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HomeMy WebLinkAbout012-1006-60-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division + INSPECTION REPORT GENERAL INFORMATION ~ (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Howell, Pat Erin Prairie, Town of ;ST BM Elev: Insp. BM Elev: BM Description: /~ ~~M\ ~' TANK INFORMATION TYPE MANUFACTURER CAPACITY ~~ R.. D~ Dosing ~ _ ^ C \ `Y~ ~i,~ 1,~c, Aeration Holding TANK SETBACK INFORMATION TANK TO P/I_ WELL BLDG. Vent to Air Intake ROAD Septic ~ `J Y"-~ Dosing ~~ 1 ~~~~ i 7 r Aeration Holding PUMP/SIPHON INFORMATION ~~/' Manufacturer Demand ~ ~ GPM Model Number - ! / ~ ~ ~ , /i "~ TDH Lift /S . r3 Friction Loss , a System Head TDH Ft z . 59 Forcemain Length ~ Dia. ~~ z Dist. to Well ~ Sb SOIL A6SORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 463437 0 State Plan ID No: Parcel Tax No: 012-1006-60-000 Section/Town/Range/Map No: 01.30.17.46 STATION BS HI FS ELEV. Benchmark ~ ~ • z /~~' lam,) Alt. BM ~ a~ ~ ~ i q J Bldg. Sewer t t St/Ht Inlet C ~ GX t ~ ~[ /~ SUHt Outlet 73 ~~,~ ~ Dt Inlet 8 , (~ cy $S • / 7 Dt Bottom y ~ . 7 SZ ~7 Header/Man. (~ i T Dist. Pipe ~ ' 1 Bot. System . ~p Final Grade 0 • a'4 -$ Cover 3.5,t `'' q~, ' %1Q. 9.53 `1~.5 . ~' 93•~ D ~rJ ~ z ~ b BED/TRENCH Width ~ Length ~ No. Of Trench s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS (~7 ~}p ,v Q~~ ~ ,~ '~~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type f yste ~ I r ~ / - 1 /~ UNIT Model Number: ~ ~D L \ DISTRIBUTION SYSTEM r_2 ,~. _r_~ Header/M@@@nifold Length \ Dia Distribution Pipe(s) ~ ' Length ~ r~ Dia Spacing ~ x Hole Size 5 rl x Hole Spacing ~/ Vent to Air Intake SClll t^C)VFR ., nre«..~o e.•~*e.,,~ nni., ,.,. Mnnntl nr Af_rrarlc± Svctams Only ! ~"-"«' Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched B rench Center i~ Bed/Trench Edges Topsoil 1 ~ ~ yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ ~o /aO ~ ~ Inspection #2: / /. Location: 1784 215th St et New Richmond, 54017 (SE 1/4 NE 1/4 1 T30N R17W) NA Lot ~~`-'"'' '~La~ Parcel No: 01.30.17.48 CaJs~... ~~b e,a(i~` av`- 1.) Alt BM Description = ~u 2.) Bldg sewer length = ~N; ~~,^ ~~ a ~~ n ~ -amount of cover = ~j5~ i~~ Use otherlside foruadditional in Yes o ~~ '~ ~ _~_ ~~ ~5 ~- _ 1 ~ =-- formation. ___ ~ ___ -. _ Date Cert. No. /.? SBD-6710 (R.3/97) ~~~ ~,, _,.cw~® ~• : V` Safety an Buildings Division 201 P O County _~LL // t L i 3` ~ - = hin on Ave., . . Box 7162 ~~ s . I 7 t / ~con~ PQ on, I 53707 - 71 62 adi 2 5 (608 266-3151 Sanitary Permit Number (to be filled in by Co.) ! p De ai~ment of Commerc T Y ~~~ ~ ~ 3~ 3 ~j ` Sanita r Ql~ ~ 1 l0n State Plan LD. Number ~ / Z ~ ~ ~ Z In accord with Comm 83.21, is. Ad ,personal information you provide may be used for seco purposes Privacy Law, s 15.04(])(m) Project Address (if different than ling address) I. Application Information -Please Print Alt Information ~ 78[.E Z ~ ~ ~ c' / V~' Property Owner's Name Par cel # Lot # Block # Property Owner's M~-a-il7ing Andd(re~ss Property Location ~~ ~'/ S i Ci t State Zi C d h ,, ,, ect on y, ~ p o e P one Number ~ / n ~ / `~ ~ e--~J Qi' Cil ~~'1~L~LI...~ (.