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HomeMy WebLinkAbout040-1299-00-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 592203 GENERAL INFORMATION State Plan ID No: A t~ Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. N~/ Permit Holder's Name: City Village Township Parcel Tax No Steven & Joyce Klein TOWN OF TROY 040-1299-00-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 09.28.19.1728 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic _ Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet e Septic Dt Bottom Dosing Hea /Man. Aeration Dist. Pipe Holding Bot. System -7 98 0 may," / i PUMP/SIPHON INFORMATION Final Grade lb Manufacturer Demand St Cover GPM Model Number TDH Lift FrictioD..L System Head TDH Ft Forc, e ,,.Length Dia. Dist. toVVell / SOIL ABSORPTION SYSTEM T (~l BED/TRENCH Width ILengthNo. Of Trenches ~j PIT DIMENSIONS No. Of Pigs- Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: u ,{?r ~ INFORMATION CHAMBER OR (J- M-1 Ty e Of Sysgtem: V 15/ UNIT Model Number: D}STR~BUTI SYSTEM i Head ader anifold Distribution x Hole Size x Hole Spacing IVAto Air Intake 'i Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Deptt Depth Over xx Depth of eeded/Sodded r Mulched Bed Bed/Trench Edges-~i ~Topsoil xx S Ves fde- - 1 ec _ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 412 GLEN RIDGE RD 1.) Alt BM Description = 2.) Bldg sewer length El - amount of cover Plan revision Required? ❑ Yes No $ r } r , Use other side for additional information. "f, wk Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 412 Glen Ridge Road located at: SW 1/4, SE 1/4, Section 09 , Town 28 N, Range 19 W, Town of Troy , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service z Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1250 Construction: Prefab Concrete X Steel Other Manufacturer (if known): Wieser Concrete Age of Tank (if known): 13 Years Permit number (if known) 430341 John Schmitt (L' nsed Plumber Signature) (Print Name) MPRS 223760 (Title) (License Number) MP/MPRS (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 Page 10 I \'yNKI f y County µ~tl t Industry Services Division St. Croix 1 R~y~ D SqEC~ 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.) P.O. Box 7162 2 S !f Madison, WI 53707-7162 `j ZZ d ~J ST. CROIX COUNT p ENT FF311(1'K T.i'~ Sanitary Permit State Transac Number in accordance with SPS 383.21(2), Wis. Adm. Code, submissio A 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 Services. Personal information you provide may be used for secondary 412 Glen Ridge Road purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. 1. Application Infor on -Please Print All Information Property Owner's Name Parcel # Klein, Steven &Joyce 040-1299-00-000 Property Owner's Mailing Address Property Location 'J 412 Glen Ridge Road Govt. Lot City, State Zip Code Phone Number SW '/4, SE 1/4, Section 09 Hudson, WI 54016 (circle one) '1 T28N ; R19Eo& It. Type of Building (check all that apply) Lot # ® 1 or 2 Family Dwelling - Number of Bedrooms 10 Subdivision Name Glover Glen ❑ Public/Commercial - Describe Use QGQo Block # ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of 3 j GeU~ ® Town of Troy III. Type of Permit: (Check only one box on line A. Complete line B if applicable) 20.^,L, A. ❑ New System ® Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued B. Before Expiration Plumber Owner 430341 September, 15, 2003 IV. Type of POWTS System/Component/Device: (Check all that apply) ® Non-Pressuriz In-Ground El Pressurized In-Ground El At-Grade F-1 Mound ? 