HomeMy WebLinkAbout022-1085-40-000
Wisconsin Department of Commerce PRIVATE,!SEWAGE SYSTEM County: St. Croix
Safety and Buiiding Division
INSPECTION REPORT Sanitary Permit No:
• 538738 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:
Bauer, Daniel R & Janet Kinnickinnic, Town of 022-1085-40-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
13 (n 9 6-cg- 29. 18.460
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURE CAPACITY STATION BS HI FS ELEV.
Septic 17,% 4 Benchmark O (o /OZ • 6 1 -0
B Otj
ltd;
Dosing Alt. BM
12-50 z.73 cf9. 33
r
AeFatrerr Pc Ian- k Bldg. Sewer
(;7,. t L1 (071-S zw 5z1
Holding St/Ht Inlet 763 qe- S :3
7, $ z Z
TANK SETBACK INFORMATION St/Ht Outlet
3
TANK TO P/L WELL BLDG. Vent to Air nAke ROAD B®
Septic Dt Bottom Z S 5
164- ~7 39 (7-60
Dql-ng 10 Header/Man.
1 7 ~p
K.~
Aeration Dist. Pipe c ) 16, 3q ,Ip
M : d
44 cK 9. 0 -7
Holding s b ` Bot. System
Final Grade
PUMP/SIPHON INFORMATION Ile-S5 -73 • 7/
Manufacturer Demand St Cover
GPM S+---rA n- ~o ~ '~3
Model Number ~ - - -
Aca._.. i 11,75 'I S .31
TDH Lift Friction Loss System Head---TDH Ft
~r _ r /Z•3$ S7. L'9 dk
Forcemain Length Dia. Dist. to Well /Z 77,
SOIL ABSORPTION SYSTEM
BEDITRENCH Width p Length No. Of Trenches pp~~ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS I ~G.6 GJ _
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION
Type Of System: CHAMBER OR ~7 UNIT
Model Numbe
r
75' A4_
DISTRIBUTION SYSTEM /D 3-d
Header/ManVold Distribution x Hole Size @ a _,.___r Hole Spac Vent to Air Intake
P.d Pipe(s) ~
Length Dia Length Dia SOasing _
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over / Depth Over xx Deptkgf xx Seeded/Sodded xx Mulched
Bed/Trench Center / Bed/Trench Edges Topsoil
l0 Yes E No Yes 0 No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 111 East Quar Rd River Falls, WI 54022 (SE 1/4 SW 1/4 29 T29N R18W) NA Lot Parcel No: 29.29.18.460
1.) Alt BM Description = _ (30
La c S
2.) Bldg sewer length = ® Ged4---
- amount of cover = y/
nN "
Plan revision Required? 0 Yes No "
Use other side for additional informati
Date Insepctor's gnature Cert. No.
SBD-6710 (R.3/97)
PLOT PLAN Page 2 of 10
(Bauer Property)
o sZti N
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ysZ'
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a
Scale : I"= 40'
\~=.11\814 Z
~$2~\\~„Z♦ \•83
Tt-evcH ES
$ T r. foZ~ jav CuL qc SAC i~ys0 ~,`"J/Po et ga
i
@4
6,40GE
PR IV6
PRoPos~ C
♦ SM1 Elev. =100.00' Top of 2" PVC pipe y' B`6ie0O"♦
A BM2 Efev. = 96.70' Top of 2" PVC pipe O Nests
■ E3ackhoe pits, 0 eo jp a5c 40
Siope=S% W E U,
System Elevation T1 = 90.40'
T2 = 88.80'
T3 = 89.20"
38.15 Acm Parcel
SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT
Project Name: Christopher Bauer / Daniel Bauer
3 No. of Cells 10 Per Cell
3 ft Cell Width 30 Total No of 1203H
100 ft Cell Length 500 sq ft EISA Per Cell
3 ft Cell Spacing 1500 sq ft Total EISA
Manufacturer Model Laying Length EISA Rating
Infiltrator EZ12031-1-5ft 5.0' 25.0
EZ1203H-10ft 10.0' 50.0
Gravelless Leaching Unit Manufacturer: to Infiltator
Gravelless Leaching Unit Model: 1203H
Typical Cross Section
Finished Grade 95 ft
Observation Pipe with
approved cap or vent
■ Soil Backfill
36 in
Geotextile Fabric
89.2 ft Infiltrative Surface
12 in
86.2 ft Limiting Factor
>36 in Slotted and Anchored Vent/
Observation Pipe with Cap
Plumber/Designer Signature:
License MPRS 223760 Date: Novmber 12, 2012
I
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Bulling Division
INSPECTION REPORT Sanitary Permit No:
538738 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:
Bauer, Daniel R & Janet Kinnickinnic, Town of 022-1085-40-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map o:
29. 18.460
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
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid 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 Ix Hole Spacing r nt to Air Intake
Pipe(s)
Length Dia LDia 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 0 No E Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / /
Location: 111 East Quarry Rd River Falls, WI 54022 (SE 1/4 SW 1/4 29 T29N R1 8W) NA Lot Parcel No: 29.29.18.460
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Plan revision Required? 0 Yes ® No
Use other side for additional information.
SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No.
Safety and Buildings Division County _
as 201 W. Washington Ave., P.O. Box 716 s / C, ele X
I sc0ns n Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce (608)266-3151 15 ? 7 3 9
Sanitary Permit APPlieat' State PIanJLnDI. Number
In accord with Comm 83.2 1, Wis. Adm. Code, personal in at u provide
may be used for secondary purposes Privacy La \5.04(l)(m) I'act Address (if different than mailing address)
L Application Information - Please Print AI formation
\ ;t Q
Ga'r~C~
Property Owner's Name h Parcel # Lot # BI #
A N 19 t AL4 ' Q C 07,Z -io S- - 4z
Property Owner's Mailing Address Property Location
9y 7 ,4RR V PoA v
SL Section Z 91
City, State Zip Code Phone Number
I V Eta rp z- <l -.5-4/0 Z Z T 4 N R I (circle one
R
II. Type of Building (check all that apply)
❑ 1 or 2 Family Dwelling - Number of Bedrooms &A-o2vy\ Subdivision Name CSM Number
❑ Public/Commercial - Describe Use r-►
❑ State Owned - Describe Use ❑City_❑VillageCTownship of K)'NwAelrlgljC
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. 10 New System ❑ Replacement System El Only El g y
stem
Treatment/Holding Tank Replacement Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS System: Check all that apply)
® Non -Pressurized In-Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At-Grade ❑ Single Pass Sand Filter ❑
Constructed Wetiand P surized In-Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel-less Pipe ❑ Other (explain)
V. Dispersal/Treatment Area Information:
Design Flow ) Design Soil Application gpdsf) Dispersal (sfj Dispersal Area Pro (s
pos System Elevation i i _Sd O. y/ SGJCN.C~J 90.yo , 8t.8o , 89, z o
VL Tank Info Capacity in Total Number Manufacturer '1 Prefab Site Steel Fiber Plastic
Gallons Gallons of Units I51 Concrete Constructed Glass
New Existing 1 C~
Tanks Tanks /p J
Septic or Holding Tank / I ESE Co V CA? ETF
Aerobic T. Unit /
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached pleas.
Plumber's Name (Print) Plum Si ure MP/MPRS Number Business Phone Number
JONAI SC14,4Ilrr t 27-3760 76 0 -0 5186
Plumber's Address (Street, City, State, Zip e)
61i 15-07-9 AVt ~5arn
VUL Coun /De rtment Use On
Approved Disapproved Sanitary Permit Fee (includes Groundwater Date sued Issuin t Signature o
Surcharge Fee) A175, ~ b
tven Reason for al
OL Conditions of Approval/Reasons for Disapproval
SYSTEM 01NNEW
1. Septic tank, effluent filter and
dispersal cell must all be servtces / maintained
as per management plan provided by plumber.
7- All aetback requirements must be maintained
Per applicable code / ordmancea.
Attach complete plans (to the County only) for the system on paper not less than 31/2 x 11 inches is size
SBD-6398 (R. 01/03)
Page Iof10
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: Bauer Conventional Gravity Septic System
Owners Name: Daniel Bauer / Christopher Bauer
Owners Address: 947 Quarry Road
River Falls, WI 54022
00
Legal Description: SE'/., SW S29, T2~ N, R18W
Township: Kinnickinic
Subdivision Name: 38.15 Acre Parcel
Lot Number: na
Parcel ID Number: 022-1085-40-000
Page 1 Index and Title
Page 2 Plot Plan
Page 3 System Cross Section and Sizing
Page 4 Tank Specifications
Page 5 Filter Specifications
Page 6&7 Maintenance & Management Plan
Page8 Septic Tank Maintenance Form
Page 9 Warranty Deed
Page 10 CSM or Plat
Attachment: Soil Evaluation Report
Designer/Plumber: John Schmitt License Number: 223760
Date: November 24, 2010 Phone Number: 715-760-0486
Signature
L
Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 S1313-1 10705-P (N.01/01).
