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HomeMy WebLinkAbout038-1073-70-050 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 567247 0 GENERAL INFORMATION 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: Rivard, Patric J., Joseph & Price (joint tenants Star Prairie, Town of 038-1073-70-050 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: i /OD, 0 /00, t, CC7.(-c _ .S,4,' 17.31.18.305A-05 TANK INFORMATION ELE ION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark D vv 2 5 S- p • c Dosing / / Its S- Alt. BM Ct~ - Aeration Bldg D Z Z s Holding St/Ht Inlet v N 101.5 p/ Y6)' 3. D7~ TANK SETBACK IN ORMATION St/Ht Outlet TANK TO P/L W/ BLD Vent to Ai take ROAD Dt Inlet Septic ~ I 00 t ~ l Dt Bottom Dosing Header/Ma Aeration Dist. Pipe 9 ~IVw q Holding r Bot'System PUMP/SIPHON INFORMATION Vr Final Grade Manufacturer 5 _r~-f 1 t ` G M and St Cover Z !7, Model Number C a / - ?T y / TDH L7D Friction Loss System Head T Ft Forcemain Len Dia. 7 Dist. to Well SOIL ABSORPTION SYSTEM 7 BED/TRENCH Width Length No. Of Trenches IT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / t SETBACK SYSTEM TO P/L J~, BLDG WEL LAK STREAM LE NG Manufacturer: INFORMATION Ty Of System: CHAM R OR A4rd ~~~f I Model Number: DISTRIBUTION SYSTEM S- d Header/Man d Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length is Length Dia Spacing SOIL OVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded T Mulched Bed/Trench Center Bed/Trench Edges Topsoil 0 Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:/ Inspection #2: / 13 Location: 2140 100TH ST New Richmond WI 54017 NE 1/4 SE 1/4 17 1 N R18W metes & boun L Parcel No: 17.31.18.305A-05 of 1.) Alt BM Description = rQ, Ikh _ 2.) Bldg sewer length 3 - amount of cover CKft , ~ d pt•,,LQ. Plan revision Required? Yes No 1 Use other side for additional information. SBD-6710 (R.3/97) Date Insepctors Signatur Cert. No. PLOT PLAN PROJECT Joseph Rivard ADDRESS 2140 100th St. Somerset Wi 54025 NE 1/4 SE 1/4S 17 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX SYSTEM ELEVATION 95.0' BEDROOM 4 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons DOSE TANK SIZE 765 I HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA 1000 # of chambers none BENCHMARK- V.R.P. Bottom of siding ASSUME ELEVATION 1001 ❑ BOREHOLE O WELL *H.R.P. same as benchmark Old System is to be tale = 1 40' pumped and buried 40 acre parcel 1320' Property Line ST D1' Co ExistI ng 4 Bedroom WEII House O B* Grading is to be done to divert Huffcutt gbmbo Tank run-off away from system i B-1 50' N' B-2 96' 95' 94'-r -t'1•G~ B-3 Ctn. - 92' a k is t Aroma # 5= ixe+w system p ro p-e r I y bedded a is to remain provided with undisturbed Iockdown covers L y-~ with approved / Lb warning labels 100th St. - d~ w County - L _ •'r ~ rNx Industry Services Division '1400 E Washington Ave Sanitary Permit Number ([o hc. filled it by Co.) ,4 Sp P.O. Box 7162 S a Madison, WI 53707--7162 ` i ary Permit Application State Transa ion Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmewal unit Z is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (ifditferent than maili ig 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 lnformati PI se Print All [ft! 'o r Property Owner's Name ' Parcel ti Ses ~-►vcc~ n ~Aoi4T _SP Property Owner's Mailing Addre Is - - - ° Property location 3.o 57A-0 S) >vt. Lot City, State Zip Code Phone Numbf7 y, Sec ion III, Type of Building (check all that apply) j Lot #f~~ or2 Family Dwelling-Number ofBcdroom I - Subdivision Name _ t .1 fly Block DPublic/Commcicial -Describe Use CSM Number ~ _ ~ State Owned - Describe Use Village of.