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HomeMy WebLinkAbout040-1310-00-023 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 561001 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Harper, Michael & Kristine Troy, Town of 040-1310-00-023 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: j Z ~lC un 10-F I hhQ- 17.28.19.2010 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic S~ Benchmark / /Dl' Q l (]Q 6 l peg Ing Alt. BM G Aeration Bld . Sewer L~ Q L4L Holding Inlet 9 .s 3.3 TANK SETBACK INFORMATION St/Ht Outlet G TANK TO C_ /L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 1'_j U /J y SO r / • t+ ( Dt Bottom 2 . lg~ Dosing t ead r/ an. s z, s Aeration Dist. Pipe y g .9 _ Holding Bot. System },•f t' 7 ~7 l PUMP/SIPHON INFORMATION Final rad 3S 90` 7 Manufacturer Demand St Cover GPM M Z 3 JOl•(~ b, L 0- Model Number TDH Lift Friction Loss em Head TFH Ft 2~S St~h~s Forcemain Length ia. Dist. to e SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS t D 1 a r$r J / SETBACK SYSTEM TO P/L BLDG WELL LAKE/STR AM ' LEACHING rM_od~elNumber: INFORMATION Typ f System: r CHAMBER 0 77 -f rAh N 6 IBUTION SYSTEM [mq!( Xf1Z'~ h S Sj' Heade anifold 'gyp 3 Distribution ( x Hole Size x Hole Spacing e t t Air Intake Pipe(s) 4- Length Dia r Length V Die Spacing 111 ~'`A~ - 1 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 Bed/Trench Edges Topsoil ~ Fa Yes ~ No ~ Yes L7, No COMMENTS: (In Jude code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 311 Meadow Ridge Court Hudson, WWI 54016 (SW 1/4 SE 1/4 17 T28N R1 9W) Meadow Ri ge of Troy Lot 23 Parcel No: 171.28.119.2010 1.) Alt BM Description = f (J 0~ ~/Yw✓! 6-4 - U-'t ~~lS ~Gyl (/V f ~Cqf vyQ'0 vo J Z_ 2.) Bldg sewer length = ti ~~Z,- l -amount of cover = a/ wt hwdau h) Yes o Plan Use other revision side for Required? additional information. Date ( Insepctor's ignature Cert. No. SBD-6710 (R.3/97) e4 County n " Safety and Buildings Division r l no ltd r` 201 W. Washin ton Ave. Box 7162 Sanitary Permit Number (to be filled in by Co.) S Ma PA ,2 a 5 1 - 1 a)NP~~ l oo 1 i Sanitary Permit Application `'gyp State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form t ante governmental unit N is required prior to obtaining a sanitary permit. Note: Application forms for st ned POWTS a submitted to Project Address (if different an mailinrdr s) the Department of Safety and Professional Servies. Personal information you provide may ~bor secondary ,/N C Purposes in accordance with the Privacy Law, s. 15.04 1 m , Stats. J i 6 CL4 J S I. Application Information - Please Print All Information V\Ikx GOra Property Owner's Name 1 C~.Gn-C4.~~ ` 5 w-•C~ ~ GO,RX CO Parcel Property Owner's Mailing Address a 10- 1316 00 Z~ 5 ~ Property Location Za 16 City, State -3 Govt. Lot ' Zip Code Phone Number '/e,eollSection circle o II. Type of Building (check all that apply) T N; R E r W or 2 Family Dwelling - Number of Bedrooms Z~ Subdivision Name ❑ Public/Commercial -Describe Use _ - ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of C¢.115 L,J own of 7_21--67 C, III. Type of Permit: (Check only o box on line A. Complete line B if applicable) A. -;K-New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. El Permit Renewal nnit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Dale Issued Before Expiration Owner IV. Type of PO TS System/Component/Device: Check all that apply) X41pn-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound 124 in. of suitable sod ❑ Mound < 24 in. of suitable soil GL''t e 11 Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Trea ent Area Information: Design Flow (gpd) Design Soil A ication Rate(gpd Dispersal Area Required (sf) Dispersal Area Propose sf) System Elevation VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units ,ad ccq iy New Tanks