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HomeMy WebLinkAbout026-1165-26-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 579089 Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Township Parcel Tax No: Steve Dalton TOWN OF RICHMOND 026-1165-26-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: f Da /3, ►vt 22.30.18.1292 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER tiyS CAPACITY STATION BS HI FS ELEV. Septic Benchmark S 4...>I F.► z. 1606 4,6 /D /da Dosing Alt. BM '1 GeJw '7•L ~j A/' Aeration Bldg. Sewer 7 Holding SUHt Inlet ~s 9g TANK SETBACK INFORMATION St/Ht outlet 94'.15 i TANK TO P/L WELL BLDG. en o Air Intake ROAD Dt Inlet Ad 5 S w.- Septic 7 Zo 57 Z, Dt Bottom Dosing Header/Man. 9 I' Aeration Dist. Pipe 9. `7 9 • 3 R•~ 9fi•Z Holding Bot. System /b.7 fie ia,8 S. Z PUMP/SIPHON INFORMATION Final Grade Manufacturer GPMand St Cover / / L 16 x 7 Model Number TDH Lift on Loss System Head H Ft Forcemain Length Dia. ist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth 7 ~1 f 4.,`~ DIMENSIONS 3 76 /74, SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Z:-, P"1~-~411 ~ Type Of o System: 4cj UNIT Model Number:~,~ ~DISTRIBUTION SYSTEM t-7 +-1 3S s Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air I take Pipe(s) -Z--- I~_ Length 17 Dia Length Dia Spacing E S SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center / Bed/Trench Edges \ Topsoil Yes [R No Yes [M No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1443 129TH ST CL I 8 1.) Alt BM Description = r aI ` 2.) Bldg sewer length = Z ( - amount of cover Plan revision Required? Yes No -'i' Use other side for additional information. Date Insepctor' ignature Cert. No. SBD-6710 (R.3/97) -7 9 otieaxrsrevr County Industry Services Division f, 1400 E Washington A~/e a ~ ~ $ Sanitary Permit Number (to be filled in by Co.) COUNN P.O. Box 7162 ST. ►TY DVELOPM Madison, WI 53707-716 ' 9OF.TSIOI3A~•S~ N►MUN Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(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 the Department of Safety and Professional Services. Personal information you provide may be used for secondary et Address (if different than mailing address) purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stats. I. Application Information - Please Print All Infor ti 60je,V3 /29 ~t4 y4 Property Owner's Name Parcel # ~£vC- D11fOAJ (U3 02,1, -1AIX-7, 000 Property Owner's Mailing Address Property Location 6 4_4 t~G I Dc . / 2_5 2- 9,30 Govt. Lot City, State Zip Code Phone Number N W'/4, 5f_ '/4, Section 2- Z 0A-M f 2S 1A, I (circle one) T3,0 N R/g E o(9V II. Type of Building (check all that apply) Lot # 121-l or 2 Family Dwelling - Number of Bedrooms Z Subdivision Name El Public/Commercial - Describe Use OFLL- 6' pry Block # 4 1.-,, d Ie, d o w ~ e44 (14.A- R h El City of El State Owned -Describe Use CSM Number ❑ Village of 2 1 b,,,, C~.(JC?GA L~ 1-7 t17 (..,~A Town of , G GL 4 h. C III. Type of rmit: (Check only one bo on line A. Complete line B if applicable) ^e- A• New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renew Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System/Component/Device: (Check all that apply) Non-Pressuri zed In-Groun ❑ Pressurized In-Ground El At-Grade El Mound > 24 in. of suitable soil El Mound < 24 in. of suitable soil J Holding ank Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treatme rea Information: .2 - C VI .S 3 wit !c Y i of Qu ,'r q -f Design Flow (gpd) Design Soil Application Dispersal Area Required (s tspers Area Proposed (sf) System Elevation - - - - - - Rate(gpdsf)-- VI. Tank Info Capacity in Gallons Total # of 28 o Gallons Units Manufacturer ~w °c New Tanks Existing Tanks f 'gym £ r~ U .5 n w C7 P, eptic r Holding Tank DOD S;FO .A,. ❑ ❑ ❑ ❑ Dosing Chamber ❑ ❑ ❑ ❑ ❑ VI Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. P ber's Name (Pant)/ Plumber's Signature MP/MPRS Number Business Phone Number a a C N",~. k;tl S Z16 7 2. IIJ--Y91 S388 PI mbe s Address (Street, City, State, Zip Code) Q 0' I- k_w,X t W .sySS3 VIII. Feount epartment Use Only Approved I ~a Is ~ Permit Fee Date sued Issui b gent Signat e rven Reason enial $ 5 cc 10 2f~ IX. Condi t ea$ons forDisapproval n ~e pw. I : < Septic' nk, efUiuont Biter iWd 3) Q D J i kM J 1isperrai ceil'.must OR be Serv es es per management plan provided by plumber. 