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HomeMy WebLinkAbout030-2128-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 572870 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: Smith, Kevin & Kari I St. Joseph, Town of 030-2128-10-000 CST BM Elev: Insp.BM Elev: BM Descriptio Section/Town/Range/Map No: d G-57 25.30.20.1043 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER e.'N CAPACITY STATION ' S BS HI FS ELEV. � . ZZ I bs•Z �aa Septic Benchmark W�eS.2�.� ;'il•t.�.z.o � Z�C7 /► 1.5 /bl, l5 /db Dosing- Alt. BM ' ' �d • 7Z.�t Aeration Bldg.Sewer CJ Z.b-- /63, Z Holding St/Ht Inlet 5�St/Ht Outlet `7 W, S 7�C ` TANK SETBACK INFORMATION 7 TANK TO /[i/� WELL BLDG. Vent to it Intake ROAD Dt Inlet Septic 7 Sa /1 z1 �/fib/ _ Dt Bottom Dosing �^ Header/Man. 4 ,64 /u �. Aeration Dist. Pipe S •!! 4► 6 Holding Bot.System •o • !/ 9 .l� qa •�'a Final,Grade PUMP/SIPHON INFORMATION �.' Manufacturer Demand St Cov �' I .5 a 3 • 7 Model Number TDH Lift Q.Friction Loss System H TDH Forcemain Length Dia. Dist.to well SOIL ABSORPTION SYSTEM BED/TRENCH Width IL mgp i No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. —7 uid De tp h DIMENSIONS 3 I 2 I It G'�V –—� – _ SETBACK SYSTEM TO �O P/L JBLDG IWELL LAKE/STREAM LEACHING Manufacture+ INFORMATION CHAMBER OR ��r t Type Of System- t � � )�Llt.� UNIT Model Number: DISTRIBUTION SYSTEM A41 ZZ ZA Header/Manifold Distribution x Hole Size x Hole S acing Vent to Air Intake // Pipe(s) Length_Dia 3 Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over 1 Depth Over xx Depth of xx Seeded/Sodded xx Mu hed Bed/Trench Center /� Bed/Trench Edges ` Topsoil es 0 No s No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 1346 Birch Park Ridge Houlton WI 54082(E 1/2 SW 1/4 25 T30N R20W) Ridge at Birch Park Lot 1 Parcel No: 25.30.20.1043 1.)Alt BM Description= 2.)Bldg sewer length= 3� ,(�, -amount of cover= 11 Plan revision Required? Q Yes NO Use other side for additional information. ' ✓J "``���� Date Ins#Signatu Cert.No. SBD-6710(R.3/97) AarxrEyr County In try lvic ' Di a r C PZM iD e filled a �� � � ��* �. 162 Sanitary Permit Number(to b--fi7l e n by Co.) Ss .� � ��r).� M ion. 2 Z. /0 �O�SSrossti�`� 10MMI!11IIIY D_rmit Application State TransactionN ber In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary Pro'ect Address(if different than mailing address) purposesin accordance with the Privacy Law,s.15.04(1)(m,Stats. Q t Sr I. Application Information—Please Print All Inform on 6 44C l Property Owner's Name Parcel# cv j t,D + k P�Xk Svxl ' b - ag - 0 v Property Owner's Mailing Address Property Location 'RC H )(. eib6& Goyt Lot r City,State Zip Code Phone Number / —,5 W'/., Section circle 00 to Sloe Z T 'Z5N • R ()E orone) 1_I.�ype of Building(check all that apply) Lot# or 2 Family Dwelling—Number of Bedroo L4 Subdivision Name ❑Public/Commercial—Describe Use Block# R 1 i e5 6(4 ❑ City of ❑State Owned—Describe Use CSM Number ❑ Village of L A,4" L-J 2.1{-2Z er-JS 14 Town of 15Tr -1-0 III.T ype of Permit: (Check gnly one box on line A. Complete line B if applicable) A. tem ❑Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) B. ❑Permit Renewal Permit Revision Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Pi her Owner kOV111, f POWTS S stem/Com onent/Device: (Check all that a 1 on-Pressurized In-Ground ❑ Pressurized In-Ground ❑At-Grade ❑ Mound>24 in.of suitable soil ❑ Mound<24 in.of suitable soil olding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Devi lain) V.Dis ersaVTreatmen rea Information: ( 93,1QUi a q