Existing Tanks `4. V ' w Bea(` ~l v w C7 a Septic or Holding Tank 7- Dosing Dosing Chamber VII. Responsibility Statement- I, the undersigned, assum ponsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's ature MP/MPRS Number Business Phone Number r -J. 7- Z6 Xyn 71-1 ~4~6- VJYL Plumber's Address (Street, City, State, Zip C ) 5Z L» VIII. Court /De artment Use Oat Approved ed Permit Fee Date sue Issuing ent Sign Lure ven Re for Denial $mi D 5' 5 /3 IX. Cond 'o easons for Disapproval f : ink, fWW ( dispersal cell must all be eery e9 I maintalW / as per management plan provided by pktg"r 0., :AH'l k reg*eeW*rts MUM, be rMhintali* Attacb to complete plans for the system and submit to the County only on paper not less than 8 in x 11 inches in size SBD-6398 (R. 11/11) Soil Test and System PLOT PLAN PROJECT Michael Harper ADDRESS SW -114 SE 1/4S 17 /T N/R 19 W TOWN Troy COUNTY ST. CROIX a MPRS Shaun Bird 226900 DATE 4/30/13 BEDROOM 4 CONVENTIONAL XXX IN-G ND PRESSURE CONVENTIONAL LIFT HOLDING TANK I MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1500 # of chambers BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 88.5/87.0 4' below qrade Town road Well is to meet all setbacks required by WDNR All piping shall be SDR 30/34, within 10' Property Line of tank, piping shall be Schedule 40. Fence Line Scale is 1" = 40' unless otherwise noted Pro 4 Property Line Bedroom House 200 30' ST 12' 150' 90'92 B-1 100' Gi 1 88' I d 30' 86' 5' B-240' ents B M. 30' 2-3' X 122' Cells with >3' spacing B-3 17%Slope Property Line AY TO THE ORDk~2 0' ' WELLS FAR„BANK, t Wisconsin Department of Commerce SOIL EVA ~ ' SPORT Page of Division of Safety and Buildings T in accordance with Comm 85,1 County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), directio n Parcel I.D. a~o 2 2 percent slope, scale or dimensions, north arrow, and location and d~c n~re~ad. - 131A d® DZ J C7~ Revie b Please print all informatio Date y ~ Personal information you provide may be used for seconds u es Priv , s. 04 ry P rPos ( (1)(m)). Properly Owner C~ _ Property Location %t~clL,1/[J,~ Govt. Lot SW 1 /4 s~1 A S/ T N R E (o W 11 Property Owner's Mailing Address Lot # Block # Subd. Name CSM# 2 - le t` Try City State Zip Code Phone Number ❑ City ❑ Village Town Ne st R d Construction Us t. Residential / Number of bedrooms Code derived des gn flow rate 6d o GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material a-Zly'l .a Flood Plain elevation if applicable V ft. General comments 4,6.k. /3P~Vc and recommendation: Qc System Type , System Elevation -3 8 . SZ- 8 7 l) # E] Boring j pit Ground surface elev. a . s ft. Depth to limiting factor i 1Z Q 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 l) 0-1Z- /0"./ ~h_ ~ J- - i- s- s N - "*A Q r Boring # Boring Pit Ground surface elev. P ft. Depth to limiting factor ~d y 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 L4 i ;Z7 _3 1 tt I A0 1 • Effluent #1 = BOD > 30 1220 mglL and T >30 < 1 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name {Please Print) CST Number Bird Plumbing, Inc. Shaun Bird i 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 y-~'~ - 715-246-4516 i Property Owner _ Parcel ID # Page of ❑ F Boring # Boring 8 Pit Ground surface elev. S ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color C / Gr. Sz. Sh. 'Eff#1 'Eff#2 a-151 _3V2_ . 3 ~ o S OS / ~ ~ d ❑ 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 a Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS 130 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-9330 (RAM) comrnerca,wl. Suet and}3uildingsllivisiun County r 201 W. Washington Ave., P.O. B(tx 7162 It Isconslr at, Madison, Wf 53707-716? $ankury horaii N i m..Lur (tu bu lrlluA '.7 -,y c <c) Depatirnatrtrt of t~mmetca^+ ~ T e Sanitarit:,~',e~=ii~~Wpplication State Trawsuclion Number In accordance with s. Comnr_ 83.21(2). ~Witr llw Code, submission ofthis form to the appropriate mma _ _ _ uarit is required prior to obtaining a sanitary permit. Note: Application tomes for state-owned PO are roject Address (ifdiflerent than ma - - s ibmitted to the Deportment of Conanerc.e. Personal information you provide may be used for ser nntlar ~ a ess) urposes in accordance with the Privacy La►4, s. 15.