HomeMy WebLinkAbout022-1041-60-030
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 600233
GENERAL INFORMATION State Plan ID No: 3001 398
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
SCOTT POESCHEL TOWN OF KINNICKINNIC 022-1041-60-030
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
G S T 15.28.18.227A-20
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic, Benchmark
/000
Dosing Alt. BM
6orki°p
Aeration , Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/ L WELL BLDG. 'Vent tb Air Intake ROAD Dt Inlet
Septic /0 A IA- Dt Bottom Z g~
Dosing o+ 30 I Header/Man. /
Aeration Dist. Pipe
_ 3 9 9
Holding Bot. System
Final Grade /
PUMP/SIPHON INFORMATION 2;+ Manufacturer Demand St Cover ZA 67o , 3 23 GPJ~ 13
Model Number
C~ I n
TDH Lift( -lF f Friction Loss System Head TDA
J ~i c' `4' 13 i
Forcemain Length I Dia. Dist. to well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. rench PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L 1 BLDG WELL LAKE/ST EAM LEACHING Manufacturer:
INFORMATION Type stem: CHA LINER OR Model Number: 'IlIIIIIA DISTRIBUTION SYSTEM
Header/Manifold Distribution j ix Hole Size ix Hole Spacing, V to Air IntakeI
x. Pipe(s) 5T
Length_lq Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded rched
Bed/Trench Center /,7 Bed/Trench Edges NN, Topsoil Yes No
'~'tyes I~ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 372 OLD CEMETERY RD
1.) Alt BM Description
2.) Bldg sewer length gnalwe - amount of cover Plan revision Required? Yes No Use other side for additional information. Date Insepctor's Cert. No.
SBD-6710 (R.3/97)
_J
t C~11V Af° 017
e°~' xc' t^ g `L 'u .1 ? Coumty~
raj a.! Safety and Buildings Division ~ ~ • ~ ~
0 C~UN 20'11 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
UNgy DEVELOPMENT Madison, WI 53707-7162 Sanitary Permit 2AC4Z0 State Truasacb.Number
In ac cordauce with SPS 383.21(2), Wis. Adm Code, submission Qt U- 7$pFFC I unit 9 m-:) 1 Z
is required prior to obtaining a sanitary permit Note: Application forms for stake-oval" . _ te&to Project Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for scwndarv
purposes in accordance with the Privacy Law, s. 15. 1) m), Stais. /
L Application Information - Please Print All Information
Property Owner's Name Py cel k
r? ✓U 03C
Properly Owners Mailing Address- ^ Property Location
V, i3- 99-7 C,
f f Govt Lot
City, State Zipfode Phone Number
Section I
/ (circle
- T 'j N R or W
II. 'I;ype of Building (check al at apply) Lo
Family Dwelling -Number of Bedrooms~~ Subdivision Name
Block
❑ Public/Commercial - Describe Use
❑ City of
❑ State Owved -Describe Use CSM er ❑ e of
1ti of liC
W. T of Permit: (Check only one box on line A. Complete line B if applicable}
A. ystem ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B Permit Renewal El Permit Revision El Change of Plumber 11 Permit Transfer to New List Previous Permit Number and Date Issued
❑
Before Expiration Owner
IV. Type of POwTS S stemt/Com onent/Device: Check all that a
❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade > 4m. of suitable soil ❑ Mound <24 in. of suitable soil ^P
❑ floldrne T-` ❑ Other Dispersal Component (explain) ❑ Pretre=nent Device (explain) e
V. Dispersal/Treatment Ate- -1. formation:
Design Flow (gpd) Design Soil AppL, m Raze(gpdsf) Dispersal Area Required (sfl Dis al Pr 071j ST= Elevatio
so /I Y SV
VL Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units
New Tanks Existing Tanta ~ w ~
aU M n C -
Septic or Holding Tank
Dosing Chamber
J
VII. Responsibility Statement- 1, the undersigned, assn esponsibility for installation of the PORTS shown on the attached plans.