(J~ / ~ 7 D l ~ ~~ N R ( l W e 11. pe of Building (check all that apply) ; r Family Dwelling-Number of Bedrooms Subdivision Name CSM Number ^ Public/Commercial -Describe Use ^ State Owned -Describe Use ^City ^Villa o ip of ~ ~/-~ /-. I~(.t~/1 III. Type of Permit: (Check on one box on line A. Complete line B if applicable) A. ^ New System lacement System ^ TreatmentlHolding Tank Replacement Only ^ Other Modification to Existing System B, ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T e ofPOWTS S stem: (Check all that a 1 ^ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil -Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersatll'reatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber plastic Gallons Gallons of Units Concrete Constructed Glass New E~asting Tanks Tanks Septic or Holding Tank ~ t~ ~ ~ ~ D Aerobic Treatment Unit ~ Dosing Chamber 4/ VII. Responsibility Statement- I, the undersign ume responsibility for installation of the POWTS shown on the attached plans. Plumb is Name (Print) s~ Plumber' afore MP/MPRS Number ~ Business Phone Number '1 ~ ' ~ f , wt, ~ z ~ ~ z 6 ~i~ Plumber's Address (Street, City, State, Z' l ~v , l ~ l ~- ~~ ~ ~~(~C VIII oun /De artment Use Onl pproved ^ Sanitary Permit Fee (includes Groundwater Da Issu lssuin gent Sign Stain ^ O er Gi eason for Denial Surchazge Fee) ~ ~~ 2,7 ~ 5 1X. Conditions of ApprovaUReasons for Disapproval n(~ SYSTEM OWNER: ~ ~~~ ~a~ng ; ~ Sd'~.~-e., ove.sC~ ~, (~ eptic~nk, effluent fifter and ~ (~C` ~ r~ ; ,,` e~' ~- w l ~~ S G , dispersa ce us a e serviced /maintained as per managemen p a provided by plutXtber. Pef'~`ti~ ~'• 2. All setback requirements must be maintained as per applicable code/ordinances. Attach complete plans (to the County ody) for the system on paper not less than 81/2 : I I inches in size SBD-639$ (R. 01/03) n. ' ~ PLOT PLAN PROJECT Pail Howell t ADDRESS 1784 215th St. New Richmond Wi 54017 SE 1/4 NE 1/4S 1 /T 30 N/R 17 W TOWN Erin Prairie COUNTY ST.CROIX SYSTEM ELEVATION 100.3' BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 848 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none ,BENCHMARK V.R.P. To "pipe ASSUME ELEVATION 100' Filter Sim-Tec Inline ^ BOREHOLE O WELL *H.R.P. Same as Benchmark - _..~ Hwy 63 Grading is to be done to divert run-off away from system 100' Scale = 1 /4" _ Tank is to be properly bedded and provided with lockdown covers with approved warning labels Failed System Property Line 500' 215th St. ~~ ` commerce.wi.gov ^ ^ ~scons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary Apri122, 2005 CUST ID No.226900 SHAUN R BIRD BIRD PLUMBING, INC 1008 192 ND AVE NEW RICHMOND WI ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/22/2007 SITE: Pat Howell 1784 215th Street Town of Erin Prairie St Croix County SE1/4, NE1/4, S1, T30N, R17W Identification Numbers Transaction ID No. 1127172 Site ID No. 697167 Please refer to both identification numbers; _- above, in all corres ondence-with the aQenc . FOR: Description: Three Bedroom Replacement At-grade System Object Type: POWTS Component Manual Regulated Object ID No.: 1014114 Maintenance required; Replacement system; 450 GPD Flow rate; 36 in Soil minimum depth to limiting factor from original grade; System(s): At-grade Component Manual, SBD-10570-P (R.6/99), Pressure Distribution Component Manual, SBD-10573-P (R.6/99); Biofilter 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. 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 approved plans, and with publication SBD- 10570-P (R. 6/99) "At-grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems". • The pressure network is to be constructed in accordance with publications SBD-10573-P(R. 6/99) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81)". 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. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. 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 Comm 84 product approval conditions. P.O.