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HomeMy WebLinkAbout038-1127-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 572895 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)J. Permit Holder's Name: City Village X Township Parcel Tax No: Dodor, James R. Star Prairie, Town of 038-1127-30-000 CST BM Elev: Insp.BM Elev: BM Descnpti n: Sectionrrown/Range/Map No: 31.31.18.517A TANK INFORMATION 1r1JS '• ' h ELEVATION DATA TYPE MANUFACTURE �`\, CAPACITY STATION BS HI FS ELEV. Septic Benchmark n , 1, p � Alt. BM Airrad1q Bldg.Sewer olding StHit'Inlet TANK SETBACK INFORMATION St�Ht Outlet TANK TO P/L WEL ' BLDG. 60oro Air Intake ROAD Dt4ntet --- Septic Dom` •�— ._. �gjgg Header/Man. AskAimR Dist.Pipe Ho Bot.System W 11.1 l.5 1 c I.4, PUMPISIPHON INFORMATION Final Grade La •d �•I!1 Manufacturer Dema St Cove* Model Number TDH Lift Friction Loss stem Head Ft Forcemain Length Dia. Dist.to Well SOIL ABSORPTION SYSTEM �Q IBC" C"/,sC BEDITRENCH Width I Length I No. Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/ BLDG IWELL LAKE/STREAM LEACHING Manufacturer: 1 r1 , ' 1YG��Q INFORMATION T e Of System: 1 1 CHAMBER OR Model Number: '_l bNV�1�1bN 12' )ZS uiL St, uS DISTRIBUTION SYSTEM Z ` Header/Manifold FLPei�pn ution x Hole Size x Hole Spaci Vent lt'o/Air { take ' j1 ) Length_ Dia h Dia Spacin g SOIL COVER`_, G x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Bed/Trench Center Y V E -J'' '^f�� Over Edge �Depth of xx Seeded/Sodded ❑ xx Mulched ❑ Fa-] No l� Yes No Yes COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: S / /1/ S Inspection#2: Location: 1873 Raleigh Rd New Richmond,WI 54017(SW 1/4 NE 1/4 31 T31 R1 8W) NA Lot 1 Parcel No: 31.31.18.517A ' " 1.)Alt BM Description= TAY 611 "F l/V�Q � fi o i nS? C j i o r1 r c�.4 2.)Bldg sewer length= "(S t • ��fi•-•n5 �tfl L�S b r, Fl }t N'n\. + +t' lot jot l o►J °J -amount of cover Plan revision Required Yes ® N o Use other side for additio information. — Date Insepctor's Signature Cert.No. SBD-6710(R.3/97) PLOT PLAN PROJECT James Dodor ADDRESS 1869 Raleiah Road New Richmond Wi 54017 S 1/2 NE 1/4S 31 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST.CROIX SYSTEM ELEVATION 97.0/96.0 5' below qrade 3/30/15 BEDROOM 3 DATE CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 kk BENCHMARK V.R.P. Top of steel fence post ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Property Line All piping shall be SDR 30/34, within 10' Pro 3 of tank, piping shall be Schedule 40. Bedroom House 25' Scale = 1 /4'1 = 10' ST .J9 2-3' X Fcs >3' s cing 30' B-2 Ve is 102' 30' 100' 30 70' B-3 50' 250' 98' 12% Slope 5' B.M.* IF Property Line Vent Raleigh Road >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 4' Long 12" /C A 3491 Grade at System Elevation CF-1VEV County t ' Safety anb Buildings pnnslon __. �T. r t 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(to be filled m by C40 COUNTY Madison,Wl 53707-7162 r 1 � LoPME 5_? -4--37 tom' State Transaction�umbpr� Sanitary Permit Application J/ In accordance with SPS 38321(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 Project Address(if different than mailing address) the Department of Safety and professional Servies. Personal information you provide may be used for secondary e putposes in accordance with the Privacy Law,s.15. 