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HomeMy WebLinkAbout042-1077-20-025 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 592205 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Township Parcel Tax No Ron Stewart TOWN OF WARREN 042-1077-20-025 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 4~ 1 G ez)-T 28.29.18.440A-25 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER 44% CAPACITY STATION BS HI FS ELEV. A- 15 Septic Benchmark e e 1" 14, C) DDO q 7- o /bl 160 Dosing Go„,a Q 9 Alt. BM J O eA., 117, T ~P Aotat ierr I Bldg. Sewer ~ I ~ ~ ✓ ri 14 'hw Holding St/Ht Inlet Q ` TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. ent Air Intake ROAD Dt Inlet r ,I Septic S~ 7 Say g' Dt Bottom -71 -Z Y Dosing 7 SU/ 7 561 j Header/Man. 7 ~ o Z. tS Aeration Dist. Pipe ` D 161- Cj, Holding Bot. System 4.61 Final Grade /4 PUMP/SIPHON INFORMATION 3. $ Manufacturer Demand St Cover o p GPM 1 7• Model Number 117 TDH Lift Friction Loss System Hea TDH ~ 6.5 Forcemain Lengt Dia Dist. to Well SOIL ABSORPTION SYSTEM 'O Nw a t O7 BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Z_ SETBACK SYSTEM TO P/L BLDG ei WELL LAKE/STRE LEACHING Manufacturer: INFORMATION CHAMBER OR UNIT Model Numbey.~ TyOfhSystem J't,~~ DISTRIBUTION SYSTEM p(+L- l(p = 3 Z. ~j Header/Manifold it Distribution x Hole Size x Hole Spacing Vent o Air Intake ~7 Pipe(s) Length / Dia Length I--- Dia Spacing d SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Altos Depth Over Depth Over xx Depth of xx Seeded/Sodded 1xx Mulched Bed/Trench Center 4- V Bed/Trench Edges Topsoil No S Xfs [E] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Location: 750 112TH ST e,,f ~s a-- 4 a `K. S 1.) Alt BM Description 2.) Bldg sewer length = ~ /y amount of cover = ✓ 4.4 I{4~ 6 7 16 iwI", alv% Plan revision Required? ❑ Yes No - Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's ignature Cert. No. St, w ~ai6 j l V County Safety and Buildings Division i 201 W. Washington Ave., P.O. Box 7162 ry t" X yv Sanitary Permit Number er (to be filled in by Co.) EIED 16 Madison, WI 53707-7162 V\ ROIX COUNTY J it Applica ioi StateTransact ionIN ber Q_ In accordance with SPS 383 21(2), Wis. Adm. Code, submission of this form to the appropn- { is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS Project'Address (if different than mailing address; the Department of Safety and Professional Servies. Personal information you provide may be used foi purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. //Z L Application Information - Please P nt All Information ff al Property Owner's Name Parcel # 7V, fex;71 Property Owner's Mailing Address Property Location 74 !t' ~ T Govt. Lot 7 City, State Zip Code Phone Number Y V ' 1 + , ~ • Section l~ b r'! 5 L) .54o 2 3 r_ lU /e~/..j ~'4? 3t 61) (circle on I . Type of Building (check all that apply) y 1 Lot T, N; R E or 2k I or 2 Family Dwelling - Number of Bedrooms w~ Subdivision Name 6k n.A Block # ❑ Public/Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use rr / CSM Number 16 ❑ Village of ,Town of YY C h III. Type of Permit: (Check onl one box on line A. Complete line B if applicable) r (0 l A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration _ Owner ~Ln~l 01/1 IV. Type of POWTS S stem/Com onent/Device: Check all that apply) A 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. Dispersal/ reatment Area Information: Design Flow (gpd) Design Soil Applicat 7 ion Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (so System Elevation VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units / o° v New Tanks Existing Tanks a. L) U-0 ~~c)) w 0 a Septic or Holding Tank ~ ~ 1 dDV I I ESC oNt Dosing Chamber 47 F ~ ~ t VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumb is Name (Print) Plumb s Si ature MP/MPRS Number Business Phone Number a Y X 55 ~/3 ter , ` )/7 Plumber's Address (Street, City, State, Zip Code) " Q t7 CGc Z << o e< l 3 j a" `i-- VIII. Gaunt /Department Use Onl Approved ❑ Disapproved Permit Fee Date Issued Issuing' gent Signature / $ / t b Owner Given Reason for Denial IX. CondiSM041r "FAIReasons for Disapproval 1 Sieptys tank, effit4t i lilte* erki chsper so cell must all be set_h ~s' na nta ^e as per management plan pro /ided by plumber. V r r Z~ Ito 6-69 r-+ ~^~l 2. =.Aq.MO k requirements must be maintr.ir.Ed i as Per wlica►ble codf: 1,::rdinancw. Attach to complete plans for the system and )b`t to the Coun only o aper not less than 8 I/2 I1 inches in ize SBD-6398 (R. 11/11) iLv r ! c; ~v(1ty r.1 C., n I`cclr I r 40 E21/ r,• ty shat L~'~ Yk lh LE~ T ? a L ~ - Ilp A 113 Coq P)7 l ©c1(~Ge VrC,, OS'C G~ CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: f~ A) J S 7 -e to 01 f Owner's Name: V, 0hLi~/! s'7- r<, , tk Owner's Address: G ~ r ~S 546 , -3 Legal Description: (V ic.~ ~9 S r,., J A '7'-,U cl rV, R) 9 Township: CCU G I, ✓ vt County: d I yti Subdivision Name: Lot Number: Parcel ID Number: 0112-W'17 .-I?o (;,,e5 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 Att chments: Soil Test & House Plans Designer/Plumber: License Number. 0 SS Date: l Phone Number, Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 w~ Via S~~?Y ao W- bGlzo6e-, 6yk vjC6+i>c "r ~i I y 12G 11 413' Gq A. SC I,n~~LS S.Qy Cc~h 1. r e,6Yd t vcc~~,ac ~6 -Se 2 5 C G l~l ~(i < G~ 4 (Y 1 OI~z i i I 1 i 4nk _ s i v \ V-11 a IJ - } rC)4 ~ ~ _-rat' ~ Page 3 Of 1- or 2- Family Dwelling In ground Soil Absorption System (2-cell Conventional) Daily Wastewater Flow (DWF) _ CC # of bedrooms x 150 gal/day/bedroom = 45>0 gal/day Design Loading Rate (DLR) or Soil Application Rate = - 7 gpd/ft2 (per SPS Table 383.44-1, 2, or 3) Required Distribution cell area = DWF gal/day =DLR 0•7 gPd/ft2 = ft2 # Chambers =Required Distribution cell area ft2 - ~ 70 ft2/ unit EISA = . ~1,7~5 Chambers Chamber Manufacturer and Model: J 2~, 7 v~~Gv ~J f~ ! L k~ij~ Actual Distribution Area = Total Chambers distribution area (,4 p ft2 + ft2/ unit EISA End Cap Pair - 5~Z ft2 Cross-Section In-ground Soil Absorption System (2-cell): Max Bury Depth = Limiting Factor l~ inches - 36 inches= 30) inches or feet i 4" Schedule 40 PVC 12 inches`r vent pipe with vent cap minimum ASTM# ~fL'Lr 5 12 inches minimum , t qO Final Grade Elevation I l inches soil cover l'l Trench 1 System x= - f Elevation a- inch Chamber Height t Y~ ft Trench 2 System Elevation r a~~ a ft ft 36 inch minimum separation from Trench Separation Leaching Chamber Width Bottom of System & Limiting Factor Limiting Factor-inches Plan View In-ground Soil Absorption System (2-cell): below ground surface Trench 1 ft Modify header/ I design as r17"" ft ~Leaching Chambers ~ needed. Trench 2 4 inch Header Sch. 3-S 1js~n 3 0-3~ I ma~• C~, \ ftwith end caps f Syrn 0574 S' C Draw O for a Vent and for Observation Pipe above. They will be located _ (j ~f_tfrom e 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. Page-~,v~ Of-L- SEPTIC TANK & PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" VENT PIPE 12" MIN. ABOVE GRADE WEATHERPROOF ? 