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HomeMy WebLinkAbout022-1070-80-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 578929 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)]. Permit4HoldVs Name: City Village X Township Parcel Tax No: Struve, Benjamin I Kinnickinnic, Town of 022-1070-80-000 CST BM Elev: Insp.BM Elev: BM Description: /� Section/Town/Range/Map No: d� L-57— 25.28.18.392C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER wyS CAPACITY STATION BS HI FS ELEV. Septic Z,. Z Benchmark W;�eser F;ak,, a' /000 .35 xz-3 /66 Dosing I 1; n— -3 Alt. BM )r 'D .L /DU'59 Aeratinn 6 Bldg.Sewer . Holding St/Ht Inlet 3 .'3 TANK SETBACK INFORMATION St/Ht Outlet TANK TO hP`� WELL LD en it take ROAD Dt Inlet 93 I 't 7. 3 Septic oJ'u- Dt Bottom > �p (�5 (00 ' — 12.53 $7. 77 Dosing 7 lb/ >/bar 7 /bd� Header/Man, Z .35 loo •f 5 Aeration rJ� Dist. Pipe Z. 35 16 Holding Bot.System 3 S PUMP/SIPHON INFORMATION Final Grade Manufacturer / l S Demand St Cover / 40* l-�y GPM .S I �7. Model Number EP 644 Z/ ' (" 3.�5 TDH Lift Friction Loss System Head TDH 16.it 61-7 1, 15,if Forcemain Length r Dia. ,r Dist.to well 76 z Boa SOIL ABSORPTION SYSTEM BED/TRENCH Width ength(06 1 No.Of Tgnches PIT DI NME SIONS No.Of Pi Inside Dim_ Liquid Depth L DIMENSIONS -7-5 � _ e SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR � Type Of em: UNIT Model Number: ovr. 17/ 8l 5 �� /M DISTRIBUTION SYSTEM es $1e Header/Manifold., Distribution Z i x Hole Size/ x Hole Spacing�f Veyy Air Intake Pipe(s) �j 7 }� ^ Length 3.76-- z Length 57 Dia �' Spacing 3 '7" 3Z 3�p / SIT' SOIL COVER r x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center / Bed/Trench Edges Topsoil I Q—. es R No a Yes ® No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: 7 / / 1 ✓ Inspection#2: � Location: 1441 EVERGREEN DR River Falls,WI 54022(SE 1/4 NW 1/4 25 T28N R1 8W) NA fo 2 f- ar 1 No: 25.28.18.392C 1.)Alt BM Description _ t 2.)Bldg sewer length= Lb -5 6,� �'OC.+ -amount of cover= a,ti -LA Plan revision Required? 0 Yes VNo 5 �j lj- Use other side for additional information. 7JL SBD-6710(R.3/97) Date Insepctor' ignatur Cert.No. r,w yz5- 5-341 Safety and Buildings Division F'J' 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(to be filled.in by C(,.i 4"� - P Madison.Wl 537 c Z c7 State Transaction Number XC Permit Application In=or&=W1 Code,submission of this form to the appropriate governmental unit 7-�64 3�3 (o is required prior to obtaining a sanitary permit Now.Application forms for state-owned POWTS are submitted to Project Address(`AUT--tu than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary PU s in accordance with the Privacv Law,s. 15.04(l)(m).Stats. p1,411 j�F-✓e r� I. Ap pficadon Information—Please Print All Information Propertyj %vnar's Name <-, parcel# 7 , Property Owner's iling Address j Property Location 7 Govt.Lot 317 State Zip Code Phone Number City, -Zd,/ 114, Section (T 11.Type of Building(check all that apply) Lot T C� N; R E Q 4 or2 Family Dwelling—Number of Bed t,==, Publi(dConuncrcial—Describe Use To,taca."A.., Block i Subdivision Name ❑City ol, M Number D Village of 0 State Owned—Describe Use A A Town of of A�) Ill.Type of Permit- (Check only one box on line A. Complete line B if app)cibla A. 0 14tmv Syslein Replacement System 0 TreatmnifHolding Tank Replacement Only Other Modification to Existing Systent(t:xpVaivj t R. 0 Permit Renewal Permit Revision 0 Change of Plumber ❑Permit TtaWarto New List Previous Permit Number and Date issued Before Expiration Owner IV.Type of POWTS System/Component/Device.