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HomeMy WebLinkAbout010-1006-20-000 (2) Wisconsin Department of Commerce County: PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: SAN-2018-104 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: Kelly & Kristine McNamara TOWN OF EMERALD 010-1006-20-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 02.30.16.30A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM uid BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liq Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length 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 xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No E] Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 2520 170TH AVE 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes ❑ No Use other side for additional information. Date Insepctor's Signature Cert . No. SBD-6710 (R.3/97) IN unty Sanitary Permit Application ST. CROIX COUNTY WISCONSIN t In acco d with Chapert 12 St. Croix County San' Or nc PLANNING & ZONING DEPARTMENT %onal information you provide may be used for ST. CROIX COUNTY GOVERNMENT CENTER I [Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road St Cr ix County enl Hudson, WI 54016-7710 (715)386-4680 Fax(715)386-4686 Commune Attach complete plans for the system on paper not less than 8-1/2 x 11 inches in size. Cou y Sanitary Permit # Check if revision to previous application 1. Application Information - Please Print all Information Location: Property Owner Name _ J~ 6 k V~ NC L L Y' tAtv)Y) (Z 1 / J 1) e T S 3C'C 1 N, P01/4, Sec , R~ E (or) Property Owner's Mailing Address Lot Number Block Number & V z k) c cal S T City, State Zip Code Phone Numer Subdivision Name or CSM Number 1zA VcC Z GS OA Val Z P 35 Z 11 Type of Building: (check one) amity ❑ Village ®To f 1 or 2 Family Dwelling - No. of Bedrooms: 4 ❑ Public/Commercial (describe use): EN\ i= LD Al L P ❑ State-owned [Nearest Road . II. Type of Permit: (Check only one box on line A. Check box on line B if applicable) L✓~ / l%' T H A Parcel Tax Number(s) C?d A) 1.❑ Repair 2. IS Reconnection 3.❑Non-plumbing 4. ❑ Rejuvenation Sanitation 1 '6, G 00& ZE% - ©CC Permit Number B) Date Issued (M State Sanitary Permit was previously issued Z 4j 7 Z l L - / CI lL~ IV. Type of POWT System: (Check all that apply) ❑ Non-pressurized In-ground ® Mound 24 in. suitable soil ❑ Mound 5 24 in. suitable soil ❑ Mound A+0 ❑ Sand Filter ❑ onstructed a an ❑ Peat Filter ❑ Drip Line ❑ Pressurized In-ground ❑ Holding Tank ❑ Single Pass ❑ Other ❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating V. Dispersal/Treatment ea information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required' Proposed (Gals./day/sq.ft.) (Min./inch) : Elevation 7- z y,30 3 97 - cc. i 5 VI. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks El ❑ 'c, ~ ` SO 4,5C ❑ ❑ VII. Responsibility Statement I, the undersigned, assume responsibility for repair/reconnenction/rejuvenation/installation of non-plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non-plumbing sanitation system. Plumber's Name (print) Plumber's re (no sta ps . MP/MPRS No. Business Phone Number Plumber's Address (Street, City, State, Zip C r rr vc Ste: ~ YI L Sfl/ L S VC, Z AVIII. County Use Only Sanitary Permit Fee ate Is ed Issuin gent Si atur Approved Own en Initia verse -5/ZIP, etermination IX. Conditions of Approval/Reasons for Disapproval: / % Rev: 8/05 SYSTEM