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W/ PADLOCK & FINISHED GRADE 7 WARNING LABEL 4--4" MIN. 18" IN. 6" MAX. b INLET WATER TI HT SEALS GAS- t TIGHT i APPROVED A SEAL JOINTS WITH APPROVED -B i ALM APPROVED PIPE PIPE ON 3' ONTO C SOLID SOIL PUMP OFF ELEV. 9,3 FT. OFF RISER EXIT D PERMITTED ONL IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK% CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER : ~-j I~ Cc~h NUMBER DOSES PER DAY TANK SIZES: SEPTIC ,13 GAL. DOSE VOLUME INCLUDING DOSE 00 GAL. ~ b, e, e-, FLOWBACK: ) 3,2-19 GAL. 447S'1120 ALARM MANUFACTURER: CAPACITIES: A = (7, INCHES = 3C O GAL. MODEL NUMBER: t,T SWITCH TYPE: B = 2 INCHES = 35-7-.GAL. PUMP MANUFACTURER : z(; c: t'Y _ C = INCHES= GAL. MODEL NUMBER : T5-111-- SWITCH TYPE: D =,~,2.5b INCHES= 0IG.S GAL. REQUIRED DISCHARGE RATE GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . . t.' FEET + /c? D FEET FORCEMAIN X FT/100 FT. FRICTION FACTOR . FEET 9.15d TATAL DYNAMIC HEAD = FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH ; DIAMETER LIQUID TI~ y ~.7~.1• s y s ;)IV sl e 3 ib d TOTAL DYNAMIC HEAD/CAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DEWATERING MODEL 152/153 LLJ L,J w MODEL 152 153 50 Feet Meters Gal. Liters Gal. Liters 153 5 1.5 69 261 17 291 12 40 152 10 3.1 61 231 70 265 0 5 4.6 53 201 61 231 w 30 20 6.1 44 167 52 197 Q 8 25 7.6 34 129 42 159 z 0 30 9.1 23 87 33 125 20 35 10.7 22 85 0 ~ 40 12.2 11 42 4 10 Lock Valve: 38.0 Ft. (11.6m) 44.0 Ft. (13.4m 014508 0 20 40 60 80 100 GALLONS LITERS 0 80 160 240 320 6 1; 4 3 27,32 4 578 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS 3 27/32 • Timed dosing panels available. ~ 3 27/32 • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik-box available for outdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. I 1521153 Series 2 8 1521153 MODELS Contr_o_I Selection Model Volts-Ph Mode Amps Sim lex Du lex N 152 115 _-L - Naa--- -8 5- _ 1- - 2-or_3--- - 5 1 3 - - BN152 115 1 Auto 8.5 Included 2 or 3 SK2064 E152 230 1 Non 4.3 1 2 or 3 T BE152 230 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN153 115 1 Auto 10.5 Included 2or3 SELECTION GUIDE E153 230 1 Non 5.3 1 2 or 3 BE153 230 1 Auto 5.3 Included 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. A CAUTION 2. See FM0712 for correct model of Electrical Alternator E-Pak. All installation of controls. protection devices and wiring should be done by a qualified 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA), or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump, -~7 MAIL TO: P.O. BOX 16347 1 Louisville, KY 40256-0347 O Manufacturers of. SHIP TO: 3649 Cane Run Road o Louisville, KY 40211-1961 QVi1L/TY~UMP9 S.YCE l,9 3d http://www.zoeller.com %)711")7 !O_ 1(502) 778-2731 • 1 (800) 928-PUMP FAX (502) 774-3624 © Copyright 2001 Zoeller Co. All rights reserved. C, ~ ~ a 9 I N lc7 O cn V C•7 N C? CO U-3 t Cco I I~~ ~ J z o O U) v t= F- o z o- w C/') X X W w w = Z C,() F- C7~ ~WJ F-- w z_ 7- 0- J <D w z C ~a O a- :5 U -D X0 0- L w _ LLJ co Z W =F a- O CD Cl- C/D ca N C~ m = u•) Z F- ® O ~ Lu F j Wc° CD c5 O LO z EE N W I Q ! 44 III I' I Ifl I i I l I Ip l 111 11 it 1, ''I ' I ~ i r pp O ~1 I', u O O O o L'I,I, II Isl II e co E U r N O N U N ~ U O O O Lq r D _ N N u N U u E o V U M CR co II r-. u fll, yll 'a II ~ ~ I. tl. u 1.~. M w III ~ I I T h~ ~I N v II 11 I III i ~ III P ~I I I f I r, ~,~I 1V~j 4 ~IL I, ! ~~I ~I~, I I ~ ~ uq idV~ VIJ~u~I~~~', •i I'~ I~ ~ ~~~~~~I~~ Ij: ~ rn ~ III III III II~ ~ I I ~I~I~ i I I 1~ I ril I I Vla,~~ II I~ € ~ A lill i. I I I III ~ I, 9. ~ i I I ~ r~zraacmew~l ~i ~ E J1 Isl~il~l ek,~ICA~ aI~~I .III I III IJ I I,I~III ~ I II I I ~.'I ~ (D U ^ 0 ~ ~ I , Illfl I II r I~~rlfil i'I ~ Illi~. i~a~aw1 v ~ ~I III ICI I I~ ~I ~ i ~ r A" ~ ~1 ~ ~ ~ + q ~q II III III ~ II I fl III j I ~'~~~~W/ ~ III ~IIIIII I~ II II II I~ IU ~ I~;`~~~II~I~'SI n II (D U c/D c6 u I LIJ ~~"h~ i cl~ c N O v z zo OJ v O Cl) O D N co tJi w C~ LO m crn O a_ o O w m c/D Lu Z O v cl- _ U) c-) 0 of Cr- LL LLJ U) /11[11J/ - w O m LLJ cr- ~oOw U) o sva aid yr~ t LLJ YOQCO O Z ~ w O Q Q 0 Q Q 0 0 0 m