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HomeMy WebLinkAbout026-1292-28-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 556386 0 , GENERAL INFORMATION State Plan ID No: r 6 Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 2,4 Y Permit Holder's Name: city Village X Township Parcel Tax No: Karner, Claudia Richmond, To n of 026-1292-28-000 CST BM Elev: Insp. BM Elev: BM Description: Gt / Sectionfrown/Range/Map No: b ✓V - ( GS 15.30.18.1477 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. /.lli D/,3 106. U Septic 2 Benchmark z 70z S - 6 Dosing Alt efyy) .7 r . BM wGL[ / 13. &S Aeration Bldg ~f "7.2.5- Holding St/Ht Inlet (7770 - (""oD -1464-111 . Yi i-e. 06 7 s St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet / Septic \ I©D / / I n J Dt Bottom sl2P~(~ IS Nvf `75 7 ~o Dosing / IV > U5 Heade ah Gf c,, (I S Aeration Dist. Pipe t l 2.r,5- 91.3 Holding A~ 13!x. t S- a 5~ ,-7- 9 q 7-d PUMP/SIPHON INFORMATION - yQ F! an racle d ~~Lf1rt.. ~u 1001. f~ Manufacturer 14 Demand Cover / M= GPM ~ 3 ~s'7 DS~~J Model Number f TDH LiftS Fricti' n Loss Syste Head T O ,Ft t i / I I ~P . S I- b Forcemain Length 0, Dia. Z t1 Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width 9 Length / No. Of Tren PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/ LDG W LAK TREAM ' L CHI G Manufacturer: INFORMATION Type Of System: CHAM OR / / \ ibU t / ✓ ` rl I t1 Model Number: DISTRIBUTION SYSTEM S J ) 7 Heade anifol Distribution x Hola Size x Hole Spacing ent to Air Intake Pipe(s) / '2 ~ 7/ 7/ Z j P+~' IJ~ rL Length i I Dia iLength_//- Dia Spacing SOIL COVER x Pressure Systems Only x d r At-Grade Syst n ~d L/ Depth Over Depth over jKx Depth of xx eded/Sodded xx Mulc ed Bedrrrench Center Bed/Trench Edges Topsoil es M No [I Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Z Inspection #2: / ~Z. Location: 1552 127th Street New Richmond WI 54017 NE 1/4 SE 1/4 15 T30N R18W Cher Knolls 2nd Add L t18 Parcel No: 15.3 .18. 77 G G~ 1.) Alt BM Description P - n s~ s 2. Bldg sewer length 5 - I V 1~1D ~ t - amount of cover = l 3~~ A~-3S1j8' Q3K Plan revision Required? ❑ Yes o / - L - j~ O- Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Sig ature Cert. No. PLOT PLAN PROJECT Claudia Karner ADDRESS 887 E. 6th St. Aot #4 New Richmond Wi 54017 NE 1/4 SE 1/4S 15 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 98.5' BEDROOM 4 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK XXX 1255 gallons DOSE TANK SIZE 765 SEPTIC TANK SIZE MOUND HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. same as benchmark ~l C 1.1 Property Line Grad' ng is to be Property Line (not to done o divert scale) run- ff away from y/stem 7% Slope WeiI is to meet all DN set bac ks 170' 99' 98' ('0n B- 97' 96' B-3 Area 15' below system Y Q~V - is to remain undisturbed Pro 2 Acre Lot H uffc t Bed roo m Combo ank to House nk is to be properllyb dded and provided ith lockdown covers wi h approved Property Line warning labels { not to sca I e l0b P~ Scale = 1/4" = 101 N.;~.~ 127th St. corrrrnarce, vW.',; Safety and 13ui ; _ t Count - ■~C~n w~ 2t)1 W. Washington A e., P~x 7#' i r n ~ ry Madison, WJ 537 j(>2 Snai/.u.y Pnnnlt Number (w be Fi!!ud n by Co.) l~rtmertt of ca"" r'( ~ 4- _ Sanitar,~,-F it App lCatYOn s e Transaetion Number In accordance with s. Comm. 83.21(2)~,~►►1Clu1m. Code, submission of this form to the appropriate governmental Z unit ;s required prior to obtaining ii~.aiitary permit. Note: Appficatiun fotms for state-owne@ POWTS are Pritjeet Address (if difleient than mailing address} submitted to the Department of Commerce, Personal inti mration You provide may be used for secondary U oses in accordance with the Privac Law s. 15.04 1 m , Stats. / GC / Z~ / r C~, 1. A lication Information - Please Print Al! Information ✓ ~J 7 J Property Owner's ame Par•wl it Property Owner's Mailing Addresses - - / Properly I.ucalfon ` s~ le Govt. Lot 6 / ` 7 