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HomeMy WebLinkAbout006-1042-60-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 574332 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Powers, Ryan &Alicia C Ion, Town of 006-1042-60-000 CST BM Elev: Insp.BM Elev: BM Descntion:^ Section/Town/Range/Map No: 117d `0 �Dn ' 0 bl/", r 19.31.16.290 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ZK Z S--D Benchmark Dosing ZS Alt.BM^--- W a �y C✓r. Aeration Fid s 9� Holding t Inlet 6 k- t O utlet TANK SETBACK INFORMATION TANK TO F3, take ROAD Dt Inlet Septic Dt Bottom 0-z DosingYoh lMfsy� He s an. D Q� Aeration 0 Dist. Pipe / D q(a,Z10 Holding Bot.System - -7-7 1L PUMP/SIPHON INFORMATION Final Grade 0yj Cth Z Manufacturer GPM Demand St `0 S :2. K► Model Number / TDH Lift Friction Loss System Head I DH Ft Forcemain Length Dia. Dist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length(, No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS UX -_,-` SETBACK SYSTEM TO P/L BLDG WELL - LA E/STREAM HIN Manufacturer: INFORMATION Ty f System: \ r NIT OR Mod I lumb DI R UTION SYSTEM vu - �engthjp adernf Id Distribution x Hole Size / Ix Hole Spacing Vent to Air Intake Z Pipe(s) �— V D r Dia L ength Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over X Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center /� Bed/Trench Edges Topsoil /� Yes No Yes i No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: V q Inspection#2: Location: 2032 Hwy 46 New Richmond,WI 54017(NE 1/4 SE 1/4 19 T31 R1 6W) metes&bou ds t --or- Parcel No: 19.31.16.290 1.)Alt BM Description 2.)Bldg sewer length= �5 r S �b aU 4 - (l,q 49 -amount of cover Plan revision Required? [j LJ � L , Use other side for additional information. .__- ___L_____ Date Insepctor's Signatur Cart.No. SBD-6710(R.3/97) r J ,r r of� N Yv� w o a niA w 5L e N � y n W c • O c H n ;a r j J `^ SCall 1ZI 5,a�. LL Me16I���P ��Gw�J /C ,¢ �W{�IL Q r -+ 1 County CEIVE® Safety and Buildings Division ST. CROIX 201 W.Washington Ave., P.O. BOX 7162 Sanitary Permit Number(to be filled in by Co.) s .ss _ JUL I 02014 Madison,WI 53707-7162 Ll COUNTY ` PA j 3 I ! P^ mit A - State Transactipn Number �OMmUN N �4 In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this orm late goverttmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are oie Addr s(if different than mailing address) submitted to 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. WAY 46 I. Application Information-Please Print All Information v11,u, Property Owner's Name Parcel# RYAN & ALICIA POWERS 006-1042-60-000 Property Owner's Mailing Address Property Location ` �G 835 HIGHVIEW DRIVE, APT A Govt. Lot // City,State Zip Code Phone Number NE '/4,S_ '/4, Section (circle one NEW RICHMOND, WI 54017 N/A T 31 N; R 16 EorbTJ II.Type of Building(check all that apply) - Lot# 4 � N/A Subdivision Name 1 or 2 Family Dwelling-Number of Bed orns �`✓%�' vY! 3 U i bFl tN��lo.� /�1�1�` Block# N/A t ❑Public/Commercial-Describe Use 1—ft7 D c/ N/A El City of ❑ State Owned-Describe Use CSM Number ❑ Village of N/A Town of CYLON III.Type of P (Check only one box on line A. Complete line B if applicable) A. New System El Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System(explain) List Previous Permit Number and Date Issued B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑Permit Transfer to New Before Expiration Plumber Owner I o S Component/Device: (Check all that apply) �Non-Pes-ri�ed d ❑ Pressurized In-Ground ❑ At-G/�rade,� ound > 24 in.of suiit/aaple il Mound < 24 in.of suitable soil Dispersal Component(explain)tZ �� "— retre'd�evtce( mt V. Dispersal/Treatment Area Information: Design Flow(gpd) Design Soil Application Rat pdsf) Dispersal Area Required(sf) Dispersal Area Proposed(sf) System Elevation 600 .5 1200 "� 1200 96.5 VI.Tank Info Capacity in Total #of Manufacturer .' /�" Gallons Gallons Units /� S G ,nZ "-w— U N �. New Tanks Existing Tanks 1 ��%' `�--� v o L a re U rn h rn iw C7 a Septic or Holding Tank 1250 0 1250 1 W ESER X Dosing Chamber N/A VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) P Signa� MP/MPRS Number Business Phone Number PAUL KOEHLER _ 225410 715-246-2660 Plumber's Address(Street,City,State,Zip Code) NSIN DRIVE-* NEW RICHMOND, WI 54017 rApproved De artment Use Onl Permit Fee Date ssued suing Agent S' natur ❑ Disapprov ed $ �/1J ❑ Owner Given Reason for Denial IX.Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: (� Z • C���% i 1.Septic tank,effluent filter and <3Q�1 � dispersal cell must �serviced/maintained ' as per management plan provided by plumber. setback t I tem and submi to theS ounty onlyT paper not less than 8 1/2 x 11 inches in s z , as per applicable code/ordinances. � 3 (LD SBD-6398(R. 11/I1) r r w ro U N C ,�— 1-...f. y — o t^ o o e N � Q P W or j.a Pa r LA � � 0 =H - r ' I 6 • Cap + i ?� ca J h SGaIL � �mLD �DGy�G�^ rr'\ss6 KToP �/GA�� R,v i A Lo NK fn.:1 F J OWNED BY WISCONSIN<DEPARTMENT Ps OF NATURAL RESCOCRCES ` Q 'SEC 7 LINE ski St)LtTN:/ CO • . � .'• . � . • •. ' . . ' . • ....'.-_• . .Spa°58't2'E 2643, T .. , ti 463.5 ' ` �5l7.SD' ` 340',8" r 142.64` 372,W 322.8d'` 184.4 '' S00°5812"E 26 �FE"(:E.R JuINAIlTS `tiff F11 �--{ \. `. • ', • ,' -_ .cam , V 0 m W U u-s Kri r 76 <1 r r : ZrFfa7 m � m e 0 ; 9M r 9 -i,-X4 ` r' c , I Soil Absorption System Cross Section 4" Schedule 40 ft' PVC Vent Pipe with Vent Cap Final Grade Geotextile ....... ....... ;..: .: _: Barrier Material ,T 9 7. �---- ae° System Elevation —ft Soil Absorption System Plan View ft ft g� .s ft T rench l f Trend 2 Vent or Observation Pipe EZRow Chambers Leaching Chamber Specifications Manufacturer and Model � �oa✓ EISA bating _sq.ft. per chamber Soil Application Rate _gpd/sq.ft. S Application Rate_ 5b EISA=—Chambers G�� gpd Design Flow-,r Soil App' Is rows of 00 chambers each } s l z A 8 k m 53' k j � m G U/5- \ � m £ CAS / > m 47" 4 ( 0 j 8 x _ m UP m" > cs � m a ? l \ / ,4 m 0 -0 0 0 =>e t % 50 j O> z n X m>� § En \\� § §�0 / \M i 0 m k z z z 0 0 § 2 > -n o ..� x w § b � R -f m � 2m m n z z >oz ° > > AS-'m o> w rn xm Lo z A o OCO n 29n ot> \� �¥ q m � �� > > MOO �§\ \§k �/� kN� �� z0 is F z 0" � q$k oIk ,,AFn80" �xcn� � (n �® s o § > 0 OD >m tee® ch §Eagt� §=1 p n > 2 § of § > � � 0 j� { \�§ > �Zn #0@/2� §\ 55 / \ { k § ~ 2 \ k k t m 2 § o @ 2 D m § z ne c � wo r n-> >o m ) \ \ A 2 k 22 -0 z i j z I#0 ® 0 O .. .. .. 2 -4 # 0 � � � 0-n o CD 2 q o Z -n A � 0 r am n V) O ( � o o q o/ 2 0 2 0 A q 0 m� k m > 0 z 2 c 0 ° z F w \ m20M MIEGER �����E7E game »E 2E: , ate" nD�u q g S PnC MANUAL 5420 DATE: JANUARY 2010 DATE: Kg-&R W3716 aHa � RN me « P REVISED J N 2010 800-325-8456 ,LE: m250-0 i T Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buil �� In accordance with Comm 85,Wis.Adm.Code County Attach comp ete site plan on p t less than 8'/s x 11 inches in St. Croix Include but not li �tqqd� tolUwe�Jk d horizontal reference point i d f Parcel I.D. 006104260000 Percent slope,sca�°�dimensions,nool arrow,and BM reference nearest ro CROW*l)N Rev' ed by Date ,¢ information Personal information yo hq�re used for secondary purposes(Privacy Law,s.15.04(1)(m)) Property Owner Property Location Alicia Powers Govt.Lot NE '/4 SE S 19 