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HomeMy WebLinkAbout032-2176-02-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 578996 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, x.15.04 (1)(m)j. Permit Holder's Name: City Village X Township Parcel Tax No: Watkins, Brian C. Somerset, Town of 032-2176-02-000 CST BM Elev: Insp. BM Elev: BM Descriptio ' Section/Town/Range/Map No: M'U lb &W VIAUCAI 2- 30.19.1487 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM y / Aeration Bldg. Sewer f~ C wA 1' v O• J Holding , ,'v St/Ht Inlet TANK SETBACK INFORMATION SVHt Outlet TANK TO P/L WELL BLDG. Vent to Air Intake AD BtirtT€f ' Septic Df~ Dosing Headerfh' n. " 2Cit Aeration Dist. PipeJf~' r~z 2.2 ~/i✓ E. k 9&11y Holding Bot. System Il. ~ ~C" % Final Grade PUMP/SIPHON INFORMATION jq. b - Manufacturer GPM and St Cover it r O.~s Model Number TDH Lift Friction Loss System Head TDH Ft ^ V a We- 4 Force main Len Dia. Dist. to Well SOIL SORPTION SYSTEM DIMENSION Width A Length ~~t No. Of Trenches -2, PIT DIMENSIONS No. Of Pit Inside Dia. Liquid Dept --j - S hJ SETBACK SYSTEM TO P/L BLDG WELL LAKE//STREAM LEACHING Manufacturer: r17.J~`~'q INFORMATION CHAMBER OR Typ t S t i , ( 11 / too► UNIT Model Number: IvVItY1 j. DISTRIBUTION SYSTEM f Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Length / Dia Pipe(s) Length Dia Spacing / SOIL COVE 11L x Pressure Systems Only xx Mound Or At-Grade Systems Only if AaJ I-V Depth Over Depth Over xx Depth o~ xx Seeded/Sodded xx Mulched Bed/Trench Center 1AU Bed/Trench Edges Topsoil [j, es 5] No k--yes 0 No COMMENTS: (Include de discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1602 83rd Street New Richmond, WI 54017 (SW 1/4 SW 1/4 11 T30N R1 9W) Lakeside Estates Lot 2 Parcel No: 1.30.19.1487 1.) Alt BM Description u- wG i( on Sl dt p-f / G_use(fyoej 2.) Bldg sewer length = ~ ~ amount of cover Nti C ItG.~l15 6!~ ~OL !t~ I /isis /k l~ hviwVt ow Plan revision Required? ® Yes No Use other side for additional informati n. SBD-6710 (R.3/97) Date Insepctor's ignature Cert . No. 3RINO VvATbM(,, S`vj 'Lq S S ~L_ 1 361 1 e IG W LOT 2, L AtC-5iDC IL-STX C `T'6 K)/0- or SC wl tZSE`i' 6NKALE I ISEL&DIA rrl Fps ZqZ \ ~ , BNB ~ f t ` E~15~"~I~G ~1 f ESErZ -rA~ J~ J~ r A os;~NcttK1 fex- ~ I T&P DF ALUM vvALKDuT DooIL v a C.L eL= 161 l j s 58NL ZC) ~COPY L go, LST~-1(-t~Zoby Aarnreyr County Ind stry Services Division s'7° L~ RDR.L 0 ` 140 E Washington Ave Sanitary Permit Number (to be filled in by Co.) P y P.O. Box 7162 rrI Madison, WI S ! VE 1 B99(p Sanitary Permit Appli ation JUN 1 2Q15 State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appro naate_P~ovemmental unit NJA is required prior to obtaining a sanitary permit. Note: Application forms for state-owne~~O~ ix 1 w the Department of Safety and Professional Services. Personal information you preWldW%1UYeiU£eVCK l Dl ect Address (if different than mailing address) purposes in accordance with the Privacy Law, s. 15.04(1) m), Stats. -A:~ w d 1. Application Information - Please Print All Information 2 Property Owner's Name Parcel # EoA>j N&IM ) WS 0 OZZ. -Z i-1L -BZ- 6b,8 Property Owner's Mailing Address Property Location 11,02- S& R.a SIZE cn- D Govt. Lot City,, pState Zi 'Code one Number ~W ''/t, S {rl f y<, Section A11= V1/ K l elfl 1 o wh "[I ~/BI7 T~ N R 1'7 (cirE o to H. Type of Building (check all that apply) ✓ Lot # / 1 or 2 Family Dwelling -Number of Bedrooms r+ Z ✓ Subdivision Name ❑ Public/Commercial - Describe Use n A\ Block # L K~5 T] 57'A: Y ES ❑ State Owned - Describe Use ❑ City of ,d , _ ( CSM Number ❑ Village of Z D)~e16GM N LEU-S W 1 ~ M E&CH Town of sd MLR! ~--r III. T e of Permit: qplegfly one o line