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HomeMy WebLinkAbout022-1048-10-160 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 5638,86 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: Moreland, Todd & Laurie Kinnickinnic, Town of 022-1048-10-160 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: /Qa 1 GS"V 17.28. 8.257615 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER A/, 22 CAPACITY STATION BS HI FS ELEV. ~r, 7 .7 / Septic Benchmark /,_3 /6/ Dosing Alt. B LA-,' I a L0_ Or.. t n~ b~ Bldg. Sewer /Yiz gG~~y Holding P6 St/Ht Inlet /7~/ C / TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent t it Intake ROAD Dt Inlet /loo r u.. ~ Septic 72,Dt Bottom „y Dosing . rr 7Z I Z7 / Header/Man. 3. >5 716.3 Aeration Dist. Pipe 3.63 98, 211 Holding Bot. System 3. {5 47 7. PUMP/SIPHON INFORMATION Final Grade ock Manufacturer Demand St Cover `5 ~.I.7 O v S GPM aJ J~~ ✓ 7 Model Number Z 3 q 6 TDH Lift Friction %0q3 System a T H QFt Forcemaini7 Length / Diaz it Dist. to Well AIA~ 1 16 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Tj~nches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 45 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: UN OR INFORMATION Type stem: 111 ?3 CHAMBER IT Model Number: \ by J DISTRIBUTION SYSTEM /!e: et5 Header/Manifold, f it Distribution x Hole Size x Hole Spacing Ve Air I ke Z Pipe(s) t5 Length_ Dia Length Dia Spacing Z :36 KY ILI SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only e. Depth Over Depth Over xx Depth of xx Seeded/So xx Mulched Bed/Trench Center / Bed/Trench Edges Topsoil S;<s [0 No Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 9 / Z5 / 13 Inspection #2: Location: 381 North Libert d River Falls, WI 54022 (NE 1/4 NE 1/4 17 T28N R18W) NA Lot 2,CQ,,~,/ , Parcel 17.28.28.257B15 1.) Alt BM Description = J I _ + r f e5 ~ 2.) Bldg sewer length = 3v P`~~ a -amount of cover = ? I ZNo Plan revision Required? Yes Use other side for additional information. ' b ~6 t7 Date Insepctor's 5 nature Cert. No. SBD-6710 (R.3/97) s} s a (lr z ~ i -0 J d Z 1 v OIL- ra e ~i •c s 4 4 4 „ v r• - Count)' Safety and Buildings Division ! j 201 W. Washington Ave., P.O. BOX 7162 Sanitary Permit Number (.to be Glled.in by U0 Madison, WI 53707-7162 s ACt 5 ~0 3 8'C7 State Transaction Number Permit Application - Z 3 $ In accordance with SP is. A Code, submission of this form to the appropriate governmental unit is required prior t as it. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address the Department 0 fessional Servies. Personal information you provide may be used for secondary 3 7tv1 ~-Q,.~ purpo Les in accordance with the Privacy Law. s. 15.04 1 m), Slats- O I b~( I. A lication Information - Please Print All Information C reel # Property Own r' Name Viw n - G Property Location Property Owner's Mailing Add u (25-7 Ci f <3 ~ X44 Lot 1,~. Phone Number RO/X C - 'a, Section Ci , tat Zip bode 4 f f ircle one) T N; R EorW G Ij'V 1 UUU""" IL Type of Building (check all that appl Lot Subdivision Name ~ 1 or 2 Family Dwelling - Number of Bedr Blac ❑ Public/Connitercial - Describe Use ❑ City of State Owned CSMNamber D Village of - Describe Use Vp ( 2 Z +C Town of /~I rr r ~ 7 5 0 5 2F~jS371o0 III. Type of Permit: (Check only one box on line A. Complete line B i pplicabte) i A. JR~New System D Replacement System ❑ Treatment/Holding Tank Replacement Only D Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. D Permit Renewal D Permit Revision D Change of Plumber D Permit Transfer to New Before Expiration Owner 8U IV. T e of POWTS System "Omonent/Device: Check all that a 1 D Non-Pressurized Iri-Ground 11 Pressurized In-Ground D At-Grade TR Mound ? 