Loading...
HomeMy WebLinkAbout032-2185-35-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 579017 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Brunell, Christopher Somerset, Town of 032-2185-35-000 CST BM Elev: Insp. BM Elev: BM Descri Se p on: ction/Town/Range/Map No: /b6 S.. r t5,►, i P. ` 12.31.19.1582 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark nnq Ig P~ Sz Alt. BM A Aeration Bldg. Sewer ~T Holding - St/Ht Inlet $ c. J TANK SETBACK INFORMATIO St/Ht Outlet TANK TO P/ WELL BLDG. Ve to Air Intake ROAD Dt Inlet Dt Bottom Septic 7 5~ N/I ' -7 Dosing Header/Man. Aeration Dist. Pipe C715'.5 Holding Bot. System -741-5 Ljk PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cove GPM Model Number TDH Lift Friction Loss System Head ski Ft I Forcemain Length Dia. Dist. to Well SOIL ABSORPTION YSTEM BED/TRENCH Width Length N0. Of Trenches z PIT DIMENSIONS No. Of Pits Inside Dia. DIMENSIONS ~3 -7T "I., G A Liquid Depth SETBACK SYSTEM TO P/L BLDG 1 WELL LAKE/STREAM LEACHING ManufacturKp~. L INFORMATION CHAMBER OR i'.I I f Type Of/System: Q / 1 - j ) ber~ 41 -711.,., 1 : lS7SVWeK/~~6A~ ~S~ ~f/ UNIT Model N DISTRIBUTION SYSTEM .41( / Cr A- 346 Header/Manifold Distribution \ Ix Hole Size ix Hole Spacing Vent to Air take Pipe(s) 1Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over \ xx Depth xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges \ Topsoil Yes ~ No ~s ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 719 224th Ave SSom rset, WI 54025 (NW 1/4 SW 1/4 12 T31 N R1 9W) Wild Turkey Retreat II Lot 35 Parcel No: 12.31.19.1582 1.) Alt BM Description = rf c, (~G~ 2$ 2.) Bldg sewer length = -amount of cover= GD ek- ~aAk,`(~ Plan revision Required? E] Yes ❑ No 0 Use other side for additional information. L _ r _ -lO - iz, Date Inse ors S ature Cert. No. SBD-6710 (R.3/97) RECEIVED 110 D sion q'J60 County ~amital+t !Ce.Wp~gap -Safety and i3uildt7 Oi7C/col lh~!"1'Y 201 W. Wasbingtoll A✓C C 1^d r ~ ~ Madison, WI 562 Sanitary it Number (to be filled in by Co.) Aapertlrnettt of <%omtnercet State Transaction Number Sanitary Permit Application in nccordance with s, Comm. R3.2.1(2), VA. Adm. Code, submipgion of this form to the appropriate governmental ,mil is required prior to nbtaining a sanitary permit, Note: Application forms for state-owned POWYS are Project 4Address differ;,,, than mailing addtnsa) submitted to the Department of Commerce, Personal information you provide may be used for secondary urlroses in accordance with the Privacy Law, s. 15.04(1) m Stats. ` l✓~~ -*-7 / 9 Please Print All Info, on i. _Application Information Property Owner's Name Parcel # z - s- ~s -ce-SO Frnpany Owner'a Mailing Address Property Location / J O l F_ < C -'L/ r Ij - Govt. Lot , !7 t:ity, 4tate - Zip Code Phone Number /~dr y,, '/n, Section (circle one e K T _-3-Z- N; R _ 13 r w~ li. 