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HomeMy WebLinkAbout038-1095-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 578916 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Miller, Joshua & Whitne Star Prairie Town of 038-1095-30-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: y f. 3 - I C-6 r 23.31.18.398 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Z Benchmark A) M6 7~ 162.E ~ s 3 Dosing .3 Alt. BM ff ~J n r Bldg. Sewer C I L i l-`~• nti.l. 0 .3 7 J1 Holding St/Ht Inlet lZ• 9g~3 TANK SETBACK INFORMATION SUHt Outlet TANK TO P/L WELL BLDG. ent o Air Intake ROAD Dt Inlet Septic yS Dt Bottom .F 4" Z_ Dosing / A)A- 46 S4 1 Header/Man. 7,-7 qS /4b Aeration Dist. Pipe .7, -Z c7 S Holdin Bot. System 1.7 c?,J/ Final Grade PUMP/SIPHON INFORMATION Manufacturer a Demand St Cove~GP 3 Model Number 2~' 3 6 r~~-~~ j r-j'L TDH Lift, Friction Loss ,Z System Head TD 3. g Ft l~ r Forcemain Length Dia. al Dist. to Well 36 Z SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. 0 re PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Z 2S / S nch SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Ot,Systerry UNIT Model Number: N/CI' N SJfYYI~d( )LU- - DISTRIBUTION r/ ST/EM Header/Manifold TDte ibution x Hole Size I I Ix Hole Spacing Ven Air In ke (s) L ength gth Dia Spacing c3 L SOIL COVER 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 Z Bedrrrench Edges ~ Topsoil • Yes K No es r!-.] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 '7 27/ 1 ~ Inspection #2: Location: 2042 124th Stree New Richmo d, WI 54017 (NW 1/4 SW 1/4 23 T31N 18W) >35 acres Lot Parcel No: 23.31.18.398 1.) Alt BM Description = ~ ~8 ~ NO -7y,,, 1 11 2.) Bldg sewer length - amount of cover = It Z a~ Plan revision Required? 0 Yes No Z? ~,L 3 S Use other side for additional information. Date 41nsepctor Cert. No. SBD-6710 (R.3/97) I r u, County ~~afe and Buildings Division ST /^o 1 G a z L l ,A 201 k W. VhlitCn Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co) P ' '---Ntadts©rt -Vdt..53707-7162 9 1 lmil Y DEIJ~:LOPMENi° Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate govetrimental unit J 2-2 Do 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 purposes in accordance with the Privac Law, s. 15.04(1) m), Stats. i/~ 1 9-- J 1. Application Informatio - Please Print All Inform lion '06 z f C~ Property Owner's Name D'J vim, 4- (Aiv-147n Parcel # A 36 - as o tkb Property Owner's Mailing Address Property Location moo, / 72 Y_/ I Gosrt. Lot City, State Zip Code Phone Number j Section Ic J( dAA~ ...f 0 ' j cic o T / N; RE W II. Type of Building (check all that app Lot # amily Dwelling-Number of Bedro Subdivision Name ~(L O Block ❑ Public/Commercial -Describe Use Y,O~~- r ❑ City of ❑ State Owned 7- Describe Use CSM Number f ❑ Village of - _ Z k wn of lC~~ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) Ze x A' New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) I i B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued / Before Expiration Owner r I IV. T e of POWTS System/Component/Devi ce: C a lv ❑ Non El -P Holding ressurized ]n-Ground El Pressurized In-Gro d ade Mound > 24 in. of suitable soil ❑ Mound< 24 im of suitable soil Tank ❑ er Dispersal Component (explain _ ❑ Pretreatment Device (explain] _ V. Dis ersal/'Tre ent Area Information: Design Flow (gpd) Design Soil Appheation Rat gpdst) Dispersal Area Requir (Sf) Dispersal Area Proposed f) System Elevation VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons I Units ' o v view Tanks Existing Tanks p V V m Septic or Holding Tank 1 7, Dosing