24 in. of suitable soil D Mound < 24 in. of suitable soil ❑ Pretreatment Device (explain) ❑ Holding Tank ❑ Other Dispersal Component (explain) V. Dis ersal/Treatm nt Area Information: Dest Flo ) sign Soil Application Rate(gpdsf ) Dispersal Area Required (sf) ispersal Area Prop° System Elevation Capacity in Total # of Manufacturer VI. ank Info Gallons Units ° y Gallons u v H y New Taaks 2 ~ rani "o cc rs to C- Septic or Holding Tank ~S t° Y Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plu Signature MP/MPRS Number Business Phone Number ait PI r'sAddress Stmt, City, rate, zi Cade) WA A l s VIII. aunty/De /Department Use Out Permit Fee Date 1 ued Issuing A t Signature Approved roved $ 7S I D~ g 3 tven Reaso nial iX. Cttndi easons for Disapproval / t~►r~ 5 OtJ G I. Septic tank, efflulant fitter # dispersal cell must all be serokes l ntal { as per management PIan Provided by ` 2 SAM s0Wk requiremsnts MU# be. W Soil - 'aie tlodt / oldfnsrices. Attach to complete plans for the system and submit to the County only on paper not less than 8 12 x 11 inches in size SBD-6398 (R. 11/11) ` itivA.R-z~r_ DIVISION OF INDUSTRY SERVICES 10541 N RANCH ROAD HAYWARD WI 54843 0 R, Contact Through Relay (3 S www.dsps.wi.gov/sb/ 4 P www.wisconsin.gov 9Z ~ S w O Scott Walker, Governor Dave Ross, Secretary August 02, 2013 CUST ID No. 220673 ATTN. POWTS Inspector CHARLES L WEBSTER ZONING OFFICE WEBSTER SOIL TESTING & DESIGN ST CROIX COUNTY SPIA N5815 770TH ST 1101 CARMICHAEL RD ELLSWORTH WI 54011 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 08/02/2015 Transaction ID No. 2276398 Site ID No. 793461 SITE: Please refer to both identification numbers, Todd Moreland 381 N Liberty Rd above, in all correspondence with the agency. Town of Kinnickinnic St Croix County NE 1/4, NE 1/4, S17, T2 8N, R1 8W CO FOR: A Description: Mound, 3 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1440220 DEPT Maintenance required; 450 GPD Flow rate; 27 in Soil minimum depth to limiting factor from original grade; Sys ESS Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01101, R. 10/12), Pressure Distribution Component 3 of , lb" 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 construct and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. SEE COR 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: Key Item(s) • 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. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 384.10. No fixture, appliance, appurtenance, material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system, unless it CHARLES L WEBSTER Page 2 8/2/2013 is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • Maintain well and waterline set backs per SPS 383.43(8)(i). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. 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. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Pa ' is L an rf . Please Include a Copy With Your POWTS Plan vie r , Integrated Services Payment Submittal. (715) 634-7810 F : (715) 634-5150, M - F 8:00 a.m. - 4:45 .m. WiSMART code: 7633 paf.shand6ff@wisconsin.gov v Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm 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 ,ems,.,.,,.. - ---1SPS" 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. CHARLES L WEBSTER Pa°e 2 8/212013 is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • Maintain well and waterline setbacks per SPS 383.43(8)(1). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. 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. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Pa ' is L an rf _ Please Include a Copy With Your POWTS Plan vie r , Integrated Services Payment Submittal. W (715) 634-7810 F : (715) 634-5150 , M - F 8:00 a.m. - 4:45 .m. WiSMART code: 7633 paf.shandorf@a wisconsin.gov w r f : -dc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm 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 to recognize the relocation of the Division of Industry Services from the former Department of Commerce to a.- 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. Webster Soil Testing & Sewer System Design Charlie Webster, Owner N5815 770th Street Ellsworth, WI 54011 WI Licenses: MP220673, ST220673, PE18803 Telephont(715) 273-3430 POWTS Index Sheet Page 1 of 8 Mound System for a 3 Bedroom Residence Property Owner/Project:T4Todd Moreland NE1/4 NE1/4 S17, T28N, R28W 381 North Liberty Road Town of Kinnickinnic, St Croix County Parcel I. D. 022-1048-15 Page 1 Of 8 Index Sheet Page 2 of 8 Plot Plan Page 3 of 8 System Cross Section Page 4 of 8 Distribution Pipe Layout -A"ONALLY Page 5 of 8 Pump Chamber Layout 'PROVED Page 6 of 8 Pump Performance Curve ` SAFETY AND Page 7 & 8 of 8 Management Plan OVAL SERVICES 41DUSTRY SERVICES RESPQN ~SCO'N cE HAALM ,N~' 1 WEBgTER z E-18903 ! C • ELLSWOR'TH MI = `.~`I&:..~ {fi Component Manual Used: Name: Mound Component Manual for POWTS Version:2.0 SBD-10691-P Dated: January 30, 2001 Name: Pressure Distribution Manual for POWTS Version: 2.0 SBD-10706-P Dated: January 20, 2001 i. 0 00 w ~ a d A-4v r O v r d u 13 . . ` v s K cl ' a Q ♦p a ~ 40,~- To z lylokr- Page .Of s~,s tc t"*j C.- N O s Sc C t/ D i-7 Approved Synthetic Covering prsTh'1 C- 33 Distribution Pipe Medium Sand Topsoil Elev 9 7. 73~ G 3 E o . °le Slope - Force Main Plowed Bed Of - 2 -2 Aggregate From Pump Layer o Cross Section Of A Mound System Using E tiil• t4.~tw A Bed For The Absorption Area G b, Ft. A ~t. / H D Ft. Linear Loading Rate=6- ?-GPD/LN FT B Ft.5 i esigr. Loading Rate=o.33GPD/SQ FT I ~ Ft. 74ccctr x J Ft. rkKdAieI/4~t ~ K - Ft. 9,4~ L; l L Ft. Ty~,~1/ {~tc<tl e.c ~ wa7Ft. a`Observation Pipe - - _--_.-r----- Nfa;si Fo/d Y~ p e C~ - - Distribution bed Of' 2 - 2% Pipe Aggregate L •r t Observation PipeAl. (Anchbt securely) OLsC~'V~~~O.•! ~b•`oP.S ~/~e ~ //hihL•HsGth+ ~.~c1MC~:.'i ~ Ihch~i 6C ProL~~tY_v,l'~~ 4. tl~`C'r Ci / f/ ~ ~1 711 C po 7~fab+7~i~.,eliCS.S~u t t190~ P G s c C cc. a !f' ds, c`rcf e.Q . Plan View Of Mound UsJhg A B-ed For The Absorption Area o ct `,l f ' cr c~Q /Gpcf cZ .17 ct 1, CX 19 Perforated Pipe Detail End View Perforoled y PVC Pipe o e Jots ` d Holes Located On Boil,,, sc eb ar~ Are Equally SpaCed 1^ ' t Dislrijution / Pipe l See d c~ d. l ~ Distribution Pipe _ Layout ,r ~ e he f7- rj7uM /r/1s, - - 5 Ft. -7 1-A& lp0 ji .9,u s:-. st!/ s te.1 ('/P4,, ro p, X 3 ~ Inches 9 Y Inches Hole Diameter Inch Lateral / Inch(e, Manifold Incise Force Main inches # of holes/pipe ~ ~«ess box ) rr--- *k&'Ctc%d per, Invert Elevation of Laterals Fc9..~~7i-t_ ~-/ate,i I Place 1st holelS~-lfrom s,Kdo'g1►~i~t+~a« with succeeding holes at?0,flaintervals. A4 C~, of /10// ct h 140o, VV P a g e 0 : C> / _sZ • Co rp O,AJ'~.~ry .,~C~/C 71 y l~/~4.h~ CA l (No Scale) C'-r•nr S~~d9o .Approved Locking Manhole Covers Cei1r e With Warning Labe1S Attached ~r""''e''~ "'•~olow of fl'~,S`1 Weatherproof Approved ci 7r .,"t~'~/y~✓✓ e/= p Junction Box Vent Cap ~T 1 12" Minimum / G►.+o% F'~ •~t~Mjn;ttn► .},t 411 Minimum ' 18" Minim Quick um Disconnect "-4.a.01kArd rOV*1. 