1 m,Stats. L Application Information—Please Print All Information Property Owner's Name Parcel# j Property Owner's Mailing Address Property Location Govt,Govt,Lot �` City State Zip Code Phone Number s y, Y., Section 4.) / 1 L cic one IL Type of Building(check all that apply) Lot# Subdivision Name 2 Family Dwelling—Number of Bedrooms Block# ❑Public/Commercial—Describe Use ❑City of CSM Number ❑'Village of State Owne}d�—Describe Use Of III.Type of Permit: (Check only one box on line A. Convolete line B if applicable) ❑New System ❑Replacement System Q Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) B. ❑Permit Permit Revision ❑Change of Plumber D Permit Transfer to New List Previous Permit Number and Date Before FxpR � Owner IV.Type of POWTS S stem/Com onent/Device: Check all that a 1 J ��Cf14�Z4<i on-Pressurized In-Ground El Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil ❑liolding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dis rs*Vrreatment Area Information: S r T Des' Flow(gpd) Design Soil Application Rate(gpdsf) Dispersal Area Rcwtircd(sf) Dispersal Area Proposed(sf) System Elle on VL Tank Info ` Capacity in Tatal #of Manufacturer u Gallons Gallons Units ) New Tanks Existing Tanks IOU + y / ;!` _ " 5� •�°�• .°�'_ `� t,/1,II 1 n.8 Cn Septic or Holding Tank Dosing Chamber VII.Responsibility Statement- 1,the undersigned,as a responsibility for installation of the POWTS shown OR the attached plans. Plumber's Name(Print) Plum ignature MP/MPRS Number Business Phone bcr s '7476 I- Plumber's Address(Street,City, 4p Cod "- A"Ip_�l I.- S �/a/ County/Department Use Only r1 r: n�P t Permit Fee _ Date Issped i Issuing Agent Signature ; Approved G�mPPrQVQd _ $ s '� �1 [}Owner Given Reason for Denial l- . " 0L Conditions of ApprovaUReasons for Disapproval ' ` — 1.Septic tank,effluent filter and dispersal Cell must ble 5ery iced/mai.n.�ained as per management plan provided by plumber. 2.All setbacr requirements must be maintained as per applicable code/ordinances. Attach to compkw platy for the system and submit to the County only oa paper not less than 8 M2111 tales m sae SBD-6398(L 11/11) Soil Test and System PLOT PLAN PROJECT James Dodor ADDRESS 1869 Raleiah Road New Richmond Wi 54017 S 1/2 NE 1/4S 31 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST.CROIX SYSTEM ELEVATION 92.5/91.5 5.5' below qrade 5/12/15 DATE BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of septic tank cover ASSUME ELEVATION 100° Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Property Line 19, All piping shall be SDR 30/34,within 10' >6 Quick4 Standard of tank,piping shall be Schedule 40. of Cover Leaching Chamber with 20.0 ft2 of Area Scale = 1 /4" = 10' 4' Lon 5.6ft^2/pair of end caps Grade at System Elevation 2-3' X 66' cells with>3' spacing B-2 40' Vents 30' Pro 3 0' Bedroom Raleigh Road House -3 B.M.* 70, 11% Slope 40' ST 10' B-1 10' 70' Property Line Property Owner_ Parcel ID# Page of_ .. 5 Boring# ❑E Boring Imo.Pit Ground surface elev. 10, 0 ft. Depth to limiting factor� in. �iI Iica6on Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 =13 C 3 ( 0S' 0' U F-1 Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. –go—ilApplicabon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Colo Gr.Sz.Sh. •Eff#1 •Eff#2 F-1 Boring# E] Boring E-] pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Colo Gr.Sz.Sh. 