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HomeMy WebLinkAbout018-1098-04-000 Wisconsin Department of Commerce Count PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: Y 463124 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)i. Permit Holder's Name: City Village X Township Parcel Tax No: Arrowwood Builders, LLC I Hammond Township 018 - 1098 -04 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: QYf Gip-' 30.29.17.811 TANK INFORMATION ELEVATION DA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic .! Benchmark /OI 2 Dosing AILBRI IIk Aeration 1 Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet '9 uk %9 ra TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet q Q ? 0 0 Septic ' q / Z 30 / 5 7 / � Dt Bottom Dosing { , 5 . 7 r '57 Hea — de r /R n. Iz T 41Z 5 � Aeration Dist. Pipe Holding Bot. System p J Final Grade Q 9 � v; i 1 / PUMP /SIPHON INFORMATION .7 1 7 ? (11 Manufacturer Demand St Cover C, GPM S 5� JZ• Model Number ! -• . t �Z 3u (�k i TDH Li Friction Loss System Head TDH Ft zs Forcemain Length 7 Dia. // Dist. to Well SOIL ABSORPTION SYSTEM 0 C(v �, o$ BED/TRENCH Width / Length / No. Of enches PIT DIMENSIONS No. Of Pits Inside ia. Liquid lbepth DIMENSIONS `7 (21 '�-� `` SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: Ed INFORMATION A CHAMBER OR Type O[.$ystem: Z 7 / 5 � / -6 4 �� )� UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution Cµ r r x Hole Siz // x Hole Spacing Ve to Air Intake Pipe(s 4 Length / Dia /Z t Length •4 Dia 1 ,IL Spacing—/L �� // �'� SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded Mulched Bed/Trench Center / Bed/Trench Edges \ Topsoil 1 l'� • Yes No *Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /I,/ C ` Inspection 2 3 � 1 I &5_ Location: 1506 73rd Ave. Hammond, WI 54015 (NW 1/4 SW 1/4 30 T29N R17W) Emerald Acres Lot 4 Parceo: 30.29.17.81) 1. Alt BM Description 2.) Bldg sewer length - amount of cover Wnat�ure� Nc Plan revision Required? (1 Yes j� _ Use other side for additional information. � ✓i ___. _ _____ -- SBD - 6710 (R.3/97) Date Insepct Cart. No. Safety and Buildings Division County r 2 N *Isc 6 n4in Madi(h 01 W. WM S itary Permit Number (to be filled in by Co.) -3151 3 Department of Commerce Sanitary Per 't 0 2004 St to Plan I.D. Number /00V3 -V In accord with Comm 83.21, Wis. pe al inou provide may be used for secondary s vacy Law, ►g)f • C�UiX COUNT? Pr ject Address (if difTerent than mailing address) ZONING OFFICE 1. Application Information — Please Prin 11 Information 1,s Property Owner's Name Parcel # Lot # 7 C✓ Ze v Property Owner's Mailing Address 0 g / l 1,21 A r Ste /., Section City, State Zip Code Phone Number (circle one iZ 7 O TN; R12Eo II. Type of Building (check all that apply) GV Subdivision Name CSM Number I or 2 Family Dwelling - Number of Bedrooms El ❑ State Owned - Describe Use Public/Commercial - Describe Use 2i221 (, 7 j f ❑City_ ❑Village arownship of , III. Type of Permit: (Check only one box on line A. Cable) A. New System ❑ Replacement System El Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal 11 Permit Revision El Change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiratibn Plumber Owner IV. Type of POWTS System: Check all that appl ❑ Non — Pressurized In- Ground ® Mound > 24 in. of suitable soil El Mound < 24 in. of suitable soil 11 At-Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland El Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit El Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber El Drip Line ❑ Gravel -les Pipe Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design,Soil Application e(gpds� ` Dispersal Area Requir (s Dispersal Area Proposed (s ,$ystem�n / 0), , .a � x;00 a 5 VI. Tank