1 /4" Weep c'*b Baffle , Hole j 44 it e jehe . A ar a f,Pr~ ve d ~ Alarm B efa. ✓s/ev t On 6, e u.,'t4.i&.p *APPROVED Off C F~-" ~ off' coyar y - JOINTS WITH APPROVED PIPE ro P p SOL~DT~OIL ~ Con,:. 310-x c3.S" 3" of Bedding Under Tank-/ Number of Doses:S-.3Per Day Gallons Per Day/Doses: 9¢-3 -alloys Volume of Back fIow:- Tank Manufacturer: U/,eSCr Cohertt~ Total Dose Volume: _Gallcr.s Tank Size-Septic/Pump: ivvo eoa L/ Gallons Alarm Manufacturer: - 7.7-,ip ,F{,&,,, 6 44 X - Model Number: -S'1- u k- Capacities: A z-kinches ors'CGa; lons Switch Type: 441 7 + Bo-inches orGa'lons Pump Manufacturer: Ce~cc/ + C inches or IO/ Gallons Model Number: 67c,,,,.,/a( 38'71 k' A~o ,,5'- + p inches or O/ Gallons !Minimum Discharge ate: oZ /_3 Total.....= .,tinches or: o-6- Gallons vertical Difference BetKeen Pump Off and Distribution Pipe:/+.OFeet Minimum Required Supply Pressure:.. ,+6. --Feet 160 Feet of Force Main x/. O Friction Factor/100 Feet: + / o eet Inch Diameter Force Main Total Dynamic Head: ...=-2/*Seet In;.ernal Tank Dimensions: Lengthfs 0 Width9411, ,.Liquid Depth f w,*,~q CLisro7 /dPr c, o o4L c~`1c~ " `6 7~~c ! S ~ArG R • e Gail.. r~ C it ~UP` / i/ ' / tom" 7 j,~ry i"' ~Q ~ C fir:. i>>f ran Pun EP04 13871 EP05 APPLICATIONS • Fasteners: 300 series Fully submerge in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: ' Capable of running lubrication and efficient strength, and durability. • Effluent dry without damage to heat transfer. systems components. ■ Motor Cover. Thermopias- • Homes Available for c and tic cover with integral handle • Farms Motor: Available and float switch attachment • Heavy duty sump • EP04 Single phase: 0.4 HP; mo" Me~sni~ai • points. opwaft. • Water transfer 115 or 230 V, overload with l Swkh ailed and 01 PO. Cam: Severe duty Dewatering RPM, built in overlo-wit automatic reset. prom M tbe hdory. rated oil and water resistant. SPECIFICAT11M • EP05 Single phase: (15 HP, N BUf1W Upper and lower 115 V, 60 Hz, 1550 RPM, FEATUM3 heavy duty ball bearing Pump: EP04 built in overload with construction. • Solids handling capability: automatic reset ■ Ef~04 • Thermo- Plastic Semi-open design maxximum. • Power cord: 10 foot AGMY LISTING with pump out vanes for • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. • Total heads: up to 24 feet, with three prong grounding a Cu"MSUNd"Assoddoo • Discharge size: 11/2* NIT. plug. Optional 20 foot m B" impo . Thermo- (CU listed numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic -desad design for end in ste or model rotary/ceramic-stationary, three prong grounding plug improved performance. ) BUNA-N elastomers. (standard on E1305). ■ C> and Base: Rugged • Temperature: thermoplastic design provides 104°F (400C) continuous superior strength and 140°F (WC) intermittent contusion resistance. • Fasteners: 300 series UETM FM stainless steel. 10 i • Capable of running dry without damage to s 30 components. Pump: EP06 8 i • Solids handling capability: 25 W maximum. LU • Capacities: up to 60 GPM. x s 20 I • Total heads: up to 31 feet. • Discharge size: 11h7 NPT. • Mechanical seal: carbon- 5 rotary/ceramic-stationary, ° 4 15 BUNA-N elastomers. • Temperature: 1°- 3 10 104°F (40°C) continuous 140°F (600C) intermittent. 5 I C/ 1 i T-H 1....1 4A- /A/ 4Le_ 0 00 10. 