K\ Design Flow(gpd) Design Soil Application Dispersal Area Required sf) rspersal Area Pro sed(sf) System Elevation 6W Rte ) r 857 > 85 `�� 9�. VI.Tank Info Capacity in a Gallons Gallons Units M of ` er /� New Tanks Existing Tasks k�'1`�. (� Cg yr v� w C7 G� Septic or Holding Tank ( /.6 Q / W aCrL ` , J& ❑ ❑ ❑ ❑ Dosing Chamber ❑ 11 ❑ ❑ ❑ VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. P-luum—rb-e'rt'ss Name(Print) Plumber's S' ature M�P� 7 ber Business Phone Number Plumber's Address(Street,City,State,Zip Code) ' `0, 54-6 - VII oun /De artment Use Only Approved ❑D' Permit Fee Da sue Issuing ignatum en R �d eason for Denial $ J 1-5 IX.Condi§ �rteasons for Disapproval , I �P L 1) �(/ V a tom. r 3aphe tank,effluent fitter and d dispersal cell must all an services/maintained • as per management plan provided by plumber. I/ 2. �h it@ ►c!c re9uiromenta must be tnawntairied eI o—cbfnPl2lFPrfi7dr the system and submit to the County only on paper not less than 8 in x 11 inches in size SBD-6398(803/14) � N 1 `3 9 �40 -k LD �ID 6� c � 0 �. 1-r 1 N { V s � nl i Sail A n Buster Cross 8ectlon (e� ft final Grade 4'Sdr duk 40 PVC Vera Pipe C13. ft � Wtth Vera Cap Leaching Chamber Eteva*m 8011 Absorotlo Flan Viet O ft g LeacHng Trench 1 ft Vent Or Observation RPO Chambers C Die, Trench 2 Header Leaching Chamber 8c►ecif[ca#lons/ t,� Manufacturer And Model ElSA Rating�_$q per chamber Soil Application Rate�_gP�sQ ft _(C gpd Design Flow t . ? Solt Application Rate =. Z.C) ElSA= Y _Chambers 2 rows of Z 2 z-chambers each. Page Of Property Owner, ` Parcel ID# A66 Page s of E 9 Borin # E] Borin g ,, [A Pit Ground surface elev. p „5 ft. Depth to limiting factor_in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * ff#1 * ff#2 9 9 " Z• •r Boring# Boring ❑ ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ff#1 *1-ff#2 Boring F-1 Boring# Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * ff#1 ff#2 I *Effluent#1 =BOD 5>30<220 mg/L and TSS>30 <150 mg/L *Effluent#2=BOD 5<30 mg/L and TSS <30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,contact the department at 608-266-3151 or TTY through Relay. SBD-8330(RI 1/1 1) Wis.Dept.of Safety and Professional Services SOIL EVALUATION REPORT Page/of Division of Safety and Buildings in accordance with SPS 385,Wis. Adm. Code County , Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. percent slope,scale or dimensions,north arrow,and location and distance to nearest road. J154 1AA Please print all information. Review by Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Property Property Location Govt.Lot �14 / T 30 N R E(ordv Property Owner's Mal ing Address Lot# Block# Subd. ime or SM# City State Zip Code Phone Number City [:]Village- OTown Nearest Road New Construction User Residential/Number of bedrooms Code derived design flow rate GPD ❑Replacement '' ❑ Public or commercial-Describe: Parent material_ Py,�:/✓1st Flood Plain elevation if applicable ft. General comments /7 and recommendations: FBoring# 1 ❑ Boring ® Pit Ground surface elev. -Y ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * ff#1 * ff#2 X "s 7 — 0 r ' Boring# Boring Pit Ground surface elev. SIZ2 9 ft. Depth to limiting factor 7//,Q in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ff#1 ff#2 * Effluent#1 =BOD >30<220 mg/L and TSS>30 <150 mg/L *Effluent =BOD <30 mg/L and TSS <30 mg/L CST Name aZeP rt) � Sign CST Number Address Telephone Number SBD-8330(RI 1/11) Property Owner ` r Parcel ID# Page '--� of Boring# ❑ Boring 7 pit Ground surface elev.,9�,.s"� ft. Depth