T 31 N R 16 w Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# 835 Highview Dr. Apt. A 7 V at/Lo, City State Zip Code Phone ❑City ❑Village 0 Town Nearest Road New Richmond WI 54017 715-220-7101 1 C lon Hwy 46 0 New Construction Use: 0 Residential/Number of Bedrooms_Code derived design flow rate 600 GPD ❑Replacement ❑Public or Commercial-Describe: Parent Material Loess over Till Flood Plain elevation if applicable N/A ft. General comments and recommendations: Recommended loading rate of 0.5 GPD/fe r y� 1 Boring# Bormg 0 Pit Ground Surface Elevation 98.0 ft. Depth to Limiting factor >84 in, Soil ADDlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-10 10YR3/3 - SIL 2-f-pl mfr Cs 2f 0.0 0.2 2 10-26 10YR4/4 - SICL 2-m-bk mfr cs if 0.4 0.6 3 26-33 7.5YR4/3 - VGRS 0-sg ml gs if 0.7 1.6 4 33-61 7.5YR4/3 - GRS 0-sg ml cs - 0.7 1.6 5 61-84+ 10YR4/4 - FS 0-m mvfr - - 0.5 1.0 Boring# O Boring OPit Ground Surface Elevation 98 ft. Depth to Limiting factor >90 in. Soil Apolication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-9 10YR3/2 - SIL 2-m-bk mfr cs 3f 0.6 0.8 2 9-14 7.5YR4/4 - VGRCL 3-co-bk mfi cs if 0.4 0.6 3 14-22 7.5YR4/4 - S 0-sg ml Cs if 0.7 1.6 4 22-42 7.5YR4/4 - VGRS 0-sg ml cs if 0.7 1.6 5 42-59 10YR4/4&3/2 - FS 0-m mfi cs - 0.5 1.0 6 59-90+ 10YR4/4 - S 0-sg ml - - 0.7 1.6 *Effluent#I=BOD,,>30<220 mg/L and TSS>30:5 150 mg/L *Effluent#2=BODS <30 mg/1.and TSS<_30 mg/L CST Name(Please Print) Si a CST Number Mark Iverson 46672 Address Date Evaluation Conducted Telephone Number P.O. Box 155 Hammond, WI 54015 June 25, 1014 715-796-5664 t Property Owner Alicia Powers Parcel ID# 006104260000 Page_2—of 3 F31 Boring# 0 Boring OPit Ground Surface Elevation 99.4 ft. Depth to Limiting factor >90 in, Soil Aimlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-7 10YR3/2 - SIL 2-m-bk mfr cs 3f 0.6 0.8 2 7-17 10YR4/3 - VGRSL 0-m mVf1 gs 2f 0.2 0.6 3 17-33 10YR3/4 - VGRLS 0-sg ml cs if 0.7 1.6 4 33-90+ 10YR4/6 - S 0-sg ml cs - 0.7 1.6 4* 33-90+ 10YR3/4 - FS 0-m mfr - - 0.5 1.0 th horizon O Boring *Layers in four 4 Boring# OPit Ground Surface Elevation ft. Depth to Limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 Boring# 0 Boring Wit Ground Surface Elevation ft. Depth to Limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 *Effluent#1=BOD5>30:s 220 mg/L and TSS>30:5 150 mg(L *Effluent#2=BODs<30 mg/L and TSS 5 30 mg1L 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. r Page 3 of 3 Oft. 24 ft. 40 ft. 80 ft. N Corner post I I Proposed House I I I I B-1 98 I I S/ I O I B-2 a u? O B-3 I 98 ° 99.4 97' BM#1-Top of "'on Pipe 10 99' I I f 100' 101' Approximate location of property line I BM#&Description Elevation = Bench Mario VB-1 Boring Location&Elevation Owner: Alicia Powers Site Information: Completed By: Mario Iverson, PSS#197 835 Highview Dr. Apt.A NE1/4, SE1/4, S19, T31N, R16 680 Larcom Street New Richmond, WI 54017 Town of Cylon Hammond, WI 54015 St. Croix County 715-796-5664 Phone: 715-220-7101 CST#46672 r _ s Parcel #: 006-1042-60-000 07/02/2014 12:32 PM PAGE 1 OF 1 Alt. Parcel#: 19.31.16.290 006-TOWN OF CYLON Current ❑X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner O-POWERS, RYAN A RYAN A POWERS C- POWERS,ALICIA D ALICIA D POWERS 1990 HWY 46 NEW RICHMOND WI 54017 Property Address(es): *=Primary Districts: SC=School SP=Special Type Dist# Description SC 3962 SCH DIST NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST Notes: SP 1700 WITC Legal Description: Acres: 40.000 SEC 19 T31 N R16W 40A NE SE Parcel History: Date Doc# Vol/Page Type 01/03/2014 990984 TD 12/09/2002 701560 2074/45 WD 05/03/2002 