HomeMy WebLinkAbout038-1136-50-050
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
578987 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:
Kelley, Timothy & Brid et Star Prairie, Town of 038-1136-50-050
CST BM Elev: , Insp. BM Elev: BM Description: Section/Town/Range/Map No:
00•0 •a T • 33.31.18.557A10
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing w / r _ Alt. BM
Aeration oZ•G t Bldg. Sewer &-Wl L "Jet 0- Holding 3a ! ~~s ~ e~ _9t_/Ht inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic y t~ t Dt Bottom
Dosing Header/Man.
Aeration Dist. Pipe a t pp ; p ,
r fl b0.
Holding Bot. System o
. µ0
PUMP/SIPHON INFORMATION Final Grade C
•3 n~ ro
Manufacturer Demand St Cover 1A L
GPM
b • 2
Model Number
TDH Lift n Loss System Head TD Ft
Forcemain ngth ra,~,_ Dist. to We
SOIL ABSORPTION SYSTEM ~~a~.l.~ ~,•IeMQC
RE C Width I L~~ I No. f Tr nches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth Cg I DIMENSIONS a
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Mao
INFORMATION CHAMBER OR 't+
Type Of System: ` zoo . UNIT IM=el m. r. A
• 1 ♦ Ott J\ MG- A ` S
DISTRIBUTION SYSTE
Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air I
Pipe(s)
Length Dia Len Dia Spacing
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 Bed/Trench Edges Topsoil ® Yes ® No 1 [2 Yes 0 No
O NTS• Include de d sc a enciep,,,pe~r~sons fires nt, etc. I Ins ction #1: / Inspection #2: / /
ocation: 1022 Hwy 64 New Richmond, WI 54017 (SW 1/4 SW 11./44-33T3114 R18W)Bmetes & bounds Lot Parcel No: 33.31.18.557A10
1.) Alt BM Description
2.) Bldg sewer length = (p ~o f U
-amount of cover=
Plan revision Required? ❑ Yes No
Use other side for additional information J
C Date [ ~Insepctor's Signature Cert. No.
D-671 00a1(.RYW'iG) wt W~~ C IO jj~ ~ tQ~ db ~KiJ•tr.'7~1tt~~JH~C `C.
PLOT PLAN PROJECT Tim Kellev ADDRESS 404 W 5th St. New Richmond Wi 540 Vol
SW 1/4 SW 1/4S 33 /T 31 N/R 18 W TOWN Star Prairie
COUNT . CROIX
SYSTEM ELEVATION 99.2/98.4' 4.5' below grade 6/10/15
DATE BEDROOM 3
CONVENTIONAL XXX IN-GROUND PRESSURE
CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651
# of chambers 32
BENCHMARK V.R.P. Top of 1.5" pipe
~'14 ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL *H.R.P. same as benchmark
Scale = 1/4" = 10'
Pro rty Lie Pro 3
(priv to r ) Bedroom
House
i. 10' 2-3'X 66' cells with >3' spacing
; , 35 35 -2 104'
B
B-1 vents 103'
Scale is 1" = 40'
30' a..
unless otherwise 102'i•
noted 101, d,
B-3
20' 8% Slope
500' ti » (I
B.M.*
0 All piping shall be ASTM SDR 30/34 within
500 10' of tank, piping shall be ASTM F891
- Vent
v► r~~ >6" Quick4 Standard
of Cover Leaching Chamber
with 20.0 ft2 of Area
12" 5.6ft^2/pair of end caps
• • 4' Long
34" Grade at System Elevation
100th St.
Community Development Department Page 2
vegetation removal is prohibited unless specific conditions are met. Contact this department if
any vegetation removal is desired.
17.30.P.4.a A complete Land Use Permit application was submitted on 6/9/15 with the $350 permit fee.
Implementation shall be completed within one year from issuance of the Land Use Permit;
17.30.P.6.a however up to six month extensions may be granted by the Zoning Administrator prior to the
expiration of the Land Use Permit.
