HomeMy WebLinkAbout022-2004-40-000 County:
Wisconsin Department of "Commerce PRIVATE SEWAGE SYSTEM St. Croix
Safety and Building Division
• INSPECTION REPORT Sanitar Permit No: 453054 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
Pieten ol, John & Jane I Kinnickinnic Township 022- 2004 -40 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
!vim . 1 , e , /va.• a� IGP r_"i si I (o C1 �' 36.28.18.571
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing y Alt. BM
S. Y. Cow
Aeration Bldg. Sewer
Holding SUHt Inlet f
SUHt Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic ' 2�� � lCw - 7 Dt Bottom /� 7
Dosing �� Header /Man. /
Aeration Dist. Pipe
Holding Bot. System � Z___ 9 3 3
latl 3 rinc
Final Grade
PUMP/ IPHON INFORMATION ID T.
Manufacturer - ^ Demand Cover q S % gs --
� GPM 7 /'c
i . Model Number 2U
r
TDH Li Fricti n L ss System Head TDH Ft
�. /_ K. -�-- -- � - �7
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pit Inside Dia. Liquid Depth
DIMENSIONS 3 e z a y
SETBACK SYSTEM TO / P/L BLDG WELL LAKE /STREAM LEACHI Manufacturer
INFORMATION CHAMBER R — X,
[ Type Of System: 8 t l ` 8 /� UNIT Model Number:
Get vu�n o r C+ ! -
DISTRIBUTI SYSTEM L ,, .,, _ oh a •• 3 ` -.
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
� Pipe(s)
Length Di. Length is — L
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over n t Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center / Bed /Trench Edges Topsoil
1 Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: +� / /Z - i G Inspection #2: ! /
Location: 23 Cottonwood Lane River Falls, WI 54022 (S 1/2 SW 1/4 36 T28N R18W) NA Lot c/ Parcel No: 36.28.18.571
l
1.) Alt BM Description = •"Tc P � ! C G 11 � i
2.) Bldg sewer length = £3 '? t v (�✓ a b'' ^ % r�
- amount of cover
Plan revision Required? Yes No
se other side for additional informal /
--
Date Ins ctors Signature Cert. No.
1-6710 (R.3/97)
Safety and Buildings Division County
201 W. c�
Washington Ave., P.O. Box 7162
Madison, WI p Sanitary Permit Number (to be filled in by Co.)
iseonsln
Department of Commerce (608)211-315 RE(;EI 3 �-
e
Sanitary Permit Applicatio R ry 5 Stat — Plan I.D. Number
_______
In accord with Comm 83.21, Wis. Adm, Code, personal informati you pr ,4
may be used for secondary purposes Privacy Law, s15.0 1)(m) Pro ct Address (if different than mailing address)
ST. CF�OIX ;� .
I. Application Information - Please Print All Information NG OrFiC
Property Owner's Na me Parcel # Lot # Block #
Property Owner's M ailing Address Property Location
co - �3
City, Sp ]! Zip Code Phone Number ' 4A Section � 3
KO Z„ 2 ucle one)
II. Type of Building (check all that apply) T = _t,lty; R_&E ore
1 or 2 Fancily Dwelling - Number of Bedrooms 2 3 ,c $� tr. �pQQs Sum CSM Number
❑ Public(Conunercial - Describe se _
❑ State Owned - Describe Use�J2 u T -
❑City ❑Village Township of
! i✓�/CG k t -."VI G
III. Type of Permit: (Check only ox on line A. Complete 1 ne B if applicable) !�
❑ New System Replacement System ❑ Treatment /Holding Tank Replacement Only ❑ Otlter 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
1V, Ty e 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 Wetland ❑ Pressurized In - Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter
❑ Recirculating Synthetic Media Filter KLeaching Chambe ❑ Drip Line ❑ Gravel -less Pipe ❑ Odier (ex lain)
V. Dispersal/Treatment Area Inforn 2p( . Jo
Des' n Flow (gpd) Design Soil Applicc Rate(gpdsf) Dispersal Area Required (sf) ispersa Area Proposed (sl) System Elevation 9 3i j
b2 lPLw� �C� 8 94,0
L 7
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel iber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
TaLiks Tanks
— Septic or Holding "Cat>!c
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- I, the undersigued, assume responsibility for installation of the POWTS shown on the attached plans.