A. Complete line B if a licable 1,\ N, A. ❑ New System Replacement System ❑ Treatment/Holding Tank RePlacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner -4- 3~ , 2 200 IV. T e of POWTS S stem/Com onent/Device: Check all that apply) 7 Non-Pressurized In-Ground Pressurized In-Ground ❑ At-Grade ❑ Mound 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ff er Dispersal Component (explain) ❑ Pretreatment Device (explain) S e f bf t G 64 ff V. Dispersal/Treatment Area Information: 46 ' Z Designio~~d)~ Design Soil Application Dispers~~a`Required Dispersal Proposed (s]) System Ele ation (f t,' ''77 Rate(gPdsf) r 77JJ VI. Tank Info Capacity (05 S s .Q u~ in Gallons dons Un is Manufacturer w h y }~°3 New Tanks Existing Tanks U 00 h w C7 p Septic or Holding Tank j w) C567 12, Dosing Chamber ❑ ❑ ❑ ❑ ❑ VIL Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Sign a V umber Business Phone Number oK <Zp 2Z32W Z `?l5- 755 2y6 Plumber's Address (Street City, State, Zip Code) If ) P f?- 90Y_ Slay 1-_,RES9L2 VV I ~:'Ihb , 7 . Coun /Department Use onl Approve d roved Permit Fee Date Issue Issuing Agent Signa iven e $ ? C v Z~ IX. Conditions of Approval/Reasons for Disapproval 1. Septic t nk, u A~ r and dispersal cell must"be serviced / maintained as per management plan provided by plurnber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach to complete plans for the system and submit to the County only on paper not less than 8 in a 11 inches in size SBD-6398 (803/14) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Q 16,A l,'-) WATK) M-S Owner's Name: Ain. E Ownees Address: /4-~o 83 5`i'>,'6CY NCa1 iPI c r\).b W/ S'Io/7 Legal Description: _ 5 MI'JY S Oil S j Z '-r 30 N & /q W Township: e1DM EZS9-r County: S-r Ckwi Subdivision Name: 1aKE5) Di` Ec 7l' -res Lot Number. Z Parcel 1D Number. 022- 2 /?Lo ° 02- Dt D Page 1 index and tide Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Informiltion Page 6 Management Plan Page 7 St. C y §Wtic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber ~Tcv-f✓ fb-)r- License Number. X25 22.~Z `l2 Date: Lo Jb Phone Number 7 15' 755- Z q L I Signature pursuant to the In-Grouno 308 Absorption C nporwt Manual for PoWTS version 2.0 SBO-10705-P (N.01101). Page 1 G R1u)J iNf-rt) m(, Slw '/q Sw =~5/ S 1.Z^ i 3b N I e LOT Z LAI:I~-SIDC i SlTk--tcS - 6WO a Sb)ut FZS~`)' ~ tat,E g~D~~,,~ CmJs 'oxuruN bcJSE W` rt1 p(Zs -Z SZW Z B>~t IAIT)IJb VWE sE(L -rA K nn 'I / a / f by f,. Cl9 f, A,. A FiLNCNKlttPIL I T&P OF ALVm VVALKbUt Eno 2 (LL EL = 160 cr SDt 6o R) N I 5c4LF- 1'r- ze) / Soil Absorption System Cross Section -l 1$5 ft 95 s Final Grade .4 4' Sduxk& 40 PVC Vent Pipe S With Vent Cap 9/` Leaching --p,, Chamber It System Elevation 9/~ ft S ft Soil Absorption System Plan View -7Z ft . ft ft Vent Or Observation Leaching Trench 1 Chambers Die. Trench 2 Header Leaching C bar Specifications Manufacturer And Model IN/LT &Mp_ CiGK L1 I EISA Rating ?Q sq ft per chamber Soil Application Rate - 7 gpd/sq ft gpd Design flow ,"7 Soii Application Rate = EISA = 3 -Z Chambers 2 rows of 16 chambers each. Page of } POWTS OWNER'S MANUAL AND MANAGEMENT PLAN e: w FILE INFORMATION SYSTEM SPECIFICATIONS Owner H VAWIO-S tic Tack aci DNA Permit # Septic Tank Manufacturer W ESER 0 NA DMGN PARAMWAS Effluent Filter Manufacdrnr /tJ 6 D NA Number of Bedrooms 1 m O NA Effluent Filter Maiel V N 04. 