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HomeMy WebLinkAbout030-2038-50-300 County: St. Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT Sanitary Permit No: 592261 (ATTACH TO PERMIT) State Plan ID No: GENERAL INFORMATION Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] Parcel Tax No: Permit Holder's Name: Cole Handevidt City Village TOWN OF Township SAINT JOSEPH 030-2038-50-300 Section/Town/Range/Map No: CST BM Elev: Insph M Elev: BM Description: r ~ ~ 25.30.20.48113- 10 /`V O~J~ o TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER Al CAPACITY STATION BS HI FS ELEV. Septic rrrr Benchmark - -Aj 0 'r. IL-- 3 1660 Dosing Alt. BM ' ~ ~ ~ ~~,t.~. ~~Jr► 0 Bldg. Sewer 1 r ~ St/Ht Inlet Holding St/Ht Outlet 5 ~ TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Ai Intake ROAD Dt Inlet M Septic Dt Bottom Dosing Header/Man. 95, S Aeration Dist. Pipe ii • I Holding Bot. System & Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover 7 / / Q1 GPM f+~` C.~f q Model Num -7. t TDH Lift Friction Loss Head TDH Ft $ -7 93.37 Forcemain Length Dia. Dist. to Well lj~, 3 SOIL ABSORPTION SYST / r' O r Z BED/TRENCH Width No. Of~nche PIT DIMENSI S No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 1/ ~nl~ Manufactur i / SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING INFORMATION CHAMBER OR Type Of System: UNIT Model Numberi 7 1 ?16 3(c y#-l4-P-14 tI Ajs DISTRIBUTION SYSTEM Header/Manifold / .41 Dist ribution x Hole Size x Hole Spacing Vent to Air Int ke Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only a Mul r- Depth Over xx Depth of, xx Seeded/Sodded 41~~ Depth Over Yes No Bed/Trench Center Bed/Trench Edges ~ Topsoil No Inspection #2: COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Location: 1392 25TH ST d4o'A-5 Q 1.) Alt BM Description = v g 2.) Bldg sewer length = ~3 I - amount of cover = I/ Plan revision Required? ❑ Yes No 2 L se other side for additional information. Insepct s Sign a Cert. No. U Date SBD-6710 (R.3/97) RECEIVED Safety and Buildings Division Coun 201 W. Washington Ave.; P.O. Box 7162 Sanitary Permit Number (to be fined in by Co.) Madiso W1 707 2 SEP Z 0 2011 IZ Z, (60 1 MUN lY1C°- • t)vg49 ~ State Transactio Numb In accordance wit E SPS 38321(2), Wis. Aden Code, s, w7 Q07 ~c governmental unit is required prior to Safety and a Professisanitary permit Note: a state-owned POWTS are submitted to Project Address (if different than mailing s) the Department of Sfety an her onal Servies. Per _ urrortnation you provide may be used for secondary oses in accordance with the Privacy Law, s. 15. 1) in , Stats. I. A lication Information - Please Pr'nt All Informatio Property' Oy~te's Name A Parcel #i r/ f 7Te OwPrLocation Govt I~pt Cm' state Zi Code Phone Number ~ , -7 1,, Section rw/ ~ (czz~~ttc e} M Type of Building (check all that appl T ~ N; R CJE 1 or 2 Family Dwelling -Number of B Dons Subdivision Name loc ❑ Public/Commercial- Describe Use 6Cic ❑ City of ❑ State Ded - Describe Use CSM Nt1bCr ❑ Village of ` c.✓ !3-i3.~-13a-~ 9 own of s III. Type o ' ermit: (Check only one ox on line A. Complete line B if applicable) A. ter ❑ 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 IV. of POWTS Svstem/Com onentfDevice: Check all that apply) Tlon-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 rsanreat ent krea Information: Des' Flow Design Soil Application dsf) Dispersal Area Required (s Dispersal op (sf) em lev on, -17 VL Tank Info Capacity in Total # of anufacttn-er Gallons Gallons Units 2 = New Tanks Existing Tanta m v U v w, a U in v co C7 Septic or Holding Tank Dosing Chamber ~ _ I VII. Responsibility Stateme - the undersigned, ass esponsibility for installation of the PO shown on the attached plans. Pl b s Name (Print), PI ignature MP/MPRS,Number Business Phone N bee P70 'ress (S eet city, te, Zip < ounty epartmeut use Only r oved I ❑ Isa r ve Permit Fee Date ued Issuing . t Signature S _ 9Q. oo /7 v Reason for Denial DL Coaditr ri a ~omn g;:PWpproval disper. % cell must all be sindc2s ! roEints`rec 3J i.. 1~.