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HomeMy WebLinkAbout022-1015-70-200 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 404965 0 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: 70 — d P.C. Collova Builders, Inc. Kinnickinnic Township 0224019"A■900 CST BM Elev: Insp. BM Elev: BM Description: r i6 i o � � • _ 5 e L UA TANK INFORMATION ELIWATION DAT TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 2 ,C _ I /o , 6 Septic 3 Benchmark / no O Dosing CO Alt. BM �f�" a! I g. _K /. 2T 17- Aeration = Bldg. Semler 3 S,3 7 J1 Holding SUHt Inlet 2 �- TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 'trr r i Septic , / 1 Dt Bottom 9� 7 fi Dosing H 01.9f /. oS 106, Aeration Dist. Pi � "� Q 1 p ` 1 c "l A /O /. /00 7 Holding__ - Sot. System 0 i �.�� /60.2 Final GraS]s� PUMP /SIPHON INFORMATION (Qi,� �4�� I /tq/• Manufacturer Demand St // Cgve 710_ q O GPM Model Number ,ON /15-2- 2.0 2. � , 7S 1 TDH Lift / Frictio Lass- S TD • Ft Forcemai6 Len , Dia Dist. to well r�, U 2 NOT SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches � PIT DIM No. Of Pits Inside Dia. Liquid Depth DIMENSIONS � / �6 SETBACK SYSTEM TO P/L jtJLDG WELL r LAKE /STREAM A ING Manufacturer: INFORMATION I CHA ER OR Type Of System: / ./� A) / u Model Number: J �/ v 7 E'r DISTRI ON SYSTEM .tPi4_ d Heade WMa'old7 Dist ribution x Hole Size x Hole Spacing Vent to Air I ake N Pipes) � n it Z P Length Dia Length J Dia ' (j Spacing ! ` ;�� SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only r / Depth Over t Depth Over xx Depth of xx Seeded7Sodded xx Mulc Bed/Trench Center ��,� Bed/Trench Edges Topsoil Yes No ] Yes I No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 1 10 b Inspection #2: to 151 Location: 529 90th Street River Falls, WI 54022 (NW 114 SW 114 6 T28N R1 8W) NA Lot 2 i l 6 ``mil Mot if - r � o 06.28.18. N tD� 1� S� 1.) Alt BM Description =�op of 'i` U*11 ,ah'� Alat od inj a frtl / � ►► Off 11 4,4 f 2.) Bldg sewer length = 30 - amount of cover = 35+ + 3.) Contour = qg 9 , Plan revision Required? Yes I No `O IO rm t - Use other side for additional inf o a Ion. L___ Date Insepctor's ignature Cert. No. SBD -6710 (R.3197) Safety and Buildings Division County /! ar 201 W. Washington Ave., P.O. Box 7162 . (r i ' ` Iseansi n Madison. WI 53707 - 7162 Site Address 6 D of Com merce a 6 z 8// Z a Per Sanitary Permit tf0 r Sat luary mit Application a � S In accord with Comm 83.21. Wis. Atha. Code, personal information you provide ❑ Check if Revision may be used for secondary ses Privacy Law, 05. l m I. Application Information - Please Print ,kU Information State Plan I.D. Number Property Owner's Na n 1 o Parcel Number Property Owoer's Mailing Address Prope Location -7 J G 4 j Ld u 54 • S !'J Tag N. eE City, State Zip Code umber °vNE %Number Block Number f S � . C' NG ivision Name CSM Number 1 J //J / I II. Type of Building (check all that apply) lv�p °iw ❑City 1 or 2 Family Dwelling - Number of Bedrooms ❑Village ❑ Public /Commercial - ribe Uses ownshi ❑ State Owned ` -" "'�" to i tl ate mad M. Type of Pe ta#t: (Check only one box ion Hne (numbering scheme for internal use). Complete line B if applicable) A ' 2 ❑ Replacement System 3 ❑ Replacement ; 6 ❑ Addition m For County use stem 'ran 20 Existi S stem B. ❑ Check if Sanitary Permit Previously Isiated Permit Number Date Issued IV. Type of Permit: (Check all that apply :�(mmnbering scheme is for internal. use) — 1 ` 44 ❑ Nott - Pressurized In -Ground �lrlound 47 ❑ Saul Filter 50 ❑ Constructed Wedand 22 ❑ Pressurized in- Ground 41 ❑ Holding Tank 48 ❑ Single Pass S1 ❑ Drip Line 45 ❑ At -Grade 46 ❑ ,Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. reseal Are Inform ations Design Flow (gpd) Dispersal Area Dispersal Soil Application Percolation Rate System Elevation Final Grade Required Ptopos� Rate( Gals. / Days /Sq.Ft.) (Min./Inch) Elevation 6 Z / S� VI. Tank Info Capacity is Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanlrs Septic. or Holding Tank Dosing Clamber '7/1 VII. Responsibility Statement I, the undersign pomboty for installation of the POWTS shown on the attached PlumbName (Print) Phsmbec's S' MP/1vIPRS Number Business Phone N r t Z zd G� Plumber's Address (Street, City, State, Cod > i rq O)? VIII 1De artment Use ON Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) eb ❑ Owner Given Initial Adve rse: Determination 3 m A Z n /� dlt�R� q s pp %�p °w�coti @pPr . al P2.