__ owu of ~ f III.. Type of Permit: (Check only one box online A. Complete line t3 if applicable) A. D New System - _ acmnent System ❑ Treatment/Molding Tank RePlaeement Only Other Modification to Existing Systt 'n (explain) an - - --D List Previous Permit Numbe and Dale slued B. D Permit Renewal D Permit Revision Change, of Plumber Permit'[ wrisfer to New Before Expiration Owner _ 1_________ IV. Type of I'OW'I ;S stem/Component/Device; (Cfaule uN tlratapPly~-- _ Non-Pressurized In-Ground D Pressurized In-Gros ;rack : [_I Mound _.74 in of suitable soil ❑ Mound <24 rn of suitable soil D Holding Tank D Other Dispersal Component (explain)___ Ll Pretreatment Device V. Uis ~ersa111'reatrnent Area information: ~ _ ~ - ' ~ Design Flow (gpd) Design Soit ~ppllcation Rate(gpds Ulspcrsal Ar Requued (sO Dispersal Area Propo> (sI) Sys err Elevation ~y p / VI. anti Info i-- Capacity in 10 Total N of i6fawfacturer Gallons Gallons Units b, New Tanks Existing Tanks k) fto u v U cn `ti rn w C7 w Septic or nn116o8 Tank s' 02 DosingCtnunber~--- V11. Responsibility Statement- I, the undersigned, assu sponsibility for installation of the POINTS shown on the attached plans_ _ Plnmb 's Name (Print- Plurnbe ' azure - MP/MPRS Number Business Phone N a er Plumber's Address (Street, City, State, Zip Code) Onl ~ VITICount !De artrnent Use - - Permit Fee Date Is*10d Isswrig Agent Signatut~ Approved U Disapproved / j~p , •a' f 4 , - - _ D Owner Given Reason for Denial $ IX. Conditions of Approval/Reasous for Disapproval SYSTEM OWNER: uon J', WWI 1. Septic tank, effluent filter and 3 dispersal cell must be serviced /maintained Yv «-s~ as per management plan provided bY Plumber') Akk t,tl,s~~ _ 2. All setback requiremF~ent.ffs,,,~~mu~~st~~hP mainfair,p~l-___-_;~ as per appllcabl@rta6ItlW/UfC 4,J Rft for the system and submit tut a County only ou paper 06( less than 8 I!2 x 1 I inches in site 1 ~t ) 2 , J~_ E vT r,1 &L t SBD-6399 (80313) o~4ART~ DIVISION OF INDUSTRY SERVICES Ta*0 PO BOX 7162 MADISON WI 53707-7162 D ; Contact Through Relay www.dsps.wi.gov/sb/ 3 9~ P www.wisconsin.gov Y'P A~OSIONScott Walker, Governor Dave Ross, Secretary October 24, 2013 CUST ID No. 226900 ATTN.- POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 10/24/2015 Transaction ID No. 2325688 Site ID No. 796976 SITE: Please refer to both identification numbers, Joseph Rivard above, in all correspondence with the agency. 2140 100TH St Town of Star Prairie St Croix County NE 1/4, SE 1/4, S17, T3 1N, RI 8W Subdivision: Metes & Bounds FOR: Description: Four-bedroom At-Grade, 20% Slope Object Type: POWTS Component Manual Regulated Object ID No.: 1455461 Maintenance required; Replacement system; 600 GPD Flow rate; 37 in Soil minimum depth to limiting factor from original grade; System(s): At-grade Component Manual, Version 2.0, SBD-10854-P (N.03/07, R. 1/12), 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: Reminders • The existing POWTS shall be properly abandoned per SPS 383.33, Wis. Adm. Code. CONDI • Your design still references "Dept. of Commerce" code sections. To prevent future plan review delay, APP please update all your plan details and/or management plans so that they are current with SPS code. DEP'T' OF • To prevent future plan review delay, please remember to include the ASTM Nos. for all piping material PROFESSIO used in the construction of this POWTS, including pipe material between the tank and the building. DIVISION OF INC • Building sewers shall be insulated beyond 30 feet per SPS 382.30 (11)(c). • The area within 15' down slope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. SEE RR 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. rr' , SHAUN R BIRD Page 2 10/24/2013 • 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). • 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. 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, S4Shwrn Please Include a Cop y With Your Eng Consultant, Integrated Services Payment Submittal. (608) 264-7782, Monday - Friday 7:45 am - 4:30 pm WiSMART code: 7633 sally.shiunaker@wisconsin.gov cc: 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 "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. rr l?FCeIVED OCT 15 2013 Cover Page 1IVI)USrR~SERVICES Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 10/10/13 Owner:Joseph Rivard Location:NE1/4 SE1/4 S17 T31 N,R18W 2140 100th St. Star Prairie System type: At-Grade Manuals Used: At-Grade Component Manual version 2.0 SBD 10854 (N. 03/07) Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01 /01) 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 