17.30.P.6.b The applicant shall schedule pre-construction and post-construction inspections with CDD staff
Based on these findings, approval of the land use permit is subject to the following conditions:
Compliance Conditions for land use permit approval
Date
A pre-construction on-site meeting must be scheduled with the CDD staff to verify placement of
erosion and sediment control (silt fence). Photos will be taken to document pre-construction site
conditions for enforcement purposes.
The sanitary permit to be issued for installation of the POWTS will require compliance with all
conditions of the land use permit, including erosion control. Developer/Contractors must be
made aware of the conditions regarding erosion and sediment control.
The applicant or their agent will be responsible for implementation of the approved storm water
management plan by installing infiltration devices.
The applicant shall maintain all erosion and sediment control measures until permanent, self-
sustaining vegetation is successfully established on all disturbed areas of the site.
No phosphorous fertilizers shall be used. on the disturbed areas of the site, unless a soil test
confirms that phosphorous is needed for establishing permanent vegetative cover.
Within 30 days of completing the project, the applicant shall submit photos of stabilization of
disturbed areas and installation of stormwater control for documentation of compliance with
permit conditions. Photos may be sent electronically via e-mail attachment to the CDD.
This approval does not allow for any additional construction, structures or structural changes, grading,
filling, or clearing of vegetation beyond the limits of this request. Your information will remain on file in
the St. Croix County Community Development Department. It is your responsibility to ensure compliance
with any other local, State, or Federal permitting or regulations, including obtaining a building permit
from the Town.
Conunun' pment Dept. Au tall Signature
Enc: Land Use Permit Card, LU88590
Cc: Brian Wert, Town of Star Prairie Building Inspector
Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, Wl 54016 Fox 715.386.4686
/stcroixcountywi cddPco.saint-croix.wi.us
www.sccwi.us/cdd www.Lacebook.com
ST. CROIX C0-UNTY Land Use
Planning & Land Information
Resource Management
Community Development Department
June 11, 2015 File#: LU 88590
Timothy & Bridget Kelley
404 W 5 h Street
New Richmond, WI 54017
Land Use Permit for Parcel ID: 33.31.18.557A-10. Town of Star Prairie
Site Address: 1022 Hwy 64 (subject to chance)
Community Development Department (CDD) staff have reviewed your application submitted on June 9, 2015 for
filling and grading within a Shoreland area >2,000 sq. ft. within 300 feet landward of the Ordinary High Water
Mark' (OHWM) of a navigable waterbody to construct a single-family dwelling with an attached garage, accessory
structure, gravel driveway and a private on-site wastewater treatment system (POWTS). A Land Use Permit is
required pursuant to §17.30.1.2.1. of the St. Croix County Shoreland Overlay Zoning District. Staff determined
that the proposed project meets the spirit and intent of the St. Croix County Shoreland Overlay District based on
the following findings;
Code Proposed Project Standards & Requirements
References
17.30,F.4 The proposed single family dwelling with an attached garage and pole shed will be a legal
G.1, & G.2, conforming principal and accessory structure that is >75' from any OHWM and >50' from any
H. Ld shoreland-wetland boundary >10,000 square feet.
There will be >2,000 sq. ft. of land disturbance within 300 feet of the OHWM required for the
17.30.1.1 & 2 construction of a single-family dwelling with an attached garage, an accessory structure, gravel
driveway and POWTS total land disturbance activity is estimated at 7,500 sq. ft.
The total of amount of impervious surface proposed is 6,648 sq. ft., or 0.6% of the 962,305 sq.
17.30.) ft. located within 300' of the navigable waterbody. Impervious surface is allowed on up to
10% of a lot without the requirement for Mitigation..