2. 1"s* k requirements must, br maintairid as per applicable code / crdiromm. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size kjaf dr ao- ~GEI/ 45-4f~5 to-n-15- B SD-6398 (R03/14) w 1 n a © r ~r z ~ ~ ~ sue- ~ n 3 M b tvn, N. "A ;c, v_ ) ll y~ \ 10 h J o / 0 3 ~ Q O ~ t ^ e- -y w n 3 w 3 \ m O 114 tr\ AZI U v V Soil Absorpticn System Cross Section 4" Schedule 40 Final Grade PVC Vent Pipe 9s9 ~~th Vent Cap ft y `J Leaching ~ Chamber 9Y,9 System Eievaticn .3 L S Soil Absorption System Plan View ft 3~ VIII I I I I IIII~IIIII I hillllll IL F Vent Or Observation Pipe Leaching Trench 1 I Chambers IIII11111 ii III ~ I,IIII!il i ~ I I i II II~~~ i.III~~~ 4" Dia. L Trench 2 Header LQaching Chamber Specifications 71SAR And Model ,.~;e.4' y s sq `t per chamber Soil Application Rate 9p 7 d/sq ft t ' ,v G ,U pp Soil A e - - I p. Rat,. EIS„ - 3'``/ Chambers I 2 rows or _ 7 _ chambers each. Page or FIVER Wsccns ~p'a en of Safety and Professional Services Division of Industry Sery OAT SOIL EVALUATION RE 05 Page of 3 ST. CROD(CouNTY in accordance with Comm 85, Wis. Adm. Code Atha on DEVELOPMENT CountK5 CA. o ' X e site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Z• ` Please print all information. Revi d by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Z I / Property Owner Property Location Govt. Lot ll.w 1/4 it 1/4 Z~ T 3o N R I$ ®r)W Property Owner's Mailin ddress Lot Block # Subd. Name rM# 950 16A_,Lii £ Dom. W d ,•e, d owj city State Zip Code Phone Number it,py E]Village Town Nearest Road c50M►«s~f !J1 ( ) I~C1~.~, GI / Z 91 New Construction Use Residential / Number of bedrooms J Code derived design flow rate J GPD Replacement n Public or commercial - Describe: Parent material Flood Plain elevation if applicable ft General comments and recommendations: IT 1 12 Boring # 0 Boring Pit Ground surface elev. f~U` ft. Depth to limiting factor' 103 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 ~%a 317- / ,,T, c' s . Y .7 Z- Ke-7-1 1,011-Y13 41M - Z -_3 f 3 X 30 6Y.eY/Y S as a S > v S -7 it- .s os r as . s • 9 -1/ /6) 1 s ~t FZI Boring # Boring ~ ~ / Pit Ground surface elev.O• 0 ft. Depth to limiting factor,/ l3 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ,,n 56lc z s L 7 0 v-1 '11.3 /eY41,/Y IT i -fit, -L 2 * Effluent #1 = BOD > 30 < 220 mg/ and TSS 30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST m (Please Print) Signature CST Number Lelquf awk~AiS j ZZ87Z- Address/ (j el s Date Evaluation Conducted Telephone Number . z G sY~s3 76-) YQl-s39g SBD-8330 (R07/13) Property Owner Boring (Parcel ID # Page °2 of 3 3]Boring # F Pit Ground surface eled~b ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 l ow ou 3~z J l A- as a,,. Y • 7 3 18:sY /oY~'~N S ❑ Boring # Boring , n Pit Ground surface elev. ft. Depth to limiting factor in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe 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 Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L SBD-8330 (R07/13) mss--°-~ CC v 4 ~ o CZ N ~ I O I 1 ~ N O 3 a ~ -r v ~ NQ1 ki 1* J J J V do `TO~raeru~lTO C g County U I-A Industry Services Division 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.) SE 7 11 P.O. Box 7162 ZO 15 Madison, WI 53707-7 G y°~ -oMS" CROIXCOV 579d~ ~ft'SS10,:Atisw Sanl " it Application ransactionNumber In accordance with SPS 383.21(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 ing a dress) the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address (if different than mail purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. 40 4. I. Application Information - Please Print A or 'on Property Owner's Name 3 Parcel # 3~f£ L.-F 'Da 14, o z co 11. - Z_ 4, - 0"'0.0 Property Owner's Mailing Address Property Location Z . •36 , 13„ 1 a 4 2 / j 0~l.kv C Z)/ Govt Lot City, State Zip Code Phone Number 6~j Section li 2- Z0, >1" tit--J~ ic ~ p/ ' ; (circle one i T50 N R`8 EoiW IT. Type of Building (check all that apply) Lo 1 or 2 Family Dwelling -Number of Bedrooms 3 a Subdivision Name 04 RAr.