678090 1884/504 WD 04/04/2001 642097 1613/291 LC more Plat: *=Primary Tract: (s-T-R 40%160%) Block/Condo Bldg: *N/A-NOT AVAILABLE 19-31N-16W 2014 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 08/24/2012 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 37.000 3,900 0 3,900 NO UNDEVELOPED G5 3.000 2,100 0 2,100 NO Totals for 2014: General Property 40.000 6,000 0 6,000 Woodland 0.000 0 0 Totals for 2013: General Property 40.000 6,000 0 6,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/1712001 Batch M PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 -- - POWTS OWNEa'S �_ .... �...�..� lO z MANUAL & MANAGEMENT PLAN Page I of -2i FILE INFORMATION -'-'- Owner SYSTEM SPECIFICATIONS RYAN & ALICIA POWERS Septic Tank Capacity ❑ NA Permit # 5� �3� 1250 gal _ Septic Tank Manufacturer JFSER Q NA DESIGN PARAMETERS Effluent Filter Manufacturer POLYLOK ❑ NA Number of Bedrooms 4 4 NA Effluent Filter Model 525 ❑ Nq Number of Public Facility Units NA Pump Tank Capacity gal P Na. Estimated flow(average) 450 gal/day rlDispersal Tank Manufacturer N.q Design flow (peak), (Estimated x 1.51 600 Pump Manufacturer NA Soil Application Rate -� •5 al/day/ft2 Model N a Standard Influent/Effluent Quality Monthly average' tment Unit N.a Fats, Oil & Grease (FOG) 530 mg/L /Gravel Filter ❑Peat Filter Biochemical Oxygen Demand (BODS) 5220 rng/L ❑ NA hanical Aeration 11 Wetland Total Suspended Solids (TSS) 5150 mg/L fection 13 Other: Pretreated Effluent Quality Monthly average al Cell(s1 d N,�Biochemical Oxygen Demand (60135) :g30 m g/L ound (gravityl ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ` NA ade ❑ Mound Fecal Coliform (geometrio mean) ' u/100m1 Q [Xjp-Line p ether; Maximum Effluent Particle Size Y in dia. ❑ NA Omer: 0 NA Other: ❑ NA Other: ❑NA *values typical for domestic wastewater and septic tank effluent, Other: ❑Nib MAINTENANCE SCHEDULE Service Event Service(Frequency Inspect condition of tank(s) At least once every: ❑month(s) (Maximum 3 years) ❑Nit EI year(sl Pump out contents of tank(s) When combined sludge and soum equals one-third (Y3) of tank volume ❑ Nit Inspect dispersal cell(s) At least once every: ❑month(s) (Maximum 3 years) ❑ NEB yeads) Cican effluent filter At least once every: ❑month(s) El NIL • year(s) Inspect pump, pump controls & alarm At least once every. !0 month(s) ❑year(s) f3 NA Flush laterals and pressure test At least once every: ❑month(s) N�, Other: ❑ year(s) JP At least once every: ❑ month(s) ❑ Nei Other: 0 year(s) O N�� 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. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and soum and to check for any back up or ponding of effluent on the ground surfacs. The dispersal cell(s) shat) be visually inspected to check the effluent levels In the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a falling condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third W31 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 11:1, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION Pegg Z of Z' For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicI that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the conteril of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will b discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge c effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restorin Power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls t 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 are, 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 th4 