Plumb e 's Na me (Print) � er's Si gnature MP /A+EPR94Number
�� Business Phone Number
Plumber's Addre ss (Street, City, State, Zip Co
VIII, Count /De artment Use Onl
Approved ❑ Disapproved Sanitary Permit Fee (' ncludes Groundwater Date Issued su' g Agent Sign r o Stamps)
Surcharge Fee)
❑ Owner Given Reason for Denial v3 f 3p�D
LK. Conditions of Approval /Reasons for Disapproval _
�X-t S ,
SYSTEM OWNER: 3) s - a�
1 Se tank, effluent filter and
dispersal cell must all be serviced / maintained ,
as per management plan provided by plumber. oil
2. All setback requirements must be maintained
as per applicable code /ordinances.
Attach complete plans (to lire County only) for the system on paper not leas than 81/2 x 11 inches in size
SBD -6398 (R. 01/03)
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w►sconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
DWWon of safety and Buildings
in aocordarroe with Comm 85, NES. Adm. Code County St. Croix
Attach complete site plan on paper not less than 812 x 11 inches in size. Plan rrurst
Include, but not knitted to: vertical and horizontal reference point (BM), direction and Parcel I.D. 022 - 2004 - 40 - 000
peroent slope, scale or dimensions, north arrow, a
VE Dat
Please print all info - V
Personal information you provide may be used for second@ y Purposes (Privacy Law, s. 15.04 (1) ( U
, i
PropettyOvater L SW 1/4 SW 1M S 36 T N R IS E (cr'a
TODD E. AND PATRICIA E. RO EY Govt Lot
Prr >frertyOwrrer'sMallxrgAddress ZONING OF S<u 7 23 Cottonwood Lane
CRY State Zip Code Phone Number p ViNage • own Nearest Road
River Falls, WI 54022 ( ) NK Cottonwood Lane
C] New Constnxxion UseEj Rmk*rWW / Number of bedrooms 4 Code derived design flow rate 600 GPD
0 R"Iac:ernent ❑ public or commesaal - Describe:
Parent material outwash Flood Plain elevation if applicable NX
General comments Conventional In- ground trenches (pumping may be required) - to be designed by installer
and = Loading Rate 0.5
(18 - 30 frost - thawed)
Boring
# Q Pit Ground surface elev. 96.50 ft. Depth to linridng factor 78 i Str r cetion Rate
Horizon Depth DorteDominant Color Redox Desc iption Texture ucture Consistence Boundary Roots in. Mursell Qu. Sz. Cont. Color Gr. Sz Sh. -0102
1 0-8 10YR2 /1 — I 3f-mgr mvfr cb 3vf-co 0.8
2 8 -12 10YRW 2fabk m`fi ci 2vf-c o 0.8
3 12 -26 10YR3/2 1 2f -mabk mfr cb 2vf-m 0.8
l IOYR3 /4 — Is 2f -mabk mvfr cvv 2vf-m 0.7 1 . 2
4 26-32
5 32 -36 I OYR3 /6 — Is 1 f -mabk dsh cw 2vf-m 0.7 1.2
6 1 36 7$
IOYR4 /6 — fs Osg ml as Ivf-m 0.5 0.9
8 t 10YR4 16 t2f I0YR3 /6 fs Osg ml — -- 0.5 0.9
❑ g g Borin 94.75 76
• Pit Ground surface elev. ft. Depth to limiting factor m. Sol{ ADOWW Rage
Horizon Depth Dominant Color Redox Description Texture Structure Cer
oce Boundary Rods GPDIfF
in. Mursell Qu. S7_ Cont. Color Gr. Sz- Sh. - Etl i Et 2
1 0-4 10YR2 /1 — 1 3f -mgr mvfr ci 3vf-co 0.5 0.8
2 4-12 10YR2/2 — 1 2f -msbk dsh cb 2,f-, 0.5 0.8
3 12 -24 10YR3/2 — l 2f -msbk dsh ai 2vf-m 0.5 0.8
4 24-38 IOYR3 /4 — sl 2f- -mabk mfr
cb 2vf-m -
g 38 -76 10YR4/6 — fs Osg ml cb lvf-m 0.5 0
6 76-85 — — scl/till —
Z (Horizon 5 has some gravel <10%)
• Efiluertt *1 = BOD > 30 220 mglt.. and TSS >3D : s 150 mglL / �/ ��* E ® �fl�uent #2 = BOD _< 30 mg& and TSS <_ 90 n►91L
