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HomeMy WebLinkAbout026-1302-09-000 q-(K-15'6 W,'00 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 578948 ~ GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: !,7 Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Z 5_ 3z d 7J1 Permit Holder's Name: City Village X Township Parcel Tax No: Duffy, James & Susan Richmond, Town of 026-1302-09-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: l7 rOp,vD TOp d ~~IGG PAJ 07.30.18.1586 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ~l~✓ G 106 • l vo. v a Dosing f Alt. BM ` G /kC Aeration Bldg. Sewer S Q Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION ~O0 TANK TO P/L WELL 4BLDG. ent to Air Intake ROAD Dt Inlet lp,~ ,00 Septic > 7 A11A ✓ , v f Dt Bottom - 30 Dosing Header /Man. Aeration Dist. Pipe 3 ~v3.~D Holding Bot. System y Zal. Final Grade ' PUMP/SIPHON INFORMATION +11)q. Manufacturer 1 Demand St Cover 0 P(-4tef o Pj/ GPM w2 •~0 Model Number 7 ± ~Z TDH Lift , Friction Loss System Head T DH Ft .2 4 Y. /0 Forcemain Lengths Diaz h Dist. to Well I , SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR 40Z~ I Type Of System: , UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size Ix Hole Spacing Vent to Air Intake Q ~r Length Dia Le Pipe(s) ngth -U o Dia__~~ Spacing ? 3 v Z 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 > / f Bed/Trench Edges ] fv Topsoil 16 l ' a Yes [jd No R Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:_ g' / ly / ` 111~~~~ Inspection #2: 0 / `9' / /S Location: 964 165th Ave New Richmond, WI 540117 (NW 1/4 SE 1/4 7 TT30N R1 8W) Ninety Fifth Street Site Lot 9 Parcel No: 07.30.18.1586 1.) Alt BM Description = -i g our t aE ~/f~-/ . 2.) Bldg sewer length C A(~E - amount of cover = 42 Plan revision Required? ❑ Yes ❑ No 0 ` Use other side for additional information. 0 / ~Z b K'S SBD-6710 (R.3l97) Date Insepctor's Signature Cert. No. County 4afetyand Buildings Division ` L 201 W WashbgtoaAye., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) l' Madison, VN 53707-7162 S 7~ / NW zF State Transaction Number Sanitary Permit Application 53 o~~ in accordance with SPS 38321(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit X is requitrA prior to obtaining a sanitary permit. Note: Application forms for slant-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 i pUTqSCS in accordance with the Privacy Law, s. 15. 1 m , Stats. 9 (-7 Ll 16-5& -4~ L Application Information - lease Print All Inform n Parcel # Property Owner's Name 1) A1_19_4 PProperq Owner's Mailing Address Property Location ve-, Govt. Lo ` City, tale Zip Code Phone Number Saxion n~ J0 c >c o T ~ N; R W U. Ty f Building (cheep all that apply Lot ^ Subdivrsron `ame~ ' y Dwelling -Number of l3eirN ~~s / 1,~o.r:e B !l~~jj ok. c b ❑ Public/Commercial-Describe Use D City of CSM Number ❑ V' age of ❑ State Owned - Describe Use x ~ wn of Z V 4onli III. Type of Permit: (Check only one boA. Complete line B if applicable) d x A. System ❑ Rcplacemcnt System ❑ TrcatmenUHolding Tank Replacement Only D Other Modification to Existing System (explain) List Previous Permit Number and Date Issued 11 p B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New $efote Expiration°g 1 that a 1 IV. T ypof POWTS S stem/Com nent/Device: Check D Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil D Holding Tank D Other Dispersal Component (orpl Pretre=nent Device (expl ) V. Dis rsallTrest eut Area Information: Desi Flow (gpd} Design Soil ADD licatian R9Tdsf) Dis Area Required sf) Dis Area Pro (sf) S~~ yuon zersal El 1-5-s ~Q VL Tank Info Capacity in Total # of Manufacturer o c Gallons Gallons Units 2 s' U New Tanks Exunng Tanta Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- 1, the undersigned, ass a responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' at= MP/MPR/S~Number Business WPhN ber . LL.C.i Plrnu s Address ( Ci