City, State Zip Code one Number / c %a5~ %a, Section/ II. Type of Building (check all that a ) Lot s T N; It J_ 1i r W 1 or 2 Family Dwelling - Number of Bedrooms 2 Subdivision Name / 0 Public/C Iramercial - Describe Use / 0 City of _ 0 State Owned - Describe Use / CSM Number LJ Village of own of _ III. Type of Permits (Check only one bore on litre A. Complete line B if applicable) A• New System 0 'Repiacernent System 0 TreatmeuttHolding Tank Replacement Only ❑ Other Modification to Existing System (explain) B, ❑ Permitt Renewal ❑ Permit Rovision ❑ Change ofPlumber ❑ Permit'fransfer to New List Previous Pcsnnit Number and Date issued Before Expiration Owner / CV. Type of POWTS SystemJComnoaent/Device: Check all that a I" ] Non-Pressurized In-(hound ❑ Pressurized ht-Ground 11 At-Grade d 2Q in. of suitable soil 0 Mound < 24 in. of suitable soil holding Tank 0 Other Dispersal Component (explain) ❑ Pretreatment Device (explain)_ w 7. Dis ersa!/Treat:nr nt Area Information: l )sign Flow (Led) Design Soil Application pdsf) Dispersal Area Required Dispersal Area Propos t) System Elevation '`,ll. Tank Info apacity in Total # of Manufacturer Gallons Gallons Units o New Tmiks Existing Tanks ~ ~S optic or Holding Tank ~S i Losing Chamhor 7 %1L Res onsibility Statement- L th ndersigned, assn risibility f'or installation of the POWTS shown on the attached pleas, lumber' N (Print) C - Plumber's MP/MFRS Number•• Business Ph ne Number ~Tiumber's A (Street, CAy, State, Code) 1 1J o nt /De art®ent Use On Approved Permit Fee Date I ued lssuiri t Signature wner r Reason for Den 1.L Condi l Reason for Disapproval ` aa ~~,Gl zo 1. Septic tank, effluent filter ent) ^r n dispersal cell must all be servfoes I mairtial~ . -F~~ ~ /Q r t qty a ll►SrL as per management plan provided by phrrnbar. 2. Atl setback regwitemeMs mast tJ&,Ir~aintairldd 5 efii ate- m ~fA,t,, , 3 ` yr t~G Attach to complete plans for the system and submit to the Co ly only ou paper not less s t/t x 1 t i Ises In slue J n^-' MID-6398 (R 02/09) ^ G~'t~t~t pl',r o gptipnxTAg~~Q.n Safety and Buildings 141 NW BARSTOW ST FL 4TH 0 WAUKESHA Wl 53188-3789 Contact Through Relay www.dsps.wi.gov/sb/ 91F www.wisconsin.gov ~ SSto's Q Scott Walker, Governor Dave Ross, Secretary November 02, 2012 CUST ID No. 226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 11/02/2014 Transaction ID No. 2168930 SITE: Site ID No. 785700 Claudia Kamer Please refer to both identification numbers, 127TH St Lot 28 above, in all correspondence with the Town of Richmond agency. St Croix County NE1/4, SETA, S15, T30N, R18W Lot: 28, Subdivision: Cherry Knolls Second Addition FOR: Description: Mound, 4 bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1400043 Maintenance required; 600 GPD Flow rate; 26 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD-10691-P (N.01/01), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01/01); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.01/01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERS)12.0" SBD-10706-P (N.01/01). The building sewer and distribution network piping shall be of material listed 'lb,384!3D-3 and 384.30-5, Wis. Adm. Code. J In the event this soil absorption system or any of its component parts malfunctions so a~o eate a health hazard, the property owner must follow the contingency plan as described in the approved plans.i addition, the owner must comply with the operation, maintenance and monitoring duties as described in section VIII of the mound component manual. A copy of this information must be given to the owner upon completion of the project. All holding/treatment tanks are to comply with SPS 384.25(7)(a). SHAUN R BIRD Page 2 11/2/2012 Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s_ SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Si ely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Julia Lewis-Osborne Please Include a Copy