0 NA Number of Commercial Units kNA Pump Tank geEk 911 ❑ NA Estimated flow (averags)* pp RLdaj Pump Tank Manufacturer NA Design flow (peal*, estimated x 1.5* 5 ~ Manufacturer A Soil Application Rate 7 da Pump Model NA Influe Mf luent Quality (NAD) Monthly Averap" D 13 San SaaGra Unit Fats. & 5 30 dlCrravel Filter D Peat Fitter mg/Oxygen Demand (BODs) L ❑ Mechanical Aeration D We:tiand Biochemical D Disinfection p Total Suspended Solids (TSS) ` 220 mg/L Other hbnutfacttuer: Model: 5 250 mg/L Pretreated Effluent Quality Monthly Average*** Dispersal Cell(s) Biochemical Oxygen Demand (BOD$) 5 30 gl -ground (gravity) D brground (mod) Total Suspended Solids (TSS) D At grade p Mound Fecal Coliform (geometric mean) 30 mg/L D e a Other: <IO cfn/100011 D Leaching Chamber Mantifacturer N L Maximum Effluent Particle Size 1/8 inch diameter Model y l{ Laying I.engdt/Cbamber *Wastewater Flow Verification and Calculations: Soil Application Rate, Area Req. (ell (Outer than bedroom based) Infiltrative Surface/{ E&A Rathtg__ W _ Re Minimum. Number of C;hambets D Aggregate Des" Flow/Loading Rate- main Values typical for domestic (non-commercial wastewater Materials: all materials must comply with WI Adm. Cote and septic tank effluent COMM84 and be installed per manufacturers gxmfm*m ***Vahws typical for pretreated wastewater: and approval letters. DESIGN CRITERIA p "Wisconsin At grade Soil Absorption System. Siting, Design & Construction Manual" (Converse etaL1990) D "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, I.C. and EJ. Tyler. Publication 15.22 ❑ "Design of Pressure Distribution Networks for Septic Tank-Soil Absoigtwn Systems" Publications 9.5 C3 "Design of Conventional Soil Absorption Trenches and Bats". R.I.Otis - ASAE Publications "7 and "Design Manual - Onsite Wastewater Treat sent and Disposal Systems". EPA 625/1-80-012 October 1980 D SBD -10570-P (R.6/W) "At-Grada Con4oneut Manual Using Pressure Dkk*udW D SBD - 10567-P (&.6/99) "In Ground Absorption Component Mannar SBD -10705-P (N.Olltll) "In Ground Soil Absorption Component Manual" Version 2.0 0 SBD -10628- I' (N.W99) ` Recirculating Sand Filter System C.ornponent Manual" D SBD -10656-P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual- [3 SBD -10572-P (&6199) 'Mound Component Manual' ❑ SBD -10691-P (N.01101) -Mound Component Manual" Version 2,0 D SBD -10595-P (.86(99) "Single Pass Sand Filter Component Mannar" D SBD -10657-P (8.6199) "Drip-lime Effluent Disposal Component Manuar' D SBD -10573-P (R 6199) "Pressure Distrrbutum Component Mannar' D SBD -10706--P (N.O1roI) "Pressure. Distribution Component Manual" Version 2.0 p Drip-line Effluent Dispersal Cou p meat Manual for Multi flo Onsite Wastewater Trastmnent Unite MAINTENANCE AND MANAGEMENT MAM TF.,IVANCE MONITORING SCHEDULE Service Event Service Inspect condition of s At least once eveg o months O yano 3 Pump out contents of s When combinedsludge imd scum pals one-tt►ird 1/3 of t Wk volww Impact dispersal ge s At lust once e D months D s 3 Clean effluent filter At least once every p months D Y"90 Ins controls & alarm At least once every ❑ months p a ❑ NA Flush laterals and pressure test At least once every D months D Yeav(s) D NA • • , - At wart nor' Pve•.rv n mouft ❑ veer(s) ❑ NA System start up shall not occur when soil conditions are frozen at the infiltrative sutrliuce. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible- Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegautW fruit peels and seeds, bones, alai food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette buds, dental floss, and cotton swabs should not enter the system Chemicals such as petroleum products, paint: disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contarn mate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of stow over the dispersal unit may cause it to freeze up, D Valves Valves shall be opemtaed in the following manner. 