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HomeMy WebLinkAbout018-2011-52-000Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Timber Rid a Homes Hammond, Town of ~ST BM Elev: Insp. BM Elev: BM Des ription: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic / ~ ~ ~~ Dosing ~ ~ _ n _ // ,~l~f Aeration ~ ~ ~`~/l~~ i if~ Holding p < < ~ ~ ~ ~ YI ~rS -~' t s v TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ` S~ / / Dosing ~~ ~ ~ ,L~ A` ,^ ., i 1 ( Aeration Holding PUMP/SIPHON INFORMATION 6~G" Manufacturer ~ ~ ~ ~~ GFM nd Model Number ~ ,n,/ ' !,` TDH Lift • a Friction Loss^ ~..~ 1 System He d TDH Ft Forcemain Le v Dia. 2 <. Dist. towe~ ~~ / ELEVATION DATA county St. Croix Sanitary Permit No: 463395 0 State Plan ID No: Parcel Tax No: 018-2011-52-000 Section/TownlRange/Map No: 30.29.17.1067 STATION BS HI FS ELEV. Benchmark N~- Z.vS~ l6 2. .~ /6lJ . o Alt. BM ,~` `~,~ Bldg. Sewer /r. 96 Qa v ~ SUHt Inlet ~ ~ ~ ~ St/Ht Outlet Dt Inlet / ~ Dt Bottom d ~ SG/.~ C~j ~O.'l ~~• 3 Header - 5 r i 1l ~~_ ~~ ~, Dist. Pipe ~ ~ Z~ r ~r./ B . Syste . ~~ ~ s' r/ final Grade AL Ua _ / CrJ~~' y~ ~~ St~~r ~. 3 ~i5~ -eS~ . ~/ 3 , d ~~~ (~+' - S(lll ARSnRPTIl7N SYSTEM 7 L ['~it/~iv-~,~f.-P/l~O .~~[~~~- BEDRRENCH Width f Lengt f No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 ~~ 3 ~- SETBACK SYSTEM TO P/L BLDG WE LAKE/STREA LEACHING Manufacturer: ~ INFORMATION CHAMBER ~ t Typ Of System: ~ - /, t 2 t ,.~T t \ ~ `r-~" U Model Number. ~/, , ~ - ~ nISTRIR11Tl(1N SYSTEM Header/Manifold (s Distribution ~ x Hole Size x Hole Spacing Vent to Air Intake ' ~/ f n y(,~ ~ C' Pipe(s) r/~ ' r~ ~_ 2~ Le~tH tr' Dia Dia Spacing Length I v SC111 CnVFR v Oroem~rn Qvc4uma Anh, vv Mnunri t7r Ot.Crade $VSteMS Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bedlrrench Edges Topsoil ~ Yes ~,~ No Yes [ j No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: l~ / a 3/ 0 ~ Inspection #2: / /, Location: 791 154th Street Hammond, WI 54015 (NE 1/4 NW 114 30 T29N R17W) Emerald Acres 1st Add Lot 52 Parcel No: 30.29.17.1067 1.) Alt BM Description = ~ ~j(,~Q/fy~ ~ / ~~~ 2.) Bldg sewer length = ~ ~~EG~ ~~~~~~ -amount of cover=' ~r ~~~~~~~~~--U ~~~~ ` [-[^^a''~~i, _ _ ,- - _- _ _ - -_ _ ~~/ b 4v~G Plan revision Required? Yes I r~<1~1o I ~ Use other side for additional Information. i - ~ ~~ °~~ ~ ~~ ~~ ` - Inse ctor's Si na ure ~ ~ C~N~ Date P 9 SBD-6710 (R.3/97) ~~ os ~ ~3 ~ ~ .S ~ tit// ,Q,~G~a?J~.,(~.i. G~-d!/n,~'.vV~ ~ y /~ r-~-, .~.'' ~'~`'~ .~ 20 s ~r ~, ~, ~ ~~ ~ ~ ~$3~ k ~~ s~~~ ~~ y.. co ~~ Q~ -°~ yL ..: S s~ ~~ y ~ 5~' ~. d s 7 Safety and Buildings Division County ~ ~ 201 W. Washington Ave., P.O. Box 7162 S~h ~:RO(X ~~~~~~~~ Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266-3151 ~ ~} 5 Sanitary Permit Appliea ' REC I d ith C 83 21 Wi Ad C d i ate Plan I.D. Number, Q,17r n accor w omm . , s. m. o e, person rma on you prov de o05 may be used for secondary purposes Privacy w; 0 (I)(m) 2 Z 1 Pr ct Address (if different than mailing PR ,~ ST I A lication Information -Please Print All Information OV ~ ~~~ ~~ . pp RO\XG ~ 1G -~ . G GFF ~ ~Yt c/ Property Owner's Name / Parcel # Lot # Block # Property Owner's Mailing Address Property Loa i N8052 575 rtt STREET NE '/4, N W '/; S 30 , T 29 N, R 17 W City, State Zip Code Phone Number ~~ ~~d - MENOMONIE, WI 54751 715-505.0782 (O /lll II. Type of Building (check all that apply) / 3 3 Oa-4_ / l or 2 Family Dwelling -Number of Bedrooms 4 ~ -~•h t'S ~~ ~- • L • Subdivision Name y~.,C~'~ Number EMERALD ACRES Js~ NA o Public/Commercial -Describe Use // g ~ , ~ ~ ' d ~ ~ O City O Village ~ Township of HAMMOND ~ 15 P ~~ o State Owned -Describe Use ~~ ~~'f'l~N~ y~~'y III. Type of Permit: (Check only one boz on line A. Complete line B if applicable) A. / New System o Replacement o TreatmenUHolding Tank Replacement Only o Other Modification to Existing System _~ System B o Permit o Permit Revision o Change of o Permit Transfer to List Previous Permit Number and Date Issued Renewal Plumber New Owner Before Ex iration IV. T e of POWTS S stem: Check all that a I Non -Pressurized In-Ground O Mound > 24 in. of suitable soil O Mound < 24 in. of suitable soil O At-Grade O Single Pass Sand Filter O Constructed Wetland O Pressurized In-Gr and O Hold Tank O Peat Filter O Aerobic Treatment Unit O Recirculating Sand Filter O Recirculating Synthetic Media Filter ~ Leaching Chamber O Drip Line OGravel-le ipe O Other (expl V. Dis rsal/Treatment Area Informatto /1 r ~n Design Flow (gpd} Design Soi Application Rate(gpdsf) Dispersal rea Required (sf} Dispersal Area Pro osed System Ele anon 3~ ij 600 0.4 1500 1507.2 ~ 96.80' ~ ~ r~ t%~1 s ~~ V[. Tank Info Capacity in Total Number Manufacturer Pr ab Site Steel Fiber pla ' Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 1250 1250 1 HUFFCUTT X Aerobic Treahnent Unit ) 7v/~- ~ *~ ` Dosing Chamber 750 750 1 HUFFCU T X VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number DARRELL FRAZER ~. ~ ~ ~ 221071 715-288-6225 Zf CELL 71.5-828-5734 Plumber's Address (Street, City, State, Zip Code) FRAZER EXCAVATING - 16317 BLOOMER, WI 54724 Vlll. Count /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Dat Issued uing Age t Signatur amps) Surcharge Fee) y~ p v ~~ _ `~ y >, ^ Owner Given Reason for Denial V~ -~ ~ DS IX. Conditions of Appr~al/ROaso~for D~roval ~ ,'// .. Y /`1'r'- Z ~ ~~ ~1 M ~~ G ~ 3- S - ~~ t 'GV~ J f~ Se tic tank, effluent filter and ll be serviced /~a~ fined ` t ll mus a dispersal ce as per mana ement plan provided by plumber. 3 ~~ ~~~GZ~~ 7v ~ )~1tin~d du-Q~ ~ 2. se ack requiremen s mus e m ~ ~ 12 ~ er applicable code/ordinances. ~° as p Attach complete plans (to the County only) for the system on paper not le% tha~81/2 x 1 it ches in size ~ BUILDING SEWER MUST COMPLY 1 WITH COMM 82.35 WAC (11)(C) t t ~ OCATION OF WELL MUST COMPL I WITH WDNR CHS. NR 811 & 812 WINSAND BUILDERS SITE PLAN EMERALD ACRES LOT #52 /r' I I ~ I /V i 3 3 }' /' ~ ,r i i j i ; ~/ ~ /'1 I i 3 1 :/ 4 j ~ I 3 ii i ~ ~ i fh`•. / i : i ~ F I j f 1 t ~.~ n '....PROPOSED 4-BR ._ UILDING SITE ;; 'f IM' ~ ~_" AEI,,,,,,, ~~ _~ ~-~ ~~~Q` i i r~ _-~ {~~ v ,) ~~'i i Q'_ , y/' ~~/~ -25' • 4" ASTM PVC % 't ~ r ,I BUILDING SEWER LINE /,'~ I`,~~ ' 1 '~ r V ~ r /: ~ n i i I f i/ ... .... /3 3 t : 'i t 3~,., dQ k J'~' v #2 /Y/V~_ ~ 1 3Y f ~ ~~ J I i r' (3) NON-PRESSURIZED DISTRIBUTION CELLS /~ j `Y EACH CELL USES (26) LEACHING CHAMBERS %l~ I IMP TANK ~/ (wlapproved outlet filter) ~ ~ ~' ~~ 60' - 2" SCH 40 PVC FORCEMAIN (must drain back to pump tank) (MODEL -INFILTRATOR QUICK 4) EtSA RATING = 99.1 PER CHAMBER / SYSTEM ELEVATION = 96.80'./ ,~, W LEGEND ~.___._.~..-. .....__...__.o..~...___.._,.-, I +~ BENCHMARK ELEVATION = 100.0' I I (top of 1" pvc pipe) I ~ o LOCATION OF SOIL BORING(S) ~ =_~ LOCATION OF SOIL PIT(S) t I * NO APPARENT COMM 83.43 SETBACKS I ~ ®DESCRIBED LOCATION OF LOT LINE ~ I (~ LOCATION OF RIGHT-OF-WAY I I Q CENTERLINE OF DESCRIBED ROAD I L......, ..... _. _.. ~.., _...