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HomeMy WebLinkAbout022-1012-90-075 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 579046 -•9~ GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)1. Z.-S-6 DIs(p Permit Holder's Name: City Village X Township Parcel Tax No: Oeverin Homes LLC aka Oeverin Pro ertie Kinnickinnic, Town of 022-1012-90-075 CST BM ev: Insp. BM Elev: BM Description: \ Section/Town/Range/Map No: ISA Do.ua / pp. v° STAKE OE Gor <-&X'V62 (NE 6o(2A1~ 05.28.18.78C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic IIu G~~ ~~r7 SfCir!'2 Benchmark Dosing Alt. B Aeration Bldg. Sewer 4 f L Y$' '7 q~j• Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 7.5 J //d sO r y sO f Dt Bottom ,V!/7 ~z • 7 Dosing 6e , ,,t t . „ u Header/Man. q/ • f !4.7 Aeration Dist. Pipe z, 9 7 Holding Bot. System 3 6z 9~- t Final Grade Q PUMP/SIPHON INFORMATION 4 1, > ! r Manufacturer 70C~~/~ Demand St Cover L GPM Dig S. T pu / • 6 Model Number rs Z tr-r TDH Lift 6' 1 Friction Loss System Head TDH Ft Z• / 3• /s8 Forcemain Length , Dia. „ Dist. to Well 30 Z ti1.9 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length t No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR A04-4 I Type Of System: I , UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size / x Hole Spacing Vent to Air Intake t u Pipe(s) K 3/~G~r Ly~~ LengthDia_ Length Dia Z Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over v> VF Depth Over (7Z $a) xx Depth of xye eede odded xx Mulched /Trench nter 7 Bedrrrench Edges Topsoil - • ~p [ Yes ®No 0 Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ Inspection #2:: ' G.~• - p6ow o. K • '✓/LE/rtE'L 6Riff 6K- Location: 1062 Rudy Drive Roberts, WI 54023 (NW 1/4 SE 1/4 5 T28N R18W) NA Lot 2 Parcel No: 05.28.18.78C 1.) Alt BM Description = N~ w6tL ~T IXJ9~6710a/• 2.) Bldg sewer length A) - amount of cover = }q~ cog i Plan revision Required? ❑ Yes No 9 Use other side for additional information ` r Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) Iss County L Safety and Buildings Division 2n+1 %A!-~;R£°°-°ve., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) i t Q Madison, W1 53707-7162 1x 00 V191'r y~i~gy S 5 79 Co I p S-5-3 ,omWK Sanitary Permit Application State Transaction Number ~g , S In accordance with SPS 38321(2), Wis, Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than ' ing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary pmposes in accordance with the Pri Law, s. 15.04(l Km), Stats. D [ ( + L Application Information - Please Print All Informatio Q Property Owner's Name ~ Parcel # 67-5 (!),e v2 Property Owner's Mailing Address Property Location /q-5 5 a m Govt. C/ Coy state Zip Code Phone Number LLO 7/, Sec ,on p l\ _ (circle o W V T N; R E W IL T e of Building (check al apply) Lot # Subdivision Name oily Dwelling-Number of Bedroo (2-7) Ok- Block # ❑ Public/Commercial - Describe Use p ❑ City of ❑ State Owned - Describe U3c - L CSM Number ❑ Village of J 5 7 A wn of KA A" Type f Permit: (Check only one box on line A. Complete lice B if applicable TTT A. System ❑ Replacement System ❑ Tmatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ permit Renewal 11 Permit Revision ❑ Change of Plumber 11 Permit Transfer to New List Previous Permit Numbs and Date Issued Before Expiration Owner r .7 IV. Tyg~ of POWTS S stem/Com onent/Device: Check all that a 1 L__e 0111V D t) on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade d > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ent cc (explain) ❑ Holding Tank ❑ er Dispersal Component (explain) V. Dis rsalfrrea ent Area Information: 1-10" 11 JAAJe t Des- Flow (gpd) Design Soil Appticat, Rate(gpdsf) Dispersal Area Rcq ' (sf) Dispersal Z opose S Elev n 41-f 2_1'/ k 1 VL Tank Info apacity in Total # of Manufacwrcr y Gallons Gallons Units ~4u o $ E Now Tanks Existing Taa3a i+ r~~ r ` U f s G Septic or Holding Tank Dosing Chamber 35 VII. Responsibility Statement the undersigned, assu Po sibility for installation of the POWTS shown on the attached plans. P'sName (Print) t Pltmmber' MP/MPRS Number Business Phone Number 7X Plumber's Address (Street City, S Zip Code) VIII. Countv/De artment Use Onl )>CrPprovcd Disapprov Permit Fee Date Issued Issuing . t SigNtkqr pw~er Reason for Denial DL ConditiStl'aSoTf~RW r Disapproval t 'it~ritl Y Cam t ~s a 1 fa e. WW' , ) dis -nts!