'Type of Rttilding (eheek nil that apply) Lot # Subdivision Name Al 1 or 2. Family Dwelling Number of Bedrooms fiinc Tf---- ~ C G~ l c+-f ~ L'C•rt'~-'L~~ C.1 Puhiir./Cn nnu-mial Describe Use- .i ❑ City of 5 CSM Number ❑ Village of _ State Owned Deseribc Ilse ^ o ~'S I oy~ n} _ ~yn• -7 (11. Type of Prrmlt; (Ghee only one Itox on line A. otrtplete line R If applicable) 2 D lawtornt Only ❑ Other Modifleation to Existing Sylrtetn (explain) A. D New System Replacement System y.tem ❑ Treatment/Holding TankReP List Previmm Permit Number and Date Issued 1,K e R. Permit RenewBnnit Revision 0 Change ofPlumbe Perrnit Transfer t0 New Before. Expiration Owner 1V. 'Ty r of PONS_o~ont ntlAevice (Check all tdat apAlY) KNnn-Pressurized In-Ground ❑ Pressurized In-Ground L.1 At-Grade n Mound 24 in. of suitable soil Q Mound < 24 in, of suitable soil I 1 14olding'1'nnk ❑ Other Dispersal component (axplain)_ Pretreatment Devices (explain),_._. ;real/Treat at Area Informs faraign Flow (gpd) Drsign s-il Application Rat gilds rear Area Required (af) Diapersal Area Proposed System Elkvadon r, VI. ',Heir Info- - - T- - Capacity in Total of Man f acto Gallons Clallons Units 1 I LJ 7 S A ~i New Tanks - Exiadng Tanks !J Q ; X l~Cc1 e t'n Srptf c or Molding Tank x Dosing Chamber VII, Responsibility Statement- 1, the anderslgned, assume responsibility for installation of the POWYS wn an the attached plans. Pbtmher's Name (Print) Plumber's Signattlra P PRS Number 8usinesa Phone Number ~.'~l:'eL~st rh 1v►ctlCr!i ~l ~.~+~--zf~r .Za7V< d 7 7 3i !2e Plumber's Address (Street, City, State, /Zip Codo) V11 'ounty/Deva-rtment Use Only - pprovr~rl ❑ approver Permit Fee Date las"m lingt Signature 15 eo 11 ()sitter t3iven Rcaann for l]enial IN. Condit &~Tt~ easoss for Disapproval Q C r7 1. " Septic ank, ftk* tt fi terglid 3) 6 r r t,J ~C C V dispersal cell must all be servlcg$ / malnWned as,per management plan provided by plumber, 1 acv- - ~(e 2. ,A$'a*isck r uiMMWtS"Must. ge maintained t ` ss_perWiDllea ble code / 6~rclhianaes. Attach to cnmplcte pram for the, system and subratt to t-hr. 2my only on paper not too than a m x 11 Inches in size sill)-b3911 (R. 02109) Tv P o ~-a I-J a~ /UUL"5 ~l~ ~t L ZyCt.u ~ '7 clold CA- h~ Tv P c F ~a c4 a trrs L~ 6~i 3 a I CIO C. ~.`a g ,z g° ,7 rz G ten t 1 ~2 a. -7 9`1- } Soil Absor on S ste Cross Section X74ed le 40 Pipe cap Leaching ft Chamber Sysgys Elevatlan ft 3 ` ft Boll AberIMAO0 SV$tBl111 Pi$17 View 7~~ ft I Leaching Trench ft Vent Or Observation Pipe Chambers 4" Die. Trench 2 Header l.eachins~ Ghnbe~ St~cations e~ Manufacturer And Model Soil Application Rate _ gpd/sq ft FISA Rating sq 't per chamber ,5'D EISA Chambers gpd Design HOW A - Soil Application Rate . _L__.- 2 rows of chambers each. 1 Rage of I` RECEIVED `y SS 2405 Wisconsin DeAKn&7of ®P~ SOIL E RT Page 1 of 3 + 5 PS 385 - in Soil & Site Evaluations in accordance with Gerr+rrr85, Wis. Adm. Code county (q C@V5k Tnot less than 8'/2 x 11 inches in size. Pla St. Croix ~"u e- but not limited to: vertical and horizontal reference point (BM), directio percent slope, scale or dimemsions, north arrow, and location and distance t( Parcel I. D. 032-21 -35 00 Please print all information. Revie Da;/////-5 Personal information you