~ __ ~ .W. _. _. _n _... ,~..... A~ __ ..., N S SCALE 0 15 30 (UNLESS SHOWN OTHERWISE) NE-NW-30-29.17W HAMMOND TOWNSHIP ST CROIC COUNTY, WI PARCEL DESCRIBED AS _ AC. E ~~ WILLIAM J. BERGH WISCONSIN CERTIFIED SOIL TESTER DESIGNER OF ENGINEERING SYSTEMS CUSTOMER ID 227819 PAGE 2 OF 8 Covey Sheet NON•PRESSURIZED IN-GROUND SOIL ABSORPTION COMPONENT Reference SBD-10567-P (.6/99) "In-ground Absorption Component Manual" Location: EMERALD ACRES -LOT #52 NE'/4, NW'/4, Sec. 30, T 29 N, R 17 W Town: HAMMOND County: ST CROIX Designer's name and license # I the tendersigned and sub. Designer's signature: Designer's address: Designer's phone number: Contents William J. Bergh (License No. 1577-007) that these plans were designed i under my authority. 2667 l 1 s, WI 54729 715-723-5555 voice 715-723-7535 fax 715-577-6838 cellular Page 1-cover sheet ~~~~~n~nn~~~~. Page 2- site plan ~.~' (~NS~ ~ Page 3- leaching chamber x-section ~~: ~~DG•"' " "• Page 4- leaching chamber manufacturer specifications +~~;~ •• Page 5- septiclpump chamber x-section ?~,~~~~~~~ ~.~ Page 6-pump curve G Page 7- management and contingency plan ~ ~ ~. B~a Page 8- management and contingency plan y~ ''ti. ~~•~'~IONA~_C Page I of 8 BUILDING SEWER MUST COMPLY WITH COMM 82.35 WAC (11)(C) I OCATION OF WELL MUST COMPL WITH WDNR CHS. NR 811 & 812. ~ ~ . WINSAND BUILDERS SITE PLAN EMERALD ACRES LOT #52 #2 `~~c' i _25• _ 4.. ASTM PVC ~ z~ ',~P: BUILDING SEINER LINE ~~~ ~ ~ ~ ~~ ' ` Q~P`~ Q.. /~ .3~ ~~( i } 3 ~ / Y ~_ k E ~~ ' ~ E,= i#3 HUFFCUTT MODEL 1250/750 SEPTICIPUMP TANK '' (wlapproved outlet filter) ~-~ 60' - 2" SCH 40 PVC FORCEMAIN (must drain back to pump tank) NE-NW-30-29-17W HAMMOND TOWNSHIP ST CROIC COUNTY, WI PARCEL DESCRIBED AS _ AC. (3) NON-PRESSURIZED DISTRIBUTION CELLS EACH CELL USES (26) LEACHING CHAMBERS %~ ( (MODEL -INFILTRATOR QUICK 4) EISA RATING =19.1 PER CHAMBER / SYSTEM ELEVATION = 96.80'/ N LEGEND I ~ BENCHMARK ELEVATION = 100.0' I ~ (top of 1" pvc pipe) I ~ o LOCATION OF SOIL BORING(S) ': _ LOCATION OF SOIL PIT(S) s * NO APPARENT COMM 83.43 SETBACKS ; q ®DESCRIBED LOCATION OF LOT LINE ~ ®LOCATION OF RIGHT-OF-WAY I Q CENTERLINE OF DESCRIBED ROAD t_...,..w...~. __ ~ .w.. ,.~ ... .......... ._..,. _....~ .~....~ ,., .,.,....3 -W E S SCALE 0 15 30 (UNLESS SHOWN OTHERWISE) WILLIAM J. BERGH WISCONSIN CERTIFIED SOIL TESTER DESIGNER OF ENGINEERING SYSTEMS CUSTOMER ID 227819 PAGE 2 OF 8 GRAVELLESS LEACHING CHAMBER CROSS SECTION (typical) installations may vary & require additional cells (not shown here) "DRAWING NOT TO SCALE" .,,~ ~p ti' ~' ~~ ,~ ,x,15 ~ OBSERVATION PIPE ~~ hJ~ SOIL TO PROMOTE 26 NUMBER OF LEACHING CHAMBERS (per cell) 3 NUMBER OF CELLS 78 TOTAL NUMBER OF LEACHING CHAMBERS (all cells) A MINIMUM OF 12" OF SUITABLE SOIL IS REQUIRED OVER THE CHAMBERS INFILTRATOR QUICK 4 STANDARD CHAMBER -OPEN BOTTOM AREA = 9.1 SQFT INFILTRATIVE SURFACE PER CHAMBER BASED ON EISA RATING =19.1 SQFT QUICK 4 STANDARD END CAPS PER PAIR EISA RATING = 5.8 SQFT ALL MA ERIAL AND PIPING SPECIFICATIONS AS PER THE CONVENTIONAL SOIL ABSORPTION COMPONENT MANUAL PAGE 3 OF 8 SYSTEM ELEVATION = 96.80' / COMBINATION SEPTIC TANK/PUMP CHAMBER X-SECTION (DRAWING NOT TO SCALE) MANHOLE RISER & COVER FINAL GRADE {per COMM 84.25 (7) & (8)} (slope around surface awav from / \ ~ manhole(s) for proper drainage) / I BUILDING SEWER {per COMM 82.30 (11' ELECTRICAL 8 ALARM SUPPLY (electric 8 alarm wiring must be installed on separate circuits) ELECTRICAL JUNCTION BOX MANHOLE MANHOLE 18" min. l LET MANHOLE - a. properly sealed BOTTOM OF INLET (invert elevation) ~ ~3„ when not~use`d (wastewater level)-----L--- ~ -- '^ °I . RESERVE J CAPACITY i ,I' _ , 4.. .. C 4" INLET PIPE FILTERED B e (tee or baffle) APPROVED EFFLUENT