test 'ZONALLY 20VED 12. Filter Specifications 1AFETY AND IAL SERVICES USTRY SERVICES Shaun Bird Signature License number 2 00 P 0NL NC i PLOT PLAN PROJECT Joseph Rivard ADDRESS 2140 100th St. Somerset Wi 54025 NE 1/4 SE 1/4S 17 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX I SYSTEM ELEVATION 95.0' BEDROOM 4 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK I MOUND SEPTIC TANK SIZE 1255 gallons DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA 1000 # of chambers none BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. sameasbenchmark Old System is to be Scale _ 140' pumped and buried 40 acre parcel 1320' Property Line ST DW Existing 4 Bedroom WEII House O B.M. 80' Grading is to be done to divert Huffcutt Combo Tank l~. run-off away from system i B- 1 ~50' B-2 96' I 95, 94* `J E~ 92' B-3 Tank is to be Area 15' below system 209 Slope properly bedded a~nd1-" is to remain provided with f undisturbed Iockdown covers with approved I warning i labels 100th 8t. 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"r a rrrrr r d r• d rY Y } . !.`sr.'` ~ .r"M!.Mw.F"~1lwh'S,Y~wMxyr tlMwd ~ 1't ~ Olttt)l.Ir 1,ryrw w•t+v w .r,~ - c ,tad r rrr d d r b yr w wYw w w v wY~,• ~`'i. ,tip . ~ ~ ~ k«, n,p d r "rid r r d•r d r"d a : r•drd 4 r e',''S a-.r, w w w t v w t-w v w.,'L w•- i~,+~ d, l~ ~Cl"4.L..~+.L'~'~ xn,rr ~r J'~+dK a'4rwJ'~ owd ~3_ex l' 4l flow(d tiSur it, Slope Direction ('ENERAiL INSTALLATION: The at-grade area is staked o~trt along the design contour. I xi f 11 L2, vegetation is mowed and raked off the site. The basal area (f, x \,V) is staked out and plowed w t 't a moldboard or chisel plow. Plowing may not proceed If the soil is wet errough at tl)e l)IONNI del.}I r to form a %4 inch soil wire when a sarnple is r-olledbetween the palrus of the hands. The A x 1-1 acre i is covered by clean aggregate deposited overhead by a backhoe. ~yl)ecia! (;arc; rrltrs,i be used r1 I erI placing the aggregate to rninirnize compaction o.f the ptowed suri~ce. After the topsoil cap is plaf:; xi, the entire at.-grade is seeded and mulched to prornote vegetative, 1:)rorwth, limit erosion and pr('t pct born 1ieezing. The observation pipes are pertbrated in the, lower 6 inches and sectared in place. 0:3/05 lgj Paec _ of VreSS-r J-C- Lateiral L"';Y0111 One Lateral FJrrc l Manifold Ca -a,out force Main Lateral TUITI_ up X l ,ort `weep 90 l lend Press twc System t 'oristru c:ttiott Distribution Netwvott k S~erLificatious Lateral Diameter 2- in, l_,ateritls titre coaristructed of Schedule 4.0 11\ Orifice Diameter ln• plpe. Orifices ai-e chilled perpertdicuiar i L) - X (Orifice Sac. jtng) the pipe with a sharp drill hit and fact; cloy i, 1, (Lateral L j. yth) ~ 1~t• 1,aleral turn,-ul:.)s tenninaw with a thread d 1'otct Matra Diameter ;c 1Y1. c.leanotit hlt:vl~, and are enclosed in a 6--11 in b FotLe Main Lenf-th_ l~tdiatneler laivn spritMer vidw boy accossit c front l:iraished grade. *a... Grade ~ ~ ar ~ ~ • _ ~ = ~ : - ~ a ar ~ w at ar 6-8Inef Lawtt L_L Sprinkler Valve li► Box 0-3/05 lej Page _ of Septic.-Dose Y~ 4w&- C" r)ss ectio A>t d t':fftp Perfi)MI-ance Spec C,Y,k Mar,ufitc:ttrror - lyLitti JVltrtrttlac,t7~tcrr ~x rr:. f Z" '1 attk 1Vlodul Nutuber ? _ Purrnp Model Numbel, 1 tytsrl 'l tats Capacity Alaytrr lblrartyyixyt:ttrrt 104~- Mart. Bu l]re th _ _ - y r Alain Model lri mibet, /r tivutLrli t tltc r Mar ufac,trrrot l'ttttrl Dyrrxrrrtic 146.acl CI DD l"rr;C l°rltei Model Ntanber - _ _ _ . - luvab.+art i'lead . Y:yistrrt .lyressr~tt NOWt`►rlc 1-,088 tVltn.inittrn ]Eyorrt ► 'et lcrrrrx rwr; JE eq tine 11011t,e dVlFtin l-,crss /'0 Outlet Manhole llvl!irt. 4." Above, Glade With Locking )-hi cice,. Inlet' IVhrlbole Manhole Min. 4" hove 6,nidt.. 6" Below r fettled Warter'ti Yt'a. l r crrtf l.y lVltrtarttcyto With Looking i ~cvice, ~ .CtrttOW111 Dow ltro.f /4.bcThw Grade - 1 1VMmare:s with 'Ve.11t Cap Vy 4~V VV::77 r'4M~•V~Yr'Vr yY'Y-r"C'YYy -v-Y Y V a Y,•1{a 4, 414,Y 4 6V D 4 6 ~`,'4Y~rb D1 ~WyYycNyWV'^4y 'V"r rV~l-WWtl""^'V'Y-'Y'y-Y' 1 Y 1'Y,1 a1 4~6`!