Stormwater management is required to infiltrate 100% of the proposed impervious surface
17.30.x.1 volume for the site for a 1.5-inch (0.125') rainfall event. The total amount of impervious
surface proposed (6,648 sq.ft.) will require 831 cu. ft. or 6.216 gallons of runoff volume. Two
(2) rain gardens will be installed to account for 831 cu. ft. (8" deep and 340 sq. ft.) and one (1)
grass swale consisting of native vegetation will be installed along the driveway to account for
400 cu. ft. (200' x 2' x 1').
17.30.x.2 As shown in the erosion control site plan, two (2) rows of silt fence will be utilized to control
sediment runoff during construction at the downslope side of all excavation.
17.30.L.1 Land between the ordinary high water mark (OHWM) and 35 feet inland is designated as the
primary vegetative buffer zone and may not be mowed, except for a viewing access corridor
that meets 30°% of frontage or 30 feet wide is allowed.
17.301.3 The area between 35' and 75' landward from the OHWM is a secondary vegetative buffer, and
Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, Wl 54016 Fax 715.386.4686
WWW.sccwi.us/cdd www. acebnnk.eom1stcroixcountywi cddC5co.saint-cra1'x.wi.us
County A
e,
J Buildings Division '
1 n 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in Co.)
8s' 4
a M 53707-7182
~Vi`LQPMCNl` State Transaction Number
M Sanitary permit Application
Wis. Adm. Code, submission of this form to the approprtate govetntnental unit s if different than trailing address)
In SPS 383 accordance with bta ing, (2), Note: APPlication forms for state-off POD are submitted to Project 1 D 22 -1 Y 6H
is required Prior to obtaining a sanitary Pelmet. for secondary VV
the Department of Safety and professional Servies. Personal information You provide may be used
SOS in accxadanco with the Pri Law, s. 15. 1 M , Stets.
Parcel #
~ l
I. A lication Information - Please Print All information
property Owner's Name Property Location 55-7A - CJ
Property Owner's Mail¢ig Address Govt. Lot
, ll, soon 33
Zip Code one Number
City, State J (,~k one
T N, R f/~ E w
l " v Lot # Subdivision Name
IL T p , of Bailding (check all that apP1Y) d
2 Family Dwelling -Number of Bedrooms
lock #
❑ City of
❑ publiclCommercial - Describe Use Lo l V-te of
CSM N
of
State Owned - Describe Use 1 1 e u
011 LMP CEPS /J
In. (Check only one box on 'Inc A. Complete C e B if ap icable)~ Modification To Existing system (piaiiI)
ew System Rcpiaccmcnt System ❑ Treatment/Holding Tank Replacement only I 0 -7 t X
~
List Previous Permit Number and Date Issued
❑ Change of Plumber 11 Permit Transfer to New
B. ❑ Permit Renewal ❑ Permit Revision Owner lJV
Before Expiration
24 , of ttabie soil
OWtto om onent/Device: Check all that apply)
Pressurized In Ground [3 At-Grade [J Mound, 24 in. of suitable soil ❑ Mound
*don-Pressunzrd In-Crioimd Pretreatment Device (explain)
g ❑ Other Dispersal Component (explain) ,
ea Information: posed (s system levauo
rsal/Treatme Ar dsf) Disper;al!+rc1 Required D / ~.1 7j l
V. Dis ign Soil ttcation Rate(gp
Design Flow (gpd), p 6 (7% QcJ L.