Info Capacity in Total Number Manufacturer Pre Site Steel Fiber Plastic Gallons Gallons of Units Con rete Constructed Glass New Existing Tanks Tans Septic or Holding Tank /A s Aerobic Treatment Unit A � Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) P is Signature MP/MPRS Number Business Phone Number ,7 I PlAt C1111f17 1 1; 'A -1. e_- ! � � Plumber's Address (Street, City, State, Zip ode) J� S VIIYCounty/DepartmenfUse Onl Approved ❑Disapproved Sanitary Permit Fee includes Groundwater Date Issued uing Agent S' natur (No t s) Surcharge Fee) ✓ El Owner Given Reason for Denial �j (J IX. Conditions of Approval/ easons for Disapproval � ���Z����GZ.(_ / _ •/— SY M OWNE eptic tank, effluen�and O3 G,L�jCp�i�/f�ttit T,,,,I G_ dispersal cell must all be serviced / maintained Q� as per manag ement 121an provided by lumber. / 0 2. se ack requirements must be maintained as per applicable codeJo� plans (to oua rdinances. S! 7� d u Attach complete pl the C only) for the system on r not less than 81/2 : 1 hes i SBD -6398 (R. 01/03) i I i I , I ! — /w r �•� 45 - �OIUTOU Po a a j ! { I j i P� ! i I I! � ��� I i goo . 1Z�o GAU BED j j i I j I ! I w,T il I ( G 2 /00 IN /tl IQ owee- - -- I 18o�,E Noc.�s .Poo CO *Tpu l e i 1 S L oPCI I I I I j I I I i - - -- I i I 7 3 OD, A v PW e IwI I` I , 7- O a Nd T / Si t r Safety and Buildings commerce.wi. OV 4003 N KINNEY COULEE RD g LACROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.coe.wi.gov/sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary September 30, 2004 CUST ID No.223760 ATTN: POWTS Inspector JOHN F SCHMITT ZONING OFFICE SCHMITT & SONS EXCAVATING ST CROIX COUNTY SPIA 586 VALLEY VIEW TRAIL 1101 CARMICHAEL RD SOMERSET WI 54025 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/30/2006 Identification Numbers Transaction ID No. 1064350 SITE• Site ID No. 689981 Arrowwood Builders Please refer to both identification numbers, 73RD Ave above, in all correspondence with the agency. Town of Hammond St Croix County NW1 /4, SW1 /4, S30, T29N, R17W Lot: 4, Subdivision: Emerald Acres FOR: Description: Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 982793 Maintenance required; 600 GPD Flow rate; 32 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01/01), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 101); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, CO71 stats. /, Vvk La The following conditions shall be met during construction or installation and prior to occupancy or use: DER RTME OF General Approval Requirements: SEE CORI • 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.01 101) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD - 10706 -P (N.01101). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • 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. JOHN F SCHMITT Page 2 9/30/2004 • 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. Stat • Comm 83.22(7) A copy of the approved plans, and this letter shall be on -site during construction a nd open to infection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • Comm 83.52 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. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 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. 