0 Alarma Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to setvicc POWTS. Thera is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. INPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Phunber, Maeft Phmtber Restricted Sewer, POWTS Maintainer or Se ptage Servicing Operator (per the attached trim Schedule). D Septic Tanks Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, musure fire volume of combined sludge and scum and to check for any backup or pondiag of effluent to the ground surface- Access opesimp used for service or assessment shalt be sealed and/or locked upon completion of service . Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diatmeter shall be sectr+ed with an effw ive locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one-third (1/3) 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 NR113, Wisconsin. Administrative Code_ The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank, Filter, cleaning may be necessary at more frequent intervals titan stated in the maintenance schedule to keep the system operating. a Puma ChambWrreatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and otter hardware and the condition of any Mica. Any service needs or repairs shall be promptly taken care of M in-Crround Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be prOmpdY reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indictee overloading or impending hydraulic fatlune necessitating more frequent monitoring. Psge of O Mound, At-Grade, In-Ground Pressure The inspection shall include recording tube levels of pondmg, if any in the observation tubes and a visual inspe0bon for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to flee regulatory authority. Ponding greater than 755/6 of the height of the component may indicate overloading or impending hydrAllic failure Ming score frequent manitoring. The pressure distribution system is provided with an opening, at the cad of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system WORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to enure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code. - All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. - The contents of all tanks and pits shall be removed and 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 other 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: O 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 mfrmged upon by reganred setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in ihe fiord for a new soil font existing and proposed shucaure, lot lines and wells. Failure to protect the replacxmeirt area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement system awn comply with the rules in effect at that fir ne. Q A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. p 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. p 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. «wARNwG>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN 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 POWTS MAINTAINER Name F O Name phone 4i -115 ~ 7 55 -Z alp Phone SEPTAGII SERVICING OPERATOR LOCAL REGULATORY AUTHORITY Now A 70106 phone Phone -1 t - - Hip D r"ItWSe! Print 4111 lnrOrM8UOn. E7 u~+.e iO^y Yen M povidi m.Y be wed for sra=Wwy p xpoM p"4ftp Law. S. 15.04(1)fm)). y ZO 6 q PrapertYOMrrrer M/}' itl Sd tJ N U~i~ _hWAIZ f Gotit, Lot 54) 1/4sW114 S 12- T.30 N R ~ ` y ) W 04-1 ST L slodc 0 Subd Nam orCSW /l s / 3 2- LAY Lj~~t' SHOE ~ST.tTZ~'S State Code Number l ❑ ClY ❑ Vftge O T&AM Nearest Road Sfi/~wA~~. /~~ll S'So t 8 so.~-rER 5.2 /(p p ~U~ . ANew t:ongructfon Use: Residential / Number of bedrooms code derived design flow rate O GM ❑ Replacement ❑ Pubic or commercial - Desa*e: Pwad General awleerns ` Flood Plain elevation ff appiicable R ma ' L ? 