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; ail, painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be 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 tolls and cannot be repaired the following measures have been, or,must be taken, to provide a code compliant replace ent system: ZA suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absor tkrn p P system►. The replacement area should be protected from disturbance and compaction and should not be infringed upon I)y required setbacks from existing and proposed structure, lot fines and wells- Failure to protect the replacement area K(ll 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 instatled as a last resort to replace the failed POWTS. • glue ' te o �arrk e e fZoKllb re2l' A-04 N Canrs`'TRc/ v� ❑ Mound and at-grade soil absorption systems may be reconstructed In place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules In effect at that tine. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NC T PNTIi:R A SEPTIC, PUMP OR OTHER TREATMEI T TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFiiCULT OR IMPOSSIBLE. ADDITIONAL COMMENTS r POWTS Ii11STALI,ER POWTS MAINTAINER Name COUNTRYSIDE PLUMBING & HEATING, INC Name PAUL KOEHLER Phone 715-246-2660 Phone 715-246-2660 SEPTAGE SERVICING OPERATOR(PUMPERI LOCAL REGULATORY AUTHORITY lvame POWERS LIQUID WASTE MANAGEMENT Name Phone 719- -5738 This document was drafted in compliance with chapter Comm 83.22(2)lb)(11(d)&if) and 83.54(11. (21 &(3), Wisconsin Administrative Code. S Inc. INSTALLATION INSTRUCTIONS W;E a": :`s���a� ti/ AZdmcno;?oyiaktnc PL-525/PL-625 FILTER PL-525/PL-625 FEATURES & BENEFITS Features & Benefits: e Rated for 10,000 GPD .PL-525 = 525 Linear Feet of 1/18" Filtration PL-625 = 625 Linear Feet of 1/32" Filtration PL-525 PL-625 *Accepts 4" and 6" SCHD. 40 pipe The PL-525/625 Effluent Filter should operate efficiently a Built in Gas Deflector for several years under normal conditions before :Automatic Shut-Off Ball when Filter is Removed requiring cleaning. It is recommended that the filter be cleaned every,time the tank is pumped or at least every *Alarm Accessibility three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the *Accepts PVC Extension Handle filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. RECOMMENDED PRODUCTS y Polylok PVC .Filter Extension Handle 3 3 J Risers.&Riser Covers Extend& Lok- Riser Safety Screens Filter Alarm Panel and Polylok risers bring your Polylok Extend& LokTm Polylok safety screens SmartFllterTm Control septic tank cover to grade. is a simple, easy to use prevent tragic accidents Switch This allows locating and solution that can extend from happening by children Polylok filter alarm panels servicing your filter easier the inlet or outlet pipe and and pets failing into open and switchs provid a visual and time saving by elimi- make filter and/or baffle septic tank entrances. and audible notification of P Hating digging to find tank installation a snap. im entrance. Fits 3"and 4" pipe. servici endin 9 filter and tank ng. For a full list of Polylok products please visit our web site at: www.polylok-com I i ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �'�Cl�-s.S �--tt.l gyp►- <ye���c� Mailing Addressd z0.3X Property Address "-t om.y 4A o �,Qg (Verification required from Planning&Zoning Department for new construction.) City/State `- M° Parcel Identification Number co,Iv LG 4-L - G;- cl LEGAL DESCRIPTION Property Location L--c V4 , 5:� %, , Sec. , T 1 N R 16 W,Town of Subdivision �'�-�� , Lot# Certified Survey Map# , Volume , Page# Warranty Deed # � "r a� ��" � Z Z`�� , Volume � � � , Page# Spec house y no Lot lines identifiableno SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance 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 andior(2)after inspection and pumping(if necessary), the septic tank is less than 113 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 Planning& Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe amiare the owners)of the property described above,by virtue of a warranty deed recorded in Register of Deeds Office. Number of b odd roo s S ATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.08105) -- UNOFFICIAL COPY DOCUMENT NO, STATE BAR OF SCONSIN F ORM16-1982 �I II�III I�I IIII�IIII�II��IIIIi I TRUSTEE'S DEED 8203 $ 49 Tx;4168722 990984 Darryle L.Powers and Renee A.Powers,as Trustees of Darryle L.Powers and BETH PABST Renee A. Powers,Trustees or their successors in trust under the Darryle L. REGISTER OF DEEDS and Renee A.Powers Living Trust dated December 27,1999,for a valuable consideration coveys to Ryan A.Powers and Alicia D.Powers,husband and wife ST. CROIX CO., WI Grantees,the following described real estate in ST CROIX County,State of 01/03/2014 09:09 AM Wisconsin: EXEMPT#: NA REC FEE: 30.00 TRANS FEE: 300.00 PAGES: 1 The NEV.of the SE'/,of Section 19,Township 31 North,Range 16 West, Town of Cylon,St.Croix County,Wisconsin EXCEPT lands previously RETURN TO conveyed for highway purposes in Vol.356 of Rec.,pg. 130,as Doc.No. 257295. St.Croix County Abstract&Title 219 S Knowles Avenue New Richmond,WI 54017 Tax Parcel No: 006-1042-60-000 Dated this 31 st day of December,2013. Darryle L.Powers and Renee A.Powers,Trustees or their successors in trust under the Darryle L.and Renee A.Powers Living Trust dated December 27, 1999 C/ / &-ia�EAL * Darryle L owers * Renee A.Powers ) Trustee Trustee AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN authenticated this day of 20 ss. OUNTY OF ST CROIX * TITLE:MEMBER STATE BAR OF WISCONSIN Personally came before me this 31st day of December,2013,the (If not, above named Darryle L.Powers and Renee A.Powers, trustees authorized by§706.06,Wis.Stats.) of Darryle L.Powers and Renee A.Powers,Trustees or their successors in trust under the Darryle L.and Renee A.Powers Living Trust dated December 27,1999,to me known to,be,fhe person w o exec ed the fore oing instrument and ackriowledk': e t e. THIS INSTRUMENT WAS DRAFTED BY .,;.. Lober Law Office/Robert L Lober 1316943 * Amy Palq a "� alp( '� � },•••.d•:�'�r. il• " , Notary Publ' t.Croix County,Wis. �+ My Commiss• n is permanent. ? (Signatures may be authenticated or acknowledged. Both are If not state expiration date: 10/21/17 s;`• not necessary.) .f aids I- %. r �'• ••' e�' *Names of persons signing in any capacity should be typed or printed below their signatures. I Al TRUSTEE'S DEED FORMtNO. 16-1952 St. Croix County 990984 Page 1 of 1 Community Development Department Page 2 The sanitary permit issued for installation of the POWTS requires compliance with all conditions of the land use permit and contractors must be made aware of the conditions regarding erosion and sediment control. A stormwater management design was approved by the CDD staff. It included specific details and location(s)of infiltration devices that will provide adequate capacity to handle stormwater runoff from impervious surfaces on this site. The applicant or their agent will be responsible for implementation of approved storm water management plan by installing infiltration trenches. No vegetation removal is approved outside the construction area shown in the approved plans or within 35' of the