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 Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 t SCIIMITT 8 SONS EXCAVATING S86 Valley View Trail Somerset, W7 54025 71S- S49 -66S1 MOUND SYS .M For: Arrowwood Builders, LLC Address: 1220 2nd Street, Hudson, WI 54016 Legal: Nti SW a 5 3 0 T 29 N R 17 W Township: Hammond County: St. Croix Contents Page I Plot Plan Page 2 System Cross Section Page 3 Pipe Lateral Layout Page 4 Dosing Chamber Page S Pump Curve Page 6 Management Plan Attachment I Soil Evaluation Report Attachment 2 NONE Mound Component Manual (Version 2.0) SBD -10691 P(N. 01/01) 'on all Pressure Distribution Component Manual (Version 2.0 p ) QED SBD- 10706 -P(N 01 /01) 1F o0 0 DINGS By: aL -'Idia, ENC MPRSW 223760 Date: 9/15/2004 lse RECEIVED SEP 4 2404 SAFETY BLDi D1V I — f , — , L C9 /nod u i S' �0AM out Z-I ry c r Yl4iA1 -- ��a P c w& o -- — - - -- - Q,0 M — -- -i 1 6o GAU BED ! -_ v _ _ _ - 1/ . OD F6 L i N ELI �N Pow. e ,00LF , n� =� _ 6.�.60 4 o ��� ��o� — i _oo + i — iBoQr �ieiLr — I P o� '05 L�Iu'r i ( I ! ! f I t 73 A' A vi X19 1 I I ul f I, I` u wim * o�e: I 1�1?�WiAu 2�ocJ o ( 14, Z O aNv T /�7 O7 - r0.5o ov IW IT 1 6 page 2- 'f 4 i Straw, Marsh Hay, Or AST'M C33 Synthetic Covering MI'MuM Sand Distribution p�Pe 6 " Toosoll H 9 E F SY& ELEV. 9_2.1( C _5 % Slope Bed Of 2 ��" - Force Main Plowed Aggregate Layer (6" Below Pipe) D 0.5 Ft. Cross Section Of A Mound Sy61ern Using E 0.71 Ft. A Bed For The Absorption Area F 0. 79 Ft. ` G 0.5 Ft. Signed: A 7.0 Ft. H 1_0 Ft. 8 85.7.5Ft . License umber; _22370 K 7.2 Ft. Date: 9 15 /2004 L 100. Ft. 9 J 449 Ft, Alternate Position of T 8.1 Ft. Force Main I W 20.0 Ft. L - Obeenr�tt Plpe 6 1/6 To 1/10 B From'End of Bed - - -- -------------------- A _ - -- , - W -- - j--------- - - - - -- ------------------ - - -- Force Main ^ �Di etribution bed Of z 2 t Pipe Aggregate Observation Pips Permanent Markers 1/6 To 1/10 $ Fr om End of Bed Plan View 01 Mound using A Bed For The Absorption Areo Page 3 Of 6 Turn -up wfth Cleanout Access B Plug or Bali Vahte �' ,► PVC Force Main Distribution Lateral LL r w w PVC Manifold P � X X X --{ 1 X/2 Distribution Lateral Layout P 4, �, 4 Ft. S 4.0 X 32 Hole Diameter 3/16 , Inch Signed: Lateral " 1 Inches) License Num er: 22376 ©. Manifold 1 , Ar+che5 Date: 9/15/2004 Force Main " _?_, Inches # of holes /pipe Invert Elevation of Laterals 60 Ft. F4fii" 4 Uf • PUMP CHAMbf.R CROSS SCCT!014 AUD SPCCIFrCATIQL'S VCWT CAP 4 VENT F WCAT14EK *ROOF APPROVED LOCKIJLZC. r 1 1 r K �Ir� IIIIrlo . J u&XT IOW box �MA COVC N I Nuu w UM t mLbil to'Mlsi• Alit INTAKE GRADC I I N' MIN• f coUCU1T _ _ l e• :JJ. IAJL.CT PROVIDE 1 I APPROW&O JOIUT A I I AP/ DVLD JD W /C.Z, rom I () I W /C.. PIPE EXTCwaIJ& 3' I 11 LVEMOmo ; OIJTO W610 •OI ALARM � 21-76 gal /inch I I ONTO coup 1 I I i I ou LLCV. 8 .?: 60FT. PUMP —` '—� Q � Ofd � CONCRETE &LOCK i 1 R15CR EXIT PCKMITTEG WJLtl IF YANK MAAJUFACTURCK HAS SUCH AMPp 04AL 3'•App ��001 scPrlt f SPEGIF 1CATIOh1S DO5!< TAWKI 1AANUFACTURCK: Meek's Q p +Or_ -5 f.tUJ•�t> C R OF D O S C b: r P E R �� TAJJK LIZC : _ 8nn `. GALLOWS DOSE VOLUME A1.ARM1 MAWurAGTuKCst: Sel2tronics Tankmate IWCLuauc, •ACKPLOW: 108.8 GAIL ON MOpCL 1JUMrlCK: TM -1 CAPACITIES. A . 19 413.4 1AICHC3 OR f�' LOyI •WITCH TyPCi ._ �1`lercury --�— � 5 2 . IUCt1EE OR 4. 52(ofLLWl P UMP MAIJUPAtTURCR: Zoeller Mahc WU MSEK-. 152 C ° 5 — IuCwt6 opt 10 � 8 8 6AL601Jl 0 -- u._�IMCNES OU 2 39.3 %A Lou SWITCH Tt{P[: _ Mechanical - - PUMP AND ALARM AFL[ TO OL mililmum 015Ct ARGE KATC 442 • 24 �C PJ INSTA..LEG OW SEPhRATE GIRCUIY& VERTICAL WfEILEMLEI OETWECy PUMP OFF AIJD.D PIPC.'. 10.0 FEr-Y + PAW)MUM NETWORK SUPP1.y PRCSSUItC 3.25 'FE.ET + 50 fE,ET or FORCf [.%A,&, y, 66 F% Iv01LFKIC710►I FACTOR.. 83 FEET TOT,L 0y1JAMIC HLAD c 15.08 Fr,-ET 1NT ERI3AL. D^LWSiowfi OF TA K: LEtJC.TH �_. ;wIDTH �• i LIpu10 C)JiPT M 3'9 in . 910IJ LICCUSE lsuheCr;: 223760 Dh'T fi TOTAL DYNAMIC HEAD /CAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DEWATERING MODEL 152/153 w w MODEL 152 153 50 Feet Meters Gal. L; , , ers Gal. Liters 153 5 1.5 69 261 77 291 12 40 152 10 3.1 61 1 231 70 265 0 5 4.6 53 201 51 231 a i 20 6.1 44 167 52 197 U 30 z 8 25 7.6 34 129 42 Sa r 30 9.1 23 87 33 125 j 0 a 20 3 10.7 -- -- 22 85 40 12.2 j -- -- 11 42 4 10 Lock Valve: 138.0 Ft. !1;.6m) 44.0 Ft. (13.4m), 014508 0 20 40 60 80 100 GALLONS LITERS 0 80 160 240 320 E /4 3 27/32 —r —�t4 5/8 �y FLOW PER MINUTE 3 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS a _ a • Timed dosing panels available. 