1 1
Page 2 of 10
PLOT PLAN
(Bauer Property)
oQ s2H N
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G~~ S/ Scale : I"= 40'
qZ \ 11\BM Z
\ c3 ~
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r
B2 ~ \ \ ~ \ 83
3 -3'Xl00"Qu1,tN
T4rA CH ES
\ \ 1 $~1'll
CUL 06 SAC
1 1 • ~ 9
1200 GAL 5,-r
91 W~ Pny Lo lc szs
Gq
Prtoaos~ o
♦ BM1 Elev. =100.00' Top of 2" PVC pipe g`oeoo~+~
A BM2 Elev. = 96.70' Top of 2" PVC pipe ~lous,~
■ Backhoe pits
Slope=6%
System Elevation T1 = 90.40'
T2 = 89.80'
T3 = 89.20"
38.15 Acre Parcel ~j
Page 2 of 10
PLOT PLAN
V~ (Bauer Property)
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41 .11
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Scale : I"= 40'
4Z \'iz11\BM Z
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.62 8.3
3; P4
\ \ 3 -3XIoo'Qu/kq
-F46WH ES
\ \ ~►YiI
cut, DE SAC
RI ~ 9
/ 20,0 GAL 5, I
90 92 W/ PDt~Loh SLS
GA4409E
PRoP0, o
♦ BM1 Elev. = 100.00' Top of 2" PVC pipe 3
I~OtlS~
A BM2 Elev. = 96.70' Top of 2" PVC pipe
■ Backhoe pits
Slope=6%
System Elevation T1 = 90.40'
T2 = 89.80'
T3 = 89.20"
38.15 Acre Parcel
i
Page 3 of 10
Soil Absorption System Cross Section
WOO ft
94..00 it
e Schedub 40 FhW Graft
PVC Vent Pipe
Willi Vent Cap 90.80 ft
Umwhh g
Chsrn er
t I I
89-20 ft 89.80 R. - ft 90.40 r t.
System >3 A
System va ua wn System va uahon
Soil AbsoMtlon System Plan View
100
I
3 ft
I
>3 ft Trench 1
i
Trench 2~ HGWW
Vent Or Observation Pipe
Trench 3
L.._ _
i
Leachma Chamber Specifications
Manufactuer and Model INFILTRATOR Quik 4
ESIA Rating ~sq. ft per chamber ESIA Rates 5.8 sq. ft per 2 endcaps
DWF ®gpd Sol Aplication Rate 0.4 gpd/sq. ft
®gpd DWF 0.4 Soil Aplication Rate= 130 sgft
1t0 SO - 5.8 sgft/2 endcaps x # of rows= 1483 sgft
sqft/ E~20 sgft per chamber- T4.13 Chambers
rows of 25 chambers each.
I
i
Page 4 of 10
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° - m + SEPTIC MANUAL REV.
z W3716 US HWY 10 MAIDEN ROCK, NA 54750 Y 2010 DATE. -POUR.
REVISED JAN. 2010 800-325-8456
Rage 5 -of 1(
INSTALLATION INSTRUCTIONS
AN
ADM-IP I- PL-525/PL-625 FILTER
INSTALLATION INSTRUCTIONS
Center filter
with opening
ix z
W
J
X O
a e
Additional pipe or
Polybk Extend & Lok° Glue
for centering.
Step 1: Step 2: Step 3:
(A) Locate the outlet of the septic tank. (A) Before installation, place the (A) Glue the filter housing on the
(B) Remove tank cover and pump tank filter housing on to the outlet pipe. outlet pipe.
if necessary. (B) Make sure that the housing (B) Insert the filter cartridge in the
is positioned so the filter can be housing, making sure the filter
removed from the tank for cartridge is properly aligned and
maintenance and service. completely inserted in the housing.
MAINTENANCE INSTRUCTIONS
1 _
Step 1: Step 2: Step 3:
Locate the outlet of the septic tank. (A) Remove tank cover and pump (A) Insert the filter cartridge back
if necessary. into the the housing making sure
• NOT USE PLUMBING REMOVED (B) Pull the filter out of the housing. the filter is properly alighed
WHEN FILTER IS and completely inserted.
(C) Hose off the filter over the septic tank. (B) Replace septic tank cover
WE RUBIM GLOVES Make sure all solids fall back into the
WHEN CLEANING FILTER septic tank.
INSTALLATION INSTRUCTIONSZabel
nrPdytokmu PL-525/PL-625 FILTER
OLY4 I
PL-5251PL-625 FEATURES & BENEFITS
r ~
u
Features & Benefits:
a Rated for 10,000 GPD
. PL-525 = 525 Linear Feet of 1/18" Filtration
PL-625 = 625 Linear Feet of 1/32" Filtration
Ali is
PL-525 PL-625 • Accepts 4" and 6" SCHD. 40 pipe
Built in Gas Deflector
The PL-525/625 Effluent Filter should operate efficiently
for several years under normal conditions before .Automatic Shut-Off Ball when Filter is Removed
requiring cleaning. It is recommended that the filter be
cleaned every time the tank is pumped or at least every «Alarm Accessibility
three years. If the installed filter contains an optional
alarm, the owner will be notified by an alarm when the *Accepts PVC Extension Handle
filter needs servicing. Servicing should be done by a
certified septic tank pumper or installer.
