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032-2181-17-000
County: St. Croix r)epartment of commerce PRIVATE SEWAGE SYSTEM Sanitary Permit No: 5579087 Building Division INSPECTION REPORT (ATTACH TO PERMIT) State Plan ID No: Z-5, 0(03 GENERAL INFORMATION [Privacy Law, s.15.04 (1)(m)] Parcel Tax No: Personal information you provide may be used for secondary purposes CiVillage Township 032-2181-17-000 Section/Town/Range/Map No: Permit Flolder's Name: Jason Wood TOWN OF SOMERSET CST BM Elev: Insp. BM Elev: BM Description: 01.31.19.1541 t06L O tao Pt E , aO d~ l? ~j((VlG ELEVATION DATA HI FS ELEV. TANK INFORMATION STATION BS APACITY TYPE MANUFACT Benchmark s `og. `d c7 Septic I T 0 1015- Bldg. Sewer Htlnlet` Holding SUHt Outlet TANK SETBACK INFORMATION TANKTO PL ELL B DG.. V to Air make ROAD Dt Inlet . Dt Bottom Septic 7 t-11 n. l V Dist. Pipe Iq (P ,5A Aeration 2 I D 5 . Bot. System Holding Final Grade Ib3 PUMPISIPHON INFORMATION Demand St Cover Manufacturer C' G 4,b log. Model Number SZ / TD , Z ,Ft TDH Li Friction Los System Head • ~j to Well Dist. Lengt D/ Dia. i f Inside Dia. Liquid Depth SOIL ABSORPTION SYSTEM , No Of r ch PIT DIMEN NS No. Of Pit Length BE /TRENCH Width ~ LEACHING Manufacturer: DIMENSIONS PIL LD WELL LAKE REAM CHAMBER OR SETBACK SYSTEM TO ( UNIT Model Num y ht 1 1 INFORMATION T fS s erPc '7 )L) v Hole Spacing Vent to Air Intake x I DIST N SYSTEM N x Hole Si Distribution II Head Manifol -7/I Pipe(s Length ) Dia Spacing U Length Dia xx Mound Or At-Grade Systems Only Systems Only xx Mulch x Pressure Sy Depth of xx Seeded/Sodded / Yes 0 No Depth Over Topsoil ~I21' es D No SO dlTrench IL Center COVER e Depth Over BedlTrench Edges ~/L~ / Be ~S ~ . 57• _ persons present, etc.) Inspection #1: [p- Inspection #2: lv' fE~ ,9t,(, 5/ a -1 ~ COMMENTS: (Include code discrepencies, a-~ TD Ck i,SE1plau5- : PLO o-j (ztPP - m Pce-- I 1 Location: 752233RDAVE /U/}ru2~y ~G~ / Af1 1 ~S 1.) Alt BM Description = t i1 2.) Bldg sewer length = UZ ) L11 6 n aI 1 nS ,-\n - - amount of cover = ~ ~ G 5 S) VU(I Dn L b ' / Cert. No. Plan revision Required? 0 Yes NO I epctors ignature i Use other side for additional inform at' n. t pate 3t, 4 SBD-6710 (R.3197) ~I e ~1 1 S`~& \~J 1 J~J i \ C pVVt~ `1~ `J vQ"""iwT county Safety and Buildi Dmslo , t< $ 'X 06 201 W. Washington Ave., ox 71 tart' permit Nnmber (to be fined in by Co.) S; Madison, Wl 53707-716 17E ijwy LOPMEN U Sanitary Permit Application State Transaction _ 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 stare-owned POWTS are submitted to Project Address (if different than mailing address) the Depattmem of Safety and Professional Servies. Personal information you provide may be used for secondary, purp oses in accordance with the Privacy Law, s. 15. 1 m , Stats. - -z_ --~V L Application Information - Please Print All Information J 3 Properly Owner's Name Parcel # Property Owner's Mailing Address Property Location Cr ) ..31, )q . , 5q 1 ~s Z 2 7 3 Govt. Lot city, state Zip Code Phone Number '/4, section cle e T N; R ~r EL Type of Building (check all that apply) =Bloc Family Dwelling - Number of Bedrooms Subdivision N 9" Q Public/Commercial - Describe Use Q City of Q State Owned - Describe Use CSM Number ❑ Village of X57 (AQL, Town of C, We e ~ en, III. T of Permit: (Check only one box on line A. Complete line B if applicable) A. System Q Replacement