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Home My WebLink About026-1165-08-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 584726 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. A Permit Holder's Name: City Village Township Parcel Tax No: Todd Marek TOWN OF RICHMOND 026-1165-08-000 CST BM Elev: Insp. BM ; lev: BM Descripti . U 1 V ^ / Section/Town/Range/Map No: lJ/, / ' 'v rn 22.30.18.1274 TANK INFORMATION ELEVATION DATA TYPE MANUF t CAPACITY STATION BS HI FS ELEV. Septic J i I zoo r Benchmark + D5 15 100, Dosing O , Alt. BM Aeration Bldg. Sewer Z '72. 0 Holding ~L p t- Ht Inlet Qz+b 7 C/ (S Q C. TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom • D Dos, ead /Man. L4. 03.7 Q Aeration Pipe I r 2 5 ,Z y.9~ Holding Bot. System 6.1;14 &P-0 JZ Final Grade jV0r4* 0tv? PUMP/SIPHON INFORMATION 33• l~ ilk •V" vbfj tAk Manufacturer Deman~k St Cover •Gy~ p , U GPM ,/JJ I Model Number - \ eat, W TDH Lift r, FrictioGyLos4 System Head TI5, L"Ft Forcemain Lenggl r\ 1 Dia. Z 1 r Dist. to Well -7,5 O~ Z"S SOIL ABSORPTION SYSTEM } BED/TRENCH Width LNo. Of Trenches PIT DIMENSIONS No. O Pits Inside D> a Liquid Dept ,1 1 DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufact rer INFORMATION CHAMBER OR T pe Of ystem: v ) i 5 UNIT Model IBUTION STEM V G I /W\ Heade ani old N Distribution f~ J x Hole Size Ix Hole Spacing Vgnato Air , 1 Pipe(s) No j/-/t' ength Dia Length Spacing SOIL COVER II ( x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench C ter~j ' t I it/tTh'Over ench Edges I t Topsoil / C Yes E] No Yes No DV COMMENTS: (Incl a code discrepencies, persons present, etc.) / Inspection #1: Inspection #2: Location: 1450 129TH ~kkw Co otw I 1I n 1 Ay S~ J I ~ L T ✓ `ten 1.) Alt BM Description = (J V~')p,,/~ A p.~ n S C.II 2.) Bldg sewer length = -7 Vr~y __TT p 6 0 - amount of cove; = G ( 1 1 Dn ~CL (~lJ p cove✓ on All) S e✓ C Plan revision Required? ❑ Yes 64 No Use other side for additional information. a / e o s in ure Cert. No. SBD-6710 (R.3/97) I ~EQ.xrar~r County ' RECE. Safety and Buildin ivision _ ~a r 201 W. Washington Av .0. x 7 2 Sanitary Permit Number (to be filled in b}' Co.) i S } 201' Madison, WI 537 - 554 7Z ST. CROIX COON 31 ~3 anitary Permit Application State Transaction umber in accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit AA is required prior to obtaining a sanitary permit. Note: Application forms for state-owned PORTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary. purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats.j 1. Application Information - Please Print All Info 'o Property Owner's Name Parcel # o, i ))7 t/ 7U r ifs Z i' Property Owner's Mailing. Address ' Properh Location / Z74 l OV Govt. Lot City, SSttate) Zip Code Phone Number Section q ~ Z one) )J~~ r'v ( /l~t~/up 5 7 - 7 b Z T-~U N: R~lEol&l 11. Type of Building (check all that apply) Lot # ❑ 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name ❑ Public/Commercial - Describe Use - ❑ City of CSM Number ❑ Village of ❑ State Owned -Describe Use ~ ZTOWn of 4- 45 66A" Or:,Adn, - 3 ~'VO- Geals III. Type of Permit: (Check only one boa on line A. Complete line B if applicable) ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) A. ❑ New System ❑ Replacement System List Previous Permit Number and Date Issued B. ❑ Permit Renewal X Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner W. Type of POWTS