~~~.T,S. Cor~dLtionally SHAUN R BIRD Page 2 4/22/2005 • The existing septic tank must be inspected for structural soundness, size and baffles and must be brought into conformance with the requirements of ch. Comm 83, Wis. Adm. Code. If it does not conform astate-approved tank must be installed. • Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on-site during construction and men to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. 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. 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 Ivl. 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 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 4/15/05 Owner:Pat Howell Location:SE 1/4NE1/4 S1 T30 N,R17W 1784 215th St. Erin Prairie System type: At-Grade Manuals Used: At-Grade Component Manual version 1.0 SBD 10570-P (R.6/99) SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01 /81) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-11. Soil `--` Shaun Birc Signature License rn APR 1 8 2005 ~" pE.pAR7MfNS Of COMBU-Lpl GS pIVIStON AFEtY AND ~. E NDENCE SEE CO SAFETY & BUILDINGS RECEIVED •, PLOT PLAN PROJE~"T Pat Howell ADDRESS 1784 215th St. New Richmond Wi 54017 S E 1 / 4 NE 1 /4S 1 /T 30 N/R 17 W TOWN Erin Prairie COUNTY ST. CROIX SYSTEM ELEVATION 100.3' BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 848 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none ,BENCHMARK V.R.P. TOp Of 1/2" pipe ASSUME ELEVATION 100' Filter Sim-TecInline ^ BOREHOLE O WELL *H.R.P. Same as Benchmark ~ ~ Hwy 63 Grading is to be done to divert run-off away from system 101' 100.3' 9 9' B-1 Scale = 1 /4" = 10' B.M. B-3 8~io Slope Well p 15 0' Area 15' below system is to remain undisturbed B-2 Weeks DT Pro 3 Bedroom House Tank is to be properly bedded and provided with lockdown covers with approved warning labels Failed System Property Line 500' 215th St. ONDEN~~' ~ORR~ 100' ~ ~t ~Y, ~7: >tJ ~ _r ~ _ _ -_ ...._~ '-~l ~ 5 ~ ~-; ~ -____~_..:~TUli~i- IFS" ,, ~~l ~ ~-- D[Sre~,t`K,.tTtart #.AZ'ERAI ..f - i ~Y A ~ STA$f~t~ED at3~~.;~A?tars V~tELL` a~ ~--- y° ~ ~t i A = ~~ ff. $ = ~ ~{. ~ "~ ~'t . lk PP Rb1f E D V6B ~ SY~tYt~~c. Fc~brrc ST~B~ ~. i~~t~ Q bser va ~~t~~ -----._,,,~ it~te ~ # ~ Sasl Cover Plan Vimmw and Crciss Sectior~ of Gisaonsin Rt-grade Unit with a Single Absorgtian Area an a Sl~ging Site I/6B 112 B .f ~, -----cE~.~ ~~ ~z - 2Iz a~~~~~~TE PYC FtyRE.E.MA1 i~t ~IS~rf~}UTIflJ~ Lt]i'eral -~ % S~op~ Page Of t3istrib~tion Pips Detail Far LatPrai 1$etworlc ;~T;.tRN -u~., ~GL~t~ouT~ --~ P11C force Nain ;`"'1 ~~1 PYC flistributinn Pape P A~ ce r~ ~~ P ~ Ft. Note i3ia:neter ~/3~z Inch % '~.~ Inches. Lateral Diameter ~ _ Inch{es} Y ~' Inches Fore Main Diameter ~ Lt~ches pf holes/Pipe .~ =avert Elevation Df Laterals ~~~ ~ Ft. Signed; L~CeIlSe ~iilll~t'r: Date: ,s'"; ~J~ ..,,, ~ .. ,.,,,.... H~ -~- C.:. rte! MwC +~. L~ std ~ OOC+~ .,y-pq~e Ot- rR ~s K ~'N!W- ~:~c ~ ~ fit f fjhP GtJI~e "rr~ wtnat+a~ sfGTtG~ {.1titLr S"tti~_;~s'j ~ ~~., -- j 11lATi{~Jl1R0l~F f =~a3t"':O~ aa: ~irRAti~ ~"1~ ~ 3 ~~.tQvca 4t~GKt1-16 M~iiNOL S l.OS-~ R ~~~, t ~ +~+~ ~rQ~i+ .,~xr~ ~ T l~c~-~. t f f w GAG S~h'-"rEGN C'll.?ER~ I~f MODEL N°. $TF'-100 t~ ~-t.~-R+n s } ~ +API'RQYF~ ~ t ~t ,30?~ ~~n ~ ,t 'I`QLIO sDS~ co+~c~rc,rc svc~c _ _ - A~fflt liuT ~C~tw~ a~~~ r* ~-~+c ~,~wur~c~ru+taa sit aunt w~taa+~~-~. :a~c~~~c.~te~~ amt I, rwe~l~aCTYR~ ~ ~-j` ~ ~,._, ~+bc~ ~ ~at~: ERR >oAr ?AYIt ilii: $ - SraLLQyR X03# V~.WN[ ~ :....K.~~si. ' .~~ ~.. f 11C~.fIIIslli~Qr ~iKEbA' •t ~,..- -...~ M-,yf11N ~, xO0t1, wYMRiR: ~... :.~l~AClTlat l-s °~3' ;.iiCliti QR `~~ ,,~AwOYf fwl7T,rM '~'~ii ~ .•' _ ~ f a.~ ,~.. tYC~+[i OR -~- i~L~oari ~ AWii~I16!'I~tiEt ~'~-~' C s J/": ~„~.att+~ts' aR . ~~~oy11 / D~, MOOii. YitKRiR: I `J / ~ ~.~..,..,,~.r... D +R ~..l..~iNC~ RR OA~LO~It switCM ~tt~s: ~ ~ ~' _ ...._..