- (Check all that apply) ONon-PTessinizedIn-Ground C1 Pressurized In-Ground 0At-Grade ;9 Mound R:24 in.of suitable siAl D Mound<24 in.of suitable soil Holding Tank 0 Other Dispersal Component(explain), 0 Pretreatment Device(explain V.Mperselffren0nent Area Information:, Design Flow Design Soil ApplicatiolvXate( 5 1 Area Requ (sf) Dispersal Tee Propo Syst(Wn Elevation Dispersal 8'Y -2 Vi.Tank Info capacity in TOW #Of Manufacturer Gallons Gallons Units a 2 E ^s New Tanks Existing Tanks c U -4 P6 Li 5;, 3 'n M in L, 3 It septic or Holding Tank Dosing Ormbff -J. VII.ELseansibifity Statement- 1,the undersigned,a=upe responsibility for installation of the POWTS shown on the attacked plans. Plumber's Nam(Print) Pli�=ignatuv MP/MFRS Number Business Phone Number V N 15-V 5 Plumber's A4dress(S Lcity state.zipc 6j VIIL"Cous Jlie rtstent..use OR!, Appmved rpy Po"'n't Fee Dati Issuid Issuin gent Signam J en Reason for Delftial- $ Z!5 TX.CondidW 1." Septic t",eflikw*RW W4 .disoers3l cell must all he sllokU j adt 40 .--- I(I-� e.1^4cir L".)/ 44,�, �erA^ as per management plan 4j'P;IPMbAf- Is PW applicilwooft,/NOWN111, it d 4)l �44CWN-1 a�CLJOV�lp Attach to complaft plow far the system and sAiuit to the County lY an paper not less tkas 3 1#7 x I I inchft in size (16 CL SBD-6398(R. I Ill 1) S�¢�'.0 h T'�,, y►l aoare O S'GW G>` �R h �0�". ._ �t!►�/.GK,'JJryt C /.0 n� .�.5�t rvs Y a W 01 —100, S�t P/o-rt 2 k J./ _ 1, .s�:�,Le ..1 c�e�: _ ,54.�'�• , Sec.a.tt'� 3 n Ca4A s C �^Bd 7'D IIGGV �}rTP► `/ ` tC6'f �r �Qwrn,? �if/l.01��Z r.=t'I Al 4p!Cn ce l C scot, rang dhy.rr� C� /wcx� P,lfCr.co Ab,ur rr� /ao/t t /-o Neszre,CT ( k 2,icls PY� lb 4. li i f 2 h 4i ti a P. Ir di1 J ! CHARLES L WEBSTER Page 2 8/29/2014" • Materials shall conform to the requirements of SPS 384.10.No fixture,appliance,appurtenance,material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system,unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • The existing POWTS must be properly abandoned per s. SPS 383.33 Wis.Adm. Code. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department,which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building,structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 °•�._ This Amount Will Be Invoiced. When You Receive That Invoice, Please Include a Copy With Your Patricia L Shandorf Payment Submittal. POWTS Plan Reviewer,Integrated Services Wyment S'bmitt 1. (715)634-7810, Fax: (715)634-5150,M-F 8:00 a.m.-4:45 p.m. pat.shandorf@wisconsin.gov cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services(formerly Safety&Buildings)will be modified. Code references with prefixes starting with"Comm"have been replaced with "SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety&Professional Services.Additionally,all IS(formerly S&B)codes have been renumbered and addressed in a"300" series. For future reference,the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. P.RT,�g� DIVISION OF INDUSTRY SERVICES 10541N RANCH ROAD `JP HAYWARD WI 54843 3( i R " Contact Through Relay P www.dsps.wi.gov/sb/ www.wisconsin.gov o' 'ssroN��'w Scott Walker,Governor Dave Ross,Secretary August 29,2014 CUST ID No. 220673 ATTN:POWTS Inspector CHARLES L WEBSTER ZONING OFFICE WEBSTER SOIL TESTING&DESIGN SERVICES ST CROIX COUNTY SPIA N5815 770TH ST 1101 CARMICHAEL RD ELLSWORTH WI 54011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/29/2016 Identification Numbers Transaction ID No.2443836 SITE: Site ID No. 804880 Betty Stenglein Please refer to both identification numbers, 1441 Evergreen Dr above,in all correspondence with the agency. Town of Kinnickinnic St Croix County SETA,NWIA, S25,T28N,R18W FOR: Description:Mound,3 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1497331 ASEE Maintenance