System/Component/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 q ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpds Dispersal Area Required (sDispersal Area Proposed (sf) System Elevation VI. Tank Info Capa ity in Total i of Manufacturer _ Gallons Gallons Units New Tanks Existing Tanks 8 - / /&7 1 0. U v: v cr, i-, v W Septic or Holding Tan} 2 z ~ Cr7_ fC Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the PORTS shown on the attached plans. Plumber's Name (Print) Plumber's S ature MP/`sNumber Business Phone Number Z Z&'K9 Z 7r5 - Uzi - I/ Y- ~ Plumbers Ad ess (Street, Cit}', State, Zip Code) L k i,t> s VI ounty/De artment Use Only Approved ❑ Di Permit Fee Date ssued Issuin _ent Signa e Owner eason for Denial g10. A. CondifiWFWA$*V1 Reasons for Disapprova 1. Sept] tank, eJlUnt lite* and ) l Q, ; disper- cell must all be lc=s ! rn~ ntair. as per management plan pro tided by plumber. W W► ~'Vw~ 2.(MliUiwl 7MCt ~V111i1 til~itt~a as Pw m*lc W code / adi1/nw, t Attach to complete plans for the system and submit to he County only on paper not less than 8 112 x 11 inches in size 5, 5 5J I, %,A, 6 J e 1 SBD-6398 (R 11/11) 7 5b j ~t ti ~ f v ; a [ 5 fl j I ~ [ i I i ~ i [ I v ~ G~ J r ,x ri V L ~ r t vv f .1- or 2- Family Dwelling In-ground Soil Absorption System cell Conventional), Daily,Wastewater Flow (DWF) = T-# of bedrooms x 150 gal/day/bedroom = gal/day Design Loading Rate (DLR) or Soil Application Rate = gpd/ftz (per SPS Table 383.44-1, 2, or 3) Required Distribution cell area =DWF gal/dayDLR C gpd/ftZ ftz # Chambers = Required Distribution cell area ftz'Z: ftz/ unit EISA = 7,5_ Chambers Chamber Manufacturer and Model: _ 1 A2 r/C -AA4o i= ~U4CK ~ 16LUj Actual Distribution cell area = Required cell area ~0 ^ ft z + ftz/ unit EISA End Cap Pair ftz Cross-Section In-ground Soil Absorption System (3-cell): 4" Schedule 40 PVC vent pipe with vent cap 12 inches minimum 12 inches minimum"_~T r I I f ft T1 FG ` ft Tj FG Final Grade (FG) L -inches Soii mover inch Chamber Height Trench 1 System Elevation Trench 2 System Elevation Trench 3 System Elevation C70 Q do tft ' _ ft tft ft 7 Trench inch to limiting factor Separation Plan View In-ground Soil Absorption System (3-cell): Trench 1 ER Modify ft header/ design as . III ft Leaching Chambers 0 needed. Trench Z RE 1111~~ 4 inch Header Sch. Trench - ft with end camps Draw O for a Vent and for Observation Pipe above. They will be located ft from the end of the cell. Vent pipes shall be Schedule 40 PVC and extend at least 12 inches above finished grade. Observation pipes that extend above finished grade must also be 4 inch Schedule 40 PVC. L 1~~G fY v f All SID GG!! NCO QL F+ t{ ` ~,ry~ ~ F`? l 1 JV Y fd d c c rG~; L~ t f f t U~LL r f - Comtenation SePtic,'.Tank and PUMP CHAME)ER CRO55 SECTION ANO SPECIFICATIONS yf<~1T CAP WEATHER PROOF juQr-TIDQ 5OX APPROVED LOCKIQC, ,-C.1, VENT PIPE MAIJHOLE COYER tvt~ j T0' FROM OOOK. wAR~- 1> 14 L p.gEL. ,lIIJDOW OR FRESH COJ IT, t+-~sP 10?J 1'tp~ A1R IIJTAKE J w / rYtcz~'1 s q l Gs'P ~ ~ tJ I , b"i1WC . ~ I H. NI1.I. j 6~..w. loo T I I _ 11~ ^ _ i.; PROVIDE IAILET AIRTIGHT SEAL I III A I III APPROYED J~11J APPKOVED JOIKIT Zf'Wzz Ft~ c I III w/C.T. [IPF~P w/C.'I. PIPE OK Tank construction II ALARM shall comply with I II TLHR 1,3.15 and 83.20 5 I I QQ ~ 'I I 1 PUMP-1 OFF D COAICR.ETE Y'1 BLOCK RISER EXIT PERMITTED OIJLy IF TAWK MkQuFACTURER HAS SUCH APPROVAL gFppING SEPTIC F 5PECIFICATIOtJS DOSE INI~,S JCCZ 1; IJUMbER OF DOSES: PEfi DAB TAUKS !'