to limiting factor ' in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * ff#1 *f#2 Z• .r ❑ Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ff#1 * ff#2 Boring F-1 Boring# Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. :fF#1 ff#2 *Effluent#1 =BOD 5>30<220 mg/L and TSS>30 <150 mg/L *Effluent#2=BOD 5<30 mg/L and TSS <30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,contact the department at 608-266-3151 or TTY through Relay. SBD-8330(R11/1 1) Y P a/ �VP/ m I 1 J \ c 4 t i1 0 - _ 1 OMNI Safety and Bt M • ~ L P 2M.W_ W Avi P.O. Boot 7162 g ►Pamitwww" to ' e>8 ediaby{:o) Ufa . Wl 53707-7162 s, DECEIVED 5 72:'TS 7a x° Sanitary Permit Application FEB 0 6 2015 h In a~cda$oeh WS 383210. Wis Ades Cody, of ~ ~ w ~ 6Ye Proju~ Adds C¢) sfor 1~ k rtoo Sa A&Ssi ~ tft DCVtt+OW ofsafeti md see ees ym L Applicp - Iu#or~ation-PlimePriotAlll n l propwyowi Ise V.3D 2 b FV11J ~ FmpatyowadsAd~s~A - I M3 GUVLL Code PhoneWumber Ed V, sewm ~ i i/c~ T- 0 It R Z~y(E _ Type ( alitl~at apply) Lot# 14=w 1 or2Fa~y-1~~ - - , , ak kx- Blocks QSuftowwi-DesciftUw cw-rI/067544° 0vown oaf 2„~. 22 ~-ZZ^ Gl~. P HL Type ofPermit: (C be& ~i box an Mae A. Complete Me B dv Sysdaa Q R S7A~m Q T ==Lo~* ❑ ova w S (02010" List l lamittrru"Now- © Tr suxew - s. Q PftR~ 11 Pe~Rs"Im Q cMwGfi ae&e Owner Exphvdm IV. T of PO'9V15 a Beck aH t~ fiy) 1a-Cca~ Q P ia-{found Q At-(ale Q Mamd?24 is ofse soi! DMa-d-24inu[sis oid- T=c Q 0&,w bp=d Comte (=P1=) Q Pe Dare (esplsin) V. Area Area \ S1' Design (0) Desi SOB R / 06 01) a .-7 V ✓ v VL Tank Info capacity m Tats f - C Craltm Units i TaeYs T~ia67-1 / ~r ae~ oo ~u G 1 i-CJI ~~at j 20 l v VJ/E S C/'~- i VIL Statemeut- ILA ,a espoesHakyEw bidoNsfim ar~POVIMshmmORe a p~me?Iv~ 7 7 Pi Nhm OW) phw6ws -0 2 yz ,is-ass zy~ F Pt`r~s ~Z) SEA'` coos use i~ s XVGve wa~~~ IS R"M ~ - s q•M 2. -1 VIL Conditions of A,pprovaWieasons for Disapproval ~ r MbIti i SBD-6398 M it/il) t i cue OF jovtvl i CZ - m Z EL + Vfib SDrG~, r~~ yeti ` t v4ul CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Kcyt/ t K A (~i S rn L-L- - Owner's Name: Owner's Address: Legal Description: SVJ (fir S T- iu 91 L Township: S~ S H County: 0 x Subdivision Name: ►Z IAA R~~ Lot Number. Parcel ID Number: Zl zA -.10 01)0 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: I P mud License Number: P r` S X 23 7 Date: Phone Number Z S 7 5S- Zy( Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 ~l s'Vtf S 25" 3o u 4 zo w At f i ce Of cokwi f cz - Jai, 4i Q Nl Z ` 6b ta SDIG ~~l~~O i Soil Absorption System Cross Section r ft 4, Schedule 40 Final Gr2de PVC Vent Pipe ; With Vent Cap Leaching Q Chamber - ~Lft V System Elevation ~ ft ~ ft . Soil Absorption System Plan View ft { 3 ft ~ft Leaching Trench 1 Vent Or Observation Pipe Chambers 4° Dia. Trench 2 Header Leaching Chamber Specifications Manufacturer And Model (N I 0 - pqq l~ EISA Rating 0 sq ft per chamber Soil Application Rate gpd/sq ft _ gpd Design Flow : Soil Application Rate Z EISA = Chambers 2 rows of ZZ chambers each. Page of Installation and Maintenance Instructions Installation Step l Dry fit the filter case onto the outlet pipe going to the drain field. Ensure it is centered directly under the access opening. (if outlet pipe is already in a fixed position, additional pipe may need to be added) Step 2 If utilizing the additional single side support and the two bottom supports: While the case is still dry fit to the outlet pipe, measure and cut 1"schedule 40 pvc pipe to the length needed to extend from the hubs that are pre-molded into the