provide may be used for secondary purposes (Privacy Law, s. wed vl~;(~_ Property Owner Property Location Christopher Brunell Govt. Lot NW 1/4 W 1/4 S 2 T 31 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name CSM# 1844 45th St. 35 na Wild Turkey Retreat II City State Zip Code Phone Number City Village ✓ Town Nearest Road Somerset WI 54025 Somerset 719 224Th Ave. ✓ New Constructior Use: ✓ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable na General comments and recommendations: Site suitalble for in-ground POWTS at 0,6 gpd loading rate. Recommended elev. = 94.5'. Replacement area identified by previous soil evaluation and sanitary permit on file. ❑ Boring # Boring ✓ Pit Ground Surface elev 99.89 ft. Depth to limiting factor >1 08 in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPDff in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh 'Eff#1 'Eff#2 1 0-10 1Oyr413 none sil 2fgr mvfr cs 2fmc 0.6 0.8 2 10-24 1Oyr3/6 none Is Osg dl cw 2fmc 0.7 1.6 3 24-30 1Oyr4/6 none Is Osg dl cw - 0.7 1.6 4 30-108 1Oyr5/4 none s Osg dl - - 0.6 1.0 H#4 contains 1/4" - 1" bands of Osg 1 Oyr4/4 Is spaced at 4" - 10" interva ou o horizon. Loading rate adjusted to reflect reduced permeability of hori associated with banding. ❑ Boring # Boring ✓ Pit Ground Surface elev 99.39 ft. Depth to limiting factor >1 02 in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structur( Consistence Boundar Roots GPD/ffi in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh 'Eff#1 'Eff#2 1 0-33 1Oyr4/6 none s Osg dl cs - 0.7 1.6 2 33-102 1Oyr5/4 none s Osg dl - - 0.7 1.6 41, II Site cut in preperation of house construction. Effluent #1 = BOD 5 30 <_220 m /L and TSS 0 < 150 mg ' Effluent #2 = BODS< 30 mg/L and TSS < 30 mg, CST Name (Please Print) S' nature: CST Number James K. Thompson Address A.C.E. Soil & Site Evaluatio Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 8/3/2015 715-248-7767 Property Owner Christopher Brunell Parcel ID # 032-2185-35-000 Page 2 of 3 3] Boring # Boring ✓ Pit Ground Surface elev 97.87 ft. Depth to limiting factor >92" in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ft' in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *Eff#2 1 0-10 1Oyr4/3 none sil 2fgr mvfr cs 2fmc 0.6 0.8 2 10-26 1Oyr3/6 none sl 2fsbk mvfr cw 2fmc 0.6 1.0 3 26-44 1Oyr4/6 none Is Osg dl dl 1vf,fm 0.7 1.6 4 44-92 1Oyr514 none s Osg ml - - 0.6 1.0 'LL n H#4 contains 1/8" - 1" bands of Osg ell 10yr4/4 Is spaced at 4" - 10" int rvals dow horiz n. Loading rate adjusted to reflect reduced permeability of horizo associated with banding. ❑ Boring # Boring Pit Ground Surface efev ft. Depth to limiting factor in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ft° in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *Eff#2 ❑ Boring # Boring Pit Ground Surface elev ft. Depth to limiting factor in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ft° in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *Eff#2 Effluent #1 = BOD > 30 <220 mg/L and TSS >30 < 150 mg Effluent #2 = BOD 30 mgiL and TSS < 30 mg. The. Department of Commerce is an equal opportunity service provider and employer. Ii Non need assistance to access services or need material in an altemate format. please contact the department at 608-266-3151 or TTY 608-264-8777- 5BD-fi?10 (P 0- 00, A.C.E. Soil & Site Evaluations 33rr- 5ri.