24 in. of suitable soil El Mound < 24 in. of suitable soil Holding Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treat nt Area Information: Design Flow (gpd) Design Soil Application Dispersal Area Requi ed (sf) Dispersal Area Pro sed (sf) System Elevation 857 900 98.00, 600 Rate(gpdst) 0.7 VI. Tank Info Capacity in o o ° Gallons Total # of 2 U Manufacturer Gallons Units 2 0 2 2 ? -0 E2 5 New Tanks Existing Tanks a. U ~ cn U- 0 a- Septic or Holding Tank 1250 1250 1 Wieser Concret ® ❑ ❑ ❑ ❑ Dosing Chamber 1 ❑ ❑ ❑ ❑ ❑ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber'sS7~n ur, MP/MPRS Number Business Phone Number V'223760 715-760-0486 John Schmitt Plumber's Address (Street, City, State, Zip Code) 616 150`h Ave. Somerset, WI 54025 VIII. unt /Department Use Only Approved Permit Feel, Date Is, yed jIssuingent a ture ven Reon for Denial $ / IX.ondi o rlDisapproval 'tlislier v% cell •must all be s I fcas c tIntc ees as per maragemen! plan prciided by plumber. 2. dill tse41Wk reouireraenrs must be mairttdr.ed as per aK-liciable c;odo 1 , rdinancm Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x l I inches in size SBD-6398 (R03/14) PLOT PLAN N Project Name: Klein 4 Bedroom Replacement Soil Absorption Area Legal Description: SWIM, SE114, S09, T28N, R19W P.I.D: 040-1299-00-000 Subdivision Name: Glover Glen Lot 10 Township: Troy Parcel Size: 2.001 Acres SCALE: 1"=ao' County: St. Croix System Elevation: T1= 98.00' Existing 62.50' Chamber Trench Slope: 10% T2= 98.00' Existing 62.50' Chamber Trench BM1 Elevation: 98.00' Bottom of existing existing T3 T3= 98.00' Existing 62.50' Chamber Trench BM2 Elevation: T4= 98.00' Proposed 60.00' EZ Flow Trench ■ Backhoe Pits: T4= 98.00' Proposed 60.00' EZ Flow Trench T4= 98.00' Proposed 60.00' EZ Flow Trench See CSM or Plat for complete view of parcel S1 Existing Wieser Concrete WLP1250-MR Existing Zabel A-100 Valve Bull Run Valve 4 inch Sch 40 -ASTM D2665 4 inc 0'4 - ASTM D3034 L V R.3 CL. Page 2 CONVENTIONAL COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Klein 4 Bedroom Replacement Soil Absorption Area Owners Name: Steven & Joyce Klein Owner's Address 412 Glen Ridge Road Hudson, WI 54016 Legal Description: SW1/4, SE1/4, S09, T28N, R19W Township Troy County: St. Croix Subdivision Name: Glover Glen Lot Number: 10 Block Number Parcel I.D. Number 040-1299-00-000 Plan Transaction No. Page 1 Index anti _rtla Page 2 Plot Plai Page 3 Existing' ,.K Page 4 Existing Effluent Filter Information Page 5 Valve Information Page 6 System Sizing & Cross Section Page 7 EZ Flow Information Page 8 & 9 Management and contingency plan Page 10 Existing Septic Tank Certification Page 11 Septic Tank Maintenance Agreement Page 12 Warranty Deed Page 13 CSM or Plat Attachment 1 Soil Evaluation Report Attachmemt 2 Previous Sanitary Permit Designer: John Schmitt Licnese Number: MPRS 223760 Date: 12/3/2016 Phone Number: 71S-760-0486 Signature: Ly / L97[G In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 PLOT PLAN N Project Name: Klein 4 Bedroom Replacement Soil Absorption Area Legal Description: SW1/4, SE114, S09, T28N, R19W P.I.D: 040-1299-00-000 Subdivision Name: Glover Glen Lot 10 Township: Troy Parcel Size: 2.001 Acres SCALE: 1"=40' County: St. Croix System Elevation: T1= 98.00' Existing 62.50' Chamber Trench Slope: 10% T2= 98.00' Existing 62.50' Chamber Trench A BM1 Elevation: 98.00' Bottom of existing existing T3 T3= 98.00' Existing 62.50' Chamber Trench BM2 Elevation: T4= 98.00' Proposed 60.00' EZ Flow Trench Backhoe Pits: T4= 98.00' Proposed 60.00' EZ Flow Trench T4= 98.00' Proposed 60.00' EZ Flow Trench See CSM or Plat for complete view of parcel