RECOMMENDED PRODUCTS
y Polylok PVC Filter
Extension Handle
Alf,
r1i
Risers & Riser Covers Extend & Lok- Riser Safety Screens Filter Alarm Panel and
Polylok risers bring your Polylok Extend & LokTM Polylok safety screens SmartFilterTM Control
Switch
septic tank cover to grade. is a simple, easy to use prevent tragic accidents
This allows locating and solution that can extend from happening by children Polylok filter alarm panels
servicing your filter easier the inlet or outlet pipe and and pets falling into open and switchs provid a visual
and time saving by elimi- make filter and/or baffle septic tank entrances. and audible notification of
nating digging to find tank installation a snap. impending filter and tank
entrance. Fits 3" and 4" pipe. servicing.
For a full list of Polylok products please visit our web site at: www.polylok.com
N L9 K i:tZ, INSTALLATION INSTRUCTIONS
"n°vario°s °;srrai°° AObel PL-525/PL-625 FILTER
A 97asrPwater Pr'o~+.-ce a oinsion or Fdyld¢ Inc. PL-525/PL-625 FEATURES & BENEFITS
Features & Benefits;
a • Rated for 10,000 GPD
• PL-525 = 525 Linear Feet of 1/18" Filtration
PL-625 = 625 Linear Feet of 1/32" Filtration
411111 -4 if
PL-525 PL-625 *Accepts 4" and 6" SCHD. 40 pipe
The PL-525/625 Effluent Filter should operate efficiently • Built in Gas Deflector
for several years under normal conditions before *Automatic Shut-Off Ball when Filter is Removed
requiring cleaning. Itis recommended that the filter be
cleaned every time the tank is pumped or at least every a Alarm Accessibility
three years. If the installed filter contains an optional
alarm, the owner will be notified by an alarm when the • Accepts PVC Extension Handle
filter needs servicing. Servicing should be done by a
certified septic tank pumper or installer.
RECOMMENDED PRODUCTS
Polylok PVC Filter
Extension Handle
M
A&13
s
Mtiylryli
Risers & Riser Covers Extend & LokTM Riser Safety Screens Filter Alarm Panel and
Polylok risers bring your Polylok Extend & LokTM Polylok safety screens SmartFiiterTM Control
septic tank cover to grade. is a simple, easy to use prevent tragic accidents Switch
This allows locating and solution that can extend from happening by children Polylok fitter alarm panels
servicing your filter easier the inlet or outlet pipe and and pets falling into open and switchs provid a visual
and time saving by elimi- make filter and/or baffle septic tank entrances. and audible notification of
nating digging to find tank installation a snap. impending filter and tank
entrance. Fits 3" and 4" pipe. servicing.
For a full list of Polylok products please visit our web site at: www.polylok.com
Page 6of10
POWTS OWNER'S MANUAL & MANAGEMENT PLAN
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Daniel C h r i s t o her Bauer Tank Manufacturer: ❑ NA
Permit# Wieser Concrete
■ Septic ❑ Dose ❑ Holding Volume: 12 5 0 gal
DESIGN PARAMETERS Tank Manufacturer: NA
Number of Bedrooms: q ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: gal
Number of Public Facility Units: i NA Vertical Distance Tank Bottom(s) to Service Pad: It
Estimated (average) Flow : 400 ga" Horizontal Distance Tank(s) to Service Pad: ft
Design (peak) Flow = estimated x 1.5: 600 gal/da Specfic servicing mechanics must be provide if vertical is >15 feet or if
y horizontal is >150 feet. Specific instructions to be provided on back.
In Situ Soil Application Rate: 0.4 ga+/day/ie Effluent Filter Manufacturer: P o l y l o k
❑ NA
Standard Domestic InfluentlEffluent Monthly average Effluent Fitter Model: 525
Fats, Oil & Grease (FOG) s30 mg/L Pump Manufacturer.
Biochemical Oxygen Demand (BOD5) x220 mg/L ❑ NA ® NA
Total Suspended Solids (TSS) s150 mg/L Pump Model:
High Strength Influent/Effluent Monthly average Pretreatment Unit
Fats, Oil & Grease (FOG) >30 mg/L Manufacturer:
Biochemical oxygen Demand (BODS) >220 mg/L 0 NA M NA
Total Suspended Solids (TSS) >150 mg/L ❑ Mechanical Aeration Q Wetland Filter
Pretreated Effluent Monthly average ❑ and/ectioi
❑ S Sand/Gravel Fitter ❑ Other.