(}4{Ixm), Sta(s. ~eJo , 1. Application Information _ Please Print All Inform Property Owner's Nurne f t .✓r a ' _ Parcel 4 - ~ 3 - Property Owner's Mailing Address - Property Location _ Govt. Lot ~ City, State j Yiippf_Code~ / Phone Number - SkJ 14 - - % Section 6 •7 ' (~7 {ureic one) 11. Type of SWIding (check all that appI Lot f N; IZ/.____,- fi or W _ Subdivision Name or 2 Family Dwelling - Nwaber of 13edro)~ E Public/Commercial -Describe Use ~f--- ❑ city of t/ El State Owned - Describe Use CSM Number ' U Village of - _ -Q~- C.~~ t.✓ CI~..~r3 mown rif1r.~2 _ 111. Type of Permit. (Check only on box on line A. Complete line 8 if applicable) A ew System El Replacentartt System ❑ Treatment/Holding "rank Replacement Only U Other Modification to L='xisting System (explain) B. ❑ Permit Renewal ❑ Permit Revision E] Change of Plumber 0 Permit Transfer to New List Previous 1?unnit Number and Date Issued Before Expiration Owner f ?~t 11 r. T e of POWTS System/Component/Device. (Check all that apply) - _~_..Q~_ 46-on-Pressurized In-Ground ❑ Pressur ized in-Ground ❑ At-Grade ❑ Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil p t )n ❑ Holding Tank ❑ Other Dispersal Cum ponent (explain) Pretreatment Device (explain)___ DispersaUTreat ent Area Information: levation D:sigll Plow (gpd) Design Soil plicaaion Rat gpdsfl DisQer al Are tequ' d (st) - DisN'i e Pro pose sf) S s off E. -600 aK, boo 1 C) Vt. 'lank Info Capacity in Total of Manu'tacturer Gallons Gallons Unit' 61.0 ~ , Now Tanks Existing Tanks, d ,u li✓f l^ U° v~ rn it c5 -a--- Se ptic or Bolding Tank Dosing chamber V11. Responsibility Statement- 1, the undersigned, as responsibility for installation of the PO'VYTS shown on the attached plans. Plumber' Name (Print) Plum gnature MP/MFRS Number liusmess Phone Number ) Plumber's Address (Street. City, State, Zip (Ode nApproved artment Use Date Issued ssuing Signature usapprove $ ven Reason to jai ! 75- b6 Z / Z - - t ttA- E"{ Condi0WjM4QgM"sWReasons ror Disapproval l ,lo / 7 J v~ rte. d t, 4eptic.tank, effttlent f~er and 3 / j / dispersal cell must all be serveces hnitbtaW . ir, cement ptan proyid0 by pluwitset, 2. All Setb., auirements must be mtnrttuiirrdd ~_as per applicable o6de./ ordinances. ` r rn A, OS r'ti _ _10 _ Attach to euanpiele plans for the system and submit to the County only aupaper out 's th 81n rc t in~ as in si/ze ~v 1 I b 1 ~ JO a I tCR. C IS 1313-6398 (R. 02/09) a Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 12/5/12 Owner: Micheal Harper Location: SW1A SE1/4 S17 T28 N,R19W Lot 23 Meadow Ridge of Troy System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet Signature License nu a #226900 PLOT PLAN PROJECT Michael Harper ADDRESS SW 1/4 SE 1/4S 17 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 12/5/12 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE ABSORPTION AREA l # of chambers'?' /5-C> BENCHMARK V.R.P. Top of conduit ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 965.7/964.5/963.3 1.3' below Town road All piping shall be SDR 30/34, within 10' Property Line of tank, piping shall be Schedule 40. Wel is to meet all setba ks required by Scale is 1 = 40 WD unless otherwise noted Pro 4 Bedroom House 80' 20 ST 100' 25' B-1 30' B.M. Alt. X 102' Cells with >3' spacing Please note: 1 further testing will B-3 be done to lower Property Line system elavation ' and raise loading rate! v Cross