With Your POWTS Reviewer 2, Integrated Services Pavment Submittal. (262) 397-6005, Fax: (608) 283-7481 WiSMART code: 7633 julia.lewis@wisconsin. gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety& Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. Cover Page RECEIVED Shaun Bird 0 C T 31 2012 Bird Plumbing Inc. SAFETY & BUILDINGS 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 10/ 28/12 Owner:Claudia Kamer Location:NE1/4 SE1/4 S15 T30 N,R18 W Lot 28 Cherry Knolls 127th St. Richmond System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-12. Soil test 13. Filter Specificati n and cross section Shaun Bird Signature ' s License n er 226900 L, \ yC', s PLOT PLAN PROJECT Claudia Karner ADDRESS 887 E. 6th St. Ant #4 New Richmond Wi 54017 NE 1/4 SE 1/4S 15 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 98.5' 4 BEDROOM CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. sameasbenchmark B .M.* Property Line Grading is to be Property Line ( not to done to divert scale) run-off away from system 7% Mope Wel l is to meet al I DN 170' B-1 99' setbacks 98' B-2 97' 96' B-3 Area 15' below system is to remain undisturbed Pro 4 2 Acre Lot H uffc utt Bedroom Combo Tank House Tank is to be properly bedded and provided Property Line with lockdown covers with approved warning labels (not to scale Scale = 1/4" = 10' 127th St. Mound System Cross Section and Plan View . Pt lEfCi"[ i + I +k ~i +~r- pw ~s~+ + +az ~+De . Dimension Feet A _ F J B 7 D h t E A W 5 G Z v H r a ~ I F: I I 3 K C. L L7 y 3:i:j::~ r:Siy,fr:..jaJy{ZiEd~ir_:A..im.. ,r. J K ,lr-- B 1 Z ' T 2- L Slope % 1"1 = opsoil SaAa f1TM C-33 /Z to an aggrde sate 0 observation p0 ppevc r Cap Material Geotextile H Fabric r, 1 f F Ft I D E Ft Contour Plowed Surface Slope Direction `y GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a'/4 inch soil wire when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe: Special care must be used when placing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/071gj Page of Pressure Lateral Layout Two Laterals - End Manifold .0 Threaded . Cleanout Lateral Turn-up Plug Manifold M X L Force Main Long Sweep 90 Bend Distribution Network Specifications Pressure System Construction Lateral Diameter Z In. Manifold Diameter 2. In. Laterals are constructed of Schedule 40. PVC Orifice Diameter 5/ 3 Z.- In. pipe. Orifices are drilled perpendicular to X Orifice Spacing) a 9/ . In, the pipe with a sharp drill bit and face down. L Lateral Length) ` 7, Ft. Lateral turn-ups terminate with a threaded M Manifold Length) Ft. cleanout plug and are enclosed in a 6-8 inch Force Main Diameter 2. In. diameter lawn sprinkler valve box accessible Force Main Len vz~ Ft. from finished grade. Grade •••r•r :C •rr•••• 6- Inch Lawn Sprinkler Valve Box d1h Page of 03/051gj I r Septic-Dose Tank Cross Simon And Pump perfo nmsnce Specifcation$ Tank Manufacturvr Pump Manufacturer 0 Tank Model Number 9 st> 7 ~5-7 .Pum Model Number 9,E1f Tatal Tank Capacity I Z 5 sr 16 5` Alarm Mangy PCC_ - Max. Bury Depth Alarm Model Number G- r/ Swftch Type 1276 G r+. C' ~ r EtZ7 Filter Manufactuuar Total REM!eic Head (TDH) - Fact Filtea' Modal. Number Elevaatt'cm 1 T- 3 r ` Distal PTOWUW Network Loss Minimum Pump Required Force Main Loss . C4F Ft TDH TOW Chalet Wmahale i~{fake 4" Above Grade With Lrraring De~tice. Inlet Manhole Manhtole Min. 4" Above Grade < b" Below (lade seated "'atecrdsht Securely Mounted Looking Device Junction Hoc r. Fie~ished Grade vat min. 12" Disconnect Above Grade Means ' With Vent Cap •a; 'Y • '►'►'Y•h .yY•>• tYl>. `.,,1 1 / 1 / ~ 1 • ~1 ~ r r . a 1 1 « r . / Outlot • Filter Wet valet Barre ~ ; - } Ir Suited: and keserve C"Wig i CiPI Weep ~i'; Teak Volume Hole Dimension: In ASS Volume Gal. 8 all- resexve (aloe B ~ 2. '..b% Off Elevation C . Ft doso) C 3 Bottm s> (dam) D Elevaidon It ra . ► ► 1 ► h ► ► ► a Y . Total s Ft a/ 11111+•/1 a<, >+>'i > >'>•Y'~'1'1•Y}.