Biochemical oxygen Demand (BODS) s30 mg/L Soil Mso on System
Total Suspended Solids (TSS) s30 mg/L
Fecal Colifor (eometric mean) S104du/100ml • 0 In-Ground (gravity) ❑ In-Ground (pressure) ❑ NA
NA
❑ At-Grade ❑ Mound
Maximum Effluent Particle Size: 3f; in dia. ❑ NA ❑ Drip-Line ❑ oar:
Other. ❑ NA Other:
❑ NA
MAINTENANCE SCHEDULE
SONIC* Event Service Frequency
Pump out contents of tank(s) ■ When combined sludge and scum equals one-third of tank volume
❑ When the high water alarm is activated
Inspect condition of tank(s) At least once every: ❑ month(s) Maximum 3
3 ® Year(s) ( years) ❑ NA
Inspect dispersal cell(s) At least once every: 3 ❑ month(s) (Maximum 3 years) ❑ NA
Clean effluent filter At keg once every: ❑ moft(s) ❑ NA
1.5 ■ year(s)
Inspect pump, pump controls & alarm At least once every: O❑ mmoa~;s) ❑ NA
Flush laterals and pressure test At least once every : ❑ month(s)
❑ NA
❑ year(s)
Other. At least once every: ❑ month(s)
Other [I year(s) ❑ NA
❑ 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 POWT
S Inspector, POWTS Maintainer; Septage Servicing Operator (pumper). Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any packs or leaks,
measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The
dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent
on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate
notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any treatment tank equals one-third 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 fitters, mechanical or pressurized components, pretreatment units,
and any servicing at intervals of s12 months, shall be performed by a certified POWfS Maintainer.
A service report shall be provided to the local regulatory authority within 30 days of completion of any service event.
(Rev.2/05)
Page 7of10
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other
chemicals or sediment that may impede the treatment process and/or damage the soil 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 extended 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 and may overload them resulting in the backup or surface discharge of effluent.
To avoid this situation have the contents of the lump 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 contras 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) discharge; 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 property
and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks, pits and other soil absorption systems 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 removed and the void space filled with soil,
gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide the opportunity to obtain a
sanitary permit for 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 replacement area will result in the need
for a new sal and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in
effect at the time of their permit issuance.
❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be
rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation
must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a
last resort to replace the failed POWTS.
❑ 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: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT
OXYGEN TO SUPPORT LIFE. NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY
CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY
DIFFICULT.
ADDITIONAL INFORMATION:
POWTS INSTALLER POVVTS MAINTAINER
Name: John Schmitt Name: John Schmitt
Phone: 715-260-0486 Phone: 715-760-0486
SEPTAGE SERVICING OPERATOR Pt;HNPER LOCAL REGULATORY AUTHORITY
Name: Name: St. Croix Count Zonih
Phone: Phone: 715-386-4680
This document is intended to meet minimum requirements of Ch. Comm 83.22(2)(b)(1)(d)&(f? and 83.54(1), (2) $ (3), Wsconsin Administrative Code. Use
of this document does not guarantee the performance of the POWTS.
(Rev. 2/05)
Page 8 of 10
' ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer 8 ie h/ / 5 7o ,e BqN E,2
Mailing Address cTy 7 up 019
Property Address
(Verification required from Planning & Zoning Department for ne construction.)
City/State Rl Fm, ` Wt Parcel Identification Number 0 z Z -/085- y0 - Dp D
LEGAL DESCRIPTION J0
Property Location _ %4 , ,5W '/-,Sec. Zj, T ~N R/16W, Town of j NN 1 C Ki N c
Subdivision Plat: , Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # (before 2007)Volume , Page #
Spec house yes no Lot lines identifiable yes no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
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 Planning &
Zoning Department within 30 days of the three year expiration date.
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
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms_
SIGNATURE 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. 09/07)
Page 9 of 10
D000Mt►rT WO. jj!{'fA'T6 BALE Ollf w'$OONlIN ~R11 1-1%M w`KS aaeaivaa ie~ ia~iarta w
1 WARRANTY Mo 4"M ji
VOL 835 Pja 543
! This Deed. made between Gus.tave..E.-Schults.......... $T.a Co., vi
and Kathryn N.. Schultz, .husband.. And. vita............. aced for Rams!
II
areater. 40 99AP. 14JN9
and . Daniel..R. Bauer and.Janet-lt..Bauer.,...husband 1120 P. A4
I and. wife, as survivorship marital..pr*Wty......... a
araatee.
fi Witnesseth. That the said Grantor, for a valuable tonsidersUen......
conveys to Grantee the following described real estate in "~V1M' rs
S.C.....CiT.Qi•Il......_.
County, State of Wisconsin:
See attached L! _ -
Tax Parcel No:
j'
2
`I
I~
ll
This is not. homestead pl..perty. j:.
do (is not) ~j
I~ Together with all and singular the bereditsments and ap?urteaates thereuato
belonging;
And- ...Gustave E.. Schul.tz.. and-Kathryn. N.-Schultz. _
warrants that the title is good, Indefeasible in tae simple and free and clear of encumbrances ex~vpt
easements and rights of way of record
and will warrant and defend the same. rl
Dated this ~SM day of ......~...ivt,Tisr......._........ 19..88.. ~i
(SEAL) I
• ...G.t1A.t.aVe.,A...Sahultz
G ].y~
(SEAL) (SEAL) !
