HomeMy WebLinkAbout022-1053-90-100
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
561051 0
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:
Lubich, James & Helen Kinnickinnic, Town of 022-1053-90-100
CST BM Elev: Insp. BM Elev: BM Descrip n: SectionlTown/Range/Map No:
66 Vn /6'10 19.28.18.29513
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER ,t CAPACITY STATION BSI ??HI FS EL
Septic Benchmark
6 e ad-; /AZ /NW . ddb
D"Iing`_ pr Alt. B
if-L a fl')04 &1 G, z 73
Aeration Bldg. ewer
x v4
Holding G St/Ht Inlet
rTANK SETBACK INFORMATION St/Ht Outlet y 'Y'
TANK TO WELL BLDG. ryynt ,j to Air Ake D Dt Inlet ~Z.
,~/V / L, L, Z~
,
Septic UT ' 4 _ Dt Bottom 14,-31
IlQsing
IV ~P 5 35 ! Z4 ^ Header/Man. ♦ , C
A1[Jeeration J _I Dist. Pipe G4 (~J
Holding Bot. System
3.55 ~S.~S
Final Grade
PUMP/SIPHON INFORMATION /,7 ci7. ~J
Manufacturer p Demand St Cover ~y 4k
(r'r GPM , cp . /~[3
Model Number CL J ILI-S j/W Co w~ e~~ S' 3 4FT•
TDH Lift Friction Loss System Head T DH Ft 41 LOL- /j. 2.7- , 01
Force main Lengt / Dia. Dist. to Well
Z
SOIL ABSORPTION SYSTEM
BEDITRENCH Width/O Length / Njr enche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ''TLCJ ~je,
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: `
INFORMATION Type f ystem: 1 CHA LINER OR
0J 1L Model Number
DISTRIBUTION SYSTEM
Header/Manifov Distribution C x Hole Size 1 x Hole Spacing Ve Air Intake
1114
Length 7 Dia 7- Length I Spacing ? J• 5
Z Dia 1, 3 Z ~ L / v 0,0
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of _ T'~Yes x Seeded/S dd xx Mulc d
Bed/Trench Center N Bedrrrench Edges ` Topsoil t I[] No m e~~ j No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: S / Z 3 / / Inspection #2: /
Location: 903 Chapman ve River Falls, WI 54022 (SW 1/4 NW 1/4 19 T28N R1 8W) metes & bounds Lot I ~Parcel No: 19.28.18 95B
1.) Alt BM Description = `'a`w` „ a,%-
2.) Bldg sewer length 16j
-amount of cover
= C/bc-
Plan revision Required? ❑ Yes No
Use other side for additional information. ✓
SBD-6710 (R.3/97) Date Insepctor gnatur Cert. No.
CROIX COUNTY
PLANNING ZONING
h'
FAX MEmo
a
DATE:
To:
CodeAdministraaon FAX NUMBR:
715-386-4680
Land Information &
Planning FROM.
715-386-4674,.--;
FAX NUMBER: 715-386-4686
Real Pro~erty PHONE NUMBER: /
7L5, 386-4677 741- 151& - 1(086
Recycling
715-386-4675 NUMBER OF PAGES, INCLUDING COYER SHEET:
RE:
fF 713
ST. CROlX COUNTY GOVERNMENT CENTER 715386,4686 FAX
FZ@CO.SAJNT-CRO[X.WI.US 1 101 CARMICHAEL ROAD, HUDSON, W/ 54 016 WWW.CO.SAlNT-CROIX.WL.US
ST. CRQjAW%s- T Y Land Use
Planning & Land Information
l C'f~fx t 12
Resource Management
Community Development Department
Friday, May 24, 2013
James & Helen Lubich
903 Chapman Drive
River Falls, WI 54022
Regarding septic inspection for James & Helen Lubich.
Location of Property in St. Croix County:
Municipality: Kinnickinnic, Town of
Subdivision or Plat: metes & bounds
Certified Survey Map:
Lot:
Address: 903 Chapman Drive
Dear Applicant:
A septic inspection of the above reference property was conducted on May 24,2013.
This property is located in the SW 1/4 NW 1/4 of Section 19, T28N R18W, metes & bounds
(Lot Kinnickinnic, Town of, St. Croix County, Wisconsin. At the time of the inspection, this
septic system was found to be code compliant for a 3 bedroom home.