System Q Treatment/Holding Tank Replacement Only Q Other Modification to Existing System (explain) R. Q Permit R enewal Q Permit Revision Q Change of Plumber Q Permit Transfer to New Lis[ Previous Permit Number and Date Issued Before Expiration n Owner IV. Type of POWTS System/Component/Device: Check all that a I Q ^ Q Non-Pressurized In-Ground Q Pressurized In-Ground Q At-Grade ound > 24 in. of suitable soil Q Mound < 24 in. of suitable soil Q Holding Tank Q Other Dispersal Component (explain) Pretreatitient Device (explain) V. Dis rsallfrea entArea Information: / Design Flow (gpd) Design Soil ApplicV1% Rae( dst) Dispersal Area Re4 Dis t c) / tarsal Area Pro ed f) S El ruler / VL Tank Info Capacity in Total of Manufactiuer Gallons Gallons Units e New Tanks Fvicr~o Tanis w U 2 4j Septic or Holding Tank Doug Chamber 3v VII. Responsibility Statemen - I, the undersigned, ass esponsibility for installation of the POWTS shown on the attached plans, Plupbgr's Naive (Print)Plum ignature MP/MPRS/Number Business Phone Number Phanber's ~state' Zip Cde Zi ~ ono .s - / t C~/~ Vim no /De artment Use On Approved Permit Feel Date su issuing t Signature ten Reason for Denial $ YTi.7 Z~ IX Conditi as for Disapproval 1. ca"tank, efflubntfifter and 41s}wmal cell must all be aervloes / air 1 A as per management plan provided by plumber. dQfa,` nor. 2. ,j*V0*4* requ*ments~:enusit ye Maintair4d Y- PK aDPNcabk tide / adinanas. / 6 t~► t to Attach to complete phins for the system and submit to the Coco only an not less than 8 in z 11 inches in site ~J ~J I Y 7 /O~ 060 ~ L well ~ C# 1 4hb~ SBD-6398 (R. 11/11) I l , k)4*_r neA* L t $ .4 iq oco AI- z PLOT PLAN PROJECT Jason Wood ADDRESS 1956 Ctv Rd C Somerset Wi 54025 NW 1/4 SE 1/4S 1 /T 31 N/R 19 W TOWN Star Prairie COUNTY ST. CROIX SYSTEM ELEVATION 106.5' 8/3/15 3 DATE BEDROOM CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 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. same as benchmark Property Line B.M. All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Scale= 1/4" = 10' Wel I is to meet al I WDNR setbacks 3 Acre Lot 106' 10 5.5' Grading is to be lane to 1 05' B- 1 divert run-off array from system co B-3 Pro 3 p 4 % Slope Bedroom House `Huffcutt Area Area 15' below amank system is to remain undisturbed Pro a 2 Acce r B din ~y S Tank is to be properly bedded and provided with lockdown covers with approved warning labels Property Line 233rd Ave P 9wPaxr.~ra~T DIVISION OF INDUSTRY SERVICES 10541 N RANCH ROAD fQ/ 9 HAYWARD WI 54843 0 Contact Through Relay ~3 ~ h1 P http://dsps.wi.gov/programs/industry-services www.wisconsin.gov vd v~/ Ado Scott Walker, Governor ss[ON Dave Ross, Secretary August 14, 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: 08/14/2017 Identification Numbers Transaction ID No. 2585063 SITE: Site ID No. 815969 Jason Wood Please refer to both identification numbers, 752 233RD Ave above, in all correspondence with the agency. Town of Somerset St Croix County NW1/4, SETA, S1, T31N, R19W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1550694 Maintenance required; 450 GPD Flow rate; 25 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: 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 8/14/2015 Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Carl J Lippert Please Include a Copy With Your Wastewater Specialist, Division of Industry Services Payment Submittal. (715)634-5035, M-f 7AM - 12PM W iSNIART code: 7633 carl.lippert@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm SHAUN R BIRD Page 2 8/14/2015 Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Carl J Lippert 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: 8/3/15 Owner:Jason Wood Location: NW1/4 SE1/4 S1 T31 N,R19W 752 233rd Ave Star Prairie /jI. 