Chamber 2-01 VII. Responsibility Statement- I, the undersigned, assume s risibility for installation of the POWTS shown on the attached plans. PM0__-Fp_) ' Nam e (Print) Plumber' i e MP/MPRS Number Business Phone Nttm e .2 22 Plumber's Address (Street, City, S7Z~x / S~, / v VIII. County/De artment Use Only Approved ❑ d-~` Permit Fee Date sued i ssuina. pent Signature Reason for Denial $ &25 • 00 ,5115 IX. ConditiSifsStllE4 asons for Disapproval SLL 5t; ~glj2. ~o r _ 'f:' Septic tank, effluent filter and dispersal cell must all be services I maintained' / is per management plan provided by plumber. A N_ A,,,` 16 60b z. a.~ ~D 2. + it f gNirements must be~t~Mairied ✓ 11 / n per , Code / ordlnartoes. J i 3 f v r 6j W; V.11111- 1000 L{- OIL 496. r~ Attach to complete plans for the system and submit to the County only on paper not less than 8 t2 x I I inches in size SBD-6398 (R 11/11) Deru t`~ rC¢t~ dL . PLOT PLAN PROJECT Josh Miller ADDRESS 1008 192nd Ave New Richmond Wi 54017 NW 1/4 SW 1/4S 23 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX SYSTEM ELEVATION 94.5' DATE 3/30/15 BEDROOM CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none Ilk BENCHMARK V.R.P. Top of 3/$" pipe ASSUME ELEVATION 1001 Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark 700' Property Line kale = 1/4" = 10' 40 Acres Scale is 1 - 40' to 124th St. unless otherwise All piping shall be SDR 30/34, 500 note. within 10' of tank, piping shall be Schedule 40. We l l is to meet al l D N R setbacks 5.M.* Grading is to be done to divert run-off away from system H uffc utt Pro 3 Property Line B-1 Combo Tank Bedroom 9 4.5' House 94' B-2 95' Area 15' below system 93 is to remain 10% Slope undisturbed Tank is to be properly bedded and provided with lockdown covers with approved warning labels 0 P y N SHAUN R BIRD Page 2 4/8/2015 • Maintain well and waterline set backs per SPS 383.43(8)(1). 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, Division of Industry Services Payment Submittal. (715) 634-7810, Fax: (715) 634-5150, M - F 8:00 a.m. - 4:45 p.m. WiSMART code: 7633 pat. shandorf@wisconsin.gov III cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm ~~pAxrsrE~ DIVISION OF INDUSTRY SERVICES 5~~' Toy 10541N RANCH ROAD Uo~ 9~ HAYWARD WI 54843 3 Q Contact Through Relay 9 P S http://dsps.wi.gov/programs/industry-services www.wisconsin.gov sION~~ S Scott Walker, Governor Dave Ross, Secretary April 08, 2015 CUST ID No. 226900 ATTN POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/08/2017 Identification Numbers Transaction ID No. 2529003 SITE: Site ID No. 811440 Josh Miller Please refer to both identification numbers, 124TH St above, in all correspondence with the agency. Town of Star Prairie St Croix County NW1/4, SW1/4, S23, T3 IN, RI 8W FOR: Description: At grade, 3 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1530667 Maintenance required; 450 GPD Flow rate; 40 in Soil minimum depth to limiting factor from original grade; System(s): At-grade Component Manual, Version 2.0, SBD-10854-P (N.03/07, R. 1/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter CONDII APP The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes DEPT OF I and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed PROFESSION and located in accordance with the enclosed approved plans and with any component manual(s) referenced abovg The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code DIVISION OF INC 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: SEE CORRI Key Item(s) • In the event this soil absorption system 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 the At Grade Component Manual are complied with. A copy of this information must be given to the owner upon completion of the project. Reminder • The orientation of the at grade 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 at grade per At grade Component Manual. • Surface water drainage shall be diverted away from the system area. • Materials shall conform to the requirements of SPS 384. 