20 i 30 40 50 GPM 0 2 4 6 8 10 12 nP/h CAPAMW ®1995 Goulds Pumps, Inc. Effeeth a May. 1995 0-- POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page -7 of FILE INFORMATION SYSTEM SPECIFICATIONS Owner T- d l am c h 01 Septic Tank Capacity /0490 al ❑ NA Permit # g Septic Tank Manufacturer Wit°5,-• t'aar~etP NA ~'~az go : j DESIGN PARAMETERS Effluent Filter Manufacturer Poi ❑ NA Number of Bedrooms 5 ❑ NA Effluent Filter Model ❑ NA Number of Commercial Units jl(NA Pump Tank Capacity trj al ❑ NA Estimated now (average) p p gavday Pump Tank Manufacturer GU, rse,, C rj ate ❑ NA Design now (peak), (Estimated x 1.5) ,S © al/da . Pump Manufacturer (v vu / of ❑ NA Soil Application Rate 0., 3.3 au /fe Pump Model jE c> ❑ NA Influent/Effluent Quality Monthly average' Pretreatment Unit ONA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/C;ravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) 5220 mg/L ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other. Manufacturer Pretreated Effluent Quality ❑ NA Monthly average" Dispersal Cep(s) Biochemical Oxygen Demand (BODE) 530 mg/L ❑ In-ground (gravity) ❑ In-ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ At-grade ❑ Mound Fecal Coliform (geometric mean) 510'' cfU/100ml ❑ Dri ine ❑ Other Maximum Effluent Particle Size Y. inch diameter values typical for domestic (non-comma daq 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 ❑ months year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (lr,) of tank volume Inspect dispersal cell(s) At least once every ❑ months 'year(s) (Maximum 3 yrs.) Clean effluent filter W- At least once every 3 ❑ months Xyear(s) Inspect pump, pump controls & alarm At least once every ❑ months ❑ year(s) ❑ NA s//e Flush laterals and pressure test At least once every ❑ months ❑ year(s) ❑ NA Other At least once every ❑ months ❑ year(s) jd NA Other: At least once every O months ❑ year(s) )(NA MAINTENANCE INSTRUCTIONS yNofZ-;cF/earcomlh.~leh %,J s/e~X,ir~r ~l/ttr oH~t vNry 3Ye'16s.4.~eL!'co~rnt.s d t~,t•!- Frl~ry eyt),pr// ro ~v.Icfa~~ryry p••`/.rw du.r~~ -the wlot='+= Inspections of tanks and dispersal cells shall be made by an individual carrying one of ttfe 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 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 (X) 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. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreattment components; and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service 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 yystem start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fig above normal highwetar levels. When power Is restored the excess wastewater will be discharged to the dispersal oeg(s) in one large dose, overloading the Cep(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 Servking Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within IS feet down slope of any mound or at-grWe soil absorption area. Reduction or. elimination of the following from the wastewirtar stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; corette 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. ABANDON14ENT When the POWTS falls and/or is permanently taken out of service the following steps shag be taken to Insure that the system is property and safety abandoned in compliance with ch. 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 property disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shag be excavated and removed or their covers removed and the void space filled with soli, 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 struckwo, lot Ones and wells. Failure to protect the replacement area will result in the need for a new sail and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules In effect at that time. ❑ 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 fast resort to replace the failed POWTS. ❑ 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 infiltrative 