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HomeMy WebLinkAbout030-1073-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 574366 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: Graveen & Helms, Steve& Mary Jo St. Joseph, Town of 030-1073-20-000 CST BM Elev: Insp.BM Elev: BM Description: `]`� Section/Town/Range/Map No: 1167-Ap 8 -3 G� ( 26.30.19.255E TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �J�J �I�� / !Z/Q Benchmark �• � • �az r Dosing 1 i a Alt.BM .....� P 766 ; 7.z ADM, puff- V Bldg.Sewer .—f Cum- C Holding St/Ht Inlet 13. 9 Z• J TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent Air Intake ROAD Dt Inlet ` \ Septic y 5.a 3�I _ •^ Dt Bottom Dosing � 5,a/ • J� � � ,_.-,� Header/Man. Aeration �v Dist. Pipe ' 7. °3 T"Z 7, � c:r 7.' Holding Bot. System `rte '47.Z Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover �,� GPM 4- lei l -A- . ZMOP Model Number 5'.3 3 /1Z TDH Lift 1. FrictionOLoss System Hea n- TDH/ Ft Forcemain Length i 'Diaz Dist.to well ! ' 66 SOIL ABSORPTION SYSTEM DIMENSIONS Width ILength No.Of Trenches s �4r ^ PIT DIMENSIONS No.Of Pits Inside D_ia� Liquid d SETBACK SYSTEM TO P/L V BLDG WELL/�! LAKE/STREAM LEACHING Manufacture( INFORMATION CHAMBER OR X. V, /� TY ,,, 4 a.t, �to "7'D A UNIT Modgl N�mber s�c�.,eV DISTRIBUTION SYSTEM /t/ ZO 3.e l = Header/Manifoll 11 Distribution \ x Hole Size x Hole Spacing Vent to Air Intake g� 'T Pipe(s) �Bia '\ \ ` 415 Length Dia Length Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only •�'°�'` Depth Over Depth Over xx Dep of xx Seeded/Sodded xx Mulched d' Bed/Trench Center ' Bed/Trench Edges �„�\ Topsoil Yes No Yes No �S Q.n�rJ t COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 1350 Awatukee,�T�ail Hudson,WI 54016(Gov't Lot 6 26 T30N RI 9W) NA Lot 2 P rcel No: 26.30.19.255E 1.)Alt BM Description= fl"�- 2.)Bldg sewer length= 33 '`t 5 ka.,Q -amount of cover= 1 Z-1 Plan revision Required? [ ] Yes No Use other side for additional Information. — _� _ L_ _�Insepctoes __Date nature Cert.No. SBD-6710(R.3/97) PLOT PLAN PROJECT Steve Graveen ADDRESS 16616 Eaale Ridae Dr. Minnetonka Mn 55345 1/4 1/4S 26 /T 30 N/R 19 W TOWN ST. Joseph COUNTY ST.CROIX SYSTEM ELEVATION 98.0/97.5/97.0 5' below grade DATE 9/2/14 BEDROOM 4 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE765 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambe S 60 BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. Vent Scale = 14" = 10, >6„ Quick4 Standard of Cover Leaching Chamber AwatukeeTrail with 20.0 ft2 of Area 5.6ft^2/pair of end caps 4' Long 12" Grade at System Elevation 34" 556' Property Line 82' cells with>3' spacing -31 7% Slope yD Vents B-2 �� 150' Accessory Building 30 275' 103' t -1 ► ��;�� . �� 5' S L U�� 90' 01' 30' S B.M.* 5 Huffcutt Combo Tank Hoe. �,a� Co G s 15' Pro 4 Bedroom House 353' Prop erty Line 8 2 5 4 5 5 4 T Document Number Document Title I rx:4208137 St. Croix County 1001389 BETH Affidavit for a single POWTS ETA PABST©� ���®� REGI�TEI� servicing Two Structures via.Private Interceptor Main ST. tSTOIX CO., WI S�'eu L<r'cii/ cer.) RECEIVED FOR RECORD Name—(Owner)Typed or printed 09/04/2014 4.19 PM being duly sworn,states,under oath,that: EXEMPT#„ He/she is the owner/co-owner of the following parcel of land located in St. RE`s FEE' 30.00 Croix County,Wisconsin,recorded in Document Number 995206,Vol:- COPY FEE: 2.00 Page — ,St.Croix County Register of Deeds Office: Recording Area PAGES: 1 A parcel of land located in the S W'/o of the NW'/a&Gov't.Lot 6 of Name and Return Address Section 26,T30N—R19 W,Town of St.Joseph,St.Croix County, Steve Graveen or Mary Jo Helms Wisconsin,being duly described as follows(include lot number and 16616 Eagle Ridge Drive subdivision/CSM or detailed legal description: Minnetonka,MN 55345 Lot 2 of Certified Survey Map recorded March 21,1991 in the Office of 030-1073-20-000 