~ l ✓k ~uk"~i'lirl~Dii~ C/ 11 t Q~ r h~ ` e~v5:5~oP~Ccr ~ur/el~~r'oj4 71 42 ~4 • p~ 0 ,~1 tom; q cvl~y 3 c~f's; 5ec. 731,, . ,e /9~•, . -~orner'SGL s ~.4a~X Co; cvl. b` d~ ~a GI. ~ 031- 2~fIS- 3s-ccn 3 (~Cl cc~~' ~~d~ CcIGc.J~vur~ Gara~t QCGeSs fD /QS.aLLr1C¢. - V' G~ ' Assu m cci .e ).u,! _ /!XJ p ~ , ' , SG.d r ~ :u D connrrl-col , .g ion county 201 W. Washington Ave., P.O. Box 7162 ~-7e X Madison - Sanitary Permit Number (to be filled in by Co.) S o" t ME ;579D/ 7 Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental AA- unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary purposes in accordance with the Privaa Law, s. 15.04(1 m , Slats. L Application Information - Please Print All Info tion Property Owner's Name Parcel # C7 _Y1 Property Ow/nerr"ss Mailing Address' 1 y~ Property Location l5 < (1 Z-71 < T l Govt. Lot I City, State Zip Code Phone Number L/ ,t 7 C /Ij~ Section l ~ -~Q e l s' .t'_ 7- Zej t, f C u .ra J~ 7 / 5 7 6r 0' <J -2 :43 (Check One) ll. Type of Building (check all that apply) Lot T f N; R ! `j ❑ E OW ©1 or 2 Family Dwelling -Number of Bedrooms/ Subdivision Name fY~ Public/Commercial - Describe Use t\~/~/ Block # -1-1a y 1 t , h'e, -1,- ~Ci City of ❑ State Owned-Describe Use CSM Number ❑ Village of w J o ~ 5 ~ Town of ~5e 77, e ~ z III. Type of Permit (Check only one ox on line A. CB if applicab 70;~ 110- X_ I A. New System ❑ Replacement ❑ real nt Flolding%ank ent Only ❑ Other Modification to Existing System (explain) System i B. ❑ Permit ❑ Permit Revision C ge Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber ew Owner , ( L Expiration 1 C?- IV. Type of POWTS S •stem/Com onent/Device: Check all 1 t V Non-Pressurized In-Ground ❑ Pressurized In-Ground [:1 At- de _ E] ❑ Mound 124 in. of suitable soil Mound < 24 in. of suitable soil Holding Tank Other Dispersal Component (explain) treatment Device (explain) V. Dis ersal/Treat ent Area Information: i I s C-_ K - 6 ^ r T K-" .v-e e. _-~f Design Flow (gpd) Design Soil Application Rate(g sf) Di Area Required (st) Dispersal Area Proposed (st) S Elevation VI. Tank Info Capacity in Total # of Manufacturer Material Gallons Gallons Units J/, Ja~ New Tankvs Existing Tanks p 1'~ Gddtx.7 G l> f - L ~G~i~/c v' r?lv Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumbe r's Signature MP/MPRS Number Business Phone Number LPJ.. ll 6Y/ S~c /t 1-r. ti ~Li.GC,~_--' Plumber's Address (Street, City, State, Zip Code) le'7d 5'CeZZ-Xgf ~d ll/ L U G' ?Approved . Couu '/De artment Use Only _ D' roved Permit Fee Date ssued Issuing nt Signature er Given on for Dem 1 $ 75 - 06 , /S IX. Condit asons for Disapproval 1. Septic tank, effluent fifter and 3) - ~ ~°~t° ✓e dispersal cell must all ll rv es ! am lntainK! as per management plan p by plumber. 