Kathr a_M..Schultz
!
R3 AQTIMUNTICATION ACZNOWL=DOKSNT
3lgnatute(s) STATE OF WISCONSIN 1
tl
a&
II
j U rce .............Co..o.
authenticated this ........day of . 19...... Perwmm eawa~ on tAia ..dq of
. Of.1t!l
XMW .1Yir1 t1alf.. the *be" named
Gmattli re--..i... cb llt..aad
TITLE: MENDER STATY aAE Or WISCONSIN # ~lIFYA t ...................4;...h' ~ .
(if not,
itt by i 706.06: wig: -8t.................... tq........
a.thor f.,.,..._.t.:.. i~ ,
to me known to be the person ....0...... whe oxwd d the
~I r lag instrument and acknowledge .Matte- f
rwis rNsv"vmRNT w4s on./T[o ov
....C. L.._Gaylor_d,..Attorney.....-•-......-... - , ~.1
• t..exen-A &"&*I
I River-.Falls,. WL 56022.
, Notary Atbtie Pi•4.F.C.R...... 6...Ceunty. ~h. r
I~ ~eei not neeea a y be authentkated or acknowledged. Both Commission is permanent. (If not; oft" expiritkm'O r'
rl' Jtlly...9..........._.., 19 .tS II
date:
~1 •Nawsw M a.nwwa w4ninr in wn> <wsa.i•> dn,wia b. k't 4 wr "1'" ba.. m.n. Nrn.t- ~
VOL $35 PAa544 s
The SA of Section 29; all that part of the NJ of SE# of Section
30 lying North and West of the highway crossing said described
80 acres; a parcel of land located in the W$ of the NEC of Section
30 described as follows: Beginning at the Southwest corner of
said NA of Section 30-28-18; thence North along the West line
of said NEk a distance of 1147.5 feet; thence N88 00'E a distance
of 228.5 feet; thence N47 26'E a distance of 834.3 feet to an
iron pipe take on the South shore of the Kinnickinnic River;
thence N63 WE on a meander line along said shore a distance
of 56.5 feat to a pipe stake on said shore; thence due East a
distance of 403.5 feet along South line of parcel previously
conveyed by Ward to George C. Kind; thence South along the East
line of the W~ of NEC a distance of 1740 feet to the South line
of said NA; thence West along said South line of the NEk a distance
of 1329 feet to point of beginning, including all land lying
between the above mentioned meander line and the Kinnickinnic
River (this last described parcel contains 43.8 acres more or
less); all located in Township 28 North, Range 18 West; subject
to all easements and rights-of-way of record. EXCEPT parcels
previously conveyed described as follows:
i
Beginning at a point on the North line of the NEC of the SW}
of Section 29, Township 28 North, Range 18 West, 284 feet east
of the northwest corner of said quarter section thence East
467 feet, thence South 467 feet, thence West 461 feet, thence
North 467 feet, to the point of beginning. (Approximately five
acres).
That certain parcel of land located in the NW} of the SWk of
Section 29, Township 28 North, Range 18 West, Town of Kinnickinnic,
St. Croix County, Wisconsin, more fully described as follows:
Beginning at the West k corner of said Section 29, thence go
S 00'00'00"E. along the west line of said Section 29 a distance
of 322.00 feet; thence N 89'10'00" E 272.00 feet; thence N 00 00'00"
E 322.00 feat; to the north line of the SW} of said Section 29;
taeacc S 89 10'00" W along said north lino of the SWk a t"stance
of 272.00 feet to the Point of Beginning, the above described
parcel subject to easements for road way purposes along the North
33.00 feet of the above described parcel and the westerly 33.00
feet now being used for Town Road, and sub act to an easement
for driveway purposes across the North 15 last to the South 25
feet of the West 165 feet of the above described parcel.
Part of the Northeast Jk of the Southwest k of Section 29, Township
28 North, Range 18 West, Town of Kinnickinnic, St. Croix County,
Wisconsin, as set forth and described on the Certified Survey
Map which is on file in the St. Croix County Register of Deeds'
Office in Volume 3, Pagge 696 of Certified Survey Maps, dated
September 27, 1978 at Z o'clock P.M.