~.~. ~- ~ A~ !Q Oi~i Z~-RA1'[ CtR4W'!'~ ~Nit1N1rYM OtiClie/-R ;ATi ~~..~...rsr~'t V~Tttl1L ~~'fiRi~Mii ~'!'~iii /j1~M aft IW{t ~TttiLC!':lit1 fi~~.. °~ fl ~;fi'r' ~ r;••,41t~t #ltT~IQ1EK ti1P~#.~ ~R~itiiRt ....... , : ~ = ~'~.!? +. 5 ~ F o R F•IL7~~ + ~ ;, trct~ ~ >ra~eet r~t~- x ~~ " ,- ~~~u~~2 - t....... ~tez 4'~'RL[~ IIFJ~Et1<if~IQl~i Qr 's~~~,t+c: t.cll~bTh....~..~.~.;~r~DTH __?...~iw...r.ii.EQ~fD ~~-PTM `~..~..~ S~iEC: rtGCA3~F ~ILt~"~$£R: ~. ~. TDTAL CYPIF,MfC r'EfiD/CAPACITY P~ R MINUTE EFFLUENT FIND DEYlATERING 1 0 w U a 0 C _ M OREL I 15_ ~ ---~ {~ 1-'~ Fezt I Meters Gat. Liters Gol. I Lifers 5 1.5 69 ~ 261 77 291 i0 3.? ~ 6t 231 ~ 7Q I 265 ~ t 5 ~ 4.6 ~ 53 I 201 I 61 231 ~ 2C .~ 6.1 I 44 ~ 167 ~ 52 ' 97 ' 25 "/.6 ~ 34 129 42 I ? 54 I 30 9.1 I 23 67 33 ~ 125 i j 3j ~ ~.7 ~ '~ -- I -- I ZL ~ SJ ^^0 ~ 122 I -- i -- 11 I 42 Lock V09yc: 38.4 ?. 1t.6m)~ 4"-..0 rt. (13.4m)1 3 27 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. '` - • Electrical a-temators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik-Box available for outdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. 1511153 Series 152H53 MORELS Control Selection Model -Ph Yolu Mode Am s 'Sim lez I Du lez N752 ~ 175 1 Non 8.5 1 2or3 BN152 115 t Auto 8.5 Induded 2 or 3 E752 230 1 Non 4.3 1 2 or 3 BE752 230 1 Auto 4.3 Jnduded 2 or 3 N153 715 7 Non 10.5 1 2 or 3 BN153 115 1 Auto 10.5 Included 2 or 3 E153 230 1 Non 5.3 1 ~ Z or 3 BE753 230 t Auto 5.3 tncluded 2 or 3 o cnunoN Alt installation of controls, proteeHon devices and wiring should be done by a qualified licensed electrician. AU electrical and safety codes should be followed including the most. recent National ElecUic Code (NEC) and the Occupational Safety and Health Ad (OSHA). ~- 7z t/S I _I_- SELECTION GUIDE 32 :z 7 sKZOSo 1. ; nc le piggyback variable level float sv~itch or double piggyback variable level float Swit Jt. Refer to FM0477. 2. S ~e FM0712 for correct model of Electrical Alternator E-Pak. 3. ti' 3riable level control switch 14-0225 used as a control activator, spea(y duplex (3) c (<) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineerec into the design of every Zoeller pump. ;~rarL ro: ~.~. sox 7s3aT Louisville, N' =0256-0317 Manuhdohuersof.. L' SHIP T0: 304:' Cane Run Road Z . ® Louisville: F;Y #o217-t9st Q~ryP~yvs SNCE 19..93° PU/YIP LO. (502J 7?8-2737.1.80D,' 928-PUMP FAX (5C'3j ?74-3624 hitpJlwww.zoelfer.cam _ d Copyright 2000 Zoeller Co. alt rights reserved. u+cn~ Q SD l60 L4U xv . ~nwTS 01NNER'S MANUAL & MANAGEMENT~Pr~ s ES1Gn rl~~~ . - -- [] NA Number of Bedrooms Number of Commer>~ai Units Fstitn~ flow (avef age) dTb at/da Design flow (Pa'kj, (Estimafied X 1.5} ~J ~..~y~ ~ ~ sou APp~n Rabe aVd fft ~ Monthly average' trttluerttlEftluent Quarrty FOG) .0i1 ~ Grease ( Fats S30 mg/L , ical Oxygen pemand (8005) 420 mglL Biochem Total Suspended Solids (TSS) 5150 m /L " eated Effluent Quality t Monthly average r Pre B"tochemical Oxygen Demand (t30D5) l Suspended Solids (TSS) t T ~0 mg/L. 530 mgn• [ ' a o Fecal CoGform (geometric mean} ~~ 0 cfu/4 pOm Maximum Effluent Partide Size Y inchdiameter SCHEDULE Service Event inspect Gonditron of tank(s) Pump out contents of tank(s) inspect dispersal cell(s) Cf~rt effluent filter Inspect Pump. pump centrofs 8 atarrn Flush laterals and Pressure test Page of Service Frequency p months ar(s) (Maximum 3 yrs.