PLOT PLAN McNamara Reconnect Design Flow: Project Address: Attach design flow calculations for N 2529 170th Avenue commercial plans: BM1 Symb& & BM Elevation: 100.00' Pipe Materials / ASTM Standard BM Description: Top Of Well T Scale: 1" = 60' ables 384.30-3 & 384.30-5 p 60 90 120 BM2 Symbol: 0 BM Elevation: 4" SCH 40 PVC ASTM D2665 BM Description: 2" SCH 40 PVC ASTM D1785 Slope Gradient of Tested Area: 4% 1 2" SCH 40 PVC ASTM D1785 152 i Well Symbol (if applicable) Notes: 36.770 Acres i 1000/650 Septic/Dose Tank 32.38'x 84.5 Mound 2 Bedroom 4'x 64.5' Trench House Garage Shed A Well DRIVE Property Line i Shed R/W 170th Avenue MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: McNamara Reconnection Permit Owners Name: Kelly & Kristine McNamara Owner's Address 642 Willow Street Baldwin, WI 54002 Legal Description: SE1/4, SW1/4, S2, T30N, R16W Township Emerald County: St. Croix Subdivision Name: NA Lot Number: Block Number Parcel I.D. Number 010-1006-20-000 Plan Transaction No. Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and pump curve Page 5 Septic & Dose Tank Specifications Page 6 System maintenance specifications Page 7 Management and contingency plan Page 8 Plot plan Page 9 Inspection Report Page 10 Statement of Condition Page 11 Septic tank maintenance agreement Page 12 Warranty deed Page 13 Map Attachment 1 Soil evaluation report Attachment 2 House Plans Designer: John Schmitt License Number: 223760 Date: 5/14/2018 Phone Number: 715-760-0486 Signature: it i ZIC`~~l t'G~ Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD-10691-P (N. 01/01) and both SSWMP Publication 9.6 Design of pressure Distribution Networks for ST-SAS (10/81) and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706-P (N. 01/01) Version 7.0 (R. 03/2012) Page 1 Mound and Pressure Distribution Component Design Design Worksheet Site Information _ j-~-R Residential or Commercial Design Note: sand fill (D) calculations assume a _ 172.00 Estimated Wastewater Flow (gpd) Table 383-44-3 in-situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of 36 inches. 258.00 Design Flow (gpd) 4.00 Site Slope 96.90 Contour Line Elevation (ft) 24.00 Depth to Limiting Factor (in) L_ 0.60 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information j~ 0 Dispersal Cell Length Along Contour (ft) = 4.00 Cell Width (ft) ..1._000 Dispersal Cell Design Loading Rate (gpd/ftz) 1 I, Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N r o, E=: _ ~C Center or End Manifold 0.00 Lateral Spacing (ft) If N above, enter the elevation (ft) __2 Number of Laterals of the highest point. 0.250 Orifice Diameter (in) w 2.50 Estimated Orifice Spacing (ft) = 9.92 ftz/orifice 2.00 Forcemain Diameter (in) 94.00 Forcemain Length (ft) Does the forcemain drain back? Y 91.86 Pump Tank Elevation (ft) Enter Y or N 3.25 System Head (ft) x 1.3 15.33 Forcemain Drainback (gal) 5.62 Vertical Lift (ft) 28.90 5x Void Volume (gal) 1.85 Friction Loss (ft) 44.24 Minimum Dose Volume (gal) 0.001 In-line Filter Loss (ft) 30.29 System Demand (gpm) 10.73 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 Error 1.00 1.50 x 1.25 2.00 1.50 x x 3.00 2.00 x No manifold selection necessary 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Midwest _~a; Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 650.00 Dose Tank Capacity (gal) Filter Manufacturer 117.00 Dose Tank Volume (gal/in) Filter Model Number ~Mldwest Manufacturer Enter manufacturer°s name Project: McNamara Reconnection Page 2 Page 3 Of Cross Section Of A Mound Using A Trench For The Absorption Area AL- --sH Medium Sand Fill ° 1 F 6" Topsoil _.J 3 E 0 Plowed Layer Trench Of 21j" Aggregate. 