(This deed is given in fulfillment of a Land Contract dated April
7, 1973, recorded July 16, 1973, in Vol. 496 Records, Page 371,
as Doc. No. 315525, Register of Deeds' office, St. Croix County,
Wisconsin.)
t'..-. .,..tom
• VOL 8'35 Pa,-i-t544
The SWk of Section 29; all that part of the N4 of SEk of Section
30 lying North and West of the highway crossing said described
80 acres;, a parcel of land located in the WJ of the NE3k of Section
30 described as follows Beginning at the Southwest corner of
said NE# of Section 30-28-18; thence North along the West line
of said NEB a distance of 1147.5 feet; thence N88 00'E a distance
of 228.5 feet; thence N47 26'E a distance of 834.3 feet to an
iron pipe take on the South shore of the Kinnickinnic River;
thence N63 WE on '
a
meander line along said shore a distance
of 56.5 feat to a pipe stake on said shore; thence due East a
distance of 403.5 feet aloe South line of parcel previously
conveyed by Ward to Georga C. Kind; thence South along the East
line of the 0 of NEk a distance of 1740 feet to the South line
of said NE}; thence West along said South line of the NEk a distance
of 1329 feet to point of beginning, including all land lying
between the above mentioned meander line and the Kinnickinnic
River (this last described parcel contains 43.8 acres more or
less); all located in Township 28 North, Range 18 West; subject
to all easements and rights-of -way of record. EXCEPT parcels
previously conveyed described as follows:
Beginning at a point on the North line of the NEC of the SA
of Section 29, Township 28 North, Range 18 West, 284 feet east
of the northwest corner of said quarter section thence East
467 feet, thence South 467 feet, thence West 46f feet, thence
North 467 feet, to the point of beginning. (Approximately five
acres).
That certain parcel of land located in the NA of the SWk of
Section 29, Township 28 North, Range 18 West, Town of Kinnickinnic,
St. Croix County, Wisconsin, more fully described as follows:
Begi$ning at the West k corner of said Section 29, thence go
S 00 00'00"E3- along the weal line of said Section 29 a distance
of 322.00 feet; thence N 89'10'00" E 272.00 feet; thence N 00 00'00"
E 322.00 fe&t; to the north line of the SW} of said Section 29•
thence S 89'10'00" W along said north line of the SWk a distance
of 272.00 feet to the Point of Beginning, the above described
parcel subject to easements for road way purposes along the North
33.00 feet of the above described parcel and the westerly 33.00
feet now being used for Town Road, and subject to an easement
for driveway purposes across the North 15 eet to the South 25
feet of the West 165 feet of the above described parcel.
Part of the Northeast } of the Southwest k of Section 29, Township
28 North, Range 18 West, Town of Kinnickinnic, St. Croix County,
Wisconsin, as set forth and described on the Certified Survey
Map which is on file in the St. Croix County Register of Deeds'
Office in Volume 39 Page 696 of Certified Survey Maps, dated
September 27, 1978 at 2 o'clock P.M.
(This deed is Ivan in fulfillment of a Land Contract dated April
7, 1973, recorded July 16, 1973, in Vol. 496 Records, Page 371,
as Doc. No. 315525, Register of Deeds' office, St. Croix County,
Wisconsin.)
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~sconsin SOIL EVALUATION REPORT SPAID #1640
Depark neat of Commerce in accordance with Comm 85, Wiis_ Adm. Code i of 3
Division of Safely and Bindings soi Tasting, Inc.
Attach comple!!e site plan on paper not less than 8%x 11 inches in Boa Plan must County SL Crok
include, bid not limited to vertical and homwnhd reference point (BM), direction and
percent slope, scale or dimensions, north amiu, and location and dishm a to newest road. Parcel D -1
Please print au'
Date
Par Banal iifarmalion you pouide may be tort SL 15.04 (1) (m))_
Properly Owner ~i Ena Locat ion
Bauer, Daniel/Bauer, t SE1SW114, S29, T29N, R18W -nil I) Properly Owrneft Maiing Adds LoS0r CSLW
947 Quarry Road OHOIX COUNTY 38.15 Acre Parcel
City State IN L~ Ej City Yiage Z Town Nearest Road
River Falls WI 54022 715-410-0177 Kinnickinnic East Quarry Road
1 New Construction Use-X Resider" / Number of bedrooms 4 Cade derived design flow raft 600 GPD
L' Replacement "L-j Public or commercial - Describe.
Parent material Arland series, till over sand Fwd plain elevation, N applicable rna It.
General comments
and recononendations., Area is suitable for a conventional system wdh a 0.4 gpd/sgit rate. Possible system elevation, step
trenches, (High) 90.4' (Mid) 89.8' (Low) 89.7. Slope is 6%.