Section of Quick 4 Standard Leaching Chamber Typical cross section for 2 of 3 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 10.1ft^2 pair of end plates To be >1' above grade Finish grade elevation Vent _ / Typical Installation ~ 967.0' /C Grade Vent 4' 4" 141 f;'30/34 Septic Tank 4' Long 1 5 4' Long 1 34" Grade at System Elevation 34" Grade at System Elevation Spacing 5' 3-3' X 102' Cells Observation tubeNent Same on other end To be located on end of Cells ~%A B System elevations: C A_965.7 B__964.5 25 chambers per cell CY963.3 POWTS OWNER°S MANUAL & MANAGEMENT PLAN Page _ of LFILE INFORMATION ner SYSTEM SPECIFICATIONS mit # i Septic Tank Capacity 5 qal ❑ NA Septic Tank Manufacturer 11 Effluent Filter Manufacturer edrooms ❑ NA ❑ NA Effluent Filter Model FEstimateedd AMETERS ❑ NA blic Facility Units ❑ NA Pump 1"ank Capacty w (average) r~ al NA / al/da Pump Tank Manufacturer NA peak), (Estimated x 1,5) al/da Pump Manufacturer n Rate NA f S tandard Influent/Effluent Qualit allda /ftz Pump Model NA y Monthly average* Pretreatment Unit Fats, Oil & Grease (FOG) 530 mg/L NA Biochemical Oxygen Demand (BODs) 5220 mg/L 11 NA C1 Sand/Gravel Fitter D Peat Filter O Mechanical Aeration ©Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection !Pretreated Effluent Qualit ❑ Other: Y Monthly average Dis ersal Cell(s) Biochemical Oxygen Demand (BODs) 530 mg/L ❑ NA Total Suspended Solids {TSS) 530 m /L n-Ground {gravity} 11 In-Ground (pressurized) g ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) $104 cfu/100m1 ❑ Drip-Line ❑ Other: iMaximum Effluent Particle Size Other: ;6 in dia, ❑ NA ❑ - NA ~Other: i ❑ NA Other: *Values typical for domestic wastewater and septic tank effluent. 11 NA Other' El NA MAINTENANCE SCHEDULE Service Event - Service Frequency IInspect condition of tank(s) At least once every: ❑ month s) Lars (Maximum 3 years) ❑ NA (Pump out contents of tank(s) When combined sludge and scurn equals one-third (A) of tank volume ]inspect dispersal cell(s) _ 11 NA At least once every: 4 ►non~h~s) ears (Maximum 3 years) ❑ NA Clean effluent filter At least once every: month(s) Inspect pump, pump controls & alarm ar(s) [I NA ; At least once every: m ar(s}s) ❑ NA 19ush laterals and pressure test At least once every: ❑ month(s) ether: 13 year(s) El A At least once every: ❑ month(s) i~ther: ❑ year(s) q NA i MAINTENANCE INSTRUCTIONS NA 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 ombined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually Inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third more of tank volume, j:he tank shall be removed by a Septage Servicing Operator and disposed of noa c danceewith chapter tNRe113, cWisconsnf Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, land any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. la, service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page _ of START UP AND OPERATION For new construction, prior to use dispersal tcell(s)S) if for the high concentrations 'are de acted have atherconten~ksl oftthi: may impede the treatment process of the and/or POamagaior to the use. tank(s) removed by a septage servicing operator p System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks m one i) above dose, overloading he levels. When poer is restored e excess wastewater may result in the backup or surface discha ge of effliulenltt.. discharged is the dispersal cell(s) in on large tank removed by a e Servicing Operator prior to restoring power to the To avoid uent pump or contact a Plumber or POWTS Ma stainer to assist Inmanu lly operating the pump controls to restore normal levels effl 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. the performance and prolong the life of the POWT,13: Reduction or elimination of the following from the wastewater stream may improve P antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation dralin' grease; herbicides; meat scraps; medications; oil; painting producA (sump pump) water; fruit and vegetable peelings', ftener gasoline; brine. pesticides; sanitary napkins; tampons; and 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 still, 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 compiitpn replace ant system: uitable replacement area hen evaluated and may be utilized for the location of a replacement soil absorption systelm. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requlrled setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result In the neled for a new soil and site evaluation to establish a suitable replacement area, Replacement systems must comply with the rule;} in effect at that time. A suitable replacement area is not available due to setback and/or soil imita#ions. Barring advances in PO TS JechnoN1V a holding tank may be installed as a last resort to replace the failed PO S. t 4 o r 6e- 11 The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed) as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltmalive 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/Olk INSUFFICIENT OXYGEN. DO O ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. HEATH MAY RESULT. RESCUE O~ A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Flame , / ~j 41 M Phone Phone C, 2YX SEPTAGE SERVICING OPERATOR (WJMPER) LOCAL _REGULATORY AUTHORITY Name j Name j-1! Phone Phone .74',r~ This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. 10 FILTER CARTRIDGE INSTRUCTIONS 49 Installation STEP I Dry fit the filter case Sato the and of the outlet pipe to ensure it is centered under the access opening. If not, then either insert more pipe into the tank through the outlet or solvent weld (glue) additional pipe onto the outlet pipe. S',FEP 2 While the case is still dry fitted on the outlet pipe, measure the length of +14-inch pipe needed to bracts the filter to the tank end with if utilizing the optional supplemental side support. If side support method. Is not utilized, proceed to step foul: $.7 F•t' a For installations utilizing the optional supplemental side support: solvent weld the M-inch pipe onto the filter case. If side support method is hot utilized, proceed to step four. Solvent weld the filter case onto the outlet`' h pipe. Insert the filter cartridge into the case, pressing down until the filter locks into the bottorn of the case. ~a1+ ~..t s If a VRS switch is utili;.Aed_ insert into the filter and lock by turning :~f~?ys clockwise 90°.'; Maintenance 1. The effluent filter should be ciearted every time the septic tank Is serviced. 2. open the outlet access apening to Inspect the tank and filter, 5. Pump the septic tank cornploteiy, making sure to rarnuve the sludge layer on the bottom of the tank and not just the scum and effluent. 4. once the effluent level has been lowered below the invert of the outlet pipe, firmly pull up on the filter handle to dislodge the cartridge from the case.}. 5. Slide the cartridge up and at it of the case for cleaning, r?ri 6. it a VR5 switch connected to an alarm Is present, the switch should be removed by turning counterclodmise 90° and cleaned with water only. r, 7. While holding the cartridge on its side (large flat surface facing m "5 off. , down) over the access opening, rinse off the cartridge with water ' only, making sure all ssptagte material is rinsed back into the tank. ' a. If VRS switch Is utilized, replisv* by inserting into filter and turning clockwise 90°. 9. Insert the filter cartridge back into the case, pressing down until the filter locks into the bottoun of the case. 10. Replace and secure the access opening on the tank. t:' C<~. s" IL "°r; ~ 4Y1 :'#17+(rd ' hfti- 4 d.' . Srit' f. 