- 4rfttC� _ 1� Attach complete plane (to the County only) for the system on paper sot leas than 8112 z 11 loche s in size SBD -6398 (R. 05/01) HEAD/C S HEAD CAPACITY CURVE EFFLUENT MODELS ■ ■ ■ ■�mm0omo0amm0�0 ©m0moo000 ■ \N ■ ■ ■� ©mmmm ® ©mo ®omm ®m ©m ©om ©m ■ \ ■■ = mmmm ©m ©mo ®o ®m ®000mm ®mo ■ammo ©mmm ©m ©o ® ®mo ®mm ©mm® ■ ■■ ■�ommmmmmmmmm0000mum ©mmm ommmmmmmmmmmmmommmmm=in •� ■ ■ ■ ■ ■ ■�ommmmmmmmm�smmmmmom ©mmm ' \� ■ ■�■■�o ®mmmmmmmmmmmmmmm ©mmm® o ®mmmmmmmmmmmmmmmmmmmm • �� ■� ■ ■�ommmmmmmmmmmmmmmmmmmmm ■ \ \ ■► \ ■�o ®emmmmmmmmmmmmmmmmmmm ■ ■�, o® mmmm MM IM ��■ ®mmmmmmmmmmmmmmmmmmmm ►` mmmmmmmm ■ 1■�mmme�mmmmmmmmmm ■_■ ■� ■�mmmm .. ■ \\ \III \1 \ \ \ ■ ■ ■ ■ ■■ m0m0m�m�m0m0m0m© ■ \ \ \!�1�1 ■ \■ ■ ■ ■ ■ ■■ m ©mmm ®mmoomomM \' \ \� II �� I ■■ V \ ■ ■ ■■■ omomm ®mmoo ®mm® ©m ■\ \III ► \`� ■■ \ \ ■ ■ ■■ mmmmmmmmoommmMUM ■� �� 1111 \ \ ■ ■ \� \ ■ ■�■ mMUM== moomom ©©m ■ \�� 11► \I I■ \ ■ ■\ \■ ■ °m©®om ®mo ©m \ ► \�1►1► \! \ \ \ ■ ■ \ ■ ■■ mmmmomm ®oommoo ©m -MI \\ Mil I\ �0��\ \ ■■ mmmmmomm ° ° ®mommm ©m • eammmmmmmm ® ©v ©mmm . -.. m=am mmmmmmmmmoan to less than 30 feet \�� 111 � � ���■■■��■ mmmmmmmmmmmmmmom ': NOTE: For on proof pump, see SEWAGEAND mIM DEvvAi ©mmmm ®mmmmmm ®o ®mmmmmmmm ® ®m mmmmm ®m ®m ®mmmmmm ®m ®mmmmomm mmm ®moomomommmm ® ®omom ®mmmm mmmmmmmmmomom® ©mmmm ©mmmomo ,�\ mmmmmmmmmmmmmmommmmmmom ® ®o ommmmmmmmmmmammm ®mm ®mm ®mmm mmmmmmmmmmmmmmmmmmmmmmmomm Model 293/4293 should not be subjected to less than 15 feet TDH. m ®mmmmmmmmmmmmmmmmmoommm ®m ... o ®mmmmmmmmmmmmmmmmmmmmomm® m ®mmmmmm ■mmmm �`_ PLOT PLAN ?:C. Collova Builders Inc. ADDRESS 507 ctv rd E Hudson Wi 54016 4 SW ' 6 /T 2 /R 18 W TOWN Kinnickinnic COUNTY ST. CROIX RS Shaun Bird 226900 DATE 3/6/02 BEDROOM 3 CONVENTIONAL IN -GR D PRESSURE CONVENTIONAL I L FT HOLDING TANK MOUND )= SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A-1 ❑ BOREHOLE O WELL •H. R. P. Same as Benchmark SYSTEM ELEVATION 100.9 'Scale = 1 /4" = 10' Cn Tank is to be properly bedded o and provided m with lockdown covers with r approved m warning labels Pro 3 Grading is to be Bedroom done to divert House runoff away from system Huffcutt 99 Combo tank 2% B -3 Slope Area 15' below system is to remain Well is to undisturbed maintain all setbacks found in Comm. 83 B- B- B -1 472' Property Line B.M. #2 Safety and Buildings t 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 �sconsi►n www.w w ww.cornmerce.s tate. wi. us/sb isconin.gov Department of Commerce Scott,McCallum, Governor Philip Edw. Albert, Secretary March 14, 2002 CUST ID No.226900 ATTN. POWTS Inspector ZONING OFFICE SHAUN R BIRD ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/14/2004 Identification Numbers Transaction ID No. 711665 SITE• Site ID No. 641896 PC Collova Builders Inc Lot 2 Please refer to both identification numbers, 90TH St above, in all correspondence with the agency. Town of Kinnickinnic St Croix County NW 1/4, SW 1/4, S6, T28N, R 1 8W Lot: 2, FOR: New mound, 450 GPD Object Type: POWT System Regulated Object ID No.: 831975 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. P.O•VV•T The following conditions shall be met during construction or installation and prior to occupancy or use: c ditio) General Approval Conditions: • e with the enclosed approved plans and with the 4F d This system is to be constructed and located to accordance pp p "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 1069 - 1 ( N.01101) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment 7 Systems" SBD- 10706 -P (N.01 101). • In the event this soil absorption system or any of its component parts malfunctions so as to create health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Slats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The maintenance plan for this system must be given to the owner of the POWTS. Note • The bottom of the distribution cell shall be level per the Mound Component Manual. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. SHAUN R BIRD Page 2 3/14/02 • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(i). • Provide frost protection per COMM 83.43(8)(c). 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 Safety & Buildings 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 to the owner and any others who are responsible for the installation, operation or in ' nance of e POWTS. Sincerell Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Patricia L Shan POWTS Plan Reviewer ntegrated Se ices WiSMART code. 7633 (715) 634 -7810, Fax: (7 5) 634 -515 , M -F 7:45 am - 4:3 pm pshandorf @commerce.sta cc: I c Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 3/6/02 Owner C. Collova Builders Lot #2 System) pe: Mound System a�rrrals Used: Mound Component Manual version 2.0 (01/31) Pressure Distribution Manual version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan s 3. Mound Cross Section 4. Pipe Cross Section /Pipe Layout 7 I 5. Pump Chamber Cross Section / 6. Pump Curve 7 -9. Maintance and Contigency plan 10 -12 Soil test i y Signature =, License nurrf er 226900 3/6/02 PLOT PLAN PROJECT P.C. Collova Builders Inc. ADDRESS 507 ctv rd E Hudson Wi 54016 NW 1/4 SW 1/4s 6 /T 28 N/R 18 W TOWN Kinnickinnic COUNTY ST. CROIX MPRS Shaun Bird 226900 �— DATE 3/6/02 BEDROOM 3 CONVENTIONAL IN -GR D PRESSURE 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 450 # of chambers none BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 100.9 C 'Scale = 1 /4" = 10' Tank is to be Cn properly bedded 0 and provided with lockdown covers with approved m warning labels Pro 3 Grading is to be Bedroom done to divert House runoff away from system Huffcutt 99 Combo tank 2% B -3 Slope Area 15' below system is to remain undisturbed Well is to maintain all setbacks found in Comm. 83 B -1 472' Property Line B.M. #2 M. #1 V ' Q 081guer No Dace 60) !r y 4" Observation pipe perforated Non-Woven Filter Fabric Below Filter FELbric Distribution, Pipe AS11�i C - :33 5 o n d� � Topi;oti H a i n's s:. -w r 2M ­ 7 3747 �. slope Bed - Of z F / = Forc Moin F r,, 0 � o Dram Rock From Rump �Lo er I , Cr ess Section Of A Mound Sys t em _ Usin / E - er , A Bed For The Absorption A - LIZ , ~� F � SS G A d F't . Ft. Ft. Ft UT . /,.. K Ft. f n U.�o s �._._ Ft . L w Ft. `f 4:'Observotion Pipe a o + - j Force Mai From P Distribution Bed Of —2 I ` Pi Drain Rock e � Obl►ervation Pipe Permanent Marker Pi PC or Rods P102 View Of Mound Uging A Bed for The Abaorplion Ar PA G E'OF�_ Perf�orot_a Pine 001011 nd few �Perfo►oieo ,,�• pvG r.pe �� °e Noiot LOftdled Or► a0110111 Are CQUODY 3peeea . 5f ! r PVC Force Main �Ir F,less A" ua�tt �O ca+noe��n r PVC Manifold riPe �a s+��C o/� a;e�riiv #gar► 7 a 0-01 w "t4 'r Dislribuhan PiPt Layouf p 5q Ft R y Ft. X Inches Y ?. Y inches 3 � Signed: Hole Diameter Inch License Number; .Lateral �» Inch(es) � Z f� � � d0 sKa n i fo 7 d �� _ �•-- Inches data � y � �` Force Main " oG Inches # of holes /pipe"$ Invert Elevetian of laterals /, Ft.., SEPTa T A, - , PUMP HAt BEi CROS 5 CTION AND SPCCIrICATIONS VE C NT pY'E ix " MiN. aeov£ GRADE c wBAtNI1lrR00! ?. 23 # FROM DOOR. WINDOW OR JUNCT ?ON BOX APPROVED FRBSN AIR INTAKE --- WITH CONDUIT MANHOLE COVER W/ AAA WCX t rzNIS E WARNING IASLL M, „ N it IN. C.Z.. QSii�W�i�a nrs INL WATER TIGHT SEALS GAS- TIGHT, q R i yr LP, - ---+.. A SEAL. MPROM -A- 0 4 � ALM ��=PIPE pt" 3 ow SOLID T i + 4N SOLID SOIL PUMA OFF ELEV .Q FT. OFF D 3" APPROVED BEDDING UNDER TANK i ) CONC RCTE PAD SPECIFiCJTI0N9 SEPTIC / DOSE TANK MANUFACTURER: NUMBER DOSES PER DAY : ,�,.,�, Tom„ Ur 3 SEPTIC L GAL. DOSE uCWME FL T° GAS., DOSE 6AL . Al 1W MAI�P"ACT41t to 1/ S n� CAPACITIES; A / S IH oHZS MODEL NUM S R I +, g. 2 INCHES • 1 U GAL. S WITCH TYPE: � .-,-.. fo C x i " NCHZS : =-5 GAL PUMP MAWrACTURNR a 14 M SWITCH TYPE i • .,,..,.,, INCHES ■ l �....