tact, Zip Code c C AV-21 VIII ountv/De artment Use Onl o Si~naz Permit Fee Date Issu~e/d i Issuing t a Approved isapprov D la "T I D owner Given Reason for Denial DL Con t t for Dapprovatl (l(J ' "h 5 eph ank, a Uen Br anic 33 P(a (r t ~s L J dispersal cell'must all Ie services / maIntairte 7 /d rjoa Z as per management plan provided by plumber. ~a t S G ~J / g. All s'W'p , rtaqjkements must be mall tainted. s persplk bti I ordinaries. a ~'J Attacb to campkte plans for the system and submit w the County only or paper not less tft 8 in i 11 inches in size SBD-6398 (R. I1/11) Jl ,~,o_ ; A- J 61V t elf' 2~/VL N) ale- t ~ e"~ L4 ~ 0~ PLOT PLAN PROJECT James Duffv ADDRESS 964 Elm Drive Unit 2 Huao Mn 54017 NW 1/4 SE 1/4s 7 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 101.6' DATE 4/12/15 BEDROOM 3 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 survey iron ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark 325' Property Line Scale = 1/4'1 = 10' B.M. All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. B-21 101'101.6' 102' 8% Slope Area 15' below system is to Grading is to be done to remain undisturbed divert run-off away from syste m B-1 B-3 Well is to meet all WDNR set bac ks Tank is to be properly bedded and provided with Huffcutt Combo Tank lockdown covers with approved warning labels Acre Lot Pro 3 400' Property Line Bedroom Scale = 1/4 = 1 01 House 1 65th Ave SHAUN R BIRD Page 2 5/55/2015 • 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, Please Include a Copy With Your Patricia L Shandorf Payment Submittal. POWTS Plan Reviewer, Division of Industry Services 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 9~yXRT,kfE DIVISION OF INDUSTRY SERVICES yti? ' ~o,. 10541 N RANCH ROAD HAYWARD WI 54843 3, i Q Contact Through Relay 9 P http://dsps.wi.gov/programs/industry-services www.wisconsin.gov 101 S.4 Scott Walker, Governor Dave Ross, Secretary May 05, 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: 05/05/2017 Identification Numbers Transaction ID No. 2532039 SITE: Site ID No. 811785 James Duffy Please refer to both identification numbers, 964 165TH Ave above, in all correspondence with theagency. Town of Richmond St Croix County NW1/4, SE1/4, S7, T30N, R18W FOR: Description: At grade, 3 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1532154 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 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed CONDI i i and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. AP The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code DEPT OF S requirements. PROFESSIO No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145-06Vt$IoN OF IN stats. uu 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 malfunctions so as to create a health hazard, the property owner must SEE COR 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- - - - - Paget 5/5/2015 - • 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, Please Include a Copy With Your Patricia L Shandorf Payment Submittal. POWTS Plan Reviewer, Division of Industry Services 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 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 4/12/15 Owner:James Duffy Location:NW1/4 SE1/4 S8 T30 N,R18W 964 165th Ave Richmond 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 F17-TY AND AL 4 ~RVICES 5. Pump Chamber Cross Section US RvICES 6. Pump Curve 7-8. Maintance and Contigency plan 9-11. Soil test ESpOND6NCE 12. Filter Specification Shaun Bird Signature License numbe 26900 PLOT PLAN PROJECT James Duffv ADDRESS 964 Elm Drive Unit 2 Huao Mn 54017 NW 1/4 SE 1/4S 7 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 101.6' DATE 4/12/15 3 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 survey iron ASSUME ELEVATION 1001 Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark 325' Property Line Scale = 1 4u = 10 B.M. All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. B-21 01 101'101.6' 102' 8% Slope Area 15' below system is to Gradi ng is to be done to remain undisturbed divert run-off away from system 13-3 B-1 Wel I is to meet all DNR setbacks Tank is to be properly bedded and provided with Huffcutt Combo Tank lockdown covers with approved warning labels Acre Lot Pro 400' Property Line Bedroom Scale = 1/4'1 = 101 House 16 5th Ave At-grade System Sloping Site Cross Section and Plan View E ~ %Fyt ,,,,,,,•,.,.