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I I I II \r \ Nn \ ~ it a ~ ` \ \ ~ b•F+: \ ~ N I„ I N i. I h W'8WI I~' h ` % • SJ $ t °a S q ^ \ - - Fat \ N h p~. I 0 I $ _ p p8~ N \ \ \ x.10, _1/ n ea 1 I h I p ~I °°1' I 'I / 9~ 4 j S$$ e fla Y rc m 'd, nnAran \ xaacWS i j , 00 I L L.._.._.._.._..~ L.._.._ ..1 1 p ~~H Alin N F N L.._.._. _~1~!'.Pd x71C YY r7arrn 0 = ,xsu titEAZa7S b h ° _ ~ • 6E W 3lE,ISloS 11141 02 : I DnN1Yns 3fCB000N \ C~ Z Q5f'9d41'10A aE'uz•IbOwY a 0 11 O tu~'64S'JIL01 i 101111 I 1 }I_~~__-- 110iL10 j 8a Dpi F I QOOS1hONd30JYId IOjIII I 000AMON1,dORld All I I I I 1 i • ' 4 I i A I N ~ ar _ ~ 11 111 wi, . I~ l l I 1 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ` Mailing Address 2 _3 Property Address _ (Verifianon required in Planning &epartment for new cons chon.) City/State Parcel Identification Number LEGAL DESCRIPTION Property Location Lt) y4 , Sec. -'7 ZSN R W, Town of Subdivision /WW,~~, Lot # _Z_3 Certified Survey Map # Volume , Page # Warranty Deed # Volume Page # _ Spec house yes(../ Lot lines identifiab oy 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 li,ensed 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 (l) 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. [/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 tc the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on is forth are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a rranty deed recorded in Register of Deeds Office. s _ Numb of bZTM SI OF AP PLICANT(S) DATE TE ***Any information that is misrepresented may result in the sanitary permit being revoked by the PI +nning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/d5) I ~ II IIII III II~IIill~~lllllli 111 , B 0 Tx:4070530 0 ocument Number WARRANTY DEED 964461 THIS DEED made between DCCI Land Planners Inc., a BETH PABST Wisconsin Corporation ("Grantor") and ich el J. Harper and REGISTER OF DEEDS Kristine D. Harper, husband and wife, as survivorsvp marital ST. cROix co.r wi property, ("Grantee"), 10/01/2012 12:14 PM EXEMPT#: NA WITNESSETH, that the said Grantor, for valuable consideration REC FEE: 30.00 conveys to Grantee the following described real estate in St. Croix TRANS FEe: 298,50 County, State of Wisconsin: PAGES. 1 Recording Area Name and Return Address Lot Twenty-three (23), Plat of Meadow Ridge of Troy, in the Township of Troy, St. Croix County, Wisconsin DCCI Land Planners, Inc. PO Box 445 New Richmond, WI 54017 040-1310-00-023 (Parcel Identification Number) i This is not homestead property. i I i Dated this 28th day of September, 2012. DCCI Land Planners. Inc orporate Name I ti 7Ao! L rick si nt i ichael R. Stevens S cretary STATE OF WISCONSIN ST. CROIX COUNTY Personally came before me this 28th day of September, 2012, Ronald L. Derrick, President, and Michael R. Stevens, Secretary of the above named Corporation, to me known to be the persons who executed the foregoing instrument and to me known to be such President and Secretary of said Corporation, and acknowledged that they executed the foregoing instrument as such officers as the deed of said Corporation, by its authority. THIS INSTRUMENT WAS DRAFTED BY Tammy LI d Michael R. StevensMichael R. Stevens DCCI Land Planners, Inc. Notary Public St. Croix County, Wisconsin. PO Box 445 My Commission Exoires: October 30. 2013. New Richmond, WI 54017 TAY Lloyd Notary' Public State Of Wisconsin Vlfisoonsin Department of Commerce Vh- OIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in 7'a m 85, Wis. Adm. Code Attach complete site plan on paper n 81 11 inches in size. Plan must County St Croix include, but not limited to. vertical orftal I PM r.. Parcel I.D. r, e....:.,..e :e a:..,e.,:...,. .,,d 1 Y..,. ...wr.., ..