S1 Existing Wieser Concrete WLP1250-MR Existing Zabel A-100 Valve Bull Run Valve 4 inch Sch 40 ASTM D266S 4 inc 0 4 - ASTM D3034 O C 3 2 'r 1L ,u Page 2 8n-09ZVA :3113 9~~8-5Z~-008 0 \ 750d-1SOd ~31H0 00/00/00 :31b0 09L49 IM 'NOOb N301b'W OL .IMH S(1 9LLCM Via ~y(1NdW OIld3S Z w .bflOd-3ad :3~VOS dOM :J.B NMd?JO 31380!100 13531M W HN-05Z LM \ D w w cn w H Q J U D o Co O m W a J Z U J U Q W (n o 2 CE w V) a } 0 ZO ~0 0 0 m W a m U) U W F J N U- W l/) Q o p J - Q Q J § u > w z D w O Wow U o_ ° Q Z ce m a w °Q Q pm o Q z o a U H O o o Z S Q > w ~n U H J Z W N W OQ Q=~U J aM D mU F 3 LL u LCCL Q if) m (7) J W W 0 z z ~ Q nom. 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N W Q L~ W D J Z Z Q W af Q „9E ol~jinoi2j Sd « tig V) z Q F Page 3 r" h? l ' Zvi»Jrr~r~~~r~~~:s~~ C r A100 A300 A6O0 V-12 Series Filters ht' m: fr l _ rit: -•,g b-, .t_t :cd fl' _itc_:: { !nf('d '-tit t-, r,, a If nc -ion on 1S°',31`th15 Irrtr. {-4rouio b4' wt rYvt tti:,; ;latcf,<y::nC;~~S >Ug} `,t :140 ,J i'it- furs h:: IabC'E 'liter .1°IC' r.r t N, frr-,q~pncy ce scr-ocing fct the tank, stmid the cleart<d ncor, l -K, sq to^k is cfrnally rspxted and purnp; Ic e e .-f cur fi*.cr is viriualty sR ck =^'ng. the ccrjrr,; d anon, ci tho aws rob oroar,.-,ms c-r thf label flex cause= t} 'sc,Vs 'o disintc:gr;~'e and fall to tr _ -f re, -r ; w r --t-4 n, ~i.-r, t a'.:°i' v-,- -J[ bc. nu f, _ Tr lvhen t"c- "',rr nes:,~< r•, To service de fiber. r.'r,. STEP S EP STEP 4 it j F-17a t to-ik V %-d-C a-d sires tt to .,'=_VCni any ts~_-i-tqc cut of the =js `rrn . ,an^ cam'. ! r n"YC+j. k STEP STEP 1. pis It v: t tt c fircr carmd;c back " i- , rYaking sure vie" CQt; s'iy 'insC 0 ~'K Ca_- I ti l c tr y?' ss rtcpe,: y A r.: and coTgp m dy n.,::rtcd in L`te case. a,c 'ic; the se;kc tank ccvc~ s ~ _ ti•:ry+_ t.~:E~'1'~f . Elj °a'.fc'r .~'3r f'!.:'J:. C~=-tll7?xC"' a~:7'l~~l? `1~'tf ` _ E ` • 1-800-221-5742.Or Order Online: www.zabelzone.com ;:4,t1: for , free ,~l+I? t /1-, Page 4 12/3/2016 American Manufacturing Company Bull Run Valve - -•wil fr :.ef1 ~r±c eus ,i it`r?ct r`q i Treatment _ Controls _ Products Downloads Design Guidance J !fI ft l 'WATER-TIGHT - h 7 r Q ACCESS CAP RI SER CAP ADAPTER " RI SER TUBE ' VALVE DIRECTI0N HANDLE The Bull Run Valve"' is designed to split flows to septic h`r 4" e I.-JT F C RT fields or systems. In addition to the advantages of longer life and easier installation it is the most public 4" OUT PORT health safe alternating device available for wastewater disposal applications. The use has absolutely no contact with wastewater due to the valve's leak-proof and external operating characteristics. The change over from one drainage field to another can be accomplished 4" IN PORT in less than a minute by simply turning the valve without digging or contact with wastewater. The Bull Run Valve is available in 4" sch 40 pvc and is suitable wherever septic disposal systems are used - in commercial, industrial, and residential applications. OPERATING THE VALVE The direction control handle should be rotated Field Field Field Field periodically to direct effluent to one or the other No.1 1To.? No. 1 No.2 of two septic fields. After removing the screw %5` t cap at the top of the riser tube, the valve handle Valve Valve can be turned with the valve key furnished. Positioned 1~ - Positioned on No. 1 onNo.2 BULL RUN VALVE during during Complete Valve Kit Cidd Years Septic Selatic Even Years Contains Tank Tank 1. Bull Run Valve body 2. 