Lot NE 1/4 NE 1/4 S 33 T 28 N R 16 W Property Owner's Mailing Addre$ of # Block # Subd. Name or CSM# S. 306 Church Ave. ST. CROIx COUNTY City State City _~ Village j,~ Town Nearest Road Spring Valley ~ WI 54767 715-778-4471 Eau Galle CTHW 66 New Construction _„_ Replacement Parent material till General comments and recommendations Use: ~1 Residential / Number of bedrooms 4 Code derived design flow rate Public or commercial -Describe: Flood plain elevation, if applicable : install 6' x 104' rock bed mound on 100.5 contour as upslope edge of rock w/ 0.5' sand fill 600 GPD NA ^ Boring # I Boring /i Pit Ground Surface elev. 100.5 ft. Depth to limiting factor > 65 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GP D/ft= in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh, •Eff#1 •Eff#2 1 0-7 7.5YR 3/2 - sl 2 m gr mvfr cs 1f/m .5 .9 2 7-18 10YR 4/3 - sl 2 f-m sbk mvfr cs 1 m .5 .9 3 18-35 7.5YR 4/4 - sl 1 m sbk mvfr cs 1 m .4 .6 4 35-48 7.5YR 4!4 - s 0 sg ml gs 1 m .7 1.2 5 48-65 10YR 4/6 - s 0 sg ml - - .7 , 1.2 ^ Boring # Boring Pit Ground Surface elev. 100.5 ft. Depth to limiting factor 50 in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `E~2 1 0-5 7.5YR 3/2 - sl 2 m gr mvfr gs 1f/m .5 .9 2 5-10 7.5YR 3/2 - sl 2 f sbk mvfr cs 1 m .5 .9 3 10-20 10YR 4/3 - sl 2 f-m sbk mvfr gs 1 m .5 .9 4 20-36 7.5YR 4/4 - sl 1 m sbk mvfr cs 1 m .4 .6 5 36-50 7.5YR 4/4 - s 0 sg ml cs - .7 1.2 6 50-60 10YR 4/6 f2f 10YR 6/2 s 0 sg ml - - .7 1.2 tttluent #1 = t3oD5> 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = OD < 30 mg/L and TSS < 30 mgt'_ CST Name (Please Print) Sin ure: CST Number Henry F. Grote ~ 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 3/1/2002 715-233-0398 1A Property Owner GdyIC, Don & Diane Parcel ID # Page 2 of 3 Boring # .:.~ Boring ' 1/~ Pit Ground Surface elev. 99.8 ft. Depth to limiting factor 49 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 1 0-4 7.5YR 3/2 - sl 2 m gr mvfr gs 1f/m .5 .9 2 4-9 7.5YR 3/2 - sl 2 f sbk mvfr cs 1 m .5 .9 3 9-25 10YR 4/3 - sl 2 m sbk mvfr cw 1 m .5 .9 4 ~ 25-49 7.5YR 4/4 - sl 1 m sbk mvfr cs 1 m .4 ~ .6 5 49-60 7.5YR 4/4 f2f 7.SYR 4/6 f3f 7.SYR 5/3 s 0 s g ml - - .7 1.2 i I a Boring # ~ Boring s! Pit Ground Surface elev. 100.5 ft. Depth to limiting factor 51 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 1 0-4 7.5YR 3/2 - sl 2 m gr mvfr gs 1f/m .5 .9 2 ~ 4-11 7.5YR 3/2 - sl 2 f sbk mvfr cs 1 m .5 !I .9 3 ~ 11-24 10YR 4/3 - sl 1 m sbk mvfr cw 1m .4 .6 4 24-34 7.5YR 4/4 - sl 1 m sbk mvfr cw 1 m .4 .6 5 34-51 7.5YR 4/4 - Is 0 sg ml cs 1 m .7 1.2 6 i 51-66 7.5YR 4/4 f3f 10YR 6/2 Is 0 sg ml - - .7 1.2 horizon 5 has stratified inclusions 10YR 4/6 s (0, sg, ml) Boring # -~-` Baring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' j in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 -- ~ --- I i ~I 'Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L '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. SBD-8310 (R.07/00) Certified Soil Testing ,' J i a y 0 f' M M f 2 tp 7 s ~~ 0 .~ a V d a d s ~.~ Q' - ~ 3 J ~` q g. .~' a a F- - ~.~~ r f ~ R '~. v~ a ~S ~ r 9 0 3 ~, ~ ~ ~ ~' ~ f . ~ o ~ ~ ~ ~ s ^ ~ ~ ~ 0 0~~; d ~ ~~ ^ :~d~~~ ' ~ s • ~' A' ~ d ~~ ~ ~ ~ w i J ~ ~ J ~ ~ v S °~ ~ ^I ~ . ~ d~ o Z ~ r `~~ A /~ r° .