� L . REQIIIRSD DISCHARGE RAT .3 ? GPM PUMP E ALARM WIRING AS RCR ILMR 16.23 WAC VISTICAL 02FFCREKIC SrrWEEN PUMP OFr ANA DISTRIBUTION PIPE FEET + PLY PRESSURE . i . • - ' r d !'EEC' FORC6MAYN x 3 3 FT! l a FT • Flt ON FACTOR + • � U �E .� MINIMUM NCVORK SUP ---). TOTAL DYNAMIC HEAD A _ INTERNAL DLMEHSION OE' 1 PUMP 'T ANKS LENGTH � t p�M�,i O:AMETER ....�.� LIQUID LICENSE IaUMS£R : ATE !/88 « ing Details SHEF4! Performance Data 40 r 30 Pumn Charaic rlstics„_ 4 i y h1e1a 20 A=llN Ii &M =402— 10 4/10 M IWAM 12 1 u MeN► 4 0 1 I 10 20 30 M 11! no .. ToMI Now 00" 10 14 IT 1 08i 28 810 U Ibth � - 47 1wr Wo A O!M (US OM) so 60 s0 40 00 20 10 0 LT Olm Data Seib 3 4" ii re+nrteird %ttd. —"� is� � 2. {oagteailM dlmsin�Nas my Materials of Construction 11011► mob X?J w �. V purl 4. OWWA na and tirti W m� ._ appt0idlnol� « Jd h a d S O t1 cw. Sh1; r (��lt b lMdenta l: SW Fmm teurbaalGr�eesie � �" tlYd 0n{I nvbi ouc pro soak Sad Sad SSe Sf+ w' '` r ? ��. " .;�$• {` `'� s -.' +1�i�� +"��. i t� r �i �! �r v;;; ®19'98 le" Pum r b, HYDROMATIC 1840 8aery 8oad Ashland, Wv 44805 1* 419.29'7`3042 f a• : 4I MM A917 Wit Site: wwwsmaltpmm SHIES OfFKES IN Ali. MAJOk CRIES AND couli was �8 ) i r....... «wweo lirertnry frr 1ro47 loca OistribWpr r ':, .,' Maintenance and Contingency Plan for a Mound System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Dose Chamber is to be pumped at the same time as the septic tank. 3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 4. Once every 3 years the mound is to be inspected via the inspections pipes in the at- grade. The laterals are to be inspected via the cleanouts. 5. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 6. Pump and electrical components are to be checked at the time of the pumping. 7. Owner agrees to leave the area 15' below mound undisturbed. 8. The owner agrees to save this plan. 9. Trees, shrubs, and other similiar vegitation are not be planted on system. The system is not be driven over. 10. Effluent Quality is not to excede the requirements found in Comm. 83 Contingency Plan 1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if needed, then bypass pump float and try pump without float. If this works, float is bad, replace float. If pump still does not work, check power at the pump with a electrical device such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is power, then um is bad and needs to be replaced b a P pump P Y lumber. P 2. If mound fails, determine cause of failure, test another area or remove pipe and sewer rock, retill soil, install new mound system. 3. Replace an other failing components as needed. P Y 9 P Important Phone Numbers Plumber: Shaun Bird 715- 246 -4516 Pumper: Jerry Kolve 715 - 425 -9188 P rY St.Croix County Zoning 715 - 386 -4680 Shaun Bird #226900 3/6/02 POWTQi OWNER'S MANUAL & MANAGEMENT PLAN Qaoe � FKA INFORMATION SYSTeM SPECIFICATIONS Owner , e, 1 u . '' . Septic Tank Capeow al O NA Pam* # Septic Tank Manufaitursr O NA DEEM PARAMETERS Effluent Filter Manufiftm a NA Number of Bedrapms ?✓' O NA Effluent Ffltsr Model D NA Number of Cornmer+c tat Units ONA Pump-Timk Cape* X D ga l O NA Esti rided flow( 0 V Pump T0* MwWfacturer �r�- O NA Design Aow (pall, (Estimated x Z.S) .Y , fflo Misr ro ` o NA SoA Application Rate b aV Ht= Pump Model O NA InA oWIE.fiiuerd Qta llty MontthlY g e Fats, till & Grease (FOG) ) :930 � 3o nV& a Sand/0" Filter 0 Peat Filter a abd Mmical Oxygen Demand (BCIDJ :%220 mgA. O Mechanical Aeration ❑ wetland Total Suspended Soflds (TSS) :0 60 mg& © Disinfection O Other. Manuhdlarer PrefreWad Effluent Quaaty >I44 Monthly average" Dispersal W(s) Biochemical Oxygen Demand (BODJ S30 mg1L O in (gravity) O-ground (pressurized) Total Suspended Solids (TSS) S30 mglt. Fecal 00111011111111 eMc mEAn :51V ofullooml O O Other. �a7xlmum Effluent Particle Size Y inch diameter vakm typrea for doawft (norrownmarda4 waatewMw wW aeppa tank ~nt. •+ vskm typtca! W pmftatad walw~ MAINTEN SCHEDULE Ser Event Service Frequency inspect condition of tank(s) At least once every o months Xyear(s) (Maximum 3 ym.) Pump out contents of tank(s) When combined