•,•1.q• I I !•J':r:.%r f1r~r:rlrlr j1r1r r11'~J1r1r:r:r~'~~''~'' r11:1':r ,'r~r jtif'j: j. j.j. j•!•~•~;,• I L 1 : I e rS•. W :,1 e.e. e; e.e. .!;:r ; c1 /6 B L E L- - B ~T Slop_ e ~ ~ L - 1 = Plowed MAI~ = Clean aggregate O = 4 in. sch. 40 pvc ` - ~ basal area %2 to 2'/2 in. dia. observation pipe Lateral with 2" Topsoil Cap aggregate over pipe Observation Pipe Geotextile G With Cap Fabric .1•-r j'j p t Ft Lateral Invert r;r•r~r:j•j:s• r r r•r ! r•! • Topsoil Cap L 'L•~•~ ~ti`1.1.1• 1 1 L L 1 1 1 1.1.1 r ! r•r r r•!•r•r'~•r ! r r;r ! r•r•.••~• .•'•r:j.r•r r•r•.'•!'' F r: f; r=f=r=j'f'r•r'..r_r.j.f. ~r,r, _ L ,•,•1.1.1.1.1.1 [~O~oFt Contour L•1•'4.1.1•`••1• r.} !_r:rtij'r'r'r'` ' •j r•!; j.r.r•r•r•r•r•!•!• J i _ 4.1•L•1.1 1•L•1.1 1.1•. ijy~ X~y._~1.::~cJ°} ~ -..ti.1••._ti:sa:rtirtir~:Lr~r~r•!•! Jam{{,{, ~~e,'may - ~ .•..1!L D Plowed SL Jrface Slope Direction GENERAL INSTALLATION: The at-grade area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The basal area (L x W) is staked out and plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a '/4 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 must 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. 03/0510 Page of Pressure Lateral Layout One Lateral - End Manifold 4-- Threaded Cleanout Lateral Turn-up Plug Force Main i X~ L Long Sweep 90 Bend Pressure System Construction Distribution Network S ecifications Lateral Diameter In. Laterals are constructed of Schedule 40 PVC Orifice Diameter =5' Z_ In. pipe. Orifices are drilled perpendicular to X (Orifice Spacing) In. the pipe with a sharp drill bit and face down. L Lateral Length) Ft. Lateral turn-ups terminate with a threaded Force Main Diameter- In. Cleanout plug and are enclosed in a 6-8 inch Force Main Length Ft. diameter lawn sprinkler valve box accessible from finished grade. Grade 0::::::::: 6-8 Inch Lawn Sprinkler Valve BOX 031051gj Page of Septic-Dose Tank Cross Section And Pump Performance Specifications n - Manufacturers { 1 ank Manufacturer ,p I'ruik Model Number Pump Model Number Manufacturer <,/c - <>t~' ' r I otal Tank Capacity Alarm - - - Alarm Model Number Max. Bury Depth ~ Switch Type 14 '--1 - - - - - - - > Total Dynamic Head (T'DH) - Feet - Filter Manufacturer ad r _f s,l iF16r Model Number Elevation He llistal Pressure Network Loss ~s__ Mintmttm Pump Performance Required Force Main Loss GPM: Ft TDH Total Outlet Manhole Rhin. 4" Above Grade With Manhole Min. 4" Above Grade Locking Device. Inlet Manhole With Locking Device { 6" Below Grade Sealed Watertight Securely Mounted Weather-proof \J Junction Box ' Finished Grade . Vent Min. ITT Disconnect Above Grade Means With Vent Cap Outlet Filter - Inlet Inlet Baffle - - =1- 7 •~t-------~`-` i t,t; A "iwitch Settings and Reserve Capacity V411 Tank Volume GPI Weep - Dimension : Inches volume Gal_. B Hole (reserve) A Off Elevation C (alarm} B r~ Ft (dose) _P r (dead) D Bottom p' j p Elevai~ioi Total _ aL 3 0 1 'T"-i'~Tf~i S-i~'[T~F'~'iTIT-{-1-i~- ~3T~1 Tf-i- ,.a. . . • ♦ • a r . a r a a . . a r a a a . a . r'a' ♦ f ! ! >•1 Y la>a!•Y•>•Y !•Ii.f fa e+a,a a ,.j~ ` I . t•/a.•1•f•t a!a a a l t {Yi•t•l•{Yt•t♦1.1!<•I.1•f f•1♦a•a♦t•r a•1•a♦.•a•1>r 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 excavation mid the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28. 02/05 U Page ctf `C P E R ti ITv CURVE t~ L CNT rtiv Uc~IIATERIN~ H' CAP At, MDDtI 152~15~ ~,2 50 3 I _ ~ 40 - I j n 12-Il 152 23`. 