required; Replacement system; 450 GPD Flow rate; 24 in Soil minimum depth to limiting facto original grade; System(s):Mound Component Manual-Ver.2.0, SBD-10691-P(N.01/01,R. 10/12),i essur Distribution Component Manual-Ver.2.0, SBD-10706-P(N.01/01,R. 10/12); Effluent Filter nj The submittal described above has been reviewed for conformance with applicable Wisconsin AdministratiCb'de and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be ctruct and located in accordance with the enclosed approved plans and with any component manual(s)referenced ove.The own er,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all co requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Key Item(s) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,the property owner must follow the contingency plan as described in the approved plans.In addition,the owner must insure that the operation,maintenance and monitoring duties as described in section VIII of the mound component manual are complied with.A copy of this information must be given to the owner upon completion of the project. • The bottom of the distribution cell shall be level per the Mound Component Manual. The"D"dimension shall be a minimum of 12". The maximum finished slope of the mound surface shall not have a slope ratio steeper than 3:1 per the Mound Component Manual Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. • Limit activities in the area 15'beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. CHARLES L WEBSTER Page 2 8/29/2014 • Materials shall conform to the requirements of SPS 384.10.No fixture,appliance,appurtenance,material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system,unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • The existing POWTS must be properly abandoned per s. SPS 3 83.3 3 Wis.Adm. Code. A copy of the approved plans,specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department,which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building,structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Patricia L Shandorf Please Include a Copy With Your POWTS Plan Reviewer,Integrated Services Payment Submittal.WiSMART code:7633 (715)634-7810, Fax: (715)634-5150,M-F 8:00 a.m.-4:45 p.m. pat.shandorf @wisconsin.gov cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services(formerly Safety&Buildings)will be modified. Code references with prefixes starting with"Comm"have been replaced with _ "SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to a the Department of Safety&Professional Services.Additionally,all IS(formerly S&B)codes have been renumbered and addressed in a"300" series. For future reference,the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. Webster Soil Testing & Sewer System Design Charlie Webster, Owner N5815 770th Street Ellsworth, WI 54011 WI Licenses: MP220673, ST220673, PE18803 Phone (715) 273-3430 POWTS Index Sheet Page 1 ofX q Mound System for a 3 Bedroom Residence Property OwnerBetty Stenglein SE1/4 NW1/4 S25, T28N, R1W 1441 Evergreen Drive Town of Kinnickinnic/St Croix County Parcel 1. D. 022-1070-80-000 Page 1 Of 9 Index Sheet Page 2 of 2 Plot Plan Page 3 of 9 Plan View Cross Section Page 4 of 9 Distribution Pipe Layout '10NALLY Page 5 of 9 Septic Tank Cross Section LOVED Page 6 of 9 Pump Chamber Layout AFFET TY AND E Page 7 of 9 Pump Performance Curve UST VIC S JAL SERWP Pages 8&9 of 9 Management Plan rlrrtlkll�j���i yG�NS�, f� :SPONDENCE 6� ID 2"o LgWO .. E� WIS• �v �FSIG Component Manual Used: Name: Mound Component Manual for POWTS Version:2.0 S13D-10691-P Dated: January 30, 2001 S ketc 1, tt..� rr o•�.