- ❑Public/Commercial-Describe Use 61C B ~k--d 1~t -L 41011L M i ❑ City of ❑ State Owned-Describe Use 06'.d.. ❑ Village of V CSM Number ' 9d Town of ,~CLI rm d A-4r,) " III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ew 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 IV. Type of POWTS System/Component/Device: (Check all that apply) [R Noll-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Hol ing a c 0 er Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treatmen rea Information: 3 --e- s ffs 3 `K L' X d~ v r C< ` s Design Flow (gpd) Design Soil Application Dispersal Area Required (sf) 7 is ersal Area Propos (sf) System Elevation Rate(gpdsfl----- - frz~ - VI. Tank Info Capacity in _ U Gallons Total # of Manufacturer A U Gallons Units New Tanks Existing Tanks _U ~ 0 P. eptib r Holding Tank d O 0 S k~ w6 ❑ ❑ ❑ Dosing Chamber ❑ ❑ ❑ ❑ ❑ V Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. u ber's Name (Print) )J / lumber's Signature R umber Business Phone Number PI mber's ddress (Street, City, State, Zip Code) to C) . 0.2 H c k Lam.. 3-Y,6 J-3 VIII. Coun '/De artment Use Only pproved ved Permit FFeele~ Date sued Issuing t Signature ivenReas Denial $ ~ 66 / Z! /-5 IX. CondiiMTc1l PAWGRReasons for Disapproval #1W~ A&J 6 1, I tank, effluent filter i r d' / .dispersal celi'must all be aervtces / mar d W Ljti, 4,;1-5, 1 ti • *a per, management plan provided by plumber. k rege±diiet~irr~tnust4~rr~tttairt~d M codr / ordinancAS. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R03/14) La v Cl d `R V ~ o ~i s Q I Ik- ~ ln~ a NL ~ v a i I I CONVENTIONAL COMPONENT DESIGN Residential Application LINDEX AND TITLE PAGE Project Name: ~Gt 1T0 d Owner's Name: 0/6) I Owner's Address: _ ~-9,i0 6A-a vt DA, ~J O sM fiL,S £ ~p~, Legal Description: J EC Z T3 Q g Township: /~~Gh.~r+z 0C/ County: S7 Subdivision Name: A, uAC4 d 0'a 5 Lot Number: Parcel ID Number: L(~ d S' t-L -.0,6 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: 6o,_e--)L4 C a.w License Number: 2 2 Z 7 7- Date: !J- Phone Number ~!-Y g! -J388 Signature II Designed pursua to the In-Ground Soil Absorption Component Manual for POWfS Version 2.0 SBD-10705-P (N.01/01). Page 1 i o y a , v J w 3 a A o a o+ 3 y O 1r A ~p b v. v ~ M a ~ 4? l~ o _Q h ~ ~ ~ C] ~ Lv Soil Absorption System Cross Section I~/• ft ft 4" Schedule 40 Final Grade PVC Vent Pipe With Vent Cap 7- ft Leaching 9/ Chamber - ft System Elevation v 3 ft ft zy- ft Soil Absorption System Plan View r7`- - ft 8 ft Leaching Trench 1 Chambers 4" Dia. Trench 2 Header Vent Or Observation Pipe Trench 3 Leaching Chamber Specifications Manufacturer And Model _Qu - C k y S' EISA Rating Z 1) sq ft per chamber Soil Application Rate gpd/sq ft gpd Design Flow _ Soil Application Rate EISA = '~7 Chambers 3 rows of / chambers each. Page of `.J POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner 7-f 'e V ,q l ~A N Septic Tank Capacity /000 gal ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ,6 NA Number of Bedrooms ,3 ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units _2-1A Pump Tank Capacity gal .8-IQA Estimated flow (average) 'I J-0 gal/day Pump Tank Manufacturer JD-NA Design flow (peak(, (Estimated x 1.5) 1-7 J gal/day Pump ManufacturerA Soil Application Rate . ~r gal/day/ft' Pump Model ? Standard Influent/Effluent Quality Monthly average* Pretreatment UnitA Fats, Oil & Grease (FOG) <_30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODE) <_220 mg/L J21NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :0 50 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD5) :530 mg/L I~ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L „.[~!'NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) <_10' cfu/100m1 ❑ Drip-Line ❑ Other: Other: ❑ NA Maximum Effluent Particle Size Ys in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) Maximum 3 years) ❑ NA -2 year(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA At least once every: j ❑ month(s) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) wear(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA . 1 tear(s) A Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) S341A ❑ year(s) Other: ❑ month(s) LrNA At least once every: ❑ year(s) Other: ❑ 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 (Y3) 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 NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <_12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals 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. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at 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. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name , S t; Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name s Name t' Phone ~i sJ 'VY V 8 Phone 171r-3e6- 7 6 8 0 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals 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. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at 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. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name. Name Phone °I / - y -5- 3 0 0 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name 5 6", Name Phone 0i / - -7 if ~ 5 Phone ? l 3 " Y680 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. 1.if,eti me 1, i'' L Installation and Maintenance Instructions Installation Step 1 Dry fit the filter case onto the outlet pipe going to the drain field. Ensure it is centered directly under the access opening. (if outlet pipe is already in a fixed position, additional pipe may need to be added) Step 2 If utilizing the additional single side support and the two bottom supports: While the case is still dry fit to the outlet pipe, measure and cut 1"schedule 40 pvc pipe to the length needed to extend from the hubs that are pre-molded into the case to the side wall and the inside floor of tank. solvent weld pipe into the hubs that are pre-molded onto the case. Step 3 Solvent weld the case to the outlet pipe. Insert the filter cartridge into the case pressing down on the cartridge until it locks into place at the bottom of case. Step 4 if utilizing a vertical read switch: Insert switch into the hole pre-molded into the top of the filter. Press straight down until it locks into place Maintenance 1) Remove the access lid of the tank. Note: To ensure undesirable solids do not exit the tank and into the drain field, the tank should be pumped out until the level of effluent is below the outlet level of the tank. 2) To remove the filter cartridge from the filter case, pull up firmly on the handle of the cartridge dislodging it from the case. (if utilizing a vertical read switch, removal of switch is optional) 3) Using an ordinary garden hose, rinse the filter cartridge ensuring all visible septage material is removed. 4) Place the filter cartridge back into the filter case pressing down on the cartridge until it locks into place. 5) Place the access lid back onto the tank ensuring it is secure. Lifetime filter has a lifetime limited warranty: Lifetime filter LLC warrants the filter will be free of manufacturing and workmanship defects during normal use for the period of time the original purchaser owns the product. Lifetime filter will provide a replacement filter in the event that the original filter was not damaged during the installation or maintenance process. Damage to this product caused by accident, misuse or abuse will not be covered under this warranty. Improper care or malfunctions resulting from product not being installed, operated or maintained properly will void this warranty. Lifetime filter assumes no responsibility for labor charges, removal charges, installation or other incidental or consequential costs. Contact: mike(@Iifetimefilterllc.com Phone: 502-724-2231 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer / a I a p-, Mailing Address A,^V e A.. Property Address p(Verification required from Planning & Zoning Department for new constriction.) City/State ,~tod Fell iIJ? p + l(/, Parcel Identification Number U Z6 ! I6r- Z' 6 ° a0 y LEGAL DESCRIPTION Property Location /1 Sec. Z Z , T 90 N R I8 W, Town of 4AO? '1 y .c~ Subdivision Plat: k'4.CJ A.-I..' , Lot # • ZIP Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume Page # Spec house ),yes no Lot lines identifiable eyes no SYSTEM MAINTENANCE 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 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 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 ( I ) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1 /3 full of sludge. I/we, 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 Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on thi form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a war arty deed recorded in Register of Deeds Office. Number of bedrooms 3 SIGNATURE F APPLICANT(S) DATE ***Any 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 Rellister of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) d • a \ ~ i • a .tam ~~.y~ ~ \ \ n ; q ~ p ACMGC r t't .d e._; \ \ v \ \ n u s 220'00 z m a, \ 4g 6L~ 5 ~ Z \ ~ • y r' j V X11 - ~ ` er9a. try # S 0377•18' E 300 51 ~ E r C4I ~ AOPPM ~tt6 b ~ ~i c y / ! 