Additional Notes: Existing 1000 gal Wieser with new 600 gal Huffcutt pump chamber and 10'
x 45' mound cell.
If you have any questions regarding this, please contact our office at 715.386.4680.
Since ely,
Ryan Ya ington
Zoning Specialist
cc: file
Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, W154016 Fax 715.386.4686
www.sccwi.us/cdd www.facebook.com/stcroixcountvwi cdd co.saint-croix.wi.us
6~~9~lrp.n County 1 r V 1 T
8 Safety and Buildings Division
1 $ P 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
:o S Madison, Wl 53707-7162
gNAti
Sanitary Permit Application State Transaction Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit 22Z io / ✓3 d/
is required prior to obtaining a sanitary permit. Note; Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04 1 (m , Stats.
1. Application Information - Please Print All Information <
Property Owner's Name v
Parce! #
02,;z /o.S'3 - CrU
Property Owner's Mailing Address Property Location Z 5 Q
Govt. Lo
City, State Zip Code Phone Number
'a, Section
l ~CCJCJ~Ci 01-/` S cle
II Type of Building (check all T N> R / or W
Lot #
r 2 Family Dwelling - Nu ooms Subdivision Name
Block #
❑ Public/Commercial - Describe Use
❑ City of
❑ State Owned - Describes Use CSM Number ❑ Village of
Ills Type of Permit: (Check onl line A. Complete line B if applicable)
_A.
❑ New System lacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. El Permit Renewal ❑ Permit Revision El Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Iss~d
Before Expiration Owner
IV. Type of POWTS System/Component/Device; Check all that 5t~;d ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade > 24 in. of suitable soil ❑ Mound < 24
in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatmen vice (explain)
V. Dis ersaUTrea ent Area Information: ~
L ~ (gpd) Design S~ApplicationR ogpds } Dispersal Area Req'le~ fem. Dispersal Area Propo (s Sy
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units &
o d
New Tanks Existin Tanks l w 2 U
t aU rn wC7 a,
Septic or Holding Tank
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume r nsibility for installation of the POWTS shown on the attached plans.
P) u is Name (Print) Plumber's 5 a MP/MPRS Number Business Phone Number
l~J^
Plumber's Address (Street, City, State, Zip Code)
t
VIII. un /De artment Use Only
proved Drsapp Permit Fee Date sued Issuing t Signature
p er Given Reason for al $ ~ ' Co J~ ZZ ~3
IX. Com easons for Disapproval u. A C
3 COt~str!•v+~~ •~1~b
1. Septic link, ef~ntfilterand and
dispersal cell must all be services t hiailttBito w r~ ~eX.,.;
as per management plan provided by plumber.
2. AN te6ackrequiferilertts MW, ba-lna stain"' t
Ao
Attach to complete plans for the system and submit to the Coon only on paper not less tpan 8 1n x I I ' hes in sire
Lj ak PeP.%4ote44-4, 6 t- 1WvA_X go
SBD-6398 (R 11/11)
PLOT PLAN
PROJECT James Lubich Trust ADDRESS 903 Chamoman Drive River Falls Wi 54022
svv 1/4 NW 1/4s 19 /T 28 N/R 18 W TOWN Kinnickinnic COUNTY ST. CROIX
SYSTEM ELEVATION 93.7' BEDROOM 3
CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK
1000 gallons DOSE TANK SIZE 630
MOUND XXX SEPTIC TANK SIZE
HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none
BENCHMARK V.R.P. Top of 1" pvc pipe ASSUME ELEVATION 1001
❑ BOREHOLE O WELL * H. R. P. same as benchmark
Chapman Drive Right of way
Seale - 15% Slope
1/4 11 = 1 01 Area 15' below
system is to H uffc utt
90'
remain Dose tank ri B-3 91'
undisturbed 92'
B- 93'
'fie I I
B.M.,*2 o B-2
98.16'
Grading is to
Existing 2 bedroom be done to B.M.01
house ossible 3 divert run-off N
P away from
bed roo m system
1 000 gal Ion ST
275' Property Line Weiser tank
i
250'
Property
Line
210' Property Line
tienaxn DIVISION OF INDUSTRY SERVICES
141 NW BARSTOW ST FL 4TH
o`' P WAUKESHA WI 53188-3789
3 Contact Through Relay
www.dsps.wi.gov/sbl
www.v4smnsin.gov
~Oss1 c~rzt*~5~ Scott Walker, Governor
Dave Ross, Secretary
April 12, 2013
CUST ID No. 226900 AM. 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
PLAN APPROVAL EXPIRES: 04/12/2015 Identification Numbers
Transaction ID No. 2229534
SITE: Site ID No. 789703
James Lubich Trust Please refer to both identification numbers,
903 Chapman Dr above, in all correspondence with the
Town of Kinnickinnic, 54022 _ agency.