► d s w tr l a h fo l'', C3 Wit- QErf�' ST�NGLFSN ►liNhi�Glf".'hni � �wa�p �'S�' Arai k ��Y P. G A.a o 70 - o o: See N i tu' y � T a�,• ��" tom., �h�lR�+,arah -gk 2cf� 4 S e c ante'f' ,� tr ��t h o"w c:. t"'11- / ft� .rt. s &he e�•�, .p� d •tb,Poy�.Ks?s- Ya n� c/Ml"-' // C lip h*,C'(7t P o'Iyeh.ter` 4-rR��FC C/ I/C IQaPr t-o.re.zr�,rr � s�'� �i 1Pa-rct_ gi4b c� v 0.I � u � y Y i 13y(►,s�°� a /'� /o" f Page,Of Approved Synthetic Covering R•ST" C 33 Distribution Pipe Medium Sand N iz _ G Topsoil- ==- = F Elev = �- 3 J ' E p % Slope Bed Of 2 i Force Main Plowed Aggregate From Pump Layer p /a h. t Cross Section Of A Mound System Using E !h• �2' t`1 A Bed For The Absorption Area G C1_ Ft. A 7•-�7 Ft. H ® Ft. Linear Loading Rate=�5 GPD/LN FT 13 6-0 Ft. Design Loading Rate=a 31.GPD/SQ FT j 16•.�—Ft. — y4cccsJ x J Ft. TkK.�dG�r/ 1 K _./(2— Ft. l�te..t 8 Ft. T1'PicJ/ etft/tn W Ft. L I 4rObservation Pipe lit -- ----------------=- - ----------- "Cio e--s to Ma„F.'/d w) P t �,Distribution Bed Of 2% L Pipe Aggregate -r t Observation Pipe, I �C& (Anchor securely) r .PPS di ,c e- fi"V• C7LsC V a�t�ON c� 4„d , f.'c (rf c��� �dV oe 74iC h”-'tales G�iyc�iel S�4r���/t�be secure d"e6taia Plan View Of Mound Usilkg A Bed For The Absorption Area Par Pi Perforated D e Detoll 0 End_View Perforated 1' PVC Pipe t ) a� Moles Located on 80,10m, SC ( �C a; Are Eououy Spaced / s 1 ttt 1 1 i p161 a lion 1 / Pipe P !/ / Distribution Pipe. Layout r— ( S Ft. �OI�C/ICS `'J� / t X —7 Inches Hole Diameter Inch Lateral 1 llt it . ' Inch(es Manifold . Inches Force Main c Inches # of holes/pipe a O � #-Ak ess 6.X Invert Elevation of Laterals/0'=prt. i ��t�re!c%d P /etc•! 1 r 1}/�Z'c� 0 e,017 Place 1st hole)8 from etNde►+f'dis�ASirt+•�`a With succeeding holes at �ih intervals_ • )per,,(/ .f � � a/"� .�- � q a _ S��fi.e T��► K ff F,-/�4.. 1%e�ar wo., 4(q-" 44C Q c#--r..OA k/.. /� /aI+✓C 7� 4 T T�C 4-i' AII� 4.l ! ,`1' /►pyy t H !O w't j Ir C GCK e d j,.o�� �t to ijF�.♦ 6,:��� w,•t�i w���.t,�_ `�tja.�+' ,tt a as e� 4:r► ari,:....n Ear '� /!'PP""vc d`o,«t1' c..i t,y a p,>•we / p,jr/C ?�'I� sa!'o s•�''� �raa..►d � 3��tsP ��' �r'rh¢ T f R�l G' �!r I•�'�Pr � �'���at �e��M C�� Q f COY C.L-. TdNX kpwl�.►c1`urer' c), (oackef 7-j. k S: t /000 i . � ,� , t 4t 6_ 1 PArV PUMP CHAMBER CROSS SECTION AMD SPECIFICATIO►JS • VEIJT CAP �h•'n h15 To L4iy�lh flop Cvv&r to pr.v"de et-ec-Cr 4"C.1. oi-xaed•4o APPROVED LOCKIAIG '04 dJ -17t 1k 4t/% e WEATHERPROOF JUIJCTIOW BOX MAWHOLE COVER �/Ofr•.FROM DOOR, IZ"M►U. WIIJDOW OR FRESH ( AIR IAITAKE 4�g't�s ' GRADE 1 -7 . C01JDUiT "k PROVIDE INLET AIRTIGHT SEAL ALARM wsel° h./c i *APPROVED i i °W c JOINTS, WITH j I APPROVED PIPE ELEv FT. 3 ONTO PUMP^� _ I " OFF t 0 SOLID SOIL �I COIJCKETE DLOCK RISER EXIT PERMUTED OWL'.d IF TAWK MAWFACTURI~R HAS <jUc:H APPROVAL sEPrlc E SPECIFI'CATiO!� S C, TAWKS MAIJUFACTURE:R: IJt.IM6ER OF DOSE! ��� PER DAB S r""'c /v v o �n r�/oc a TAlJK SIZE : '�� t L h 9C 7.9 0-GALL0WS DOSE VOLUME v� / INCLUDING 0ACKFLOW:;/©/,"�'� L GALLONS o� ALARM MAIJUFACTURCR: 16 � MODEL klUMOER: CAPACITIES: A=._ `---IWCHES OF, GALLOWS M ,,r° Ile L.s, �r B='-' IIJCHES OR _1= GALLOWS SWITCH TyPf: � PUMP ANUFACTURER: "< f C��� IWCHE5 OR /0 GALLOWS MODEL MUMDEK. Ts f - C S ) D=� •d_ IAICHES OR" /�" GALLONS SWITCH TAPE: MP 4a,�c OTE: PUMP A14 ALARM ARC TO DE INSTALLED OW SEPARATE CIRCUITS MIWiMUM DISCHARGE RATE__2 ` ° GPM e < VERTICAL DIFFEICEWCE DETWEE►J PUMP OFF ARID DISTRIDUTIOW PIPE.. �FEET t miwimLIM NETWORK SUPPLY PRESSURE .�'� c:t���,i` • �` �' FEET --y FT,�� � f FEET .{ l� FEET OF FORCE MAIN X 7 Y100 FtFRICTIOIJ FACTOR. TOTAL Dtj JAMIC. HEAD = FF.ET ..4-,a,, . .p{ ! LIQUID IMTERNAL DIMLWS%OQQ OF TAQK: -6S-kfY" H r C<cc:°a w 2 cam_ a fil:*Cr S F.