`qj 1, be 3ervlcesImaintained t / J ~2.("J►ti► 1 as p: provided by plumber.- t ti ii q ) L A11setbdcK eyu ` t~eifldintained. •n pef applicable' l Of t1t10fi+ ~e d ~ 6 4T~.~ 9~ toe_ tt~ Attach to complex plans for the system and submit to the County only s papernot less than 81 z 11 inches in ` SBD-6398 (R. 11/11) PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NW 1/4 SE 1/4S 5 /T 28 N/R 18 W TOWN Kinnickinic COUNTY ST. CROIX SYSTEM ELEVATION 96.2' 7/19/15 3 DATE BEDROOM CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1,0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. sameasbenchmark 383' Property Line B-2 All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 B Area 15' belo,v s}stem is to remain undisturbed B-3 8% Slope Wel I is to meet all WDNR setbacks Grading is to be done to B-1 95' 96' divert run-off away from 93' 94' 95.2' syste m Huffcutt Combo Tank Tank is to be properly bedded and provided with Iockdown covers with approved warning labels Pro 3 Bedroom House Scale = 1 /Tu = 10' 2 304' Property Line Acre Lot Rudy Drive e` i ~i, kxrAr&vr DIVISION OF INDUSTRY SERVICES 3824 N CREEKSIDE LA ® HOLMEN WI 54636 K Contact Through Relay 9 P http://dsps.wi.gov/programs/industry-services 2d `Gw www.wisconsin.gov A~0, ,foll4p, Scott Walker, Governor Dave Ross, Secretary August 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: 08/05/2017 SITE: Identification Numbers Oevering Homes Transaction ID No. 2580156 1062 Rudy Dr Site ID No. 815294 Town of Kinnickinnic Please refer to both identification numbers, St Croix County above, in all correspondence with the agency. NW1/4, SE1/4, S5, T28N, R18W FOR: Description: Three Bedroom Mound System / 8% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1548231 Maintenance required; 450 GPD Flow rate; 28 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01101, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01101, 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 and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: CO Reminders A DEPT O • A sanitary permit must be obtained from the county where this project is located in accordance with the PROFESS requirements of Sec. 145.19, Wis. Stats. [)'VISION OF 1 • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided 0EE COR per SPS 384 product approval conditions. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • 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 SHAUN R BIRD Page 2 8/5/2015 Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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. &rd Swim When You Receive That Invoice, lan Re viewer, Division of Industry Services Please Include a Copy With Your (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm Payment Submittal. jerry.swim@wisconsin.gov WiSMART code: 7633 cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm 2015 sty` Cover Page - C I Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 7/ 15/15 Owner:Oevering Homes Location: NW1/4 SE1/4 S5 T28 N,R18W 1062 Rudy Drive Kinnickinnic Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan ~'T ~OIVgLL 3. Mound Cross Section ~ S~OV ~D Y 4. Pipe Cross Section/Pipe Layout ONAL SER IC JpUST~Y 5. Pump Chamber Cross Section SERVICES 6. Pump Curve 7-8. Maintance and Contigenc plan 9. Filter Specifications and cro section ENCE Attachments: Soil Test Shaun Bird Signature License number 2269 Page 1 of PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NW 1/4 SE 1/4S 5 /T 28 N/R 18 W TOWN Kinnickinic COUNTY ST. CROIX SYSTEM ELEVATION 96.2' 7/19/15 DATE BEDROOM 3 i CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. sameasbenchmark 388' Property Line B-2 13 All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 B•~•~ Area 15' below system is to remain undisturbed B-3 8% Slope Well is to meet all WDNR setbacks Grading is to be done to B-1 95 ' 96' divert run-off away from 93' 94' 98.2' syste m Huffcutt Combo Tank Tank is to be properly bedded and provided with lockdown covers with approved warning labels All, Pro 3 Bedroom House Scale _ 1/4" _ 101 2 Acre Lot 304' Property Line Rudy Drive Mound System Cross Section and Plan View ~ - ~ Dimension Feet... J I A l B - T I r r r. r r r~ L L L I I T I I D A J :L:f1 1:1j.r•L .J~:frt,iJ.::r~l :::4:jrti .