PI beta's Name (Print? Plumber' r er
I ~ Z- ature MPIMPRS Numb Business Phone Number
PI 's Address (Street, City, State, Zr )
,Dq 01
'cam. Countv/Department Use Only
pproved isapproved Permit Fee Datessuued Issuing ent Signature
_ er Giv n enial S
DL Conditions of Approval/Reasons for Disapproval
SYSTEM OWNER:
t`'~ 5} Atxka
1. Septic tank, effluent filter and C {~I S ppvvm.
dispersal cell must be serviced / maintained
as per management plan provided by plumber.
2. g Se
and submit to the County only on paper not less than 8 in x I I inches in size
as per applicable code/ordinances. .
SBD-6398 (R 11/11)
tYY~E`~T DIVISION OF INDUSTRY SERVICES
Gn 2331 SAN LUIS PL STE 150
GREEN BAY WI 54304-5211
M3 o Contact Through Relay
[ http://dsps.wi.gov/programs/industry-services
www.wisconsin.gov
A~OFZy;510ti
Scott Walker, Governor
Laura Gutierrez, Secretary
October 04, 2017
CUST ID No. 226900 ATTN: POWTS Inspector p
ZONING OFFICE
SHAUN R BIRD ST CROIX COUNTY SPIA
1432 120TH ST 1101 CARMICHAEL RD
NEW RICHMOND WI 54017-6409 HUDSON WI 54016-7708
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 10/04/2019 Identification Numbers
Transaction ID No. 3001398
SITE: Site ID No. 843531
Scott Poeschel Please refer to both identification numbers,
372 Old Cemetery Rd above, in all correspondence with the agency.
Town of Kinnickinnic
St Croix County
SE1/4, NEl/4, S15, T28N, R18W
FOR:
Description: Mound System (4 Bedrooms - New Construction)
Object Type: POWTS Component Manual Regulated Object ID No.: 1730231
Maintenance required; 450 GPD Flow rate; 28 in Soil minimum depth to limiting factor from original grade; System(s):
Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual -
Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed
and located in accordance with the enclosed approved plans and with any component manual(s) referenced above.
The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code
requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site.
• With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped
prior to homeowner occupancy.
• Wastewater generated from contractors cleaning of equipment and tools and/or left over construction
products shall not be discharged into the drains discharging to the private onsite wastewater treatment system
(POWTS). Waste generated shall be properly disposed of on-site or off site.
• Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to
prevent matting under the dispersal area. All loose organic material to be removed from mound area.
• Divert surface water from POWTS Area.
• Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches.
Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil
moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire,
the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not
proceed until it dries.
i
SHAUN R BIRD Page 2 10/4/2017
• All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5
• Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c)
• Well setbacks to meet chs. NR 811 & 812
• Tank Installation to follow all manufacture's recommendations.
• SPS 383.54(1)(e) The management plan for a POWTS shall specifically address the servicing mechanics of an
aerobic or anaerobic treatment tank or a holding tank where either of the following conditions exist:
1. The bottom of the tank is located more than 15 feet below the elevation where the servicing pad is located.
2. The bottom of the tank is located more than 150 feet horizontally from where the servicing pad is located.
• Verify property line(s) prior to installation.
• Pump Floats to be set and verified per approved plan. Any changes may result in pump resizing to meet
TDH and GPM Specifications.
• Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil
available for proper treatment. If no other site is available, trees in the basal area of the mound must be cut off
at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide
sufficient infiltrative area.
Owner Responsibilities
• The current owner, and each subsequent owner, shall receive a copy of this letter including instructions
relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate
operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS
383.54(1).
• In the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard, the property owner must follow the contingency plan as described in the approved plans.
A copy of the approved plans, specifications and this letter shall be on-site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
In granting this approval the Division of Industry Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any
others who are responsible for the installation, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 250.00
This Amount Will Be Invoiced.
When You Receive That Invoice,
Please Include a Copy With Your
Tim Vander Leest Payment Submittal.