the St.Croix County Register of Deed in Volume 8 of Certified Survey parcel Identification Number(PIN) Maps,page 2325. As owner of the above described property,I acknowledge that a Private On-site Wastewater Treatment System (POWTS)serving the primary residence is sized for 4 bedroom(s)with a design wastewater flow of 600 gallons/day (DWF is based on 150 gpd/bedroom @ 2 persons per bedroom). A maximum of 8 occupants are permitted;if the number of occupants exceeds the maximum for POWTS design,the system will be undersized to accommodate increased wastewater flows and/or contaminant loads and may be subject to premature failure. An accessory structure NOT to be used as a 2"d dwelling has been connected to the POWTS via Private Interceptor Main Sewer(PIMS)in compliance with SPS 382.30(12). I understand that disclosure of this information will be made to any patties interested in purchasing this property in the future. Dated this dayof %-PPleJ71117f['.2014. 42Z.err, , q S * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OFD ) I N ) �»�t h.. � ss. S Grerrx County. ) authenticated this day of Personally came before me this 4' J day of (year) ' stir) 20 h-( ear the above named r- TITLE: MEMBER STATE BAR OF WISCONSIN to me known (If not, to be the person(s)who executed the foregoing instrument and acknowledge the same. Authorized by§706.06,Wis.Star.,) THIS INSTRUMENT WAS DRAFTED BY s Pamela Ouinn,Land Use Specialist Community Development Dept. Notary Public,State of Yea 1 t�j (Signatures may be authenticated or acknowledged. My Commission is permanent. If not,state expiration Both are not necessary.) date:Wit\ 3l I 2�D1 S Date: j AN EARL BEWH�Ai'3DUS NOtZlry Public Minnesota ion Expires J 31,2018 "THIS PAGE IS PART OF THIS LEGAL DOCUMENT—DO NOT REMOVE" This informatlon must be contpleled by submtlter: document Lille.nanre&rettern address.and PIN(f required). Otter infonnation such as the granting clauses,legal description,em nrav be pt—d on this first page of the document or ntay be placed on additional pages of the do—neru.Noter Use ofthis cover page adds one page to your document and$2.00 to the meQrdin fee_ Wiseomstn Statutes,59.43. County— I Safety and Buildings Division Tb iO�,k 201 W.Washington Ave.,P.O.Box 7162 SimitaryPermit.Number(to be filled in by Co.) %3 707-7162 Madison,W1 53 PAID Stew Transaction Number Sanitary Permit AppliZkiDn In with SPS 38321(2),Wis.Adm.Code,submission of this form to the appropriate governmental .it is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project AddresAW"I z=l thanpailinj add-W the Department of Safety and Professional Servies. Personal information you provide may be used for secondary -3�Z, k­e-� pLaposes in accordance with the Privacy law,s,15.04(1 Xm),Stat& L Application Information-Please Print All Information Property Owner. N -TO Parcel 75L.20 ' —1 0`7 —2 n cL-j-e�� Property Ow&�MaT�Addrcss Property Loc;ation 16 1 JL i" r Govt.Lot 6 City,State Zip Code 4'Phone Number 1/-1 1/4, Section circle oamp-N Lot T,12 N, R —Ee II.'PjW of Building(check all that apply) il Subdivision V1 or 2 Family Dwelling-Number of=law Block ork 0 C3,5 ❑Public/Commercial-Describe Usc6 zt 1 0 City of I L7 ❑State Owned-Describe Use CSM Number 0 Village Of own of III.Tywuqulwmit: k only one box on line A. Complete line B if applicable) A- (� S ❑Replacement System ❑Treatmentffioldig Tank Replacement Only ❑Other Modification.to Existing System(explain)ew B. ❑Permit Renewal ❑Permit Revision ❑Change of Phunber ❑Permit Transfer to New Last Previous Permit Number and Date Issued Before Expiration I I I Owner IV.IM of P0WTSSy&WComponent/Dcvice: (Check all that apply) ❑Pressurized J.-Ground Q At-Grade ❑Mann >24 iTL gf"swtable Mound<24 in.of suitable soil []Bolding T.k ❑Other Dispersal Component(explain),;I IC C ce v Dei , �.(e)V -A V.Dispersal/T reatment Area Information: -/,, --- U7(-, ��-L'�O_ A ?