•fL 1JL :ryLfr 1 :rJ :r1 : J:r:lJ L :'.'Jf.. '.•~Jr1.1rti\J:L L yr.t~1 r~.. I I .:L1:.L 1:Lti~.•:. rt Lr L J.J . J •4J I I I.-.. fY.1 ~ I F - W 40 L' G I I It L -z T L Slope - 1 = Topsoil ASTM C-33 Clean aggregate O = 4 in. sch. 40 pvc Cap Material sand fill to 2 in. dia. observation pipe Geotextile Fabric G H F fQpp~ Lr •r 'r ! i7 r t S~ `~zK~' Plowed Surface: -CI' ~R Ft Contour Slope Direction GENERAL INSTALLATION: The mound area is staked out alone the design contour. F,Xistin~Ll vegetation is mowed and raked off the site. The mound basal area (L. x W) is 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 so;1 wire when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed.. the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/07 1tj' Page ~ of Pressure Lateral Layout Two Laterals - End Manifold •4-- 'Threaded Cleanout lateral Turn-tip Plug Manifold M X I, - Force Main Long Sweep f 90 r' Bend r Distribution Network Specifications Pressure System Construction Lateral Diameter_ In. T Manifold Diameter Laterals are constructed of Schedule 40 PVC Orifice Diameter In. pipe. Orifices are drilled perpendicular to X (Orifice Spacing) ~V~ In. the pipe with a sharp drill bit and face down. L Lateral Length) Ft. Lateral turn-ups terminate with a threaded M (Manifold Length) Ft. cleanout plug and are enclosed in a 6-8 inch Force Main Diameter In diameter- lawn sprinkler- valve boys accc-ssiblc i Force Main Length; Ft_ From finished grade. Grade 6-8 Inch Lawn Sprinkler Valve Box r. 1." Page oI - - - 03/05 lgj Septic-Dose Tank Crass Section And Pump Performance Specifications Tank Manufacturer Pump Manufacturer r_ v •/f. - _ _ j Tank Model Number Pump Model Number Total Tank Capacity s _ Alarm Manufacturer nom, > 4 . Max. Bury Depth Alarm Model Number l1 " Switch Type Filter Manufacturer Total Dynamic Head (TDH) - Feet Filter Model Number ' ~ Elevation Head Distal Pressure 3 f Network Loss Minimum Pump Performance Required Force Main Loss / -7 GPMFt TDH Total Outlet Manhole Min. 4" Above Grade With Locking Device. Inlet Manhole Manhole Min. 4" Above Grade < 6" Below Grade Sealed Watertight Securely Mounted With Lacking Device - Weather-proof } Junction Box t r. o ° Finished Grade r .r .r Vent Min. 12" Disconnect Above Grade Means With Vent Cap x.xI Outlet Filter Inlet Inlet Baffle - - - - - i Switch Settings and Reserve Capacity A e" . • Weep GPI Tank Volume = f ~ Hole Dimension Inches Volume Gal. B X T_ (reserve) A` B 2 Off Elevation C (dose) C F-'t 'n Bottom (dead) D / D Elevation Total J~rFt GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the ications. Maximum depth of bury as specified by the manufacturer may not anufacturer's product approval specif in be exceeded without poor 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 and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.2:1. Page of 02/0 U ' A'J o f ~ f ~i L AIL i Z IS l41 2 _ •j 4 e - y - --;I -----r- _ ---Y J i -T C" r - - r s 8 - - T i T E_ "R S CONSULT FACTORY FOR SPECIAL APPLICATIONS Timed dosing panels available. ° Electrical alternators; for duplex systems, are available and supp~ied'.vith an alarm. Variable level control switches are availab e for controlling singie phase systems. Double piggyback variable level float switches are available for variable evel long and short cycle controls. - Sealed Qwik-Box available fcr outdoor ins.a!iat:ons. See FV142,- Over 130"F. (54°C.) special, quotation regl '.red. 1521153 Series - - - - a ~ 1521153 MODELS Control Selection_-; Model I Volts-Ph _I Mode Amps_ 1 SimF •_14152 115 1 Non sQIUI t f3N152 115 t Autr = E_5 !nCU ed _r or L- - 1 E1,912 230 1 Non 4.3 2c, _ I dEt52 1230 A, to a 3 naw:ed ? or 3_ 14153 1114 __NNan 1C.5 2 or 3 , SELECTION GUIDE i