St Croix County
SWl/4, NWI/4, S19, T28N, R18W
FOR:
Description: Mound, 3 bedroom
Object Type: POWTS Component Manual Regulated Object ID No.: 1422296
Maintenance required; Replacement system; 450 GPD Flow rate; 28 in Soil minimum depth to limiting factor from
original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.O1/01, R. 10/12), Pressure
Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01101, R. 10/12); 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 stems VERJ 2 "
o
SBD-10706-P (N.01/01). '
N o
The building sewer and distribution network piping shall be of material listed in 8 30IS lInd
384.30-5 Wis. Adm. Code.
np w
In the event this soil absorption system or any of its component parts malfunctions so as to a health hazard,
the property owner must follow the contingency plan as described in the approved plans. In on, the owner
must comply with the operation, maintenance and monitoring duties as described in section II 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 4/12/2013
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 Industry Services 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.
Sin rely, 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 Industry Services
(formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been
replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of
Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have
been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code
will be addressed by SPS Chapters 360-366.
a
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 4/ 3/13
Owner: James Lubich Trust
Location:SW1/4 NW1/4 S19 T28 N,R18 W 903 Chapman Drive Kinnickinnic
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 Specificatio nd cross section
Shaun Bird
Signature
License nu e/226900
PLOT PLAN
PROJECT James Lubich Trust ADDRESS 903 Chamoman Drive River Falls Wi 54022
SW 1/4 NW 1/4S 19 /T 28 N/R 18 W TOWN Kinnickinnic COUNTY ST. CROIX
SYSTEM ELEVATION 93.7' BEDROOM 3
CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK
1000 gallons DOSE TANK SIZE 630
MOUND )OOC SEPTIC TANK SIZE
HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none
BENCHMARK V.R.P. Top of 1" pvc pipe ASSUME ELEVATION 100'
❑ BOREHOLE 0 WELL *H.R.P. same as benchmark
Chapman Drive Right of way
Scale = 15% Slope
1 /4 " = 10' Area ow
system is to
H uffc utt 90,
remain Dose tank B-3 91'
undisturbed 92'
B- 93
Well 94'
B.M.*2 o B-2
98.16'
Grading is to
B.M.*1
Existing 2 bedroom be done to N
house, possible 3 divert run-off _
bedroom away from
syste m
1400 gal Ion ST
275' Property Line Weiser tank
250'
Property
Line
210' Property Line
Mound System Cross Section and Plan View
-
Dimension Feet
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40 K B Z
Slope /S%
L
Clean aggregate 4 in. sch. 40 pvc
1 = Topsoil = ASTM C-33 Ell
L sand fill %2 to 2 '/2 in. dia. observation pipe
Cap Materia
Geotextile G H
Fabric
{ M1 Lf f M1fy{M1
}r}{ {f r L J .lti 9
;rw}r }rLrLiY{r:f:i{~ F
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Flowed Surface
• ~ 3 _ Ft Contour ~ S o~G
Slope Direction
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.
10/07Igj Page of
Perforatea Pips Detail
End Vill+r
Per (arAtlA l,,J
.^f PVC P,Pe
~6 MONS LOCeltd On 8011em,
Clean ~t,,~ 1 Are Equally Specee
^ PVC Force Mah
I'
~'lRilT Kml.l» KaxT ro rAan~tec}pan
PVC
Manifold Pipe
Pipe
PiPs Loroul P Ft.
RsF.