\A>-,UFACTURE:R.: TAMK SIZE: L~0 GALL0QS D05Z VOLUME SS ~-L ZO SLLST ~I~ ItiCLUDIAJG dACK-FLOW 4`- GALLONS ALARM MAIJUFACTUfZCR: MODEL QUMbER: 10L Mw CAPACITIES: A= -VI CHE5 OK~ GALLOWS SWITCH TYPE,: L~Nt 8 - IWCHES-OR 1!-C,.LLOLIS PUMP MAMUFACTURCR: _z0~ ID `LL.P CIWCHES OR ' ZC,ALLOLIS MODEL IJUM6ER: P D= INCHES OK L33` GALLOML SWITCH TYPE: MOTE: PUMP AfJO ALAR.In ARE TO bL MIWMLIM D15CKARGE RATE GPM INSTALLED 0Q SEPARATE CIKCUITS VEKTICAL DIFFERE,VCE 15ETWED.1 PUMP OFF A1JO..DISTRIbUT10Q PIPC.. ` FEET MIWML1X tJETWORK SUPPLY PRE$$UKE , : FEET + ~ FEET OF FORCE MIN X , Y100fLFKICTIOW FACTOR.. Z ( FEET TOTAL.OyQAMIC. HEAD FEET As per,nanufacturer gal/in. s APR-12-2005 16:28 FERGUSON ENT HUDSON 715 386 6144 P.01 RGOULDS PUMPS Submersible lC Effluent Pump PE ""liff PUMP SPECIFICATIONS MOTOR FEATURES Pump - General; General: s Corrosion resistant • Discharge: 114" NPT • Single phase construction. • Temperature: 104°F (400C) • 60 Hertz ■ Cast iron body. maximum, continuous when a 115 and 230 volts ■ Thermoplastic impeller and fully submerged, a Built-in thermal overload pro- cover, • Solids handling: 'h- tecdon with automatic reset ■ Upper sleeve and lower maximum sphere, • Class a insulation. heavy duty ball bearing APPLICATIONS ' Automatic models include a • oil-filled design. construction. float switch. • High strength carbon Steel ■ Motor is permanently Specially designed for the a Manual models available, shaft, lubricated for extended following uses: • Pumping range: see PE31 Motor service life. • Mound Systems performance chart or curve, • .33 HP, 3000 RPM ■ Powered for continuous • Effluent/Dosing Systems PE31 Pump: • 115 volts operation. • low Pressure Pipe Systems • Maximum capacity: 53 GPM a Shaded pole design ■ All ratings are within the • Basement Draining • Maximum head: 25' TDH PE41 Motor working limits of the motor. • Heavy Duty Sump/ PE41 Pump: • .40 HP 3400 RPM ■ Quick disconnect power Dewatering • Maximum capacity: 61 GPM • 115 and 230 volts cord, 20' standard length, • Maximum head: 29' TDH • PSC design i heavy 15 or duty 16/3 Si w with 230 volt grounding PE51 Pump: PE51 Motor: plug Maximum capacity: 70 GPM .50 HP, 3400 RPM ■ Complete unit is heavy duty, Maximum head: 371 TDH 115 and 230 volts portable and compact. METERS FEET • PSC design ■ Mechanical seal is carbon, 40 - ceramic, BUNA and stainless PE5ir I I I I ' I I . - I MODELS: PE31, PE41, PE51 steel, 3$ I I I ! HP.33, .ao, .so ■ Stainless steel fasteners, 10 •~Ea t` I t I 2cPM 30 I' i 1; I' i I I I AGENCY LSTIN GS 1 Fr w ! I I I I I , I• I• ~i ' r ~ •i x 25 ~E I ! I I i I I I• U' ' I I i I I Q zo ! I I' , - II I C us I I ' ' I •I a _ : i _ i I • ' Tested to UL 778 and 1 I I I I iii j I I 'I I I i- ' I I i' l l j CSA 2221o8 standards p 5 By Canadian Standards JSodaoon j j l 1. f. i f i Ii ' i I! rile #rx39s4y 10 "-'"t I „L ! ! I I f I I I . ~ ' ' ' I GoWds Pumps is ISO 9001 Reginered. ~•I j~'I Ill ! A I • I I i ' ' I I I~ 0 O II ' j ljl il' I 0 10 20 .1. 