} At least once every y} of lank volume When combined sludge and scum equals one-third (' M~mum 3 yrs•) At least once every j ^ months ear() ( At least once every At Least once every At (east once every At feast once every At least Once every p months . ear(s) p months r(s) O NA D months ~eaKs) ^ NA p months ^ year(s) ^ NA ^ months ^ year(s) ^ NA Mg1NTENpNCE 1NSTRUCTtONS one of the following licenses or inspections of tanks and dispersal cells shall be made by an individual p.Ryttlg dor, POWTS Maintainer, Septage Master Plumber, Ma ns m st indude~a ~ l t~P~t~}° ate tan~k(s? ~ tdenttfjr any m~ssrng or broken , cerf~f+c~6ons. $e~g pperator. Tank inspedyo ~aSUre .the volume of combined sludge and scum and to check for any back up har~dwane, klent~ at~Y cracks or leaks. to check the effluent levels or pending of effluent on the ground surface- The dispersal cell(s) shall be visually inspected ndi of effluent on the and to check for any Fording of effluent oft the ground surfatce. The P° '~ autho~l- in tfie observation Pipes uires ttie immediate notification of the local regulatory ground surface may indcate a failing cordrfion and r+eq - oafs one-third {X) or more of the tank volume, the When the combined accumulation of sludge an a $eP~ Servicing Operator and disposed of in accorclance with di. NR entire contents of the tank shall be removed b3G nents~, and any 1'[3, Wisconsin Administrative Code. ~ orients, pfe~tfm~t Campo The serviang of effluent filters, mectlanicat or pressurized p01A(TS comp rformed try a certified POYVTS Maintainer. other maintenance or monitoring at intervals of 12 months or less shall be l~ of completion of any service event. q ~ repoxt shati~be provided to the local regulatory authority within 10 days resence of painting products or other START (1P AND OPERATION if hi h conceni>ati°ns are For new eonstruuctyon, prior to use of the POWTS check treatment tank{s) for the p e the treatment process and/or damage the dispersal cell{s). 9 chemicals that may impel removed by a septage servicing operator Prior to use. detected have the contents of the tank(s) Vahies typtcat for domestic fnfl~*~"T~~`q wasw.*+.~ ~•,•• • optic tank etftuent. .~ Yatues typical ~ pretreated vwastewater_ ~' i ~. ' d-ti ns are frozen at tr7e tnfi{tratve surface- Page of shall not occur when sot! ~n ~ o System startup is restored the ext~ss outages Pump tanks may ~ above normal highwater levels. When P°`~ During Povrex m ~e disp~et~i celt(s} in .one Large dose. overloading the ~{s} and may n~trtt in the grater wr~l tie disc~-araged To avoid this s ituatior< have the contents of the pump tank removed by a tip ~ ~~ ~rsdtarge of e~uent. ~ ~ i'te effluent pump or contact a Plumber or POW7"S Maintainer to Sel~9e n9 pperat3oc ptiot.tC~restDrirtg Pte' a~ in mantralty oPerabtig ~ pt~P contorts to restore norms! revers within the pump tank- drive orpark vehicles over tanks and dlspersa! t~iis. Do not drive ar park over, or otherwise disturb ar compact, ~ ~ mound or at-grade soil absorption au~ea. the area wlfhln is feet down slope of any' cove the petfotrnance and prolong the ~fe Reduc6ott or-etiminatton of the following ~R' fl7e waste rater strream may imp oiganette burls; ~ndoms; oQtton swabs; degreasem; dental floss: diapels~ of the POWTS. antibto6CS: baby wfPes: ttm water; fruit and vegetable peel'uigs gasoline; grease; herbiades; meat dlsu~fedants; tat; foundal~on dra~i {starlF p p} ~; mEd~ns; 0(4 fainting pnoduc~s: pesticides: sanifiary napfdns; tampons: and water softener brine. ABANDON~~ atte taken out of service tt,e following steps short i~ taken t° Insure that the when tNe POWTS farts andlor is perm trtiy system is properly and safely abandoned in compliance .