X 7 InChQ$
Signed: Y Inches
hole Diameter 513 Inch
License Number, Lateral
~w Inch(es)
Date: Manifold ? Inches
Force Main Inches
# Of hole$/pipe 2 Z
Invert Elev4tion of Laterals "2-Ft, '
i
Dose Tank Cross Section And Pump Performance Specifications
Tank Manufacturer Minimum Pump Performance Required
Tank Model Number 001 GPM @ I Ft TDH
Total Tank Capacity a
Max. Bury Depth
Total Dynamic Head (TDH) - Feet
Pump Manufacturer ti Elevation Head
Pump Model Number
Y Distal Pressure 3
Alarm Manufacturer Network Pressure Loss
Alarm Model Number ZT) Force Main Pressure Loss , 7 f . $
Switch Type e ' Total
Manhole Min. 4" Above Grade
With Locking Device
Vent Min. 12" Weather-proof
Above Grade
With Cap Junction Box
Finished Grade - -r
T
Depth of Cover Ft Disconnect
srA 're-1 Means
1 F`
J~.' Outlet
ISwitch Settings and Reserve Capacity Tank Volume GPI Dimension Inches Volume Gal. <
} A /4
} 4? (reserve) A 1
(alarm) B / 2 30 B i Weep
Hole
S '9
(dose) C b
7 Off Elev. C
s, (dead) Iy J- 9y Z Ft~
> >
Total zl~ D
>L D
Bottom of Tank Elev.3 Ft
<
<>S
>i> > > > > > > r a a > > r > > > > > > > > > > > > > > > > > > a > a > > > > > } > r r
< S S i; S S S S{{{{{ i S S i S S i S S S f i 4 S f S i S S{ S f i 4 i S S S i i i S{ S S f K 4
GENERAL INSTALLATION: The dose tank is bedded and back filled in accordance with the
manufacturer's product approval specifications. Maximum depth of bury as specified by the
manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have
an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved
material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or
sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the excavation and is sealed
watertight. Electrical service complies with NEC 300 and Comm 16.28 Wis. Adm. Code.
03/05lgj Page of
own --.Lum
Wast,ewin ter -
SEN-40 Series
4/10 hp Submersible Effluent Pump, 3/4" Solids
Construction
Flow - Liters/Minute
0 50 100 150 200 250 300 Cover Epoxy-coated cast Iron
35 11 ~
nnotQrHousing Epoxy-coatedca$Iron
10
30 9 Impeller Material Thermoplastic Elastomer
25 a IRipeller Type Non-clog
m 7
20 6 ; Volute Epoxy-coated cast iron
15 5 Poyver Cord SJTW
~ 4
X 10 3 = Mechanical Shaft Nitrile with carbon and
Seal ceramic faces
2
5 1 E 'sten'ars Stainless steel
0 o Shaft Steel
0 20 40 so 80 Upperintered sleeve
Flow - Gallons/Minute BP.~{ings = arld lower ball bearing
a.ea•--I
t
&IG'
G W' 8.15"
i
G.80'
4.68'
9.6U'
SEN-40-AF SEN-40
Specifications
MODEL NO. ITEM NO. H all=
SEN-40 509211 4/10 115 1-1/2" FNPT _ 9/920 80 I 70 60 d5 I 25 32 14 20 26.5 1750
y $
SEN 40- :-5Q~ 12 '4110„~ 115- 1-1%2°, FKPT 9/929 0 60 25' 32 14 U, =30 X7;5 1750
SEN-40-AF 1 509213 4110 115 1-1/2° FNPT 9/920 80 70 60 45 25 32 14 20, 27.5 1754
S O=AF . 5092"t~•,- 4/10 _j 1-15 1-1/2" FNPT 91920 80 ' ti Y"0 $0 45- 1 25 1---02 `'1'4 30 28:51750
Franklin Electric
400 East Spring Street, Bluffton, IN 46714
Tel: 260.824.2900 • Fax: 260.824.2909
Form: 996199 7-11 www.franklin-electric.com
" . POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _ or
FILE INFORMATION SYSTEM SPECIFICATIONS
Septic Tank Capacity
QyVrter a1 ❑ NA
Permit # Septic Tank Manufacturer uto%~.>^~ ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms O NA Effluent Filter Model ~$T /OV ❑ NA
Number of Commercial Units NA Pump Tank Capacity .j0 al ❑ NA
Estimated now (average) vU gal/day Pump Tank Manufacturer + NA
Design flow (peak), (Estimated x 1.5) D pal/day Pump Manufacturer / l ❑ NA
Soil Application Rate e9 al/d /ftz Pump Model _ O NA
InfluentlEffluent Quality Monthly average' Pretreatment Unit A
O Sand/Grgvel Filter O Peat Filter
Fats, Oil & Grease (FOG) 530 mglL O Mechanical Aeration D Wetland
Biochemical Oxygen Demand (BODE) 420 mg1L
Total Suspended Solids (TSS) 5150 m /L p Disinfection ❑ Other
Manufacturer
Pretreated Effluent Quality NA Monthly average" Dispersal Cell(s)
Biochemical Oxygen Demand (BODS) 530 mg/L ❑ In-ground (gravity) ❑ In-ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L O At-grade 7Nfound
Fecal Coliform (geometric mean) 5104 cfu/100m1 O Drip-line D Other.