-&YJLQ.., Flow(gpd) Design Soil Applic"Rato(gpdsf) Area Required Area Proposed(sf) SX92m. V V I (sV Dispers!� E"on rr�o .0 -5- 1 Y81 VL Tank Info Capacity in To #Of Manufacturer Gallons Gallons Units New Tanks Existing T=ics Septic or Holding Tank Dosing Chaniber VII.Responsibility Statement-1,the undersigned,assume bility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber' MP/MPRS Number Business Phone Number C., I , Plumber's Address(Street,City.State,Zip&A) VIM Corn /De artinent Use Only I Permit Fe Date Issu "S.gn, Approved ❑Disapproved $ Fee for Denial Issuing 0 Owner Given Reason IX Conditions of Approval/Rusons for Disapproval SYSTEM OWNER 1.Septic tank,effluent fliter and /VA dispersal cell must be-sa maintained as per management plan provided by plurnber- 2.All setback requirements must be maintained as per applicab*00J@A000ft06a%r the rjsftm and submit to the C as pow t Wn than size SBD-6398(IL 11111) h, Private Interceptor Main Sewers Comm 82.30 (12)— • =Cleanout ,d ffi 4"Pic Not a PIMS when Building 2 separate pipes Sewer y are used in approved Directional Fitting inlet/outlet ,� POWTS acc s`�lz openings Private �-- Interceptor { openings are not Main Sewer Holding i5o sidered Tank cleanouts because Watertight Tank Joints ?� Pipe to tank joints must be an approved type as well as watertight y , ♦ we ur �I Ali No concrete joints, openings cast in place or smooth bored. Private Interceptor Main Sewers 1 July 1, 2002, Comm Table 82.20-2 14 inch diameter private interceptor main sewers no longer require department review Counties should review designs ,.- Code change pending regarding department reviews for 2 buildings served by one POW I-S 1 Defined: Means a privately owned sewer a� serving 2 or more buildings and not l �- w directly controlled by a public authority I b A kt, Private Interceptor Main Sewers Comm 82.30 (12) 1 Setbacks, pitch, • =cleanout installation same as r✓ =a"PVC for building sewers Building Comm 82.30(11)(c), Sewer (d),and (e) 1 Frost protection same as for building Private Directional Fitting sewers Interceptor Frost Sleeve 1 nout required at Main'Sewer the m0 co in Direction point of the PIMS Holding of Flow See Comm 82.35 Tank �_ 1 Cleanouts <= 100 ft Access Road apart. Cleanouts L.. ... • require a frost sleeve Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 9/2/14 Owner: Steve Graveen Location: Govt Lot 6 S26 T30 N,R19W Lot 2 Awautukee Trail St. Joseph System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Pressure Distribution Manual (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet 8. Dose Tank Cross Section 9. Pump Curve 10.-12. Soil Test Signature License nu er#226900 PLOT PLAN PROJECT Steve Graveen ADDRESS 16616 Eaale Ridae Dr. Minnetonka Mn 55345 1/4 1/4S 26 /T 30 N/R 19 W TOWN ST. Joseph COUNTY ST.CROIX SYSTEM ELEVATION 98.0/97.5/97.0 5' below grade 9/2/14 BEDROOM 4 DATE CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE765 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambe s 60 IL BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 100, Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. Vent :Scale = 1 /4" = 10' >6" Quick4 Standard of Cover Leaching Chamber AwatukeeTrail with 20.0 ft2 of Area 4' Long 12" 5.6ft^2/pair of end caps 34" Grade at System Elevation 556' Property Line 3-3' X 82' cells with>3' spacing B-3 7% Slope Vents B-2 150' Accessory 30' 275' Building 103' -1 -r 011� 45' 90' 101' 30' B.M.