~sLi43~iy LtlY.t 1~tl~db-3~~4Y 4 a°1°v°B'L aDYG~~IY YVY D, V+4°YV4JU1l y1i4 l La , ,n +~~de. V_-e~.Y.J° :sC.si1~.:.irN''L'! Y•♦ _ •uu I ( ~ 1V 'u 'Cruet Battle Switch and Reserve . al➢ar tl:r >F ' • 'rank Volurne f y9 s~ D' woop Off Elevaboft J t 7- c} ' 40 J4t '.X ~UE".r) ~..5__.__.-_.___ -_c~ lt,Y4✓ttfroxr 4 TOW 1 h1~JY e ly ~ ~ C%'\rr f14'~! (1- G J 4 'i- Y' I s L 4 s 4 4 1'1 (-Y 4 D D 1 1 ro 4 ti r"' 4. . 4 t r ruD'' L r r4~1'c'bT L'3'Y-' 1• ;'''4YY Y'4 1> ~ ,7 li l Y ' > ♦ .:~>f~in 11 fYi J'J41 iY !~__L~~1 i4Y i4V4 J! Ytl4, VY >V}°4 4Y D I+JU 44'L V4+'1'Y4Yb'~i~1D' y4 1421+4'e h i i {-i Y 1 {41 ~1-~ ' u + , •~l , 41 ~1'"V{b IkYJ t Y4 { ,ui41 1 i ° !11''.l J.l.!_.1_1{r F„fi,y„~„!~. n 3`y.~~1~0~.l ul~ka.YaY~1Y~2~1~h.2 ~l~h L ~~k..111 L1 k,L.it.LJ YJ_k._LI 1JkVk+LYk_L.1. 1JIy.Ly LkJY,k,~yy1~~~`°• ~Y1l~;tV1C)El'.AIL ~1VS'll iil:,l~l~'lr'Y(~1~~ lire sep~tia~dtya+rj talrk it; budded and bwk filltd it, at:aorcltrrrt;t; gill, tltc ' rnarttrttwt►xrer"s Product appfor~at spnoilc+itionji, MaxitnYint depth o'1' but-y s speoi~eci by the rratrrtr "Chlrer wly hot be exceeded r ittiorxt prior Approval, lblarl 11016 `"ve"" exW-Nod it, t;.t'&'do heve au ei`tbotivo loukin doviuv installed. Piping at the, inlet mid outlet is OF approved tttaterial" cx~Y notetl to the tank. °wido waterrtiglyt l-itt j ~thpta ild laid oil st.abltr sail to r:,t-event sattling of Sagging. TIM titr'cts tnttitr is,,;leevw d with 411 Sc;lt- 4Cl l~ } wcouvttdux, and the sleeve is scaled'watwtiplrta Crltrt tric,al service c<rrtiUliew with N)~3C; 300 tt tl Comm 1 ~,,.,7~~ ht t<trtls: I W Wcast ew- SEN-40 series 4/10 lip Submersible Effluent Pump, 3/4" Solids ~►r~)~tw ~l~twrtrrw FIOW - l..lter's/IVIItYtrte 0 50 100 150 200 260 300 35 --I__.~~..__ CovHrr f:puxy-coated oast iro i Itl h0tcr Iioualny .Fpo$ acnatae I,amt 1r 1 30 9 Impeller Material Therrrroplastic Flastorr e 25 w Impollog,'rypo Norjl-clag eL 20 6 w Volute Epoxy-coated cast iror Power Card m 'SA VII t w 10 iViecharricaf Shaft Nitrile with carbon and Seal ceramic faces I f rte :tlrs 5tairllxasb steel' Shaft p 20 Steel 40 60 110 Flow Gallons/Mirruto t]~rarir y1;; llpp ~r altltora 41y yh and (vwor bald 4parihp UB"' 11.15' ) \ - l ~;y r 1, y-,_....... -r• - '-_r_,. t7~1 V 8FIV-411 Specifications FiN M- 014 -1 • SEN-40 509211 4/111 Y15 1 1/L" FNPI 6/9211 8r) 70 60 45 25 32 '14 SEN, 30 ZU.S 750 Bt~J~~_ ~~110`i ~Y~` 9/tlzo f30 , 70 OU -t15 14 UO Y50 SEN 40 AF 50921(3 4/10. 115 1-11P" FINN I' ~T 25 SEN-40-AF 50J214 {/1Ptb~ 1 1/~?"°ENPl~1=. 8190 80 70 611 45 P5 2 14 10 l'!.5 150 91910 80 TO 6U _4xi,. 25 12 14 30; X8.5 750: Frank0in Electric 400 Fast Spring Street, I3luftion, IN ' ii714 Tel: 260.824.2900 - Fax: 260.824.29, Forme: 996199 r-t 1 wvvvv.firan Ic Yin-eIy CtYI C.{ ore r PO'U T OWNER'S MANUAL, MANAGEMENT 1:01-ANON I.1L.lr Inr~r~iFtarlAl-I P441 (C- KCI owner' SYSTEM SPECIFICATIONS jtjr ~ertiu ';;rl Capacity 1 NA W y~al ~~....,.~w....,.~. re..~ r ~eCJtrc J ryrYt IVlarrufacaur'er w ~ I I tilu~nt F rifer rVianuf~ac,turoi / ~ r J NA Number e-✓,. atl.~~ umber of F3edraonab _ t f VA L tfluent ! tlter Model I Number of Public Facility Units _N_ A Pump Teak Gapacity Estimated flow (average) c a1 ! I NA F'unrp Tank MWILrtactul'er ~J~' '_.F J !VA 1 Design flow (peak), (Estimated x 1.5) ~ [22PumpMannfacturer 1-1 CIA boU Application Rate F'urnp lVlWICIl 1 Standard Intiuerrt/Effluent Ouality rnthly avera.7t e, t ats, Coil Grease (F()C~) rng/!. ;3rarrci/Cir;avel l=liter LI F'oat Filter Blochernical Oxygen Demand (C OD6) 0 ing/t. CI NA 1-1 Nlachank;al Aeration (1 Wetland Total Suspended Solids (f58) S"150 rritl/t. IJ Disirifection r7 parer: Pretreated Effluent Cdualrt _ y lVlortthly aver'aga Dispersal t' all(a) _ Biochemical Oxygen Oernand (800,5) s*30 rrr /t, t..l NA d l;l irl-C7ruL11111 (gravity) l:l In-(;rourrcl (press I n[:red) Total Suspended Solids (`1156) s30 mtq/t. dA - • r'adka I:J Mound Fecal Goliform (geometric mean) ~(g`i efu/100rnl CI Dii t..ine 0 Other: Maxunurn Fffluent Particle 51re - - !ti in dia, ! 7 IV<9 I- NA C7ther _ I -A INA "Values typical for dornestic wastewater and septic tank effluent. Other: 1 NA i~IAll TENANCE SCHEDULE _v r . Service Event - ~._~.__._.~.~,,...~..~..