Maximum Effluent Particle Size Y inch diameter • Values typical for domestic (non-oommerdaQ wastewater and
septic tank effluent
Values typical for pretreated wastewater.
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every Z5 D monthsear(s) (Maximum 3 yrs.)
Pump out contents of tank(s) When combined sludge and scum equals one-third (Yof tank volume
Inspect dispersal cell(s) At least once every 3 D months Y year(s) (Maximum 3 yrs.)
Clean effluent filter At least once every D months--F}cear(s)
❑ months -ar(s} 13 NA
Inspect pump, pump At least once every
p controls & alarm
Flush laterals and pressure test At least once every ❑ months ;ljcear(s) ❑ NA
Other At least once every ❑ months ❑ year(s) 0 NA
other: At least once every ❑ months D year(s) ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or
certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer; Septage
SerAcIng Operator. Tank inspections must include a visual Inspection of the tank(s) to identify any missing or broken
hardware. Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up
or ponding of effluent on the ground 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 (4) or more of the tank volume, the
entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR
113, Wisconsin Administrative Code.
Tice servicing of effluent filters, mechanical or pressurized POWTS components, pretreattment components, and any
other maintenance or monitoring at irAervals of 12 months or less shall be performed by a certified POWTS Maintainer.
A servicd report shall be provided to the local regulatory authority within 10 days of completion of any service event.
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other
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.
Page of
START UP AND OPERATION
For new construction, prior to use of the PO1I TS check treatment tank(s) for the presence of painting products or other chemicals that
may impede the treatment process and/or WITS
the dispersal cell(s). If high concentrations are detected have the contents of the
tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent.
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the
effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the primp 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 soll absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS:
antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain
(sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products;
pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be takeli 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 he excavated and removed or their covers removed and the void space filled with soil,
gravel or another inert solid material.
CONTINGENCY PLAN
if the POWTS fails and cannot be repaired the following measures have been, or must be !taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system.
The replacement area should be protected from disturbance and compaction and should not be infringed upon by required
setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area 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.
13 A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a
holding tank may be installed as a last resort to replace the failed POWTS.
The site has not been evaluated to identify a suitable replacement area. Upon failure of tie 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 rernoval of the biomat at the infiltrative
surface. Reconstructions of such systems must comply with the rules in effect at that time.
<<WAR NI NG>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name
~,ci✓j: _ Name '
Phone ~~J ;ot -cf ~G Phone 7
7Sl
4 42
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
E Name ' 6 Name
Phone Phone /
This document was drafted in compliance with chapter SRS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code.
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01659o H[JF H.IN HAY NUR H-l Pf]
H f!YNE I._ I 'Y, Pal 1 ~7I
J HQWFTY STF-100
_ 1 I
STATE OAR OF WISCONSIN FORM 1 1982'
00Cl1MEr•11 NO. -_VQ!~t ._"I~~rrMPACC~J'•1_.J9
IX CO., WI
FZ~Q. R'S OFI=ICE
This Deed, made between ; arm3.H.__Lubich,_AwRn~td
Grantor, 2 1996
and Diana 5 A.
E3ebecCa.. M4llar_n and aP . - 1G1_A L)aioit.
Reglstttr 4f Dgeds
-
_L' Grantee
pyWitnesseth That the said Grantor, fo}r~a valuable consldcrauon _Ollt°_ THIS SPACE ReSERVED FOR RECORPINf: DATA
d" - °"'Q• ~ -y9.h /,i-~_~Q rat;.Q l NAME AND RETURN ADDRESS
conveys to Grantee the following described real estate in Edward F. Vlaek, Davison & Mack
County. State of Wisconsin: 200 East- Elm St.