28" Valve Key 3. Riser Cap Adapter ITEM DESCRIPTION 4. Watertight Access Cap BRV4 BULL RUN VALVE 4" BRVBULK BULL RUN VALVE & KEY ONLY BRVCIRISER BULL RUN VALVE RISER W/ CAST COVER BRVKEY28 BULL RUN VALVE KEY 28" BRVCIRISER - 4" BRVKEY36 BULL RUN VALVE KEY 36" ADJUSTABLE TO 28" HIGH BRVKEY48 BULL RUN VALVE KEY 48" file:///C:/Users/John%20SchmitUDesktop/John/American°io2OManufacturing°/"2OCompany°/o20--°/o2OBull°/`2ORun%2OValve.html page 5 1/3 SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Project Name: Klein 4 Bedroom Replacement Soil Absorption Area Gravelless Leaching Unit Specifications Manufacturer Model Laying Length EISA Rating EZ1203H-5ft 5.0' 25.0 Infiltrator EZ1203H-10ft 10.0' 50.0 System Sizing EISA Rating per Foot of EZ Flow 5 ftz Soil Application Rate 0.7 gpd/ft2 600.0 gpd Design Flow Soil Application Rate _ ~ EISA = 171.4 Feet of EZ Flow F-3-]trenches 60 feet long each 3 No. of Cells 6 Per Cell 3 ft Cell Width 18 Total No of 1203H 60 ft Cell Length 300 sq ft EISA Per Cell 3 ft Cell Spacing 900 sq ft Total EISA Typical Cross Section Finished Grade 102 ft Observation Pipe with approved cap or vent I I ~ r---Soil Backfill 36 Inch Geotextile Fabric 12 Inch O I) 0 O I Slotted and Anchored Vent/Observation Pipe Cap A with d- 98.00 ft Infiltrative Surface >36 inch I 95.00 ft Limiting Factor Plumber/Designer Signature: License MRS 223760 Date: December 5, 2016 Page6 Installation Instructions for 44EZ OwTM E41gow Systems in Wisconsin flbyFILTRATOR Wisconsin Department of Commerce, Safety and Buildings 5. The Absorption area (SF) necessary for a given site shall Division, has reviewed the specifications and/or plans for this be sized based on maximum daily sewage flow (GPD) and product and determined it to be in compliance with chapters the Permeability for the site. If certain criteria is met, the Comm 82 through 84, Wisconsin Admin. Code, and Chapters EISA sizing can be used in Wisconsin, resulting in a 40% 145 and 160, Wisconsin Statutes. All sites must meet the Site smaller drainfield. & Soil Conditions & Locations & Isolation distances as noted in local regulations. 6. Place EZflow bundle(s) in the EZflow configuration ap- proved by system design permit specified for the particu- The approved products are 1203H (3-12" bundles with pipe in lar site. The top or center-most bundles containing pipe center bundle in 5' or 10' lengths) and 1203HP (3-12" bundles are joined end to end with an internal pipe coupler. Any with pipe in each bundle in 5' or 10' lengths. additional aggregate only bundles that may be required, • should be butted against the other aggregate-only bun- A single pipe bundle contains a four inch perforated pipe sur- dles and do not require any type of connection. rounded by EPS aggregate and is held together with poly- : ehtylene netting. A single aggregate bundle contains aggregate 7. The top of each GEO cylinder contains a filter fabric pre- only and is held together with polyethylene netting. manufactured in between the netting and aggregate. The fabric is inserted to prevent soil intrusion. The installer Materials and Equipment Needed shall make sure the the GEO is positioned upward and is • EZflow Bundles in contact with the fabric contained in the adjacent cylin- • EZflow Geotextile Fabric : der before backfilling. • EZflow Internal Pipe Couplers • Pipe for Header and Inlet 8. The EZflow Drainfield Systems should be installed in a • Backhoe/Excavator level trench in all directions (both across and along the trench bottom) and should follow the contour of the ground Installation Instructions _ surface elevation (uniform depth), with all continuous The instructions for installation of EZflow products are given adjoining 10-foot cylindrical bundles placed end to end, below. This product must be installed in accordance with state with central bundle distribution pipe interconnected, rules defined in chapters Comm 82 through 84, Wisconsin Ad- without any dams, stepdowns or other water stops. ministrative Code, and Chapters 145 and 160, Wisconsin Stat- utes, as well as the local health department's current design 9. The trench top shall be graded such that water will not manual. : pond. Backfill should be seeded or sodded immediately after completion to reduce erosion. 