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/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 MAYBE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER r ,,w n Name T Wct h E Xca . H Name Phone -Phone S EPTAGE SERVICING OPERATOR PUMPER C4 n sty n LOCAL REGULATORY AUTHORITY Name Agency S I' 4 o r n Phone 71 S - e6' tS ~J his document was drafted by the stafFs of the Green take, Marquette and Waushara County Zoning and sanitation cremes. This document meats .he mWmum requirements of ch. Comm a3m(2)(b)(1)(d)&M and 83.54(t), (2) b (3), Wboonsin Adff*A t do Code Use of this document does not guarantee the performance of the POWTS. GMW (2/01) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT .1 1 AND OWNERSHIP CERTIFICATION FORM Owner/Buyer brel-4.14 Mailing Address 1l 0 0~ C20244 r 6106'14 L J 1 Property Address 3tl xt'tert~ 6- 'aX e(~O ( Verificationrequired from P ng & Zoning Department for newconstruction.) City/State Parcel Identification Number 0 c~ (/a lGW'110 1K) LEGAL DESCRIPTION Property Location V. Sec. T C9 g N R C9 W. Town of f11f1 khjflo lA Subdivision Lot # Certified Survey Map # S 3 -7t j , Volume LW , Page # Warranty Deed # '7 Volume , Page # Spec house yes no Lot lines identifiable yes 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 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. Owner maintenance responsbilities are specified in §Comm. 53.52(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 (1) 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. 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 Coimnerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of warranty deed recorded in Register of Deeds Office. Nu r of bedrooms ✓ /T SIGNATURE O APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & 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. 08/05) 8376ti 1 VOL 22 PAGE 5299 KATRLM%'N H. REGISTER OF DEEDS ST. CROIX CO., MI RECEIVED FOR RECORD 10/30/2006 10:45AN CERTIFIED SURVEY MAP REG FEE: 13.00 eepif Pee: ES: 2 CERTIFIED SURVEY MA P LOCATED IN PART OF THE NE i OF THE N£ # OF SEC710N 17 TOWNSHIP 28 NORTH, RANGE 18 WEST, TOWN OF KINNICK/NN/C, ST. CROIX CO&NTY, WISCONSIN. THE OWNER SHALL FILE AN AFFIDAVIT SUBSEQUENT TO FILING THIS CERTIFIED PREPARED FOR- SURVEY MAP THAT STATES THAT OUTLOT 1 AND LOT 1 OF THIS MAP SHALL MYR17N ISZLER REMAIN UNDER COMMON OWNERSHIP. BEARINGS ARE REFERENCED Cj g Q THE NE CORNER OF SEC. 17, TO THE EAST LINE OF THE 1J~ T. 28 N, R. 78 W (FOUND ST. NORTHEAST QUARTER. \ I O\,%' CROIX COUNTY ALUM. MON.) N. W. CORNER OF LOT 7, El Y EX TENSION OF- - NORTH LINE OF LOT 1,-, THE N. LINE OF LOT 1 VOL 18, PG. 4666 C.S.M., VOL 18, PG. 4666 C.S.M., VOL 18, PG. 4666 - - ; - -N89h738~ 984,97- - q I 0o I i --794.97-- - ZI cn k~ I -66104 - --i vI Q fa ~O of - - 1 z W 100.07 728.93 190.00 iJ rn ~~50 n N.E. CORNER OF LOT 1,- 11 N8310.008 ELI q C. S. /d., VOL 7Q PG. 4666 1 / ~ ~ -I N89h7:3B E 342.05_ G°- LOT 1 a4, ~I W13~ 6. 01 - ~0 ~OJ of QI 4.472 ACRES LOT 2 3 194,790 SO. F7 h ti I ° o 320 AC. EXC. R/W h z 4. , I 2.000 ACRES N 188,186 SO. FT. QQ opUTL0 4 o I 87121 SQ.. FT. I`i N 1 V' H 1 I `r 3 Z n 11,61A AC. EXC. R/W 70,498 SO FT. 1.547 ACRES o m 1 342.05 _ v 67,394 SO. FT. 285.30 452.54 190.00 I . 56. 75 - Q) d I Z ` 89017'38"W 98459 - - o o ' 133 33~ SOUTH LINE OF LOT 1, - - o S W. CORNER OF LOT 1, C.S.M., VOL 18, PG. 4666 Z p Z - C.S.M., VOL 18, PG. 4666 J 72 / -NORTH LIBERTY 01 W~ I W ROAD p=16°1355" PGA 5W R=233.00 0 0 L=66.01 L C.=65.794 C. B. = S9'28'58.5 "W Eli (Ii TAN. BEAR. IN .