° An V I : 38 71 EP04 EP05 APPLICATIONS • Fasteners:300 series Fully submerged in high ■Motor housmg:OW iron -1 Specifically designed for the stainless steel. grade turbir.L*1-x for efficient heat transfer, following uses: • Capable of running lubrication ar,'.e."":int zTfengt;,and durability. •Effluent systems dry without damage to heat transfe. 1;Motor Cover.Thermoplas- •Homes components. Jo cover with integral handle •Farms Motor. Available for automatic and 19 manual opemika.ALlomatic and float switch attachment •Heavy duty sump EP04 Single phase:0.4 HP, pomts. madels inthwe machinical o;230 IV' 0 Kz,1550 •Water transfer ,GO RPM,built in overload with fkwswm* '"Ciewl �'777"-7,7411r., T Stvere duty •Dewatering e,-,.er resistant.►actrimlitin preset at the SPECIFICAT11111108 • EP05,Sirlgie phase:0.5 HP, R Bearinilc Upper and lower 1151,50 Fz.15,50 RPM, FEATUPES ha.avy duty ball bearing Pump:EP64 built 3n cveluad w construction. • Solids handling capability: autorraitic reset. ■a 8104 kWlheor:I I iet rno- %'MOAMUM. c Pi nA Fer cord:10 foot pkWlc�Prrll-ormo Oe,�!pn ASENCY&)STING • Capacities:up to 55 GPM. standard leri 1W, SJTO with numn nvt,r,�ier'nr •Total heads:up to 24 feet. Oh crounding mecheni,>0 sej1prnte0jon, • Discharge size:11/2'NPT. plufg.O"onU2(J foot numbers • Mechanical sea]:carbon- le", 16P�,-rrw with In �F'or"AG".) rotary/ceramic-stationary, thr2 pronc',grounding Mug improved perfol rqan^e. BUNA-N elastomers. (str.ndard c,E"fl. 0 '•Pd F ugpad •Temperature: thermwanic lefivi r fovides 104°F(40°C)continuous super or sti d,14 L!I wu 140°F(60°C)intermittent. coiwsio I • Fasteners:300 series MUM141-3 iTFIET stainless steel. • Capable of running dry without damage to components. Oil Pump:EP05 • Solids handling capability: 7 Y4"maximum. • Capacities:up to 60 GPM. 9 6� 20 • Total heads:up to 31 feet. L • Discharge size:1 V ............ T- NPT. z • Mechanical seal:carbon- 0:0- rotary/ceramic-stationary, t. BUNA-N elastomers. •Temperature: ------- 104OF(400C)continuous 140°F(60°C)intermittent 21- 51 01. 10 Z GPM 2 A 12 M3/h ®1995 Goulds Pumps,Inc. Eff9cbve May,1995 R'2071 I POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page FofT FILE INFORMATION SYSTEM SPECIFICATIONS Owner e t e s� ,'n Septic Tank Capacity /o© p al O NA P7—# Septic Tank Manufacturer Gf//CS r 0 NA ermit DESIGN PARAMETERS Effluent Filter Manufacturer Pa/ /, k 0 NA Number of Bedrooms 0 NA Effluent Filter Model 07 DNA Number of Commercial Units NA Pump Tank Capacity 7S d al 0 NA Estimated flow(average) ?0 C2 gal/day Pump Tank Manufacturer G{/,use, 0 NA Design flow(peak), (Estimated x 1.5) 4S-C? gal/day, .Pump Manufacturer 's f Ql 0 NA 8a s.O r�7� G� 9''A°° n e' Pump Model Ia�`I ❑ NA Soil Application Rate . © alida /ft� 7/ influent/Effluent Quality ' °' / Monthly average' Pretreatment Unit NA Fats, Oil&Grease (FOG) 530 mg/L D Sand/C3ravei Fitter D Peat Filter 0 Mechanical Aeration 0 Wetland Biochemical Oxygen Demand (BODb) 5220 mg/L Other Total Suspended Solids (TSS) 5150 L 0 Disinfection ❑ Othe Manufacturer Pretreated Effluent Quality . 0 NA Monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (BODS) 530 mg/L 0 In-ground(gravity) 0 in-ground(pressurized) Total Suspended Solids (TSS) 530 mg/L 0 At-grade Mound Fecal Coliform(geometric mean) 5104 cfu/100m1 0 Drip-line 0 Other-. Maximum Effluent Particle Size K inch diameter Values typical far domestic(non-corrunercial)wastewater and septk tank effluent. •• Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every O months years) (Maximum 3 yrs.) Pump out contents of tanks) When combined sludge and scum equals one-third(X,)of tank volume Inspect dispersal cell(s) At least once every ,7 0 months )Kyear(s) (Maximum 3 yrs.) Clean effluent filter W- At least once every 3 0 months Xyear(s) Inspect pump, pump controls&alarm At least once every 0 months 0 year(s) 0 NA AAlee Ve df Flush laterals and pressure test At least once every 0 months 0 year(s) 0 NA If.S- Al,e (,-/p Other At least once every 0 months 0 year(s) O NA Other At least once every 0'months 0 year(s) 13 NA cco01AVC. 0.J'C/c��,N� f'T�fe)• 04 veer 3Yr1lS,Wc%eco/MAt,s d t6/'f MAINTENANCE INSTRUCTIONS Y.0 C/uH Yr/•lei- eyery Pd// to -OV0,0'ar 's ¢he wrti}er 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 indude 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 ch. NR 113,Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatipment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event START UP AND OPERATION. 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. Page of 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 wastewateir will be discharged to the dispersal oell(s)in one large dose,overloading the oell(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.eiimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics;baby wipes;cigarette butts;condoms;ootton 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 safety abandoned in compliance with ch. 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 property 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 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 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 FOWTS INSTALLER POWTS MAINTAINER 6,4/_� v w i' Name � a,, Name Phone SEPTAGE SERVICING OPERATOR PUMPER eA rh e,"o LOCAL REGULATORY AUTHORITY Name Agency .Sy- Phone Phone This document was drafted by the staffs of the Green Lake,Marquette and Waushara County Zoning and Sanitation agencies. This document meets .he minimum requirements of ch.Comm 8322(2)(b)(1)(d)&M and 83.54(1),(2)&(3),Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. GMW(2/01) ST.CROIX COUNTY SEPTIC TANK ACkINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM � _ S�pa C/ Mailing Address 7�l Llwqreoi Properly Address l y 1 ti ( L '� (vorification required from Planning&Zoning DepwUn apt for nww comtrvctkm.) awstate �4 j�01, Parcel Identification Number LEGAL Pffiffl�tlp'MlY Pro Location E- 'fa , *� Y,,Sec.d�J ,T k Nr R Town of Subdivision . Lot# cerow Survey Neap# ,Volume Y P,,it // (�, Warranty Deed# ,Volume _, Page# Spec house yes Lot lines identifiable_�y no U&TAI ANC AND Q CL41EICAU—ON �� Improper use and maintenance of your septic system could result in its premature failure to handle uutes. Proper maintenance consists of pumping out do septic tank every three years or sooner.if needed,by a licensed pumper. What you put into the system can affect the Amcdon of the septic tank as a treatment stage in the waste disposal system. Owner maintenance res 1 --amities are species in§Comm.8352(l)and in Ch VW 12-St.Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix Canty Planning dt Zoning Department a cettification form,signed by the owner and by a master plumber,jotarueyman plumber,restricted phm*a or a licensed pturer verifying that(1)the oat-site wastewater disposaal system a in prow opemM*condition and/or(2)after inspection and pumping(if necessary),cessary).the septic tank is less than I/3 hall of sludge. twee,the undersignedhavereadibe above requirements and agree to maintain due pzivafit,s!wap disposal system wtdt due standards set fcirdt,Lorain.a s set by the Department ofCoirirns�ce and the De Beret of Nawreil Aiioiicas,State of wucoasm. Cwh0casion stating that your sceptic system has been maw mast be completed plated and retenaed to the St.Croix