'Sr iS ~S'U17-4A .L' f02 j4N WA) l,E~ TiDa, Wgq12ou>~D f7- . O. C.e~ • ~ ,S . T3.iOD~'~~'vS~ GpQ~PS V C Borbp * ❑ Q Q / Pit Ground surface elev. • 7~? fL Dapth to in WM facbr > / O im Sol Applicalim Rate Domilwit 0010, Redoot Desaiptlotl Ten Sbuchae Consistence Bolrrda y Roots GPON h Munsefl Qu. SL Can. Color Gr. SL Sh 'EW1 'Etflle2 ~d R %6 L 1 sh,~ s cs Z • ~ s si ~ zf s ~e cs - . ~ • 8 ° 7-svk 30 nn S . S - 7 /6 7 S -Z4 W2 © ~ * B MV ' Ground surface elev. ~ S k Depth to Uniting factoPit ` O in. Sol Appkalion Fkxtm^ Depth Dorm um Color Redm Dm alp m TWAto Sbuolue Corm tenor Bourrdery Roots GPM Rate in. Mursell OU. Sz. Corn. Color Gr. Sz Sh 'Elf t 'E1 .3 19, A, p .Z EfAuern #1= am > 301 220 mglL and TSS >30< 150 nV& Mot #2 = eoD < and TSS 130 MOIL CST Name lPlease - - P" SWIM" Astizz a z C 4r -3 t~ Address Date Evakodon Conducted Telephorw Mumber /L 7 - v e 7/S • 77,,) • 3 elf-el . Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 Borirp # U Boring Pit Ground surface elev. • ft. Depth b knifing factor O in. Horizon Depth Dorn wt Redox Desaiption Texture Stitx;pre SollyRate IM Munsell Qu. Sz. Cora, Color Cons oe Boundary Roots C~PONI~ Gr. Sz re Sh. 'Eff#1 'EM lY L ifs s~ cs . , 7.5 _ S - -0-1sa CC ^-04 S 41. V ❑ pit Ground surface elev. ft. Depth b Rrni~g factor in. Horizon Dapth OWWn Redwc Description Textrre Struck" Consistence Roots Sol GPM [Rate in, Mtrused tau Sz Corot Color Gr. Sz Sh. 'Efiiil 'EiW Bodn9 # ❑ Bodng ❑ pit Ground surface elev. ft /Depth to Cnritirg factor in. Horizon r d Rate 060 Dominant Cokx Redox Description. TMdM Struct re Cons~noe Boundary . Roots GPOR in. Mu nsell Qu. SL Cont. Color Gr. Sz Sh. `OWI 'E1f#2 EEEI Etlklent #1 = B006:1- 30 < 220 7 TSS -30:E 150 mglL ' Effluent 02 = BODE < 30 mglL and TSS 130 rtglL 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, phase contact the department at 608-266-31 S 1 or TTY 608-264-8777. ssaa~w~,r~oo~ -Pto pos D LD r CON tf 3 ~ PH - M IV 1 r-~ ~ I - qg p TAP o~ Awe 4>A1 POOR , No0, q~.o 76 yon . ~q p 3 13 o ToP eF • = aA~~ p ~ r ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer 11 F 30A10 y~~YK11~S Mailing Address r(~DZ 93 ~a ~T ~W 2f C~lWib4v Lv 5y~ ProlpaV Address s me (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number [76U- 7-176 - Dz- i)b0 LSGAL DILSCRIPTIQN Property Location 5W j/. , S 0-f , Sec. i Z . T 36 N- R P7 W, Town of Sa NIEt') 9-1- Subdivision Plat: LAVf.S7C>r- ESTI~`TES Lot: Z . Certified Survey Map # . Volume , Page # Warranty Deed # (before 2007)Volume . Page # Spec house Z yes : no Lot lines identifiable-- yes:: no gYSTEM + NANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tans: as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is is proper operating condition and/or (2) after inspection and pumping (if neoewary), the septic tank is less than I/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commc= and the Department of Natural Resources, State of Wiseonsln. Certification stating that your septic system has been maintained must be completed and returned to the St Croix County Planning & Zoning Department within 3t) days of the three ear expiration date. Uwe certify that all statements on s form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a my dead recorded in Register of Deeds Office. Number of bedrooms SIGNATURE O APPLICA NF(S) DATE '''Arty information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded Warranty deed from the Register of Deeds Office and a copy of the certified survey trap if reference 13 made in the warranty deed. 2863P 021 Lot 2, Lakeside Estates EBjT A Gv. ~ ~ Julie Peterson From: Watkins, Brian C (Investment - HIMCO) <brian.watkins@himco.com> Sent: Tuesday, June 16, 2015 8:52 AM To: Community Development Dept Group e-mail account Subject: 1602 83rd Street, New Richmond, septic Attachments: 1602 83rd Street New Richmond.pdf, ATT00001.txt Julie Here is the signed one page document we discussed this morning. Please let me know if you need anything further. My work contact information is below and this is the best way to get a hold of me during the week. Also, here is my home phone 715-246-9255. The contractor I am working with is Jeff Fox, phone 715-755-2461, cell 715-491-3458. Brian Watkins Director - HVIT Mutual Fund Reporting Voice: 651-739-6838 Fax: 866-784-1024 Email: brian.watkinsCo)-himco.com 500 Bielenberg Drive, Suite 500 Woodbury, MN 55125 Nl C www.himco.com 1 Jun.17.2015 08:21 AM PAGE. 015-06-08 10:01 The Hartford - 555 555 5555 p 1/8 1-o : je4 F=)c .Ittue M ::1113 AaCeEe Soil & Site Evaluations Jamew & Mkompstmii otic-C-01,- W1 U020 Deparfytectet owttisefety & ProfcNNiostal NelovlecN C MicnHnl *0111021 MaNter Islu,ul r. Ccrtiried Mull Tc.lcr. 1'ler►ul►uts; InNltecdor. 1o11W rig Maittta7itter. nrnwoat (:antnd limlw~ UN It Certified Nntall Watcr Nyxtcstt (A'I'M/NN) (lprrtetor ,*G209h Now Brian Watkins 1602 83rs St. New Richmond, WI 54017 RE: Existing POWTS evaluation Brian Watkins property, 1602 83m St., Now Richmond known as Lot 2, Lakeside Estates, Sec. 11, T.30N., It.19W.. Tn of Somerset, St. Croix Co., WI„ parcel 100324176-02-000 Mr. Watkins: I have conducted an evaluation of the POWTS (septic system) serving the tosidom at the above address. The existing POWTS was dwigntd and installed In June of 2004 to accommodate a three bedroom home. It Is a conventional system which transmits wastes from the house by gravity to a 1.000 gal. concrete septic tank. The clarified waste water than passes through an effluent filter and out to two (2) 3' x 71' below grads dispwrst,l trenches, The waste water then drains away through tho underlying soil, Attached Is a copy of the County Inspection Report that was completed at the time of the system Installation, which indicates that the system was in compliance with code standards in effect at the time of installation. The septic tank was pumped by Powers Liquid Waste Management as part of this Inspection. It wpQ (ey rn;ngd ttt~ the tank and inlet baffle are structurally sound and are performing as intended. Bused on the age of the tank, its outwar'3 appearance and the manufacturer, 1 do not anticlpato structural problems with the tank. St. Croix County Zoning Departmc nt records indicate that the tank has been pumped 4 times over the life of the system generally complying with the requirements of Wisconsin Administrative Code and sound system maintenance which spucily that the tank should be pumped once every three yours. A soil evaluation report for this property is on file with the County Zoning Office indicating that the system complies with the minimum 3' vertical soparttdon standard as required by SPS Chapter 383.44. A soil lest was not completed as part of this evaluation to confirm that report. The system is compllam with the cods requirements of Administrative Code Comm. Chapter 83 that were in ei'Poct at the time of the system installation, Currently, theft is 8" - 9" of effluent ponded within the dispersal trenches. Tho system is functional, but it is operating at a very restricted capacity and appears to be nearing hydraulic fhilum. The far end of the southern trench is dry. This indicates that soli has filtered into the trench, and in affect created a "load dam" which prevents affluent tom ranching the far end. It cannot be Mermined where the blockage is located without extensive excavation