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HomeMy WebLinkAbout012-1055-90-000 .u Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County INSPECTION REPORT Sanitary Permit Nov / Safety and Building Division SQ3-0-4u/ GENERAL INFORMATION (ATTACH TO PERMIT) ~O Personal information you provide may be used for sec ally purposes [Privacy Law, s.15.04 1 IT State Plan ID No Permit Holder's Name: City Villa &XTownshh' Parcel Tax No: 4440! CST BM Elev. in BM Elev: BM Description: OSection/Town/Range/Mas~''2 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septi . 7 Benchmark Dosing r iZ~ D ~Z • ~Q 1--4wG.t.4.1-`r' P~Q Att. BM Aeration Bldg. Sewer Holding S✓Ht inlet TANK SETBACK INFORMATION St/Ht Outiet TANK TO P/L WELL BLDG. Vent to Air intake `30' ROAD Dt Inlet Q Q o S Septic $ DH3ZITO-m Dosing t t OeZ'~~ 3D + 3 Header/Man. Aeration Dist. Pipe 3~ ~ • 3 p . ~ t Holding t. System 3.0 -5.0 in ade . O G` Ro PUMP/SIPHON INFORMATION 0 V L-.-? wLLt Manufacturer a0 J t~ m St over w. pM L„ f„r% ~ odel Number MC%d TDH Lift Friction Loss System Head TD H~~ l Ft -37- Forcemain Length I Dia. u Dist. to Well ` SOIL ABSO N YSTEM S µ p D ENSIGNS Width r Length No. Of T~agapas. PIT DIMENSIONS No. Of Pits Inside Dia. Li uid Depth SETBACK SYSTEM TO PIL BLDG WELL LAKE/STREAM LEAC G Manufacturer. INFORMATION '^r~ CHAMBE mber. Type Of System: ,5 ! (GAD) 112- , U u DISTRIBUTION SYSTEM la -toC We'MR.l ipw 11164 Header/Ma nifolr~ Distribution «a' Pipe(s) l o x Hole Size x Hole Spaci" Vent to Air Intake 1-ength~~ Dia 2 Length Dia • Spacing /1~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of Bed/Trench Center Bed/Trench Edges Topsoil Seeded/Sodded xx Mulched Yes ~ No Yes D No ovj (include code discr pencies, persons ent, etc.) Inspection C Pinspection #2: / on: . K; ~ rcel No: 1.) Alt BM Description = Csr(3r, , ' • ~ J O 2.) Bldg sewer length amount of cover = I 40 w 3 orj".t4k 0(,k du~~•►~dMG .4.44%4A"W Q. o Plan revision Required? Yes XNo Use other side for additional informations S Sir I ..J SBD-6710 (R.3/97) 7 yv~pl~ ePr~Q i ~nr~ ert No. ~Qo~k~ s ~ ~ c~,,A,►s~'v+Q . cam. a~Q c~c2e rQ$s~ua~,ft ~ ~ i ~ • . Kevin Grabau From: Kevin Grabau Sent: Friday, September 04, 2015 5:10 PM To: 'sbird@frontiernet.net' Subject: RE: here is my email! Attachments: 20150904165848965.pdf Shaun, This is the a PDF copy of the signed inspection form, from today's inspection for Barbara Daniellson/Cynthia Turnure Rev Trust, that you asked for. If you have any questions, please let me know. Thanks. 'fin Gra6au From: sbird( frontiernet.net [mailto:sbird@frontiernet.net] Sent: Friday, September 04, 2015 3:33 PM To: Kevin Grabau Subject: here is my email! REC ED county 1 a Safety and Buildi n fl S K 201 W. Washington Ave., P.O. 2 anitary Permit Number (to be filled in by. Co.) ROIX COUNTY Madison, W! 162 ITY DEVELOPMENT f /7 Q ~O$ A r Sanitary Permit Application State as Number 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 mailing address) the Department of Safety and Professional Servies. Personal information you provide may for secondary purposes in accordance with the Pnvacy Law, s. IL21 1 m ,Snt L Application Information - -Please Print All Information '~I Property Owner's Name Parcel # ltd-/ sr Property Owner's Mailing Address Property Location jvn Govt Lot City, State Zip Code Phone Number _L1,~'/+, Section .2 ucle W / T N; RE n IL Type of Building (check all that apply) Lot V : r or 2 Family Dwelling - Number of Bedrooms / Subdivision Name Bloc ❑ Public/Commercial - Describe Use I4~~ °k- ❑ City of ❑ State Owned - Describe Use / CSM Number ❑ Village of )r 1J rQ own, P III. Type of Permit: (Check o ,ply one box on line A. Complete tine B if apllp (J A. ❑ New System lacement S yytem ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number -"L- Issued Before Expiration Owner t 0/ 1 IV. Type ofPOWTS S stem/Com onent/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade Mound > 24 in. of suitable soil ❑ Mound < 24 in of suitable soil ❑ Holding Tank ❑ Ottgf Dispersal Component (explain) ❑ Pretreainnent Device {explain) V. Dis ersal/Trea ant Area Information: Desi Flow (gpd) Design Soil Application dsf) Dispersal Area R ed (s Dis~ ► Area Prpposed syn. Elevation VL Tank Info Capacity in To # of Manufacturer Gallons Gallons Units Now Tanks Existing Tanks u v U E Septic or Holding Tank Dosing Chamber 3 VII. Responsibility Stateme - I, the undersigned, as esponsity for installation of the POW Ts shown on the attached plans Plumber's Name (Print) Plum S' ature MP/MPRS Number Business Phone N j~m bar 1 t7 P ber's Ads (Street ity, State, Zip J . Z- e VIII. un /De artment Use Oni ff Approved Permit Fee Date sued Issuing t Signature ~ven Reason for a(al $ ~ Z-5. 04. TX Cond' o s f~ir 11 approval 1.'' Septic tank, effluen~filter anld CD ,~i G ; ti r G dispersal cell must all be servires / maintained ' as per management plan provided by plumber. aft, IN C~'F'~ W eTiK~' 2~. All saRt~ack l'~quiriements t►xst lae m, airttairt~d Attach to compiete plans for the system and submit County ly on pa= tba; 8 If, : I l inches in sac SBD-6398 (R 11/11) ~~~Ol)n PLOT PLAN PROJECT Barbara Danielsen ADDRESS 1305 200th st. Baldwin W i 54002 SW 1/4 SW 1/4S 25 /T 30 N/R 17 W TOWN Erin Prarie COUNTY ST. CROIX SYSTEM ELEVATION 100.0' DATE 8/12/15 BEDROOM 3 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 66 BENCHMARK V.R.P. Top of sidewalk slab ASSUME ELEVATION 100' Filter Simtec Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark 200th St. Property Line All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 5 acre lot area 1 5' below system is to remain undisturbed Scale _ 1/4" _ 10' Grading is to be done to B-1 divert run-off away from p system 5% Slope Tank is to be properly bedded and provided with lockdown cover B- with approved warning labels O B.M.* Qtr ❑ Well 100' 99' B-2 Ae~ 98' Existing ST Bedroom (fai led) House DW Old DW is to be pumped and buried 527' Property Line 1 30th Ave r opy otirT~~ DIVISION OF INDUSTRY SERVICES ~yti~' Tom 10541 N RANCH ROAD o/ 'JP HAYWARD WI 54843 13 i El $ P Contact Through Relay 11 hftp://dsps.wi.gov/programs/industry-services \''y S f www.wisconsin.gov ~os'sror sw Scott Walker, Governor Dave Ross, Secretary August 25, 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: 08/25/2017 Identification Numbers Transaction ID No. 2591281 SITE: Site ID No. 816451 Barbara Danielsen Please refer to both identification numbers, 1305 200TH St above, in all correspondence with the agency. Town of Erin Prairie St Croix County SWI/4, SW1/4, S25, T30N, R17W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1552535 Maintenance required; Replacement system; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed 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: The existing treatment must be checked for structural integrity and general worthiness. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. SHAUN R BIRD Page 2 8/25/2015 Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Carl J pert Please Include a Copy With Your Wastewater Specialist, Division of Industry Services Payment Submittal. (715)634-5035, M-f 7AM - 12PM WiSMART code: 7633 carl.lippert@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 8/12/15 Owner:Barbara Danielsen Location: SW1/4 SW1/4 S25 T30 N,R17W 1305 200th st. Erin Prairie 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 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout CONDITIONALLY 5. Pump Chamber Cross Section APPRO""E ) 6. Pump Curve DEPT of SAFE-Ty NU KONAI- SER 7-8. Maintance and ontigency plan PR®FESS TRY SEP'VICES [31VIS1®N ®F INDUS 9. Filter Specification d cross sec ion Attachments: Soil Te O ESPONDENCE 40 ~ Shaun Bird Signature License number 2 9 0 Page 1 of 9 PLOT PLAN PROJECT Barbara Danielsen ADDRESS 1305 200th st. Baldwin W i 54002 SW 1/4 SW 1/4S 25 /T 30 N/R 17 W TOWN Erin Prarie COUNTY ST. CROIX SYSTEM ELEVATION 100.0' DATE 8/12/15 BEDROOM 3 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 sidewalk slab ASSUME ELEVATION 100' Filter Simtec Filter ❑ BOREHOLE O WELL * H. R. P. same as benchmark 200th St. Property Line All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 5 acre lot Area 15' below system is to remain undisturbed Scale = 14" = 10' Grading is to be done to B-1 divert run-off away from ❑ syste m 5% Slope Tank is to be properly bedded and provided with Iockdown corner B- with approved warning labels 0 B.M.* ❑ Well 100' 99' B-2 98' Existing ST Bedroom (fai led) House DW Old DW is to be pumped and buried 627' Property Line 130th Ave Pressure Lateral Layout Two Laterals - End Manifold ---'T'hreaded Cleanout Lateral Turn-up Plug Manifold M X t L Long Force Main j Sweep 90 Bend e a Z of., Distribution Ne ork Specifications Pressure System Construction . Lateral Diameter In Manifold Diameter In. Laterals are constructed of Schedule 40 PVC Orifice Diameter 3In. pipe. Orifices are drilled perpendicular to X Orifice S acin ~ ~ In. the pipe with a sharp drill bit and face down. _4 L Lateral Length Jr-' Ft. Lateral turn-ups terminate with a threaded M (Manifold Length) Ft. ceanout plug and are enclosed in a 6-8 inch Force Main Diameter Z In. diameter lawn sprinkler valve box accessible Force Main Length Ft. from finished grade. Grade 0 6-8 Inch Lawn Sprinkler Valve Box page of - 03105 lgj Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Minimum Pump Performance Required Tank Model Number 60-0 GPM @ / j Ft TDH Total Tank Capacity G 10 Max. Bury Depth Total Dynamic Head (TDH) Feet Pump Manufacturer Elevation Head Pump Model Number Distal Pressure 3 !G Alarm Manufacturer V S~ Network Pressure Loss Alarm Model Number Force Main Pressure Loss Switch Type ' G Total J Manhole Min. 4" Above Grade With Locking Device Vent Min. 12" Above Grade Weather-proof With Cap Junction Box " " - - - Finished Grade - - - -0 Depth of Cover Ft y Disconnect Means Y >S tY > { 3 i Outlet 1,44 i Y{ y S ISwtch Settings and Reserve Capacity _ Tank Volume ~ / r Y Dimension Inches Volume Gal. A <'< < (reserve) A o2 1? '/a" Y` < (alarm) B 2-- 3o p < < Weep Hole -1 o- ' (dose) C • 7,-> < { ' i Off Elev. i < (dead) D Ft < < > Total Y ~ t D Y } 7F > L Bottom of Tank Elev. ' L Y Y •i ; i C t{ t t; ~'Y ><>S>i>SYS>S>S>t>S>S>S>S>SYL~L>S>S>S>{>CYSYS>S>S>S>SYS>C>C<SYS'i>S>S>S>C>C>S><>S>L>i><>i>{ {>S < t { C S { { t SYSS GENERAL INSTALLATION: The dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling; or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the excavation and is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 Wis. Adm. Code. 03/05 lgj Page 5 of -7- 'i TAL DYNAMIC HiEAD/CAPACITY ?ER ?J'WUTE HEAD CAPACITY CURVE EFFLUENT AND DEWATERING LI MODEL 152 153 ! V, - U 52 153 I W - 50 ~ eel 'f`4eter5 Gai. .l Liters I I I l 5 69 26, 77 291 ,I 153 I I v J i o f ( 23 i 0 ~o~i 12 40 I I 5 j 4.66 53 1 201 61 231 2G E.1 44 u7 ' S2 y7 30 I 25 , 7.6 34 129 42 =yam I r '0 t 3 8? z Z5 a I 20 o ` 4-1 ~3E__ _5r 4' 10 0 4eoa ,i 7- i ~ II ~ ~ I 1 i 0 20 60 80 100 GALLONS T- ~ 5 t/.; LITERS 0 80 160 240 320 2 / 2- -t~4 5/5---i FLOW PIER MINUTE -----J-~ - ~ CONSULT FACTORY FOR SPECIAL APPLICATIONS -r- I, _ • Timed dosing panels available. 