~.,~..M~....._~__._~._~..,.~..u_.m.~~ Service Frequonrsy Inspect condition of tank ~ _ »~a,,, (s) At least once every C~ C7 fnonth{5) - A (IVta~riruuirrr year .j II 1~IJ1 F'urnp out contents of tank(s) When u.unibiried sludge and scum equals one-third (i~) of tank voiurne Inspect dispersal cell(s) At least orict every P, ( ) year L_1 NA can effluert filter > ~ At least arrc e every nrorlftr 5 - - - - - year(s) L-J NA ns ect tTurn _ l:i rrronth s p p, pump ccmtrols ti, alarrrr At feast once every, Flush laterals and pressure test At least once every: ether: NA At least once every: I-'] month(s) year(s) I I NA 11 NA MAIN TI=NIANICE INSTRUCTIONS Ilnspectiorls of tanks and dispersal cells shall be rriade by an individual carrying one i sf 11he, fallowing IlGenses or certificati 05: Ma~ IPlurriber; Master Plumber Restricted Sewer; POWTS Inspector; PQWT`; Maintainer; Se lAage Servicing Opurator, `l'ank insp c.tiunlsl to oust include ;a visual inspection of the hank(s) to identity any missing or, broken hardware, Idranti jcombined sludge and scum and to check for any back of or pondinc3 of effluent on tfra g uund Surfa(A). fhe dispersul ur; (8)tstj ;jll,tjc3 visually inspected to check the effk.aent levels in the obsewatiort pipes and to check for any pondhig of effluent on the gra. nd surtaco. the ponding of effluent can the ground surface may indit,ate a failing condition and 1egUlr'o5 tho immediate notification if the locaal Iegulatory authority. Where the combined accumulation Cif sludge and scum in arty tank equals one-third or rnore of the tank vOILIM0, the errtiri : contents of [he tank shall be removed by a Septage Servicing Operator and disposed of it awordanc o with r.;Irapter NR 11':, Wisconsin Administrative Godw III other services, including but riot limited 'to the servicing of effluent filter's, inechanical or pressurtdr©ci cornporients, pretre; I rlcartt urrit8s land any servicing at intervals of <i2 months, shall be performed by a certified POWTS 1`11aintalner. A service report shall be provided to the local regulatory authority wittun '10 days of completion of arty service event. page Uf STARTUP AND opmkrm For new construction, prior to use of the POVVI'S check tre;atrnent tattle(s) for the presence of pairrtinr3 ptoduc:ts or othe r: ~iemicait; thtit may impede the treatment process and/or darnage the dispersal c ell(s). it high concentrations are detected haver the ci intents of thj:; tank(s) rernoved by a septage servicing operator, prior to use. System start up shall not occur when sail conditions are frozen at the infiltrative surface. During power outages purnp tanks may till above normal highwatei ieveis. When power is restore cl the excess war tr water will bar discharged to the dispersal cell(s) in one large dose, overloading the cell(s) arid may ra uult in the backup or surface disch 11 10 of effluenlt. To avoid this situation have the contents of the pump tank rernoved by a Septager Servicing Operator prior to restorir g power to Ote effluent pump or contact a Plumber or POWT'S Maintainer to assist in manually operating the pump controls to re3stor : normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal nulls. Igo not drive; or park over, or otherwise disturb or cornpect, t rya area within 'I S feet down slope of any around or at-grade soil absorption area. Reduction or eilmination of the following from the wastewater strearn may improve the performance and prolong the life the POWT,11 antibiotics; baby wipes: cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; f ri indation drab, (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oll; pa .r .ing producils; pesticides; sanitary napkins; tarrrpons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taker ~e the following steps shall be taken to insure that tite sy! i fn is rrrr_rpe0y arid safely abandoned in compliance with cha ,Comm tt3.33, V ' consin Administrative Oode: Y All piping to tanks and pits shall be disc; . and the abandoned pipe openings sealed. W 'rhea contents of all tanks and pits shall be removed and properly dispersed of by a