into the systaam. This evaluation is my professional opinion of the condition of the existing septic system and in no way guarantees the Jun.17.2015 08:21 AM PAGE. 2/ 2015-06.08 10:01 The Hartford - 555 555 5555 P 2/8 immediate of long term oporation of the system. This inspection did not involve physically excavating into the system and was based on a surfka evaluation. Accordingly, there is a possibility of hidden defects that were not discovered by this inspection. The failure of a septic system Is a progressive proom and Its useful lifespan greatly depends on how the system Is used and maintained. Accordingly, I cannot predict how long the system will continue to dispose of sewage effluent. In an ofibrt to prolong ft system's life, state should be taken to minimize the wastewater flow that cnlers the system and the tanks should receive regular pumping and servicing. Thank you for the opportunity to provide this service, if there am any questions or concerns that I can address, or If I can be of further servloe. please feel fro to call me at (715) 248.7767. Sincerely, Jumus K. Thompson Dcp't of Saaltly dC NrofwkmW Savlam C ll k tiul 030021 Cc; Sam Schullo Coldwell Banker Burners file 2 .....M.. 3epartment of Commerce PRIVATE SEWAGE'SYSTEM County: St. Croix Building Division , INSPECTION REPORT sanitary permit No: 4 537 .NERAL INFORMATION (ATTAGI~ TO PIERMIT) g~M plan ID No: a ersonal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: r- City Village X Township Parcel Tax No: Somerset Township CST BM Elev: I Insp. BM EI BM Description: S NTown/Ra p No: 100'o Nd r¢ S/ 44.4e c py S; 12.30.19. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic t Benchmark Dosing {YI - qpr S, I 6N 0 /00-6 &I. Aeration / • fO!~ Bldg. Sewer Holding SVHt Inlet S (~1 TANK SETBACK INFORMATION SVHt Outlet - 97, 0 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic h p i Dt Bottom - _ f ~D tier I h (3/ Dosing Header/Man. 1 7 Cj3 y3 Aeration Dis . Pi Holding Bot. System tutu , L• C~?Z,fff x taJ N',13 61, Z Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cove r0. GPM S.O loo-321 Model Number = 3 TDH Lift Friction Los System Head TDH Ft Forcem Length I Dia. Dist. W Well SOIL ABSORPTION SYSTEM u„-k, CG,~.~ c BEDITRENCH Width Length No. Of Trenches ~;C~ " PIT DIMENSI No. Of Pits Inside Di Liquid Depth DIMENSIONS / SETBACK SYSTEM TO O P/L BLDG ~KA WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR~il'h"~ Type Of System: K 0 nQ c , "O / UNIT Model Number: wrl) Q-14 j DISTRIBUTION SYSTEM Header/Manifold ID Pipe(istribution ix Hole Size ix Hole S I Vent to e Y 11-ength'_ Dia Length Dia Spacing / __X SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only S Depth Over Depth Over xx Depth xx Seeded/Sodded ulched BedlTrench Center Bed/Trench Edges % Topsoil 1l 3 7 ~ Yes [Q:j No Yes•; No COMMENTS: clude cod disrxegencies, persons present, etc.) Inspection #1:bto /Zj 16q I Location: /Somerset, W1114025 (SW W 1~/4 12 T330N R19W) Lakesi¢q Es Lot 2 Parcel No: 12.30.19. ~ i b t _ . 1.) Alt BM Description = 644v C covz-f o 0 2.) Bldg sewer length C10 U1 vri di S+UV1~C~ - CVI.AJ CQ* - amount of •cover at = i1 rPly b w~-~p gol l S , Plan revision Required? Yes No I1r_ n'( ("q,' r se other side for additi nforma n. L_L u l f L_.,.._ _ I-.. ~ Date Insepctors Signature Cert. No. -8710 (R.3/97) • - ~ m o~eo pos~fl I a7Z ' I ~oA) u,vD~R flM 3 ~ eH , At W /,Zpo 11 , 4liESE7P Ce~G,!{~ . 3~, r ~H ~ ~ sip r,7c T~r~je o~ R$p TaP 6 ° AIvN , WtKw7 / aoo,P Sill r / Or ya/ '83 8Z S STEM y sy s rE.ti 13.0 1 12.o O i iilS POWT SYSTEM SHALL INCORPORATE PER COMM. 2 83.44(2)c A PROPER ZABEL FILTER MODEL # 4 - /00 Top of 3Al - ~I ' ~ COPY 134 4&4e 'rc lee