30 40 50 60 70 GPM 8o O 5 10 15 m3/h Goulds Pumps ® 2004 ITT Water Technolo CAPACITY Effective June, 2o04 9Y inc. ~a T "E"/°' ` ITT Industries Parcel ID # Page of Property Owner 3 ❑ Boring ❑ Boring # / Pit Ground surface elev. ft. Depth to limiting factor L y~ in Soil lication Rate GPDlfF Horizon Depth Dominant Color Redox Description exture structure Consistence Boundary Rooms 'Eff#1 •Eff#2 Gr. Sz. Sh. ° in. Munsell Qu. Sz. Cont. Color -Z 0 W~ J~ i I 01-1 Boring # Boring in. ❑ Pit Ground surface elev. ft. Depth to limiting factor Soil lication Rate F-I ❑ Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots .Effftl GPD/fFE in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. D Boring # Boring in. ❑ Pit Ground surface elev. ft. Depth 40 limiting factor Soil Application Rat< GPDIff Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots ,Eff#1 `Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. ' = < < ' Effluent #1 = BOD; > 30 < 220 mglL and TSS >30 < 150 mg/- Effluent #2 BODs 30 mgA- and TSS 30 mglL - assistanc The Department Commerce is an equal opportunity department at 608-2 6-3151eorr TTY 608-264-8777 services or an alt rnate format, service material need S13"33o X") I Soil Test Plot Pla Project Name William Stock/Steve Dalton Sh Bird Address 1748 112th St. New Richmond Wi 54017 ATM #226900 Lot 8 Subdivision Lundy Meadows Date 8/11/03 N 1 /2 SE 1/4S 22 T 30 N/R18 W Township Richmond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 97.0/96.5 *HRPSame as Benchmark Alt. B.M. Alt. BM Top of 2" Pipe @ 100.2' B.M. 252' Property Line 10' S' B-1 30, Scale is 1 " = 40 5' unless otherwise 90, noted Please note: Installer must 5% B_3 verify all lot lines and setbacks Slope before installation. B-2 99, 100' a 0 N N M Please Note: Tested area may not be suitable for desired building area. Check system location before excavating. 'vErwrcnr~r County Safety and Building isio'~" X _ < , 1} r 201 W. Washington Ave., . 71 Sanitary Permit Number (to be filled in by Co.) APR G L0 I Madison, WI 53 -716 :5-9,q CRCIX COUNTY 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 Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m , Stats. 1. Application Information - Please Print All Property Owner's Name Parcel # Property O er's Mailing Address Property Location j dt irY. 7Y Govt. Lot ,A City, State Zip Code Phone NumberI I V / 5 1/-X Section A.M circle one /\j 1 l~ 1~ C L l/ 7 T~ N, R E cO H. Type of Building (check all that apply) Lot # 0-1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name Block # L L4Pd~./vrr g~,f)e W ❑ Public/Commercial - Describe Use f L . i - ❑ City of ❑ State Owned Describe Use ~J CSM Number ❑ Village of Town of C14 /K40'/lf*0 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) fl-e-" ❑ Treatm oldin Tank Re e Onl Other Modification to Existino S stem ex lain A. XNew System ❑ Replacement System g y 11 a y ( P ) List Previous Permit Number and Date Issued B • ❑ Permit Renewal El Permit Revision ❑ Chan of rmit Transfer to New Before Expiration Owner W. Type of POWTS System/Component/Device: Check all a s I YY Non-Pressurized in-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in, of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaU1'reatm t Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (so Di! sal Area P osed (sf) System Elevation VI. Tank Info Capacity in Total # of M a r Gallons Gallons Units 9 o New Tanks Existing Tanks a Y C5 , Septic or Holding Tank r w% E 1 Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/M#I~FNumber Business Phone Number 7,-Z- Plumber's ddress (Street, City, State, Zip Code) C S C 5 w"1"L 0 VI Coun /De artment Use Only Approved Permit Fee Dat Issued r/ Issuin et Signature Q_Ql Given on for Denial $ 'M IX. Conditgt~IMNMKteasons for Disapproval I fa~/~. AG~,.