sNt53-ttN Auto ^tCS - ~N :eN ~1c Single picuy ack va Iable level float 5w itch or double piggyback variaole level tloat LE 153 23014 a 3 r 3 L©E1531 230 _~Auto 3 m 'u^ed _ 2 wrc7. Re er to A CAUTION [ See 7f,l,"/ 2 for co recmode or Electrical A;emator E -PS,. All installation of controls, protection devices and wiring should be done by a qualified 3, ~a,;aDle eael con-lm swach 10 0 25 used as 8 control acuvaior, Specify duplex j3, licensed electrician. All electrical and safety codes should be followed including the most o- As f;,oat 5'y'Ste recent National Electric Code INEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual ccnditlons a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O 0`0k"75347 L i rie 40 5 v ' a> acru ers Z /7 6 SHIP TO 364, r n Zo~~s\ a o s r e yo - t+ , 7o_? 3 i • ' t1i~J! tic':, P,. 41" http://www,zoel)er.com .4Y 364 '3 Copt )Tight 2000 ZGeder/1,0. Al"; 'ICrIS ieSe!',elI POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pageor FILE INFORMATION SYSTEM SPECIFICATIONS Owner , Septic Tank Capacity- Permit # a1 ❑ NA Septic Tank Manufacturer r ' NA DESIGN PARAMETERS Effluent Filter Manufacturer Z,, ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Commercial Units ANA Pump Tank Capacity e f at ❑ NA Estimated flow (average) ~7 gal/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1-5) Sal/day . Pump Manufacturer ❑ NA Soli Application Rate , C2 al/da /ff Pump Model ❑ NA Influent/Effluent Quality Monthly average' Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Grgvel Filter 11 Peat Filter Biochemical Oxygen Demand (BODs) 420 mg/L ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 m /L ❑ Disinfection ❑ Other. Manufacturer Pretreated Effluent Quality A Monthly average' Dispersal Cell(s) Biochemical Oxygen Demand (BODS) 530 mg/L ❑ In-ground (gravity) ❑ ground (pressurized) Total Suspended Solids (TSS) s30 mg/L ❑ At-grade Mound Fecal Coliform (geometric mean) 5104 cfu/100171711 ❑ Dri ine ❑ O er. Maximum Effluent Particle Size Y. inch diameter Values typical for domestic (non-commerclao wastewater and septic tank effluent. Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ month . ear(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,) of tank volume Inspect dispersal cell(s) At least once every ❑ mont year(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ months_ ar(s) Inspect pump, pump controls & alarm At least once every ❑ months-ear(s) ❑ NA :a Flush laterals and pressure test At least once every ❑ month ear(s) ❑ NA T Other. At least once every ❑ months ❑ year(s) ❑ NA I Other At least once every ❑ months ❑ year(s) ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications- Master Plumber; Master Plumber Restricted Sewer, POWTS 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 (Y,) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatgment components, and any other maintenance or monitoring at it ervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. Page of START UP AND OPERATION or othe For new canshe tprior to use dispersal tcetank(s) for the presence of painting ll(s). If high concert ations are detectedthave thercont nts loftt of the IDWTS and/or check may impede the treatment process 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. disc power outages pumelt snk one large above overloladhighwat inng the levels. When poer is restored the excess may result in the ba kup or surface di cha ge ofreffluenit storing ose, r prior to discharged the dispersal c I() in 9e d avoid this is situation have a ePlthe umber contents of the pump POWTS Ma nt inerr to assist din manually operating t he pump ocontrols to eresttore normal lev e's effluent pump or contact 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 life of the POW1'13: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; edinfectant ; fa; foungationd drain (sump pump) water; fruit and vegetable peelings: gasoline; grease; herbicides; meat scraps; m oil; pesticides; san!tary 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 prope, y and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • Ail 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 oe 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 comp/, lint replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the nE,ed for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the ru1E~ in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technologll a f holding tank may be installed as a last resort to replace the failed POWTS. `1- File--site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation f must be performed to locate a suitable replacement area. if no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infi!tralivr s'Urface. 