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 C®N®PROVe9 4. Pipe Cross Section/Pipe Layout EPT OF SAv fS CCS 5. Pump Chamber Cross Section PR FESSIODUSTEtY S I~VIC S 6. Pump Curve ®IVISION OF tN 7-8. Maintance and Contigency plan 9. Filter Specifications nd cross section SEE ESppN~ENCE Attachments: Soil T Shaun Bird Signature License numb 22 00 Page 1 of 9 PLOT PLAN PROJECT Jason Wood ADDRESS 1956 Ctv Rd C Somerset Wi 54025 NW 1/4 SE 1/4S 1 /T 31 N/R 19 W TOWN Star Prairie COUNTY ST. CROIX SYSTEM ELEVATION 106.5' 8/3/15 3 DATE BEDROOM CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 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 WELL * H. R. P. same as benchmark Property Line 8.~.~ All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Scale= 1/4" = 10' WeiI is to meet all WDNR setbacks 3 Acre Lot 106' 1 05.5' Grading is to be done to 105' B- 1 divert run-off away from system CO B-3 Pro 3 4 % Slope Bedroom House H uffe utt Combo Area 15' below Tank system is to remain undisturbed Pro B-2 Accessor Building Tank is to be properly bedded and provided with lockdown covers with approved warning labels Property Line 233rd Ave Mound System Cross Section and Plan View Dimension 4 Feet I I A f I B, I 14J4::4 : f M1 O r r : 4 4 4 I LI r i F A I r r r r:r-?ti is{ri{?• :i?; r:,?{ r r :l. I-- .:.r...:::4ri}:'•4,:4t,..r.: -:.:.J~::::J:::::i~i~F:}: :J•:?:..i....4.:.4.:..:.::. 4 4 M1 L--_ tp I Y:.'~:.': :r4r4f~•r. tif4•M1f4j 4.4. ..4f4+M1.M1.M1:.. ti.4?M1?M1.4?1:..::.: i:1? 111 i 1 G : ' W K 1 B Z L Slope - -t = Topsoil = ASTM C-33 = Clean aggregate = 4 in. sch. 40 pvc Cap Material 0 _ , P sand fill /2 to 2 /2 in. dia. observation pipe M Geotextile Fabric 1-1 G F rrt -I 1) l ,1^h<' Plowed Surface ~».x1 ' Ft Contour Slope Direction GENERAL INSTALLATION: Me mound area is staked out along the design contour. Fxistin(2 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 'A inch soil hire 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 lgj Page M- of Pressure Lateral Layout Two Laterals - End Manifold 1 breaded Cteanout Lateral Turn-up No Plug. Manifold M X ,1 Long Force Main Sweep 90 Bend Distribution Network Specifications Pressure System Construction Lateral Diameter In. Manifold Diameter ln. Laterals are constructed of Schedule 40 PVC _Orifice Diameter In. pipe. Orifices are drilled perpendicular to X Orifice Spacing) -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 box accessible. ~Force Main Length Itfrom finished grade. • • • • • Grade • • • • • • • • • • • • • 6-8 Inch Lawn Sprinkler Valve Box k .F L } 1'age of -J 03/05 lg; Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Pump Manufacturer t Tank Model Number'` r Pump Model Number r 1 =.Total Tank Capacity Alarm Manufacturer ; Alarm Model Number / _Max. Bury Depth Switch Type rr' ' t,r.m. w Filter Manufacturer F Total Dynamic Head (TDH) - Feet Filter Model Number ? Elevation Head I. Distal Pressure Network Loss Minimum Pump