a- :2 0 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 11_:'7 of C? FILE INFORMATION SYSTEM SPECIFICATIONS Owner 5~7_e_w ' Tank Manufacturer: , L 577` , c_ ❑ NA Permit # JX Septic ❑ Dose ❑ Holding Volume: (gal) DESIGN PARAMETERS Tank Manufacturer: it rev Cc, )I G ❑ NA Number of Bedrooms: ❑ NA ❑ Septic A Dose ❑ Holding Volume: (gal) Number of Public Facility Units: W NA Vertical Distance Tank Bottom(s) to Service Pad: +U (ft) Estimated (average) Flow : CSC (gal/day) Horizontal Distance Tank(s) to Service Pad: tU (ft) Specific servicing mechanics must be provided if vertical is >15 feet or Design (peak) Flow = (estimated x 1.5): ,o (gal/day) if horizontal is >150 feet. Specific instructions to be provided on back. In Situ Soil Application Rate: (gal/day/ftz) Effluent Filter Manufacturer: 1 10 ❑NA Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model: j Fats, Oil & Grease (FOG) <30 mg/L Pump Manufacturer: Biochemical Oxygen Demand (BOD5) <220 mg/L ❑ NA ❑ NA Total Suspended Solids (TSS) <150 mg/L Pump Model: High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L Manufacturer: (BOD5) >220 mg/L] NA El 95.NA (TSS) >150 mg/L Mechanical Aeration E] Peat Filter Pretreated Effluent Monthly average ❑ Disinfection El Wetland Y 9 ❑ Sand/Gravel Filter ❑ Other: (BOD5) <30 mg/L Soil Absorption System (TSS) <30 mg/L NA Fecal Coliform (geometric mean) <_104 fu/100m1 gin-Ground (gravity) ❑ In-Ground (pressure) ❑ NA Maximum Effluent Particle Size 1/g inch dia, ❑ NA ❑ At-Grade El Mound ❑ Drip-Line ❑ Other: Other: ❑ NA Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) ❑ When combined sludge and scum equals one-third (/3) of tank volume ❑ When the high water alarm is activated Inspect condition of tank(s) At least once every' El month(s) ❑ year(s) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every' El month(s) El year(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: El month(s) ❑ NA ❑ year(s) q inspect pump, pump controls & alarm At least once every: ® month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS • Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). 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 a check for any back up or ponding of effluent on the ground surface. The soil absorption system 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 treatment tank equals one-third (%3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. • All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of _<12 months, shall be performed by a certified POWTS Maintainer. • A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. ,~~ti START UP AND OPERATION PagetQ of A- 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 absorption system. If high concentrations are detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. 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 treatment tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge. 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 Wisconsin Administrative Code s. SPS 383.33: • 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 (pumper). • 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: (Check all that apply) ❑ 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, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINTAINER Name ~I e Name Phone / J Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULAT_Q AUTHORITY Name Name Management Dept. Phone Phone 715--,',~~ 3&,-4660 This form is In compliance with Wisconsin Administrative Code s. SPS 383.22(2)(b)(1)(d) & (f) and SPS 383.54(1), (2) & (3). ST. CROIX COUNTY SEPTIC "TANK MAINTENANCF? AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer -4- ~ +-l y2e f~ j €~i-►JA LT I Mailing Address C, i i 1. , Property Address -75 - ; . (Verification required from Planning & Zoning Department for new construction.) City/State ' C'P,C " i 1- Parcel Identification Number LEGAL DESCRIPTION Property Location1.l'W /4 , Sec. A_, T .2,~jNR/3 W, Town of tjA1_r_e.