~ ch_ Comm 83.33, yrisoonsin Adminlstrafive Code: Ali piping to ranks and pits shall be ~S°_ °nneded and the abandoned pipe openings seated. .. The contents of aIt tanks and pits shall be removv~d and properly disposed of by a Septage Servicing Operator- , after pumping, a1[ tantcs and pill shat[ be excavated and removed or tfietr caovers removed-and the void space filled virth soil, gravel ar another inert solid material CONTINGENCY PLAx the following easures have been, or must be taken. to provide a code if the ppWTS fans and cannot be repaired r'' comprrant reeplacement system. O A suitable ~;placaement'area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area shocrir. be protected from disturbance and compaction and should not be infringed upon b}r required setbacks from existing and proposed sftucfure, lot lines and wells- Failure to protect the replacement area will result in the n~-~ for a new soli and site evaluation to establish a suitable replacement area- Replacement systems must comply with the rules in effect at that time. O A suitable replacement area is not available due to setback andlor soil {im{tations_ Barring advances in POwTS tecfinology a holding tonic may be installed as a last resort to replace the failed POWTS_ -The site Nos not been. evaluated to rdentrfy a suite-:hie repiaoen•~ent area Upon failure of fhe POWTS a so~.and site evaluation must be performed to locate a suitable replacement area- if no replacement area is ova{fable a Noldng tank may tie installed as a last resort to mpiai~e the faired PJWTS_ Mound and at-grade saT absorption sYsterns may be reconstluCted in place following removal of the biomat at the lnflitTBtive suf'faCe_ RecorlsGu~ns of such systems must comply with the rules in effect at that time- c<ttllARNlN©~ SEPTIC, PUMP AND C1THF..f21RF,AIME[~T TANKS MAY CONTAIN LETHAL GASSES ANDIOR tNSUFFIC[F~IT' OXYGEAI. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREAT141ENT TANK UNDER ANY CtRCUMSTAAICES. DEATH MAY RESULT. RESCUE OF A Pt..RSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDfTTONAL CUMMENTS POWTS INSTALLER Name ~ ~ -,~' %f-~ Phone ~- .-- l~owrs MA(NTAtxt=R t~iame ~~ tl~ > ~~ Pfione J =- Z c~f~ ~ ~-%/r~ SEPTAGE SERV(CQHG GPERATOR PUMP1= LOCAL RFGULATORYAtITHORf7Y Agency ~ ~ ~ S~- + ntame ~,,,,,~, ~ „~ Phone -~/ ,.i ~" Z ~ ~'" f ~ ,~ Phone t'//': 3 ~, '._ 6" ~ 77za aoaxneru was diartsd dY the staffs of the Green Lake. Marquette anc Waushara CounCf Zaring and San1?alion aget>deS_ This doaumenl meets me minimum n~Quiremertts of c!L Comm 83.22(:~(6j{t)(~1t~{t) arsd 83.56(1). (2? ~ C.3?. Wisczsnsin .4d[ntntsfrativa CcGe Use of this datrrment QoCS not guarantee the performance of the pOW(S_ GAAVV(?/Qt) # ~ • ' 28 EAR SIM/TECH EIETER 06598 H~RTON BAY NDRTH RO B~YNE CITY, MI 49712 1-888-999-329D FAX 1-231-582-7324 CTM/TCfIJ GTI TGP ACS' V f1GTAT1 PATENT 5AA5~15~ Wisconsin Department of Comma o ['"~ O RT Division of Safety and Buildings n n ~cOr n omm 85, Wis. Adm. Code County ~~ ~ Attach oom ate site Ian on a r not less than 8 1/2 x 11 inches ' I ~~Q ~ indude, but not limited to: verb a nd horizontal reference int ( tfire~i~ and - 5 Parcel I.D. percent slope, scale or dimensions, north arrow, and locati nand distance to ne r d. ST. CROIX C~U~ Reviewed y Please print all informati ZONING OFFICE Personal iMorrnation you provide may be used for sewndary purposes nvacy w, s. 15.04 (t) (m)). Page of Date I ~1Z5/ d Property Own r ~ Property Location ~ 3v 1 ' ` (~ N R E (or /4 S T . 1 /4 Govt. Lot ~ Property Owner's Mai i Addre Lot ~ lod~# Subd. Name or CSM# City State Zip Code Phone Number ^ City ^ Village own Nearest Road N~2~ i s~ ~ ~ (~~~ )Z~r 6-ba~ ~ ( ~ ~ W 3 ^ New Construdaon Us esidential /Number of bedrooms Code derived design flow rate ~~ GPD Replacement ^ Public or commerdal -Describe: ____.