42 -,4 129 j JO F---~- L - J 44 4 - -c +s~a -1 t I 1C- i I I C ! 20 40 60 80 100 GALLONSN_ LITERS g':0 .60 240 J2C - - 5 9 ^ FLOW PER MINUTE s\ CONSULT FACTORY FOR SPECIAL APPLICATIONS • Tamed dosing panels available. Electrical alternators, for duplex systems, are available and supplied with an alarm. Variable level control switches are availab e for controlling single phase systems. - Double piggyback variable level float switches are available for variable j ievel long and short cycle controls. Sealed Qwik-Box available for outdoor installations. See FM142i) - • Over 130°F. (54°C,) special quotation required. - 1521153 Series j 1521153 MODELS _control Selection k _ r -1✓ ModeiTVolts:Ph I Mode Ames_SIm~Iex Duplex Nor 8 T2_or3 Sn2064 N 152 116 1 -i SLU iu UU 3 85 inc!uned 2 or. i BN152i 115 1 ! Auto L- Non 4.3 2 cr 3 E1 210 BE1521 230 ! Auto l _ 43 inclu:edd 2 or 3 _1 Non 10.5 t or SELECTION GUIDE N153 1 i5 ;--5 inclined 2cr3 level float switch 115 Auto p 99y ~E153 ; 230 1 i Non 5.3 1 2or3 Single piggyback variable153' 230 Auto l 11 nc'U-di 2 or 3~ switch. Refer to FM0477. A _-CAUTION 7 2. See rlV10712 for correct model of Electrical Alternator E-Pak. 3. Variable level control svr!tch 113-02215 used as a control activator, specify duplex (3) All installation of controls, protection devices and wiring should be done by a qualified licensed electrician. Ali electrical and safety codes should be followed including the most or;4, Opal s'4steM recent National Electric Code (NEC) and the 0ccupatienal Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual ecnditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO P.O. BOX 75357 - - Louisville KY 40256.034' blanvFacrure soi. SHIP 70: 3649 Care ku,a Woad I ~ Locisva!e, KY 40271-79s7 QuaurrPu~PS ,5ircE /9~.G9„ 07 `/~t\ j502)7178-2731 • 7 (600) 929-PUMP FAX (5t72j 774-3624 ttttp.11www.zoelier.com _ 0 Copyright 2000 Zoeller Co. All rights reserved. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS ~ Owner 3 rti? `~Y + Septic Tank Capacity al ❑ NA Permit # 'i Septic Tank Manufacturer L ❑ NA ~)ESIGN PARAMETERS Effluent Filter Manufacturer= ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ANA Pump Tank Capacity 6 = v al ❑ NA i Estimated flow (average) < Pum Tank Manufacturer (.77. al/da p NA Design flow (peak), (Estimated x 1.5) C ry7 gal/day Pump Manufacturer ❑ NA Soil Application Rate allda /ft2 Pump Model ❑ A Standard Influent/Effluent Quality Monthly average" Pretreatment Unit q Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter 0 Peat Filter Biochemical Oxygen Demand (BODs) <220 mg/L. ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODs) 1530 mg/L ❑ in-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L t-Grade ❑ Mound Fecal Coliform (geometric mean) :104 cfu/100ml ❑ Drip-Line ❑ Other: iMaximum Effluent Particle Size ;6 in dia. ❑ NA Other: ❑ NA ~Other: Other: A ❑ NA t *Values typical for domestic wastewater and septic tank effluent. Other ❑ NA IAINTENANCE SCHEDULE Service Event Service Frequency i iinspect condition of tank(s) At least once eve month(s) ry' ears (Maximum 3 years) El NA (Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: `Qyear(s) s} (Maximum 3 years) ❑ NA Clean effluent filter . At least once every: ear((ss) ) ~ on ❑ NA Ins ❑ month(s) pect pump, pump controls & alarm At least once every: 'year(s) C1 NA 1=lush laterals and pressure test 1 At least once every: ❑ month(s) -,C year(s) NA ether, At least once every' ❑month(s) ❑ year(s) ~ NA Other. NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: M ster 'Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local Regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of I:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. 1411 other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, find any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. 