«.w..w... w.. rues" pn all irnaormi von. Personal information you provide may be used for secondary rposes,D"r- 6 ( w1s. M 6) Property Owner Ply n V YJ DCCI Land Planners Inc ST. CR01X T S 1/4 SE 1/4 S 17 T 28 N R 19 ~ El Property Owner's Mailing Address # Subd. Name or CSM# I 1505 HWY 65 I ~3 I I Meadow Ridpe of Tmv city State Zip Code Phone Number ity viiiage ■ own Nearest Road L New Richmond WI 54017 I 1 East Cove Road New Corstrudion UseEl Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD n Repiacernent n Public or commercial -Describe: Parwd maMrud Loess over falacial till Rnnd Plain P •nn if ar"IraWn 1 TA n I and Geri" comments * with greater than 50"/o volume bedrock A, -L o a o r- M ~a a* 14 cJ rn n Boring U rV « Pit Ground surface elev. 967.39 R Depth to limiting facto 52 in. Solt Apiplication Rabe Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/IC~ in. Munsell Qu. Sz. Cart. Color Gr. Sz. Sh. *Efi#1 *Ef 92 1 0-10 10yr3/2 - sil 2msbk dsh as 2f .6 .8 12 110-281 fn.,,eie i - I sil I lmshk i dsh I ew I If I .4 I .6 I 3 28-45 10yr4/4 - sl om dh cw - .2 .6 4 45-52 7.5yr4/4 - s Os dl cw - .7 1.6 5 52-68 7.5yr4/4 Bedrock s* Osg* dl - - .7 1.6 ' L 0 2 Boring # Boring ng Q Pit Ground surface elev. 963.88 ft Depth to limiting factor won in. Sal Rabe Horizon Deth Dominant Colod Redox Description Texture Structure Consistence Boundary Roots GPDAf° I I in, Maintop I t,:: S7 r:nnt r;nlew I I r,r Rh I I I i FfM I *Ff -1 1 0-8 10yr3/2 - sil 2msbk dsh cw 2f .6 .8 2 8-27 1 0yr4/4 - sil lmsbk dsh cw 1 f .4 .6 3 27-42 7.5yr4/4 - is Osg dl cw _ .7 1.6 4, I -5y,Y,- I - I S I a~ I di I- _ I I 16 1 ' Efltfent #1 = BOD. > 30 < 220 mglL and TSS >30 < 150 mglL * Ef luent #2 = BOD 30 mq& and TSS 30 moll r--,T Nara fPfraacn PriM1 Rinnahen r:RTN:.r*or Thomas C Nelson 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, WI 9/18/05 715-246-2454 Property Owner DCCI Land Planners Inc Parcel ID # Pending Page 2 of 3 Boring 'Boring 955.04 >90 Pit Ground surface elev. ft Depth to limiting factor in. Soil Application Rate Horimn Depth Dominant Redox Description Texture Structure Consistence Boundary Roots GPDM I I in. I Munsell ( Qu. Sz. Cont. Color I I Gr. Sz. Sh. I I I I 'Eft#'l I •011#2 1 0-8 10yr3/2 - sil 2msbk dsh as 2f .6 .8 2 8-18 -L "A _ sil Imsbk dsh cw if .4 .6 3 18-90 7.5yr4/6 _ s Osg dl .7 1.6 Boring # ow t I Pit urourw ssurrdw elev. TL uetmr w nmmny nxacn pry Sal ication Rafe Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'E111112 L I ~ ~ I I I I I I I a i i I I i I i I I i I I Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Appikation Rate Horizon Depth Dominant ZolorF Redox Description Texture Stnx u e Consistence Boundary Roots !G!PrVW I in. I Munsell I Qu. Sz. Cont. Color I I Gr. Sz. Sh. I I I I *Ewi I 'Eff#2 I • FRI wN *1 _ Roll- > An <97n rmn aril Tfili >In < I Sn rmA * Ff i cant #7 o Ron < In nV0 WWI TSR < Rn nV0 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 608-2648777. SM-WI saes pu.mmo) DCCI LAND PLANNERS, INC. 8 • Lot # 23 -MEADOW RIDGE OF TROY ®SOIL BORING • ♦ BENCHMARKS SW 1/4 OF THE SE 1/4 OF SECTION 17, T28N, R19W, TOWN OF TROY, ST. -TOP OF CONDUIT / I • • t • LOTS= CRODC COUNTY, WISCONSIN. Q ALT BENCHMARK \ -TOP OF CONDUIT TOM NELSON CST - Lic. # 227387 N NOTE: THE CONTOURS IDENTIFIED ENVIRONMENTAL BY DESIGN ARE PRIOR TO CONSTRUCTION. 1432 120TH ST. CONSTRUCTION GRADING WAS IN PROCESS DURING SOIL TESTING. • NEW RICHMOND, WI $4017 CONTRACTOR MAY NEED TO • ph. # 71$-246-24$4 CONFIRM FINAL CONTOURS Lv W DURING INSTALLATION. • SCALE IN FEET 1• - Ald • 0 Fm iiiiia 100 0 100 w ~I p o ~ \ ry0 75\ ' k 4 .0 4 • ~ ti~O 93 .5 B 9 7. 7 01 l i 2 i 9 2 6 8 'L i i 11 'C4 OT I S ; a r~~~q o J ~ ' -u4.iV Y!Y'I.~s, : 11L-`LSVI •'a. :+1i1V1 _ y.. i ~L7- ,y _~y I . i?lr / p ti p ~ ` ~4 ~ i~li Ei .ice ITT.. + ~ I i I I 1 i I Air C m, wwaY: ~ N I ~I I 11 I I I i ~n'rd • I I 1I1 I 1 I' . w 1i ~ I 'i.... I I k f lie. 17, u N