2. Ail 6*ft It r_WPments must; be#rtaintaw as per applicable code / ordinances. Attach to complete plans for the system and submit to the County., only on paper not less than 8 I/2 x 11 inches in size a r + SBD-6398 (R. 01/07) Valid thru 01/09 JUL ~09 2G~~i vr, I7~s~c~,ti',e(l ~c)TS 'juri;zy ,qe-7r 7-e> ~0 lam` i ~ .v j v ~c ~IS4 C4 14 I L / s-- q 17&1 711-7 CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: A !r. 5 e- 0, Owner's Name: -G%/ S 1~f1 5 T` Owner's Address: ti,-) ip e7 Z,,,, Legal Description 4,c t 'G4, ~`!c~ 'rj ` 4) Township: G Wf 3 C County: !5'7- X Subdivision Name:e~ y0. Lot Number' . .5- Parcel ID Number: G3 Page 1 Index and title Page 2 Plot Plan Page 8 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber; dc's l l~ ct ~z7 ~r CciNa`~ kicense Number: _2 -7 4' VO Date: / Phone Number -7! 57- :7i2/ Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01101). Page 1 y c c~ Sy 6".,v e- l c~T -q. ' u, c,-r- 0 I ~ v All, N 16 h i w C-) CL o CD --j cy- a_ LY g wo v)3C-4 EL ! N W= m Z O O dY. g o d z 0 0 0 o o U) C) ~ ~ L5 0- a E75v O0a 0a- =D ¢ i cli c+') O III- M _ j J O U J co M C~ C=; M U ~ N U :D O N ~ Cl) 1 ~ N O U ~ O N V) O CD CL ZO W ~ U U W ¢ U) iX z ~ 0 O 2 oz5 U) ~ U) O ~ J Z \ U W Z O _ o ¢ H~ ~I U u ::D - 0 Ur LLJ CO z z W N U) J o O d U) = N O W Z Ln i LLJ c,4 a- O j a: Z w LL. co d U) t¢-w0 :E LO N J c ' ofa~ ~O~< CD zF--i N F- W J M L ~ : H = J Q Q O ::D LCD n 0_ = 0 co ~ I,lu' ~ VIII III!r:_ ll~II~.,If.VI ~JII Il_I:!. I ~ ',"I Ij. . o ®~~III~~'~1~i~1~~~~llfd"~~~~ll~fli~ I ~ ~~!'9u uV~ I II ~~~]ll~~1LilVV'uV I IT I .I ~LI I~ ~ 1~~~~ III I I', IIII ~ SCI?.I I !I~~ I I i I I II f~1 I~ ° o ; I.VI.~1./',9~1L. o I I'..[ ~ o II II _ ,.~1fl~ol II 1, ' 'I~.. I I 'pi II Obu E ~ U _ O t7 O C-j E N N O U N U C5 O L q O N U N ~ O N O O ~ V U Q) c7 C'-J C9 co I 11 ~ ~ III I I I~ I i 'i fll I I I Ili Ili Lfi } + I I VIII I I I I I l Ill I I I~ U III m I~ r. I I I~ 1~I,,' I i I III III IIII I~ I II I III"I I I II 'I Cl) d~P ~v VI ~I IIII III l"I, II~ ~1~ J. I I I I IIII II I I C I I I v~L~.~aQdl cu Ial' V ~I~ I, t I u 11 jIJL~GJ. L~u.~l ~U~u~uu V ,.~J VJ J l 1 I.I. ~.:~,J A, ~ co V F 44111 1 I4 U F 6' III : ~ r ti U D®R10k~F7L09 E~ V OCD .It r 'I _lill (IIII I L' I II II II ~V 4 1~1~lfrf I ~I !..IL ' I II1I~II " ~.°I f I I Ir I I I O u lk~ 1 llI I I~~~~'ll ~ I k','il IIII III 4 IIII I IIII I , II~'l~ _ II I I ,III ~I'II hi l~....l~,fi. III IIII VI. CD U N ti oc, IplIf y~, \Jp~ 1' U 0 u ~ LLJ a I A p q co ~r ~l~ 19 ~~i~rl l l~e~l /ii"l l~ d d~✓~ l rl (r rl r ~ %l 11 l~ ll!l l pr / U 6 rn N CID \ r LO cn N O U J C) H Z U D U) CO U Z ¢O H c C~ U w f~ Lc') Cl) - w O o O li w ~ ¢ CO ft~ ILL. U O U' ~ W w ¢ p F Y U p elf Lf_ S ~~l l rll ✓ l r lr rrr ~~psA / l' ~ / ry r r r r F- LLI O 00 l f rrl/ l' l' ~ rl (l~ ~ ( l l ll~ Lr- lf) LL? ~il /llll q lh ~y~~lalr /®~lr,~~~lr~~~ llA„/ l Q W oM rn LO O /'p U rr r „>✓o~ N n n rl / f l r l rl l r l~ ~ ~ r~l tl✓r l" //r d~ln l l r l/r~l/~ /r / ~/r N O r Q l GG6 ~i pd rl rrr /ir / l/r / J_ ~ ~ LL ~r~JfY/lrrl llf'l~~l ~ ~ ~ Z Lo LD l~~ul l Gu G ~~G U? O w q~ J M a' fY LLJ r J d J m J_ J Y d Q if L L OJ Z J J 101, OR o a Q o 0 0 PER -j cr 11-- -J F- d a Mi U I--- 1 Soil Absorption System Cross Section ~l,-0 ft Final Grade 4" Schedule 40 PVC Vent Pipe With Vent Cap ft Leaching Chamber ft System Elevation ft S` ft Soil Absorption System Plan View y ft 3 ft t S'' ft Leaching Trench 9 Vent Or Observation Pipe Chambers Die. Trench 2 Header Leachina Chamber Specifications Q ~.)S Manufacturer And Model, l~t-a. rn EISA Rating IWO sq ft per chamber Soil Application Rate 7 gpd/sq ft gpd Design Flow + 1? Soil Application Rate 3 EISA Chambers 2 rows of 1C chambers each, Page of POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of _ FILE INFORMATION SYSTEM SPECIFICATIONS Owner e 1 Septic Tank Capacity 16co gal ❑ NA Permit # Septic Tank Manufacturer G ❑ NA i ? t_.t' DESIGN PARAMETERS Effluent Filter Manufacturer ®j a ~t ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units A Pump Tank Capacity A J4- al e<NA Pump Tank Manufacturer 'ArlA Estimated flow (average) ,3ab gal/day Design flow (peak), (Estimated x 1.5) `JZ) gal/day Pump Manufacturer e%ehA Soil Application Rate j) , al/day/ft' Pump Model A Standard Influent/Effluent Quality Monthly average* Pretreatment UnitA Fats, Oil & Grease (FOG) 530 mg/L 11 Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODJ 5220 mg/L ❑ NA 0 Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODJ 530 mg/L IR In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Conform }geometric mean) 5104 cfu11 OOml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y in diia. ❑ NA Other: ❑ NA Other: ❑ I Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank(s) At least once every: ,yea (s )(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA year(s) Clean effluent filter At least once every: 3 13 month(s) ❑ NA _ N year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and ressure test At least once every: ❑ month(s) 11 NA P ry❑ year(s) Other: ❑ month(s) ❑ NA At least once every: 11 year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal call(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. 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 that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a Septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers rernoved and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the rea'3cement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has .h- POarTS moil and site ~onl.romnnt nron If nn rnnl -kip- a hnl(fino tank ❑ 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> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name j / t z , lu- SC l~~c 1ltz~f T..~ Name Phone 7 _ TF 7 3 f / Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 5-f . CCa : Phone Phone 1619C V d- This document was drafted in compliance with chapter Comm 83.22(2l(bI0)(d)&lf) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COU_N7Y SEPTIC TAN INzALN7ENANCE AGREEMENT -AND O-VVNERSPEP CERTIECATION FORM O-wner"Buyer ~ ~ _>t J.y bke V j' 1 ~rv ' ~ MI a inc Address C T ff dam-- Jam.