Part of the West half (Wtz) of the Northwest quartet River Falls, WI 54022
(NW4) of Section 19, Township 28N, Range 18W,
described as follows:
Cvaiitrneaccing at tai= iiiteresectio n of the central lino of
Chapman Drive located in said, Section, and the West - -
quarter (W'-4) line of Section 19, Township 28N, Range 7,81,,7; (Parcel Identification Number)
quarter South 300 feet; thence East 210 feet; thence North 275
feet, more of less, to the central line of Chapman Drive; thence Northwest
(NW) along the central line of Chapman Drive to the point of beginning.
James H. Lubich reserves the right to live ont he property so long as he is physically
capable. If there is n Mies -on as to whether he is physical capable, it shall be determined
by his physican.
This Warranty Deed is given in full satisfaction of that Land Contract recorded in the
office of the St. Croix County Register of Deeds on the 13th day of August 1996,
in Vol. 1194 of Records , at page607-608, as Document No. 548103
This homestead property.
(is) 0o=)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And gXant-nrS-----,._-----
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
'restrictions, reservations and covenants, if any, of record, highway rights-of-way and
liens or encubrances created by acts or defaults of the grantee.
r,
,i and will warrant and defend the same.
u
Dated this - - 30th day of At1gU3t - 19_.96 i
;1 - (SEAL) t . ' ~YIT.~~~_- ` (SEAL) it
- If
- i
- (SEAL) - (SEAL) t
i7
,f
THENTICATION ACKNOWLEDGMENT
ii
Signature(s).__L~i7~~_C}1 STATE OF WISCONSIN
ss.
County.
authenticated .is . d o - Z • 1 _6 Personally came before me this day of
.19- the above named
.Edward F. Vl k - - - -
TITf.E: MEMBER STATE BAR 01; WISCONSIN
-
(If not.
authorized by §706.06• Wis. Stats.) to me known to be the person who executed the
foregoing instrument and acknowledge the same.
il-I15 INSTRuMENT WAS DRAFTED 8Y
Eduard F. Vl.^. ck, D?vi_ann and Vlac k
200 E. Elm St., River Falls, WI. 54022 Notary Puhlic County. Wis.
(Sigrialures ma% he,:uthenticated or ackno%%lcdged. Ralh are not My cnmmission I% perman,mt. (If not, state expiration date:
nccc%sarvj '
..i r r. ...tn,•.f :n .r 1•w. ....h..:.l.i .w tM'J . , I..n„.I Iha .,c,..,,..ra
N ♦Rlt %%I% h£FI) • r %f F' RAR-OF' ItISr OVRI1 W.srnns••+ L-IA: Bark r•.n Inc
FOR ~1 v,,. t - InR! M11-a.:kep Wra
.
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF AN EXISTING SEPTIC TANK
This is to certify that LI have inspected the septic tank. presently
s('rving the :M N1 I-,zr ('f residence located at.:
TZ _N R_,~La _W , Town of
IQLAJ-'4 r section
Upon inspection, I certify that I have foi-ind
the tank and baffles to be in good condition, and it appears to be
functioning properly.
E.,ast time serviced:
Did flow back occur from absorption system?
Y es No (T f , no, skip next line)
i.e
-
Approximate volume or length of time: gallons in n t.7 t. s
acity: /OOV
construction: Prefab Concrete Steel Other_
P.7,_tnufacturer: (If known) :
Age of T nk (If known) : 9.5 U ~
{ .gnature) (Name Please print
(License Number)
Pa to
[orm to be completed by licensed plumber (s.145.06, Wisconsin
Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative
Code)
- - - - - - - - - - - - - - - -
Plumber (applying for sanitary permit) Certification:
Iii accepting the above statement regarding existing septic tank
condition, I certify that the tank /183,. thee of my knowledge will
conform to the requirements of ILHdm. Code (except for
inspection opening over outlet baNameSignatuMP/MPR
s
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMP NT
AND
OWNERSHIP CERTineATION FORM
Owner/Buyer
Mailing Address
1
Property Address S. ,_e_
-_-(v'erifioation required frorri-Planning & Zoning De
i partment for new
City/State
Parcel Identification Numbar
...~-E A DESC.R~PT1'C~IPdV 6;22~~°~
Property Location c> y4 V , Sec.