Cmmty Phunung dt Zoning Dement within 30 days of the three year expiration date. We cartify that all statemients on this are true to the beat of my/our knowkdgt. Ihn am/are do owners)of the property dual above,by virtue of a dead recorded m Register of Deeds Office, Ntatm ATUR,E LICANT(S) DATE wet*Any hWoram"that ism'- mg :eaeated may remelt ht the smiieary pa=it bait revoked by the Ptsami=&Z De pwumnt.a.s Inchtde with this application a recorded warranty deed from the;Register of Deeds Office and a copy of the ca tified survey map i f t+e%rence is made is the warranty deed. Parcel #: 022-1070-80-000 10/06/2014 11:57 AM PAGE 1 OF 1 Alt. Parcel M 25.28.18.392C 022-TOWN OF KINNICKINNIC Current ❑X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 00 0 Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner 0-STENGLEIN, BETTY L BETTY L STENGLEIN 1441 EVERGREEN DR RIVER FALLS WI 54022 Property Address(es): "=Primary * 1441 EVERGREEN DR Districts: SC=School SP=Special Type Dist# Description SC 4893 SCH DIST RIVER FALLS SP 0100 CHIP VALLEY VOTECH Notes: I Legal Description: Acres: 9.620 SEC 25 T28N R18W PT OF E1/2 OF SE NW LOT 2 CSM VOL 4 PAGE 1167 Parcel History: Date Doc# Vol/Page Type 06/21/2012 958615 TI 07/23/1997 745/245 Plat: *=Primary Tract: (S-T-R 40%16oY4 GL) Block/Condo Bldg: * 1167-CSM 04-1167 022-82 25-28N-18W SE NW LOT 02 2014 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/07/2010 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 80,000 118,900 198,900 NO PRODUCTIVE FORST LANDS G6 4.620 23,000 0 23,000 NO Totals for 2014: General Property 9.620 103,000 118,900 221,900 Woodland 0.000 0 0 Totals for 2013:. General Property 9.620 103,000 118,900 221,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch#: 223 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Property Owner_ Parcel ID# Page of Boring# Boring 9 0 Pit Ground surface elev./ ' ft. Depth to limiting factor y in. Soil 6EEt2tion 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 F-1 Boring# El 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 F-1 Boring# E] 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/fF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 Effluent#1 =BODS>30<220 mg/L and TSS>30<150 mg/L '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. SBD-8330(8.6/00) i A\�. 1 / Wisco"n Department ofCorn erceC)> G� Lr�jf I'-V"S L REPORT Page of Division of Safety and Building (,,C'• in accordance accordance with Comm 85,Wis. Adm. Code wx County Attach complete site pl� yl�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. 10( 4? 70 6Q Please print all information. Revfe-wqdfiy 9 Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). t tx' I��l liq / Property Owner Property Location r � anz; N R/ Govo ' 1/4 /4 S 7.�T Property is Mailing A" Lot# Bloc # Su . or CSM#N ev r a E( )W Z2 State LZp Code Phone Number ❑city ❑village To N!arest Road ❑ New Construction UseZRResidential/Number of bedrooms v Code derived design flow rate y�ZZ GPD eplaoement q Public or commercial-Describe: __— Parent material Ul Flood Plain elevation if applicable ft. General and rein rents G s: GL � �;- fir, System Type System Elevation / G(,(-l/tk F-71 kwj �# Boring J KJ // 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 I 'Eff#2 a � — Z IZ— i r ❑ Boring® �# U pit Ground surface ele4. `E 6 ft. Depth to limiting factor OL in. n*Eff#1 ation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots /fF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#2 -:5/-L- S L' all 2 _ •------- S� ' 62 r Effluent#1 =BOD >30.