sludge and scum equals one -third (>) of tank volume Inspect dispersal call(s) At least once every G monfhsX year(s) (Maximum 3 yrs.) Clean Miluent filter At least once every 13 months , ar(s) Inspect pump, pump controls & alarm At least once every 0 months yar(s) O NA Flush laterals and pressure test At k" once every O morttlts r(s) 0 NA At bast once every Cl months O year(s) O NA At least once every a months O year(s) D NA MAINTENANCE INSTRUCTIONS lnspeoflons of tanks and dispersal cets shat: be made by an Indivktual carrying one of the following Booms or oeruncadons; Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintalner; Septage Servl*V operator. Tank inspections must include a visual inspection of the tank(s) to Identify arty missing or broken hardware, Identify any sacks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground s;arface. The dispersal ceN(s) shall be visually inspected to check the sMuent 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 emndition and requires the immediate noffc ation of the local regulatory authority, When the combined accumulation of ;fudge and scum in any tank equals one -third (K) of more of the tank volume, the entire contents of the tank shall be retnoved by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mec tmnical or pressurized POWTS components, pretreat9ment Components, and any other maintenance or monitoring at iniwvals of 12 months or Sass shall be performed by a WOW POWTS Maintainer. A service report shall be provided to Vie local regulatory authority within 1 0 days of completion of any service event. START UP AND OPERATION For new construction, prior to use of tine POWTS check treatment tank 8s s) for the prencs of painting products or other chemicals that may impede the treatr•ient process and /or damage the dispersal ow(s). it high conoentretions are detected have the contents of the tan '�:(s) removed by a septage servicing operator prior to use. System w� start up shall not occur when soil'oonditions are frozen at the infiltrative surface. Pape of During power outages pump tanks rrmy fill above normal highwater ieveis. When power !s restored the exasas wastewaw will be discharged to the dtoperael osil(a) in one tare does, overloading the "We) and may result In the backup or aurface discharge of et font. To avoid this situation have the contents of the pump tank removed by a S%AW Servkkq Operator pdw 0� rosladrtp'power to the eMuertt pump or contact a PkarAw or POWTS Maintainer to assist In manually opsraft the paaap controls to restor+s normai levels within the pump tank. Do not drim or park vvshk*A over tsnim and dispereal calls. Do not drive or park over, or otherwise disturb or compact, the area within 16 fret down slope of any mound or ate toll sbsbrption area. Reduction or- oWnInetion of the follow from tho wastewater strram may improve the performance and prolong @te rota of the POWTS: andbkVAW baby b4pes; egaretta butts; condoms; cotton swabs; degr+essew dental floss; dlgtera; dieksfecants; fotjiridatfon alt» lfrt (surstp ;Meat pump) water; fruit and vegetable peelings; gasoNlte; gneaee� iserblotdes soul , msdioatloria; at paii<ttlrtg pnWuc W, poo4des; a nkwy napkins; tampons; - and water softener t>wirte. ABANDONMMENT . What the POWTS falls andfor Is pamanerttly.taken out of seeviee the kftwhg saps shall to taken to insure that the system Is properly mW safey sband med In compliance with ch. Comm 83.33, Wisoonsin Adff** tut foe Cede: e Ali pk*V to tanks and pits shag be disconnected and the abandoned pipe openkVs seal6d. • The eonterits of all tanks ant pits shall be removed and property disposed of by a Septage Servioing Operator. • After pumping, all tanks and pits shag be excavated and removed or their covers removed and ttte void speoe filled wkh tilt, graW or anodes but solid material. CONTINGENCY PLAN if the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide ai code compliant reph oerrient systems: CI A suitable repbacement'are,s has been evaluated and may be utilized for the location of a replooement