1. After the local health department has determined sizing, configuration, and layout for the EZflow systems, stake 10. EZflow EPS bundles are flexible and can fit in curved or mark with paint the location of trenches and lines. Be trenches as may be necessary to avoid trees, boulders, or careful to set correct tank, invert pipe, header line or dis- other obstacles. tribution box and trench bottom elevations before instal- : lation of pipe bundles. 11. EPS aggregate is lighter than water, therefore, it might • be expected that natural buoyancy forces would tend to 2. Remove plastic EZflow shipping bags prior to placing cause EZflow assemblies to float out of ground when bundles in the trench(es). Remove any plastic bags in the ponding occurs. Field experience has shown, however, trench before system is covered. that this is not a problem when systems have a minimum of 6" of soil cover as recommended by manufacturer, 3. This product must have geotextile fabric that meets re- quirements of s. Comm 84.30 (6) (g), Wis. Adm. Code, installed directly on top of the product and extending 1203H-GEO down along the sides of the product to a point at least six inches from the bottom of product. Geotextile - Barrier Material • j. 4. When installed in a trench, the trench should be dug to - a width of 36 inches. This not only saves labor in excava- : 12" tion, but also provides better load-bearing capacity after i backfilling is complete. 36" ; Page 7 POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Steven & Joyce Klein Tank Manufacturer: Wieser Concrete ❑ NA Permit # Q Septic E] Dose ❑Holding Volume: 1250 gal DESIGN PARAMETERS Tank Manufacturer: Wieser Concrete NA Number of Bedrooms: 4 ❑ NA ❑ Septic ❑ Dose ❑Holding Volume: gal Number of Public Facility Units: 71 NA Vertical Distance Tank Bottom(s) to Service Pad: ft Estimated (average) Flow: 400 gal/day Horizontal Distance Tank(s) to Serivice Pad: ft Design Flow = estimated x 1.5: 600 gal/day Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate: 0.7 gal/day/ft2 horizontal is > 150 feet. Specific instructions to be provided on back. Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: Zabel ❑ NA Fats, Oils & Grease (FOG) 5_30 mg/L Effluent Filter Model: A-100 Biochemical Oxygen Demand (BOD5) 5220mg/L ❑ NA Pump Manufacturer: Total Suspended Solids (TSS) :5150mg/L Pump Model: High Strength Influent/Effluent Monthly average Petreatment Unit d NA Fats, Oils & Grease (FOG) 5530 mg/L Manufacturer: Biochemical Oxygen Demand (BOD5) S220mg/L 0 NA ❑ Mechanicai Aeration ❑ Peat Filler Total Suspended Solids (TSS) 5150mg/L ❑ Disinfection ❑ wetland ❑ Sand/Gravel Filter ❑ Other. Petreated Effluent Monthly average Biochemical Oxygen Demand (BOD5) 530mg/L Soil sortlon ystem Total Suspended Solids (TSS) _30mg/L ❑ NA In-Ground (gravity) ❑ In-Ground (pressure) Fecal Coliform (geometric mean) 5104cfu/100m1 ❑ At-Grade ❑ Mound Maximum Effluent Particle Size: % in dia. A ❑ Drip-Line ❑ Other: Other: Other: NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third (Y3) of tank volume Pump out