____ __ ____,______ __- Parent material ~("•c 1) Flood Plain elevation if applicable ~ /~"' ft. General comments and recommendations: /`/ ~ j ~C-. e. ~~+/LG~'~~~(/1.~~ ~ ~~~ IJLJ Boring # Boring Pit Ground surface elev. -fi-f- ft. Depth to limiting fador ~ ~ in. Soil lication Rate Horizon Depfh Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eff#1 •Eff#2 .3 -3 .~ -- ~ - ~~ ® ~ # ^ Boring ~~ (q r., n9 ~ / ~- Pit Ground surface elev. ft. Depth to limiting fador ~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Z --1 ~ °--- ~s ~< ,~ ~~ , 3 !7- ~ ~~ ~ Q ~ r~ ~ ~._ ~J S I ~ ~ ~~ ~ • Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 1 ` Emuent iF'1 = tiuu < su mgiL ana i a~ < su mgru CST Name {Please Print) ,,~. ~ na CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 5 17 ,- ~ ..r~.~ 715-246-4516 Property Owner Parcel ID # Page of Boring # ^ Boring ~{ pit Ground surface elev. / ~ t I ft. Depth to IimiGng factor ~_ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 0--7 ,31 ~ ~--~ ~ ~ ~ 6 ~ 2- - I ~ ~ > ' ~ .~n 3 9-~ ,~. ; , ---.. S ~ ~ r,~ , L , 3'~~?U ?~ ~ ~ S ' ~'Y~ ~ ~~ ii// w/~ ^ Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil icatron Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GP Dlff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 'Effluent #1 = BODE > 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. SB0.8330 (8.6/00) ~~ ~ ~ ~ Soil Test Plot Pla Proj~t Name Pat Howell Sh ird Address 1784 215th St. M New Richmond Wi 54017 TM #226900 Lot ---- Subdivision -------- Date 4/15/05 SE 1/4 NE 1/4S 1 T 30 N/R17 W Township ErinPrairie Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1 /2" pipe System Elevation 100.3' * HRpSame as Benchmark Hwy 63 Scale is 1" = 40' unless otherwise noted B-3 101' 100.3' 9 9' B-1 We G B-2 Property Line 500' 100' 215th St. Failed System ,~,.,.. ST. CROTX Ct'UNTY ZONING OFFICE CF3RTIr ICATION STATEtKBNT FOR UTILIZATION OF AN EXISTING gEP'`TIC TANK This is c certify t'' I have: inspected the septic tank pras4ntly serving the _ ~~ ~~ residanee located st: „~,_~C: ~'~~ Sec . ~„_R T~O N. R / 7 N, Town of ~ },,. e~.t/Z.~~ St . Croix Cou2ltyr Wi,eCOriein. 'Upon iru3pectian, s certify that I halve found thw tank and baffles to be in good aoxit5itian, and it appears to be funatioriirig prOporly. ~,aat ti~ae+ serv3.ced m~ Q ~.~ 2vt~ -~~ - Ua.d f taw back occur fry a3~a-oxpt ion system? Yes____ No~ E if no, skip next 1~pproxiaaxte nalurne or 3ength of time: gal2ans ~ mimatae Capacity: Ccnstxt~etioA: Pre at Concretes ~ ~ Steel Other _ Maautacturar (if known}: ~ Ag® of t~.f known} lj ~ `~'w~~.J a ura {Name, Please Fr nt ZZd ~~ '~-'° tL tenet Nu er ~-it e ~ .. ~~ n~t~f , Form to be completed by i.iCCrised p;.umbar is• 15.06, w~.sconein Statutes) or l,icenaed di.apQSCr {NR li3 Wisconsin Administxative CodE} Flu~nber (applying for sanitary permit} Certification; Irta:ecepting the above statement regarding sxi certify that the tarok, to Lhe beat of my kx ra~.re~artta of ILHR B 3 , w is _ Adtr . Code { exce outlet baff a}. Nature ~ `~~~ r Signature MPiMPRS ~ g aspt.ic tank caridiC~.on, i edge, wi1.2 conform to t.lre fcr inspeetioa cpeai.ng over • ST CROIX COUN'T'Y `s SEPTIC TANK MAINTENANCE AGREEMENT • AND OWNERSHIP CERTIFICATION FORM ~-~ OwnerBuyer Mailing Addr~ property Address ~4-K-~ (Verification required from Planning Department for new construction) City/State Pazcel Identification Number LEGAL DESCRIPTION C / ~ r Location~,~ `/4/~~'/4, Sec. ! , T~~ N-R~W, Town of /' 1 n ~ ~~ Property Subdivision .Lot # Certified Survey Map # ,Volume ,Page # _ Warranty Deed # , Volume ~z3 ~ .Page # /~ Spec house ^ yes Lot lines identifiabl ^ 