~. as per lanagement plan pro riaed by plumber . 2. -All m4kwk regUierlents mustpe:.rnairtL ir.E;i as per a-licnblr, aadp / rdincinom Attach to complete plans for the system and submit to the County only on paper not less than 8 it x 11 inches in size SBD-6398 (R- 11/11) Soil Test and System PLOT PLAN PRO,=ECT Cole Handevidt ADDRESS 5853 Otter Lake Road White Bear Lake Mn 55110 NE 1/4 NW 1/4S 25 /T 30 N/R 20 W TOWN St. Joseph COUNTY ST. CROIX SYSTEM ELEVATION 96. .5/93.0/91.5 4' below qrade 9/20/17 5 DATE BEDROOM CONVENTIONAL XXXX Z''7 - L~ CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/630 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1 082 # of chambers 53 BENCHMARK V.R.P. Top ofWalkout foundation ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark - Scale = 1/4" = 10' Vent >6„ Quick4 Standard 25th ST. of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 12" 4' Long Grade at System Elevation 34 Pro 5 Bedroom House B.M.* 20' Garage P.L. ST 3-3' X 50' Cells 13' X 54' cell 10, 30' >3' spacing B-3 Vent 100 120' 9 ' B-1 'CO r" 20' 20% Slope 35' 35' B- ' ' P.L. 92 -Iqq SEA fe 0 l X ^T Wisconsin Department of Commerce Page of Division of Safety and SOIL E W7007DW98FRBM Attach complete site plan on paper not less than 8 1/2 ) usr include, but not limited to: vertical and horizontal reference point (BM), direction and lRevi . percent slope, scale or dimensions, north arrow, and location and distance to nearest road. J~ 3% -3 O-S by Date Please print all information. ~12l6ll'7 Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Property Location Owner A Govt. Lot 1/4 J )/4 ~o T N R2-DE( Property Owner's Mailing Address Lot # Block # Subd. Na CSM#,.~ y State Zip Code Phone tuber ❑ City E3 Village Town crest Roa New Construction Usd-;i~Residential / Number of bedrooms Code derived design flow rate Z.; - - GPD ❑ Replacement ❑ Public commercial - Describe: Parent material Floodf; e lion if applicable General comments and recommendations: System Type 1" 1'e2 r✓f System Elevatio ' ❑ Boring Bcxing # n 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#2 106 Boring _ r~ ® Boring # Ell- - Pit Ground surface elev~ Cft. Depth to limiting factor /l' L in• Soil "cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 l • Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 rrg/L and TSS < 30 mg/L CST Name (Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address _ Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 715-246-4516 Property Owner _ Parcel ID # Page of Boring # ❑ Boring ) pit Ground surface elev/ ~ Tz/ft. Depth to limiting factor l~V in. Soil lication Rate Horizon Depth Dominant Color Redox Description Roots GPD/ff Texture Structure Consistence Boundary ~~11 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (8.6/00) Property Owner _ Parcel ID # Page of ❑ Boring Boring # Pit Ground surface elevl-: LITZ'ft. Depth to limiting factor in. Soil ligtion Rate Ir, 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~ F-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/ff 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 Application Rate Horizon 7epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (8.6100) Soil Test and System PLOT PLAN PROsECT Cole Handevidt ADDRESS 5853 Otter Lake Road White Bear Lake Mn 55110 NE 1/4 NW 1/4S 25 /T 30 N/R 20 W TOWN St. Joseph COUNTY ST. CROIX SYSTEM ELEVATION 96. .5/93.0/91.5 4' below grade 9/20/17 5 DATE BEDROOM CONVENTIONAL XXX < CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/630 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1 082 # of chambers 53 BENCHMARK V.R.P. Top ofWalkout foundation ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Scale = 1/4" = 10' vent ALo Quick4 Standard 25th ST. Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 2 Grade at Syst em Elevation 34" Pro 5 Bedroom Ouse N B.M.* 20' Garage P.L. ST 10' 30' 3-3' X 50' Cells 13' X 54' cell >3' spacing B-3 Vents 100 120' 98' B-1 6' 5 94' 20' 20% Slope 35' 35 B- ' 92' P.L. III, ,A) 1 ©>7 2~J County - Safety and Buildings Division 'j !t 1 201 W. Washington Ave., P.O. Box 7162 Madison, W1 53707-7162 Sanitary Permit Number (to be filled in by Co.) r~ ~fS ^ Sanitary Permit Al State T n Number In accordance with SPS 383.21(2), Wis. Alta Code, submission of mis w,m is required prior to obtaining a saniF permit- Note arY P Application forms for state-owned POWTS are sub ' mitred tP the Department of Safety and Professional Servies. Personal information you rovide Project Address (if di$erent than rnubng address) oses in accordance with the Priv ~ Law, s. 15. 1 m), Slats. Y may be used for sewn L A lication Information - Please Print All Information ! ~ Property Owner's Name y Parcel 4 Property Owner's Mailing Address F- Property Locationdd/15 3 Crty, State Govt Lot rp Code Phone Number / i ~ . Section (c~le on II. Type of Building (check all that apply) Lot 4 T,3 P N. R 4-C E W T 2 Family Dwelling -Number of Bedpoo tJ Subdivision Name ~k, ❑ Public/Commercial - Describe Use ❑ , C.N. Block . City of ❑ Stare aed - Describe Use _ / 9 CSM Number ❑ Village of 1-547 K/ 114qBT ; Town of __J C~ J' ! ✓ III. Type of Permit: (Check only on box on line A. Complete line B if app c e A. 1 System ❑ Replacement system ❑ Treatment/Holding Tank ent Only Q Other ModificZ18 AQ_ ation to Existing System (explain) B• ❑ Permit Renewal ❑ Permit Revision I ❑ ange of PI List Previous Permit Number and Date Issued Before Expiration ermit Transfer to New Owner , TV. of POWTS System/Co am onentJDevice: b k a Iv )ae~`~vl"v on-Pressurized In-Ground ❑ Pressurized In-Ground Trade ❑ mound > 24 in. of suitable soil ❑ Mound < 24 in, of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (expl " r1~D ❑ Pretreatment Device (explain) V. DispersaUTreat nt Area Information: - Design Flow (gpd) Design Soil Application Rat dsf} Dis rsal Area Re tilt Pe 4 f1 Dis ai A ea Proposed ( S ctrl Elev on - 7~ / Tank Info Capacity in Total #i of aManufactuncr n~ ` r Gallons Gallons Units i New Tanks Existing Tanks m v J Septic or Holding Tank I ( ( 1. e P - C'^ > G~ Dosing Chamber VII. Responsibility Statement- the undersigned, a res ousibili for installation Pi p of the POWTS shown on the attached plans. Signature MP/MPRS Number Business Phone N-1- -17 Plumber' Address (Street, Ci --State, ountv/De artment U e Only. pproved isapprove Permit Fee Date su Issuing t signature O eason far Denial IX Condit] a asons,l(or Di royal 1 Sept. tank, eI t.Ent It c~ VTI, uisr tit cell must all In s~i'.Ic its et 3) des as per ?tar.3gement plan pia tiae t by pi-- r. 2. All it~Ar w.,W.r ann M1,09 tw I71Fi Ott it E .g so per VXAC S co& / , .rdinancti. i Attach to complete plans for the system and submit to the Coun only on a ry p per noT less than 8 12 z 11 inches .n sue SBD-6398 (R. 11/11) System PLOT PLAN PROJECT Cole Handevidt ADDRESS 5853 Otter Lake Road White Bear Lake Mn 55110 NE 1/4 NW 1/4S 25 /T 30 N/R 20 W TOWN St. Joseph COUNTY ST. CROIX SYSTEM ELEVATION 93.0/91.5/90.0 5.5' below grade DATE 4/5/17 BEDROOM 5 CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/630 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1096 # of chambers 54 BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Driveway Easement l~ ~V %Co alg = 1 / 10, 25th ST. jL „ Quick4 Standard eaching Chamber ith 20.0 ft2 of Area .6ft^2/pair of end caps Grade at System Elevation 3493' 96, 9 B-2 30' Pro 5 17 % Slope 20' ST Bedroom House B-3 102' w i 7 5' B-1t... 23' 41' 364' Property Line 23 B.M.