Private Sewage Plan Reviewer, Division of Industry Services WiSMART code: 7633
(920)492-2214, Monday - Friday 6 am To 3:30 pm
tim.vanderleestC wisconsin.gov
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St. y -3
New Richmond Wi 54017
y 715-246-4516
Date: 9/10/17
Owner:Scott Poeschel
Location: SE1/4 NE1/4 S15 T28 N,R18W 372 Old Cemetary Road Kinnickinnic
Manuals Used: Mound Component Manual Version 2.0 (N.01/01, R. 10/12)
Pressure Distribution Manual Version 2.0 (N.01/01 R. 10/12)
Page#
1. Cover Page
2. Mound Plot Plan
3. Mound Cross Section
4. Pipe Cross Section/Pipe Layout
5. Pump Chamber Cross Section
6. Pump Curve
7-8. Maintance and Contigency plan
9. Filter Specifications and ss secti n
Attachments: Soil Test
Shaun Bird
Signature
License number 6900
FtecENE
EP 1 Page 1 of 9
System PLOT PLAN
PROJECT Scott Proeschel ADDRESS 372 Old Cemetarv Road River Falls Wi 54022
SE 1/4 NE 1/4S 15 /T 28 N/R 18 W TOWN Kinnickinnic COUNTY ST. CROIX
SYSTEM ELEVATION 97.5' 9/10/17
DATE BEDROOM 3
CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK
MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630
HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456
# of chambers none
BENCHMARK V.R.P. Top of PVC Pipe ASSUME ELEVATION 100' Filter Lifetime Filter
❑ BOREHOLE O WELL *H.R.P. same as benchmark
B B-1 592' Property Line
B-2 ❑ 98'
97.5'
97' Scale = 1/4" = 10'
uffcutt Combo Tank
t2•
B-3 96'
6% Slope
Grading is to be done to divert Pr 3
run-off away from system Area 15'b low droom
system is t ~b ouse
remain `
undisturbed
Well is to meet all WDNR setbacks
Tank is to be properly
Property Line bedded and provided with o
lockdown covers with
approved warning labels
Old Cemetary Road
2~
Mound System Cross Section and Plan View
77 Dimension Feet
.7 777
J r
A
1
1
B
i :.•rti:~r:. sl
• J.fY•!YY-Y•f•1•: Y•.f\K-f-'t•1• Y• FLJ1 N~~:f:JY h'-•f~f•~•.fK-J•• ~MJ~• . ~,'.;I D
A I YYLK YYYL-YL-L-YL•YL•\K Yµ L•L Y
• h LCD L•Y1~•f-L ~•L•LK•LYY•YYL. YLJ JL-YLJKJ•J'.f~-LK.f.Yi+L.Lf•Y\JY.fY.J.f-.•.JYN.f•J•f•JV•fwf•
f•JLM1 \-\w-L'L•tir•1KK•YL•ti.ti:tiKK•L.YYL~Y JY.JL%YN~.J•WyY•-• r~
f`f•fi•I'•MJ-JY•/YYY.IY.f.fYY.fYY.f•J.fYY.L-L%~JY- jK-L-L•L.1KK•Y f•J•yyy+Y E
.f•L-~~.f~YYL.fy.• •L•1KK.YL-YLK•KK•YL•L-LKK•L.L.LK•YL•LK•t.LK.L•JYY•JYY•J
W I YYL YLK Wtif f JYV J-J.N.fY.J J-JYYfYM.fY. f-f JY~NLfY~ L KKKK y
- •~•f`t•f•f-JY.f•f..-•f.f•fV•I•J.•Mfw.fLIK.J•'YLf.JUJ:fY f• J.JYY•l~f-~•JYJ4ftf-.yiM1f•~'-Mf f•MKK•tiKKKK. .,1 TI
I JYY.fYY f fYY ' F
1 1 G
1
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I
it
J
Q
!1
K
L
- q 3
K ---T B W _J
Z
Slo e
L
1 70
I
=Topsoil II
=ASTM C-33 =Clean aggregate = 4 in. sch. 40 pvc
L,:- „ Cap Material sand fill 1/z to 2 %z in. dia. O
observation pipe
Geotextile
Fabric G H
J4Kf -:K%1•~~Lf•-••J
NJ•f fti wwi~~f' F
Y•f M•.~YYYYLK
.
D
E = .
Ft Contour Plowed Surface
` Slope Direction
GENERAL INSTALLATION: The mound area is staked out along the design contour. is mowed and raked off the site. The mound basal area L x Existing
( V) is plowed with a moldboard or
chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a 1/4 inch soil wire
when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately
after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or
is placed overhead by a backhoe. Special care must be used when placing sand of
less than one foot
thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound
is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The
observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange.
10/071gj Page _S_ of__
j
Septic-Dose Wank Cross Section And Pump Performance Specifications
Tank Manufacturer Pump Manufict>=
Tank Model Number ' Pump Model Number SZ
Total Tank Capacity Alarm Maaufacturer S
Max- Bury Depth j Alarm Model Nmber 4
Switch Type ~O G
Filter Manufacturer Total Dynamic Head (TDH) - Feet
Filter Model Ntaaber ; Elevation Head
Distal Pressure D
Network Loss
Minimum Pump ~ wfommm Required Force Main, Loss
GpMI Ft TDH Total S:
Outlet Manhole Win. e Above Grade With
Looking Duce. Inlet Manhole Manhole Min. 4" Above Glade
< 6" Below Grile Sealed W'aterdak Securely Mounted Device
Weather-proof
Junction Boer
Finished Grade a~
Vent Min. 12" Disconnect
Above Grade Mesas
With Vent cap
sr,`s >•i s >is> :`s Lf>`, ~`,a `i ::>sJ>>ii<>`>s>>`'
Outlet Filter --~,i
Inlet hilet Ba$!e -
svntch Se*p and Reserve Capacity a A
Task Volume = GPI Weep
Hole
Dimension: Inches Volume Gal.
(rope) A
(alarm) B : 2 . -1? Off -Elevation C
,
: .
42 _
(close) C ' . 7, Ft - Bottom
(dead) D D Elevation
Total 2 F't
~i>a>ll<<f a<tf'<ttia{•a t<t<t{ <aaala <<f fi5<•'l<ttaa <a~>:• • t~ vf< •fl>t>fi<t ttaa<. <a ♦aa. tasal
> > > s > > > > s > > > >~fs>sy: spa>i a>:>i >t>ai>s~a>s>i f>.a>t~<>r>: a>s>i ai>i f>: a>a>s>a><i>i <i>a>a•:i i>i <>s>f>v>{>:i i i s>s>ai>i <i>i <>si>:>s>t>a>i ::a>:a'
<<aa sst ssaa
GENERAL INSTALLATION: The . septic/dose tank is bedded _ and ba& filled in accordance with the
.
manufacttu~er's product.q)lx val specifications. Maximum depth of buryas, specified by. the Manufacturer may not
have an efoc v, locking device (padlock)
be exceeded without pior. *Troval-. Manhole covers exposed to grade
installed. Piping at the inlet and outtet is of approved material, conneOad to the tank with wateZtight fittings, and
lth 4" Scd~. 40 PVC to bridge the tack
laid on stable soil top ment setdmg or swing. ' tziaim as sleeved w
Eie cxtl . complues with NEC.300 and Comm 16.2 .
excavation and the .sleeve. is sealed.waertit
Paige of
02/05 11
TOTAL DYNAMIC HEAD/CAPACITY
HEAD CAPACITY CURVE PER MINUTE
EFFLUENT AND DEWATERING
Ln MODEL 152/153 r-
w w i MODEL I 152 153
50 Feet Meters Got. Liters I Gol. I Liters
153 5 1.5 1 69 261 77 291
12 40 10 3.i 61 231 70 265
152
15 4.6 53 201 61 231
O
W 20 .I 6.1 1 44 167 52 197
30
25 7.6 34 129 42 159 .
r 8 30 9.'• I 23 87 1 33 125
20 35 10. 7 f - - ; 22 85
1
0
40 12.2 I I 1 42
4~ j Lock voive: 138A (11.6m)I44.0 Ft. (114m)
10 D143W
I
0 i
20 0 60 80 100
GALLONS
LITERS 6
p 80 160 240 320 i
3 27/32-~-~----~7s 5/8+4
FLOW PER MINUTE I r`-
3 27,/32
CONSULT FACTORY FOR SPECIAL APPLICATIONS _ 1
• Timed dosing panels available. ® 3 2i/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.