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 NIOI ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O'= A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS - - POWTS INSTALLER POWTS MAINTAINER _ h-- Name Name Phoneme Phone', SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Name _ ' n? f ? Phone j r r Phone 71 This document was drafted in compliance with chapter SPS 383.22(2)(b)(^)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. E; I ' 1 ~ r r r o n G V- 7 M All( ~ 7i LL j}t , 1- i i l y ~f ~ 1ti v♦ 1K:: t' . ~~4 ~l 4 1,.1 I ~ ~i r~ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer_ Mailing Address -Property Address' U b - - (Verification r?tedft Pla nning Zonng Depa t for new construction.) City/State b~ y Parcel Identification Number Property Location '/a i Sec. T 2 -----a ~ N 1Z j - - ~ _-w, Town oi' .r Subdivision _ Certified Survey Map # - - VolumeI 1 `T Page # Warranty Deed # volume Page # Spec house ~sno Lot lines identifiabl '''yes no SYSTEM MAINTENANCE AND OWNER CERTINCAT.ION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of'pumpin 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 tank 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 Sanit The ary Ordinance. property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by $ master plumber > journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessa less than I A full of sludge. ry), the septic tank is 1/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with ti standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, . Certification stating that pour septic system has been maintained must be completed and returned to the St Croix. County Planning Zoning Department within 30 (lays of the three Year expiration date. State of Wisconsin. ng & I/we certify that all statements on s form are true to the best of my/our knowledge. I/we an/are the owner(s) of the property described above, by virtue of a anty deed recorded in Register of Deeds Office. Number of bedrooms iG' AT O DATE - ***Any .information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. 1•nclude with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map it- reference is made in the warranty deed. (.REV. 08/05) Af f7 h d A mmi 11 Q _ N I~ VON 11 sir M ~ gill 1 r «C r ■ r . , VEDC a_ Wisconsin Depa466 ott3~r1{r►5~ SOIL EVALUATION REPORT Page of Division of Safety and BuildiTs ST. CROIX C~UNTY ordance with Comm 85, Wis. Adm. Code r ' i~I.TY DEVELOP ~Etlqestchcan County Attactr ~ i e plan on paper 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. L9 a - 0 Please print all information. Revie by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location O U67tJ '-if I Govt. Lot (.J 1 /4 1,E1 14 T N R E ( ) W Property Owner's Mailing Add Lot # Block # Subd. Name CSM# ~IK City State Zip Code Phone Number ❑ City ❑ Village Nearest Road Construction Us Residential /Number of bedrooms Code derived design flow rate Sy GPD ❑ Replacement ~Q Public or commercial - Describe: Parent material Flood Plain elevation if applicable d,,'1 ft. General comments and recorrwnendations: 9 System Type C9 el A-V System Elevation F Boring # Boring Tl pit Ground surface elev. ~ ft. Depth to limiting factor in. Soil Appli Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Boring # Boring 1171 pAa-pit Ground surface elev. J ft. Depth to limiting factor 3~--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 (nj I ~ Effluent #1 = BOD. > 30 < 220 rng/L and TSS >30 < 150 rng/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mglL