3 27/32 Electrical alternators, for duplex systems, are available and supplied with e an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls, -,tom • Sealed Cwik Box available for outdoor insialiations. See FM1420. • Over 130°F. (54°C.) special quotation required. 1521153 Series 1521153 MODELS Control Selection Model Volts•Ph Mode Ams Simex ! Ou lex It~^--- /5 N152 115 t Non 8.5 2 or 3 T BN152 115 1 Auto 8.5 Inclu•ied I 2 or 3 SK2064 E152 230 1 No 4.3 1-- 2 or 3 BE152 230 1 Auto 4.3 Included i 2 or 3 1 10.5 1 i _or» f N1s3 115 No Z SELECTION GUIDE BN153 115 1 Auto 10.5 Inclined 2 or 3 I E153 230 1 No 5.3 I 1 2 or 3 1 Single piggyback variable level float switch or double piggyback variable level float BE153 230 1 Auto t 5.3 Included r 2 or 3 switch. Refer to FM0477. A CAUTION 2. See FMC712 for correct model of Electrical Altemator E-Pak. All installation of controls, protection devices and wiring should be done by a qualified 1 Variable level control switch 10-0225 used as a control activator, specify duplex (1 licensed electrician. All electrical and safety codes should be followed including the most Or (41 float system. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual ccnditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 15347 1T Louisvil-e, KY 40256.0347 Manufacturers of, . Zo ~ \ ® SHIP TO: 3649 Cane Run Road /7 L ,46yf' ii`rrr`✓ Louisville, KY 40211-1961 al~l Qpq/JTY/-UMPS ,.IINCF 77O„ f'LlMP l,0. (50Z)778-2731.1 f800J 928-PUMP http://Www.zoetier.com FAX (502) 774-3624 © Copyright 2000 Zoeller Co. All rights reserved. 6 0 ~ 9 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner r~ (X J $L° Septic Tank Capacity l~i7 al ❑ NA Permit # Septic Tank Manufacturer &A rtdILI A ❑ DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Commercial Units Pump Tank Capacity al ❑ NA Estimated flow (average) gal/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) X27 aVda Pump Manufacturer ❑ NA Soil Application Rate aUda /ftiz Pump Model ❑ NA Influent/Effluent Quality Monthly average' Pretreatment Unit ;RQA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODS) 420 mg/L ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) x150 mg/- ❑ Disinfection ❑ Other. Manufacturer Pretreated Effluent Quality -AltkA Monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (BOD5) s30 mg/L ❑ In-ground (gravity) ❑ In-ground (pressurized) Total Suspended Solids (TSS) s30 mg/L ❑ At-grade Aound Fecal Coliform (geometric mean) s104 cfu/100m1 ❑ Driine ❑ Other. Maximum Effluent Particle Size Y inch diameter Values typical for domestic (non-commercial) 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 ❑ months year(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 ❑ month. rear(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 Flush laterals and pressure test At least once every 3 ❑ months~~ear(s) ❑ NA 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, pretreattment components, and any other maintenance or monitoring at irervals of 12 months or less shall be performed by a certified POWTS Maintainer. A servicpi 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 esence