=S01 22'07 "W v TAN. BEAR. OUT . =577°3556 "W THE E 1/4 CORNER OF- - - ' NOTE: THIS MAP IS A SUBDIVISION SEC. 17, T. 2B N, R. 18 W (FOUND BERNTSEN "SURVEY MARK" NAIL) OF THE CERTIFIED SURVEY MAP RECORDED IN VOLUME 18 OF CERTIFIED SURVEY MAPS, PAGE 4666. LEGEND • FOUND 1' IRON PIPE O SET 1' O.D. X 18' IRAN PIPE WEIGHING 1.13L BE PER LINEAR FOOT. rA G ? 11f GOVERNMENT CORNER AS NOTED JAMES M. WEBER 50' BUILDING SETBACK LINE SPRING~ VALLEY, 1' = 200's~ WI Q3 S 0 100 200 400 JAMES M. W 17, S-1804 PASSE ENGINEERING, INC. SHEET 1 OF 2 126 SECOND STREET HUDSON, WI 54016 q,~6-05 THIS INSTRUMENT DRAFTED BY JAMES WEBER DATED Vol 22 Page 5299 8 1 2 9 9 9 9 Tx:4104799 STATE BAR OF WISCONSIN FORM 1 - 2000 972685 WARRANTY DEED BETH PABST Document Number REGISTER OF DEEDS THIS DEED, made between N•lyron lszler, a single person and Nova ST. CROIX CO., WI Isr.ler, a single person, Grantor, and"fcxld \[oreiand and Lauri Moreland, 02/04/2013 4:03 PM EXEMPT#: NA Grantee. REC FEE: 30.00 TRANS FEE: 135.00 Grantor, for a valuable consideration, conveys to Grantee the following PAGES: 1 described real estate in St_ Croix County, State of Wisconsin (the "Property"): Lot 2 of Certified Survey Map recorded in Volume 22 Records, page 5299, as Document No. 837601, being a part of the Northeast t/a of the Northeast t/ of Section 17, To%viiship 28 North, Range 18 West, Town of Kinnickinnic, St. Croix- County, Wisconsin. Recording Area Name and Return Address: Title One #18881 Together with all appurtenant rights, tide and interests. 022-1043-10-160 Parcel Identification Number (PIN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Roadways, easements and restrictions of record. Dated this 27th clay of Deceinlxr, 2012. * N/lyron lszler * N< va lszler * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ST.CROIX COUNTY. ) ss. authenticated this 27th day ol'Dcccmlx:r, 2012 Personally came before me this 27th clay of December, 2012 the above named Myron lszler, a single person and Nova * lszler, a single pcrson to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) *,lav P Penliclc THIS INSTRUMENT WAS DRAFTED BY Notary Public, Stat sconsin My commission is permanent. (If not, state expiration date: 8/7/2016 ) \,Iichael H. Forecki, Attorney (Signatures may be authenticated or acknowledged. Both are not necessary.) 'Names of persons signing in any capacity must be typed or printed below their signature .Notary 4UItt; State of wj,C 1 of 1 orlsln WARRANTY DEED STATE BAR OF WISCONSIN No. 1•Z000 Parcel 022-1048-10-160 07/03/2013 11:48 AM PAGE 1 OF 1 Alt. Parcel 17.28.18.257B-15 022 - TOWN OF KINNICKINNIC Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 10/30/2006 00 0 Tau Address: Owner(s): 0 = Current Owner, C = Current Co-Owner TODD & LAURI MORELAND O - MORELAND, TODD & LAURI 1182 207TH ST BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 381 N LIBERTY RD SC 4893 SCH DIST RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.000 Plat: 5299-CSM 22-5299 022-2006 SEC 17 T28N R18W PT NE NE FKA LOT 1 CSM Block/Condo Bldg: LOT 02 7/1834 EXC PT TO NORTH LIBERTY RD FKA CSM 18-4666 LOT 1 (8.019 AC) BEING CSM Tract(s): (Sec-Twn-Rng 40 1/4 1601/4) 22-5299 LOT 2 (2 AC) 17-28N-18W NE NE Notes: Parcel History: Date Doc # Vol/Page Type 02/04/2013 972685 WD 10/30/2006 837601 22/5299 CSM 12/10/2003 748780 2472109 WD 12102/2003 748022 18/4666 CSM more... 2013 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/07/2010 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 40,000 0 40,000 NO Totals for 2013: General Property 2.000 40,000 0 40,000 Woodland 0.000 0 0 Totals for 2012: General Property 2.000 40,000 0 40,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0 00 0.00 e OIL EVALUATION