1521153 Series' 12 /5
152li53 NOOELS Control Selection I
i
i I ; 1/S
Model Volts-Ph Mode Args Simplex Duplex
N152 . 115 1 Non 8.5 1 2 or 3 --1
BN152 115 1 Auto 8.5 Included 2 or 3 sKZOes
E152 230 1 Non 4.3 1 2 or 3
BE152 230 Auto 4.3 Induced 2 or 3
N153 115 1 Non 10.5 1 2 or 3
SN153 115 1 Auto 10.5 Included 2or3 SELECTION GUIDE
E153 230 . 1 Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float
BE153 230 1 Aub 5.3 Included 2 or 3
switch. Refer m FM0477.
O CALI710N 2. See FM0712 for correct model of Electrical Alternator E-Pak.
Alt 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 elechical and safety codes should be followed including the most 4 float system.
recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). or RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
hWL TO. P.O. BOX 16347
Louisville, KY 40256-0347 Manfidcturersof..
SHIP T0: 3649 Cane Run Road
® Louisville, KY 40211.1961 r=17Y 1g6WA5 FIATT •OO
!c/
(504 778-2731.1 (600) 926-PUMP
http://www.zoeUer.eom FAX (502) 774-3624
Oc Copyri ht 2000 Zoeller Co. All rights reserved.
POWTS owNER'S MANUAL & MANAGEMENT PLAN page
or
FILEINFORMATtON SYSTEM SPECIFICATIONS
{ Owner 29t
Nq
Permit # Septic Tank Capacity ~ al 13
Septic Tank Manufacturer
DESIGN PARAMETERS Effluent Rte:r Manufacturer
❑ NA
mber of Bedrooms ❑ NA Effluent Filter Model
C3 NA
mber of Commercial Units
NA Pump Tank Capacity O al ❑ NA
fE
tima
ted florin (average) icyEO . alld Pump Tank Manufacturer _E1 Design flaw (peak), (Estimated x 1.5) qjv alld . Pump Manufacturer
Soll Application Rate /1J aUd 1W Pump Model ❑
Influent/Effluent Quality Monthly a4erage• Pretreatment Unit
Fats, Oro & Grease (FOG) S30 mg/L ❑ Sand/GMvel Filter 0 Peat Flter
Biochemical Oxygen Demand (BODE 420 mg/L ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) -5 150 mgAL ❑ Disinfection ❑ Other.
Pretreated Effluent Quality
Aik Monthly average" Manufacturer
Dispersal Cell(s)
Biochemical Oxygen Demand (SODS) s30 mg/L ❑ In-ground (gravity) ❑ -ground (pressurized)
Total Suspended Solids (TSS) S30 mg/L ❑ At-grade und
Fecal Coliform (geometric mean) s104 ct41100m1 ❑ Drip-line ❑ Other.
Maximum Effluent Particle Size X inch diameter Values typical for domestic (non-mmmnercla
septic tank effluent t) wastewater and
MAINTENANCE SCHEDULE Values typical for pretreated wastewater.
Service Event Service Frequency
Inspect condition of tank(s) At least once every ❑ months ea s
rO (Maximum 3 yrs.)
Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume
Inspect dispersal cell(s) At least once every ❑ months .year(s) (Maximum 3 yrs.)
Clean effluent filter At least once every At' ❑ months ear(s)
Inspect primp, pump controls & alarm At least once every ❑ months Iar(s) ❑ NA
Flush lat>"s and pressure test At least once every 3 0 months ear(s) 0 NA
other:
At least once every ❑ months ❑ year(s) ❑ NA
other.