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. SHAUN R BIRD Page 2 4/8/2015 . • Maintain well and waterline set backs per SPS 383.43(8)(i). 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 code:ubmittal. POWTS Plan Reviewer, Division of Industry Services Payment ment Submittal. 1. 763' ) (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 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 3/30/15 Owner:Josh Miller Location:NW1/4 SW1/4 S23 T31 N,R18W 40 Acres 124th St. Star Prairie Manuals Used: At-Grade Component Manual version 2.0 SBD 10854 (N. 03/07) Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01 /01) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout {z _ -Y 5. Pump Chamber Cross Section O"' ED AFET AND 6. Pump Curve JAL SER'V S 7-8. Maintance and Contigency plan `U ER ES 9-11. Soil test 12. Filter Specifications _SPONDENCE Shaun Bird 'f Signature License number 2 900 PLOT PLAN PROJECT Josh Miller ADDRESS 1008 192nd Ave New Richmond Wi 54017 NW 1/4 SW 1/4s 23 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX SYSTEM ELEVATION 94.5' DATE 3/30/15 BEDROOM CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of 3/$" pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark 700' Property Line Scale _ 1/4" = 10' 40 Acres Seale is 1 40' to 124th St. unless otherwise All piping shall be SDR 30/34, 500' noted within 10' of tank, piping shall be Schedule 40. 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C Slope Direction GENERAL INSTALLATION: Tlie at-grade area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The basal area (1, x W) is staked out and plowed with a enough at the plow depth to moldboard or chisel plow. Plowing may not proceed if the soil ' wet form a ',,a inch soil wire when a sample is rolled between the palms of the hands. The A x B area is covered by clean aggregate deposited overhead by a backhoe. Special care mus, be used when placing the aggregate to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire at-grade is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are perforated in the lower 6 inches and secured in place. 03/05 1gj Page of Pressure Lateral Layout One Lateral - End Manifold 4- Threaded Cleanout Lateral Turn-up Plug Force Main X L Long Sweep 90 Bend F ssure System Construction Distribution Network S ecitications Lateral Diameter ln. e constructed of Schedule 40 PVC tI _s are drilled perpendicular to Orifice Diameter I Inn. ith a sharp drill bit and face down. X (Orifice S acing) aterrn-ups terminate with a threaded L Lateral Length) Ft. In. cleanout plug and are enclosed in a 6-8 inch Force Main Diameter diameter lawn sprinkler valve boy accessible Force Main Length Ft. from finished grade. • • • • • Grade O 6-8 Inch I-awn Sprinkler Valve Boy. Page of 03%05 l-j -TJose ' ank. Crass Section And Pump Performance Specifications `c ~ Sept>l pip pyianufacturer- [ arxk Manufacturer Pip Model Number /k _ _Alarm Manufacturer Total Z sink Cgfpacrty Alarm Model Number Max. Bury De:.pth 4~ lLrr ['cL Switch Type - - - , Total llynamir. dead ('I'U •eet 4 !Ater Manufacturer -L-- h il.ter Model Number ~~'ievaiaon Head ,r______ Distal Pressure Network Loss _ f _ Minimtun Pump erformance 12equired - Force Main Loss 'DH j Total GPM' - , _Ft I - - - - l J. - - . . Outlet Manhole Min. 4" Above Grade With Manhole Min. 4" Above Grade Locking Device. Inlet Manhole Securely Mounted With Lacking Device < f~" Below Urade Sealed Watertight Weather-proof ' t ; Junction Box Finished tirade rw ~ ~ err w w ~ ~ ~ t tent Min. 12" Disconnect Above Grade Means With Vent Cap +•r :`t Outlet Filter Inlet Baffle - Inlet rt .A- Switch Sett;ngs and Reserve Capacity ''A '-Tank Volume GPI He Weep L)imension Inches Volume Gal. B (reserve) A -sn-rte, Off Elevation C ;(alarm) B 2?-- r Ft (dose) G - (dead) D I3 Elevatio :t> Total rt, s tI +~~T T.iTT -S'<Fai ~i...1 T'i-i- {Z~TT~ -i i i ..-1`.>~c'F's T"fTt-t-FT, t < r,~`~`y: r•.)~.;t ~r~ ~t t•t i i•1•< t•V`t f•t•t attr♦ GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavaticu and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28, 02/05 U Page of . 42 az 4 i 40 F"OW h \ b a j CONSULT FACTORY FOR SPECIAL APPLICATIONS if - H a 'With Timed dosing panels aor lja ie • Electrical alternators, for duplex systems, are avaliain~l., ar, ~ n saPp"Ed an alarm. Variable lever co^trol switches are ava~,Iab_e for o~wling ,Ir ie G"~5z sYSte1,s arc. e - Va[labi8 IEVei float SW(tCheS r a'ra'IaD!d tOr'+aiiauc • uouole plggYuac cle controls. - L eve long and short cy Sealed Qwk-Dcx available for outdcor n~ at;ar;o s. See over 1301F. special quotation reg'ued 1521153 Senes ti u Cu~trot Se~ection fir- _ 15V53 .MODELS--- _ -r- Am s SimFlex pupjex y t sr Model Volts_Ph Mode_ P oar 3 1 Auto BiS.52'y ; _ ~c _ No, 4, 2 d32✓u 4 - 43 SELECTION GUIDE 2 _ - , 1c,r , P vback var'a~;e lee floc; 1 .o - A.S,•`--jo 5 n..~~12tl ^r7 a Lltyy; Dc i a le +el ?~4at SWIfCR Of ~OUbi., G y~. r_ N153 " 115 , 1 2, o 1 1 ~ AOA 77 - p 163 -23u _ M_ - r 1 c Vita ` e a r 3. 3 Gel t gE153 23 L Rc a ~e~~ Io of Ee seu as cczucf act,.ataf, spec.{ dup.ex p CAt1T1011~ uaiifisd 3 'r ~r,u~1e rVEi ~ swit t" All installation of controls , protect on devices and wiring should be done by a q ty codes should be fulloed 1noluding the All electrical and,33ft and Health Act QSH r t s licensed ecentNatinal ElectriicCode INEC) and the Occupational safety A RESERVE POWERED DESIGN r 7veller pump veered lrto the design of every reserve safety facror is er,g. For unusual ccnd.tlors a OX ,53MA ;L TO n 1t erSY 01 o k 7r'rutlP 17JA `!t SN P TOy ~ Sat:G p 1 7v f /iAI i:.ti. 'Zi 1 blr.~ ✓'c-' I~v~Y'l.R , ahts reservev zoalter.com hit ~ Z e!;er Co ~"llwww. Cu yr;crt P"OWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page of BILE INFORMATION SYSTEM SPECIFICATIONS Owner._ / Septic Tank Capacity gal ❑ NA Permit # Septic Tank Manufacturer ~~~`~y G NA Effluent Filter Manufacturer ❑ NA (DESIGN PARAMETERS ❑ NA Number of Bedrooms - ❑ NA Effluent Filter Model ~0. NA Pump Tank Capacity al G NA Number of Public Facility Units , ~ ~ ❑ Estimated flow (average) C., . alld Pump Tank Manufacturer NA Pump Manufacturer C3 NA Design flow (peak), (Estimated x 1.5)^y_ allda z Pump Model/ lE' NR Soil Application Rate al/day/ft Pretreatment Unit A 3: g Standard influent/Effluent Quality 'Monthly average Fats, Oil & Grease (FOG) 530 mg/L ❑ SandlGravel Filter 0 Peat Filter Biochemical Oxygen Demand (BOD5) 5220 mglL ❑ NA 0 Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 150 mg/L ❑ Disinfection 0 Other. Monthl avera a Pretreated Effluent Quality Dispersal Cell(s) ❑ NA Y g Biochemical Oxygen Demand (BOD5) 530 mg1L ❑ in-Ground (gravity) ❑ In-Ground (pressurized) ❑ Mound Total Suspended Solids (TSS) 530 