case to the side wall and the inside floor of tank. solvent weld pipe into the hubs that are pre-molded onto the case. Step 3 Solvent weld the case to the outlet pipe. Insert the filter cartridge into the case pressing down on the cartridge until it locks into place at the bottom of case. Step 4 if utilizing a vertical read switch: Insert switch into the hole pre-molded into the top of the filter. Press straight down until it locks into place Maintenance 1) Remove the access lid of the tank. Note: To ensure undesirable solids do not exit the tank and into the drain field, the tank should be pumped out until the level of effluent is below the outlet level of the tank. 2) To remove the filter cartridge from the filter case, pull up firmly on the handle of the cartridge dislodging it from the case. (if utilizing a vertical read switch, removal of switch is optional) 3) Using an ordinary garden hose, rinse the filter cartridge ensuring all visible septage material is removed. 4) Place the filter cartridge back into the-filter case pressing down on the cartridge until it locks into place. 5) Place the access lid back onto the tank ensuring it is secure. Lifetime filter has a lifetime limited warranty: Lifetime filter LLC warrants the filter will be free of manufacturing and workmanship defects during normal use for the period of time the original purchaser owns the product. Lifetime filter will provide a replacement filter in the event that the original filter was not damaged during the installation or maintenance process. Damage to this product caused by accident, misuse or abuse will not be covered under this warranty. Improper care or malfunctions resulting from product not being installed, operated or maintained properly-will void this warranty. Lifetime filter assumes no responsibility for labor charges, removal charges, installation or other incidental or consequential costs. Contact: mike0ifetimefiiteriic.com Phone: 502-7242231 Page of y START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the 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 be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of 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 fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. -its i4entH` T aluati a o rng~ank I be ' e ai a ~~D~-ll~3 T'T~i~ '~D~ A/~w ~AfVS?KCl~T1. D ❑ 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 time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name ` Phone Phone 7 - 75S -~7 L1 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ST. C2o (7V & 20Aj1 'fj Phone Phone "'71S- 3g(0_ (91D This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of Z' FILE INFORMATION SYSTEM SPECIFICATIONS Owner k'GV~ d-• Septic Tank Capacity Z db gal ❑ NA Ka r, 5 ~..•a-1.... Permit # 5-7 Z -S-7o Septic Tank Manufacturer G f- ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units )I~A Pump Tank Capacity gal 10A Estimated flow (average) gal/day Pump Tank Manufacturer Design flow (peak), (Estimated x 1.5) Db gal/day Pump Manufacturer NA Soil Application Rate 0--7 gal/day/ft2 Pump Model Standard Influent/Effluent Quality Monthly average* Pretreatment Unit Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODS) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Disp saI Cell(s) ❑ NA Biochemical Oxygen Demand (BODS) <_30 mg/L In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ~A ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 510° cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size %8 in dia. ❑ NA