'Eff#1 •Eff#2 Ef fluent#1 =BODs>30<220 rng/L.and TSS>30<150 mg/L •Effluent#2=BODS 130 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SOD-8330(RAW) Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85,Wis. Adm. Code , Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must � - f I include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. A 7 percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Please print all information. Revisrved pYi l Date , Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). / "' /� - Property Owner Property Location Govt.Lot 5 1 E1/4 S 31 II T 31 N R 1 E(or W Property//Owner's Mailing Address Lot# Block# .Name or CSM# C� City State Code Phone Number [I city C]village Town Nearest Road Construction Usesidential/Number of bedrooms Code derived design flow rated GPD ❑Replacement ❑ Publlg or commercial-Describe: -_— Parent material Q k��-�J Flood Plain elevations if applicable L✓ ft. an General recommendations: v s Q� '13e�b'�•✓9f� System Type 1n y NJ System Elevation a Boring# ❑ Boring r ®, (, pit Ground surface elev./O. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I •Eff#2 Z I—iq-/o o- Yo I , Y 6, .� os p-sv /o s sr rte' rn 1✓i!� OSe MA Boring# r❑ Boring /' ® >!St Pit Ground surface elev.��, V ft. Depth to limiting factor 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 -Ef#2 50-/ 3 �- S O-s- / /e9 Effluent#1 =BOD->30<220 mg/L and TSS>30:5 150 mglL 'Effluent#2=BOD,<30 mg/-and TSS<30 mg& CST Name(Please Print) Sign ur CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 �5°1.2— 715-246-4516 Property Owner_ Parcel ID# Page of .. 5 Boring# ❑ Boring /� Q'(7< Pit Ground surface elev.�ft. Depth to limiting factor in. Soil Application Rate Boundary Roots GP Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bou ry Dlft? i Dep in. Munsell Ou.Sz. Cont Color Gr.Sz.Sh. 'Eff#1 'Eff#2 -�z )0,3rz a cs-- 2L, 1 z is-V 3 >3 3 C OS j✓ 0U F-1 Boring# ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Ou.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 F-1 Boring# E]❑ Pit Boring Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM in. Munsell Ou.Sz. Cont Color Gr.Sz.Sh. 'Eft#1 'Etf#2 Effluent#1 =BOD,>30<220 mg/L and TSS>30:5 150 mg/_ 'Effluent#2=BODS<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. seD-saw(R 6=) T EC ELF'E® � County 1 is < l •, � Safety and Buildings Division �t r f� )�,t;, td � 3 1 et t) 201 W.Washi n ve. ox 7162 „ Sanitary Permit Number(to be filled in by Co.) Melisor nA7 -71 � � CROX COUNTY ��S Stale Transa on Number e` Sanitary Permit Application � 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 Project Address(if different than iling address) the partment of Safety and Professional Servies. Personal information you provide may be used for secondary 73 ,P / ` N. u uses in accordance with the Privac'Law,s.15.04 1 m),Stats. / r,� LI J I. Application Information-Please Print All Information mob, ! Q Property Owner's Name -- /a Parcel# .. jut,"V �4)Property Owner's Mailing Address Property Location /3 6 ci --,2.7de.;,,/„.../bi Govt.Lot l 3 � �� City,State /, I Zip Code Phone Number S�r%/1/E I Section3/ - 7� r / e�� --." title on r /� _ _ tr, N, R / E o t* � ;h II.Type of Building(check all t at apply) Lot# T��� � 4112 Family Dwelling-Number of Bedrooms 1 Subdivision Name 04 eak 11A-4— 11■4054-31ock(i -----lii ei/h- vbtel P., z63 ) Public/Commercial-Describe Use A.•". `D r.4,I ❑City of ❑State Ow ed- Describe Use CSM Number w D Village of D n_T i a" /i I / / 4 D / 10 t Yi !� Town of / �l r�1LLd III.Type of Permit: Check only one t ix n line A. Complete line ; if applicable) ^— A-1 A. r` Am System D Replacement System D Treatment/Holding Tank Replacement Only E Other Modification to Existing System(explain) j List Previous Permit Number and Date issued B. 0 Permit Renewal D Permit Revision D Change of Plumber D Permit Transfer to New Before Expiration Owner Cie4 IV.Type of POWTS S•stesn/Com•onent/Device: Check all that a sly) r I Non-Pressurized In-Ground D Pressurized In-Ground D At-Grade ,' ./a ■ J4A-41.4.406 ❑Mound>24 in.of suitable soil ❑Mound<24 in.of sv .e sot r J✓\.ei Holding Tank Other tspersal Component( 'plain) D Pretreatment Device(explain) V.Dispersal/Tre went Area Information: / '>3ejt.4,vy,,e Design Flow(gpd) Designs Soil Application Ra (gpdsf) Dispersal Area Required(sf) 1 Dispe r 1.Area Propo d(sf) System Elevati /� VI.Tank Info Capacity in I Total ( #of Manufacturer I , 1J.