Manufacturer 8 c
# of =
Capacity in Total
VL Tank Info Gallons Gallons Units m y a
New Tanks Existing Tanks 1. 1 ~I L/71 H' a vi n z C~ G
Septic or Holding Tank
Dosing Chamber
es sibilitY for installation of the POWTShe/MPRS ~urnb attached
Business one Number
VII Responsibility Statement- I the uAdersigued, assume
~
's ~ er o~
$ Name (Print) Plumber's
Plumber's Address (Street, CU', State, Zip
a at
~
VIII. County/De artment Use Only Permit Fee Dau ued IsstiinpAkgert Si
Disapprov S Ob IL
~ veer Reason for Denial ~ t C O O C~`
IX Conditions of Appro Pproval
1/ p Q ( 1 II~
1, optic tank, effluent filter and
S, n CSI I f 5C C v
intained o Coniv
dtspg►! Cgli must be Serviced I ma d
aspen erg-Ment plan pro +.ded Nlumber. ~
utrements be 1!ijintained
2. All setback req
er applicable cndelordii submit s. to the County only oa paper not less than 8 trs z I1 inches in aixe
Attach to compkta plans for the system
SBD-6398 (R. 11/11)
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 6/10/15
Owner: Tim Kelley
Location: SW /4 SW1A S33 T31 N,R18 100th st. Star Prairie
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-6. Maintanance and Contingency Plan
7. Filter Specifications Sheet
Signature
License number #226900
j
PLOT PLAN
PROJECT Tim Kellev ADDRESS 404 W 5th St. New Richmond Wi 54017
SW 1/4 SW 1/4S 33 /T 31 N/R 18 W TOWN Star Prairie COUNTY ST. CROIX
SYSTEM ELEVATION 99.2/98.4' 4.5' below grade 6/10/15 3
DATE BEDROOM
CONVENTIONAL )00( IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32
BENCHMARK V.R.P. Top of 1.5" pipe ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL *H.R.P. same as benchmark
Scale = 1/4" = 10'
Property Line Pro 3
(private road) Bedroom
House
10' 2-3' X 66' cells with >3' spacing
T l0' 35' 35' B104'
-2
B-1 vents 103'
Scale is 1" = 40' 30'
unless otherwise 102'
n101'
B-3
20' 8% Slope
a500'
B.M.*
All piping shall be ASTM SDR 30/34, within
500' 10' of tank, piping shall be ASTM F891
Vent
is Quick4 Standard
Leaching Chamber
with 20.0 ft2 of Area
" 5.6ft^2/pair of end caps
3491 Grade at System Elevation
100th St.
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber
5.6ft^2 pair of end plates To be >1' above grade
Finish grade elevation
/ Typical Installation 103.5'
,jVen
Grade Vent
4"
~30/34 Septic Tank 3'
5' S' Long 1 „
3 6Grade at System Elevation Grade at System Elevation
Spacing 5'
2-3' X 66' Cells
Same on other end Observation tubeNent
At end of cell
A
16 chambers per cell B
System elevations:
A_99.2'
B 98.4"
ST. CROIX COUNI-f
SEPTIC TAMS NLAINT.1 NANCE iGREKMENT
AND
OWNERSI-11P C']ER-'T F ('A'I( N f ORM
0wner/}3u Yer
M~dling Address VD~ v4r ~ ,p~i u% / VrG Lf/ f2j, - ~ JY(~l
Property Address d ZZ
Verrfic atron required fro au Plannr2lg Zon%
g
nOr-pal turient fur new ors rriCtion.) (Verification
City/State}(,I(Q( - D~ 1''lrcel Idcnti(icat:ion v7I II~eI 0'/ 6' 6-~
LEGAL DESCRIPTION
Property I occttion.,`~~ 1 '/a ,Sec . N 1 W, Town. 01
- -
Subdivisioll
of
Certified Surrey Map #
Warranty Deed # Page #
Spec house yes no lot. linos identifiable ye.' no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Trnl-)roper use and rnainte;narrce of your septic system could result in its pumiatare failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, it needed, by it licensed pumper. Whau you put into
the systern can aflect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in Womin. 83.tiZ(1} and in Cliapter 12 - St. 0oix County SanittryOrdinance.
The property owner agrees to submit to St. Croix, County Planrurag & /Oil ng 0eparlmerat a certification li?rrur, signed b_v the
owner and by a master phunber., jo rneyman plumber, restricted plumber or a licensed purripcr verifying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspec,ion and ptnriping (if necessary), the septic tint; is
less than 113 full of sludge.