soil absorption system. The replacement area should be protected from disturbance end oompaotfort and should not be Infringed upon by required seftoks from existing and proposed structure, dot litres sand wells. Failure to protect the replacement ansa will resuft in the need for a new soli and site evaluation to establish a sultabie replacement area. Replaowlent systems must comply with the rules in effect at that tlme. ❑ A suitable replacement arse Is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding bank, trey be installed as a last resort to replace the failed POWTS. the sits has not been evs6a&sd to Identify a suitable replacement area. Upon failure of the POWTS a soU and site evaluation must be pafcrtned to locate a suitable replacement area. If no replacement area Is available a hokdirig tank may be ktstoW as a last resort to replace the failed POWTS. and at -grade cog atmiorpdon Systems may be reconstructed in place foliovAng remova of the blomat of the intllrative surface. Reckinstl uatlons of such systems must comply with the nAw in effect at flat time. <<WARNINGb> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETMIIL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT ENTER A SIOTiC, PUMP OR OTHER TREATMENT TANK UNDER ANY CiRCUMSTANCR8. DEATH MAY RESULT.. RESCUE= OF A PERSON' FROM THE INTERIOR OF A TANK MAY SE DIFFICULT OR WPOSSIBL 1. ADDITIONAL COMMENTS PO INS TALL E - R - -_ POWre AiNER Na me � Name !' Phone Phone SEPTAGE SWtMNG OPERATOR (PUM�� LOCAL REGULATORY AUTHORITY Name ,�C�/► E t 4 —ZF Phone J Oz e This doaurtW was diadted by the sfafbr of Nis Gress Lake. Mer*M" clod Waushan Cowxy ZW" and Sanitetiort agendas. This document I. the mlarMM NQulrementa of ch. Comm 83.; MM(bxlxd)&(6 and 93.51(1), (2) b (3), wrsaonsin Ad Inistrue me Co". Uwb of ions daamtant does not quanw4ee the perkwrones of the Pow& OMW ( ?A1) L Wisodnsin Department of Commerce SOIL EVALUATION REPORT Page of 3 01'vis�on of Safety and Buildings • in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County L • CZ� x include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. k &JD11U 6 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Z GW- -LoL N W 1/4 SW 1/4 S 6 T Za N R 1S E (or W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# �,- o - ?.Qs X Z01 Z 7- 1 — i —\-:N-7 O -Pos City State Zip Code Phone Number ❑ City ❑ Village RI Town Nearest Road 3T. P t'N L 0 A N j Sso-. S (b [ Z) Z3 -10 8 ? ` c 1 t C YZ. -I tJ hJ 1C q ®- New Construction Use: ® Residential / Number of bedrooms �_ Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable N ft. General comments R and recommendations: rnrj tvy7 ICJ 61 3`nZ{ U'n p y j wl t>U L.wtUM t1 " OF- Ht c - c. yL F-11 Boring # ❑ Boring ® Pit Ground surface elev. D0. ft, Depth to limiting factor Z� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell s Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 I o -LO tD`iR9CZ Z -�S6k. ti►1 �ti CS - .5 .b_ 3 2.Z -36 -�. S'4 rL 313 C4 S hs ► Ow. nl 1 . S a Boring # ❑ Boring ® pit Ground surface elev. �9. 0 ft. Depth to limiting factor 1 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 c - g JD�t tz._ 31 z s i 1 Z�sblz v►�'Fr � - , S ,_8_ _ Z -1,9 to�rZ3L� - si 1 Z`FS�i ti12 `4S` - • S SYfL 343 CAA - 1 _S Lj e S /8 Q �,,,� 1'rt ` f. -- • S Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS _< 30 mg/L CST Name (Please Print) ZIgna tu CST Number Arthur L.- Wegerer ��` ' - Z 220254 Address W e g e r e r Soil Testing. & Design Service Date Evaluation Conducted Telephone Number 421 N. Bain St. River Falls, FJI 54022 Y 715 -425 -0165 1 ! r r � Property Owner L �DQ AZT Z. Parcel ID # Ki G Page Z of 3 a Boring # ❑ Boring ® pit Ground surface elev. a C ) - ft. Depth to limiting factor z� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /11 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 - Eff#2 6 -8 IlylR- 3 LZ f Z`FSbk �`Fl- CS — • S -�d F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 'Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 I 'Eff#2 i Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L ' The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD4330 (R6M) ' PLOT PLAIT Page 3 of 3 Scale 1' = So' L to T 3 rI 0 I i i LU T Z °� _ � co ►JOT cow�,P��T ocz � / on o J O a c l $ oYi - orb dF L y �L $ — 100.4'0�J l`' Lh`Oty PI.P , M -Z- 'ON 6 u t+fGN, 3 /y "D1 P� % ?VC PLP w /L�1T1. S L 715 425 - 0165 220254 0� -SQ - LIZ CST Signature Date Telephone No. CST No. Job NO. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND ' OWNERSHIP CERTIFICATION FORM Owner/Buyer T� ° LD l`0 u Mailing Address Property Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number a k.- n► Q ZZ - f `' 1 q - /0 - ovb V 16 LEGAL DESCRIPTION property Location 1�V L� %., V4, Sec. . TziN -R1W, Town of ''— Subdivision Lot # Certified Survey Map # 1 Q Z . Volume . Page # 1 / Warranty Deed # (O 4-q is , Volume d . Page # CO3 Spec hous es ❑ no Lot lines identifiable yes ❑ no 7 1L SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastcrplumber, journeymanplumber, restrictedplumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 Z A SIa thre e y expiration date. OF APPLICANT DA OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the p rty described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE O DATE « « « « «« Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** *« Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed /d P- DOCUMENT NO. STATE BAR OF WISCONSIN FORM 5 -1982 TNIe • ►AC[ 0tI29DV6D 0100 RtCOADIND DATA alllT CLAIAL"ED 549783 U K 2 REG!ST n S OFFICE ST. CROIX 00, WI ifx! lliCS. .1+a..�,!l ;t : ,,,s1JC. +.. ancj• Denise- _/lung•_Lanerts............... Rsrdtfli " ..................................... ___ ............................... . SEP 2 0 1996 .......................................... ............................... - .............................. quit to ......... G._,Lenerta k/a Frederick at ll: iS A. M Pee ..ti!lnerts.s..Sr. ......... ......... .................................................... ` 6... `Fit J m. .............................................. .......................... .................................. Ileprstwatoesaa ..............•--................_...... ...................._- ••- -• - - -- ............................... the following described real estate in ....... St ... Craft ....................... County. State of Wisconsin A9T To S1a vC Q Po SOX /` 7 NW 1/4 of SW 1/4 of Section 6- 28 -18. The S 112 of the SE 1/4 of Section 1 and the NE 1/4 of NE 1/4 of Section 12 all in 28 --19, and the E 1/2 of NE 1/4 of Tax Parcel No .............................. SE 1/4 of Section 1- 28 -19. The E 112 of the W 1/2 of the NE 1/4 of SE 1/4 Section 1- 28 -19, EXCEPTING THEREFROM: A parcel of land described as follows: Beginning at the E 1/4 corner of said Section 1; thence SO '03'W (true bearing) 209.00 feet along the E line of said SE 1/4 of Section 1; thence S 89 ° 50'40" W 209.00 feet; thence N 0'03' E 209.00 feet; thence N 89 ° 50'40" E 209.00 feet along the N line of said SE 1/4 of Section 1 to the point of beginning; except the N 33 feet for existing town road easement and except the E 33 feet more or less for town road easement; ALSO EXCM - ING: That certain parcel of land or tract of real estate located in the NE 1/4 of the SE 1/4 of Section 1- 28 -19, Town of Troy, St. Croix County, more fully described as follows: Commencing at the B 1/4 corner of said Section 1; thence go S 0' 0' 0" E along the E line of said Section 1 a distance of 308.00 feet to the point of beginning of the parcel to be herein described; thence continue S 0' 0' 0" (assumed bearing) along said east line of Section 1 a distance of 352.00 feet; thence S 89' 51' 45" W a distance of 991.77 feet; thence 1 00" 14' 45" E a distance of 352.00 feet; thence N 89' 51' 45" E a distance of 990.15 feet to the point of beginning, the above described parcel containing 8.0 acrca, more or less, including the Easterly 33.00 feet thereof presently used for Town Road. ALSO ZKCEPTING: a parcel of land located in the NE 1/4 of the SE 1/4 of Section 1- 28-19, St. Croix County described as follows: Commencing at the E 1/4 corner of said Section 1, thence W on the Section line a distance of 988 feet and 10 ", thence S a distance of 308 feet, thence E on a line parallel with the N line of said Section a distance of 990.15 feet, thence N a distance of 308 feet to the point of beginninr for approximately 6.996 acres more or less. A NI�'�FER I � This ..... 