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is is proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank rs 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 WisconsO c~e~th~in 30 stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning the year expiration date. /~ ~~ ~ DATE S GNATURE OF APPLICANT OWNER CERTIFICATION y ( ) g ( ) the owner(s) of I (we) certify that all statements on this form are true to the best of m our knowled e. I we am (are) the property descn'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. ~~~y ~ -°`J' DATE S GNAT[JRE OF APPLICANT *****« ****** Any information that is aus-represented may result in the sanitary permit being revoked by the Zoning Department. ** Include with this application: a stamped warranty deed from the ~ referen made in the warranty deed a copy of the certified survey reap '~, "~ ., ~': i e= e' •' ~, y ~` &.~. •' n~''~. x ils ~: d~'a< x ,, ~~' ,~~, , <j.. ~ ,:~~~,~ .Ire ~« ,A ,>~~` . ~=~ ~~ ~ ;, '~r`~4' -- -R#II ~a `F Y...f 4 S_ ,~<,'~~ ., ~;t~>:_ J _~#'y ~f~ ~` "~~, ._, ,e ;•~ q-=~,:+ • 55865v ~~~ ~.~~.3fiPACE~I~.~ STATE BAR OF WISCONSIN FORM 2 - 1982 i; WARRANTY DEED DOCUMENT NO. ~~ Gordon A. Fouks and Doris V. Fouks husband and wife as survivorship marital property. com•eys end warrants to __ Patrick M. Howell ~~ AEGI5TER50f~1~&' S? CROIX C7Y~ViR n~~~ APR 3 4 193T ~ 3:20 P. M -K.a+.t.... tt ~1.,~a Mugtsa. ~ DM~:a THIS >PACE RESERVED F7R gECORDWG OAIA -! F----- .-._- ~-- ', ~; NAME AND RETURN AO~JRESS the following described real estate in St. Croix County, ,~ First National Bank of New Rietunond State o[ Wisconsin: ! PO BpX C ;New Richmond, WI 54017 All that part of the SE 1/4 of the NE 1/4 of Section 1, Township 30 North, Range 17 West, lying Easterly of State Trunk Highway "63". This_ is homesteadpropeny. (is) (is not) 012-1U06-60 ~~`' PARCEL IDENTIFICATION NUMBER ,f .. '; ;i ~i i, ~~ ,; ~I !i ~' 1 Exception to warranties: Subject to easements, reservations and restrictions of recor . Dated this ~~ day of Apri 1 , A.D., 19 97 (SEAL) ~ ~~,~?~~ (SEAL) • GORDON A. FOUK5' 2 (SEAL) ~G'''~2 ,:. ~,~~J.(~_ (SEAL) AUTHENTICATION Signature(s) of Gordon A. Fouks and Doris V. Fouks authenticated this day of Aril Ig 97 • STEPHEN DUNLAP TITLE: MEMtlER STATE BAR OF WISCONSIN • DORIS V. FOUKS ACKNOWLEDGMENT State of Wisconsin, ss. County. Personally came be[orc me this day of , 19 ,the above named to me known [o be [he person who executed the foregoing instrument and acknowledge the same„.„ THIS It1STFUMENT WAS DRAFTED BY Parcel #: 012-~ 008-60-000 04/2612005 04:40 PM " PAGE 1 OF 1 Alt. Parcel #: 01.30.17.4B 012 -TOWN OF ERIN PRAIRIE Current '~ X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): ` =Current Owner PATRICK M HOWELL 'HOWELL, PATRICK M 1784 215TH ST NEW RICHMOND WI 54017 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description ' 1784 215TH ST SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres SEC 01 T30N R17W 4.5A THAT PT SE NE LYING E OF HWY 63 Notes: 2004 SUMMARY Bill #: 16441 4AUU rlai: IV/H-IVV ~ HVHILH6LC "'~ Block/Condo Bldg: Y~ Tract(s): (Sec-Twn-Rng 401/4 1601/4) !/'i% Parcel History: Date Doc # ~~~ Vol/Page Type 07/23/1997 1236/012 ,~ WD 07/23/1997 776/320 07/23/1997 756/164 Fair Market Value: Assessed with: 168,700 Valuations: Last Changed: 05/13/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.500 12,300 100,400 112,700 NO Totals for 2004: General Property 4.500 12,300 100,400 112,700 Woodland 0.000 0 0 Totals for 2003: General Property 4.500 12,300 100,400 112,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 144 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00