mg/L NA -.Grade Fecal Coliform (geometric mean) <104 cfu/100ml ❑ Drip-Line ❑ Other: Other: A Maximum Effluent Particle Size %6 in dia, ❑ NA ❑ _ N N Other NA Other. ❑ NA Other: C NA "Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency O months} (Maximum 3 years) 11 NA :Inspect condition of tank(s) At least once every: 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: 71~ onth(s) (Maximum 3 years) C1 NA ,tia ear(s) / ❑ month(s) 'Olean effluent filter At least once every; / ear(s) ❑ NA - ❑ month(s) ❑ NA nspect pump, pump controls & alarm At least once every: ;year(s) ❑ month(s) ❑ NA =lush laterals and pressure test At least once every: ear(s) ther, At least once every: ❑ month(s) ❑ NA ❑ year(s) 0 NA Other: 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 lnspecter, 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 a# 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 1disually 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 7eguiatory 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, Wiscons,r Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. page - of resence of painting products or other chemicals th.-t OPERATION tank(s) for the p detected have the contents of thy; ART. UP AND S cheek treatment ntrations are ST• For new construction, poor to use of the PO may impede the treatment s tgs servic ng operator prior to se ersal cell(s). if high conce tank(s) removed by P System start up shall not occur when soil conditions are frozen at the infiltrative surface. ower is restored the excess wastewater will be e backup or surface discharge of effluent. pump tanks may fill above normal highwater levels. When p power to Ire rator prior to restoring During power outages tar a dose, overloading the cell(s) and may result in th cell( discharged to the dispersal a the mane g erarvic the pump controls to restore normal )eve s tank remove To avoid this situation have the content PsOo the Ma stainer to ass stf ibyrra nu ally op servicing O effluent pump or contact a Plumber or the area with n within the pump tank. rk vehicles over tanks and dispersal cells. D a not drive or park over, or otherwise disturb or cAmPa f the POWT'>' Do not drive or pa mound or at-grade soil absorption ar 15 feet down slope of any rove the performance and prolong the fat Qfoundation dra~~n antibiotics; Reduction or baby elimination of the following from the wastewater stream may imp wipes; cigarette butts; condoms; cotton swabs; degreasers; des al flos ; sups; disinfectanmedications; ts; oil; painting products; (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbic', meat pesticides; sanitary napkins; tampons; and water softener brine. s shall be taken to insure that the system is props ty ABANDONMENT When the POWTS fails and/or is permanently taken out of service the followingstep and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: sealed. • All piping to tanks and pits shall be disconnected and the abandoned pipe openings Operator. • The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Op and its shall be excavated and removed or their covers removed and the void space filled with soil. • After pumping, all tanks p gravel or another inert solid material. cannot be repaired the following measures have been, or must be taken, to provide a code compllain CONTINGENCY PLAN If the If the POWTS OWTS fails and . re requited replacement system: lacement area has been evaluated and may be utilized for the compaction and location of a should not be replacement infringsoilabsorption system ed will upon by the need A