I/we, the undersigned haavu read the above reyuire.mcuts and at,rcc to n-lair tani ;tie Inivale s vva e dnposat system with the
standards set forth, herein, as set by the Departnren.t ofC;oirrrlie, cc and the, Departincrit ofNatural Resources, State of Wisconsnt.
Certification stating that your septic system has been maintained must lac complew, t and returned to the St. Croix Cotmty 1'lanui.np &
Zoning Department within 30 days ofthe three year expilaijon date.
]/we certify that all statements on this form arc, true to the best of any/otn k nowledge. 1/wee arnlare the owner(s) of the
property described above, by virtlae of a w• ranty decd recorded in Register of Deer Is Office.
Nutnbe .-W b droor
SICr." 7 ~p APP~LICAN l (S) D A 1,
'1.**Any inforination that is misrepresented may result in the sanitary permit being; o woketl by the Planning & Zoning Oepartment.
Include with this application a recorded warranty deed h om the Regism of-Deeds 'Alke acrd a copy ot-the certilied survey rraap ri
ieterence is rtiade in the warranty (Teed.
(REV. 08/OS)
POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
EOwner / Tank Manufacturer. ❑ NA
FE1 Septic [3 Dose 11 Holding Volume: (gal)
DESIGN PARAMETERS Tank Manufacturer. NA
Number of Bedrooms: ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal)
Number of Public Facility Units: >QVA Vertical Distance Tank Bottom(s) to Service Pad: (ft)
Estimated (average) Flow : (gallday) Horizontal Distance Tank(s) to Service Pad: (ft)
Specific servicing mechanics must be provided if vertical is >15 feet or
Design (peak) Flow = (estimated x 1.5); 4/_y-O (gal/day) if horizontal is >150 feet. Specific instructions to be provided on back.
In Situ Soil Application Rate: , (gaildaytW) Effluent Filter Manufacturer:,4 I y p NA
Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model:
Fats, Oil & Grease (FOG) s30 mg/L Pump Manufacturer:A
Biochemical Oxygen Demand (BOD5) s220 mg/L ❑ NA Pump Model:
Total Suspended Solids (TSS) x150 mg/L
High Strength Influent/Effluent Monthly average Pretreatment Unit
(FOG) >30 mg/L Manufacturer A
(BODs) >22 220 mg/ L ❑ NA C3 ~ Mechanical Aeration ❑ Peat Filter
(TSS) >150 mg/L Wetland
❑ Disinfection
Pretreated Effluent Monthly average ❑ Sand/Gravel Filter ❑ Other.
(BODE) s30 mg/L Soil Absorption System
(TSS) <_30 m
(geometric mean) 510` 9/L E3 NA n-Ground (gravity) ❑ In-Ground (pressure) ❑ NA
Fecal Coliform ❑ A -Grade ❑ Mound
EOt um Effluent Particle Size '/a in d❑ NA ❑ Drip-Line ❑ Other:
. ❑ NA O ther: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Pump out contents of tank(s) hen combined sludge and scum equals one-third ('h) of tank volume
TAt hen the high water alarm is activated
st once e ve onth(s) (Maximum 3 years) ❑ NA
Inspect condition of tank(s) rY 13 year(s)
st once ❑ month(s) (Maximum 3 years) ❑ NA
Inspect dispersal cell(s) every: ear(s)
At least once every: ❑ month(s) ❑ NA
Clean effluent filter year(s)
❑ month(s) NA
Inspect pump, pump controls & alarm At least once every: ❑ year(s)
Flush laterals and pressure test At least once every: [I month(s) NA
❑ year(s)
Other: At least once every: ❑ month(s) NA
❑ year(s)
Other: NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper).
Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The soil
absorption system shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent
on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate
notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any treatment tank equals one-third or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
and any servicing at intervals of <_12 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 30 days of completion of any service event.
GMW-005 (02/05)
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other
chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are
detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use.
Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these
conditions is not recommended, as the excess wastewater will be-discharged to the soil absorption system in one large dose causing an
overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the
contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber
or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
Do not drive or park vehicles over tanks or the soil absorption system. 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 Irfe of the treatment
tanks and soil absorption system: acids, antibiotics, baby wipes, -cigarette "butts, condoms, cotton swabs, degreasers, dental floss,
diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat
scraps, medications, oils, painting products, pesticides, sani4ry napkins, solvents, tampons,'and water softener brine discharge.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that, the system is properly
and safely abandoned in compliance with s. Comm 83.33, Wisconsin Administrative Code`.
• All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator (pumper).
• 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
replac ent t
sysem:
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 the time of their permit issuance.
❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be
rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation
must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a
last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the blomat at the infiltrative
surface. Reconstructions of such systems must comply with the rules in effect at that time.
WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY
RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE.
ADDITIONAL INSTRUCTIONS:
POWTS INSTAL ER POWTS MAINT ER .
Name Name /
Phone lJ
one
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
Name Name'
Phone 71J~.-~ Phone
This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in !compliance with sections
Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
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State Bar of Wisconsin Form 3-2003 Tx:4234726
QUIT CLAIM DEED
1008299
Document Number Document Name BETH PABST
REGISTER OF DEEDS
THIS DEED, made between Philip M. LaVenture and Patricia A LaVenture ST. CROIX CO., WI
husband and wife, 02/25/2015 11:28 AM
("Grantor," whether one or more), EXEMPT#: 8
and Timothy A. Kelley and Bridget L. Kelley, husband and wife as REC FEE: 30.00
survtvorsnip marital property PAGES: 1
("Grantee," whether one or more).
Grantor quit claims W Grantee the following described real estate, together with the
rents, profits, fixtures and other appurtenant interests, in St. Croix
County, State of Wisconsin ("Property") (if more space is needed, please attach Recording Area
addendum):
Name and Return Address
The West 1242.94 feet of the W of SW ''A of Section 33-31-18 EXCEPT the North Ronald L. Siler
0.55 teet_thereof and -.EXCEPT part to Chris P. Neuman and Lvnn M. Neuman in Williamson & Siler, S.C.
2111
Volume "732", Page 19, Doc. No. 409111 and EXCEPT part to James C. Hermansen N
ew Richmond, Wl 54015e j
and Michelle F. Hermansen in Volume "752", Page 424, Doc. No. 416520 and
EXCEPT part to State of Wisconsin, Department of Transportation in Volume
"1620", Page 590, Doc. No. 643128 SUBJECT TO a 66 foot Easement as shown in 038-1136-50-050
Volume "1442", Page 281, Doc. No. 606932. Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Dated _6"az
Z~Z
- 4
(SEAL) ,Aj6 ;1 CG (SEAL)
* Philip LaVenture *-Patricia A. LaVenture
* (SEAL) (SEAL)
*
l ` AUTHENTICATION ACKNOWLEDGMENT
Sidnaturc(s)
STATE OF MISSISSIPPI )
authenticated on ) ss.
4A (t -S COUNTY )
Personally came before me on Feb. 17, 2015
TITLE: MEMBER STATE BAR OF WISCONSIN the above-named Philip M. LaVenture and Patr'01Y $10,
(If not,
LaVenture
~
authorized by Wis. Stat. § 706.06) to me known to be the person(s) who exgc~ d• e forVn4•
instrument and acknow dged the same. O
THIS INSTRUMENT DRAFTED BY:
Ronald L. Siler of Williamson & Siler S.C. * w '40
vo-
201 S. Knowles Ave., New Richmond, WI 54017 Notary Py, ~q ~I~
My Comt4l t 4~ S'trf ( 4E~ISt~ IPPI H~~ •Hd1R~►~~O
C~tITIssion E pires• f
(Signatures maybe authenticated or acknow
;OS
ge n are not u cessary
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONSAP3Mm R& 414SW"DENTIFIED.