-J Subdivision Plat?e-trc' C) 0 C, o t ,-4wt--Y r.--) , Lot # 2- j z, "7 Certified Survey Map # /.Gi -)AC S. M . Volume 1-~- Page # ~ Warranty Deed # (before 2007)Volurne Page # Spec house ❑yes0no Lot lines identifiablejyesEjno 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 Na~ural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this 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 warranty deed recorded in Register of Deeds Office. 9 od~ Nurre of bedrooms / 1 7) SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revolved 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) CERTIFIED SURVEY MAP LOCATED IN PART OF THE NW1/4 OF THE NW1/4 AND PART OF GOVERNMENT LOT 1 OF SECTION 28, T29N, R1 8W, TOWN OF WARREN, ST. CROIX COUNTY, WISCONSIN. C O OWNER SURVEYOR +►`~~t1~g HS RONALD & SHARON STEWART EDWIN C F-LANUM ~~rQ 740 112TH STREET NORTHLAND SURVEYING, INC. C ROBERTS, WI 54023 P.O. BOX 152 w w J w m I AMERY, WI 54001 s CD C~' J ~ 0% = ~00 G 0 VAV o A ~~s~,, ~gg 3S N m ~A possible violation of the St. Croix County Zoning Ordinance will be created if the existing structure located within 100' of the property line, ever houses livestock or animal units. ~ cn ~Iw c~' W1/4 COR. SEC. 28 N ALUM. MON, FD. N'm N FJ'~ `X X X X SEE SHEET 2 X X X X is ~N \ EAST-WEST 114 LINE co ILOT 2 N ~h ~ o N ~9s~ 9 15.91 AC. ± TO O.H.W.M. INC. R/W zl tC o I+ FgyO Gp~ (693,115 SQ FT.±) °a Fp~~6\ yFT' FD 5,35 AC. TO OHWM EXC R/W ISNED NgB s~3o j l2F \S \Y9/~ ~F~x \ (668,538 SQ. FT. t) 4g qz, F D w o \ o r w Nat°41'01"E 210.44' ~ Inl_m o 6 x \ w 75.00 66.15' J X101, - m U1 IUt,N C7 o SOIL BORINGS 33.27' A r ~ ~ SHED ~ I~,~'~ Z K/ N \ SS \ ti~~ a°~ WIDE J04NT o ° ARAGE P~ a EASEMEN G w ~~/v 96~, \ ~a 1 0~ l l LOT 3 sEENOtEa„ w 25' SHED 10 1a145' 5a, olo qpA \ 603342 n _ SWCOR. SEC. 28 O.H.W.M ELEV. = 966.59' p \9S \ N~`R,519°Q930W1 6 6' ~n ALUM. PAON. =D " !y~'9~ 9S~F 5X \hL~1 O~~ G.C.D. V. 872, P. 459, oh3 DOC. #459252 N LOT 3 AREA 2.22 AC. ±TO O.H.W.M. INC. RNV I~ (95,909 SQ. FT.-) 2.07 AC. TO O.H.W.M. EXC. R/W (90,153 SQ. FT.) LEGEND ® ST. CROIX COUNTY SECTION CORNER POSITION VERFIED WITH TIES OF RECORD OR MONUMENTED AS NOTED CD m a NOTE "B" 5/16`0.1 IRON PIPE FOUND C z 1" IRON PIPE FOUND N76°33'42"E 1.85' x ~ " O.D. IRON PIPE FOUND a FROM SET 3/4" IRON REBAR u 3/4 X n" IRuiX REBAR SEA WEIGHING ° C' C "THIS MAP CONTAINS AREAS THAT ARE SUBJECT TO THE .50 LBS. PER LINEAR FOOT o o SHORELAND OVERLAY ZONING DISTRICT AND FLOODPLAIN z a OVERLAY ZONING DISTRICT. ADDITIONAL RESTRICTIONS APPLY. X EXISTING FENCE LINE m ° CONTACT THE COMMUNITY DEVELOPMENT DEPARTMENT FOR v ° FURTHER INFORMATION." - 75' SETBACK FROM APPROXIMATE O.H.W.M. AND m C m WETLANDS o m o U, APPROXIMATE ORDINARY HIGH WATER MARK. SHOWN FOR O.H.W.M ORDINARY HIGH WATER MARK o m REFERENCE ONLY. rT, o PREVIOUSLY RECORDED DATA ANY LAND BELOW THE ORDINARY HIGH WATER MARK OF A LAKE OR A NAVIGABLE STREAM IS SUBJECT TO THE PUBLIC TRUST IN NAVIGABLE WATERS THAT IS ESTABLISHED UNDER ARTICLE IX, SECTION 1, OF THE STATE CONSTITUTION. SCALE IN FEET 1" = 150' 150 O 150 SHEET 3 OF 4 SHEETS Vol 27 Page 6127 St. Croix County 1014357 Page 3 of 4 2 0 CERTIFIED SURVEY MAP LOCATED IN PART OF THE NW1/4 OF THE NW1/4 AND PART OF GOVERNMENT LOT 1 OF SECTION 28, T29N, R1 8W, TOWN OF WARREN, ST. CROIX COUNTY, WISCONSIN. OWNER SURVEYOR RONALD & SHARON STEWART EDWIN C FLANUM 740112TH STREET NORTHLAND SURVEYING, INC. ROBERTS, WI 54023 P.O. BOX 152 AMERY, WI 