suitable rep The replacement area should be protected from lines sturbance with the rule`' in result comply setbacks from existing and proposed structure, Failure replacement area for a new soil and site evaluation to establish advances in POWTS technologd a effect at that time. not 0 A suitable replacement arias a to vair to lablrt due to s replace t he failed /POWTSm~tations. Barring POWTS a sail and site evaluation holding tank may be costa be installed' as- Upon the site has not been evaluat sd t identify la~Qmentlarea.iaif no area,replacement a eaaisu vail ble a holding tank may be performed to locate a must last resort to replace the failed POWTS. be reconstructed in place following removal of the biomat at the infiltraive effect fo that time. oun and at-grade soil absorption systems may with the rules in surface. Reconstructions of such systems must comply <<WARNING>> TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDlOR INSUFFICIENT OXYGEN. DO NO ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY ppS51$LANCES. DEATH MAY RESULT. RESCUE Oi= r SEPTIC, PUMP AND OTHER PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS i pOWTS MAINTAINER POWTS INSTALLER Name ~ f Name ? t < Phone Phone LOCAL REGULATORY AUTHORITY SEPTAGE SERVICING OPERATO PUMPER Name Name L hase Phone 2 & Wisconsin Administrative Code. This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), O (3'), ON, 010 INSTRUCTIONS FILTER CARTRIDGE r Installation STEP i v ht, ne 71 . case orrt { , - N t c "lit "C it e,S z)erin a '_lt r ,a1 C P_ _ o.lif_ s - t'1n .h?' OI Ct Or ~ svf,rcrrt J,, r., 1,1ta _d.-. W p ,tc, s , ie , ~E L ,L T Su C < lg}"h S EP 2 While t`ic, ase S Still `rv 5t r li -he f ie e~7 "6 }urac. Eh f iitrr e a - S . r 01 7e, Jrlai Jpr)le!"[i E'n di 55QE' `,z-lft }G". III 5;."'.E s ;ii:GGd to Se-, four. l I u P P ;i ~l{ ns ;i .m u 'lam is iv 'tt w is i re rah oipe - to Fr r-• " 1 zC Prci4ee0 ~o ster. e~ tic f 1-,c r STEP 3 5 Ic r; we id the f iter C _-$C s u; m u ca Ord:#c into, Cn as .rcs5mg do r e t" e w . tl,e caisL. STEP if a 'd.s switch ciockw!se 90'=. Maintenance , be _ <<. rvr c to^' te= h _ s C 0L :Dpe the li lU .lGt c.,-_,S5 -,t :c ~ .K t~It C'. s, u e er,t,vE 'he L~ge u,p the ser)tic tank completely mlok ng Ye ?rr the boLtcm of the tan an~ Jrr__ t re e'fi,}Prt }_,vei ".as bee- kr, ,e ^1 bel he Inv rt UT' _n2 cutlet pipe. `irnlY P'll UP ar The ^l-c- ,arirle l.e Cd rl i'6~F c-t'7 ny C-~5r - 5 ~Zlicie -the car loge up ~inG oUt lr ~ _ F ;I R _4' Svt;t r -orinected to a afar pre he " "Y to-rll .c '.:rteu --:eanel- S7tS s. ould be 'c.:1GtieC v s' with water only. 7. %Nrl le `)oloing he cart i ge c in si e ' a g a o facing thew ...d ~~:~,aatnr. down cive7 e accs4 ,pear ry pis r w„ only, , -nak ny ,u: c ali se:), y C",di .5 r1^ G ac: t, r J tar l,1, S. if VhJ SL;'IiCh 'S L;1,Aize6, replace cy f Sc.'..n~ 'lli?" aria turning -iot k~a sa 9t7° „ ~ a nse t the hit rr r_ari iG' e pa k n 7 " SSin g L: :u..:: r :',e bolt _,t. Lh4 ;ne filter locks'nto .a, Replace and secure the a: cess cpe r: ,g o ' ' - .;E?. 0N51TE'-- rjo_ -C;z rgRTRIDGE 'VF•YEA :.:.S,-T 1hA. Ii`,A,c-, Y rrp t±N ~?se -L're`.,9-Te uwte~c w +":'1 AhA ~y S'L CROIX COUNTY SEPTIC TANK..110AIT•tr[ I. NANCE , LGREEIV ENT ANL► OWNERSHIP CFRTJFK'ATlt--JN FORM Owner/I3uycr ~ A-_ __m~ cl~~ Mailing Address _ - b-1 _ _ s to - Property Address (Verification regrrired fzom Planning Zoninl~ C)cpart,.nn nC for n . contiirnctinur.