Other:` ` r 60r 11 NA Other: A Other: .5 ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: 0 NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ rnth(s) (Maximum 3 years) ❑ NA 3 year(s) Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ onth(s) (Maximum 3 years) ❑ NA year(s) Clean effluent filter At least once every: month(s) ❑ NA , ❑ year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) A ❑ year(s) Other: ❑ month(s)„ At least once every: ❑ year(s) Other: A 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 scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) 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 tank equals one-third 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 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 10 days of completion of any service event. Page Z of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the 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 be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of 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 fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. The -!%a4*ae not bee., eveltiated to ielemi aluaf a o ing~ank mAy be ' e ai a '~RD4-lI?31T~'~ ~D/L !~/~4✓ ~(VSTRCICTI0 ❑ 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 time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name V J. o Name Phone 7 -755 - 2A U Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ST. c►W ( d (VIV/ !!!t Phone Phone -71':S;-- 3 e (o_ (0 ID This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM O«iterBuyer Kevin & Kari Smith Mailing Address 1346 Birch Park Ridge Property Address (Verification required from Planning & Zoning Department fo ew construction.) City/State H o u Ito n/VIII Parcel Identification Number LEGAL DESCRIPTION Property Location 5 k/ t/4 , Sec. Q, T _5~) N R~ W, Town of JOSf4( _ y L Lot # 1 Subdivision Plat:" 1T~ i of Certified Survey Map # aft 7 5 Je~ , Volume Page # (O Warranty Deed # l 1567x7 ~f Z_ (before 2007)Volume , Page # 1 Spec house Oyes Ono Lot lines identifiable 0 yesono i I SYSTEM MAINTENANCE AND OWNER CERTIFICATION i 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 respo'biGdes are specified in ASPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 Safety And Professional Services 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. Itwe certify that all statements on . form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a my deed recorded in Register of Deeds Office. Number of b rooms 4 SIGNATURE OF AP ICANT DATE *-Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. [dude with this applicatkm 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. 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C wmonsh department Of commerce SOIL EVALUATION ' REPORT POP, l " Of 3 r mwoh of Seaty and BuHr M00 in accordance with Comm 85 Wis. Adm. Code Cour* 'ft St A A1tkh MMW6 stta p%n of t6W ntit thin 8112 x .1 ,1 Rio Wt ft, M) mist 2 mdud% twt' not hmftd tm vertical and honz€nta f reference point (SM), direction and pOR~i 1'.0,0 J D ' percent sbpe, scale or ftnenstam. north arrow, and location and distance t+onearest road. Meow pant a# ormadon ` DO* Persotwt WdorMaden you provklo way be used #+or.secondary purposes (Pfivecy Low, s. 16.04 (1) (m►}: Prpperiyowner Prpperty tocetion r Quest Development, Inc G Govt, LA E 1/2 1/4 SW 114 S 25 30 N 2d {qry O r !ClwrWs Making Address Lot # Block # Subd. Noma or CSW Suite 150107QU Q1d G vttty d 5 1 Ricer A ii 'oh Pak ity Stals 4 Code %m Number ity Village EITWWR Nearest Rea4 Plymouth 55441 7¢3-595-9512 Cagy Road E M NeW Cbt'tsductu n Use f ;Residential /Number of bedrooms 3 to 4 tide derived design to _ 4so, to 600 R"sacement Puta6c or oomrnara T t)esrr,1 . _ / 1. A Sao tar,t l=10 r3yf r 1 0d Pert= - 8 it 00 vents This Phisi4buAi; &kdbterdo0 andr¢COmrnendationc -J-7 ~ L3 r R N 1 Boring # Q Md4 it6c Boring ft; Depth to r -l GroundsurfaceSlav . soil Fats r-2~ Horizon Dew' Dominant Cohn ` Redox Texture Structure Roots GPDW In, Mkt Qu. $a.: Cent. Gr' St. Sh. "Etf#i *E . 