+>IY•Y Y ►•t•1 >+a'.'>'a'>a>/a'1'Y > ►'Y•►4'YI► 1a'1►'►`ah'►b+i 1't . a i ►'a'a•>• ,►`1`►'f+.' '►'>f►aY' +a'~'►'►•►'Y'YrY'YI ...fa~ ita la•lara r . tfi.lr <tlt/+. +<<a.-Qg ♦1 </.t....a r< r r/1//1./. a.l<r< GENERAL XNSTAOL "ION: The. sap I tic/dose .lack is bedded. and back. fiW in aefdattoe with the manufacturer's product,a*Mal spaoifiic bens. Maximum depth of Wy-as. q*Wflgd, by the i attufaarurer may not be exceeded without ptior, spprevnl. Manhole covers eked to smie have an. a ative looking device (padlock) installed. Piping at the bad and ouslat is of approved materlalf connected to flue took with watertight fittings, and laid on stable soil to pardum suing or sq&g. itiAW - ia sloAvved Wft 4`' $ole, 40 PVC to bridga the tank c ,cavadon aazdth6j oc,is sm" watextigbt, -ElacdWat"ivioe caotj lW %41ih.NEC-300 and Comm 16.28. page of 02!05 LX 41) LaserJet 3100; 1 rib bOW titltr ; muy-D-vo , MdM 94 9EM SERIES SUMP/EFFLUENT PUMP 0 gp Mlcat~vnlR ow , v , sv :e to ad hfxldp lnla 10011 A► mom Bt lar'lrl Own 1! B Za' 84 l.14 r 41 B1x5~1 49 52 8&I~lll laB7la Kok 4ItD 115 514 in iom 74 iM 0a 7B be 55 di a1 Ito ad' 74 8.11 r11b1iS.sA y~.dAl W140 wo V-4 2511 31 B.B 6 10 A low 70 M ~9 8! 19.4 as AI V1 a IIN MIS seuo~ lOB1A! wo .WO 195 ] 4 IN a Ito mus u~.ovaaa-~rewawrsllw~lw.i~a•waoonao~wu.awa+sovn,nwlam~n.ar,wranortornewa~ a~u FLOW- LITERS/HWR ~ir011> OMrt Motor Hougin °xX ` ~ Iran o looa aooo aaoo Vol Carbotote Irupeller Material c closed Vane ABS t'owslr Cord _W and ~.g MocYuuDiueI Shslfl S>;eal Nitrile with carbon ¢a oeraanio faces ~ I~alttbslers Sui~leea ~Stee1 _ 1D e.a Bearit~s UWW glaee and L oWc Ball Bearings a o an o r>4 try t Fuo Co. rLuv- GALGaastlap vc G~CtIe Qc F FRpMP PERt'dRMa"" CtJRv PO Box Iwae• amlsxmr tunoBi 13157 E-uwk alulolawsx*+I *Om " "1 0 FVVI990834---07103 wwr,.uttlemaraftlBa10• IP'OWTS OWNERS MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Qe Septic Tank Capacity /,75-S7-- al ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Iiiki:Ta s ❑ NA Effluent Filter Model ❑ NA cility Units A Pump Tank Capacity al ❑ ~ age) ' al/da Pump Tank Manufacturer NA (Estimated x 1.5) OC)al/da Pump Manufacturer S13 NA oil Application Rate / al/da /ftz rPump:M::dd:e1l ❑ NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit Fats, Oil & Grease (FO(p) 530 m L NA 9/ ❑ Sand/Gravel Filter ❑ Peat Filter Blochernical Oxygen Demand (BOD,g) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSP) 5150 mg/- ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) Biochemical Oxygen Demand, (BOD 530 ❑ NA mg/- ❑ in-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSO) 530 mg/L X!:CkA ❑ At-Grade AMound Fecal Coliform (geometrip mean) 5104 du/100m1 a Drip-Line ❑ Other: Maximum Effluent Particle Size in dia. 0 NA Other. Other: ❑ NA Other: "Values typical for domestic wastewater and s$ptic tank effluent. Other. JNA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 13 mont i's (M ~Ryear sj aximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (1~) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 13 month(s) ' ear s~ (Maximum 8 years) ❑ NA Clean effluent filter At least once every: month(s) Inspect ear s` El NA pump, pump controls & alarm At least once every: 0 nthl E(s) arts) ❑ NA Flush laterals and pressure test At least once every: J ❑ ear(s❑ NA Other: At least once every: 0 meat e)s) ❑ NA Other. ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells s~all be made by an Individual carrying Plumber; Master Plumber Restricted Sews)'; POWTS inspector, POWTS Maintalerone the ; Septage Serv Vng licenses kefnspectlons 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 efflyent IeVels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground sWaos may indicate a falling condition and requires the immediate notification of the local regulatory authority. Alhen the combined accumulation of sludge and scum in any tank equals one-third (3) or more of hie tank volume, the entire contents of he tank shall be removed by a ;Septaga Servicing Operator and disposed of In accordance with chapter NR 113, Wisconsin kdministrative Code. kit other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, rnd any servicing at Intervals of 512 months, shall be performed by a certified POWTS Maintalrler. service report shall be provided to the local regulatory authority within 10 days of completion of any service event, i I Page of START UP AND OPERATION For new construction, prior to us 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 w en soil conditions are frozen at the inflltrative 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 Plum r 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: ahtIbiWcs; 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 scrapti; medicallons; oil; painting products; pesticides; sanitary napkins; tam ons; and water softener brine, ABANDONMENT When the POWTS fails and/or is ermanently 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 pi s shall be disconnected and the abandoned pipe openings sealed. 0 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 s lid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: 13 A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area s ould be protected from disturbance and compaction and shorrld not be Infringed upon by required setbacks from existing arid 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. 0 A suitable replacement rea is not available due to setback and/or soil limitations, Barring advances In POWTS technology a holding tank may be inst sled as a last resort to replace the failed POWTS. I site has not been a lusted to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation ust be performed to loe to a suitable replacement area, If no replacement area is available a holding tank may be installed as a last resort to replace th failed POWTS. L_jA and at-grade soil absorption systems may be reconstructed in place following nimoval of the blomat at the Infiltrative surface. Reconstruction of such systems must comply with the rules In effect at that time. «WARNING>> SEPTIC, PUMP AND OTHER TR ATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOPt INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OT ER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DIIATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR FA TANK MAYBE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS I'OWTS IN ER POWTS MAINTAINER Name - Name ~ ~ v J Phone ~j Phone :;EPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name ~,u yn Name Phone J oa`~C7 -s',~f - Phone ✓O/ T I his document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)$(f) and 383.54(1), (2) & (3), Wisnoiisin Administrative Code. ''R CARTRIDGE Inaftft " SrBP I Dry lit the flitter case q to the end at the audet pipe to ern:ure it is centered under the accows opeYl Itnot, then either Insert more pips into the tank through the outlet or solve :wafd (Oe) additional pipe onto the outlet Pipe- ST tits 2 While the case is still d fitted on the outlet pipe, measure the length of IA-Inch pipe needed to brace ho fitter to the tank end wall if utilizing the optional supplemental side support. If side support noethod it not utilized, proceed to step four. 5'rV46 9 For Wstallatioats utili ei the optkmal suppierrreutal side support- solvent sweld the %Anch pipe an ithe f7ter case. If side su _ utilized, proceed to step four, ppoet ntethnd is not Solvent weW the fritter pe onto the outlet pipe. Insert the lifter cartridge into the case, pressing! aWn until the filter hrc'ks into the bottom of the case. • 'is •tki If a VRS switch is utJl" J. insert into the #liter and lock by turning clockwise Maintenance 1. The effluent fritter should bed arced every time the septic tank Is serviced. 