Subdivision
Lot#
CertMed Survey Map
Volume Page #
U
Warranty Deed # _ ~
Volume
-11 _ Page #
Spec house yes
.Lot lines identifiabl yes no
SYSTEM NTENA I CE ANll O 4Nly ll♦'R CERTIFICATION
Improper um and maintenance of your septic system could result in its prarra;ture failure to handle wastes. er
maintenance consists ofpurnpiiig out the seprtio tank every &,ce years or sooner, if needed, by a li,,ensed pumper. Whaot yo
the system can affect the ffctnctitrrr of the septic tank as a treatment stage in the waste disposal system. Owner O11 Put into
maintenance
responsibilities are specified in ;Comm. 83.52(l) and in Chapter 12- St. Croix County Sanitary Ordinance,
i
The property owner agmes to submit to St. Croix County Planning & Zoning .Department a certification form, signed by the
owner and by a master plumber, journe plumber
or a
pumper veri.f in> that 1. ) the on••site
licensed wastewater disposal system is in proper np rating Condit ontand/or (2) after inspection and pumping (if necessa the
less than 1/3 full of sludge. ry), septic tank is
Y/we, the undersigned h„ve 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 Co'
Certification stating that your septic system has been maintained mustt ble co plc deand returned to the ,S Croix Co Wisconsin.
Zoning 1Departrnent within, ;30 days of the three year expiration date. ~t7' Planning do
i 7/we cetfii'}r that all atatel7tents on tai brin are true to the best of my/our knowledge. Uwe am/are the owner(s) of the
i property described above, by virtue ofa wart ty deed recorded in Register of Deeds Office.
J er of bedrooms
SIG TUBE Op APPLTCANTt;S) - Y / /X-
:HATE
information that is misrepresented may result in, the sanitary permit being revoked by the Pfatnning & Zoning Department.
lInclude 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.
,1.:RE V. 08105)
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Parcel 022-1053-90-100 04/02/2013 03:05 PM
PAGE 1 OF 1
r Alt. Parcel 19.28.18.295B 022 - TOWN OF KINNICKINNIC
Current 0 ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
0 - LUBICH, JAMES H LE-TR
JAMES H LE-TR LUBICH
902 S WASSON LN # 17
RIVER FALLS WI 54022
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 903 CHAPMAN DR
SC 4893 SCH DIST RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 1.390 Plat: N/A-NOT AVAILABLE
SEC 19 T28N R1 8W PT OF SW NW COM Block/Condo Bldg:
INTERSECTION CENTERLINE CHAPMAN DRIVE TH
S 300 FT; TH E 210 FT; TH N 275 FT, MOL Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
TO CENTERLINE OF CHAPMAN DRIVE; TH NW 19-28N-18W
ALG CENTERLINE OF CHAPMAN DRIVE TO POB
Notes: Parcel History:
Date Doc # Vol/Page Type
07123/1997 1199/589 WD
07/23/1997 1194/607 LC
07/23/1997 1066/526 TI
07/23/1997 710/578
2012 SUMMARY Bill Fair Market Value: Assessed with:
198139 125,600
Valuations: Last Changed: 09/07/2010
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.390 30,000 111,600 141,600 NO
Totals for 2012:
General Property 1.390 30,000 111,600 141,600
Woodland 0.000 0 0
Totals for 2011:
General Property 1.390 30,000 111,600 141,600
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 314
Specials:
User Special Code Category Amount
i
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
t t 1y'; ~
P SC01 SOILS EVALUATION REPORT #1679
IMAI
Department of Comm rce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3
Division of Safety and wldin 3 j ;A Schmitt Soil Testing, Inc.
n
Attach complete site plan paper not less than >%4 x 11 in es in size. nt St. Croix
,]r H include, but not limited to: rtical and ~ P int (BM), d on
percent slope, scale or dim n and distance to road. arcel I. D.
022-1053-90-100 Z 6
Please print a►I information. ev; Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). a 3 U
Property Owner Property Location
James Lubich Trust Govt. Lot SW1/4, NW1/4, S19, T28N, R18W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
903 Chapman Drive na na
city State Zip Code Phone Number City Village ❑ Town Nearest Road
River Falls WI 54022 715-307-2819 Kinnickinnic Chapman Drive
❑ New Construction Oce= ❑ Residential / Number of bedrooms 2 Code derived design flow rate 300 GPD
Replacement ❑ Public or commercial -Describe:
aerial Sandstone Residuum (Boone Flood plain elevation, if applicable na ft.