14 service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals th,,;,t may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of th? tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the fife of the POWTI3: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins', tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requilied setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the n0ed for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rulev in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technologi/ 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 evaluatlion 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. X10- mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWf S MAINTAINER Name Name Phone T- Phone SEPTAGE SERVICING OPERATOR PU ER LOCAL REGULATORY AUTHORITY Name Name!J V /7' + Phone Phone 6; This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. P8Q 9121 FILTER CARTRIDGE INSTRUCTIONS ry~~ xoQB.. Installation STEP ; Dry ht 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 'he outlet or solvent weld ;glue] additional pipe onto the outlet pipe. y.' STEP 2 While the case is still dry fitted on the outlet pipe, measure the length o* -1, -Inch pipe needed to brace the filter to the tank end wall if utilizing the ODtional supplemental side support. if side support method is not utilized, proceed to step four. STEP 3 For installations utiizing the optional supplemental side support: _olvent weld the 3,1 -inch pipe onto the filter case. If side support method is not utd;zed, Proceed to step four. ~rv STEP 4 Solvent weld the filter case onto the outlet pipe. Insert the filter =r~ cartridge into the case, pressing down until the falter locks into the bottom of the case. " W4 4 STEP 5 if a VRS switch is utilized: insert into the filter and lock by turning clockwise 900 Maintenance he effluent filter should be cleaned every t, the septic tank is r b ,en iced. Open the outlet access opening to inspect the 'ank and filters Pump the septic tank completely, snaking sure to remove the sludge I 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. 5. If a VRS switch connected to an alarm is present, the switch l-3 should be removed by turning counterclockwise 901 and cleaned with water only. 7, While holding the cartridge on its Bice ;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. 8. if 'VRS switch is utilized, replace by inserting into filter and turning clockwise 90°. 3 9. Insert the filter cartridge back into the case, pressing down until 'he filter locks into the bottom of the case. 10. Replace and secure the access opening on the tank. BEAR QNSPTE" FILTER CARTRIDGE' - F, VE-YEAR i---M:TED 'wARkAN7Y BEAR CNSITE C111, 7it a 0m 877,MLEILTER.S (653 8 ST. CROIX COUNTY SEP'l"IC 'FANK.1VIAIN't'l.'N A1tiCE Y ~GRET?VILNT AND OWN - SHIP C> .R-T1h7CA7-h-,N FORM Owner/Buyer -'A, Mailing Address Property Address ~!/~-fi - Vertitcah -n required 4-om P anning lonizrg ()c;patttn<fnt 161 new nshuctiou') CitylState 11 rcel Identification Nut tber LEGAL DESOUPTIOIN, 9 Property Location '/4 Sec. 1" R W, Town of , A_ Subdivisiou _--'.z°/ _ 441-7- - - - Lot 9 19 Certified Survey Map # Page tr Warranty Deed # - l S~ A/t.lun e , Yage # Spec house yes no l of liltk ~ identifiable yea no SYSTEM MAINTENANCE AND OWNER CEI2 1FICA`l'[ON Improper use and maintenance of your septic system could result in its pr.~rnattlre fail-me to handle wastes. ]''roper maintenance consists of pumping out the septic tame every three years or sooner, it needed, by a licensed puntper_ What you put into the system can affect tine function of the septic tank as a treatment stage in the wasie disposal system. Owner maintenance responsibilities are specified in §Couun. 