1, a-6 1(ly /t5 1 lmsbk m cs 2Y .2 3 2 6-100 7.$YxO s psg m} 7 t.2 F-F # , aoring 105.80 >1QQ 1 Pit, &Md surface elev. l1. Depth tom faeiw in Hts117.m Depth Doftiant Coma Rsdt»t Des n Texture Structure Consistence Baundwy Rots GPM lit: MAN Qv- Sz: Conn Color ' 4f; U Stt `Et1#1 'E#i 2 1 0-8 10yr+411 SO lmsK mfg Cit 7f 2 3 2 8-1~ s mt` - .7 1.2 7,S H6 fs 9 i:tituerit #1 = BOO 30 220 mg.& and TS1$ :W f50 nd TSS. 30 mg(f.: CST Name (Please Pnrdj Signature . t ST Nurr><aex Thomas a Nelson 227387 Address` Data Evaluation Conducted Telepharm Number" 1432 120th Street; New Richmond, Wl 10/11/01 M-246-2454 errn nnna mnw+nm k SAL Property Owner Quest Development, INC Parcel ID # Page 2 of 3 Boring -Boring 3 # 0 Pit Ground surface elev. _ 98.60 _ ft. Depth to limiting factor >110 In. Soil Applicatlon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 10yr3/2 - sil 2msbk mfr cs 2f .5 .8 2 4-20 1 4/3 - sil 2msbk mfr cs if .5 .8 3 20-29 10yr5/6 - sil lmsbk mfi cs - .2 .3 q 29-110 7.5yr4/6 s Osg nil .7 1.2 ❑ i3aing # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Sal lion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Qu. Sz. Cont. Color Gr. Sr- Sh. *Eff#1 *EfI1#2 Bodng # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Sal Appkation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Mums" Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Efluent. #1 = SODS > 30:5 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD, < 30 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, SM4330Tek OL07/00) LL - 5 IL 910VS 'sIM `unspnH n n ~ Q n 'Pa IIeN,O SSJ l~ ~GJ 1~+~~ Qz 0 Q slusllnsuoo e6eMes eienlad / • O J Q seletoossv 814nl~Qltl QQQ - QL 17 r p L S-b~ v✓ C~~J' n'-=72, 1-7 -a-QO • OS' •6 F0 z ; O £ 62 •Sin-j ~-~.l WP2 QQo 07 F0Z Of 69 0 =3 r rl ~ Cvn A u In 10 51 9-` yd a~z ~os.$o a4 t Iv r ~V ( LA) a ~ r' Z 2 7 •3 ~ J ,I Parcel 0:'036-2128-10-000 07/19/2007 02:36 PM PAGE 1 OF 1 Alt. Parcel 25.30.20.1043 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - RILEY RUBY LLC RILEY RUBY LLC 9063 ITASCA TRL N STILLWATER MN 55082 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ` 1346 BIRCH PARK RDG SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 4.020 Plat: 2389-RIDGE AT BIRCH PARK 02 SEC 25 T30N R20W LOT 1 RIDGE AT BIRCH Block/Condo Bldg: LOT 1 PARK Tract(s): (Sec-Twn-Rng 401/4 1601/4) 25-30N-20W Notes: Parcel History: Date Doc # Vol/Page Type 01/03/2005 784061 2725/279 LC 01/03/2005 784060 2725/278 WD 04/23/2002 677007 1877/92 QC 07/02/2001 649986 1672/171 LC 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/12/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.020 137,800 0 137,800 NO Totals for 2007: General Property 4.020 137,800 0 137,800 Woodland 0.000 0 0 Totals for 2006: General Property 4.020 137,800 0 137,800 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 1 1 I 1 < 7~ r ~ L=-\l 1 \ / / I 3~ZfiI8igoS8N r ,68-Ctrs / ,L9'6ZZ / r r ~ r I w / OD Li. ( CD\ Lit I ,1~n ~ 5i 55- 99 1-00' 00 Ufa J ,1► ~ OD l V 1 \ ~ s t rn \ CP 66 gg5 N ~ ti\ o Q r CAD w o