of painting products or For new construction, prior to use of the POWTS check treatment cell(s). t(s)fo~ gh concentrations are detected have then contents l of thin tank(s) removed by at eptage servicing operator prior to us. dispersal System start up shall not occur when soil conditions are frozen at the infiltrative surface. . When restored excess disch 9 pow outages pump tanks may fir above normal i the cell(s)land may r su ten the backup or surface d'isch rg of efflu t e discharged to to the dispersal cell(s) in one large dose, overloading ng the Operator to restore normal levels To avoid this situation have the contetank remove nts to ssstiny manually operating th p r prior to restoring power effluent pump or contact a Plumber or POWTS Maintainer within the pump tank. ver or otherwise disturb or compact, the area witt~ln over, Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park 15 feet down slope of any mound or at-grade soil absorption area. ; foundation S: Reduction or elimination of the following from the wastewater st e degreasers; rimprove diapers and prolong disinfectants; the fat-, of the POWT~I>: dralin antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; 9 (sump pump) water; fruit and vegetable peelings; gasoline; brine. grease; herbicides; meat scraps; medications; oil; painting productIs. pesticides; sanitary napkins; tampons; and water softener ABANDONMENT When the POWTS fails and/or is permanently nil k taen Comm out 83.331 service the following ceps Qallbe taken to insure that the system is propely and safely abandoned in compliance w pte • 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 be excavated and removed or their covers removed and the void space filled with null, 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 compli,linreplacement system: 0 A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systeim. requit The replacement area should protected from p protect the replacement area will re ult In the neled structure, lot lines and wells. dFai u e ocompaction setbacks from existing p posed for a new soil and site evaluation to establish a suitable replacement area, Replacement systems must comply with the rule,[ in effect at that time. ❑ 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. '~he site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation mist 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 infiltrative s ace. 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 N ENTER A SEPTIC, PUMP OTHER A TANK MAY BE DIFFICULT OR CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O} A PERSON FROM THE INTERIOR ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone Phone Z-1/0 SEPTAGE SERVICING OPERATOR PU ER LOCAL REGULATORY AUTHORITY Name hr Name Phone Phone This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. 5 ~ ' ~ I ~ I I ~i f I II ~ 1 LI I I ~ I ~ ' II. I I k I- I } I 1 f"` ,'Tj I I I I I I i 1 0659 HORMN CAA`( NORIH RD BOPi CITY, MI 41116 -7224_ 1 °H gg-~90 FAY l Sg2 SIMiTLCH ~ rl ?CR "`~"'t f{r~ ~ ~ THP!`; 58t~~ti I i J Hn'~ERY STF 100 r , l GAMY KoT~~p~.~~l, ~G1 ~ 3~bd 03 dwnd a3663A36d 898LVLBSTL Lb:[Z ZZBZ?90/1'0 ST. CROIX COUN1 V SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERThFICATIC'N FORM Owner/Buyer - a Mailing Address OS -v - = S / - Property Address {Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Nuiaber LEGAL DESCRIPTION Property Locations '/4, Sec. i'30 NR ( Wy Town of fi=r ,r._ r. - Subdivision - - - - Lot # Certified Survey Map # r ~ ~l clurrte Page Warranty Deed # J l Va lame - Page Spec house yes no Lot lure;: identifabOY(--, n o SYSTEM MAINTENANCE AND OWNER VV-- ~~ICAT:CON 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, it 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 wasl.e disposal systenr. 