54001 SURVEYOR'S CERTIFICATE I, Edwin C. Flamm, Professional Wisconsin Land Surveyor, hereby certify that by the direction of Ronald Stewart, I have surveyed, mapped and described the parcel of land which is represented by this Certified Survey Map; that the exterior boundary of the parcel of land surveyed and mapped is described as fo I I ows: A parcel of land located in part of the NW1/4 of the NW1/4 and part of Government Lot 1 of Section 28, T29N, RI 8W, Town of Warren, St. Croix County, Nisconsin; described as follows: Beginning a; the W1/4 Corner of said Section 28 being 150 feet more or less from the Approximate Ordinary High Water Mark of Twin Lakes being the beginning of a meander line, thence S45°21'00"E, along said meander line, 369.65 feet to a point being 25 feet more or less from said Ordinary High Water ~ Mark, thence S56°03'29"E, along said meander line, 279.62 feel to a point being 25 feet more or less from said Ordinary High Water Mark; thence S47°51'52"E, along said meander line, 192.19 feet to a point being 25 feet more or less from said Ordinary High Water Mark being the end of said meander j line, thence N46°06'05"E, along the northwesterly line of a parcel of land described in Quit Claim Deed recorded in Volume 872, Page 459, document i Number 459252 at he St. Croix County Register of Deeds Office, 152.87 feet; thence N76°33'42"E, along said northwesterly line, 214.58 feet to the centerline of a town road (112th Street); thence N08°1 8'03"W, along said centerline, 2575.94 feet to the south line of Parcel 2 of Warranty Deed recorded in Document Number 964142 at said office; thence S87°56'37"W, along said south line, 597.91 feet to the west line of the NW1/4 of said section; thence S00°21'02"E, along said west line, 2138.56 feet to the point of beginning. Including all lands lying between the meander line and the approximate Ordinary High Water Mark of Twin Lakes lying between a line bearing S00°52'41 "E from the beginning of the meander line and a line bearing S46°06'05"W from the end of said meander line. Described parcel contains 44.86 acres (1,953,907 sq. ft.) more or less to the Approximate Ordinary High Water Mark Parcel is subject to town road (112th Street) right-of-way and all other easements, restrictions, and covenants of record also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236.34 of the Wisconsin Statutes, the Land Subdivision Ordinance of the County of St Croix and the Subdivision Ordinance of the Town of Warren, in surveying and mapping same. Edwin, C. Flanum, P.L.S. Date rJN 2 4 0015 ~ ~ A 4K* ST. CRUTA ICOUN 1 Y PLANNING & ZONING OFFICE i Q ~ 04 COUNTY TREASURER'S CERTIFICATE STATE OF WISCONSIN)SS COUNTY OF ST. CROIX) I, Laurie Noble, being the duly elected, qualified and acting Treasurer of St. Croix County, do hereby certify that the records in my office show no u-,cdocmed tax sales and no unpaid taxes or special assessments as of tne q~h 46affecting the land included in this Certified Survey Map. Ole Q ~~o ~4~ c01_t5_ Laurie Noble, Date County Treasurer Each parcel shown on this map (plat) is subject to State, County and Township laws, rules and regulations (i.e., wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any Darcel contact the St. Croix County Zoning Office and the Town of Warren. SHEET 4 OF 4 SHEETS Vol 27 Page 6127 St. Croix County 1014357 Page 4 of 4 Wisconsin Department of Safety and Professional Services R E1-/ E® Division of Industry Services SOIL EVALUATION REPORT In accordance with SPS 385, Wis. Adm. Code County St. Croix ST --....T'..CROIX COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, Parcel I. 1 _ VELO~(V1F scale or dimensions, north arrow, and location and distance to nearest road. 