* 5 Huffcutt Combo Tank CO 15' Pro 4 Bedroom House 353' Property Line Cross Section of Quick 4 Standard Leaching Chamber Typical cross section for 2 of 3 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 102.0' Vent Grade ent 4' 4" AV A�30/34 Septic Tank 1"4' Long 5' bo Grade at System Elevation 3 4" Grade at System Elevation 3 4" Spacing 5' 3-3' X 82' Cells Observation tubeNent Same on other end To be located on end of Cells A B System elevations: C A-98.0' B_97.5' 20 chambers per cell C-97.0' Septic-Dose Tank Cross Section And Pump Performance Specifications ---------- Tank-Manufacturer Pump Manufacturer Tuck Model Pump Model Number 6 Total Tank Capacity I -5-- Alarm Manufacturer a—& CA>,r d,Ss- -7. Max. Bury Depth 9 Alarm Model Number DL—, Switch Type 177 Q c Filter Manufacturer 23 Total Dynamic Head(TDH) Feet Elevation Head Filter Model-Number Distal Press= Network Loss Minimum Pump Performance Required Force Main Loss GPM!I A, &7, 2 Ft-fDH . Total Outlet Manhole Min.4"Above Grade With Manhole Min.4"Above Grade Locking Denim Inlet Manhole With Looking Device <6"Below Grade Sealed Watertijzht Securely Mounted Weather-proof Junction Box Now •NIN Finished Grade OWN UPON NNN, NNN` Vent Min. 12" Disconnect Above Grade Means With Vent Cap X Outlet Filter ------ Wet Baffle ------- - Inlet A Switch Settings and Reserve Capacity '/4 GPI Weep Tank Volume = F7 IX Hole Gal. B X, Dimension. Inches Volume G (reserve) A: ;26,5- Vs-D, -5' X (alarm) B 2 ,3 Off Elevation C Z 0 Ft (dose) C -2, Bottom Elevation (dead) D, D 2, Total 2 6-� Ft c d GENERAL INSTALLATION-. The septic/dose tank is bedded and back filled in accordance with the . Max Um depth of bury as specified by the manufacturer may not manufacturer's product aPPrOvId specifications iin de ac be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.2x. 02/05 U Page—of ,C AL DYNAVC 1---AD DFR %'T I E 1�T HEAD CAPACITY Cl-RVE V G D E S 53/155/57/59 25 ` /59 53/5 /57 i e 20 N e e, < 4� 0 < off Hcc- 27 f+ (5, r, 5 L /2 0 0 30 40 U.S. GALLO'NS !TERS ao 1160 6 L D' N " PER MINUTE 009897 Variable level float switches available. Variable level long cycle systems a vailable. Available with special cord lengths of 15', 25', 35' and 50'. Alarm systems available. Duplex systems available. --71 SK858 Single Seal Control Selection List ngs Model , volts;7 Phase Mode Amps Simplex Duplex CSA UL i 1. Integral float operated mechanical s witch no external control required. M53155&M57/59 115 1 Auto 97 1 Y 2. Single piggyback variable level float switch or double piggyback variable level 1 K53T66-g—N57/59—1 Non 9.7 2 3 or Y Y �15 float switch.Refer to FIV10477. —:4�7 I .--- Y Y 3. M -0075, BN53 115 1 Mechanical alternator"M-Pak"10-0072 or 10 BN57 115 Auto 9.7 N --2L 4. See FM0712 for correct model of Electrical Alternator. E595-7— 230 4—8 � Y Y --653/55&D57/59 230 Auto 48 Y Y 5. Variable level control switch 10-0225 used as a control activato with Electrical E53t55&E57/59 230 1 —N Alternator(3)or(4)float system. Non Single piggyback switch included. 'ACWG-T��I§—N ' For information on additional Zoeller products reterto catalog on Piggyback Variable Level Float Switches,FM0477; 21 Electrical Alternator,FM0486;Mechanical Alternator,FM0495;Sump/Sewage Basins,FM0487;and Single Phase i-- Simplex Pump Control/Alarm Systems,FM10732. 7�7 t For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O.BOX"R*11? Louisville,KY 4025o•c' Manufacturers of.. SHIP TO. 3649 Cane Run Road Louisville,KY 40211-1961 -2731.1(800)928-PUMP ,�7Lwlrr jaLIA05-9 FINr/09 (502)778 http.-IAvww.zoeller.com Aff"W fff. FAX(502)774-3624 @Copyright 2002 Zoeller Co.All rights reserved. POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner { Tank Manufacturer: #1-4 Gutk ❑ NA _. Se tic ❑ Dose ❑ Holding Volume:: (9 al )Permit# � DESIGN PARAMETERS Tank Manufacturer: ❑ NA Number of Bedrooms: ❑ NA ❑Septic ose ❑ Holding Volume: (gal) Number of Public Facility Units: -NA Vertical Distance Tank Bottom(s)to Service Pad, O '� (ft) Estimated(average)Flow: (gal/day) Horizontal Distance Tank(s)to Service P �- (ft) Specific servicing mechanics must be provided If vertical is>15 feet or Design(peak)Flow=(estimated x 1.5): (g01/day) If horizontal is>150 feet. Specific instructions to be provided on