} City/State Parcel Idcntif:ication Nin -fiber - ~ 3~-_--~ 0- LEGAL DESCRIPT IQN~ Property L0catio4jv,). Scc. 31 i~ R l 1W, Town of SubdiNisloll 7_l' . - - Lot s Certified Survey Map Page ft Warranty Deed # Page 70 Spec house yes no I"otliru;: identifiable. yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and rnainteriance of your septic system could result in its pr.~matu.re 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 info the systern can affect the function ofthe septic tank as a treatment stage irr the wasic disposal system Owner maintenance responsibilities are specified in K.omm. 8152(1) and in Chapter 12 - St_ Croix County Sanitary Ordinance. The property owner agrees to submit to St Croix County Planning & Zoning Department it certification form, signed by the owner and by a master plumber-, journeyman plumber, restricted plunnbcr 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. I/we, the undersigned have read the above reyuirennerits and agree to mairtain the Inivaic sewage disposal system with (ho standards set forth, herein, as set by the Department of'(~:ornineice and the Depar7rnenl of Natura.f .1csources, State of Wisconsin, Certification stating that your septic system has been maintained rust be completo.I and .returned to the St. Croix County Planning & Zoning Department within .30 dAys of the three; year expli-ation date. I/we certify that all statements on this forr arc. nue to ilae best of rnyiour k nowledge. liwe an~are the ovarer(s) of flit property described above, by virtue offaa warranty eed recorded in Rog;ister of Devi Is Office. V N tuber of bedrooms ` J 7. S1U. A ? OF APPLICANT(S) DA'TI ***Any information that is misrepresented may result in the sanitary permit being o-woked by file )Tanning & Zoning Department. Include with this application a recorded warranty deed horn the 'Register of Deeds "ffice and it copy ofihe certified survey map if' reference is made in the warranty deed. (REV. 08/05) 11111111 ll l l_I I I I I I I I I I III lalall DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-2003 $ 7x94243 5 4 7 1109 WARRANTY DEED 1010006 BETH PABST THIS DEED, made between Tommy J. Rickard and Lisa C. Rickard, husband REGISTER OF DEEDS and wife, as survivorship marital property, an undivided one-half interest, ST. CROIX CO., WI and Steven J. Wickenhauser and Christy K. Wickenhauser a/k/a Cristy K. 04/03/2015 10:35 AM Wickenhauser, husband and wife as survivorship marital property, an EXEMPTV: NA undivided one-half interest, all as tenants in common("Grantor" whether one or more) conveys and warrants to Joshua S. Miller and Whitney L. Miller, husband REC FEE: 30.00 and wife as survivorship marital property ("Grantee", whether one or more), the TRANS FEE: 472.20 following described real estate in ST CROIX County, State of Wisconsin: PAGES: 1 The NW'/+ of the SW'/. of Section 23, Township 31 North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin, EXCEPT Lot 1 of Certified Survey Map filed in Vol. 2 of C.S.M., pg. 517, as Doc. No. 345062. RETURN TO St. Croix County Abstract & Title Co. Inc. 219 S. Knowles Avenue New Richmond, WI 54017 Tax Parc 038-1095-30-000 This i is not omestead property Exception to warranties: Municipal and zoning ordinances and agreements entered under them, recorded easements for the distribution of utility and municipal services, recorded building and use restrictions and covenants, and further except 2014 real estate taxes. Dated this day of March, 2015. ' ommy J. c C sa ckard Q^ ~ ~ a ,,-A a vv a even J. ickenhauser A L C isty K. ickenhauser AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF WISCONSIN 20 S~ ss. COUNTY OF TITLE: MEMBER STATE BAR OF WISCONSIN 3 St Personally came before