FILTER EFFLUENT REQUIRED ON OUTLET , ~ .a'~. A «. ,.. '< MINIMUM OF 3" OF SUITABLE BEDDING BENEATH TANK PUMP PAD EFFLUENT FILTER ZABEL A-100 ** Tank Manufacturer HUFFCUTT Septic/Pump tank model 1250/750 ** OR EQUIVALENT COMPONENT DWF (daily wastewater flow) 600 GPD Number of daily doses -7.5 (DWF /actual dose volume) ALARM FLOAT ON FLOAT OFF FLOAT elev = 86.80` Alarm manufacturer S.J. ELECTRO ** Alarm model number HW 101 ** Forcemain volume - 5.5 Type of float switch MERCURY ** Actual dose volume (gallon 9,85 (total dose volume -volume of cemain) Effluent pump manufacturer LITTLE GIANT PUMP TANK CAPACITIES Effluent pump model number 9EH Reserve above alarm 24 inches = 409.68 gallons Alarm float above on float 2 inches = 34.14 gallons (Cl Minimum Dumb discharge rate (GPM) NA On/Off float measurement 5 inches = 85.35 gallons (Bl Off above bottom of tank 14 inches = 238.98 gallons (Aj Vertical lift (pump off to distribution lateral) 10.0' ~ b s u 1.3 feet) PUMP CHAMB NA <<~ ER DIMENSIONS Friction loss in the forcemain --<1.0 Length 54.0" " ~~ Width 70.0" i h 17 07 Liquid depth 45.0 <1~ nc . Gallons per ~0 $~'~ . 9 ~ 3.3~ -~ Z .~i ~ „y~ Z~ ~ PAGE 5 OF 8 .~Quick4TM STANDARD CHAMBER ~z -------____ Quick4 Standard Chamber MuitiPort End Caa ___-_----- 48"--- (EFFECTIVE LENGTH) .I ~ I I ~. L I i ;=i I t i_ ~, 7 ~z° I ~ I I I~ I t "" - ~-- - 34"-- --~ SIDEVIE~d FRONT VIEV'J SIDE VIEW i OF `JiEVv Quick4 Standard Chamher Nominal Specifics#ions Size (1h~ x L x H} 34" x 52" x 12° Effective Length _ _ 48" Invert Height ~ 8" MultiPort End Cap Nominal Specifications Size(WxLxH) 34"x16"x12" Invert Height 8" or 1.25" ~, ~ ~ • ~ O ~Y~T~ M ~ I N C Environmental Onsite Wastewater Solutions" 6 Business Park Road • P.C. Box 768 CId Saybrook, CT 06475 360-577-7000 • FAX 860-577-7001 800-221-4436 ~ S .ha -~ 1 i L U 1 1t -1t J '~i,J~ 1G- o ~.%t ~+N ~ '1 r 1 d~ ~ a S ~b<< Ci J-1 ~f r ai l ~II q 1~'~,ZE :,,t d E I' ,1 ~: ~ d n C ~ fl C ~a E C 'll ~[ _, 3 .,C BO tf.3C t~3 K'n ~_ ~ n `i. 2!1l~ I /S ITo of ^. d I2~It~e ~~ ti ~,~„ u'K 1 h ~a ~D C~Of1CJ~ l.. Yt?OU 5.ti 1\~ CGf;t .,~, ~f ~~/.C L_E..,h'~.1~, .,I( .Sn31 LOVI~. G~I13f115~Y.~~~3..2. FO: _OCIC, ~LfCK~U. o~J'.,k~i~y RECYCLED PAPER ar,J ?~'.b:a are atlemarks of r ilirator S,.,id ~s Inc. c 1CC3 IniJ-r~to: J%s2eir, ,~c. Printer - ..S.A. uC- ILJ~ `P-C SECTION VIEW i -_ ~,.~... _ _ _ . _ ~._._ ,_w_,. _ . __ _. _ . ~_ . _..__ . _ _. _ 9EH SERIES SUMP/EF"FLUENT PUMP Specifications MODEL CAT. SOLIDS SRE RUNNING PERFORMANCE (GPM @ HEAD) SHUTOFF PWA. CRD. WEIGHT DINENSIDNS N0. N0. LISTING NP VOLTS (Dia.ln.) ANPSIWATTS 5' 10' 15' 20' Ih.) P.S.I. (fL) Itls.l IH s L s WI 9EH-CIM 509330 UUCSA 4i10 115 3/4 13.0 1000 ?1 68 60 49 32 ^3.9 20' 27 9.11 z11,64z9.94 9F}i-CIM 5D9340 UUCSA 4/10 230 314 6.5 1000 i1 68 60 49 32 13.8 20' 27 9.11 x 11.64 x 8.94 9EH-CIA-RFS 509350 UI/CSA 4110 115 314 13.0 1000 71 68 60 49 32 13.8 20' 27 9.11 x 11.64 x 8.94 9EH-CiA-RFS 509360 L'11CSA 4110 230 3r4 6,5 1000 71 69 60 49 32 13.9 20' 2J 9.1'; x 11.64 x 9.94 tion Construc _ _ Motor Housing _ ~ Epoxy Coated Cast Iron Impeller Material - --- ---- Poly Carbonate --- to -- - ITpeller Type __ ! Closed Vane ____ Volute __ _ _ ~ ABS ~'' 7~5 W ~ Power Cord SJTW-A Mechanical Shaft Seal Nitrile with carbon and ~~ s o ~ ~ ceramic faces !Fasteners Stainless Steel I z s __ ~ Shaft ___ ~ Steel_ _' ~__ ~ Stain_less RP')1'l l1 RC tt l ~ TTr\Y1PY CIPP\/P ~]Yl fl T !1\IIPY '~ o ~ i Ball Bearings FLOW- GALLONS/MINUTE PUMP PERE~RMANCE CURVE 115V 60HZ SSPMA - ~~at ~ ~- Little Giant Pump Co. ,. ~,M. =, PO Box 12010 `Phone: 405.947.2511 -,~ Okla. City, OK 73157 Fax: 405.951.5674 ISO 9001 CERTIFIED °~` ~ °~`~ F`Form 995235 - 01100 FLOW- LITERS/HOUR 0 1000 2000 3000 INSPECTIONS Inspections shall he made by a person carrying one of the following licenses or certifications: Master Plumber.. Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule) / Septic Tank Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks of leaks, measure the volume of combined sludge and scum and to check for any backup or surface discharge of effluent. Access openings used for service of assessment shall be sealed andlor locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental of unauthorized entry into the tank. The outlet(effluent) filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank during cleaning. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating properly. / Pump Chamber/Treatment Tank(s) Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must me made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of the filter. Any service needs or repairs shall be promptly taken care of, / In-Ground Gravity Component dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge, Any discharge to the ground must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The divertor~ valve shall be switched to serve the opposing distribution component every three years (when the septic tank is due for it regular maintenance). However, if ponding is observed in the observationlvent pipe of any cell, the divertor valve shall be switch to the opposing component. Furthermore, ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails andlor Is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code. - All piping to tanks and pits shall be disconnected and the abandoned pipe opening sealed. - The contents of af(tanks and pits shall be removed and properly disposed of be 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 other 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(s), 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. o A suitable replacement area is not available due to setback andlor soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS, o 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. o Mound and At-Grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions ofsuch systems must comply with the rules in effect at that time. WARNING SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES ANDIOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OF OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. Page 8 of 8 POWTS OWNER'S MANUAL MANAGEMENT PLAN PERMIT NUMBER; OwnerlAgent: POWTS Maintainer: Local Regulatory Authority: POWTS Installer: Septage Servicing Operator WINSAND BUILDERS -LOT #52 EMERALD ACRES Geo Tech Soil & Site Evaluation -Chippewa Falls, WI 715-723-5555 St. Croix County Zoning Department -Hudson. WI 715-386-4680 Darrell Frazer- Frazer Excavating -Bloomer, WI 715-288-6225 DESIGN PARAMETERS IntluenUtmuent quauty (va~ues typ~cai for aomesuc tnon-~;onune~c~ai was~ewaie, anu aepu~ ~a~~r, c,~~~c~,~~ Fats, Oil and greases (FOG) <30 mg/L, Biochemical Oxygen Demand (BOD) <220 mg/L, Total Suspended Solids (TSS) <150 mg/L Soil Loading Rate (SLR} = 0.4 gpolft2. SYSTEM SPECIFICATIONS The components of this septic system are intended to serve afour-bedroom (600-GPD) single-family residence. The components include a Huffcutt 1250/750 gallon septiclpump tank with an approved outlet effluent filter, a Little Giant pump alarm and controls, and (2} non- pressurized distribution cells