REPORT Page Wisconsin `Department of omm rce. Division of Safety and Buil ings tin % c/ omm 85. Wis Adm. Code County /t- ~V t Attach complete site pla on paper not less than an ches in size. Plan must include, but not limited t vertical and horizontal ir)1 (BM). direction and Parcel I.D percent slope. scale or d mens~gllrs(,I~Q11~ Jand distance to nearest road. V ZZ /v 70 Revie d by Date Please / I Z D Personal information you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (m)). Property Owner Property Location / ;?7-75 r7 Govt. Lot t j 1Z 1 /4 t~ E1 / S T 2. N R / W Property Owner' ailing dress of # Block # Subd. Name or CSM# Z ~i c~r~k. a.h2 csv- 2 /y 0 6 5 ~j State Zip Code Phone Number El City ❑ Village Town N crest Road VCiV `~~Ils tit: 15 y6 (65Y)2 79--1 a3 -n 'n rc -+~.4 D New Construction User Residential / Number of bedrooms Of Code derived design flow rate ❑ Replacement ❑ "ublic or co lmerual - Describe _ Parent material Flood Plain elevation i applicable P Q t O! • , A ~ H +►'t D~ L( I' VT comments Go e 1 ~~4j and recommendations: s -th-s tiv. ZC~_ r s L4, ^~f Ell Boring # Boring 13 4 Z ft Depth to limiting factor J in. Pit Ground surface elev ~ Soil IiCation Rate ' Horizon Depth Wn Redox Description Texture Structure Consistence Boundary Roots •E GPD/ff in Qu Sz Conl Color Gr. Sz. h. tocL Z6' -5 c Jr+~.~'r 3~ p 'r x'25 / -t tM -c- 9 vwvc - y 6 ' orb 1 z~ b-$ /0Yn c. 5 S . • In. Boring # Boring Q~ 3 ft Depth to limiting factor Oz' Pit Ground surface elev Zt - Soil Application Rate Horizon Depth Dominant Color Redox Description Texture _ Structure Consistence Boundary Roots •E GrDMF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. O :jib /b 0~ 11 Y A '0!!~ 6 kAl 1-6 56k tl~- 1-9 3 $-27 lDT s S Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/- and TSS < 30 mg/L S CST Name (Please Print) n ure CST Number Z, Address Date Evaluation Conducted Telephone Number SON Testing Ssrviee j ,`?200; - W 35 g3z- ooz " L18MIGek Rd. Mondovi, Wi 54755-8145 (715) 832-0020 f Owner f / Imo(` Parcel ID # Page of Property Boring ❑ onng a # Pit Ground surface elev -3 h Depth to limiting factor ~ in. Soil Application Rate 3 Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#GPD1f*Eff#2 in. Munsell Qu. Sz Cont Color Gr. Sz. Sh. S Z-O p 4()3 Z a-5 Z & A2~'Z -"kIl 1~ D Pis -~Y- 5 6 • a-~ ❑ Boring El Boring # ❑ pit Ground surface elev ft Depth to limiting factor in. Soil A 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 r, a Boring At ❑ Boring Ground surface elev ft Depth to limiting factor in. ❑ Pit 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 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/- and TSS < 3G 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. M-8330 (R 07100) Property Owner parcel ID # Page 2 of Z'` F-37 Bonng # onng / pit Grouno surface elev q P 3 ft Depth to limiting factor I in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2 ZT1 Al. _ a -lz 3 I s Z 0-5 Ut 11 Z/ D 3 Z~s f 5 Z0 d o 3 DYIZ IlIq Zrn4 h"Xr- s 6;, '6 o o-S M `P z a5`1'~C l/l s(' 7-7 7- 1 7- ❑ Boring ❑ Bonng # ❑ pit Ground surface elev It 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 ❑ Boring # Ground surface elev. h Depth to limiting factor in. ❑ Pit 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 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 rng/L ' Effluent #2 = BODE < 30 mg/L and TSS < 34 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. SBO-8330 (R 07100) a ~a. a 10 J I ! i f p L -41 a ' L Q r _Q ° ab- m cto ~a- v ~ v N 4J L 3~ a' I--~ m -zi- N -r3 c3 14- ° d 3 c?°'' v' N N S- 'A CO > ~ co C Lo co Xy