7 ~ ~ y 1 e. N ti~h f Imo- I Im jm I > -0'0 it I a C - z I +~-o• pa y u v I L'O I I ~a i ~ i< S ! I a I ~ I l y ~ bt- iT a; ~ b IG~ A o I 17I ; ICI I 1 I I ~ it b;~ - I n 57- El~l I ~ ~ I ~ b 16r a I j ~q I I to o' I \.J=I~" Fbl _ ~ I; I I f I wry ~ ~ ~ ~ I 1 i~ Ir~• I I a I > jA J°'° f F? 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CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 06/09/2004 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner 0 - DALTON, STEVEN M STEVEN M DALTON 930 BRAVE DR SOMERSET WI 54025 ' =Primary '"Prop es) * 1443 =129THST (S Districts: SC =School SP =Special Type Dist # Description ~f SC 3962 SCH DIST NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST Notes: SP 1700 WITC Legal Description: Acres: 1.790 SEC 22 T30N R18W PT NW SE BEING LUNDY MEADOWS ('04) LOT 26 (1.790AC) Parcel History: Date Doc # Vol/Page Type 12/14/2009 908348 QC 06/09/2004 765401 10/08 PLAT Plat: * = Primary Tract: (s-T-R 40% 160% GL) Block/Condo Bldg: * 10-008-LUNDY MEADOWS 026-04 LOTS 1/3 22-30N-18W NW SE LOT 26 2015 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 09/27/2011 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 1.790 200 0 200 NO Totals for 2015: General Property 1.790 200 0 200 Woodland 0.000 0 0 Totals for 2014: General Property 1.790 200 0 200 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 I it - o Wisconsin Department of Commerce SOIL EVALUATION REPORT Page r of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must L 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. 2 210 Re 'ewed b Date Please print all'information. M" 3 6 Personal information you provide ma be used7pi ise0ild p Law, s- 15.04 (1) (m)). --M 2 Property Owner I Property Location Govt. Lot 5,----114 S T N R E (o W Property Owner's s Mai ' Address Lot # Block # Subd. Name or M# V'7 1 7 a 4~ ezz,4~-L L City torte Zi Coae Phone Number❑ City ❑ Village ,fErTq~K Nearest Road New Construction Us A Residential / Number of bedroom Code derived design flow rate _ GPD ❑ Replacement Public or mercial - Describe: Parent material Flood Plain elevation if applicable ft- General comments and recommendations: Boring # Boring Pit Ground surface elevF ft. Depth to limiting factor in. Soil pica on 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 i g -119 0 h7 C M6 /ff, 51 MY- /V ® Boring # Boring Pit Ground surface elev. Zft. Depth to limiting factor- in. Soil Application Rate /4 1 - - . 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 t~ Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (please print) SignatureeZ' CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 9- f/..._ 0 =s 715-246-4516 Property Owner _ Parcel ID # Page of F3_1 Boring # ❑ Boring Ground surface elev._"►t• Depth to limiting factor in• Soil Application Rate Pit Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •Eff#1 1 `Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -31 , Z F-1 Boring # ❑ Boring Ground surface elev. ft. Depth o limiti g factor in. Soil lication Rate El Pit Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary ROOD GPDM •Eff#1 'Etf#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. F-1 Boring # Boring Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Col Redox Description. Texture Structure Consistence Boundary Roots GPDM Gr. Sz. Sh. •Eff#1 •Eff#2 in. Munsell Qu. Sz. Cont. Color Effluent #1 = BODE > 30 < 220 mglL and TSS >30 150 mg1L • 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. SBD-8330 (8.6/00) Soil Test Plot PProject Name William Stock/Steve Dalton Address 1748 112th St. New Richmond Wi 54017 sTM #226900 Lot 26 Subdivision Lundy Meadows Date 8/11/03 N 1 /2 SE 1/4S 22 T 30 N/R18 W Township Richmond El Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 94.2/94.1 *HRPSame as Benchmark Alt. BM Top of 2" Pipe @a 100.2' Scale is 1" = 40' Property unless otherwise Line noted Please note: Installer must verify all lot lines and setbacks before installation. Not enough slope to Please Note: Tested area establish contours may not be suitable for desired building area. 45 Po^ 1% 329' Check system location Slope Property before excavating. 