Performance Required Force Main. Loss GPM: Ft TDH Total Outlet Manhole N 4in. 4" Above Grade With Manhole Min. 4" Above Grade Locking Device. Inlet Manhole Seely Mounted With Locking Device < 6" Below Grade Sealed Watertight Weather-proof Junction Box Finished Grade " " Vent Min. 12" Disconnect Above Grade Means With Vent Cap Outlet Filter Inlet A met Baffle A W, Switch Settings and Reserve Capacity Weep Tank Volume = GPI Hole Volume Gal. B Dimension. Inches (reserve) Of Elevation C (alarm) B 2 iF ? Ft ► Bottom a - {dose) C (dead) D D Elevation 6" -Ft Total` INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the GENERAL manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) be exceeded ngs, and installed. Piping at the inlet and outlet is of approved mater connsleeved ected th 4tas with 4 ptCrt ghriagiI the tank laid on stable soil to prevent settling or sagging. The force excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.23. Page - Of 0210 U i~ CAP n. - \ ~'yl N PA"~ l ~v~ v'L 5' 2 J 2~ 4c- - 4 i i - - - 41 40 20 40 J 8Ci vu GALLONS -1- ~TERS ? 00 _ ~LviN y- CONSULT FACTORY FOR SPECIAL APPLICATIONS - Timed dosing panels available. Electrical alternators, for duplex systems, are available and supplied with an alarm. Variable level control switches are availab-e for controlling singe phase systems. Double piggyback variable level float switches are avaiiable for variable ieve! long and short cycle controls. Sealed Qwik-Box available for outdoor I,ns,aliatiors. See F^11420 • Over 130"F. (54°C) specia! quotation reg,':rer. 152x153 Series = - J r _ _152 153 MODELS _ cc rtrol Selection Model Volt$ :Ph I Mode -S,mF ec Duplex _ 7 r3 y i N1522 115 1 _Non ! 8.5 - r - I Inc u 7eU ° or r i t s~o6a W52; 115 1 Auto s 1c E152 ' 230 Non 43 BE 152 ! 230 Auto 4 3 n I _ed nor 3 _ Nt53! tt5 Non SELECTION GUIDE SN153 115 A a - 10-5 na ,ea 2 c' iE553 N~ o _3 0 3 _ , ngie piggyback va'aDle level float switch or double piggyback variable level float 230 1 5 3 Inc ucad o' ! ©E1531 230 Auto ,itch. Refer to FM,0A77. n CAUT10N 2 F14 7 2 for co rect model of E'ectrical A!temawr E -Pak All installation of controls, protection devices and wiring should be done by a qualif ed 3 ar aDle e c ocd ~I svr!tc 10-02115 used as a control act :ator, Spea y duplex 3; licensed electrician. All electrical and safety codes should be followed including the most D,,;tl fl; at 5• St recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design o' every Zoeller pump. MAIL TO P,O a0;z 153»7 ~ t ' s~i c n 4c25v o aid d-,ru/erSuC F SHIP TO 5 sv c QILAG TY ~UMP.F .7/.ti r: ~J~ u Zo Z/ ' Z -a. 5 ? 77a-3 PUMP Cll. _ http.llwww.zoeller.com v Copyright 20-.00 Zoeiler Co A. i rights reserved. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity at ❑ A Permit # Septic Tank Manufacturer NA DESIGN PARAMETERS Effluent Filter Manufacturer _j NA Number of Bedrooms [j NA Effluent Filter Model ❑ NA <f f al ❑ NA Number of Commercial Units -,C.NA Pump Tank Capacity Estimated flow (average) aVda Pump Tank Manufacturer A/1 NA Design now (peak), (Estimated x 1.5) al/day . Pump Manufacturer ❑ NA Soil Application Rate al/da /W Pump Model ❑ NA NA Influent/Effluent Quality Monthly average* Pretreatment Unit Fats, Oil & Grease (FOG) s30 mg/L ❑ Sand/Grrdvel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) 420 mg/1. ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other. Total Suspended Solids (TSS) 5150 m /L Manufacturer Pretreated Effluent Quality NA Monthly average" Dispersal Cell(s) Biochemical Oxygen Dema d (BODS) s30 mg/L ❑ In-ground (gravity) ❑ In-ground (pressurized) hound Total Suspended Solids (TSS) s30 mg/L ❑ At-grade ❑ Other. Fecal Coliform (geometric mean) 510' cfu/100m1 ❑ Drip-line Maximum Effluent Particle Size Y inch diameter • Values typical for domestic (non-commerclari wastewater and septic tank effluent. M Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency ❑ months °Car(s) (Maximum 3 yrs.) Inspect condition of tank(s) - At least once every 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 ❑ months ear(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ months ar(s) Inspect pump, pump controls & alarm At least once every ❑ monthsear(s) ❑ NA Flush laterals and pressure test At least once every ❑ months, year(s) ❑ NA other. At least once every ❑ months ❑ year(s) ❑ NA 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 fitters, mechanical or pressurized POWTS components, pretreatgment components, and any other maintenance or monitoring at intervals 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 s have then onten'tsl of t START UP AND OPERATION check For new construction, prior to use of the P damage the dispersal tcell(s)s. ) if for the presence of high concentrations 'are detectedthav or may impede the treatment process and/or 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. s. When excess rest wastewate During power outages pump tanks may fill adose onormal verloadinng ,the cell(s)land may r sult in the backup or surface discha ge ofrefflulen.t discharged to the dispersal cell(s) in one large ower to 1111,e r prior storing p To avoid uthis m situation have Plumber or POWTS Ma staitank removed ner to assist in manually anu lly operati Ig theOpumpocont ols to eresttore ormal Ieve 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 wit iln 15 feet down slope of any mound or at-grade soil absorption area. f tfefoundatioOn dr i n Reduction or elimination of the following from othe ms wastewater stram may degrease prove d apers;ad~infectan she antibiotics; baby wipes; cigarette butts; con (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; ail; painting pro acts; pesticides; sanitary napkins; tampons; and water softener t;rlne. ABANDONMENT When the POWTS falls and/or is permanently taken out of service the following steps shall be taken to insure that the system is propel y and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code, • Aii 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 ue excavated and removed or their covers removed and the void space filled with Suit 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 camp , ;in replacement system.- D A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systetr The replacement area should be protected from disturbance and compaction and should not be infringed upon by require, setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the nee for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rulers i effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technologl/ 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 evaluatic mqA ti st be performed to locate a suitable replacement area. if no replacement areas available a holding tank may be installed' r last resort to replace the failed POWfS. Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltralh su Ce, 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 NI ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name 'rz c _ TM f' , 'Phone r Phone SEPTAGE SERVICING OPERATOR P MPER LOCAL REGULATORY AUTHORITY r Name - = l' - Name I / Phone Phone This document was drafted in compliance with chapter SPS 383.22(2)(b)(')(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. ~ i t _iN j 4'.. r//'t° P rr I is G 1) 1' ~ i rt.l fi trj' ,r i -N ST. CROTX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND HIP CERTIFICATION FORM OWNERS 14 51 lAJ _ Owner/Buyer Mailing Address PropertyAddress r (Verification required from Planning & Zoning Department for new22construction.,Rq 1 City/State Parcel Identification Number LEGAL DESCRIPTION Property Location Sec. T ~N R--[_ W, Town of J /O1<c~:~r7~-IG 7 Subdivision -Lot # Cerdffied Survey Map # , Volume , Page # Warranty Deed # I -161 Volume , Page # Spec house yes no Lot line, identifiabl yes no SYSTEM MAINTENANCE AND OWNER CERTMCATION 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 was tae disposal system. Owner maintenance responsibilities are specified in §Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification, form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have road 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 Departzrient 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. Uwe certify that all statements 54M are true to the best of my/our k:aowledge. 1/we am/are the owner(s) of the property described above, by virtue of a ed recorded in Register of Deeds Office. Nu r of bedro A OF APPLICANT(S) DATE y information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) 209.59' -C8 r ` g - ~g•~v - - 7.77' is8 54' - 13g 8 5 / , i . t%j o S13*0,d' 45. 0 W 78 LIJ 9.69' C7 212.32' ` O W a 211.51'-- •04,10 * 212 C6 1g•~~ O,L .4 c i a 32 I . 33' `n cn . . 0 r: '4t Of O N as ` L C%t I oho O c Cti M h . - i ~ r- Oj N rC-4 C: ) a) A a) C r) I Cq Ei') ff) E cL Oy ~o to ul _j F) L6 N0018'10"E ry : o - ~ ~ s ;o CN m ~ 442.80' so. 04 ° a x ° 1a a cn CQ '•i N c D L - `r I Cn V) ^ t.j C o c o E W U\ q+V I'D (D 1 r c v Co o v r7 ` O o L4 m cs LO -`n _i u (D =1 c (n M co_ ^ o ~tV 0 h tit O o 00 00 = ff4~S t ~ Q"gym mUti 9 4 6Is'a s Ot9~s~ N007810 ryt t cb ap :~r~' id- "~i J Q \ DI l~ { • -1069.93'- o , 111 206.66' 445.09' '66.02` -lZ N00.18'10"E 2646.38' . -N0078'10 "E 5350.83 = ° o c V u Fh 114 lone o E z " UNPLATTED LANDS 0 0 w v 0 0 O. 8 e ° a a fop a s," a Q ;A w r- N z> HE Ys$~iH, y a W LLI 3. i ac Stl gg lid lh,l Him a -LLLLLLLU z Iff .H. d Ar ~J ~ I i •I 1 d 1 i ~ ab rce 1 w4 ~r r I A ...y r~ wE ' i~ 1 d :I ~ Jb + 8 o ° x 9E b !5f j p - ~3'oi. o «ww $:Ssn°tg J - - - - F Edo ""°~9 nlgli C,) ~ o q m J Q -LLLL "Mg C @ E' i'a. _ Fc o ys : N Q _ b2a€8: 55ae3~ b§°s~°S §ss~?S 7w9y°~9o ~ ~ R, € LL n e q a y JW x R o NN x a - x - E~ J, - _ N R a _ ~ ~a J wm III - B r I I -g % I F- O O -T - x l 0 I I ~ 1 ~.o tt ~b ILJI ~ F - Ngo n~Ye ~Biy $ a 8 m e s 7 ~ O oaa 73 2 M F w 7 W ao 6 € v boa b ~ J C'4 0 ;Sa NI MN 8 y a W }e[g i 3(is iW3£a Sge 7 a & bai 8. ba°s€8: ~ Nw I I - a i I i E x z i ob RECEIVED g,P qS Y 7 Wisconsin Department ot{I;DOlrr@A 2 U 1 b SOIL F-: A^ Q' 1 ATION R FPORT Page of Division of Safety and Buildings ST. CROIX COUN"ccordance with Comm 85, Wis. Adm. Code rn~MI~I~~ County Attach complr':te'SttA' ~~ff br1 per Mfr I~ss'mert~ 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. 