2. Open the outlet access opont to inspect the tank and (Utet', " 3. Pump the septic tank comp ly, making sure to remove the sludge layer on the bottom of the to and not just the scum and effluent. ; 4. Once the effluent level has h1l ri Ipwered below the invert of the _ outlet pipe, firmly pull up on t, to Alter handle to dislodge the mrritildge from the case. S. slide the cartridge up and oY it of the case for cieanhog. s, it a As switch connected W &Win Is present, the swlti-h should be removed by turning; 4ntadodwAa 9W and cleaned with water only. 7. While holding the cartridge oo is side (large got surface facing down) over the access openin , Apse off the cartridge with avatar Ix „1 only, making sure aR eaptagu torial Is raised back Into the tank. ` s. if vfis switch is utilised, repla by Inserting into litter and turning clockwise 9W, s. Insert the Altar ctitrtrid a balk into. the rase ht.. "tu' g , Pressing down unto the litter locks into the hottoari f the case. cf to.lteplace and secure the access tong on the tank. Y,tl:'.:YVbf..:••'iIC "4i:qpi ~f~,~'N;re tl~.i-~'Lt{.: iSNt't•rl :N:ndlLf,tV". wr+vwbearauosltl .color ~ •~lt►'MM [653-45e3) ST. CROIX COUNTY SEPTIC TANK. MAINT ENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address 'erlfication required from_P! g Department for new cone - City/State traction.) - - Parcel Identificatioll Number PropOrty Location _ZV 4 Sec./ N / Rt J Subdivision Tornm o:f CertWed Survey Map # _ Lot # arnWty Deed # - _ , Volume 'VV Page # SY - -9--___ V oi . umePage # Spec house yes Lot lines identifiiabl yes o SYSTEM AII\iTE CE AlV O C.ERTI.~'YCATION Improper use and maintenance of our 80Ptic maintenance consists ofpurnphzg out the septic tank every system could result in its the system can affect the fun premat fail ure ure to handle wastes. Proper ction of the Sept, c three yearsor sooner, if needed, by a lf,:ensed pumper. What You put into responsibilities are specified in §('on=. 83,52(l) tank as a treatment stage in the waste disposal systFrn. Owner maintenance and in Chapter 12 -,(,It. Croix County Sanitary Ordinance. The property owner agrees to stxbrnit to St. Croix County Planning & Zo owner and by a master plumber, journe g ning Department a o wastewater disposal system is in proper oPp' restricted plumber or a licensed pumper verifying cation fob signed by the less than 1/3 fWl of sludge. condition and/or 2 verifying that (].)the on-site after inspection and ptunping (if necessary), the septic tank is Uwe, the ►uidersigned have read the above requ standards set forth, hereirx, as irements and agree to maintain the private ,laws a set by die Certification stating that your se the beparp~nant of Co ptic System has Obeei, n' tlfaO rnmerce and the b a [t disposal System with the Ztntin D lntained must be complet and returned t the St aoix of wisco 8 epartment within 30 days oftl2e three nsin. Year expiration date. County Planning & I Uwe certify that all statements on this £ornn are true to the best of my/our knowledge. Uwe am/are the owr property described ed above, lry virhre a warm er s p{) of the deed recorded in Register of Deeds Office. !Nairn r f ed m~ i -SIGNATURE ANT(S) _ DATE - ~ *'"AnY infottnatinn that is misropresented may result in the sanitary permit being revoked by the Plikcu►ing & Zoni M "tclude With this application a recorded ng Deparprtent. r & mce is made in the warranty deed, warranty deed from the Register of Deeds Office and a copy of die certified survey map if' (I'zV. 08105) i Easement (to be ext z extension of the roo, t N89 '59'37"E 524.68' / 262.89 261.79': S7813 n \\y a. o LOT29 33\ 33 lry LOT 28 . 