6" Below Pipe. Covered With D Ft. Straw. Marsh Hay Or Synthetic Fabric E_ Ft. r, Ft. F , So Ft. H Z S Ft. Plan View Of Mound Using A Trench For The Absorption Area Force Main Distribution Pipe Observation Pipe Permanent Markers T W A ° B K Trench Of Is" 2;1" Aggregate I L C t. I f Ft. K/0 Ft. W a~ y Ft. B Ft. J ,3y Ft. L Ft. T. License Signed: _ Plumber: iao Date: J 3o n RECEIVED JUN 2419% S96-01850 SAFETY & B1.06S.. DIV. Page y Of~ Distribution Pipe Detail For Two Lateral Network Holes LocatJ On Bottom Are Equally Spaced PVC Force Main End Cap (Y 1 V-11t T ~ PVC Distribution Pipe P P X * Last Hole Should Be Next To End Cap 1 P 3= Ft. Hole Diameter - ~5!- Inch F X 36 Inches Lateral Diameter Inch(es) Y 30 Inches Force Main Diameter Inches 14i 1' ' # Of Holes/Pipe iii; Invert Elevation Of Laterals - Ft. II ~ ,x,11 YN Signed: License Number: P/Zo / PERFORMANCE CURVES, 13ARNES PUMP MODELS EH 31. SE 411. SE 421 Date: TOTµ M.AO 11[i. IT, -A I III I T6 60 1Z b • m I TT RECEIVED s to JUN 2 4 JW ,o ,,=ErY 6:1-om. DIV. S ✓ 6 - 0 18 5 0 E~`r"`». ~o m x ` ao m ~o w~ fo m Rio 454 S Page_,J7,Of SEPTIC TANK &'PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" CI VENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W/ PADLOCK & FINISHED GRADE WARNING LABEL 4" CI RISER 41' MIN. 18" IN. 6" MAX. INLET ~WATER TIGHT SEALS GAS- HT ~IAPPROVED A SEAL JOINTS WITH APPROVED ALM APPROVED PIPE B ON 3' ONTO PIPE 3' ONTO SOLID SOLID SOIL SOIL PUMP OFF ELEV. VYFT. C c OFF RISER EXIT D PERMITTED ONI IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS RECEIVED SEPTIC / DOSE JUN 2 41996 TANK MANUFACTURER : vjcs4,, Prc Ca5f NUMBER DOSES PER DAY : . ~ r~ ► Y ~ BLOBS. TANK SIZES: SEPTIC /DOO GAL. DOSE VOLUME INCLUDING DOSE, 7-o GAL. FLOWBACK: /7= GAL. ALARM MANUFACTURER: Sd j 67l~~fa CAPACITIES: A = .2 .Z INCHES = 3 7 GAL MODEL NUMBER: to/ SWITCH TYPE: McrcurB = 2 INCHES = GAL PUMP MANUFACTURER: J54rncs, C = /6 INCHES = 170 GAL MODEL NUMBER : s t q/1 D = INCHES = GAL SWITCH TYPE: M «c u~~ REQUIRED DISCHARGE RATE c7,$,0 GPM PUMP 6 ALARM WIRING AS PER ILHR 16.23 WA VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . po FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . . 2.5 FEET + -5'0 FEET FORCEMAIN X FT/100 FT. FRICTION FACTOR . ,77 FEET TOTAL DYNAMIC HEAD = I~,5 _FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH S , WIDTH; DIAMETER LIQUID .3 _ SIGNED: LICENSE NUMBER: J&Zo1 DATE: .0011i 1/88 S96-01850 Mound System Maintenance and Operation Specifications Service Provider's Name - John Schmitt Phone E7~ 15-760-0486 POWTS Regulator's Name _ St. Croix County Zoning Phone 1 5-386-4680 System Flow and Load Parameters Design Flow - Peak 258 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 172 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 258 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 3 ears Mound Inspect for ponding and seepage once every 3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished • • • • • • • • • • • • • • • • • Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: McNamara Reconnection Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals (SBD-10691-P (N.01/01, R. 10/12), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706-P (N. 