me this 1 day of March, 2015, the above (If not, named Tommy J. Rickard and Lisa C. Rickard, husband and authorized by § 706.06, Wis. Stats.) wife, as survivorship marital property, an undivided one-half interest, and Steven J. Wickenhauser and Christy K. Wickenhauser a/k/a Cristy K. Wickenhauser, husband and wife as survivorship marital property, an undivided one-half interest, all as tenants in common to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Robert L. Loberg / Loberg Law Office~e~t~~~ Notary Public ~T County, Wis~Sl,., K q, 1418346 / asc c7t~ . ~.t v My Commission is permanent. (Signatures may be authenticated or acknowledged. Both are If not, state expiration date: s/i ~ '2:711. P : t, Cr not necessary.) O 8' N -Names ofpersons signing in any capacity should be typed or printed below their signatures. ~d•• • ' • r~Q . ~sTA~ I WARRANTY DEED Form No. 1-2003 St. Croix County 1010006 Page 1 of 1 1. _0 Ogw ~WF~`a4 'yl M _ 0 ~qGimy~ i Z W O ~S O O s h ppg y e4q }gg W ss UiLLLLM ~LU w Ox I I I i NIL ~ TI rI lI LL W Q CC LC) CC EI II 1 > t" Q J n l ~ 1 i~ NO w w§ _ I I I I I _ I I I ~ ~ I I I I I I 1 Ir i ' I I I I~ ~ ~ i l ' I I ti I + b I ti I ~F I I I mJ I I j. 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Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ L ❑ 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 Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Iepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2 Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mgA- ' 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.  sISL"33u (K.0/W) k' M tl w o'aa s~ y' ° o] d Q N o b o00 W9W"-~< g p¢ ¢'d¢ G~~ C lug-i hillf fills 4 2 ° o b gg w ? co J J J 1 J rQr ~ W Q W W O Z <y~ ~ ~`g'9 w W Y ~ Q i m noun vm i - _ I i b ° b _ N I N °e h I J ' b b v~ c a~o~ s g - - - - - - - - W o m r~ie ~ ~X 3 _ I - I I I i ~ I I+~ s 0 y~o w: o~ r- 3~ g E_ o flh o 8 g S'~°`~y ` U) N ~w-'S gw gI_y8 rn g Z u F >~o ~:a s o O CV - ff s3`o m 9"g'LLw~w N W fig g(gAgppEApy55@@yy(( yy a 9capwgg c ~~3E6b 6i2~~~ 82Y€ed g~a~n `b - w 'JY~~a'4 t5a N 8 ~ c`o a 6 b ~ w ~ a w j w Y B o~ Sd I I I II ° II w w w tl ~ Y~ Qe 8FN a 1- H w s w o C4 gad w4 ffi ¢'w g 8 E~ 8h EN~g - - 8 bum r~ ~bgb F$ 322 3 g iZZ ° Z~Z as V U U g¢a _R 22 1g., ~9 a gw ~a $ oog ai m ,29 Via` ~.v o yg4 0 3 66 sm. 8m ~c ~dB~  ~ ~ L<LLI~ I Property Owner Parcel ID # Page of ®Boring # ❑ Boring ® Pit Ground surface elev. it. Depth to limiting factor _7~ 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 Z 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 Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `EfNQ Boring # ❑ Boring F-1 11 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPQM in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. `Eff#1 `042 Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mgA- ` Effluent #2 = BODS 130 mgA- 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 (RAM) Soil Test Plot YPla ct Name Josh Miller Bir Proje Address 1008 192nd Ave New Richmond Wi 54017 #226900 Lot Subdivision p 3/30/15 NW 1/4 S W 1/4S 23 T 31 N/R18 W Township StarPrairie Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 3/4" pipe System Elevation 94.5' *HRpSame as Benchmark 700' Property Line Scale is 1" = 40' to 124th St. unless otherwise 40 Acres 500' noted B.M.* L Property Line B -1 B-2 ' 95 10% Slope 93' ° - t°O v W `o o ~dA .2 m U as y mEc E y o =8gy V y r Of U T t y 9Q C C y U O C G m Ol 2 W pi y N x ~~y 0 1 d W U r x = E d Rin E ~Q V ~ LL ~ ~ U ~ !q UJ O J K ~ fn U J3 ~ 0_ ~ K r 9~ O q i Zd ~ -moo 95 3a _ a a 4~ f4<< t .z,.r