* All piping shall be ASTM SDR 30/34, within P L 10' of tank, piping shall be ASTM F891 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 4/5/17 Owner:Cole Handevidt Location: NE1/4 NW1/4 S25 T30 N,R20W 1392 25th St. St. Joseph Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Co i ency Plan 7.Filter Cross Section Signature License number #25W900 System PLOT PLAN PROJECT Cole Handevidt ADDRESS 5853 Otter Lake Road White Bear Lake Mn 55110 NE 1/4 NW 1/4S 25 /T 30 N/R 20 W TOWN St. Joseph COUNTY ST. CROIX SYSTEM ELEVATION 93.0/91.5/90.0 5.5' below grade DATE 4/5/17 BEDROOM 5 CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/630 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 1096 # of chambers 54 BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark Scale = 1/4" = 101 Driveway Easement 25th ST. Quick4 Standard eaching Chamber ith 20.0 ft2 of Area .6ft^2/pair of end caps tion 34Grade at System Eleva jL 96' 93' 99' B-2 30 Pro 5 17 % Slope 20' ST Bedroom House -3 x 4? B-3 102' c v 7 5 ' B-1 23' ~41' 364' Property Line 23 B.M.* All piping shall be ASTM SDR 30/34, within P L 10' of tank, piping shall be ASTM F891 Cross Section of Quick 4 Standard Leaching Chamber Typical cross section for 2 of 3 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 98.5' Len Vent Grade 4' 34 Septic Tank 4' L5' 4' Long 1 34Grade at System Elevation 34„ Grade at System Elevation Spacing- 5' 3-3' X 46' Cells Observation tube/Vent Same on other end To be located on end of Cells %A B System elevations: C A-93.0' B_91.5' C90.01 18 chambers per cell POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page of ILE INFORMATION Owner ~r SYSTEM SPECIFICATIONS Permit # Septic Tank Capacity al 1:1 NA Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Number of Bedrooms ❑ NA J jVd Effluent Filter Model i Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ ~ Estimated flow (average) ? aPump Tank Manufacturer i Design flow (peak), (Estimated x 1.5) ~ NA ' aPump Manufacturer ❑ NA Soil Application Rate Standard Influent/Eftluent Quali al/dPump Model ❑ NA Quality Monthly average Pretreatment Unit Fats, Oil & Grease (FOG) 530 m L ❑ NA ~ 13 Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD$) <1' 20 m /L g El NA O Mechanical Aeration ❑ Wetland Total Suspended Solids (l'SS) 5150 m ~L ❑ Disinfection ❑ Other. Pretreated Effluent Quality Monthly average Di ersal Cell(s) Biochemical Oxygen Demand (BODs) 530 mg/L O NA Tots! Suspended Solids -Ground {gravity} ❑ In-Ground (pressurized) P (TSS) 530 mg/L -A 11 At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100m1 , C1 Drip-Line 1:1 Other: MMaximum Effluent Particle Size Other. (Other. Y8 in dia. ❑ NA 13 NA NA Other: "Values ❑ A typical for domestic wastewater and septic tank effluent Other. ❑ NA IAINTENANCE SCHEDULE Service Event Service Frequency (inspect condition of tank(s) month(s) At least once every: ears (Maximum 3 years) ❑ NA (Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume El NA (Inspect dispersal cell(s) At least once every: ❑ month(s) ears (Maximum 3 years) ❑ NA Clean effluent filter At least once every: eoarts(s) ❑ NA nspect pump, pump controls & alarm ( ) At least once every: D month(s) l9ush laterals and pressure test At least once every: ❑ month(s) El year(s) ANA ether. ❑ year(s) 11 At least once every: p month(s) 13 ether: year( ) 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 iinclude a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of i:;ombined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be 'visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local I-egulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third X I:he tank shall be removed by a Septage Servicing Operator and disposed ofinoacco danceewith chapter tNRe113, Wisco sin Administrative Code. ICI 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. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals t1*t may impede the treatment process and/or damage the.dispersal cell(s). If high concentrations are detected have the contents of thO tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when =1 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 bie discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of eftluenlt. 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 POW F$' antibiotics; baby wipes; dgare to 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 productis; 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 propefly and safety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Cade:. • Ail 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 property 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 rep ent system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelm. he replacement area should be protected from disturbance and compaction and should not be infringed upon by requirjed setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the neied for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules iti effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technologlr 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 evaluallior, must be performed to locate a suitable repiacemment area. If no replacement area is available a holding tank may be installed) as a Nast resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place foilowing removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TAN UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O~ A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFMCULT OR IMPOSSIBLE ADDITIONAL COMMENTS S INSTALLER i POWTS MAINTAINER Name Name C F ` Phone l J - , - C _ j s Phone SEPTAGE SERVICING OPERATO (PUMPER) LOCAL REGULATORY AUTHORITY Name 17 Phone '1 F F=:1 This docu rrent was drafted in comiganoe with chapter SPS 383.22(2xb)(1)(d)&(f) and 383.64(1), (2) & (3), Wisconsin Administrative Code. P 1 I I i i l 1 ' ~ P - ~ I II n _ 1 ' Ill 1 I / IL 1 - 1 v v P ~ P 1 O I W 1 1 1 1 I s ~ a ~ W e ~1 ` ~ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP ...CERTIFICATION FORM Owner/Buyer Mailing Address,?~ d%` ~ti' tti t l 1 Property Addres 7 (Verification required from Planning & Zoning Department for new construction.) City/State LA-kgtl W] Parcel Identification Number b d b S~. LEGAL DESCRIPTION Property Location N E: 1/4 , ' 1/4 , Sec. , T N R 9~'O W, To Am of , Subdivision Plat: Lot # -p Certified Survey Map # T o V5 , Volume Page # 1 Warranty Deed # (before 2007)Volume , Page # Spec house ❑ yes~no Lot lines identifia4ves ❑ no SYSTEM NLkINTENANCE AND O JWNER 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. 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 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 30 days of the three year expiration date. Uwe certify that all statements on ' form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a w anty deed recorded in Register of Deeds Office. Numb~e,y~f bedrgoms 17 / w~~ fi SI NATURE 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) 91 _B NJIS30 3SflOHp m o R ~jo`o quay ~'g E o ffi 0 6 b E`€ laIn34NVH "N.211, =11, lll~ 11 ~a`PII8 P3 "n" ae • `d" A3]HSV V 3100 p Q w w _ r . E CL .J LL LL s` Anil ~<~o I y"r Yr=~W I Ede ~4 9 6 \ s, I N I II ia' i " 1 b r _ -T- A - - - - I r ' le, 3 z-z I I i ! e r F ~b swz i x - ~ srz izm J 4 - a LL ~ - ~ I Iv - , ~~I ~ I 2~ 9 I r s _ a a 0 - .l - TiI~ 17- 69 e - T b e 11 a ~ - ~ ' I b' o I I I ~ - - w ~ II a ze 5 So LL 1, -71 ~jao 9 aIJ <"-p NJIS34 3SflOH o m s- z 4 laIn30 o NVH € ° agn a a ""~ePlinge8p3~ a` ~ J~3l HSV T 310 o ¢ w Q 7 Q CO II ~o KS,_ vv~ ~ ~a~ 88 r5 AS Ri ~~gWR~,gI bps, °~F 2~8C3t~~ F, i N „Im v sm 3S{ P~ p ~t iii vm~ ,j ~ l1 . ! Iry _ b r. LEM, II ~e ~s a, ~I I I I ry~ _ a o zr W; boo quay < - NOIS3Q 3SnOH o t a a a 141A3oNVH s a e a A31HSV V 3100 3~1,3 a - ~ ~ w z O 11n996P3 ¢ w E w a$ a 00 co 33. CC ' S~ydxa9 mi as ~ F~ ~I ~ ~zm .9 i i i , i i - - - - - - - - - - - - - - - - - - - - - - - - - i 1069 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt Attach complete site plan on paper not less than 8% x_11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St, Croix percent slope, scale ordimemsions, north glow, and location and distance to, nearest road. Parcel I.D. rt of: 30-20385-4913 Please pHnrf,4 4nformatio4, viewed Date Personal information you provide may us2d r seconds ' ' ~ kk f y law, s.15:04 (1) (m)). fO (7 Property Owner 1 -.1 Property Location Ferguson, Reid en ' a P= ? ~~IJ Govt Lot NE 1/4 NW 1/4 S 25 T 3 NR 20 W Property Owner's Mailing Address j S7 (qox tot# Block # Subd. Name or CSM# 1394 25th St y `e C04JNTY 8 na CSM City State Phone City Village vf' Town Nearest Road Saint Joseph WI 54 211 , j7.11&549L, 2~1 Sl Joseph 25Th St. New Construction Use: ✓ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material Outwash Flood. plain elevation, if applicable na General comments and recommendations: Area is suitable for a conventional system with a 0.7 gpd/sgft rating.. Step trenches recommended, possible elevations for area I, 95.00'& 93.00'. FTI Boring # Boring ~J ✓ Pit Ground Surface elev. 98.45 ft. Depth to limiting factor >110 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 *15-21 10yr3/3 none Is 1 mgr mvfr gw 2f .7 1.2 2 10yr5/3 none sl 2msbk mfr gw if .5 .9 3 10yr4/4 none sl 2msbk mfr gw .5 .9 4 21-32 7.5yr4/4 none scl 3msbk mfr gvv .4 .6 i 5 32-38 7.5yr4/4 none Is 1 msbk mvfr gw .7 1.2 6 38-110 10yr514 none ms Osg ml .7 1.2 ~r a Boring # Boring Pit Ground Surface elev. 97.8 ft. Depth to limiting factor >1 12 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-5 10yr3/3 none I 2mgr mfr gw 2m .5 .8 2 5-13 10yr4/3 none sl 2msbk mfr gw 2m .5 .9 3 13-26 10yr4/4 none sl 2msbk mfr cs 1 f .5 .9 4 26-112 10yr5/4 none ms Osg mi .7 1.2 if L * Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS <_30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt ~u~ 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 586 Valley View Trail, Somerset, WI 54025 8/11/01 715-549-6651 Property Owner Ferguson, Reid Parcel ID # _part of: 30-20385-100 Page 2 of 3 F3] Boring # Boring Pit Ground Surface elev. 92.78 ft. Depth to limiting factor >111 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots D/ ' in. Munselt Qu. Sz. Cont, Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-6 10yr3/3 none Is 1 mgr mvfr gw ; 2m .7 1.2 2 6-15 10yr513 none Is 1 msbk mvfr gw 2f .7 1.2 3 15-37 10yr4/4 none sl 2msbk mfr gw 1f .5 .9 4 37-57 10yr5/4 none sl 2msbk mfr CS .5 .9 5 57-111 7.5yr5/4 none ms Osg ml .7 1.2 ❑ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh, *Eff#1 *Eff#2 ❑ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P ' in. Munsell Qu. Sz. Cont, Color Gr. Sz, Sh. *Eff#1 *Eff#2 c * Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 <_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 -t-.I ;n - oltAmotA f-t -1-- -t-t tha .1 A., o,tmant ~t ~r1Q_7t;~_21 G1 n.- TTV AnR_7Or A_52777 r~ W4 Z~ z!c r ~ /Q3 I p~ ~ ~th . 231 AU o ~ G sue, k y ~e,~~ ~q~~~, ~fu4.► 6;~ ° Thy-~,~s- ,T, S~ti,~~, ~ 12,9 c/ aZ S .S r~, GS Tai Si.19 /Y~= y 5.2 s'~ % ~c}~/.~~c~r,✓ (7/I'~ Sal ~-G r'aS/