01/01, R. 10/12)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1 /3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continciency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: SYSTEM PLOT PLAN McNamara Reconnect Design Flow: N Project Address: Attach design flow calculations for 2529 170th Avenue commercial plans: BM1 Symbol: & BM Elevation: 100.00' Pipe Materials / ASTM Standard Scale: 1" = 60' BM Description: Top Of Well Tables 384.30-3 & 384.30-5 0 60 90 120 BM2 Symbol: Q BM Elevation: 4" SCH 40 PVC ASTM D2665 BM Description: 2" SCH 40 PVC ASTM D1785 Slope Gradient of Tested Area: 4% 1 2' SCH 40 PVC ASTM D1785 152 Well Symbol (if applicable) Notes: 36.770 Acres 1000/650 Septic/Dose Tank 32.38'x 84.5 Mound 2 Bedroom 4'x 64.5' Trench House Garage Shed b Well DRIVE Property Line Shed R/W 170th Avenue Wisc6nsin Department of Industry, PRIVATE SEWAGE SYSTEM Es,nitary Labor and Human Relations INSPECTION REPORT CROIX Safety and Buildings Division No.: (ATTACH TO PERMIT) 72 GENERAL INFORMATION Permit oler's Name: ❑ City ❑ Vi age Town o o.: KARIS, ADOLPH EMERALD Parce Tax No.: CST BM E ev , Insp- BM Elev.: BM Description: j4. 6d - /a.CU TANK INFORMATION ELEVATION DATA A96003~FSELEV. TYPE MANUFACTURER CAPACITY STATION BS HI / ptic Benchmark /CL)- otl Se i Dosing b,-r,Q-f.Gr, 5-0 A.l C Aeration Holding TANK SETBACK INFORMATION TANK TO P / L WELL BLDG Vent to . Air Intake ROAD Septic NA E Dosing NA Header/ Man. Aeration NA Dist. Pipe / Y71 Bot. System Holding mo, ~5 , 5 . PUMPOtN INFORMATION Final Grade z. e7G Manufacturer Demand 733 r Model Number 1j ~dy[ 46)-GPM it A ,*JT DH Lift s[j5~ Friction Syste TDH99,QFt r orcemain Length?</' Dia. _O' / Dist. To well SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No- Of Tenches PIT i No. Of Pits a Dia. d Depth 1 E 7 / LE i~ING.... er. SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM CHAMBER Mo a Num e,.- INFORMATION Typeo "4 / DSO OR UNIT System: f`N $D W.- DISTRIBUTION SYSTEM v, Manifold I Distribution lie(s) x Hol Size x Holeacmi i Vent To Air Intake Length 1~~ ts~a Length .~.3 Dia. 1r. Spaun SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only iii7 jxx: De pth Oxx Seeded /Sodded xx Mulched Depth Over Depth Over No Bed / Trench Center Bed / Trench Edges psoil E] Yes ❑ No ❑ Yes ❑ COMMENTS: (include code discrepancies, persons present, etc.) LOCATION: EMERALD-2.30.16W, SE, SW, 170TH AVENUE' Plan revision required? ❑ Yes W-11o Use other side for additional information. cerZug t . No. SBD-6710 (R 05/91) Date Inspector's Signature CHMITT Sc SONS Y CAVATI GINC. 586 Valley View Trail Somerset, WI 54025 schmittandsonsexcavating. com (715) 760-0486 May 14, 2018 On May 11, 2018 the septic system at the following address: 2520 170th Ave Emerald, WI 54013 Was inspected for the purpose of reconnecting it to a new dwelling. 1. The manhole riser on the septic tank should be brought to the surface and locked. The dose tank cover also needs to be locked. The power was disconnected so the condition of the pump and controls are unknown. 