- ?7_o?erL1, Address (Verification required from Planning & Zoning Department for w construction.) j Parcel Identification Dumber City,/State L •EC_4.L DESCRIPTION Proper L ocaao>i X_ Sec. _a; T ?~r R~W, Town of ~ c ywe, 11,,Lot . 1.1 -17iSlon Plat 11kV `J E IV ~ , Page Certified Survey lY.tap N~ Volume (before 2007)Volume , Page # Warranty Deed Spec house -D D yes Ano Lot lines identifiable 'yes 0 no TSTE_M NLkLNTE_T,kNCE A rD ® ER CERTIFICATION S 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 emonsibilities are specified in §SPS. =E3_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 vvstewater 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. llwe, the undersigned have read the above requirements and agree to mahotaim the private sewage disposal system with the standards set fog d4 herein, as set by the Department of Safety And Professional Services and the Department ofNatmal 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. Iiwe certify that all statements on this ` rm area e to the best of r y/our knowledge. Uwe am/are the owner(s) of the property descriE.ed above; by virme of a w t<- deed recorded in Register of Deeds Office. Number of bedrooms SIGN_gTGRE OF APPLIC_ANIT(S) DATE `Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department xxx nciude wi his applicator a recorded -warranty deed from the Register of Deeds Once and a copy of the certified survey map if r-;ferenc~-_ is made in the war mty deed.. \ 9 , - Z F. 21 CD c ~ LOT :35 LOT e36 0 A r, . p 4b 12' 0, 6 9' 2,316 4 89'06 44" IW 1[ 339.95` it ifl TWX AFir-` it ir1n-3if--v\x rte" Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include. but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. r percent slope, scale or dimensions, north arrow, and location and distance to nearest road. e " wed by Date Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). . 1 Property Own , Property Locati ) 24- /p1112 . Govt. Lot 1/45k 1 /4 S T3 l N R E (o W Prope er's Mailing Address Lot # Block # Subd. Nam~or-CS j7 City State Zip Code Phone Number ❑ City ❑ Village Nearest Roa c2c) c Sz> G fL New Construction Use' Residential / Number of bedrooms -Code derived design flow rate ?E1 Replacement ❑ Public or co m rcial - Describe: Flood Plain elevation if applicable - It -1 Parent material l L~ General comments and recommendations- __j,~~-~. ce elev. _ 3-ft. Depth to limiting factor > in. Boring F 11 # r Pit Ground surface Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color i Gr. Sz. Sh. `Eff#1 `Eff#2 r i - i i~ • W'~ J i F7--]Boring # Boring ' Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture I Structure Consistence Boundary ROOD GPD/ff ,Eff#1 'Eff#2 -11 in. MuIn Qu. Sz. Cont. Color Gr. Sz. Sh. S ,7 I Effluent #1 = BODS > 30 < 220 mg/- and TSS >30 < 150 *,Effluent #2 = BOD < 30 rrg L and TSS < 30 mg/L CST Name (Please Print) Sig CST ST Number Bird Plumbing, Inc. Shaun Bird 226900 Number Address Date Evaluation Conducted Telephone 715-246-4516 1008 192nd Ave, New