Septage Servicing Olrer~ator. 0 After pumping, all tanks and pits shall be excavated aril rernoved or their rovers rernoved arrd the void spacE filled with still, gravel or another- inert solid material. GUN TINGENG'Y PLANT If the POWYS fails and cannot be repaired the following measures have been, or, rnusi be taken, to provide a )de c:onipiiilint replacement system: r7 A suitable replacernent area has been evaluated and may be utilized for ttre location of a replacement soil abs rption systelrrr. The replacement area should be protected from disturbance and compaction and should not be infringed ur ~n by requirled setbacks from existing and proposed structure, lot lines and wells. f=ailure; ti::, protract they rs placorrient area will to tilt in ti-io nc_,je 1 for a new soil and site evaluation to establish ra suitable replacernent area. Replacement systerns must comply 1 ith the rule:} in effect at that time. [A AA suitable replacement area is not available clue to setback andlor soil limitations. Barring advances in POVVI y fochnolcq/ to holding tank may be installed as a last resort to replace the failed POWTS. X he site has not been evaluated to identify a suitable replacement area. Upon failure of the POWI'S a soil and site evaluar(ion ust be performed to locate a suitable replacement area. If no replaacernew area is available a holding tank ryray be installe (il as a last resort to replace the failed POWTS. -Mound and at-grade soil absorption systerns may be reconstructed in place following reyrnoval of the biornat r they infiltr'a'live surracp, Reconstructions cif such systems must comply with the rules in offs ct at that tir ur. <<WAARNING>> SEPTIC, PUMP AND OTTHEFt TREATMENT TANKS MAY CONTAIN LETHAL. GASSES AN IDIOR INSUFFICIENT OXYI nCN. o) Njol ENTER A SEPTIC, PUMP OR OTHER TREATMENT TikNIK LINDEIR ANY tARCUMIST'ANC E:S. VI ATN MAY Ri "BUI; I'. WSCUF 0)= AA PERSON FROM THE INTERIOR OF AA YANK MAY HE t:1IFFICUL t ON IlwPOSSIr3L I ADDITIONAL COMMENTS PCJWT'S iNSTAL.LER IrrOWT'S MAINIT'AIN ER Name _..rz r,y i /2 Nartre Phone ~ I err _ ~ , C - I-'hone SI=PTA F SERVICING OPERATOR PIJMPE.,R LOCAL REGULATORY AUTHORITY Narne -?l w~ _i ?"2 v1" - ar Name `+r 'hone Phone 'I his docment was drafted in nonrpliance witty chapter ST'S 38.i.'r {~){b)('i)(rl)&(f) arid 3383.54(l), (2) 8,(3), Ww;ousin Administrative r:ede "RIOCE 11vTF'RCAAU?1 D ANSTRUCTTON,~ rtsit:aNNatiutr~ i i _,tl • , Y'I P x l:.try tit the filter taxer unto the, ehd of tile outlet pipe to ensure it i:s entered under the acce„:s opening' Xf not, then either insert snort pipe ' 'r i t irdc through art the. tlf the nutlet or + solvent vuetd (ghee) additional tail(, onto the outlet F pL^-- ':.U`l While the case is still dry Htbitil on the outlet: pipet, Intl asure the lent th o i4••inch pipe iioed,,el to brace thn filter to the tank eralf watt if utilizing the o rtlonal supralemental ride Support. U side support rnrtho(i is Trot utrli2ed, p nreeed to St ap four„ for installatiott_r ut'illAng the optioraal supph:meotal side: support s. Wt-III weld the 301•-irrr_h pipe ,onto the filter cast(- If side support rncthocl is riot u lized, proceed to step four. Solvent weld I tic- filter cuuie unto the outlet: pipe. IlYSfirt the lifter r ':r ca ,fridge into the rasa, t:ire,Shry down until the fitter locks into tiie butt:ntu r,t Ct, a rasp- i I.f a VCJS %wit:c:h is utilized= insert info the iilte.racrd Intl( by turtmi . r I a,. cb ckvulsr. ~~CI". q R:.r„c~ lH iiNlflt~~[ti:~fi1(:R~' 'IIYt (affluent fitter should lie (leaned every time the' :septic tank is service(}. a- Open the outlet: avcais ottening to Inspod, the:, tank alyd filter, - . :3., f'tuiip khe puc tank ctimpfeteiy, making sure to rwivave the sludge layer on the bottum of the t,Ank :and "at just: the sctrrn and effluent, c' "i.. Once the effluent level has been lowered beloW the wiveert of the - - outlitt. pipe, firmly pull up ole the filter handle to cli mIlle the cartridge from the cae.s:e. 5. Slide the cartridge till arid out of the case ftlr cleaning,. fa, tf a VRS switch corured.ed to tan aiarru is present, the switch sliould he removed by turning rowlter'clac:kYnrise t)4" and cleaned ,yitf+ water only, e T. Mille holding the c:arh'idke on Its side (large Hat surfeit, f aclog town) over the arizitisr„ opening, rinme off the c:aitticlge Willa water " r tidy, snaking sure all septall a material Is rinsed laac^k into the tank. v r it.. fVRS -mwitch is utilla=ed, repiase by insertktg into filler and n turning clockwi%e. 90", 9. nserit the filter cartridge' back into the case, prtissiog rloYnm until + lee filter locks into thra bolaarn of thce caste. 