back. In Situ Soil Application Rate: CL-Z fl . ❑ NA Standard(Domestic)Influent/Effluent Monthly average.. Effluent Filter Model: Fats,Oil&Grease (FOG) s30•mg/L Pump Manufacturer: �1��� ❑ NA Biochemical Oxygen Demand (SODS) s220 mg/L ❑ NA Total Suspended Solids(TSS) ''150 mg1L Pump Model: 3 High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L / Manufacturer. L .. B.ODS) >220 mg/L A ( ' SS) >150 m /L ❑Mechanical Aeration Peat Filter Effluent Monthly average C1 Disinfection El wetland Pretreated E y g ❑Sand/Gravel Filter ❑Other. (SODS) s30 mg/L Soil Absorption System (TSS) 530 mg/L -XN& Fecal Colfform(geometric mean) s10` At-Grade (gravity) ❑Mound and(pressure) ❑ NA Maximum Effluent Particle Size X in dia. ❑ NA ❑Drip-Line ❑Mound ❑Drip-Line ❑Other: Other: NA Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) hen combined sludge and scum equals one-third(%)of tank volume ❑When the high water alarm is activated every:l Inspect condition of tank(s) At east once eve month(s) (Maximum 3 years) ❑ NA p ( ar(s) Inspect dispersal cell(s) At least once every: 3 m th(s) (Maximum 3 years) ❑ NA month(s)Clean effluent fitter At least once every: �l 1 earls) [I NA Inspect pump,pump controls&alarm At least once every: �j qs�s) C1 NA Flush laterals and pressure test 'At least once every: ❑ . Imonth(s) ❑ NA ❑yeags) Other At least once every: ❑month(s) ❑ NA ❑year(s) Other: ❑ NA I MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). Tank inspections must include a visual inspection of the tank(s)to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The soil absorption system shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third(%)or more of the tank volume,the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper)and disposed of in accordance with chapter NR 113, 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<12 months,shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. GMW-005(02/05) 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, solvents or other chemicals or sediment that may impede the treatment process'and/or damage-the soil absorption system. If high concentrations are detected have the contents of the tank(s)removed by a Septage Servicing Operator(pumper)prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator(pumper)prior to restoring power to-the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. 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. keduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the treatment tanks and soil absorption system: acids, antibiotics, baby wipes,-cgarettWbutts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump)discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps,medications,oils,painting products, pesticides,san"ry napkins,solvents,tampons,'and water softener brine discharge. 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 s. Comm 83.33,Wisconsin Administrative Coder • All piping to tanks,pits and other soil absorption systems 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(pumper). • 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 the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and baring advances in POWTS technology,a holding tank may be installed as a last resort. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biornat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINTAINER. Nam "'' f- Name S Phone �-, b Phone SEPTAGE SERVICING OPERATOR UMPER LOCAL REGULATORY AUTHORITY Name Name _ u Phone Phone -7/,_�-2,0 4 -�la 9/2 '/ d This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d)8(f)and 83.54(1),(2)8(3),Wisconsin Administrative Code. FILTER CARTRIDGE INSTRUCTION S instaftban entered.1 Dry at the rjW case=tii the Md Of the Outlet Pipe to ensure it is entered under the access opening. If not,then other insart in tank through the outlet or"ant weld(give)additional pi ore pipe