General comments
and recommendations: Area is suitable for a mound system. System elevation is 93.65' based off a contour line established at
92.98'. Slope of area is 16%. Depth to limiting factor is 28".
Boring # ❑ Boring
❑ Pit Ground surface elev. 93.04 ft. Depth to limiting factor 30 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-8 10yr3/4 none sil 2mgr mfr Cs 2f,2vf .6 .8
2 8-18 7.5yr4/4 none sil 2msbk mfr gw 1vf .6 .8
3 18-24 7.5yr4/6 none fsl imsbk mfr 9w 1vf .5 1.0
4 24-30 10yr7/1 none vfs Osg ml C5 .4 .6
5 30-43 10yr7/2 C7d 7'56/5/8 7.56/6/2 vfs Orin mvfi 0.0 0.0
Boring # Boring
❑ Pit Ground surface elev. 93.04 ft. Depth to limiting factor 28 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistent Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-10 10yr3/3 none sil 2mgr mvfr gw 2m,lf .6 1.0
2 10-21 10yr4/4 none fsl 2msbk mvfr gw 2m,lf .4 .8
3 21-28 10yr5/3 none Ifs lcsbk mvfr gw 2f .5
1/1 1.0
4 28-36 106/8/1 c fs Osg ml cs 1vf .5 1.0
5 36-68 7.5yr4/6 c2d 7.5yr6/8 fsl Om mfi .2 .5
7.5yr6/2
* Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BODS s30 mg/L and TSS s30 mg/L
CST Name (Please Print) Signature: CST Number
227429
Thomas J. Schmitt
Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number
1595 72nd Street New Richmond, WI 54017 11/16/2011 715-247-2941
SBD-8330 (8.07/00)
Property Owner James Lubich Trust Parcel 1D# 022-1053-90-100 Page 2 of 3
F il Boring # Boring
Pit Ground surface elev. 90.07 ft. Depth to limiting factor 28 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-12 10yr3/4 none Ifs lmsbk mvfr cs 2c,2f .5 1.0
2 12-22 10yr4/3 none Ifs lmsbk mvfr gw 2m,2f .5 1.0
3 22-28 10yr6/3 none Ifs imsbk mvfr gw 1vf .5 1.0
4 28-36 10yr6/4 m3p 7.5yr6/8 fsl Om mfi a .2 .5
10yr6/1
5 36-42 10yr8/1 c2d 7.5yr6/6 OSg ml cs 4 6
7.5 r6 2
6 42-66 7.5yr5/6 c2d 7.5yr6/8 fsl Om mfi .2 .5
7.5yr6/2
4] Boring # Boring
g Pit Ground surface elev. 100.53 ft. Depth to limiting factor 50 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-13 10yr3/3 none sl 2mgr mfr CS 2f lvf .6 1.0
2 13-36 7.5yr4/6 none sl 2msbk mfr a 2f .6 1.0
3 36-48 10yr8/1 none fs Osg ml a .5 1.0
4 48-50 7.5 r4 6 none fsl Om mfi cs .2 .5
5 50-62 10yr8/1 m2d 7.5yr6/6 fs Osg ml cs .5 .1.0
7.5 r6 2
6 62-74 7.5yr4/6 m2d 10yr616 fsl Om mfi 2 5
10yr6/2
❑ 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/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *ElM
* Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = BOD5 < 30 mg/L and TSS <30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-8330 (R.o7/00) Schmitt SOII Testing, Inc.
Page 3 of 3
. Conducted by: Conducted For:
Schmitt Soil Testing, Inc. Name: James Lubich Trust
Thomas J. Schmitt, CST 227429 Address: 903 Chapman Drive
1595 72nd St. City, State, Zip: River Falls, W154022
New Richmond, WI 54017
Phone: 715-760-197 PID: 022-1053-90-100
Signature Lot No.
Date Legal Description: SW1/4 NW1/4 S19 T28N R18W
Backhoe Pit Township, County: Kinnickinnic, St. Croix County
Bench Mark 1 El. 100.00' Top of 1" pvc pipe
Bench Mark 2 El. 98.16' top of well
Slope= 16% Contour Line El. 92 Contour Line Length 50'
1"=40'
chip
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