0 3 27/32 • Electrical alternators, for duplex systems, are available and supplied with e an alarm. — • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. II • Sealed Qwik -Box available for outdoor installations. See FM1420. • Over 130 °F. (54 °C.) special quotation required. I 1521153 Series 12 1/8 1521153 MODELS Control Selection Model Volts -Ph Mode Amps Sim pi Duplex N152 115 1 Non 8.5 1 2 or 3 BN152 115 1 Auto 8.5 Included 2or3 I sKZOSa E152 230 1 Non 4.3 1 2or3 SE152 230 1 Auto 4.3 included 2or3 N153 115 1 Non 10.5 1 2or3 BN1531 115 1 Auto 10.5 - Zuded uded 2or3 SELECTION GUIDE E153 230 1 Non 5.3 1 2 or 3 1. Sin 9 le 1 P99Y back variable level float switch or double I p99Y back variable level float BE153 230 1 Auto 5.3 2 or 3 switch. Refer to FM0477. A CAUTION 2. See FM0712 for correct model of Electrical Alternator E -Pak. All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10 - 0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). Or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. BOX 16347 ' 'Louisville, KY 40256 -0347 Manufadurers of.. % 7, SHIP TO 3649 Cane Run Road Louisvlle, KY- 40211.1961 Af�r S,vcE /J,99" http: / /www.zoeNer.com (502) 778 -2731. 1(800) 926 -PUMP PUMP !O. FAX (502) 774 - 24 © Copyright 2001 Zoeller Co All rights reserved. `- � y.l3cD aoo rr . Wisconsin Department of Commerce SOIL EVALUATION R EPORT of P _ Division of Safety and Buildings in accordance with Comm 85, Ms. Adm. Code County F Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D C'j percent slope, scale or dimensions, north arrow, and location and distance to nearest road. � ' - b c I ,S R Iow C Z �rJ Please p rint all fnfonttat/on. a y Da R O Personal inlormalion you provido maybe used for secondary purposes (Privacy Law, s. 15.04 (t) (m)). ta (�(/t; Q G (J�T Property Owner Property Location / CF Govt. Lot t/cr/ 1 14S'cc, 114 S T 2 F N R l E (ord roperty Owner's fgtalting Address Lot # Block # Supd. Name or CSM# ,1 r" City State Zip Code . Phone Number ❑ City ❑ Village ® Town Nearest Road New Construction Use: Residential J Number of bedrooms s Code derived design flow rate __���+� 0 0 GPD ❑ Replacement r �f Public or commercial - Describe: Parent material Flood Plain elevation if applicable / _ n• General comments s S / e � e � Q V/- ?Z1 and recommendations: �r v Boring # El Boring -- ®. pit. Ground surface elev. �L�O ft. Depth to limiting factor _ — in. Soli Application Rate Horizon Depth Dominant Color Redox Descrthtion Texture Structure Consistence Boundary Roots GPD/fl' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. /r 'EH #1 'EK #2 - I f 3 — r Zm sb � �i ' _C 1 1 l 4 l z- I -( 16'( Sr�� -I 2in Y/IX/' � S L 3 >� 3z z F _ , s- • ++--77 Boring # El Boring , r/ a L24' Pit Ground surface elev. s ft. Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Simcture Consistence Boundary Roots GPD/f? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 Z 2 Z 4 Y C S . Effluent #1 = BODi -30 < 220 mg/L and TS S >30 < 150 mg/L Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Pri ) nalur � r T Number A dress — Date Evaluation Conduct < Telephone Number . z I�3 8lJ iy� r oz s —o`° r_.r i • _ I Page of Property owner --- _ __ _ — _ - - -- Parcel ID g -- - - - - - -- -- _ �] [i] Boring It Boring n, De th to liriti ng factor L in. Sol A lication Rate � Pit Ground surface elev. = �• / p GPD1ff Horizon Depth Dominant Color Redox Description Texture $tNGtlJre Consistence Boundary Roots .EfffFt 'E11112 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 6 -10 1, mss- u f 3 Zz -y El Boring Boring # - -_ F 0 Pit Ground.swface elev. ft. Depth to limiting factor _— in. Soil A IicaGon Rafe Horizon Depth Dominant Color Redox Description Texture Siructurt3 Consistence Boundary Roots GPDIt1,Eff /F2 In, Munsell Qu. Sz.. Cont. Color Gr. Sz. Sh. ❑ Boring # Boring Ground surface elev. ___ —_ —__ ft. Depth to limiting factor __ -- in. El Pit Soil A bcation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIf? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efi #1 'EfffE2 — 7� Effluent #1 = BOD > 30 < 220 mglL and TSS >30:s 150 mg1L ' Effluent #2 = BOD < 30 mgiL 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. saor�rore.u�ron�` r PAGE_]�_OFa NAME: 1y- rocuw-J� LOT #LEGAL DESCRIPTION :,fiwl /4 1 /4,S T�,N,R, Earl SCALE: 1 y0 r ELEVATION: ) bU C BM I DESCRIPTION: rl a ,'/ : 400-1-r 1 20 BM 2 ELEVATION: BM 2 DESCRIPTION: SYSTEM ELEVATION: SYSTEM TYPE: mv v A ) dip I i I i I i SIGNATURE: /p'�8 °'1� DATE: y 1ly T :y POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 67 of 1 FILE INFORMATION SYSTEM SPECIFICATIONS Owner Arrowwood Builders LLC Septic Tank Capacity 1260 al ❑ NA Permit 0 �. Septic Tank Manufacturer ❑ NA _ P DESIGN PARAMETERS Effluent Filter Manufacturer Z ab ❑ NA Number of Bedrooms 4 ❑ NA Effluent Filter Model A -100 ❑ NA Number of Public Facility Units M NA Pump Tank Capacity 800 pal JNA Estimated flow (average) 400 g al/day Pump Tank Manufacturer Design flow (peak), (Estimated x 1.5) 00 al /da Pump Manufacturer Zoe ler Soil Application Rate 0.5 gal/day/ft' Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit 0 NA Fats, Oil & Grease (FOG) S30 mg /L ❑ Sand /Gravel Filter O Peat Filter Biochemical Oxygen Demand (BOD,) 5220 mg /L O NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) O NA Biochemical Oxygen Demand (BOD.) S30 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) S30 mg /L O NA O At -Grade ■ Mound Fecal Coliform (geometric mean) 510' cfu11OOml ❑ Drip -Line O Other: Maximum Effluent Particle Size Y in dia. r' ❑ NA Other' O NA Other: h Oter: - ❑ NA ❑ NA 'Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once eve ry' (Maximum ❑ month(s) (Mi 3 ears) ❑ NA. 3 A year(s) y Pump out contents of tank(s) When combined sludge and scum equals one -third (Y,) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) O NA, 3 Y year(s) Clean effluent filter At least once every: ❑ month(s) O NA 1 11 year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA 1 ■ year(s) ❑ month(s) Flush laterals and pressure test At least once every: 1 ■year(s) O NA`� Othar: ❑ month(s) At least once every: ❑ year(s) ❑ NA.' Other. -, ❑ 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 Servicing Operator. :Tani inspections must include p 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 call(s) shall be visually Inspected to check the effluent levels in the observation pipes and to check for any por ding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires:th( immediate notification of the local regulatory authority. ` When the combined accumulation of sludge and scum in any tank equals one -third (Y,) or more of the tank volume, the entir( 'contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter. NR' 1:1 Y A :.Wisconsin Administrative Coda. All other services; including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatmen units; and an y`servioing'at intervals-of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory author : g ry by within 10 days of completion of any service event. r s r Page of '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 tankls) 