• Gallons Gallons Units 2 I °' o +II` New Tanks I Existing Tanks `z&A, C G o , ; v j y L a i m Septic or Holding Tank +A._ I I L ( Ir • Dosing Chamber --� 1 i VII.Responsibility Statement- I,the undersigned,assu,hty for installation of the PORTS shown on the attached plans. Plumber's Name(PrintPlumbe MP/MPRS Number Business Phone Number i-14 6 7/�` Plumber's Address(Street, sty;State,Zip Cod / I 3 2 /z0 f s)/, ov a 21 C_/ (k. 3/1/ 7 __ VIII County/Department Use Only r- Permit Fee Dat Issu I issuia, ent Signature / Approved .isapprove• /J �j am it. .er iven Reason for enial I S ti 75 l�1 l J 1 .�_ IX.Condttl asoris for Disapproval fff f''8e is tank,effluent filter and 3' ..dispersal cell must all be services I maintained C66 COQ,' .. t r- i v vk re as per management plan provided by plumber. 1r 2. ; lck requirements must be maintained as PeriOlicibidiadel orditlances. Attacb to complete plans for the system and submit to the County only on paper not less than S in x 11.inches in size SBD-6398(R. 11/11) PLOT PLAN PROJECT James Dodor ADDRESS 1869 Raleiah Road New Richmond Wi 54017 S 1/2 NE 1/4S 31 IT 31 N/R 1 8 W TOWN Star Prairie COUNTY ST.CROIX SYSTEM ELEVATION 97.0/96.0 5' below grade 3/30/15 BEDROOM 3 DATE CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK 1000 gallons LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of steel fence post ASSUME ELEVATION 100' Filter BEAR Filter _ BOREHOLE O WELL *H.R.P. Same as Benchmark 41 IIII Property Line All piping shall be SDR 30/34,within 10' Pro 3 of tank, piping shall be Schedule 40. Bedroom House A 25' Scale = 1 /4" = 1 0' 1 ST 2-3' X 66' cells with>3' spacing 30' B-1 102B-2 i Vents at p30' 100' 30' B-3 98' to 70 50' opy4_ 250' apy 12% Slope 5' B.M.* • . Property Line apVent Raleigh Road >6" Lik4 Standard of Cover eaching Chamber ith 20.0 ft2 of Area .6ft^2/pair of end caps 4' Long Grade at System Elevation 34" — � 0 e wY • III Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 3/30/15 Owner: James Dodor Location: S 1/2 NE 1/4 S31 T31 N,R18 Raleigh Rd Star Prairie Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and •ntingency Plan 7. Filter Specifications/A eet Signature /1 License nu #226900 PLOT PLAN PROJECT James Dodor ADDRESS 1869 Raleiah Road New Richmond Wi 54017 S 1/2 NE 1/4S 31 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST.CROIX SYSTEM ELEVATION 97.0/96.0 5' below qrade 3/30/15 BEDROOM 3 DATE CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 ,. BENCHMARK V.R.P. Top of steel fence post ASSUME ELEVATION 100' Filter BEAR Filter lei BOREHOLE O WELL *H.R.p. Same as Benchmark 44 IIIII Property ert Line P Y All piping shall be SDR 30/34,within 10' Pro 3 of tank, piping shall be Schedule 40. Bedroom House 25' Scale = 1 /4" = 1 0' ST 2-3' X 66' cells with>3' spacing 30' B-1 102' B-2 Vents i Of 01- 30' 100' 30' 98 Vj 70' IN- B 3 50' 014__ 250' 0 12% Slope 5' B M * V • Property Line ,Vent Raleigh Road >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 4' Long Grade at System Elevation 34" Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber , 5.6ftA2 pair of end plates To be >1 above grade Finish grade elevation Typical Installation 