63Z " Z/ $ 1 -7 Please print all information. r:!y ;Zwk 000 (J,7(& Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner _ Property Location QQ X Govt. LotNL.J 1/4 /4 T N R E (o W Property Owner's Mailing Address Lot # Block # Subd. NamOF( City S Zip ode Phone Number ❑ City ❑ Village Town Nearest Road New Construction Use;.KResidential / Number of bedrooms Code derived design flow rate '2 J GPD ❑ Replacement Public or commercial - Describe: Parent material =a~a& Flood Plain elevation if applicable Al I '4 ft. General comments and recommendations: System Type zv' e.- eola System Elevation ~~'O• J R Boring F Boring # ~ Pit Ground surface ele/ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Desc npbw Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Z - .r7 r 1 -T, F7q Boring # ❑ Boring Pit Ground surface ele/pX111 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. /t •Eff#1 •Eff#2 0-7 r 3/ - G ^ 2 SY J r 7c~ , ~ r yh /yf t A-1)jZ 1"12,41 • 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) Sign r CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 'Y ` 3 715-246-4516 Property Owner _ Parcel ID # Page of Ong # ❑ Boring I'~ n Pit Ground surface elev. ~f 1Q ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ft? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Z 10 -rn-- rr1 F-1 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 E] Boring a Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil ication Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/- ' Effluent #2 = BOD, 130 mg/L and TSS 130 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. SBD4330 (8.6/00) Page - ° - r°= r r Rjt Ground surface elegy: ft C3eGtri talimit ny factor n Soi4 iication Rate f f~c~r zo , ep i L7nn nani :-o(or Pdox Des~n - Text ~re ~ structure I C sistence Boundary Roots s GpDtt V nse Gr. Sz Sh. Eff#1 F_ff#2 e" 9 { t r ~ i l r°-s IiJrr:q V L Sw rppoca ion Rate } Horizon ~ Depth ; Dominant o4ur Consistence i Boundary ~ Roots GPD!fF itl f ~se : Co Gr. Sz. Sh f , 'Ei tf#1 'E-#2 : Benny Boring # Ground surtace elev. it, Depth tr) llmiting factor in. Pit ( Soii lirztion Rate Horizon ')epth Dominant Colo ! Redox Desaipbc,r Texture ; Structure Consistence Boundary ] Roots ~ GPDIff ~ { l ~ n~. i M.unselE cau ..C<x^CsoicX Gr SZ S"r. `Eff#1 'Eff#2 t ~ E ~ l 1 Effluent SOD, < 20 rx a.v: > -0 s 7p Effluent #2 = BEDS < 30 nwA and TSS < 30 nVL The Department of, C'Tr C"le"f" is a,. equa oppor urlltV S::-VP e Dlolsider and emplover. if you need assistance to access services or reed mastl_. sin alte-",itc "";easc omiwt the depannient at 608-266-3151 or TTY 608-2(A-8777, st7a SDO !x-6•~%~ li Soil Test Plot Plan,- Project Name Jason Wood Shad ird Address 1956 Cty RD C ' Somerset Wi 54025 CS #226900 Lot 17 Subdivision Woodland Meadows Date 0/15 NW 1/4 SE 1/4S 1 T 31 N/R19 W Township StarPrairie [-1 Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of survey iron System Elevation 106.5' *HRpSameasBenchmark 441 h- Property Line ON.