2. The mound soil absorption area appeared to have been functioning properly at the time of inspection. f_ John Schmitt Master Plumber RS # 223760 ST. CROIX COUNTY SEPTIC TANK 'MAINTENANCE AGREE%IENT AND OWNERSHIP CERTIFICATION FOR\l Owner/Buyer Kelly McNamara Liailinu Address Property Address 2520 170th Avenue (Verification required from Planning & Zoning Department for new construction.).) City. State Glenwood City; WI Parcel Identification Number 010-1006-20-000 LEGAL DESCRIPTION Property Location SE , 1 SW Sec. 2 , T 30 N R 16 W, Town of Emerald Subdivision Plat: Lot Certified Survey Map # Volume Pa=e= Warranri- Deed # (before 2007)Volume . Page _ Spec house ❑yes0no Lot lines identifiable I]} es0no SYSTEM 1IAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic s}stem could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank ever}. three }ears or sooner. if needed. b} 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. 385.52(l) 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 veriA-in_ that (1) the on-site wastewater disposal s} stem is in proper operating condition and or (2) after inspection and pumping (if necessar, the septic tank is less than 1!3 full of sludge. T tve. 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 statin_ that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I we certify that all statements on this form are taste to the best of my our knowledge. I we anvare the owner(s) of the property described above. by virtue of a warranty deed recorded in Register of Deeds Office. Number of edrooms SIG-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. 041/12) , n C" IwP- F~ Sax ~rw » 3X .a.e b» s; .-w"„mw { a t » i~ ~Sw yt ,•k I PC , A >tJ # 3$2.79^ - T, ~yp `nx T i di „y . y } xJ # r ®r, qy`y' N'* ~ ` F t'YpF ; r ~ }'Y gi . , y,k8g MF . 1~ d~ t S•s a, 7~ t err x 4 fT - ~ - Milt *A Jy • • di R ~ ~ M^yry a e'~ If y J rM,S ° -C ~g a sF ~ ~ x ~ ~'e ~ e- F I)w - h i' ,r Y i~ fP-i+ s,~ 'hr. t3 C ~r 4 ~ .al ~ ~ ♦ O ~O fit., 4*W "j M- ap R 'S t C a, r, y , y^*-,rh.~J«*;1^ xr sx a 4,. r n ° . m ~ r WA il o0 n~ m E3 O c ~ rm3 o Ot w ai c O u88 ' cg O Wjs,;ohvn Department of Industry, SOIL AND 51 I E EVALUATION REPORT Pepe ~of - Labor and Human Relations Division of Safety 6 Buildings r; ~ U accord with ILHR 83.05, Wis. Adm. Code U Attach complete site plan on paper not leas than 8 112 x 11 inches in size. Plan must include, but p not limited to vertical and horizontal reference point (SM), direction and % of slope, scats or Ilk, dimensioned, north arrow, and location and distance to nearest road. , D r DBY' c:, try APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION PROPERTY LOCATION C_ !%(p PROPERTY OWNER: 5 GOVT. LOT S E 114,5W 1 a2 T 's,30,-AA C1Ci n.. f} 81v Ar ( N7~~ J~ Or , I,~F PROPERTY OW ER':S MAILING ADDRESS LOT # SUBD. a ~a CITY [O]VI OWN CITY, STATE 21P CODE PHONE NUMBER 54 j I - 9 3 ~t^a e (A New Construaion Use (~c) Residential I Number of bedrooms I (I Addition Io existtrq buI*V i I Replacement (I Public or commercial describe WV9 Recommended design loading rate D• S bed, gpolfl2 Code derived daily flow 1S-D 9Pd 0 trench, 0 - Absorption area required bed, ttz trench, It? Maximum design loading rate D •S bed, gpoltl2_.1P- trench, WW Recommended infiltration surface elevation(s) a lung, 9 ce.0 ' con ~o +.tr It (as referred lo site plan benchmark) Additional design / site considerations + " Parent material i n e S Flood plain elevation, it applicable n J - n L~q TMI( S s Suitable for system CONVFNTIOr~ MOUND IN-GROUND PRESSURE AT-cs ►oE U ~ o S ~ U U. Unsuitable tors stem ❑ S R U WS ❑ U ❑ S MU SOIL DESCRIPTION REPORT rn Depth Dominant Color Mottles Texture Structure C mistertoe ROO% faEleaPD Boring #t Horizon in Munsell Qu. Sz. Cont Color Gr. Sz. Sh. d- (0 Ground 3 - 0 ~ k - D•S Q6 elev fu l M - 4L