102.0' Vent Grade op Vent 3' 4" 3' A30134 Septic Tank • „ p • 5' Long 1 5 5' Long 1 _ Grade at System Elevation 3 6" Grade at System Elevation Spacing 5' 2-3' X 66' ' Cells Same on other end Observation tubeNent Atend of cell A B 16 chambers per cell System elevations: A_97.0' B 96.0' ST. CROIX COUNT? SEPTIC TANK MAINTENANCE /iGREF,MENT AND OWNERSTOP CERTIFICATIGN FORM Owner/Buyer SArv..9--0 ---a)h2...2 Mailing Address '' Property Address 44 i 14 73 c,..IL e...i i",_ . .12--sX1 .. _ • _.. ..._._. _. (Verification required Front Planning Ii Zoning Depar hrient for new Garish-1i on) City/State Parcel Identification Nut.... LEGAL DESCRIPTION ...„ Property Location .5" 1/4 , See. > / L.* N 1Z/Z W, Town of ,S>iziii9,-6 Subdivision Certified Survey Map #_ . ... .-- -1----+9- Vi itio-tt, , Page 11 Warranty Deed # 55 , ei Volume Spec house yes no 1.ot line. identifiabl yes o SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its pnlriature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, it 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 wasie disposal system. Owner maintenance responsibilities are specified in§C.omm. 83..52(1) and in Chapter 12 -St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning&Zoo mg Department a certification form,signed by the owner and by a master phunber,journeyman plumber,restricted plumber or a licensed pumper verifying that(I)the on-site wastewater disposal system is in proper operating condition and/or(2)atter inspection and pumping(if necessary), the septic tank is less than 1/3 full of sludge. I/we,the undersigned have read the above requirements and agree to main tam the private sewage disposal system with the standards set forth,herein,as set by the Department of Commeice and the Department of Natural Re801110CS, State of Wiscousm. Certification stating that your septic system has been maintained must be complete,l and eturned to the St. Croix County Planning& Zoning Department within 30 days of the three year expiration date. 1/we certify that all statements on/his form are true to the best of my/out I;nowledge. 1/we ant/are the owner(s) of die property described above, by...y.14m of a arrant),deed recorded in Register of Deeds Office. iel Num, -r of bedroorrig----- .__ :IGNATURE OF APPLICAN'I'(S) DAIL "*Any information that is misrepresented may result in the sanitary permit being ti-yoked by the Planning&Zoning Department. Include with this application a recorded warranty deed from he Register of I>eeds :Jffice and a copy of the certified survey map if reference is made in the warranty deed. (REV.08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION • SYSTEM SPEgFlCATIONS Owner , `n n� ��/ Tank Manufacturer: ❑ NA l7Vu" Permit# Sept ic 0 Dose 0 Holding VolumeVolume:/ e) (gal) Tank Manufacturer: )❑ NA DESIGN PARAMETERS ' Number of Bedrooms: 3 ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal) Tank Bottom(s)to Service Pad: (ft) 1. Vertical Distance Tan ( ) Number of Public Facility Units: �1,NA / Estimated(average)Flow: 2073 (9 allday) Horizontal Distance Tank(s)to Service Pad: V/0 (ft) Specific servicing mechanics must be provided if vertical is>15 feet or provided on back. >150 feet. Specific Instructions to be pro L I/da is 150 tee pe = a Y) if horizontal k Flow- estimated x 1.5): ,,'� t9 Design (peak) In Situ Soil Application Rate: . (gallday/ft2) Effluent Filter Manufacturer. �/e.... ❑ NA Standard(Domestic)Influent/Effluent Monthly average Effluent Filter Mode!: Fats,Oil&Grease (FOG) 530 mg/t. Pump Manufacturer: '/7 IA Biochemical Oxygen Demand (BODs) 5220 mg/L ❑ NA • Pump Model: Total Suspended Solids(TSS) 5150 mg/L High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L • Manufacturer. (BODs) >220 mg& NA ❑Mechanical Aeration ❑Peat Filter ..