into the pipe- tank onto the outlet S7'Er'2 While the ca"is still dry fitted an the outlet pipe,measure the length Of%-'FKA 0"needed to brace the After to the tank and wal if uhumng the groped to t=o*AW"wnftww"side supp-L If side support method.is not utilized, 3 For irdtWhitions utftng the Optional supplemental side support: solvent We'd the'%-itch Pipe*"to the Altar case. If side support math6d is not utilized,proceed to step four, Solvent Weld the After case ont)o the outlet pipe. cartridge into the case, Pressing down untM the filter locks Insert the Ater the case. Into the bottom of If a VRS switch is utilized:!DsW into the filter and fork bV turning clockwis*9(r. Maintenance 1. The effluent filter should be cleaned every time the septic tank Is serviced. 2. Open the Outlet access opening to Inspect the tank and Aker. 3. PUMP the septic tank completely,making sure to remove the sludge layer an the bottom Of the tank and not just this scum and effluent. 4. Once the Offts"t level has been lowered below the invert of the Outlet Pipe,firmly Pug up On the filter handle to dislodge the cartridge from the case. .4 S. Slide the cartridge up and Out Of the case for cleaning. 6. It a VP-S switch connected to an Warm is present,the switch should be removed by turning counterclockwise go*and deaned with water Only. 7. While holding the cartridge an ks side(large flat surface facing down) only,mating the access opening,rhiss Off the cartridge with water &king sure all 8"0 Material 15 rinsed back into the tank. a- If VRS switch is utilized ',r"lace by inSOrtinG into filter and turning clockwise wo. 9- Insert the Altar cartridge bacic into the case,Pressing down until the filter locks into the bottom of the case. 10-RaPlace and secure the access opening On the tank. 7, -wool, WWW'beWendt"On' 877-MALTERS(034583) Wisconsin Departm to om erce SOIL EVALUATION REPORT Page/of Division of Safety n di in accordance with Comm 85,Wis. Adm. Code County � Attach co to site Ian on paper not less than 8 1/2 x 11 inches in size.Plan must rn indude,b mi ed to:vertical and horizontal reference point(BM),direction and Parcel I.D. percent slopair9cale or dimensions,north arrow,and location and distance to nearest road. Please print all information. Reviewed by to Personal informatio y1ovide may be use or secondary purposes(Privacy law,s.15.04(1)(m)). S O � �. P erg 7 Property Locatign (/N O/ J� r C; �+ ' G L Govt.Lot 1/4 S z� R E( W Prop4o or's Mailing Address Lo Block# Subd. Na or CSM# 6 Ll J city State 74 Code Phondf Number ❑City ❑Village own Nearest Road X New Construction Use;&Residential/Number of bedrooms Code derived design flow rate 6 G/f GPD ❑Replacement ❑ Public or commercial-Describe: Parent material &,c e- 7.t/CL Flood Plain elevation if applicable General comments and recorrunendations: System Type 'Iaf "P / - System Elevation__ ►o F T1 Boring# Boring Pit Ground surface elev/ ft. Depth to limiting factor r in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. i -Eff#1 I -Eff#2 Z 27-1 S �--- 5— e!52SQ2 X a Boring# F�q f❑1 Boring ---JJ�/ I[�, Pit Ground surface elev.�b—�—ft. Depth to limiting factor_/,C-/in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 •Eff#2 I Effluent#1=BOD >30<220 mg/L and TSS>30<150 'Effluent#2=BOD <30 mg/L and TSS<30 mg/L CST Marne(Please Print) Sig a CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Condupted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 �/-Z 715-246-4516 Property Owner_ Parcel ID# Page of Boring# ❑ Boring Pit Ground surface elev. (L I �ft. Depth to limiting factor in. ARootsGPD/ff Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#2 2 � D I r r 7 F-1 Boring# ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I 'Eff#2 ❑ Boring Bodng# Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD5 130 mg&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(8.6/00) Soil Test Plot Plan Project Name Steve Graveen Shau ird Address 16616 Eagle Ridge Dr. Minnetonka Mn 55345 C M #226900 Lot 2 Subdivision ---°°-- Date 4/14/14 1/4 1/4S 26 T 30 N/R19 W Township St. Joseph Boring Q Well PL Property Line County ST. CROIX , BM or VRP Assume Elevation 100 ft. Top of 1" pipe System Elevation TBD *HRPSame as Benchmark Scale is 1" = 40' unless otherwise noted AwatukeeTrail 556' Property Line B-3 20' B-2 150' 110' 7% Slope 103' 30' 275' -1 45' 101' 30' B.M.