At least once every ❑ months ❑ year(s) ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an Individual carrying one of the following licenses or
certillmdons: Master Plumber, Master Plumber Restricted Sewer. POWTS Inspector, POWTS Maintainer Septage
SerVkkV Operator. Tank inspections must include a visual Inspection of the tank(s) to identify any missing or broken
hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up
or ponding of effluent on the ground surface. The dispersal celf(s) shall be visually inspected to check the effluent levels
in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of-effluent on the
ground surface may indicate a failing condition and requires the Immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third (K) or more of the tank volume, the
entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of m accordance with ch. NR
1 T3, Wisconsin Administrative Code.
The servicing of effluent filters, m nical or pressurized POWTS coinPonents retreat meat components'
. P and any
other maintenance or monitoring at ir~j is of 12 months or less shall be y
performed by a certified POWTS Maintainer-
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other
chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concebtrations are
detected have the contents of the tank(s) removed by a septage servicing operator priorto use. '
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Welty and ALUATION REPORT Page 1 1410
s Yf r 85, Wis. Adm. Code
e . PfOfeSSi0nal Services Schmitt Soil Testing, Inc.
Attach Complete site plan on paper not less than 8'/: x 11 inches in s ze. n must County St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and and distance to nearest road. Parcel I.D.
Please pNnt all lnf~ Part o C=---11041-6M25
Personal tntorinatim you provide may be usW VjiO Lary pu (PrNaCy Law, s. 15.04 (1) (m)). Rev 3 2-613
Property Owner O Property Location 5
Emholtz, Gerald Govt Lot SE114, NE1/4, S15 T28N, R18W
Property Owner's Mailing Address tX Lot # Block # Su CSM#
O
1250 Cty Rd J ej DV^ " 5 SM Pendin (4.32 Acre arceQ
City State Zip Code Phone Number ❑ City ❑ Village oMm Nearest Road
River Falls WI 54022 612-483-8546 Kinnickinnic Old Cemetery Rd
® New Construction Use: E~ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material Sandstone Residuum (Hesch Series) Flood plain elevation, if applicable NA ft
General comments Area is suitable for a mound system. System elevation is WAY Based off a contour line established at 98.34'. Slope of area is 6%.
and recommendations: Depth to limiting factor is 28`.
a Boring # ❑ Boring
Pit Ground surface elev. 98.40 ft. Depth to limiting factor 34 in. Soil Application Rate
Horznon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `EA#1 *Etr#2
1 0-15 10yr3/4 none Ifs lcsbk mvfr 9W 2f lvf 0.5 1.0
2 15-25 10yr4/3 none Ifs lmsbk mvfr 9W ic,2f 0.5 1.0
3 25-34 10yr4/4 none fsl 2msbk mvfr cs 2f, lvf 0.4 0.8
4 34-59 2.5y7/4 m 1d8/1 lvfs (?s9 ml cs 0.4 0.6
5 59-78 2.5y7/2 m2181 vfs OS9 ml 0.4 0.6
❑ Boring # ❑ Boring
Z Pit Ground surface elev. 98.70 ft. Depth to limiting factor 28 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNe
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -&W -EM2
1 0-17 10yr3/4 none vfsi 2fsbk mvfr 9W 1c,2f 0.4 0.8
2 17-28 10yr4/4 none vfsl 2msbk mvfr 9W 2c if 0.4 0.8
3 28-35 10yr4/6 f1d 10yr6/2
10vr6/6 2msbk mfr gw 2vf 0.4 0.6
4 35-63 2.5y7/4 c2ia,~/1 Ivfs Os9 mi cs 0.4 0.6
5 63-76 10yr6/6 m2d 10yr /1 Ivfs Osg ml 0.4 0.6
Effluent #t.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 227429
Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number
1595 72nd Street New Richmond, WI 54017 412612013 715-760-1978
SHD-W3O K07/00)
. Property Owner Emholtz, Gerald Parcel ID # Part of. 022-1041-60-025 Page __2 _of 4
❑ Boring
Boring # Pit Ground surface elev. 96.60 ft. Depth to limiting factor 31 In.