~ $ r v~ ~ a 1 d' -~, '~ fl ~f ~, t ,~r ~.6 M~ ~=1 m -- ~,_=._ =- - • 9~Y~ 7=»T~ 8~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer _ dJC1~ ~Cc,//ic, Mailing Address -0 36 ~ c h u ~1- u-~ ~A9-YYi ~ Property Address ~~ (Verification required~from Planning Department for new construction) Y~ City/State ~_c.,Q dlcJ ~ n ~ ¢ Parcel Identification Number 6~ ~ - 1© 3 - 1 Q - yoo . ~-(~ (~ LEGAL DESCRIPTION Property Location Q/~ '/<, ~L~'/., Sec. 3~ , T ~ N-R /~ W, Town of ~u-c~ ~.1 /~ . Subdivision _ /~~- Lot # Certiif ed Survey Map # ,Volume ,Page # Warranty Deed # `~ ~~D ~r0 ,Volume // Z2 ,Page # / ~~ Spec house ^ yes jffi no Lot lines identifiable yes ^ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, joumeymanplumber, restrictedplumber or a licensedpumperverifying that (1) the on-site wastewaterdisposal 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. 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 t your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days f e three ye expiration date. !D/~~/ yy SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (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 ro rty desc ' d above, by virtue of a warranty deed recorded in Register of Deeds Office. /~/~/a~- SIGNATURE OF APPLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed i ~i DOCUMENT NO. STATE IsAl; OF WISCONSIN FbRld 1-lYBi~ ~. Y L ~~L ~P Df~ ~-~Y- _-----_-- ----_ -_ - ~-___ ~ Steve as_Peraona2-RepresentativeeinRthetene a a X=ronen 1Thi8 Deed, made hetawn ...-..""'-•~~~~•..tanetairediviMuall Stene;__Harlen.R,_..SrgnQ,_ a(k(a--Harlen.•S•• ............ ._. _. ~_.......y.,l Laurence K-.. Stene,__a(k(a_Laurence $tenex--indigidu,{ild3[nbr, ~ and.~D~n..~-..-G~x~c..amd..A.~an4-..~....-Gav-l.~,..hWebard._~d.-i±i.~a..aa. ~ i~~Rt..tenan~8- w~~h-.>` i8ht..Q~..N>l;,xixsX~b~R.-Rli._~I~F4!TAl~ ~A....... Marital.. -P.xaRe x>;y .................•-----•-•---.......................... ~---.....----...... .........................................................................................~._.-. Grantee, W1trie888th, Tha! the saki Grantor, for a valwble ectaulderation...... receipt. of _.which.•is• hereby--acknowledged_--.,___-.__ _ conveys to Grantee the following described real wbb'a .~-~.e..~'o.~-?~ ............... County, State of WlsconsIa: TNI• a~AGt Itt[[11vtD IOR 11aCONO1Ne DATA hc~tl ice, :._..... MAY 1 T 1995 Et 9:30 !t ",' r' ,n ~~1 ~ +~ io°° Pd _ ~ sue, ~~ ~'~1 ky (e~~-~ Tax Parcel No :.................................. Northeast Quarter of Northeast Quarter (NE 1/4 of NE 114) and the South Half of the Northeast Quarter (S 1/2 of NE 1/4), Section Thirty-three (33), Town Twenty-eight (28), Range Sixteen (16). THIS IS NOT WISCONSIN MARITAL PROPERTY Thin ----.-•.•------.•----.._..-. homestead property. (fa) (is not) ~~~ FED Together with all and singular the hereditsmenb and a~urtenances thereunto telonging; And-..~iiCflA[RX&-..--• ..... ..........................................---••---•-• ---....-..-..........-.-.--..-..-............-.-...... warrants that the title is good! indefeaaiDle in fce simple sad free and Blear of encumbrances except and will warrant and defend the acme. Dated this ..----..._--•-•--•.~.~. ~ ................. day of ...._._.. M`i.X-..-.....--• •--........---....-- -...-.-..-.-......, 19-- 9.`~.-. ~~.... ..--•-- ------.. _ - .. .. SEAL --~•~-- ) -r en R.~~t -n , as ersonal Itepiesent . I•surence_ M.__Srene•__•___________________________ • _ia.Estaie..of..riyraa-S.t„n,e._-.............. -•-•• --- --------•--..._(SEAL) ~•.-~••.~dC~~~-~?..'~..~ ..... ........(SEAL) .Haden R. Steve wv:saxT><csT><ax Signature(s) -------------- aathenti:,ated this _---•.--day of ........................., 10____.- sasxoWLaaa>tcsrrr BTATIC OF WISCONSIN ss. Pierce -_____Conaty. -.~_..__..--- --•-- 13th Personally cams before me this ........._.-...day of _----.-_..1:'~aX..__._._........., 19.95. tM abon named TITLE: ME1dBER STATE BAB OF WISCONSIN (Il not, -------------------• authorized by (708.08, Wia. State) b ma wn to bs the person .8...._... ~~~c~~trameat an(~lsdgs --i