30' Line M.E11A B-2 90' B-1 15' 142' 158' Property Line Property Line i .w ST. CROIX COUNTY WISCONSIN ZONING DEPARTMENT t N t t • • • r..•r ST. CRODC COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 Iva Phone: (715) 386-4680 Fax (715) 386-4686 Memo to File From Pam Quinn Date: 4/27/2004 - Re: Sandy loam structure misinterpretation on subdivision soil reports Recent soil on-site determinations have brought a problem to our attention. During these on- sites, bofings were excavated to confirm soil conditions where two conflicting soil reports had been submitted for zonifik department review. The soil profiles, evaluated by myself, Dave Fogerty, and Dave Steel (all certified soil testers) differed from the original soil reports in that massive (structureless) sandy loams were encountered in horizons that were described as having medium ban lar bloc 2 k) structure by Adam Schumaker or weak, medium ular structure (lmgr) by Shaun Bird. There apparently has been a misunderstan mg cause by handling samples of the soil during texturing versus the soil characteristics in situ. The soil, when chunks were taken out of the profile to hand texture, with pressure parted into "crumbs" that appeared at first to be subangular or granular in shape. However, these were not true peds that broke apart along planes of weakness, but fragments created by handling. The soil when observed in the horizon did not have distinct units of structure and should have been reported as "massive". Added notation: on 4/23/04 Mark Iverson (Cedar Corp. certified professional soil scientist), Shaun Bird, and myself did an evaluation of soils on Lots 6 & 9, Richmond Meadows where the original soil report described the third horizon as sandy loam, "l mgr". On Lot 6 we checked soil profiles within a POWTS distribution cell and then excavated a test pit on Lot 9. The sandy loams in question were a weak, coarse to very coarse subangular blocky structure, where planes of weakness were just discernible when peds were parted from the profile. The peds separated with ypa li t pressure by soil tester. Sand coatings were observed on the ped faces in the Lot 9 soils, which supported the determination that some structure existed to allow water to move through the upper portion of the sandy loam horizon. However, below the weak-structured soil we found massive (structureless) sandy loams and the boundary between these horizons was irregular, which would mean a distribution cell could encounter alternating weak and massive sandy loam. Shaun said he would amend his soil reports with a memo recommending that any sandy loams he identified as "lmgr" or "2 mgr" be assigned a lower loading rate of 0.3 gpd/ft2 (see attached memo for Whitetail Meadows) to provide a larger dispersal area. Page Two - Soil Memo 4/27/04 Massive sandy loams have been assigned a soil application rate of 0.2 gpd/ft2 with the code changes in Comm 83.44-2, effective as of 2/1/04. The application rates listed on the soil reports were higher due to the structure having been described as either weak or moderate, which affects the calculations for sizing of POWTS distribution cells. Obviously, one of the concerns is to make sure loading rates for the soils are not in error and allow undersized POWTS to be installed. For example, in December 2003, Lot 35 of Richmond Meadows subdivision had to have its loading rate reduced to 0.3 gpd/sq. ft. when the installer encountered massive sandy loam at the system elevation. The sandy loam horizon had been described on the soil report as "l mgr" with firm consistence. Leroy Jansky, Dept. of Commerce Regional Wastewater Specialist, has been consulted on this situation and advised the zoning department to require on-site verifications for any lots with this potential misinterpretation on the soil reports. All soil reports with sandy loam "1 or 2 mgr" as its structure will be required to use a design based on the current code's soil application rate for massive sandy loam @ 0.2 gpd/sq. ft. unless additional soil testing proves otherwise. Z