* 353' Property Line ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP k"'O' CERTIFICATgIION FORM�Owner/Buyer C� �� ��U u�_I/°q r V too- q12 (Vht Mailing Address�� I_ _r'� !fl. 553Y Property Address — (Verification required from Planning&Zoning Department for new consttdtion.) City/State '�i�tQ . �.' Parcel Identification Nuraber 030 -/0-73—d-)- LEGAL DESCRIPTION Property Location '/4 , '/4 , Sec;. T30 N R W, Town of Q, Subdivision _ , Lot# . Certified Survey Map # z , w4ume ,Page#0- Warranty Deed# L?l Voitune , Page# Spec house yes no l,ot line;; identifiable yes o 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,ii 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&Zonmg 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 Planning& Zoning Department within 30 days of the three year expiration date. 1/we certify that all statements on this form are true to the best of my/our k.aowledge. I/we andare the owner(s)of the property desc ' ed above,by virtue of a warranty deed recorded in Register of Deeds Office. Numbe edroo SORMTIkE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being ro.voked by the Planning&Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a co of the certified survey ma if PP ty g PY Y P reference is made in the warranty deed. (REV.08/05) 995206 BETH PABST REGISTER OF DEEDS STATE BAR OF WISCONSIN FORM 2 - 2000 ST. CROIX CO., WI Document Number WARRANTY DEED RECEIVED FOR RECORD 04/28/2014 08:02 AM THIS DEED, made between Virginia D. Palmer, a single EXEMPT # NA person, Grantor, and Steven Graveen, a single person and REC FEE: 30.00 Mary Jo Helms, a single person, Grantee. TRANS FEE: 170.70 Grantor for a valuable consideration, conveys and warrants to PAGES: 3 Grantee the following described real estate in St. Croix County, **The above recording information Wisconsin: *as Joint Tenants verifies that this document has been electronically recorded SEE EXHIBIT"A"ATTACHED HERETO AND MADE A PART &returned to the submitter HEREOF Recording Area Name and Return Address: Edina Realty Title, Inc. 400 South Second Street, Suite 115 Hudson, WI 54016 1058796 Exceptions to warranties: 030-1073-20-000 Easements, restrictions and rights-of-way of record, if any. Parcel Identification Number(PIN) This is l,uT homestead property. Dated this April 17, 2014 P-'0"' Virginia . Palmer WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000 St. Croix County 995206 Page 1 of 3 I AUTHENTICATION AC KNOWLEDGMENT Signature(s) STATE OF 1A/(3 60 j2n(� COUNTY OF authenticated this April 17, 2014 r _ Z Personally came before me this �1 * the above Virginia D. Palmer, a single person to me TITLE: MEMBER STATE BAR OF WISCONSIN known to be the person or persons who executed the (If not, foregoing instrument and acknowledged the same. authorized by§706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Martin D. Henschel Cheri Brown 6800 France Avenue South, Suite 410 Notary Public, State of Wisconsin Edina, MN 55435 My commission is permanent. (If not, state the (Signatures may be authenticated or acknowledged. expiration date: 03/01/2015) Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature. s C6RR�BRo r,�TRo�gyA�ewN . 