fL y - f2 `f C br Depot to limiting factory Remarks: Boring e V jjqq 0 s dioo W 615- a Ground f>IcP Depth to limiting faces J"jk Remarks: T Name:-Please Print G U S LA 'Y1 Phone: -1-- .5- 8-13 L/ Ll I tw) A b n r 5'-r S'7 Number ress 5 LS~rer_ oats. m Signature: 3 v f - a 5- (P PROPEIMOWNER AA A ph Ka r i SOIL DESCRIPTION REPORT Pegs-1 of -3 PARCEL I.D. ar Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bot nc* Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Iend1 .v I OK2 ow m 5 MV ~jr Ol 5 6 •S" G. (o 3 19 -f a ilk Cw II 10-3, 04 Ground - 1 loyg,414 ? -5(.5i[ m C, W - 0 S 0-49 elev. g1~ft. l t)yk y drill ? Si .6-(p Depth to - ° Y~ !d - Ail ~A - 35 IS V (4 (P m Gmitirq taca~ Remarks: Boring # Ground elev. it Depth to limiting factor f Remarks: Boring # Ground elev. I h : Depth to limiting factor Remarks: Boring # Ground elev. ft Dept h to kNfing factor Remarks: S8D-6MR.0"2) r It, "I. c-c 1?1 L.a r 9.~' T aM 1 0 I c1 r ~ ~C °Q n fl't n Qrl o ~ c° 3 Pk ti h-ti Z 0 ~ N I-a1uy v. licitIz1hy, vv Vito Fast Spruce Street Wisconsin Department of Industry, INSPECTION Labor and Human Relations Gi ippewa Falls, WI 5474^9 Safety & Buildings Division REPORT ianskfe@mail.state,Wi.uS E-mail Bureau of Building Water Systems 15) 726-2549 Fax lnspecfl~ tQ~ ,a 8 1996 ss + ~7 i 726-2544 l~n~ca e 9 Namf Priem' es Ad~,rss al c ipti ownship Co~pty i'`aris Property 5 ' g~jW Emerald St. Croix Mast~p lumber N e d A dress Mas r PI ber F Na a and Address PI N i r10ma5~. US~um us` um f ~umting '5-61850 N13450 937th Street New Auburn, WI 54757 Sanitary Permit No. New. Auburn, WI 54757 NA Journeyman Plumber/Soil Tester Licensed Person's Name(s) and License Number(s) i homas D. Gus°tum, CSTM 370-1 Present: T. Gustuan, S. Gusturn. Owner's Name and Address Adolph Karis E5tirnated Daily Flour- 150 gpd 240^2 1 70th Ave. Ernerald. I 54012 nt I 0!1!r ►te, Solis veriftcat on at the rr'quest of private seyrage plan reviewer, Crave lusseff, berme of toricefmi over the description of-mUttiing provided by the CST. One soil pit was evaluated this date with the'foll6wing results rST 00-08" 10YR 412;sil, 2mshk, mfr, as. & t 08-2 V' 10YR 4/4 sii,'2rnsbk mfr; ci. 21-25" 75YR 416 sl tilt, 1misbk, mfi, 6: _ 1. 25-38" 7.5YR 4/6 si tiii, Om, mfl, wi C2-3d 5YR 416 and 7.5YR 5/3 mot. Estimated highest ievei of seasonal soil saturation is 25 Inches. Suit conditions at this site are suitabie for a mound type Systern using -a rnaximum soilloading rate of 0.5 gpd/ft` for beds and 06 g'pd/ft' fnr trcnches If there are any questions regarding this report, please contact m,!~. } , r S I Q1 : C OVF%CE ~aytNG y , Page of ' Signature of Responsible Licensed Person (only one needed) / Si na of Plumbing Cons Itan vate Sew ge Consultant Original: Co iesto: %thatappaly) sso-s192 (R. rveo) District DILHR Plumber 0 O k_aer Co'A ty/Local IrI . 0 Othe"r i --dlpzo.!wPe IIV W 3 EIObS I,M'OltRI3W 3 Utt m SIL Xtld OOSL S£8 SIL 3NOHd3l3,1 TIMAV HIOLI OZSZ O I' EOLbS IM'3HItl7J ❑tl3 - J - SZ6 XOfl Od I33HIS 31NOWON3W 619 s JNI'S.LJ3.LIHDHV NOSTI3,L3d ~Y N3Il 3JN3OIS3H V-HVWVNDW NV"Id NOI.LVONROd f M.' o a u =s - N - II b I II II 1 ° I I ,I z z I l II III ~ I I I w 0 w I ° 4 ° - ~~~e I I I ~ I, I ` I I b$a I I _ $g ~ II $g m -a ~w epee L K31- I I ° I 1, I 1 i~e~ I I I I 1 I Zi I I 4 I I . Wk-00- ~~'L. Ili I I 94z3 ~~zm I , III ' a 1 I III I I € 22 4 Ili 1 I ~ ag ga w t H - KA 4 s 4 - z a I v I z ' ~w I' I I-~ I I ' 0 I I I 1 ~ O 'An I I e