QUIT CLAIM DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 3-2003
* Type name below signatures.
St. Croix County 1008299 Page 1 of 1
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Property Owner _ Parcel ID # Page of
F-3-1 Boring # ❑ Boring
F
it Ground surface elevAL ft. Depth to limiting factor in. Soil Application Rate
A
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 ff#2
-
3 ya- s m 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
Pit Ground surface elev. ft. Depth to limiting factor in.
11 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 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mgA- • Effluent #2 = BOD, < 30 mg& and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-8330 (RAM)
RECEIVED P-A-1j)
Wisconsin Department of Comma C CIX COUNTY SOIL EVALUATION REPORT Page L of 3
Division of Safety and Buildings b I C7PNIENT
,QI+~I+itll6N!TYirt~co~ance with Comm 85, Wis. Adm. Code county ,I I
+
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must '5 1
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. D
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. eq
Please print all information. Revie Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). l(J J
Property Owner Property Location
Govt. Lot (,J 1 /4 5Le11 /4 S 33T / N R YE(or W
Property Ownee Mailing A dress Lot # Block # Subd. Name or CSM#
2/0 6t'l fft~ I - , i
City Stat Zip Code Phone Number [ ❑ City ❑ Village Town Nearest Road
ET-New Construction Us Residential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public or cc eraal Describe:
Parent material 01 Flood Plain elevation if applicable
General continents
and moorr emendations:
System Type 6 "zi t System Elevation +
F Boring ❑ Boring
# V1 pit Ground surface elev. Ia ft. Depth to limiting factor % in.
Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Str;re Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. h. 'Eff#1 'Ef1#2
Z- - , o
Boring # ❑ Boring e/
Pit Ground surface elev. ft. Depth to limiting factor f-~= 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
Effluent #1 = BOD, > 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD. < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) nature CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1432 120th St, New Richmond, WI 54017 715-246-4516
Page 2 of3
Parcel ID #
Property owner _ p
❑ Boring f - in.
F-591 Boring # Ground surface elev Depth to limiting factor Soil lication Rate
~ ft•
l"" it Roots GPDM
Horizon Depth Dominant Color Redox Description Texture structure consistence Boundary •Eff#1 ff#2
.
in. Muruell Qu. Sz. Cont. Color Gr. Sz Sh.
V
3 Ada •d
❑
❑ Boring # Boring ft, Depth to limiting factor in. Soil lication Rate
❑ Pit Ground surface elev. GPD/ff
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •Eff#1 `EtT#2
Qu. Sz. Cont. Color Gr. Sz. Sh.
in. Munsell
Boring in.
E Boring # Ground surface elev. ft. Depth to limiting factor Soil ication Rate
❑ Pit GPDIff
Redox Description. Texture Structure Consistence Boundary Roots
Horizon 'lepth Dominant Col Gr. Sz. Sh. 'Eff#1 'Efff#2
in. Munsell Ou, Sz. Cont. Color
• Effluent #2 = BODS 130 mg/- and TSS 30 m91L
` Effluent #1 = BODS > 30 220 mglL and TSS >30 1150 mglL
608. If need assistance to access services or
The Department of Commerce is an equal opportunity service provider and employer
need material in an alternate format, please contact department at
SBD4330 (R.6100)
Soil Test Plot Plan
Tim Kelley Shaun d
Project Name
Address 404 W. 5th St.
New Richmond Wi 54017 M #226900
Date 6/4/15
Lot _ Subdivision
SW 1/4 SW 1/4S 33 T 31 N/R18 W Township StarPrairie
County ST. CROIX
Boring 0 Well PL Property Line
BM or VRP Assume Elevation 100 ft. Top of 1.5" pipe
Same as Benchmark
System Elevation 99.2/98.4' *HRP
Property Line
( rivate roa )
Scale is F = 40'
unless otherwise
noted 104'
B735ii B-2 103'
102'
101'
8% Slope
500' B.M.*
500'
100th St.