10.1 repute: sand secure the, at:cess apetting on the tlulr... • . %Fop uv;,bearonlsite,carn 977-MUILVEsRS (653-4.5" ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CER IFICATIGN FORM c kva d _ c aS ~ ~Z J ~G~LC. Mailing Address Property Address C (Verification required from Planning & Zoning Department for new construction.) City/State _ Parcel Identification Number /b ? d'so LEGAL DESCRIPTION • 7aS~'lpS~ Property '/4, Sec. T N W, Town of Location r- I/ ~ 19- . 7,f Lot # Subdivision Certified Survey Map V c: iurne Page # ` tf-f IS 'Warranty Deed # J Vo[tune _0 Page # S~9 Spec house yes no Lot lines identifia oleyes 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 wasl:e disposal system Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (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. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Departrnont 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. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we arrdare the owner(s) of the property described above, by virtue o a warranty deed recorded in Register of Deeds Office, Numb f bedrooms IG ATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being ro-voked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds C'iffice and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) M Property Owner _ Parcel ID # Page of F31 ❑ Boring Boring # J~L pit Ground surface elev. & /ft. Depth to limiting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 12-21 14,, 7 ^ t ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ❑ Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil lication Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 II Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/_ ' Effluent #2 = BODS 130 mg/l_ and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altemate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (8.6100) ■ Pla Project Name Joseph Rivard Soil Test Plot n Bird Address 2140 100th St. Somerset Wi 54025 cSTM #226900 Lot Subdivision Date 9/1/13 NE 1/4 SE 1/4S 17 T 31 N/R18 W Township StarPrairie Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of siding System Elevation 94.7' *HRPSame as Benchmark Scale is 1" = 40'. unless otherwise Property Line noted D W Existing 4 Well Bedroom ST House 10' B.M.* 10' 15' 40' 80' 77 250 Ti 1 90'~ C B-1 96' l' 50' 40' 20'- 15' 94' B-2 35' 92' -3 20% Slope ; t 100th St. Parcel 038-1073-70-050 10/29/2013 08:53 AM PAGE 1 OF 1 Alt. Parcel 17.31.18.305A-05 038 - TOWN OF STAR PRAIRIE Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 07/25/2006 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner 0 - RIVARD, PATRIC, JOSEPH & PRICE PATRIC, JOSEPH & PRICE RIVARD 2140 100TH ST SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 2140 100TH ST SC 5432 SCH DIST OF SOMERSET SP 8050 SQUAW LAKE RHAB & MANAGE SP 1700 WITC L aTDoscription: Acres: 0.000 Plat: N/A-NOT AVAILABLE EC 17 31 N R18W NE SE EXC N 416.5 FT Block/Condo Bldg: XC C~1V1 12/3448 & EXC CSM 21-5231 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 17-31N-18W Notes: Parcel History: Date Doc # Vol/Page Type 07/10/2006 829152 AFF 0 828520 EZ-1 `"'8162gQ'"~ 1456/156 1275/394 WD more... 2013 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 10/10/2013 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 18.070 2,400 2,400 NO 10 UNDEVELOPED G5 1.430 400 0 400 NO OTHER G7 2.000 22,000 95,100 117,100 NO Totals for 2013: General Property 21.500 24,800 95,100 119,900 Woodland 0.000 0 0 Totals for 2012: General Property 21.500 25,100 95,100 120,200 Woodland 