<220 mg/L and TSS>30<150 'Effluent#2=BOD <30 mg/L and TSS<30 mg/L CST Nam(Plem Print) re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 /� -��' 715-246-4516 • Property Owner Parcel ID# Page of 1:31 Boring# ❑ Boring Q j S Pit Ground surface elev. ' ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf q in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eft#2 L44 17 Boring# F1 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 '042 F-1 Boring# ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate. Horizon 'lepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mgA_ 'Effluent#2=BODS<30 ffKA 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(R.NW) Soil Test Plot Plan Proje,pt Name Betty Stenglein Shaun Bird Address 1441 Evergreen Drive Z��L River Falls Wi 54022 CST 26900 Lot 2 Subdivision --------- Date 71 14 SE 1/4 N W 1/4S 25 T 28 N/R18 W Township IGnnickinic F1 Boring Q Well PL Property Line County ST. CROIX kk BM or VRP Assume Elevation 100 ft. Top of steel fence post with blue paint System Elevation TBD *HRpSameasBenchmark Scale is 1" = 40' Evergreen Dr. 2s' unless otherwise Well 3 noted 40 Bedroom House 30' T D W 100' 500' 50' 35' 40' Shed 1 150' 99.5' 97.5' 90' 13% Slope 95.5' -1 40' 35 65' Property Line B-3 15' B-2 B. Wisconsin Department of Com:ptoNQ SOIL EVALUATION REPORT Page / of Division of Safety and Bins \\ Cr►a ce with Comm 85,Wis. Adm. Code • 1X GQV pP County Attach complete site � �t mess than 81/2 x 11 inches in size.Plan must ova include,but not limit �A i I and horizontal reference pant(BM),direction and Parcel I.D. percent slope,s dimensions,north arrow,and location and distance to nearest road. O a 1 /0.70 -c?O-C70 0 Please print all information. Revie by Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Z Property Owner Property Location p t 5 teh Govt.Lot ,S�F 114 A GGI/4 S T >-6N R /0 &(ff)E Property OwneA Mailing Addr ss Lot# Block# Subd.Name I CSM# / f / ir'rh He vZ - VQ / ± a:1/ 6 /ciitty State Zip Code Phone Number ❑City ❑Vitiage P,Town Nearest Road zl iYlrAt/A WX I.S p>A( " ) ""7Ai/ C I AYev ye P4 %! ❑ New Construction Use:E9 Residential/Number of bedrooms_� Code derived design flow rate �O GPD C&Repiacement El Public or commercial-Describe: /A v,4 �I Parent material /¢/�lvl/i k m' Flood Plain elevation if applicable /{1 ft. General comments and recommendations: -/ 7 V i� • � nnc,(,,aa/P, � t,� /�1' c�.e t V1 S"!u».fip �Yey 2 y� S, r/!�s dirin� , f' vl�r� Pr4,," toe' ¢ NP/ G C/7- F-41 Bong# F] Boring T,4 ,r a. u /VO.O �' pit Ground surface elev. ft. Depth to limiting factor ��' �n. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munseil Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 ..� 6 �. .Z-✓�{' S- c a. 10YR .s- - IFS v s -?7 / 77 o ,0'VA +i ( P/", s-°YT'sf� -r vs n, e-eks' tr7 fd#re b Boring# F] Boring d 4" i i% `' 1010 P,*- s-'.' a ❑ Pit Ground surface elev. ft, Depth to limiting factor in. Soil liption 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 'Ef1#2 I 'Effluent#1 =BOD >30:S 220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD <30 mg/L and TSS<30 mg/L CST Name(Please Print) Signature CST Number C6iarf�r �c6sfoY ! / 2� G673 Address Date Evaluatiorl'Conducted Telephone Number k ��/S 7 7a 4 WT S" 4* ��5�°/4 7/5=.2- 7-�-3I30 �N�LEx>v • �iNh i GIC.'h y�"c l:W.a� ./•�'l.' �ra r k C l 00 Eve Ok N 0 /OAOL 'rli� dy� Ysc//.a d off 7` c sa,4ve ���.. �',�i�►�6a �. - r.k e der �,�//,s Set-Note � _.� /.. s�sl�--�tp�: ,',�0,�'f'• tee N+te3 , - CS--fP-"PA" :rt°:r 9 a. r < - f%s t►a•/ore k Q��`� Sec aat� ex�tt . t�►e ho c . �o4Ait Y' �li.*4/�, .fC�7�'/C r fp c"0', G lxr�^,li� �` '�- tat/t' ��►�.i..'pe,d w."tb:�e y/.ICS?� •S- /''I,: TAP �!� ,sre�� jee.�e .r` )OOPIL tv Mca..csr ( k' f ' p (� it .nnt #v�(1lei, � t n 2 = k Y 4A,