'L~~ L Please print all information. Reviewed by Date ! l J Personal information you provide may be used for seconds purposes Priva Law, s. 15.04(1)(m)). Property Owner Property Location ❑ Ronald R. Stewart + f Govt. Lot 1 NW SW S ~28 T 29 pa R 18 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 740112 1h St 3 City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Roberts WI 54023 (715) 749-3660 Warren 112'h St ® New Construction Use: ® Residential/ Number of bedrooms 3 Code derived design flow rate 450 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material sandstone Flood Plan elevation if applicable ft. General comments and recommendations: alternate sight ; L) / V J t F-1 Boring # ❑ Boring ® Pit Ground surface elev. 98 ft. Depth to limiting factor 70 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Fe In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 1 0-10 10YR3/2 SL 2 M ABK MFR C 2 F 0.6 1.0 2 10-70 10YR4/6 S 0 SG MVFR 0.7 1.6 ❑ Boring , ❑ Boring # ® Pit Ground surface elev. 98 ft. Depth to limiting factor 68 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 1 0-9 10YR3/2 SL 2 M ABK MFR C 2 F 0.6 1.0 2 9-68 7.5YR4/6 S 0 SG MVFR 1 F 0.7 1.6 1 Effluent #1 = BOD, > 30:5 220 mig/L and TSS > N:5 0 /L ' Effluent #2 = BOD, > 30:5 220 /L and TSS > 30 150 m L CST Name (Please Print) Signs CST Number Dale R. Stewart - 220879 Address D e Evaluation onducted Telephone Number 757 107'h St. 9/30/2016 (715)497-9996 SBD-8330 (R04/15) i 3 ] F Boring # ❑ Boring ® Pit Ground surface elev. 96 ft. Depth to limiting factor 66 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-12 10YR3/3 SL 2 M ABK MVR C 2 F 0.6 1.0 2 12-66 10YR4/6 S 0 SG MVFR 1 F 0.7 1.6 ❑ 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/Ft2 In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I ❑ 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/Ftz In. Munsell Qu. Az. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 Effluent #1 = BOD, > 30:5 220 mg/L and TSS > 30:5 150 mg/L ' Effluent #2 = BOD, > 30:5 220 mg/L and TSS > 30:5 150 mg/L i 1 s u R ye Y wr e n u yrt~ ~t'f'' e., q~s i i ~ 1L E ~ Q , cat C3 cc> ,C R o NA LP S TE WA 740 :2 Lo t 3 X33. ~~!l 4r.7 z ST. Land Use CROIX,,, 'COUNTY Planning &Lt nd lnl'ormadon loop <~l a~vk~a~ < a y, ReSZiurCe Manag2ln£'nf a A Jr, December 81 2016 Tile#: LUP-2016-039 Ron Stewart 740 112`' Street Roberts, WI Re: Conditional Approval LUP-2016-039, Shoreland Overlay District Chapter 17.30 Parcel ID Number 042-1077-20-025 Projcct Srtc Address: 750 112`h utrCit Ron Stewart, Community Development Department staff have reviewed the Land Use Permit application for the construction of a new single-family dwelling, driveway and Private Onsite Wastewater Treatment System (POWTS) within the Shoreland and Shoreland-Wetland Overlay District, Chapter 17.30. The request has been conditionally approved based on the application submission and the following findings. Please see the enclosed site plan to reference the general erosion control and grading notes. • Impervious surface does not exceed 15% of the lot within 300' of the Ordinary High Water Mark (OHWM). ® There are no slopes greater than 25% measured over a 50-foot horizontal distance on the project site. • Vegetation 35-feet inland from the OHWM will not be disturbed. • The midline of the roof does not exceed the 35-foot maximum height requirement. Based on these findings, approval of LUP-2016-039 is subject to the following conditions: 1. The following areas must be staked to prevent structure encroachment within setbacks (measured to closest point of the structure including eave or roof overhang): a. 75' Shoreland