CST Name (Please Print) Sign CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address ate Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 `J' 715-246-4516 Property Owner _ Boring Parcel ID # / Page of ❑ 4 J M Boring # ® Pit Ground surface elev. / J ft. Depth to limiting factor Zy in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 12 ZR- a Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor )n Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon ')epth Dominant Color Redox Description- Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mg1L and TSS >30 < 150 mgA. ' Effluent #2 = BOD, 5 30 mg/L and TSS 5 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. SBD-8330 (RAM) ='M pe~'~ 1 er t - Page of Boring # t n f u Pi,. Ground surface elev. _ tt. Depth to timiting factor +n. _ _ Soil Application Rated -r Hcx zon ( Death j Dominant Cotori Redox Description Te3cture ( Stn-rture S consistence Boundary Roots 1 GPDIff _I T1 t u se:i 1. r Cant. '-'a or Gr. 5il j 'Eff#r ? i 'Eff#2 1 7 1 ! ` ~ l f 1 ' i 1 I t t Boor; a l soar, t uno r ;e E it v fle th to iim ti "1g factor 1 Soil Application Rate HZon Dept, Da rni ant Cauri -xx De, Texture 5tnsc ra_ Consistence! Boundary Root GPD/ff .ae;l Ca Gr. Ste. Sh ! i 'Eff#1 ' "Etf#2 I ' I i r V i ? T El Bo^ng j 3 Barinc # Ground surface elev. Depth to limiting factor in. 1j, Pi? Soil Application Rate Horizon 'lepth l Dominant Colorj Redox Description, Texture i Structure Consistence I Boundary Roots GPD/ff l in Munsell Ou. Sz. Cont. Co4or Gr. Sz. Sh. ? 'Eff#1 'Eff#2 Effluent 91 = BOD, > K < 220 rng'lL and 1 SS >30 = 50 mq1 Effluent #2 = BODS < 30 mg/L and TSS < 30 rrg/L ''ire Department of C;om;ricrce is an equal opportunity service provider and employer, If you need assistance to access services or need material in an a?ternate 4;o mat, please: contact the department at 608-266-3151 or TTY 608-26,4-8777. SE; D. 8;101R &01 Soil Test Plot Plan Project Name Oevering Homes Sh Address 1433 Cernohous Ave Suite A New Richmond Wi 54017 M #226900 Lot 2 Subdivision Da 7/19115 NW 1/4 SE 1/4S 5 T 28 N/R18 W Township Kiinnickinnic ❑ Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of survey iron System Elevation 96.2' *HRpSameas Benchmark 388' Property Line B. M.* B-3 8% Slope B-1 95' 96' 93' 94' n Scale 101 2 Acre Lot 304' Property Line = 1 /4 = Rudy Drive Wisconsin Department of Commerce SOIL EVALUATION REPORT Page r _ of 3 t Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Croix Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, northarrow. oc ion and distance to nearest road. 92-2-1012-20-01S-- Please print ll inf6faU V E D DL26 Personal information you provide may be used r secondary purposes (Privacy Law, s. 5.04 (1) (m)). Pr operly Owner MAR 1 7 2003 P perlyLocation 1:1 El F red Lenertz vt. Lot NW 1/4 SE 1/4 S 5 T 27 N R 18 Property Owner's Mailing Address L # Block # Subd. Name or CSM# C~ //gy~ dj4: pD 220 Livestock Exchan INGOFFICE 2 1-7 Nit Lenertz77vd7~ City State Zip Code Phone Number ity Village • own Nearest Road St. Paul MN 55075 ( 6)51-451-7320 Nannickinak CTH N E] New Construction Use Residential / Number of bedrooms 3 Code derived design flow rate -4500 _ GPD Q Replacement Public or commercial - Describe: Z 1")4a ✓ ~-dGt o~ ~2±, '-'A Z X i6-a- 7 Parent material Flood Plain elevation if applicab General comments This site was visited by the St. Croix County Zoning office for soils verification purpos p ~t~b and recommendations: ~YUs,2.¢VA;~, dr;t,- , /1 ead s - a ~wnd ~i4ea FT] Boring # 0 Boring v-yl ~ ~r-- l Pit Ground surface elev. 94.50 ft. Depth to limiting factor >70 _ 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 1 0-14 10yr3/1 sil 2msbk mfr es 2f .5 .8 2 14-17 1 4/4 - sicl lmsbk mfr cs If 2 .3 3 17-70 10yr5/6 sicl lmsbk mfr - .2 .3 F2 Boring # Boring 94.75 >68 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDiff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 1 0-12 10yr3/1 sil 2msbk mfr cs 2f .5 ,8 2 12-29 1 4/6 sicl lmsbk mfr cs if .2 .3 3 29-68 10yr4/6 is lmsbk mvfr .7 1.2 ' Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 mg/L