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 call(s) in one large dose, overloading the cells) 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 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 15 feet down slope of any mound or at -grade soil 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 sery ice the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with 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. • 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. n ( T e s e has not evaluated to ide . y suitable replaceme a. Upon failure O a holding d tank I" valua . n mus a pe ormed to loc a swta a replacemen rea. If ant area is available may be i ad as a las esort to place the fait O Mound n at -grade soil absorption systems ma be reconstructed in place following removal of the biomat at the: in i trative surface. Reconstructions of such systems must comp y wi a ru es ln 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 MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name' John-Schmitt Name Owners choice Phone` 9 - 651 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name' ors choice St Croix Ct . :Zonin Sy �. Phone Phone 715 386- 4680 " :x This document was drafted in compliance with chapter Comm 83.22(2)Ib)(1)(d) &(f) and 83.54(1), 121 & (3), Wisconsin Administrative Code �' Y xi a 4 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer A R d Q[ /�/ Uj7 17 ,&at- /� 4 Mailing Address j & ,110 atArn S &DS QAt - Property Address 15 0 (D (Verification required from Planning Department for new construction.) City /State A -aag,,o &/" . Parcel Identification Number 018 - /0fA - 0 9 - D60 S LEGAL DESCRIPTION Property Location" %. , �SllJ %. , Sec. 70 , T LF_N R_11 W, Town of AA&,Cie„f10 Subdivision A G 12 t S , Lot # y Certified Survey Map # , Volume , Page # Warranty Deed # '7,4 a g jr, 5 , Volume a2 , Page # Spec house 0 no Lot lines identifiable es no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. 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 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 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 Zoning Department within 0 days of lrWu�l the three year expiration date. Aapp&-L -0 LL0 to SIGN TURE OF APPLICANT DATE OWNER CERTIFICATION I/we certify t4at all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the I l prope sc ve, by virtue of a warranty deed recorded in Register of Deeds Office t.t,L / / oY IGNA OF APPLICANT I DATE * * * * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warran ty deed. ' J �f �b X610 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code �rQlx Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and P rcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. A 01&--40& - 7 Please print all information sewed b Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Lp�- fm?k Property Location Q�J)(Nrd Govt. Lot ti,.j 1 /4Sw 1/4 S T Z ct N R E (or) a Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# e - Vv - - 14 4-c e s City State Zip Code Phone Number ❑ City ❑ Village XTown Nearest Road � d n l�l 'I I 1 ( 15) 5414- - 731 -/a rn VYL rt C� New Construction use: W Residential / Number of bedrooms 3 _y Code derived design flow rate 4� G GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material T. Flood Plain elevation if applicable ft. General comments S �e -e V and recommendations' 00 ln-bur e ib ft ❑ Boringti Boring # �y� Q ®pit Ground surface elev.7?' . Depth to limiting factor in. © it A on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence ot1ri'�la oo s �' /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. !