setback (OHWM: 970.31 see enclosed DNR determination) b. 10' side yard setback to driveway on easterly property line 2. Erosion control (silt fence, erosion control log or equivalent) must be installed according to the general erosion control notes on the site plan prior to any land disturbance activities; if silt fence is used it must be trenched into the ground per product specifications. a. The applicant/agent is responsible for inspecting stormwater and erosion control measures immediately following a major rainfall event. b. St. Croix County reserves the right to require additional erosion control measures to be installed during construction if found necessary due to site-specific conditions. Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, Wl 54016 Fax 715.386.4686 ta 6°v. (.J£iv{:.({.)t7t 5.`°Yit fCZtYt °~f( C7f[% C UX.bJ'.Cl "t~aariaY ,7)z?a:Prr2i€>rtrrt ~a 3. A pre-construction inspection is required to verify erosion control installation per plan, that the structure has been staked to meet the required Ordinary High Water Mark (OHWM) 75- foot setback and that the wetlands noted above have been flagged. It is the applicant/agent's responsibility to schedule this with Community Development Department staff. 4. All disturbed areas shall be seeded and mulched once the project site has reached final grade. a. Phosphorus fertilizer shall not be used to establish and/or maintain vegetation, unless a soil test confirms phosphorous is needed. 5. The applicant shall be responsible to secure any other required local, state or federal permit(s) and approval(s) prior to land disturbance activity. 6. A post-construction inspection will be required prior to removing erosion control measures to determine the entire project site has reached a point of 70% permanent vegetative cover. It is the applicant/agent's responsibility to schedule this with Community Development Department staff 7. Failure to comply with the terms or conditions above may result in the revocation of this permit by the Zoning Administrator according to Chapter 17.30 (13). This approval is subject to the conditions listed above; it does not allow for any additional construction, structures, grading, paving, filling or clearing of vegetation beyond the limits of this request. Your information will remain on file at the St. Croix County Community Development Department suite. It is your responsibility to ensure compliance with any other local, state, or federal permitting or regulations, including contacting the Town of Warren and the Wisconsin Department of Natural Resources to inquire if additional permissions are required. This permit is valid for one year, with the possibility of up to two (2) six month extensions if the applicant submits the appropriate permit extension fee and documentation to the Zoning Administrator. The permit card should be posted on the job-site during construction. Please feel free to contact me with any questions or concerns. I am typically available Monday-Friday from 8:00-5:00 PM. If you would like to schedule an inspection, please call the main office so they can direct the next available staff member to accommodate your request as best as possible; (715) 386-4680. Respect blly, Sarah Droher Land Use Technician Enclosure: Grading and Erosion Control plan submitted 11/30/2016 DNR OHWM Determination EC: Town of Warren Travis.lbi /comeast.net CC: File Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, WI 54016 Fax 715.386.4686 1lliPd.SC'C1N7,1.t5~ =J 1#rh 97?t?~il1"? !:'d,F))Atrr ixr, tfllt~~"_i C f ' C).S(7t if t }tK r1t.!( J11 4 1 c tom` l RA, 2 r { o y R11 I/ 1 21 i I 0 ~ ;C r' III Ta s f7 sc -vim air IF' c~ cf~. -61F 'Nit 15~1~T -