OHWM. The applicant shall record an affidavit referencing the approved stormwater management plan with the Register of Deeds prior to commencing construction(see enclosure). The applicant shall obtain all applicable permits and approvals required for construction of the house and POWTS. The contractor will need to provide the erosion control plan to the town's building inspector for compliance with Uniform Dwelling Code requirements. The applicant shall maintain all erosion and sediment control measures until permanent,self- sustaining cover is successfully established on all disturbed areas of the site. No phosphorous fertilizers shall be used on the disturbed areas of the site,unless a soil test confirms that phosphorous is needed for establishing permanent vegetative cover. Within 30 days of completing the project,the applicant shall submit to the CDD photos of the new gutters/downspouts and stabilization of disturbed areas for documentation of compliance with permit conditions. Photos may be sent electronically via e-mail attachment. Compliance deposit will be refunded after documentation received. This approval does not allow for any additional construction,structures or structural changes,grading, filling,,or clearing of vegetation beyond the limits of this request. Your information will remain on file in the St.Croix County Community Development Department. It is your responsibility to ensure compliance to or federal rules or regulations,including obtaining a building permit from the with any other local,state, g � g g To Community Develofment Dept.Authorized Staff Signature Eric: Land Use Permit LU88343 Stormwater Affidavit Cc: Building Inspector,Town of Cylon Derrick Homes,agent Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, Wl 54016 Fax 715.386.4686 www.sccwi.us/cdd www.facebook.com/Stcroixcountyw cdd @co.saint-croix.wi.us ST. C R 0 I-o:i- a S. N T Y planning&Land Information Resource Management Community Development Department August 8,2014 File#: LU88343 Ryan&Alicia Powers 83 5 Highview Dr.,Apt.A New Richmond,WI 54017 Land Use Permit for Parcel#006-1042-60-000,Section 19 in the Town of Cylon Site Address: 2032 Hwy 46 Community Development Department(CDD) staff reviewed your application submitted on August 4th for construction of a legal conforming principal structure in the Shoreland area of the Willow River. Staff determined that the proposed project meets the spirit and intent of the St Croix County Shoreland Overlay District ordinance based on the following findings: Code Proposed Project Standards &Requirements References 17.30 F.4, G.l The proposed house will be a legal conforming single family principal structure that is>75' &G.2,H.l.d. from the Willow River OHWM and outside the river's mapped floodplain boundary. Shoreland zoning district extends 300' out from the floodplain boundary. The house will meet all required structural setbacks. 17.301. There will be>2000 sq. ft. of land disturbance required for construction of the house, driveway and Private On-site Wastewater Treatment System(POWTS)within 300' of the Willow River floodplain boundary, so a land use permit is required. Erosion control measures are required during construction to prevent contaminated runoff from reaching the river. As shown on the site plan,there will be—220' between the construction area and the river. 17.30.J.I -4 The combined impervious surface area for the new house and attached garage will be 3728 sq. ft. or 0.68% of the 547,826 sq. ft.within 300' of the river's floodplain boundary. Up to 10% impervious is allowed without a requirement for mitigation. 