Richmond, WI 54017 Parcel ID # Page of Property owner _ Boring ~l 13-1 Boring # 1 "ft. Depth to limiting factor _ in. Pit Ground surface elev. J-~- g Soil Application Rate Horizon Depth Dominant Color Redox Description Texture + Structure Consistence w Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. § •Eff#1 'Eff#2 17 CIS I f T T ❑ Boring ❑ Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ~Rplicafion 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 Avolication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots tE GPD Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Effluent #1 = BODE > 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 need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (8.6/00) _ r Soil Test Plot Plan Project Name P.C. Collova Blyds. Inc. Shap ird Address P.O. Box 489 Somerset Wi 54025 M #226900 Lot 35 Subdivision Wild Turkey Retreat II Date 11 /18/04 N W 1/4 S W 1/4S 12 T 31 N/R19 W Township Somerset Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1/2" pipe System Elevation 96.0/95.8 *HRpSame as Benchmark Alternate Benchmark Top of 1/2" pipe @ 99.9' Pro Town Road Scale is 1" = 40' 40' unless otherwise B.M. 50' B-1 30' noted 10' 1t.B.M. 5' 90' B-3 2% Slope B-2100' 101 408' Property Line Please note: Lot lines were not adequately staked at the time of testing. Installer must verify all lot lines and setbacks before installation! B.M. TOP OF 360 HAUIUS IRON PIN ELEVATION TEYPORARY 987.24' CUL-DE-SAC EASEMENT, 10 BE • W 1/4 CORNER OF SECTION 12, REMOVED UPON FOUND 3" ALUMINUM MONUMENT NORTH LINE OF THE NORTHWEST 1/4 OF THE SOUTHWEST 1/4 E%ENSONY OF S 89'06'44" E 1339.17' ROADWAY 361.86' 360.26' 1 66.0 % I 551.05• / -722.72'- 625'1.407, I I 1 / TO CENTER OF f I / I 1 EASE.4NT U 80' RADIUS TE!.1PO.RARY BLOTSO.OFT. I lr l l 1L0=98..00' LOT 28 CUL-DE-SAC BE w u 3.01 AC. 131058 SO, FT. EASEMENT, TO 3.00 AC. REMOVED UPON O 1'rSTERLY U EXTENSION OF LOT 29 ROADWAY N 731754 S0. FT 0 3.02 AC. C~ N 89'21'04" W 599.04' z 279.20' 319.84, 567'33'001'! 86 .54 I TO CENTER ~ B.M, TOP OF 3/4 EASE).IENT IRON PIN ELEVATION c' -S 89'57'58" W - - - - _ 998.04' ~ 193.98' ` n ~ o M A 24Th 193.98' n E \ / \-N 8957'58" EA- --~-~U~ cs 3Ls0 oz so. 7 FT. LOT 25 131068 SO. FT. / 0 \ \ - / \ / ,,~o oh 3.08 AC. - 3.00 AC. B.M. TOP OF 3/4' rn IRON PIN ELEVATION w Z - _ _ - - 23,/.j / a 997.77' o 83'20'23" V ID G zo z o J 535.03' J C, ^ O I' N n; LOT 31 DO.993.OD' \ ! o rTj :E m 137273 SO. Fr. I \ LOT 26 ' 0 0 ID N N . j I I / L-° 315 AC. \ C) 131230 S0. FT, / N - -N 89'33' S 7" W W I W B.M. TOP OF 3/4• 3.01 AC. / - _ I X06 D A 2 O IRON PIN ELEVATION tpg 33' ZO rn N 947.90 452- 108.90' 77 OZ E / \ C \ \ , g:i//NV ~C-a =-S 89'33'57" E O a y 124 ~ / ~ i \ \ \ ~ ~ \ \ \ ANC 1~' N0 w. ~ ~ \ \ S 6 6 LOT 32 / / 60 /140495 SO. FT. 3.22 AC. Z i lc~ LOT 35 LOT 36 ,o ~N a J 130965 SO. FT. 130921 50. FT. 'a LOT 33 N 3.00 Ac. V 3.00 Ac. 130918 SO. FT. N LOT 34- 3.00 AC. c~ p 130834 SO. FT. 2 100 AC, cO428.09' 455.12' 220.69' 236.06' z N 89'06'44" W 133 .95' 0 0 UNPLA T TED LA1 DS j ~[UA I _