~ ~nea 1. ' Septvs tank, effluent filter and 3) ! i t b a~/\ tltsperr;. i cell must all be seivicos ! mp ntairec' ; 1) t as 1w management plan provided by plumber. 98 u / J 2. ! per o pPiirecbs code must; be rtaint~:iryEd ss per apwble colts 1 oMinan~,3. (,~Q,~ etv Attach to complete plans for the system and sub it to the ounty only on paper not less than 8 M X11 Xe' in size 6) 6V,,t,- SBD-6398 (R 11/11) k~ep 5 ~eevx 5 94-i~ 0 -t t s i 1 4 r i'7 Uf ~ N^t'~ f f ~ ~ zJ ~ ~j ~ t coo { i 1 ` v vU. t I I ~ r CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name: Owner's Address: 5C Z Legal Description: 7L LL~ Township: ~/Z (C~{ All ~ rJ A County: - C C? Subdivision Name: UlA_}~ t/I V~. Lot Number: Parcel ID Number: Z (c (U 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: C` u~72 ~1/"Cf v License Number:' u Date: Z Phone Number Z Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 LkA~ t y v NSA` 1 tti o 1 1- or 2- Family Dwelling In-ground Soil Absorption System (6 cell Conventional) Daily•Wastewater Flow (DWF) _ # of bedrooms x 150 gal/day/bedroom = gal/day Design Loading Rate (DLR) or Soil Application Rate = gpd/ft2 (per SPS Table 383.44-1, 2, or 3) Required Distribution cell area = DWF ~0 Ot gal/day --,`pLR : Z- gpd/ft2 = ft2 # Chambers = Required Distribution cell area '3 i ybG ft2, t_ 2 0 ft2/ unit EISA = l Chambers ' Chamber Manufacturer and Model: l ~Ct-•f-~~,k•f~' %L (✓iWc(~ ~ L i.lS Actual Distribution cell area = Required cell area` ftz ft2/ unit EISA End Cap Pair ft2 Cross-Section In-ground Soil Absorption System (3-cell): 4" Schedule 40 PVC vent pipe with vent cap 12 inches minimum 12 inches minimum r -ft TfFinal Grade (FG) ft T1 FG Cf ft T,2 FG t (o t z_ y!.inches Soil Cover v TZ_ inch Chamber Height Trench 1 System Elevation Trench 2 System Elevation Trench 3 System Elevation --ft ft Q4 5-5; ft (inch to limiting factor Trench Separation Plan View In-ground Soil Absorption System (3-cell): Trench 1 r Modify ft header/ design as ft Leaching Chambers needed. Trench 4 inch Header Sch. Sr Trenchra-t ft with end camps Draw O for a Vent and • for Observation Pipe above. They will be located ft from the end of the cell. Vent pipes shall be Schedule 40 PVC and extend at least 12 inches above finished grade. Observation pipes that extend above finished grade must also be 4 inch Schedule 40 PVC. w~ . ~ ~ .,~a~~~ ± ~ ~a rm 30 ro LW-L 0 y c p O d W AF Vj C r a) 0 ca cm ~L p Uj~ C ~i~•' ~ Sd u ~ F rw ' ~ ~ ~ ~Q W N s ~ ~~y W p, c ~c~tk~k t+ WYv lL 7 N 7 W p N S C bu ~C L m O ~mj tf 6. W W~ O W p- Oj •W+ C N Ca FFL-vrJia~c F~+~.tw a Mkt 'a a- Nlco' 3v n' rohL-ccp W v_ W_r d c E •O C w W L L O m {p N V~ C rWn r W3;6 o~c v o'W'crn p[ O N C j w W C o y S i f0 ~ O Q. W O C C O 'O 2 F d t pp C O. N C N i' O V W` Y i F ~ W W C W yG W G r i O 7 O. T .Ci m-10, N C C O% W= W N !i if Y B LLI 01 v~yL a~~o Nmmmo f►~ ol U2 p V E' 0 ` ed •{N m W p y m O N W Q owo~E a t=-- d~cz lt, =E W u. •~~-~`.Y P c N 3 yip .W V p b y Q t0 C7coMo w W- `r~pmm o_ W o o r, c L - m W W W N LL C.1 W= IL N y 3 C C1 7 C7 C N U. m C O N Y V) E ID W W m W W E m W W O Q = C F > qq t E O iMy~ t x r MIA f's C szm ~a cgS -`5`a c~~yyE8 N CO 1 y€ o f b$ M S c oil p u,. cc c r- Of o At sae v~ F ~IY V y =lm] ~~Y mEg Z pE~q~ Wei • 9mm P} m L ~oyy~•jCQ p {i 9 C m ~ TO 3~ H 6 L e 0 ~ .mvS h ~aa U7 1! 49: a ~ all T0! h", X b l~ h41 1 e O t C c E m ~k LL ~ } N n - V .