Effluent s z- BOD < 30 mg/L and TSS < 30 mg/- CST Name (Please Print) _ - --A-- CST Number Thomas C Nelson 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, WI 12/06/02 715-246-2454 t ~ Property Owner Lenertzkinni 2 3 _ Parcel ID#_ Page of a Boring # Boring 96.50 pit Ground surface elev. ft. Depth to limiting factor 35 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 1 0-12 10yr3/1 - sil 2msbk mfr cs 2f .5 ,8 2 12-1 10 4/6 - sicl lmsbk mfr cs if 2 .3 3 18-35 10yr5/6 - sicl 2msbk mfr cs - 4 6 4 35-40 10yr5/6 fif5yr5/8 sicl lmsbk mfi - - .2 .3 F 4 ] Boring # Boring 97.75 34 in. • pit Ground surface elev. - ft. Depth to limiting factor - Soil Application Rate I t loriZo'- 1 n-1- n-., a:.,.. c....,,a.._„ n nnnuw ~tunwn ✓aNui wtwauiwiv~ t~ouvnvwwtpuvi Toi~wizv .atiu~w~o wtwwtcnca wuuindaty t~ww yrviu in. Munsell Qu. Sz. Cont. or I Gr. Sz. Sh. *Etf#1 *Eff#2 1 0.12 10yr3/1 - A 2msbk mfr cs 2f .5 .8 2 12-18 _ sicl lmsbk mfr cs if .3 3 18-34 10 4/6 - sicl 2msbk mfr cs - ,4 .6 4 34-40 10yr5/6 flf5yr5/8 sicl lmsbk mfi - - .2 ,3 5 g Boring !i %s P%~ W1 i~ (f (J4~ ' y w~ -2 Bonn # 97.12 34 - ■ Pit Ground surface elev. Depth to limiting factor in. Soil A ica n Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf in. Munsell Qu. Sz. Cont. Color Graz. Sh, *Eff#1 *Eff#2 1 0-13 10yr3/2 _ sit lfpl mfr cs 2f .2 .3 2 13-21 0 3/2 _ sil 2msbk mfr cs if ,5 ,8 3 21-34 10yr4/6 _ sicl lmsbk mfr cs - 2 3 4 34-36 10 7/6 BedRx * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. S$D-8330rest (R.07/00) QAq~ oF3 h rL)/ ISE sec 5- j ~18G J D- I~ a 6~ ~aa ~ I ids a lCOo pkp~ 100 --T'e)p oC icon Pape- ~v~z 4ZV 50 1 ho~,c.~ ~~~So~n 'LL-1 is-7 pAgc OF3 ~ wa I~ sc lap o~wor) k i0 0~ dad k/- P , 4P12 i q or icon P Ipe Rb,).5 I ~~vk-~ ;r~c~eQz ~ Q 1 ~IW, 50 7 5 F12. 50 1 7 r • ~ i R 2z-`1 3$-7 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ^ / N M / M N ■ N N rn~r. ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road s_ Hudson, WI 54016-7710 (715) 386-4680 FAX (715) 386-4686 MEMO TO FILE: On site soil evaluations were requested by CST Tom Nelson, for the preliminary borings for the four lot minor subdivision known as "CSM `D' owned by Fred Lenertz. I was out on site for these borings on October 15, 2003. Light conditions were overcast. I visited the site by request from Mr. Nelson to verify that mound conditions existed for the preliminary soil borings. Tom had soil pits open for observation. Lot configurations had not yet been established at on site date. Some of the soil pits had bedrock and/or redoximorphic features present, but adequate soil conditions and soil depth seemed to exist for mound installations if additional soil borings would reveal similar soil conditions. Additional soil pits would be required to define the entire system area. I requested Mr. Nelson to provide a map to the Zoning office showing locations of the pits that I observed, since no lot lines had been established as of the on site date. The Zoning office received this map on March 13, 2003. Kevin Grabau Zoning Technician Parcel 022-1012-90-075 05/05/2006 05:05 PM PAGE 1 OF 1 Alt. Parcel M 5.28.18.78C 022 - TOWN OF KINNICKINNIC Current ~X; ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner FREDERICK G & LAWRENCE L LENERTZ O - LENERTZ, FREDERICK G & LAWRENCE L PO BOX 292 SOUTH ST PAUL MN 55075 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 1062 RUDY DR SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 2.010 Plat: 4617-CSM 17-4617 022-03 SEC 5 T28N R1 8W PT NW SE CSM 17-4617 LOT Block/Condo Bldg: LOT 02 2 (2.01 AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 05-28N-18W NW SE Notes: Parcel History: Date Doc # Vol/Page Type 09/22/2003 740871 17/4617 CSM 09/17/2003 740369 2412/516 CO AF 09/02/2003 738182 2395/108 EZ-1 09/02/2003 738180 2395/102 EZ-1 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/10/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.010 50,000 0 50,000 NO Totals for 2006: General Property 2.010 50,000 0 50,000 Woodland 0.000 0 0 Totals for 2005: General Property 2.010 50,000 0 50,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00