using gravelless leaching chambers. A minimum of 78 Infiltrator Quick 4 leaching chambers are required when ann{vino an F1SA ratinn pf 19.1 as specified by DCOMM A11 Harts of the components must comply with WI Adm. Code COMM 84 and he installed per manufacturer specifications and approval letters. DESIGN CRITERIA o "Design of conventional Soil Absorption Trenches and Beds". R.J. Otis - ASAE Publications 5-77 and Design Manual - Onsite Wastewater Treatment and Disposal Systems:. EPA 625/1-80-012 October 1980 / SBD -10567-P (R.6/99) "In ground Absorption component Manual" o SBD -10705-P (N.01/01) "In ground Soil Absorption component Manual" Version 2.0 MAINTENANCE & MANAGEMENT Inspect the condition of the treatment tank(s) and dispersal cell(s) a minimum of every three years, The septic tank contents must be removed in accordance with Chapter NR 113, WI Adm. Code when the combined sludge and scum equals one-third (113) the tank volume. The effluent filter should be inspected annually to ensure maximum performance. CT ~QT !~'f For new construction prior to use of the POWTS check treatment tank(s) for 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. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of wastewater will affect the performance and longevity of your POWTS. The installation of water-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also, the brine or waste from water softeners, iron removal units, and other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. The system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced be a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins, condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics (medications), solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain regular steady flow by spreading the laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the unit may cause it to freeze up. / Alarms Alarms should be tested on a regular basis by the homeowner. If an alarm sounds, contact an individual licensed to serve rUVdTS. There is normally a one day reserve capacity under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surface. rage ~ of o ~E(`EIVE® ~ SOIL EVALUATION REPORT Paye ~ ot_3 Wi~corrsfi•Depar rtof nmerce Division of Safety a BuHdfigs Or T c~ '~ rUgi~ordar wiUr Comm 85, Wis. AJrn. Ccxle ~unly ~-~- Attadr complete plan orr paper rrot 0 1/ x res br size. Plan must ~- ' ~~ ( fidude, h~tt not tirrr d to:~Y r ~~1~bb1 al refer rt ), d bra and P81~{ {, .1~~ ~ percent~lope,scal or di ~~{g~ff~ UonWre reslroad. ~ ~-j~-did _ ass prfnf all btfvrrllatlon. ~ ~,~~%~ Rev' ed b ` Uate Pmeonel rnfomrnlron rorr prvdde met be used rw secondary purposos (Privacy LnN, e. 15.OA (1) (nr)l. PrvperlyOvnte ProparlyLocalfon ~,~ ~'v ~- GcrvL Lut ~JE 1/~1 pew 1/4 S 3p T Z°I N 11 ~"1 E (or~W Property Owner's Melling Address ~ w " Lot # I Block # I Sulxl. Name ur CSHi# ~ 5 City Slate Zip Ccx1e Phone Number iy ^ Villaye -~J't'own Idearesl Ruad cl r~ wt eat (~~~ -- ~i~l C T ~ew Construclitxt Use: ~esidenl'ral I Number of bedrvorns _~ ~_ Crx1e dorived desiyn flow rate ___~~Q_ _19~~_ GPD ^ Replacement ^ Public or cotmnercial - Uescribo: _ -___- _ ___- --_--__ <~~ ----- - Parent material ~1_!.1----- __-_--_-__ Flood Plain elevation iF apirlicable __-f l~ _~~' _ ______ R. a~itd eaclorr~irne detiorts: S~S~~e V~ e) ~ V ' 1 ~ ~ l~v ~~ti ~ Boring ~ wr~wcu~• ,--- - ( Boring # {~ _' C~'"(, ~ _ rp-~rt Ground surface elev. _________ (t. Depllt lu Ihnltiny Factor _ ~V ___ in. ___ _ __ _ _ _ _ Svl A t licalion Rate Horizon Ueptit Dominant Color Redox Description Texture Sbuclure Consistence Dow~dary Rcxtts GPUIft' _ 'EFf#1 'Elf#2 In. Munsell Qu. Sz. Coral. Color Gr. Sz. Sh. _ _ _ _ ~ ©-t2 16 yr 3 I Z -~-~--- S I I 2 ,~~ m-~ ~ ~ _ ~ v -~ . ~J - ~ Z 2 -~}~ (C> ~ J - /" c _ Zrtn.S~C m-~'r _ -- c s - . ~-I " ~v 3 ( -- s 2arS ~ ~ 5 - ~~ ~ r (0 1 ~ `~" ~ S z 5 ~ • ~. 