~,d 1 d O.M1 y Y ' r ~ bs~4 ~ a Mrx d5t~, .Kx 4FU' StJG. A~ t x. .,red fir' POWTS OWNER'S MANUAL MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity /Zoo gal ❑ NA Permit # Septic Tank Manufacturer W fESF(Z ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number-of Public Facility Units fir NA Pump Tank Capacity al ❑ NA Estimated flow (average) ~ZeD gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) 600 gal/day Pump Manufacturer ❑ NA Soil Application Rate al/da /fts Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODb) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical. Oxygen Demand (BOD.) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Ya In dia, ENNAA Other: ❑ NA Other: Other: C7 NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA i MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 p month(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA ® year(s) ❑ Clean effluent filter At least once every: month(s) ❑ NA ® ear(s) Inspect pump, pump controls & alarm At least once every: `r month(s) ❑ NA -3 IS year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ® ear(s) Other: At least once every: ❑ month(s) ❑ NA ❑ ear(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 ell(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 512 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) START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or oth c emical; 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 resttire 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 tie 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 b)omat 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 PROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER 11 Name S 6 (Z C-L S O.1V Name Phone '7 1 S- Z 7 3 - 7 T Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name 3'o µ-'V, Ai i 1,4+e d Name S-I✓ C&I XZ0D^~1 Phone 7~5 Z 73 vS O Phone 7~i"7~✓k~+T~DU 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. ST. CROIX COUNTY , SEPTIC TANK MAINTENANCE AGREEMENT AND z OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address `p Property Address (Verification required from Planning Zoning Department for new construction.) % City/State/)(-5_k&) k(. C (f 114 v 1V0 Parcel Identification Number C Z (c - (f ` - C Grp LEGAL DESCRIPTION Property Location 5 '/T, '/4 , Sec. _Z T C) N RZW, Town of l 1-4 ~t ' Subdivision La n kJ Aj3 e) Lot # Certified Survey Map # , Volume , Page # Warranty Deed ? t , Volume , Page # Spec house CO' no Lot lines identifiable; 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 (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 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. Uwe certify that all statements on this rm are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warn ty deedrecorded in Register of Deeds Office. Number of bedrooms SIGNATURE OF 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 Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) 03/22/2016 22:23 FAX MEADOWS,-'-.~"- A COUM } Pfr1TJ ASa~lt QafSUcw 22, 'W'ad die Notthwmt QtTS!? l ~ ■ + FOR low, IT F asb T'o wa at'RC.~jnxmd gY' Grt'~IDr: "-ytYjsc~a.4fo. Fi,40ft AoolL►' vil CIF I TIM ST T- ycom Lt .c W03 pr pw0, ST low ~i w free ~h .p" r AG•, PQI`!D VIEW LOT ( lOT t 8 17 I / / }gEADOWS ~j 1.1 tl /J ST71Y 3A TS•-" ..ff~ff~gyy - fvid7 l 30 F YseY - JT' Tf~ f .n ar.{tTOL 1 ~ y¢ `~S. LOT 2 a 1 7*ia77 Z r.72• LOT 8 oil C LOTS LOT 6 ~ 1 k ~•y~ CI Ba6M p- R. n m \ r s~ a Lard LOTS LOT 28 m, ooo ~ rr. A = r ~ ff~~ room Lo y ea,aPt sa, rt.