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 & Zon ing Department a certification forrrt, signed by the owner and by a master plumber,,jortrneyman 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 inspeGdon and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above reyuirein.ents and agree to maintain the private sewage disposal system with tine standards set forth, herein, as set by the Department of Commerce, and the Department of Natural Resources, State of Wisconsin, Certification stating that your septic system has been mitintained must be completed and returned to the St, Croix County Planning & Zoning Department within 30 days of the three year ex- ation date. I/we certify that all statements on this form re true to the best of my/otn k nowledge,. I/we aril/are the owner(s) of tine property described above, by virtue of a warranty ed recorded in Register of Deeds Office. ,r tuber of s G SIGNATURE OF APPLICANT (S) - UA AT13 , - • ""Any information that is misrepresented may result in the sanitary per7rrit being r.-,voked by the Planning & Zoning I)eparlrrrent. Include with this application a recorded warranty deed fiom the Register of Deeds Office mid a copy of the certified survey map if reference is made in the warranty deed. (.REV. 08/05) , ST. CROICERTIX COUNTXFICATIONZONINGSTATEMENTOFFICE FOR UTILIZATION OF AN EXISTING SEPTIC TANK '['hi.-S is to certify that I have inspected the septic tank present:1 ~~(Irving the residence located f p Section ? ~ .(Jrv T a r~ 9/[/ jL D R F I' U t L' Upon inspection, - --wt:he tank and I certi-fy that I have fr;,.rcl baffles to be in good condition, and it appears to t>e functioning properly. i,a,st time serviced: I)i-d flow back occur from absorption system? No (If no, skip next line) Approximate volume or length of time: gallons t. hacity: Construction: Prefab Concrete Steel other 1-111 nufacturer : (If known) :~-c it i yi `~`j° °f (If. known) : L nature)el,c, (Name) Please - pri t ('t'itle) (License Number) 1) ri t. e t'orm to be completed by licensed Statutes) or Licensed Dis plumber (s.I45.06, Wisconsin Code) Poser (NR 113 Wisconsin Administrative [':Lumber (applying for sanitary permit) Certification: 1.ri accepting the above statement regardin existing septic tank condition, I certify that the tank to the conform to the requ' ements of TLHR 83 t of my knowledge wild. inspection opening o er outlet baffle Adm. Code (except fc,z- N ct ttt y Signatur MP/MPRS Parcel 012-1055-90-000 08/26/2015 04:37 PM PAGE 1 OF 1 Alt. Parcel 25.30.17.391 B 012 - TOWN OF ERIN PRAIRIE Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - TURNURE (TR), CYNTHIA E CYNTHIA E TURNURE (TR) 1305 200TH ST BALDWIN WI 54002 Property Address(es): Primary * 1305 200TH ST Districts: SC = School SP = Special Type Dist # Description SC 0231 SCH D BALDWIN-WDVILLE SP 1700 WITC Notes: Legal Description: Acres: 5.000 SEC 25 T30N R1 7W 5 AC IN SW SW LOT 1 OF CERT SURVEY MAP IN VOL IV PG 987 Parcel History: / Date Doc # Vol/Page Type J 02/19/2013 973517 QC 07/02/2009 899283 TOD 11/17/1999 613995 1471/440 WD Plat: = Primary Tract: (S-T-R 40i 160/4 GL) Block/Condo Bldg: * 0987-CSM 04-0987 012-80 25-30N-17W SW SW LOT 01 2015 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/01/2009 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 38,000 136,300 174,300 NO Totals for 2015: General Property 5.000 38,000 136,300 174,300 Woodland 0.000 0 0 Totals for 2014: General Property 5.000 38,000 136,300 174,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 205 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 RECEIVED AUG 14 2015 us70 Wsoonsin De omme,ca SOIL EVALUATION REPORT Page of AUNTY Division of Safe rnl QOM UNITY D LopM ordance with Comm 85, Wis. Adm. Code county ~ fb Attach complete site plan on paper not less than 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. 