contents of tank(s) When the high water alarm is activated At least once every: 3 J month(s) (Maximun 3 Years) ❑ NA Inspect condition of tank(s) year(s) At least once every: 1.5 month(s) (Maximun 3 Years) ❑ NA Inspect dispersal cell(s) ry11 year(s) At least once every: 1.5 month(s) ❑ NA Clean effluent filter year(s) month(s) 0 NA Inspect pump, pump controls & alarm At least once every: ear s Shut off T1, T2 & T2 for 5 years, Then month(s) ❑ NA alternate annually betwwen new and Annually or as indicated by 1 1 ear s old soil absorption areas inspection month(s) 0 NA year(s) 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 Insepector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank inspections must include a visual inspeciton 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 a check for any back up or ponding of effluent on 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 indicated a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumualtion of sludge and scum in any treatment 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 Admininistrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, petreatment 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 30 days of completion of any service event. 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, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil 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 extended 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 and may overload them resulting 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) discharge; 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, pits and other soil absorption systems 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 the opportunity to obtain a sanitary permit for 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 the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. 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: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT OXYGEN TO SUPPORT LIFE. NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. ADDITIONAL INFORMATION: POWTS INSTALLER POWTS MAINTAINER Name: John Schmitt Name: John Schmitt Phone: 715-760-0486 Phone: 715-760-0486 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name: Marko Septic Name: St. Croix County Zoning Phone: 715-749-3404 Phone: 715-386-4680 This document is intended to meet minimum requirements of Ch. Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. (Rev. 2/05) Page 9 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Steven & Joyce Klein Mailing Address 412 Glen Ridge Road Property Address 412 Glen Ridge Road (Verification required from Planning & Zoning Department for new construction.) City/State Hudson, Wl Parcel Identification Number 040-1299-00-000 LEGAL DESCRIPTION Property Location sW 1/4 , SE '/4 , Sec. 09 , T 28 NR 19 W, Town of Troy Subdivision Plat: Glover Glen Lot # 10 Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house Oyes[D,o Lot lines identifiable ElyesF]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 §SPS. 383.52(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. 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 Safety And Professional Services 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 3 days of the three year expiration date. I/we certify that all statements on t s 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 w anty deed recorded in Register of Deeds Office. Number of bedrooms 4 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. 