0.000 0 0 i 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 `d STATE BAR OF WISCONSIN FORM 1 - 1998 61 0290 VYARRANTY DEED KATHLEEN H. WALSH 1J6 r- REGISTER OF DEEDS Document Number VPi- • PAGE ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between 09-14-1999 9:30 AM Rich ard_.p. Rivard a marrit-d rann WARRANTY DEED EXEMPT 0 17 Grantor, j' CERT COPY FEE: and Patric J. Riyard_ Joseph F. Rivard COPY FEE: and Price S. Rivard all as married._persons, TRANSFER FEE: RECORDING FEE: 10.00 - - PAGES: 1 Grantee. j' Grantor, for a valuable consideration, conveys to Grantee the following described real estate in ct Cr i --County. State of Wisconsin (the "Property"): is Viecn.rnnq nt.=a Name and Return Address N1/2 of the SE1/4 except the No 416.5 feet and the N1/2 of the S1/2 of the SE1/4 all in section 17 Township 31N Range 18W 0 34- i 07 3 70-OUC1.4 03S-/07-r- cx This deed is given in full satisfaction 0 3~•-10-7q-.16 -GZb, 6 M•-10,73r-_ of the original land contract dated parcel Identification Number (PIN) July 27, 1989, recorded August 1, 1989 This , c not homestead property in Volume 847 of Records, Page 333 as (is) (;Snot) Document No. 450191 and the amended Land Contract dated December 9, 1992, recorded January 5, 1993 in Vol_ 988, Page 338, Doc. No. 493598. This is not homestead property. I: Together with all appurtenant rights, title and interests. is Grantor warrants that the title to the Property is good, Indefeasible in fee simple and free and clear of encumbrances except Dated this day of I (SEAL) (SEAL) Richard P. Rivard (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature (s) State of Wisconsin, County authenticated this day of Personally came before me this day of > It' : c•KBQ4~_ R • the above named `C 6bhIA~ ~2JRfkA - TITLE: MEMBER STATE BAR OF WISCONSIN to (If not, me known to be the person who executed the foregoing authorized by §706.06, Wis. Stats.) instrument and a / 1 get ame. ~y THIS INSTRUMENT WAS DRAFTED BY 7 ~ Notary Public, St Wisconsin m nt. (If not, }rate expira io date. (Signatures may be authenticated or acknowledged. Both are not ~ t' "AG (A ~1 1 necessary.) fsOLdai~ r4}~C`~ ) ` Names of persons signing in any capacity must be typed of printed below their signature WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal eiank Co., inc. FORM No. I - 1998 Milwaukee. Wis. T 6# ft ~ +"EH ~.aae. za~sr~rs a•=ate DOCUMENT NO. STATE BAR OF WISCONSIN FORM 3-1902 QUITCLAIM DEED II P 555502 VOL ST. CROIX COUNTY, WISCONSIN, A BODY CORPORATE tE^-_ISTM'S OFFICE 1 UT CrtOL: quit-claimsto Patric, Joseph and Price Rivard, Joint DEB 1. 1997 Tenancy F rat 11:15 A 111, ~I f'EIsiV 4 the following described real estate In ST CRATX County, State of Wisconsin: RETURN TO f-~ G i V Ct N t!] --W /-j /¢Pt 1 udgf2m n o •Sa r t q Tax Parcel No: A parcel of land located in sec. 17, township 31 N., range 18 W, town of Star Prairie, more particularly described as follows: That part of the N 416.5 ft. of the NE14 of the SEk lying southerly of Brave Drive. FLEE I This is not homestead property. I (is) fie not) Gated this c >n day of J 4 r I U Ct r 19 g (SEAL) ~~a (SEAL) Thomas Dorsey, County _Board Vice-Chair (SEAL)S (SEAL) ,rSue E. Nelson., County Clerk AUTHENTICATION ACKNOWLEDGMENT I Signature(s) STATE OF WISCONSIN {I St. Cto.ix as. County. authenticated this-day of 19___ Personally came before me this'- day of , 19 the above named Thomas Dorsey and Sue E. Nelson TITLE: MEMBER STATE BAR OF WISCONSIN i` ; who executed the (If not, to ma krift) 6e~-the 00 n um ack uR ge theaame. authorized by § 706.06, Wls, Stats.) forJoUiar THIS INSTRUMENT WAS DRAFTED By Gregory A. Timmerman St. Croix County Corporation Counsel NotatyPutljic County,N:is• (Signatures may be authenticated or acknowledged. Both My Com to 13'@►~~ t. (It not. state expiration }F rs are not necessary.) date: `"'~~Yufrt^•~ f 19~.) 'Names of persons slgnmg in any espaGty should be typed or printed below the!r signatures, 803 wr om STATE GAR OF WISCONSIN I e4' OVIT CLAIM DEED Neko Tax FOrms. P.O. Box ,17708. 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