® Soil Application Rabe
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1W
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. *EftM *Eti#2
1 0-8 10yr3/4 crone Ifs lcsbk mvfr CS ivf 0.5 1.0
2 8-14 10yr4/4 none fsl 2msbk mvfr 9w 2vf 0.4 0.8
3 14-23 7.5yr4/6 none fSl 2msbk mfr CS 2vf 0.4 0.8
4 23-31 2.5y7/4 none IvfS Osg mi CS 0.4 0.6
5 31-102 2.5y7/2 m2110g5/1 A Osg ml - 0.4 0.6
❑ Boring
Boring # ❑ pit Ground surface elev. R Depth to limiting factor In.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W
In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. *Eftst *Eff#2
❑ Boring
Boring # ❑ Pit Ground surface elev. It. Depth to limiting factor in.
fii-Al Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Ef►#2
I
I
III
Effluent #1 = SOD 5> 30 220 mg/1- and TSS >30 <-150 mg/t. ` Effluent #2 = BODS 30 mg/- 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.
SBD4330 (807/00) SdUTAK SON Te5ft, Dr-
Page 3 of 4
Conducted by: Conducted For. Schmitt Soil Testing, Inc. Name: Gerald Emholtz
Thomas J. Schmitt, CST 227429 Address: 1250 Cty Rd d
1595 72nd.St. City, State, Zip: River Falls, W154022
New Richmond, WI 54017
PhoneM717 978 PID: Part of. 022-1041-60-025
Sig18d'°~'" Lot No.: 5 ( Approx 4.3 acre parcel )
Date
■ Badchoe Pit Legal Description: SEl/4 NEl/4 S15 TUN R18W
Township, County: Kinnicidnnic, St. Croix County
A Bench Mark 1 El. 100.00' Top of PVC pipe.
Bench Mark 2 El. 100.03' Top of 13/4" galvanized steel conduit
Slope= 6% Contour Line El. 98.35' t Contour Li ngth 100'
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m i lei)
CIO~10~,~ ~ B3 5~~ r ~ 0
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J" 3
r a
L~1+~/S Ti NtT- P R l dR T c' / c S"S
ST. CROIX COUNT y
SEPTIC TANK MAINTENANCE AGREEMENT
AND .
OWNERSHIP ER CATION FORM
Owner/Buyer t Q.
Ma* Address a. Old ~ k-, e-.- f' fa
Property Address
(Verification required from Planning & Zoning Department for new construction.)
City/State Parcel Identification Number
LEGAL DESCRIPTION
Property Location V4 , V4 , Sec. T Z N R1 _,W, Town of
Subdivision Lot #
Certified Survey Map #
Vc plume ~ Page #
Warranty Deed # Volume , Page #
Spec house y no Lot line` identifiable yes no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
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, it needed, by a licensed pumper. What you put mto
the system can affect the fiction of the septic tank as a treatment stage in the waste disposal system Owner maintenance
responsibilities are specified in $Comm. 83.52(1) and in Chapter 12 - St Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix county Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, jommyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
less than wastewater l/3 ftull of disposal sludgesystem is in props operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
.
I/-, undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wiscm
Certification stating that your septic oas system has been maintained must be completed and reftaned to the St. Croix county planning &
Zoaung Department within 30 days of the three year expiration date.
Uwe certify that all statements on this form are true to the best of MY/our kaowledge
property descnbed above, by virtue of a . Uwe am/are the owner(s) of the
recorded in Register of Deeds Office.
7deed *
:~e bf bedrooms
GSA Z- /:l
If-AP'LIC
ANi'
(S) DATE
***Any information that is tuisrepresented may result M the salutary P=Mt being revoked by the Planning & Zoning Department.
Include with this application a recorded deed from the Re
glster of Deeds Office and a copy of the certified survey neap if
reference is made in the
warranty deed.
(REV. 08105)