1. (v `~ Bonng ~~ Boring # n 1~ Pit Ground surface elev. _I~`~b _ ft. Depth to limiting Factor ~~ _ in. Sotl Application Rate Horizon Deptlt Uaninant Color Redoz Description Texture Structure Consistence Boundary Roots GP D!(t= Mur sell 4u. Sz. Cont. Cobr r. h. 'EFF #2 ~ C?-~~ ld IZ ..____- Sr'I _ Zm W,-~'r _ e S I v..l _ S .8 3 ..~- s _ Z ~5 ~ i_o U - 10 $JZ- -- ~S r~, y~-~i ~ (o -- -- ~ -- - i ElFkrent tM1 = GODS ~ 30 < 220 ntyll arrd TSS >30 < 15U rrty/L 'Effluent N2 =GODS < 30 my/L and TSS < 30 my/L CST Name (Pte rfit) Siynature CST Number Address e_( /~~,~,~,~.~p " ' \ s~~ (y~ Dale Evaluation Con/ducted lelep/h,,o/n~~ Numbe'r]~ Jr'~ ~~ ~J~T- ~t~r t I~ 1 ~7--~t ~1JI `J`Il.)~ '~` ~~~~_~~` ----------~7~~~~t~.~,~~~=~- ~~ I I O' V ~~V`~ ParLel ID # ~0 t .~ ~ - - - Paye __~ of , Property Owner ___---- --- ^ Boring f ~ Boring # (~ . ~~ L ~-pil Ground sw(ace elov. -I ~ I[• De Ur tv GmiUn tactur ~ irr• P g Soil ~rplicaUrnr Rate e Slrudme Consistence Bvundary Rvots GPDIf(r Horizon Deptlr DorninantColor RedoxDesc,~iplion Textur .EIIIr Effg2 in. Mansell Qu. Sz. Crntt. Cubr _ Gr. 5z. Sh. - 2 I -Zy I 5 l ~ ~CC??~~ -x~- S - ~- ---~ - _ Z s ys~ ~ yf ~ ~ rn Z2'' 3 U Boring Boring # :Ground surface elev. __ (1. Depth Iv limiliny [actor ___ irr• Soh ~ licatlon Rate ^ Pil d B Rex>Is GPDIff Florizar UepUr in. Dominant Colvr Mansell Redox UescripGon Qu. Sz. Cont. Cobr Texture 5budme Gr. Sz. Sh. Consistence ary oun 'EIlg1 •ERg2 U Boring Boring q Ground surface elev. _____ It. Depth to limitiny factor _________ in. - ^ Pit _ Sorl ~ I'rcation Rale li i Texture SUudurs Consist©nce Boundary Rewts GP D/fF Horizon Deptlr in. Dominant Color Mansell ort Redox Desp p Qu. Sz. Cont. Cobr Gr. Sz. Sh. __ 'Eflgt 'Effg2 • Effluent #1 = BODS> 30 < 220 rnglL and TSS >30 < 150 mylL ' EUluent tY2 =BUDS < 30 mylL and TSS < 30 my(L 'hhe Ueparttnent of Cotnmercc is an equal opportunity service provider and cngrloycr. If you need assistance to access services or need material in an alternate fomtat, please contact the depatttnent at GU8-2GG-3151 or '1"1'Y GU8-2G4-8777. sno-utora.orrorrr ~' NAME: S~J-~-.._-- L,OCll~j~l.1?(ir1l,I)I:SI'IZII'"fl1)t~l:i{!EI/~1.l1Gt11i~1,`;30~1'Zq.~l,lt,/~I:(u~)~ _ -- _ - ___ --- ----- -- ~ f [$ (~wnl ELL'VA'I'ION:__-(~O ~ a__ - - -~ ~-- - 13ht 1 DL• SCRI I'"I'IOIJ:_~a~o_6 -~--_ ~. ~ ~~ ~~-_~ `- ~_e- QM 2 ELLVA'1lUN: _ _---~`~' -~~-d- __--- __- __._. ---- --- -- ~--- __- -_ ~e~ ~ _~~~ ..-._. -- E3M 2 DESCIZII'"1'IOt~I:_-~o~ d-~ f_~~~~_ ~~~~ " SYS'I'EN[ 1/LEVA'I'I~)tl:_--___`~'CP~_~d ___ _ __ __ SYS'1'Eht 'I'Y I'I',: -- - f del J eh {~,~~~( _ _ ~ , _ - _ - - a~,-~ ~ \ ~` ~~_z ~ E e~~~ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ~M~~ ~,oF~ , , ~L C ~, Mailing Address ~d~0~a- S~7S~ ~'~ - ~e~o„~k,n.c ~-'~ ,S'T-/7.T-/ Property Address erification required from Planning Departm nt for new ~ ~ ~ - City/State r~/eh6r~ton : ~ , [J~ Parcel Identification Number 0/~ - a0 // - ~~ _ ~p LEGAL DESCRIPTION .i~~~~ Property Location~L--' '/4 , iVGc/ %4 , Sec. ~?