83.520) and in Chapter 12 - est. Croix County Sanitary Ordirrancr;. The property owner agrees to submit to St. Croix County I'lancting & lo.n srg Department it cci (ification form, sigiic(l bar tlcc owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri:f}ling that (I) the oil site wastewater disposal system is in proper operating condition andi'or (2) utter inspu, ion and purrtping (if necessary), the septic tank is less than 1 /3 full of sludge. Thee, the undersigned have read the above requirements and at;rcc to n Zir:,tain the private sewage disposal system with the standards set forth, hereitr, as set by the Departttrerit of C:ommercc and the "Dupartnnerrt of-Natural Resources, State of Wiscousm. Certification stating that your septic: system has been maintained must he completr,, l and rei.tmteci to the St- Croix Cotmty ]'lanuirth & Zoning Department within 30 days of the three year ex[iraiion date. ]/we certify that all statements on this fo/ m ace: True io ilxC best of cny, oOm 1, uowledge. hwc antiare the owner(s) atite property described above, by vuttcc: of a warrant deed recorded in Register ol'Dect Is Office. Numb b Ins _ AT PLICANT(S) t) AT t ***Any information at is misrepresented may result in the sairitaty pcrttrit being wvobed by the Planning & Zoning 1)epart,nenr. Include with this application a recorded warranty deed f om the Register of Dt eds ,-,ffice and a copy of the certified survey reap If reference is niade in the warranty deed. (REV. OS/05) I DOCUMENT No. STATE BAR .OF WISCONSIN FORM 1-2003. 8 2 4 7 9 5 7 WARRANTY DEED TX:4202723 999544 THIS DEED, made between One Corporation; a Wisconsin corporation . BETH PABST ("Grantor" whether one or more) conveys: and warrants to James Duff and an REGISTER OF DEEDS Duff~J husband and wife as survivorship in proper ran ee"; whether 'ST. CROIX CO., WI one dr' more), the following described real estate in ST CROIX County, State of 08/04/2014 10:31 AM Wisconsin: EXEMPT#: NA REC- FEE: 30.00 TRANS FEE: 54.00 PAGES: 1 Lot 9,. Plat of Ninety Fifth Street Site in the. Town of Richmond, St. Croix Country, Wisconsin. : RETURN TO St. Croix County Abstract & Title Co: Inc. 219 S. Knowles Avenue New'Richniond, WI 54017 Tax Parcel No: -026-1302-09-000 This is not homestead 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 31 st day of July, 2014.: . One Corporation, a Wisconsin corporation By: Thomas _D. Mews, 'S Lary/Treasurer AUTHENTICATION. ACKNOWLEDGMENT Signatures authenticated this day of STATE OF WISCONSIN } 20 ss. COUNTY OF ST CROIX TITLE: MEMBER STATE BAR OF WISCONSIN- (Ifriot, Personally came before me this 0V day of July, 2014, the' above amed One Corporation, a Wisconsin corporation to me authorized-by § 706.06, Wis. Stats.) . Icno o be the person(s) who executed the foregoing instrument and a owledge the same. THIS INSTRUMENT WAS DRAFTED BY ``,`,,11'11+,~•',`,L ~f v11• ..ao.'y Robert L. Loberg / Loberg I:aw Office Notary Pubic St. Croix County, Wis A. • t " •v 3 'p ~r9 A~ alp 1418705 y7. ~li S v _ wt. SIP- My Commission is permanent. (Signatures may be authenticated or acknowledged.. Both are . If not, state expiration date: r,~'';. `•'•1.11 • ° °~e~`. ' not necessary.).. f 7 WARRANTY DEED, _11No. 1-2003 St. Croix County 999544 Page 1 of 1 C~~' UNPLATTED LANDS NB i o b ci d S 00'35'17" 1 15 4.52' yy,~ y.~ 399.88' 66.I00' _ 302.62' 375.45' ~ U T pI .t ~ w 3 ~ q -978.64'_ O I O~ N 0 N • l m NN ......Y~j.~ N1o O d O o o ^ O lV N 0707.8=5:17 W ^p m Z I o ry' p m Qh n~ Z to . 00 (Zi j r \ o~~_p o - w oy ~I r if) 4 3190; E C Y \ ~J \ _ I01 ~-6 3 • p I / 518553 v \ 2J \ $10.2}24 E 215.5 j I Z a w ~`..f 4.W 215.53` _ \ J y U I h I N10'232 v e \ _ jg6 as ~J 3 a.k a 29.08 S, , ~p U ~ Q off' a O h O 4 N a N Aj . w c m m o• ,o' m p q 9 M- N U ~ R N m O V1 40 a ! h h ~ m ~ ~ g5 82 0 3 as a a N 0 55„ W Z 81.7a 9' 494.73' 83.46• 3 -k ~F N N00'22'1 YW 660.00' 0 c ao ~CE C E R i ED S UR VE Y M'A P_ o0 ----.F-.