>/laNA (TSS) >150 mg/L //\\ ❑Disinfection ❑Wetland Pretreated Effluent Monthly average ❑Sand/Gravel Fitter ❑Other. (BOD5) 530 mg/L Soil Absorption System (TSS) , 5530 mg/L / `A Ground(gravity) ❑In-Ground(pressure) ❑ NA Fecal Califarm(geometric mean) 5_10' / Mound ❑At-Grade 0 other: Maximum Effluent Particle Size 'A in dia. ❑ NA ❑Drip-Line Other: 1 A Other: ❑ NA MAINTENANCE SCHEDULE °� Service Event Service Frequency • When combined sludge and scum equals one-third(h)of tank volume Pump out contents of tank(s) ❑When the high water alarm is activated At least once every: ❑month(s) (Maximum 3 years) ❑ NA Inspect condition of tank(s) rY ar(s) Inspect dispersal cell(s) At least once every: onth(s) (Maximum 3 years) ❑ NA tear(s) Clean effluent filter At least once every: �� 7❑mo ails) ❑ NA ❑mont (s) ❑ NA Inspect pump,pump controls&alarm At least once'every: ❑year(s) ❑month(s) NA Flush laterals and pressure test At least once every:. ❑year(s) Other: At least once every: ❑month(s) NA ❑year(s) Other: NA 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 ('h)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 5_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 roduds, solvents or other For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting p 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 bedischarged 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 restoring power tToha avoid this or contact a Plumber contents of the pump tank removed by a Septage Servicing Operator(pumper)p g 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. drive or park over, or otherwise disturb or compact, the the soil absorption system. Do not do P Do not drive or park vehicles over tanks or h rP Y P area within 15 feet down slope of any mound or at-grade soil absorption area. n the life of the treatment the performance and prolong from the wastewater stream may improve p dlowin floss ' n of the following dental floss, tanks and soil it elimination 9 ms cotton swabs, degreasers, condoms,s stem: acids, antibiotics, baby wipes, cigarette butts, co irides meat 1 herb , taaps and sa Y diapers, disinfectants, fats, foundation drain (sump pump)discharge,fruit and vegetable peelings, gasoline, greases, scraps,medications,oils,painting products, pesticides,sanii,>!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 Code: . • All piping to tanks,pits and other soil absorption systems shall be disconnected and the aba n do ned pipe openings enings sealed. a Setae Servicing Operator(pumper). disposed of by Septage ro Y • The contents of all tanks and pits shall be removed and properly P� v r • 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 rep/ ent system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. e 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. 1 : suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be -r rehabilitated and barring 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 cted in place ect af following eremoval of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK . SUFFICIENT OXYGEN TO RESULT.ESCAPE OR RESCUE SUSTAIN UFE. NEVER THE INTERIOR OFRA ANY TANKAMAY UNDER MSTANCE. DEATH MAY NOT BE PO SIBLE .* ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINTAINER. NameJ Name Sid 4,�S/60 Phone .71 J,),1/z- i6--7,Z Phone 7i,C.� SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATpRY AUTHORITY Name Name�>4 ��7/j� c~ '�r�-- �G�t2��/ Phone '�,�j= -' Phone 7),,—.,-02/7g...._ S"/f/3 `�67 ---lr6?2) 1 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)&(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code. • FILTER CARTRIDGE INSTRUCTIONS w 1:O!- Installation _ STEP 1 Dry fit the filter case onto the end of the outlet pipe to ensure it is centered under the access opening. If not, then either insert more pipe into the tank through the outlet or solvent weld (glue) additional pipe onto the outlet z,` Pipe. c ` STEP 2 While the case is still dry fitted on the outlet pipe, measure the length of 314-inch pipe needed to brace the filter to the tank end wall if utilizing the optional supplemental side support. If side support method is not utilized, proceed to step four. STEP 3 For installations utilizing the optional supplemental side support: solvent weld the 3/4-inch pipe onto the filter case. If side support method is not44r utilized, proceed to step four. „ik STEP 4 Solvent weld the filter case onto the outlet pipe. Insert the filter y ; cartridge into the case, pressing down until the filter locks into the bottom oft , the case. STEP 5 If a VRS switch is utilized: insert into the filter and lock by turning clockwise 90°, Maintenance 1. The effluent filter should be cleaned every time the septic tank is ,:4 ," r ,i" ,,.. .r serviced. t r ��I ` �tt4 2. Open the outlet access opening to inspect the tank and filter. $ 3. Pump the septic tank completely, making sure to remove the sludge rr ,,yam layer on the bottom of the tank and not just the scum and effluent. 4. Once the effluent level has been lowered below the invert of the ' *, outlet pipe, firmly pull up on the filter handle to dislodge the cartridge from the case. 5. Slide the cartridge up and out of the case for cleaning. kli,,,,' ''''''''''''..'. ' -,..,,,,,!-:, ,,F,r74,-...,,,„,,,-4,.,,=,,. - , I. ,�,. 5 6. If a VRS switch connected to an alarm is present, the switch should be removed by turning counterclockwise 90° and cleaned with water only. il >• 7. While holding the cartridge on its side (large flat surface facing k ., down) over the access opening, rinse off the cartridge with water .,. . only making sure all septage material is rinsed back into the tank. >a . 8. If VRS switch is utilized, replace by inserting into filter and i turning clockwise 90°. until '.' ., a, I ' ' ', '°'d 9. Insert the filter cartridge back into the case, pressing down until the filter locks into the bottom of the case. x - 10.Replace and secure the access opening on the tank. SEAR ONSITE'"FILTER CARTRIDGE-FIVE-YEAR LIMITED WARRANTY __ .,:< REAR ONSITE -Fitter Case-Lifetime Limited.War ary .a P . d' d. f_ F •.. � u ... ...I .': t v I :l,� tE heln f S w y i A i1: .' - c r^A �� t -.x 54- 1 c Mwr s 1 LIMA awa . , 1.../...........................,.. ............_________________ , 1, 4 V N .. z 9 Mill ....4 • 1 , iiii 51 1129 51 iligc--- 1111 ,^ 1 I 4 C4 et et 9 i h e _ 4 ,, .r, s1N lily itl .. . 9 . d a IP I ( ; 1 i it I --A t 0,_-., ... 7. ., . .F.111.- ..........r.. . 1 • NNW .1 , r i 1 1 : I g rrw 'primal 4 I Y 1•_.__.....Wm d.e♦ �� .�..... .... ..r _ i _ ..w++.v 1 y tl ® N 7,74 t 1. r il , .71. 1 • s I� L C r 4#■ �..�_a�......�.._..._.f..`._--"x._______111`__"'"_ .,. ... � ),4-111*•• ad. yya_� • 0 i . 1 .., • �.... _ . W 4•s. . Property Owner_ Parcel ID# Page of El 3 Boring# Boring j� �� (..pit Ground surface elev.ill ft. Depth to limiting factor in. I mil Application 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 •Eff#2 , 1 6-11 10, r� z 5/ (27 /r �.f _ 4 z 0� z /3 My! //' s/ ��,�1_ .1 /a/ /4 - - / v LS' .