92,522 sq. ft. f' \p 85,509 sq. ft. C 00 2. l2 acres 1.96 acres \ LOT 27 S74'5- .30.00" - - \ . \7i - f i f ~ Gh _ 0 'fit V, _ 113.53'- 52.43'-r 1~► / \f ti 165.96 LO. S87'04'49"E jQ N87'04'49"W 165.96'- s~ .JO' Drainage -4 Easement 6+, F / T \p LOT 35 o LOT 34 83,292 sq. ft. 85,695 sq. ft. (m tJ 111111 IIIII IIIII IIIII IIIII IIIII lIII Illllf IlII flll State Bar of Wisconsin Form 2-2003 * 8 6 1 5 4 1 1 WARRANTY DEED 861541 Document Number Document Name KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 10/02/2007 10:30AM THIS DEED, made between Steven J. Derrick. a married person WARRANTY DEED ("Grantor," EXEMPT t whether one or more), REC FEE: 11.00 and Claudia Karner ("Grantee," TRANS FEE: 146.70 whether one or more). PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following Recording Area ~Vol described real estate, together with the rents, profits, fixtures and other appurtenant interests, in _ St. Croix County, State of Wisconsin ("Property") (if more space is Name and Return Address w I - (9) 43PA needed, please attach addendum): David J. Estreen Lot 28, Cherry Knolls god Addition, St. Croix County, Wisconsin. 304 Locust Street Hudson. W! 54016 026-1292-28-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights-of-way of record, if a Dated c (SEAL) (SEAL " 'Steven J. Derrick (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) Steven J. Derrick a tarried erson authenticated on (f STATE OF ) ) ss. COUNTY ) *Kristina O land TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on , (If not, the above-named authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Attorney Kristina Deland Hudson, WI 54016 Notary Public, State of My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 " Type name below signatures. INFO-PRO- Legal Forms 800-855-2021 www.infoproforms.com 1 of 1 Wisconsin Department of Cxceri`j t SOIL EVALUATIO , Page of 3 Division of Safety and Buildings d F4GV010vi'v IG a Z0'M accordance with Comm 85, Wis. Adm. Code _ County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must S~ ` Ap I include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. IR p~ ~2 5(7) Please print all information. :::;~y Date? Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Z Property Owner Property Location l t Govt. Lot 1/4 1/4 S T3[? N R E06 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 7711 19 t- /I n //L- City to Zip Code M one Number ❑ City ❑ Village Nearest Road New Construction Us2)R~Residential /Number of bedrooms Code derived design flow rate GPD ❑ Replacement blic or commercial - Describe: Parent material ~T Flood Plain elevation if applicable ft. General oonunea i and reconunendations: •f- System Type System Elevation / y r F lBoring # Boring V 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. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff##1 •Eff#2 ®~8 6 rV z- MjSf: e a,-, i b r QYq1,r4A /n-7<- 9L111 ~6_ ,s S/ - ~v eve's ►~e~ t fZ1 L-* ® Boring # Boring , a pit Ground surface elev. oft. 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 O-~y /V , e S Z 91- 1? bo In, -17 - ,n a Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L nVAV'j CST Name (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~ - S 2- 715-246-4516 Y Property Owner _ Parcel ID # Page of 0 Boring # ❑ Boring ~f L Pit Ground surface elev. 'Oft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. Cont. Color *~Gr. Sz. Sh. 'Efff#1 'Eff#2 2 raZ~ sb ✓►1 o-7/JO --s~ , El Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil ication 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 = BOD5 > 30 < 220 mg/L and TSS >30:< 150 mgA- ' 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. seD-8330 (R.eroo) Soil Test Plot Plan Project Name ClaudiaKarner Sha Address 887 E. 6th St. Apt #4 r New Richmond Wi 54017 CSTM #226900 Lot 28 Subdivision Cherry Knolls 2nd Add Date 10/25/12 NE 1/4 SE 1/4S 15 T 30 N/R18 W Township Richmond Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of survey iron System Elevation 98.5' *HRPSame as Benchmark 2 2. Yq B M * Property Line Scale is 1" = 40' Property Line (not to unless otherwise scale) noted 7% Slope 170' B-1 99, 9 8' B-2 97' 9 6' B-3 Property Line (not to scale) Scale = 1/4" = 10' 127th St.