17.30.K.1 Stormwater management is required to infiltrate 1.5"of runoff from impervious surfaces, specifically roof runoff. The site plan submitted with the land use permit included use of 5'- wide river rock drainage trenches adjacent to 3 sides of the house foundation for 1000 sq.ft. of surface area. The impervious surface calculated above will require 466 cu. ft. of runoff volume,so the drainage trenches will need to be deep enough to provide that capacity. 17.30 L.1 There is existing vegetative buffer within a 35' shoreline buffer zone from the OHWM,which has been in agricultural use,but will not be mowed to the shoreline and will be maintained with an access corridor that meets the 30%of fronta e or 30' width requirement. 17.30 P.4. A complete Land Use Permit application was submitted on 8/4/14 with the$350 permit fee. Based on these findings, approval of the land use permit is subject to the following conditions: Compliance Conditions for land use permit approval Date A pre-construction on-site meeting must be scheduled with the CDD staff to document pre- construction site conditions and verify house/driveway location. Erosion control measures (sediment logs)will be installed between disturbed soil areas and the structural setback to the Willow River OHWM. This will provide a visual limit for contractors working on the house and maintain an adequate buffer zone. Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, WI 54016 Fax 715.386.4686 www.sccwi.us/cdd www.facebook.com/Stcroixcountyw cdd(u)co.saint-Croix.wi.us 1 ST. CRO NTY LAND USE PERMIT File#: rs��rasr�r APPLICATION Office Use Only Revised 02-2014 Property Owner: 9�IA4-� Qa�-0.5 Contractor/Agent: OE ��i✓� Mailing Address: X35 ktotSy ORjyF- AST A Mailing Address: IF-0, N'�� Q1C.�Nn`\�Oti lNl ��`� �(�J fZiLllrJ�t7rJ�i Vill �i'bl"] Daytime Phone: ( COSO ) 244 %S17b Daytime Phone:(�i5 ) 24 '2320 Cell: ( ) Cell: ( — ) E-mail: E-mail: Site Address: 1i�`� �� I ) 12lCA1*W-0) WI S4o)'I Property Location: � 1/4,e-Df 1/4,,Sec. ko'\ ,T. 3l N., R. I LP W.,Town of G�LvtJ Computer#: �- - 10 - 0 parcel#: ©0L0 1042 (,O(:> oc)p Zoning District(Check one): D AG. D AG. II D AG. RES. D RESIDENTIAL D COMMERCIAL D INDUSTRIAL Overlay District(Check all that apply): D SHORELAND D RIVERWAY D FLOODPLAIN D ADULT ENTERTAINMENT Type of Land Use Permit Request(Check one): D Lower St.Croix Riverway District $350 D Wireless Communication Tower(Co-location) $350 JK Shoreland $350 D Temporary Occupancy $350 D Signage $350 D Nonmetallic Mining Operation $550 D Floodplain $350 D Animal Waste Storage Facility $1,000 D Grading& Filling, 12-24.9%Slopes $350 D Livestock Facility $1,000 D Other: D Permit processed in conjunction with a Land Division,Special Exception or Variance $50 State the nature of your request: �,,.,,,,4A-3'3J L)-"- I W4YIN T" F0?- 46,f-Wf �-b� IqWb t IS' 0-.P`-N(.0 Ul//� 36D "a,<� 0q6QAAing Ordinance Reference T I attest that the information c d i is application is true and correct to the best of my knowledge. Property Owner Signature: Date 2 / Contractor/Agent Signature: Date Complete Application Accepted: l tl By: f Fee Received: /� y$ 3 —0—V Receipt#: 715-386-4680 St.Croix County Government Center 715-386-4686 Fax cdclOco.saint-croix.wims 1101 Carmichael Road,Hudson,WI 54016 www.sccwi.us/cdd A 'd t � 5wze�c� a�N m O ¢ 1J3fOtld O V I I •.b;ty •7' -ei +i7 d _.® � ON p ; •�� y� I r l� ill I 4 s d :I I j � — �\ �� �� ,, �, �I •'� � 3 I`r ul � 'fit ° % . 1 E �- i I � <� si � - I I�I I � ��� •� �I `I.'y j,z^z��-'�./=3 `�c';• - :z ,'<<,T–n-� '1-z r I l '� 1