�%/b /d el/62 �— 3 ©S ` /77/ iv>4AJi', ` 7/i Y q3, rr ,„---77 „.._4 Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/If in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 'Eff#2 Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. I Soil Application Rate Horizon 'lepth 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 =BO;>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BOD5<30 mg/l.and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8110(8.6/00) �, • Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85,Wis. Adm. Code County fi'c Attach complete site plan on paper not less than 81/2 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. ]O e i 63 d- Hu- 30 -606 Please print all information. Revie by / Date/Date / h/ Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 1 1 /1 19/1 ✓( Property Owner Property Location / / i J i •`.) n1 Q . DOS Govt.Lot 5 vim, 1/4 st) I T 3/ N R i 1 E(c Property is M '' Addr Lot# Block# S�u d. Name . CSM# ) 8 f ' .� City S to Code Phon Number ❑City, ❑Village own Nearest d- Lie 9 New z;�lUA.S 'ai71 ( 7/f)s.27-7g/7 Fr New Construction Us esidential/Number of bedrooms_ Code derived design flow rate d74JZ7 GPD ❑Replacement ❑ Public or commercial-Describe: ___-___. __—_ _-__,___.__ Parent material 0 ec�. --" / Flood Plain elevation if applicable A// /4 . 7 General comments 'owe 1c- h D r-u= e fey , 1 s a/a(c7. _ '..„ �j /�d 10/4 r. and recommendations: / m L�NU System Elevati n � r. _ * / System Type - �6 K12__>. I Boring# 11: Boring I�pit Ground surface elev. ��� Oft. Depth to limiting factor /l 0 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. •Eff#1 •Eff#2 I —/I /0y,-3/ ---.. 5/ �,r 1, ,-►� &r . - • 6 / i) 7— 11- 110 ��ri/6 z cs fyil ki'4 Na _7 /. 1 /( It 1 ii. tib Boring# Boring ) ) �-1 J/ Pit Ground surface elev. / L •C/ft. Depth to limiting factor !l 0 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. 'Eff#1 *Eff#2 I 0-10 10v,- ,1-,_ S( d m. 0 r2u _ - /D Z 10-34 /" r c H S j 0144---5101<-/ 74..t.../ l (— ' 6 / C7 a - S1 6S'(' /y' 1d,L�1,� e7 -3 l C, . ,....4---iy 13,-.4/ I.A.-1 1 •Effluent#1 =BOD.>30<220 mg/L and TSS 150 mg/L *Effluent#2=BO O30 and TSS<30 mg/I CST Name(Please Print) Signature CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 715-246-4516 . Property Owner Parcel ID# Page of Z Boring# ❑ Boring / `J Pit Ground surface elev.R f!l V ft. Depth to limiting factor 1 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/If in. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. *Eff#1 'Eff#2 1 e-11 ion.y Z --- 5/ ; � ir te' , , ' / 0 Q I3-3L i J /v 5/ 7-44,- 1--'6 /1)(7. rl j�u/ 7=4 - 6 /l, ,_-5, 3,-I/0 101‘11/ 7'. ......______ 3 , ,iy, ,,g7i ct 14 1 Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/FF in. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. 'Eff#1 'Eff#2 Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/W 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<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330(8.6/00) f Soil Test Plot Plan Project Name James Dodor Shaun d Address 1869 Raleigh Road ,/� New Richmond Wi 54017 Itr #226900 Lot Subdivision Dat:2/20/14 S 1/2 NE 1/4S 31 T 31 N/R18 W Township Star Prairie ❑ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of steel fence post next to cedar tree System Elevation TBD *HRPSame as Benchmark ■ Property Line q Scale is 1" = 40' unless otherwise noted B-2 B-1 102' 30 100' 30' B-3 98' Vj 70' 50' ■'• 250' wy 5r B.M.* V A Raleigh Road Property Line V