14- not .......... homestead ➢ rO D ert,_ � ire D ated this .. ....... / ............................. day of ...... .............. ugust....... ...-- • ......................... 19.96... .......(SE1lL) ,a.a,....... ----- ....(SEAL) . Lawrence L. rtz, Jr _...._.. .... ............................... - ... ......._.. .. ...__..... ._ (SSl►L) C ................... . ..................... ............................... __.._. E. .. . -.. (SEAL) • ..... .. ............... ......................................... . Dense Anne Lanerts AUTRANTICATION �o=>ioiOW.L>11Da>icsNs _ --------------------------- ___ -____ STATZ OF Nlt � t W91960NOW 4 es. se0watkated this ........ et .......................... I le..__ Personally came before me this � ...........day of A► umat .................. _.... -._ -., the shoe. named ..._ ......................... •..._....- -• - --- ....... -- -- - Li}XANAE!!-_ks.- umort.f s_.:Ii :_ .4!s -was . ......... • ........................ ....... �11iii!_.I' e4JF z............... __ ............. _ ..... ......_ ........... TITLE: MEMBER STATE BAR OF WISCONSIN (I aatbo�risei by; 706.08. ...................... is. 8tats.j . . .... to me known be person f......_ ...wbe ezeouted the foregoing instrument and aeknowledge the aamw THIS INSTRUMENT WAS DRAFTED Sr Steven B. Goff, Attorney at Lair ........................................... ................ ..... ................................. ............................... - -Rivas lalls,•t ..... •54M........ o ry Pub .......................................... musty Win (Signatures may be aut owled d. TlsRit My Commission is permanent (If not. state expiration are not neemmary.) date: ..............•..._....... ......................_.... -.0 ... - - - -• •ts�w eewla�a�ss Mfr► t!/.EM "now - Wr+'ne Wks (W W1w•na•AIV r- I— U 1858P 473 STATE BAR OF WISCONSIN FORM 1 - 1998 r=31-7 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number ST. CROIX Co., NI RECEIVED FOR RECORD This Deed made between Freder i ck G. Lenertz, single 03 -21 -2002 2:30 Ph WARRANTY DEED Grantor, EXDPT i and — P.C. Coll ova Builders, �r{C, EE: .0 TRANS : 11 0 COPY FEE: CERT COPY FEE: Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property "): Recording Area Name and Return Address .� P.C. 11 a Bu� F � x 90th trot 2 es� c'�` ' o" Kinni innic wsp., WI 54016 0u -Ion - 0 -bbd Panel Identification Number (PIN) This n ot Q homestead property. Lot 2 CSM Filed in Vol. 1 5, Pa 4104 C ertified Survey Maps, ( l s �c0te n Vin Part of the NW of the SW 1/4 of Section 6, Township 28 North, Range 18 West town of Kinnickinnic, St. Croix County, Wisconsin. Together will all appurtenant rights, title and interests. none Grantor warrants that the title to the Property is good, indefeasible in simple fee and free and clear of encumbrances except Dated this 15th day of March 2002 (SEAL) (SEAL) J 7/ Fr G er z (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGEMENT Signature(s) State Of Wisconsin, } ss. St. Croix County. authenticated this day of Personally came before me this 15th day of �t March 1 2002 , the above named Frederick G. Lenertz, single * TITLE: MEMBER STAN NSIN to (If not, J me known to be the person who executed the foregoing authorized by §706.06, Wis. Slats.) instrument and ac owledge the same. THIS INSTRUMENT WAS DRAFTED BY Coldwell Banker Burnet 02 -04673 l.� 1301 Coulee Road * W 1 Notary Public, St to of Wisconsin Hudson, WI 54016 My commission is jt gi t I not, state expiration date: ( Signatures may be authenticated or acknowledged. Both are � ) not nccessary.) Names o1' persons si •nin • in any capac must be typed or printed below their signature. 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