- 1. ' O ' ~•.i s as aces yy / • ` ~ 'C``~` q. ft. LOT2R ZO off" G~1 D - voA y:'. LOT 30 l.Qd o LOT 3! r L6 #I'lov sq~ .~L cm l,sY' ocray/ L1R. LOT20 h oz# so, 117 4ar*s -ef.7D60>- , B.10, 9D4 -ml i a99°473°W - N 25.85' UNPt ~.w~» rb~ ~ TM. a'^`" ~ n.eo~~aurr.r•c.~aew~+w~ ►IMs aw r rrl.w.~ ww/~ a r■iMe p1Ary ° fW, « wa ~..e6 'oNm.YPiP HNd°M °'t"'°al~.i~ tl►r LL Cnk I<f■pW d My~t fC■lE 1N Iftlt p/d■SaMMM Q'r~~~'SUQe(6~uC ~:.■y, InY Mp err wlb~et N flNr• tu•ntY ~ Af00~+~'V ~~tlIMt GbOSrR ~■~■7~ "A r■iwµlrw wY°nd., Y wntNt~e~st, 0'W a00■L 4,41 neaie~ r. d■.elap Ota.n •odG ter °d.a~. old ra M avweor+t• Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 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 include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. O~ /✓x ~h/n~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. (Q (/a W b Please print all information. Review by Date 2 Personal infonnati you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). L2-316Y Property Owner D EL- Property Location i ~s • //G~~ fj Govt. Lot 1/ 1/4 S 7 2 T N R E (o W Property Owner's Maii~n AddreLot # Block # Subd. Name or M# r1V ti t2 /~'C' GZ City /J tate Zip Code Phone Number ❑ City ❑ village ErT q~vfl Nearest Road I've New Construction Us Residential / Number of bedroom _ Code derived design flow rate GPD ❑ Replacement Public or coMmercial - Describe: Parent material ~'i~ /I "r lam/ Flood Plain elevation if applicable e ft J General comments j TICJ',GI'/ and recommendations: ~ti l (~Y r O ~~j • 'G!~'~ / ` e- v ` Boring # 9 Pit a Bonn Ground surface elev. ft. Depth to limiting factor 'n *~Cpr Soil O*GP Rate ~^rvW Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 Eff# 2 2 ~y-- -S L ~ J ' , V 11 10, 111 Boring # Boring 9 10 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 c- o`71c y m~ r V" L VL9 ZD,~, r ' c_ L 1 k < i ` 44. Effluent #1 = BOD > 3u < 220 mg/L and TSS >30 < 1 ` ffluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) tore CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 5 17 9- f/ - 0 715-246-4516 Property Owner _ Parcel ID # Page of 5 Boring # ❑ Boring / Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication 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 2- /1 `L 0 1 Boring # ❑ Boring lev. ft. Depth to limiting factor m. Soil ~Rplication Rate Pit Ground surface e a ❑ I GPD/ff Consistence Boundary Roots Horizon Depth Dominant Color Redox Description Texture Structure Consis rY in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil lication 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 I Effluent #1 = BODE > 30 < 220 mglL and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SOD-9330 (R.6N0) Soil Test Plot Pla Project Name William Stock/Steve Dalton Sh Bird Address 1748 112th St. New Richmond Wi 54017 STM #226900 Lot 8 Subdivision Lundy Meadows Date 8/11/03 N 1/2 SE 1/4S 22 T 30 N/R18 W Township Richmond ❑ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 97.0/96.5 *HRPSame as Benchmark *Alt. B.M. Alt. BM Top of 2" Pipe @ 100.2' B.M. 252' Proper t Line 10' 15' B-1 30, Scale is 1" = 40' 5, unless otherwise 90, noted Please note: Installer must 5% B-3 verify all lot lines and setbacks Slope before installation. B-2 99, 100' a~ a, 0 a iv N M Please Note: Tested area may not be suitable for desired building area. Check system location before excavating.