40 WARRANTY N WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000 St. Croix County 995206 Page 2 of 3 Exhibit A Legal Description Part of Government Lots 6 & 7 of Section 26, Township 30 North, Range 19 West, Town of St. Joseph, St. Croix County, Wisconsin, more fully described as: Lot 2 of Certified Survey Map recorded March 21, 1991 in the Office of the St. Croix County Register of Deeds in Volume 8 of Certified Survey Maps, page 2325. WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000 St. Croix County 995206 Page 3 of 3 Parcel #: 030-1073-20-000 05/05/2014 11:51 AM PAGE 1 OF 1 Alt. Parcel M 26.30.19.255E 030-TOWN OF SAINT JOSEPH Current ❑ 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-PALMER, VIRGINIA D VIRGINIA D PALMER 2020 GOODRICH AVE ST PAUL MN 55105 Property Address(es): '=Primary Districts: SC=School SP=Special Type Dist# Description SC 5432 SCH DIST OF SOMERSET SP 1700 WITC Notes: Le -Det6iiption: Acres: 3.000 SEC 26 T30N R19W SW NW&GL 6 BEING LOT 2 CSM 8/2325 EXC PT TO AWATUKEE TR Parcel History: Date Doc# Vol/Page Type ° '..,. 07/23/1997 1207/418 WD 07123/1997 1078/180 RD -- — 07/23/1997 734/571 07/23/1997 675/617 Plat: *=Primary Tract: (S-T-R 40%160%) Block/Condo Bldg: "N/A-NOT AVAILABLE 26-30N-19W 2014 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/12/2011 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 49,400 0 49,400 NO Totals for 2014: General Property 3.000 49,400 0 49,400 Woodland 0.000 0 0 Totals for 2013: General Property 3.000 49,400 0 49,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 OJAMESaCONINELL 4 67'432 CERTIFIED SURVEY MAP I�Cc)rv��io�,� LOCATED IN PART OF GOV. LOTS 6 & 7 OF SECTION 26, T30N, R19W n ALLEN C. TOWN OF ST. JOSEYt:, ST. CRUIX COUNTY, WISCONSIN. MYFfAGEN S-1407 NW CORNER + HUDSON, s SECTION 26 m W COUNTY MONUMENT LEGEND +�< R'! :ope�p Ln • 1" x 24" IRON PIPE WEIGHING 4 1.68 LBS/LIN.FT. SET. r NORTH LINE GOVERNMENT LOT 6 • 1" IRON PIPE FOUND. t S89 28'48"E 1600.76' z CD 0 .+ t� to \ N s-. A - y W �. ,•_,° CENTERLINE CURVE DATA o =" `O p = 62'J2012611 cn ti proposed-CSM R - 247.97' o - - --' --- L = 269.80' C = 256.69' z to E W 1/4 CORNER CB = N58°18'35"W r SECTION 26 _ �f COUNTY MONUMENT R/W CURVE DATA = 62 20'26" � n 287.68' N89028'4811W R = 214.97' C v N89�28'48'�W 217.50' L = 233.90' C _249.96' 255.22' \ C = 222.53' O 250.00' is-0.00' '� \ CB = N58°18'35"W 0 ^t / x mN00°31'12"E � N 33.00' h7 v / .- 4 3 z 2 \ o t 66 FOOT PRIVATE ROAD r'2 m +� °DO 'J' \ 2\ EASEMENT DESCRIBED IN w Oa -3 w °' `moo vol. 679, page 524. 01 Q Ica C) rn I r��\r as O 250.00' 390.58' �\ 250.00' 124.61'100.3. ' 353.65' ��; �\<tv 34.61' 454.04' \ N89 31110 11E 49 .97' o H{FUSE \ \ar CA OWNER � i p �s\�� � i• 330 �"'� 6% GOVERNMENT LOT 6 STEPHEN G. PALMER L2 P.O. BOX 772847 \GOVERNMENT LOT 7 STEAMBOAT SPRINGS, COLORADO NN62051-38--E 80477 563.36, 33.00' N88 46.00' N84°45-30"E 1 °39'02"E � � j1 unelatted_lands_owned_im-platter / SCALE IN FEET APPIROVfLD NOTE: SEE OTHER SIDE FOR LOT AREAS. 200 100 0 200 VOLUME 8 PAGE 2325 JUL.31 1985 DRAFTED BY DOUGLAS ZAHLER JOB NO. 78-52-184 ST.CROIX COUNTY CD�U ZCOO IG'COMMtTiU ----------------------- -------------- ------------------------------------------------------------------------, D o ED ® ®® ®®®® e e e ®_® ® ®® ® ED] 0� ® ® ® PoGNf E�LEVAflON W o -.- o IM N 2 LU ELVR710N - �.. A ED FT ........ ..... ........... .......... ................. Mill PJWLEVATM ---------------------------------------------------------------------- ----------------------------------------------------------------------- �� I i 7im.-m ^— a a a L mum il"t ,- ----------r J ww 'r A � cm �. a a Y Y W rw- TT 71 7 F�TON PLAN k • JNO SECTION m�ETraO�eEn �- r - +one ,au Vf2 od a,x — e " " - CAM 0 ant 0 101+2 ..- ,a,z ----- Y,2 a 8Mx 101,2 +one Q du :1an2 it W 101,2 v I e g x o. noo�urarr tat2 S� J21. s " W a s ewe It Z b s fQ� ui - ------- --- UM PLAN IFF i 1 W .A.a. 363 ------------------------ --------------------------------------------- ------------ ---------——---------------------------------------------