i ~ J jsg yy9= 8~ i fps a ~ I ay. ~ I I IXV SC:tt'6 SIOZ/6Z/£ wm d!neu!Wpe 71tlW3 EIOKLA1'QlV-H IN3 L[b[ SEH S[L Xtli OOSL S£H SLL 3NOHd3133 3lIN3Atl HIM OZ_Z 5 O 4w £OLBS I M 619 - SZ6X0e Od 3,ddH].S 31NO"O NOWON3W 6I9 JNI'Sl3311HDXV NOS2I313d 18 N3I1 3JN3QI1.33N VNVINIVNJI1i NV-IJ N001d L5NI3 J~I7 s ~I$I o zo a a ~ II o _ i Bpi- I. wS . qe ,o° ~ I ~Ig, I I x e ~ ~ YI k M~ I I fi ' I dw ll ~r II y~ I i ~ vr °I I I I I l C --A - -x I g ei LL i-a rII ~ - - - -1 -'o 91 - - eI n e I ° I OC O WV ETW6 SIOZ/ZZ/E ~¢oadlPZ~ulwPe 71tlW3 fiOh51,41'OldN3LV3 _ LLVL SE8 SIL Xtld 60SL 5£8 51L 3NOH"131 31IN3Atl HIM OZSZ £OL65 IM'3NItl73 [1tlH 2 SZ6 X08 Od 1338.LS 31NO11ON31N 619 H.L2ION y8 I-I.I.[lOS I ~ JNI SLJ3LIHJ2IVRIOSZIflL3dV N3I7 HJN9QISINVXVWVNJDN SN0ILVA37d2I01N3LX1 r- r s r a r r .r r 1 II 8 ~I. 'I I pp ~.i 8 1(I I I ~ II I , I I~' I I ~ n i I ~ I I _ I I P.,,.e I I I C I ~ _ ~ I I III 'I i~ i 'll I! ; I I I ~ I I I I - ~ I II I~ I I I I I >1 ~ I ~ or I z i i' I L-_ ICI l i L..-. . _ III R - e II I I r. i > W f : _ = Ln = I I 'H a u~~M 3 0 'I III II II asa ~,~a',~ ~ ~ VVV ZZ=46:6 SLOZ/ZZ/£ IIIIIIIII { IIIIIIII 111111 III 8505339 Document Number Document Title TX :4427378 F' C 1062891 St. Croix County BETH PABST Occupancy Affidavit REGISTER OF DEEDS ` ST. CROIX CO., WI P i RECEIVED FOR RECORD 03/30/2018 01:58 PM Name - (Owner) Typed or printed EXEMPT being duly sworn , states, under oath, that: REC FEE 30.00 PAGES: 1 He/she is the owner/part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume Page Document Number /056/49 St. Croix County Register of Deeds Office: Recording Area I A parcel of land located in the 5 6 % of the 5`J %4 of Section Z , T 30 N N me and Retur Ad ss r - R W, Town of E a St. Croix County, Wisconsin, being duly dish n GlY►') q c T p'-1 L X171 I! 9 s described as follows (include lot no. and subdivision/CSM or detailed legal description): Sec.Z 7 3b,Q,,,,~c 3(0•77 kcie-5 A 11~ SE aF 614.) c~rce~ lOOCa - 2-0 - 0QQ v01 2 (~e~ 35Z Parcel Identification Number (PIN) As owner of the above described property, I acknowledge that a Private On-site Wastewater Treatment System (POWTS) serving the primary residence is sized for J bedroom(s) with a design wastewater flow of1550 gallons/day (DWF is based on 150 gpd /bedroom @ 2 persons per bedroom). A maximum of Z occupants are permitted; if the number of occupants exceeds the maximum for POWTS design, the system will be undersized to accommodate increased wastewater flows and/or contaminant loads and may be subject to premature failure. I also acknowledge that I will make this information available to any future parties interested in purchasing this property. Dated this. L`rv day of ►'Kity ' LP \ O I n t 4 AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) 4 )SS. I St. Croix County. authenticated this day Per onally came before me thisv day of S' • L ! the above named ~:•~~"fARy' Z i i SfinB c, put5 C-0 2n^2r a * . N 2 ' TITLE: MEMBER STATE BAR OF WISCONSFM G / to me known to be the person(s) who executed the foregoing (If not, -O~ instrument and acknowledge the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY: J= \N Community Development Department, St. Croix County S e.- E7 Notary Public, Statt- of Wisconsin (Signatures may be authenticated or acknowledged. Both are not My Commission is permanent. If not, state expiration date: ; necessary.) Date: h ad / R I i E 1 1 St. Croix County 1062891 Page 1 of 1