* 3 Acre Lot Scale is Y' = 40' unless otherwise Scale = 1/4" = 10' noted 106' 105'13-1 B-3 4 % Slope B-2 Property Line 233rd Ave RECEI i ~ Wisconsin Departmen of Cori a 2 2 2004 SOIL EVALUATION REPORT Page I of 3 Divigi-f Saf y at jJ C~~~X Cibr{iance 'th Comm 85, Wis. Adm. Code County St.Croix Attach ni f(otu€ 11 inches in size. Plan must include, but not limit onzontal reference point (BM), direction and Parcel I.D. Pend percent slope, scale or dimensions, north arrow, and location and distance to nearest road. g -6671, Please print all infonnation. Reviewed Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location AHRH Properties LLC Govt. Lot NW 1/4 SE 1/4 S I T 31 N R 19 EE((or)W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 404 SGreen Avenue 17 - Woodland Meadows City State Zip Code Phone Number ity Village • Town Nearest Road New Richmond WI 54017 ( 715-222-0169 CTH New Construction UseE] Residential/ Number of bedrooms 3 Code derived design flow rate 450 GPD 13 Replacement Public or commercial - Describe: Parent material Loess over glacial till Flood Plain elevation if applicable NA ft General comments Site suitable for a mound system and recommendations: F'] S Boring # 0 Boring Pit Ground surface elev. 100.40 ft. Depth to limiting factor 23-26 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 0-7 10yr3/2 - sil 2msbk mfr as 2f .6 .8 2 7-13 1 4/3 sil lmsbk mfr cw if .4 .6 3 13-23 10yr4/4 sicl 2msbk mfr cw if .4 .6 4 23-26 10yr4/4 f2f5yr5/8 sicl lmsbk mfr cw - .2 .3 5 26-35 7.5yr4/4 fsl Om dvh - - .2 .5 2 F Boring # Boring 97.85 20-28 Q 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 1 0-6 10yr3/2 sil 2msbk mfr as 2f .6 .8 2 6-9 10 4/3 sil lmsbk mfr cw if .4 .6 3 9-20 10yr4/4 sicl 2msbk mfr cw I f .4 .6 q 20-28 10yr4/4 f2f5yr5/8 sicl lmsbk mfr cw - .2 .3 5 28-36 7.5yr4/4 fsI Om dvh - - .2 .5 * Effluent #1 = BOD > 30:5 220 rmg/L and TSS >30 < 150 mg& * Effluent #2 = BO < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature del-_ CST Number Thomas C. Nelson 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, Wl 11/17/04 715-246-2454 ('ITT n~~n mnnlnny w. , Property Owner AHRH Properties LLC Parcel ID # Pending Page 2 of 3 a Boring # Boring El Pit Ground surface elev. 99'~ ft. Depth to limiting factor 25-36 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 0-5 10yr3/2 - sil 2msbk mfr as 2f .6 .8 2 5-12 10 4/3 - sil lmsbk mfr cw if .4 .6 3 12-25 10yr4/4 - sicl 2msbk mfr cw if .4 .6 4 25-36 10yr4/4 flf5yr5/8 sicl lmsbk mfr cw - .2 .3 g 36-40 7.5yr4/4 - fsl Om dvh - - .2 .5 F-1 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 Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fig in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mgA- " 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. SBD-8330T est (R.07/00) L Woodland Meadows 8M1 Top of conduit pipe 100.00' Lot 17 SM2 Top of conduit pipe 98.10' 131100.401 8297.661 83 99.00' NOO q -Ae 11 I S~ r i (~0 qI r r~4 ~ oa~c Thomas Nelson ~iJnt l~n ~ 227387 St. Croix JASON WOOD Municipality: TOWN OF SOMERSET 1956 COUNTY ROAD C Permit Number: 579087 SOMERSET WI 54025 Parcel Number: 032218117000 Alt Parcel Number: 01.31.19.1541 Site Address: 752 233RD AVE Components Component Manufacturer Description Las Next Status Schedule Service Service Mound Current 36 Effluent Filter Current 36 Effluent Pump Current 36 Pump Chamber/Tank Current 36 Septic Tank Current 36 Notes Date Text 9/22/2015 10:44:07 AM Huffcutt 1000/600 tank with Lifetime filter, Zoeller 152 pump, and 8'x57' mound cell. .No data found for Maintenance History, Notices, Violations