--------------- t•-7 1-9, - P A GE 4 9~9 2 o as o V O L U M E- - q) o w Z~'~`' I I-~I I ICI I hl ~ I Q, co rpm =rn z~ p ~Z rQj I- - - - - North-South 114 Line I o Q ~ o p - - - - - - N.OO_32 Q3"-W 365G. 5E - - - - - - m~ __ann•zn'nz"w cn-rv zz' 95THSTAE x£ ISM ID a J O is SE's#3: p CO > t i2 ~ Z N z i E HUM, A w s a zN , Y [ l~ A DL J J y, ~ A r w .~yo 5 w w ~ W I z d A z ~ ~ ~ ~r s ,~5 ¢ a ~ ~ Z w s„e ~ °C ee 00 E[8 ~ ~ ~ , I a I ,3~, m.o,~~ 11 I I IA I~ y 4d ~ I 3~ II ,.F i = ,EE A~[ I i ~ III ~s ~m ~i s4 I 8 8 ~b Z him 'ifiq 8 LLLLLUiL i w i x w 3o 4 w oQ i f~~ m a ~ ~ts , e r---------------------- _ ~4~ I qq I II >vuaxa , a , I Eo I ~ I a.,, axn,nm a3awe I S b M Y I I ,I I s3 ~1 b II I d ~ ay I i t I - f ' I I I I I I I I I 1 oza~s3ssnw wov.' n I 11 1, z.c ~ 1 I Y$ I e _-----~'i F--_-_ p - - - - - - - - - I I I 1 V ® ® L I - I I I I I I I I II 1 o s L I I 1 R © 50 1 I I ~ II I ~ I I I I i 1 % ~ I 1 .vi r u .r z I C I- I I I II r 1 r 5 e - I! I I 1 I l I~ n r ~ I~ I I I I VVI C _ _J ~ L__J I I If I I I I _ I I , ry~ I 1 p , , zx-nui uoov ni .rn ii s 'r~~ I I 1 I zie v I I ~ I I f p II I 1 'I ,I 1 I I , I I I ,I I I I I I I I I I 1 r„3bn,T'nn3~rxe A q 68 ~a Wisconsin Department of Commerce VALUATION REPORT Page-Lof Division of Safety and Buildings t in a~ Comm 85, Wis. Adm. Code County 5L Attach complete site plan on paper not less the 8 1/2 11 inc t ` / + C include, but not limited to: vertical and horizon efere poir l , bt1bh'a Parcel I.D. 7 ~1 percent slope, scale or dimensions, north arrow, and I tion and distance to nearest road Please print all inforr tion. A U G 2 2005 Review by oateQ Personal information you provide maybe used for secondary rposes (Privacy Law• s. 15.04 (1) (m)). /Z p 6 S Property Owner /jam / ZONING FFCELocat n ( _ 0/ v~ 1/4 1/4 T 3O N R E W Props is Mailing Address Lot # Block # Subd. Name or CSM# ~0, X30 x -5~ 0 Psis .5 City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road IK,New Construction Us sidential / Number of bedrooms Code derived design flow rate J?~ GPD ❑ Replacement ❑ Public oJr co/mmercial - Describe: Parent material O ff/ ~T Flood Plain elevation if applicable e4o-~ ft. General corixnents _ and recommendations:.] sis/L~,ei., ~l~ vrjv~ ! v~• ~j ~JY ate,, f /off a Boring # zr Boring 10 Z 4zrL 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 Ll -I 12 -qS Boring # 0 Boring ✓ , - Pit Ground surfaceelev. Depth to limiting fadoYo 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 0 L4 r 31Z S I Z (r, r c s - a ^ 11~ - 0 y/~ Zm Fr w l !-o ~0 5 y/ d f s) ` Effluent #2 = BOD < 30 mg/- and TSS < 30 mg1L • Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 TY(Z CST Name (Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54 715-246-4516 I Property Owner _ Parcel ID # Page of a Boring # ❑ it ding Ground surface elev. ~ft. Depth to limiting factor I I in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture structure consistence Boundary Roots GPDAf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 -1L 3/z 2 y- rn,C C Z L- I q/ 2_rri! b 4~- I . b . o 3 Yl- v rY/ ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil -Application Rate Horizon Depth Dominant Col Redox Description Texture Structure Consistence Boundary Roots GPDM 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 ication Rate . Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDfff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2 Effluent #1 = BOD3 > 30 1220 mglL and TSS >30 < 150 mglL ' Effluent #2 = BOD5 < 30 mglL and TSS < 30 mglL 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. SB"330 (R6M, Soil Test Plot Plan Project Name P.C. Coliova Bldrs. Inc. Shau Address P.O. Box 489 Somerset Wi 54025 CST #226900 Lot 9 Subdivision 95th St. Site Date V18/05 NW 1/4 SE 1/4S 7 T 30 N/R18 W Township Richmond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 101.6' *HRpSameasBenchmark Alternate Benchmark Top of 1/2" pipe @ 100.3' 120' is B M 325' Property Line 10' Scale is 1" = 40' B-2 unless otherwise noted 8% Slope 0' B-1 10' 30' B-3 100' 102' 400' Property Line