~~, Ta ~ N R 7 W, Town of ~,m~7Qn Subdivision ~l ~,, ~, ~~~ ~ ~ s /~ ,Lot #,5 Z . Certified Survey Map # ,Volume ,Page # Warranty Deed # ~~~~ ,Volume ~7~7/ ,Page # ~d3 Spec house yes no Lot lines identifiable yes 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Department within 30 days of the three year expiration date. GNATURE OF APPLICANT DATE OWNER CERTIFICATION 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 pro described above,,,by virtue of a warranty deed recorded in Register of Deeds Office (~ Y /~~/mar SIGNATURE OF APPLICANT 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 warranty deed. ~~ ~~ ~??1 ° 3Q3 - ~~ STATE BAR OF WISCONSIN FORM 2 - 1982 WARRANT' DEED DOCUMENT NO. Richard O Stout and Kernon s Ra ~+ ~~ r'(~O conveys and warrants to Timber Ridge Home.,.. LLC the following described reai estate in _~t . Croi State oC Wisconsin: Gounty, Lot 52, Plat of Emerald Acres 1st Addition, in the Town of Hammond, St. Croix County, Wisconsin A.D., ~ 2005 ernon J. ast underlying PID`s PARCEL IDENTIFICATION NUMBER 018-1067-00-000, 018-1066-90-000 018-1066-60-000 This homestead propetty. (is) ~ Exception to warranties: EaSe[RentS, restrictions and rights-of-way of record, if any. Dated this 4, ,~8'th day of March • Richard O. Stout Signature(s) authenticated this `-- -- day oC 19 T[TLE: MCMBER STATL^ BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats.) to me known co be the person~_who executed the foregoing Pamela A. Will~t~„en~aekn~wledge the same. THIS INSTRUMENT WAS DRAFTED BY Notary Public ~ ~ ~. h~ ~ M Kernon Bast State of WiSCO ~ ~ry.vvv ~ /~ amela A. Willman S ~ a ! Notary Public, St . rO1X County. Wis. (Signatures may be authenticated or acknowledged. Both are not My o Ott s oft is permanent. ([C not, state expiration date: necessary.) ~ ~L ~ ~ V 7 19 .) AUTHENTICATION (SEAL) -7 '~ t7J ~+ 8 .3 iCATHLEEIt H. WALSH REGISTER dF DEEDS ST. CRDIX CG. , MI RECEIVED FOR RECdRD 1x3/25/2005 09:10A11 NARRAHTY DEED c;YEMG" a REC FEB: 11.00 TRANS FEE: 199.70 COPY FEE: CC FEE: PAGES: 1 THIS SPACE RESERVED FOR RECORDING DATA NAME glgq ,B.ETAJBW A[aDAE~SS BK!u. l~(J~!(Tl~itltelJ 7S5A France Ave. S. First Eloor E~iana, MN 55435 ATTN: Fort C1~<ittg Central ACKNOWLEDGMENT (SEAL) (SEAL) State of Wisconsin, ss. St. -Croix Personally cart 0 0 5 re me this ~~t~ day of March, L 1~} _, the above named Richar ou and Kernon 'U'.- as - 'Names of persons signing to any capacity Should b)• typed or printed below their signatures. ,,,~,,,,,,,,r~,~,;,,,, STATE DAR OF ~V[SGONSIN Wisconsin Leoat etaroc t'.n vr. GERALD ACRES 1ST ~-uv~ 'ED IN THE NW1 /4 OF THE NE1 /4, NE7 /4 OF THE NV ~F THE NW1/4 OF THE NW1/4 ALL IN SECTION 30, TOWN OF HAMMOND, ST. CROIX ~ NTM. W~SCO X 1045, 038.2 ~~]p ~ ~~ ~~~ 1047.0 N1/4 CORNER SECT ____ -------------- ------ --- STA HED FROM: C COUNTY COOK Y "T~4 1048.3 ~ 1046.9 U N K H I_ _ -------------------- ~ ___ WA _ 3.3 X-- - 1046.3 ~- - .---, ::... _ _ .__ -- - , - Y~4 - 9~ ~ --~--•-- -- -•--•- --_ _- -_ -_ -_ ~ -,~ 040.4 .x - ~•... ~~' . ' - - - - ~X ~ ~4~ .. Y .. :.~... Q4:2.9; i ~; ~.... N i ~........ LOT ....... ...... .. . ................ ..i.... ~~ ..... ~ • 1.99 AC .. ES 18; .8 Q 86590 S FT. 1C s 6' C1,7 AC,) ' LOT ~ •~ 1046.3 34.35' ~ 2.0 AC • "7' 1.41.4 ~ X ~ 201 S , ' i 1049. 0 C1.9 ~ , i ~ ~ - i ~ i i ~ N T' i ~' ~ ~ 2, 87125 ES S FT~ in N 188.92' ~ I I I , i C1,9 C.) 1 1 t , ~ 34 5' ~ 8' , _ _ 33 ~ M 14' 217 1' 211.9 ~ ~ N ~ N i _ _ i .p ~ _ i ~ - _ I • 100' i i . i 100' i , • i i ' i ~ , I ~ ^T 5 • ; ~ 105q. + I 2,00 AC ES LOT • i , x 87124 Q. FT, 2 00 ~ L T 5 , ~ <1.8 ACJ , i 8712 ~ L T ~ 48 7 1 o5s 2,00 CR I ~ 1 ,0 P 0 1, 1 ACR . ; 8 129 Q. -~ 7 33 S FT~ ~ ~ C1,8 ,) - C1,8 C,) ' i ~ 1055.2 1 ' ~ ' ' .... .. ~ .. ..... X 1 {61.3 ........ .... . . • ,. ....... • i ' \ 0'