04/12) 12/3/2016 2016-11-2213.10.39.jpg $ y Li - a t e7 e • k 1 FA).eet o4&) 'C n • isnginei sting ee *:.ee,, FAwrea-iae3 rU o ~ds~AL1' -It_R kONS L IS r a- 15 4f 5." Spa a!a.el 1 _ C4 - Af s e343 i. 1._J`J\ t 010.2 1 -'1 LCJ~ x'C ~ Ba:-t 5l_1 ee x A att.e e3 ( 446 } eat S aaa:^ / eer.z cPUll ate o t7 9 v tS Boo t G ? L 11 \ es t y +Ja4.2 T o", 2 / `1'1 •G~~\.. z,l -t u 1 j cL-LLaar- IILc=~ ` EDGE Of AAL - no.~~! xta9 rs"c. am.4 ° t j c~= ease ee9.a xaea.a x ea3.o aoea ~~u tat eer.r 25 6P23 9O3 BENCH MARK a L I t TOP F SPIKEE o /~L, EL'c~P=914.87 1 143.0 ~ a a grg.c 8r' eaCS .-TREE L'NE 3 rPo w xA, ! 10 u oWX: f as ee2.0 e9t.o ;J 18 L' ~ 1 ~ I f I 1 ~ ~ VW RT . ri f C ~'0 4 Y 143.2 f` BUILDING SETBACK ' f8 (tL2 t `'.ors i LINES PER PLAT \ ~ J I 1 st ca F- ! j h0 4OUS 0 'Al 14e~ :,_'tr1 xee7.e ess.z /r lON£Si FLOOR EL£YATIJNi r0f of BLOCK ELEVATON, 22,ES I ase,: 1 I r 00 rrJz GARAGE SLAB ELEVATON: TOB a LOONGUT ELEVARONi ` x aaeo arNOres tur»W e,.cvAt~a £,xl. ~ I / / ( osY.oY 7 acNOres rROr>nea nnncaN O 1 r JJ - _ weotcs artwtvt Mq unun eASUm4r y / r 47.0 MNCeee RRNY1.tGE 11AW eGiEOALN ~ V) --fr-ouroTCSarrie "~T~~•••~4 ( r r -•-e-- s>Q,vns arttr Iwe ':~1~,, 25 t r / ! l NOT& PRWOSEO OWES SNO1W PER 6RAOe40 KAN e>ti r ease e9Q4 1 / jrr IiGTE` e0,011,14 S it UME SHM ARE FOR AL PLANS OUPJ MLL LceA FGU 1wN 4, 4 rte. 12TO N, NOATM D04>12G4M?CNITEONAL PtMVS FOR R 90dl1140 ANO \ 094.3 JC89e.7 NJM NO SPECM "U NWE"GA170N HAS BRN PAIPtM ON AaS LOT By TNVI ` rGJ pS X SAWYM RX SWASILM OF WLS To SUPPORT THE SPEr= HOUSE r(4t'(siv FROPoSEO is NOT RiE RESAONS,'Bi4TY Of THE MEYON. \ t 17,0 J 1 ~JQti f Q NOTE TICS G6MOAM OM M NOT PURPOAT FLAT. 15 RiCW EASE%FtiTS ORiER THAN aP 1"M SM05H O ON A[ RECOM[9 PLAL \t\ \ r 91 `975.9 WYE CMIRACTOR WST 4ERSY GMYEWAY OMCK NOTE KMW45 MW" ARE 9ASE0 ON AN ASSWED OATBY ; ` ~ V M $02,5 r WIE ia.•n~ \ r 111.5 1." J'~ s t CO HEREBY CERTIFY TO THAT THIS ASAR Me TRUE ? \ / h ~Z. CCtSTUCTICN THAT S IS A A T TRUE AND EDGE OF GRAVEL ' ~"'=a CORRECT REPRESEN'TAT,,ON OF A SURVEY OF a \ r J THE BOUNDARIES OF; K \ 914.0"0 LOT 10, GLOVER GLEN: s~a.o Ott c, s~ 5T CROlX COUNTY, MSGON5iN \ 105,3 04.3 % i pS^v11 7 8~281T °e IT GOES NOT PURPORT TO SHOW IMPROVEMENTS 1JVC~pt1.~.lct • OR ENCHROACHMENTS, EXCEPT' AS SHOWN, AS ~2~' ~t~ ran.. - 94 8 ♦ yrr a SUR~EYEO BY ME OR UNDER} MY DIRECT SUPERVISION THIS TOTH DAY OF AUGUST, 2003. ,C~'~a~~~F'4 •a ~eti r~-Q~ ~ `{aR O 5CA(E : t INCH = RewsED 8-25-03 STAKED HsE stc~~o; r~ ti ~a a, P... 40 FEET https:Hmail.google.com/mail/u/0/#sent/158ad2f4b2e2ef54?projector=1 Page 13 1/1 12/3/2016 2016-11-2213.11.04.jpg ~t r r_, a ;r< A ~ .rte St)I(. EVALUATION REPORT Page t i, i r.If ht :rronrJenr r wlfft (;nntin Hs, Wis. Adm. Code County j / ' ~/t Q / K 11 hu hrc iu 5i7e Plan rttirsf - r i,~ I,I;r + r r n;lj,nr nrl Ieeq ilran a 112 tni FAreei I.L). 000 6o Y prat t yr af ani fuabnni.~i rrfrippattrr, and J^sianee to~ ea esl road _ .n nr d! ri •Irrna, nONh arrow, flr~d Reviewed by Date f'fease Pfirif all frfforrtleflorr. j a.,~., r A to sn ro rAry r,r,nncre IT dvr v 1 ew, s rson 1+1Cm1i hroperiy location t p ~J ! ~B N R frlalw'! rQAt Lot SW 1114 5t 114 s T - - /Name ocG&►~-- 9 . 2 - l.ol M ~ Hkrck p ~ Subd s - j.. _n=. mfq t+rnter 1 61a11ing~lridff'" C/d G/, ti - ~l NeareslF2oad one Ulnnber (:)City (._I Village 1~J Tbwn Fly B G/oven ~C~ ,zY3 TRbs /r derived design now rate ysa Gru ttew t trrttirurfipn Ilan Rrskienllal I Number of heJrooms ~ ,7 r'utdlc nr cantmrrdai - I)e crlhe. n. Rrptarnrnrnl I I efevallrnt It ant+ltcatda - Frnrraf comr++ertla a and recnnrrnrndalinns sr~Q.. J VVV _ ( mou f ttvrinq IO tt. - pepth to iirnli{ng laclar j In. 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