0 p - l $ S' { o Please print all information. Revi ed by Date Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)). h ii Property Owner Property Location f 6 c., tC-,-- Lot SLO 1 /4 ILJ 1 /4 S 3 Q N R E (or W Property Owner's Mailing Address Lot # Block # Subd. Name o0YCSNW State Zip Code Phone Number ❑ City ❑ Village q p Nearest R ad 1 LO ( ) 08- fir; S+- ❑ New Construction Use,11 I Residential / Number of bedrooms -_-I:, Code derived design flow rate GPD Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable f✓ A g, General comments and recommendations: System Type InCi L! A-e o- Y~ti.✓ System Elevation Boring # t Boring JCS Pit Ground surface elev. t ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Q -7 C U ''IL' 7-if b .3 8- S Zs - , Boring # El Boring r "8- Pit Ground surface elev~~ N ft. Depth to limiting factor O` in. a Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 d~(0 it) , ( - r" ~S- -Z 6-Zo L13/ Est > , 3 zo-.2 1-7 7'f ✓ r/T r 1'f'~~ r r Effluent #1 = BOD_ > 30 < 220 mg1L and TSS >30 < ' Effluent #2 = BOD, < 30 _ mg/L and TSS < 30 mglL CST Name (Please Print) gnature CST Number Bird Plumbing, Inc. Shaun Bird 1411 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 5415W 'f 715-246-4516 L Property Owner _ Parcel ID # Page of ® Boring # ❑ Boring gQ Pit Ground surface elev. ft. Depth to limiting factor 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 2 - ` si -3 7 a 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. ❑ Soil icaf Rate Horizon Iepth Dominant Color Redox Description- Texture Structure Consistence Boundary Roots GPD/fY in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD, > 30< 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 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. SB0.8330 (RAM Property Owner- Parcel ID # Boring 4 ❑ Boring Page of Pit Ground surface elev. lGj ft. Depth to limiting factor in Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots So)I D1ff Rate in. Munsell Qu. Sz. Cont. Color GPiff 1 Gr. Sz. Sh. 'Eff#2 b Boring -t Boring [I Pit Ground surface elev. ft. Depth to limiting factor _ in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil lication Rate in. Munsell Qu. Sz. Cont. Color GPD/Ff Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Horizon ')epth Dominant Color Redox Description. Texture Stricture Consistence Boundary Roots GPDfF SO1I ' /ff Rate in, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mglL and TSS >30 < 150 m 9VL 'Effluent #2 =RODS < 30 mglL 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, sea4330 (R.&W) r Project Name Barbara Daniels Soil Test Plot Plan Address Shaun rd 1305 200th st. Baldwin Wi 54002 Lot 1 #226900 Subdivision Da /10/15 S w 1/4 SW 1/4S 25 T 30 N/R17 W Township ErinPrairie [J Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of sidewalk slab System Elevation 100.0'/TBD *HRPSame as Benchmark 200th St. Scale = 1/4" 10' Property Line 5 acre lot B-1 5% Slope B-3 O 0 Well 100' B-2 99 Existing 3 Sr ' 98' Bedroom House (failed) DW 627' Property Line 13 0th Ave ~ S7 W P~~ 3 i