` *Eff#2 0 - I 10 yr 3/ Si( 2-m IC to c 5 r Z I(o -28 l r q {3 sic) 2m5 bk vWy- c� — 2 - 10yr �ll� - rQ (I✓YIPSII� — — � ► Q F-2 Boring # ❑ Boring - 1 ® Pit Ground surface elev. 7 _7 ft. Depth to limiting factor `7 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 I *Eff#2 l A 42 !o r 211 - - -- Sr rrab I< -Cr 5 I .5 'S 2 12-29 /0 yr 21 -1 Si c I Zmsbk ,, f►- s, 3 Z9 lU r3 C2P 7.5 L 2m lbk VVI * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name lease Print) Signature CST Number - 4 Z , 5 3309 Address Date Evaluation Conducted Telephone Number 0 11 2 0 1 ti S. StTneysei, W 1 510 /2 -0 -6i (715)217 - SBD -8330 (R07 /00) Property Owner U� Parcel ID # Page Z of 3 Boring # %�� E] Boring © Pit Ground surface elev. Y ft. Depth to limiting factor �xP 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. I *Eff#1 *Eff#2 I 6 - 13 Ip r 2 11 50 k cS v . 5 .$ Z /5- I _ r Sic/ 3 -4/ tU r C2P - 5 Yr `t L ❑ 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 *Eff#2 E] Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. El Pit 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 ` Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 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.07 100) .r PAGE 3 OF 75 NA LOT# Y LEGAL DESCRIPTION A/W XSw i4 ,S 3p T ZQ , / ;?- E(or)� SCALE: I "= yD BM 1 ELEVATION /DO BM 1 DESCRIPTIO o-� pvG BM 2 ELEVATION BM 2 DESCRIPTIO -1 C LPG SYSTEM ELEVATION 9 Sri / SYSTEM TYPE {Y1 G y cQ SyST < wk --�— CONTOUR ELEVATION ?D q Pa v � f o� S GNA E %� � DATE -!5 - xO O kk Z P 1 9i, 76a CE. 5�0 STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number ST. CROIX CO- WI a RECEIVED FOR RECORD This Deed, made between !' 05/14/2004 01:35PH j RICHARD Q STOUT a nd AAiET P. STOUT, ialhan WARRANTY DEED ha a nd w i f e, j EXEMPT i Grantor, y [' and ARROWmnnn 81111 -n 8, LC if REC FEE: 11.00 F !' TRANS FEE: 164.70 COPY FEE: CC FEE: ! Grantee. I PAGES: 1 Grantor, for a valuable corisideration, conveys and warrants to Grantee the following described real estate in $t- C!rn; sr County, State of Wisconsin: II Recording Arta ..... Lot 4, Plat of Emerald Acres, Town of -- -- I Name and Return Address Hammond, St. Croix County, Wisconsin. Cdtna. CIA t U Std �f#tts Mao L0 5r0�� 018 - 1098 -04 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) 4 r i .r r t I I ii Exceptions to warranties: easements, restrictions, rights -of -way and covenants of record. Dated this day of May 2004 i r (SEAL) (SEAL) Richard O. Stout Janet P. Stout i (SEAL) (SEAL) i i ! AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. St. Croix County. authenticated this day of Personally came before me this t day of Ma 20 0 4 the above named Lot 4, Plat of Emerald Acres, Town of Name and Return Address Hammond,'St. Croix County, Wisconsin, 0- ina. l i 018- 1098 -04 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) ii 1 j II ii I i Exceptions to warranties: easements, restrictions, rights -of -way and covenants it of record. I� 2004 � Dated this day of ��, t (SEAL) �- (SEAL) * Richard O. Stout �; *.; Janet P. Stout ( (SEAL) (SEAL) AUTHENTICATION° ACKNOWLEDGMENT l ,' Signature(s) State of Wisconsin, SS. St. Croix County. authenticated this day of Personally came before me this t day of May 2004 the above named i Stnllt to TITLE: MEMBER STATE BAR OF WISCONSIN (If not, me known to be the person -S —_ who executed the foregoing authorized by §706.06, Wis. Stats.) Instru nt and acknowledge the same. j Pamela A. Willman THIS INSTRUMENT WAS DRAFTED BY Notary PUbIIC t Janet P. Stout State of Wisconsin * �G r►1P 1 1 151 Awat -uk.ee TR Hudson, WI 54016 Notary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: (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. STATE BAR OF WISCONSIN 9 Wisconsin Le Blank Co., Inc. 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