Boring Fil # i Ppit ing
Ground surface eiev. 93.20 It Depth to Biting factor 98+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consis~ Boundary Roots GPDM
in. Lined Qu. Sr- Coat Color Gr. Sz Sh_ 'El 'EM
1 0-15 10yr3/2 fin A Om mfr as ivf -
2 15-37 10yr6/6 none vfs icsbk mfi 9N► A .6
3 37-42 10vr5/6 none vfSI imsbk mfr 9w .2 .6
4 42-45 7.5yr4/6 now vfsl Om mfi gw .2 .6
5 45-56 10yr5/6 none Ifs lcsbk mvfr CS .5 1.0
of some "antes, is xxd to a 0.4 gpd,/sq[L
7 56-98 10yr6/4 none fs Osg ml - .5 1.0
Pit Ground surface elev. 10.0 R Depth to limiting factor 100+ in. Sol Application Rate
Horizon Depth Dominant Color Redox Description Textiue Strutnrre Consisterwe Boundary Roots GPD1W
in. Mansell clu. St Cont. Color Gr. Sz Sh_ 'lit 'Ef>IKt
1 0-20 10yr3/3 none fsl 2mgr mvfr 9w 2f .4 .8
2 20-28 7.5yr4/4 none fst 2msbk mvfr 9w .4 .8
3 28-66 10yr4/4 none Ifs icsbk Frr& CS .5 1.0
4 66-100 10yr6/4 none fs Osg ml .5 1.0
' Effluent #1 = BOD 5> 30 < 220 mg1L and TSS >30 < 150 mgfL ' Effluent #2 = BOD5 <_30 mg1L and TSS <_30 mglL
CST Name (Please Print) Signature- CST Number -IV
Thomas J. Schmitt zr,. 227429
Address Schmilt Sal Testing, Inc. Dale Evaluation Conducled Telephone Number
1595 72nd Street New Richmond, WI 54017 10M M2010 715-247-2941
SBD-5330 (R07/00)
I
r
Property Owner Bauer, Daniel/Bauer, Christopher Parcel ID # 022-1085-40-000 Page 2 of 3
F # Z ~ Ground surface elev_ %.30 it Depth to factor 106+ in- Sol APP
Hormon Depth Dominant Color Redox Description Texture Strrrchrre Consistence Boundary Roots GPDW
in. Munsel Qu. Sz- Coat Color Gr. Sz. Sh. 'Ewl Tw
1 0-22 10yr3/4 none fsl lcsbk mfr gw 2vf .2 .6
2 22-45 10yr4/6 none fsl 2csbk mvfrr a .4 .8
3 45-106 10yr6/4 none ft 099 ml - .5 1.0
1 i•
6
- factor
Pt Ground surface elrw. It D~ to 9 in. Sol APPS Rate
Horizon Depth Dominant Color Redwr Description Texture Struchm Boundary Roofs GPDRF
in. Mu>sell Qu. Sz Cont. Color Gr. Sz Sh. 'Etrst •Eff#2
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F-1 Boring # Pit Yg Ground surface elev. IL Depth to timing bckw in_ Sol Appkabon Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKr
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EW 'Etflr2
I ~ I
~ I
u i
" Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mg/L ' Effluent #2 = BODS < 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.
SBn-8330 (8.07/00) Schmitt Soil Testing, inc.
< Page 3 of 3
Conducted by: Conducted For:
Schmitt Soil Testing, Inc. Name: Daniel Bauer/Christopher Bauer
Thomas J. Schmitt, CST 227429 Address: 947 Quarry Road
1595 72nd St. City, State, Zip: River Falls, W154022
New Richmond, WI 54017
Phone: 715-760-1978 CSM: 38.15 Acres
signature Lot No. NA
Date Legal Description: SE1/4 SW1/4 S29 T29N R18W
■ Backhoe Pit Township, County: Kinnickinic, St. Croix County
A Bench Mark 1 El. 100.00' Top of 2" PVC pipe
Q Bench Mark 2 El. 96.70' Top of 2" PVC pipe
Slope=
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ST. CROIX COUNTY
WISCONSIN
- ZONING OFFICE
N M W N A ^ Nllur. ST. CROIX COUNTY GOVERNMENT CENTER
1101 Carmichael Road
' - s--~-"" Hudson, WI 54016-7710
(715) 386-4680 FAX (715) 386-4686
Page / of
COUNTY ON-SITE VERIFICATION FORM
Inspector: 91'~4A' Date: blin
Parcel ID Number
roperty0mer Property Location
6Ar S 84 e.oL . Govt. Lot 14 114 S 11 T N R E (or) W
PropertyGwrier°sMailing Address Lot# Block# &W.NameorCSFN
City State ApCoe Phone Number ❑City ❑Village n Nearest Road
.DOowconstruafion Uae: ❑ Rasidentia l B Number Code derived design flow rate GPD
❑Replacement ❑ Public or commercial -Describe:
Parent material _ . _ ....Y - _.,_...W.. ,__,,...Y.,., Flood Plain elevation I applicable ft.
General comments
and recommendations:
'Boring
Boring f
a ❑ Pit Ground surface eiev. Depth to limiting factor in. Bel licaltian Rate
Horizon Depth Dominant Color Redox Description Taxtura Structure Consistence Boundary Rods GPDA?
in. Munsell au. Sz. Cont. Colo Gr. Sz. Sh. T-01 *0#2
Z 5 S /6 (0 LVF~ i ft, .-S - 6
L G
1,37-412 1-OW5A n.4
'7S p G S O. Z
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Conditions: l g G.(e ~O~e®
Soil Survey description::
Notes: ~dd-a1aL~ b~l C~
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