CST Name (Please print) ` J6 ^) U ` u L CST Num M Jo Hollister —s Imil 224832
Address Dale Evaluation Conduced Telephone Number
W9875 690th Avenue, River Falls, WI 54022 02 - 10 - 04 (715) 426 - 1775
r - -
s
property Owner ROBEY, TODD & PATRICIA Parcel ID 022 - 2004 -40 -000 P age 2 of 3
BMg
39 Ground surface elev. 96.30 ft. Depth to 9 factor 73 in.
Pit sod Application Rate
Horizon Depth Domirwrt Color Redox Description Texture SUrur*ue Consisterroe Bwndary Roots GPDMF
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Etf#2
1 0-4 10YR2/2 — 1 3f -mgr mvfr cb 3vf-co 0.5 0.8
2 4-16 IOYR2/1 — 1 3f-mabk mfr ci 2vf-co 0.5 0.8
3 16-36 10YR3/3 — 1 3f -msbk dsh ai 2vf-m 0.5 0.8
4 36-5 10YR3 /4 — sl 2f -msbk mfr cw 2vf-m 11.5 0.9
5 56-73 IOYR4 /6 — fs Osg m1 aw — 0.5 0.9
6 73 -77 10YR3 /4 f2f IOYR3 /6 s1 Imsbk mvfr — — 0.4 0.6
�r9
Pit Ground surface elev. ft. Depth to limift factor in. Soil Apooekb Ram
Horizon Depth Dominant Color Redox Description Texture Structure Comae Boundary Roots GPDff
in. Munsell Ou. Sz Cont. Color Gr. Sz. Sh. *Etfe1 *002
Bor" # Ground
PiB " Gnd surface face elev. ft. Depth to factor in. Sot tZalne
Horizon Depth Dornkwnt Color RedoxDescription Texture Structure Consistence Boundary Roots APM
in. Munsell Ou. SL Cora. color Gr. Sz. Sh. *ESM *EW2
* EtAuent #1 = BOD, > 30 220 mgOL and TSS >30 150 mg/L * E&wd #2 = BOD, < 30 mg/L and TSS _< 30 nrg/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 60 &266 -3151 or TTY 608-264 -8777.
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LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02
REAL ESTATE TOWN OF KINNICKINNIC
COMPUTER NUMBER 022- 2004 -40 -000 Parcel Number 36.28.18.571
OWNER NAME: First TODD E & PATRICIA E Last ROBEY
PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment
23 COTTONWOOD LA
SECTION 36 TOWN 28N RANGE 18W '/4160 1 /440
Line Description Line Description
TOTAL ACREAGE 40.000 PLAT LOT BLK
01 SEC 36 T28N R18W SW SW 15
02 LYING SLY OF COTTONWOOD DR 16
03 ALSO PT NW SW AS DESC 17
04 1160/228 18
05 19
06 20
07 21
08 22
09 23
10 24
11 25
12 26
13 27
14 28
F1- General, F4 -Prev. Parcel, 175 -Next Parcel, F7- Valuations, 178- History, F10 -Exit
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V�isconsin Department of commence SOIL EVALUATION REPORT Pape I of 2
Division of Safety and Buildings
in accordance with Comm 85, Ws. Adm. code
cou St. Croix
Attach ,Mete site plan on paper not less than 81/2 x 11 inctnes in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 022 - 2004-40 - 000
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Phase print all information. Reviewed >ry Date
Personal Wk m+a4on you provide maybe used for secondary purposes (Privacy Law, s. M04 (1) (m)).
ply Owner Property Location ❑ 0
TODD E. AND PATRICIA E. ROBEY — SW 1/4 SW IM S 36 T 28 N R 18 E (or) W
Property Owner's Mailing Address # Block # I Subd. Name or CSW
23 Cottonwood Lane
City State Zip Code Nub E]Yrllage own Neems<Road
River Falls, WI 54022 ( 1 Fl j 1 2 Cottonwood Lane
IX C0417�
New ConsUudion UseEj Residertia(/ of _ derived design flow rate 600 WD
a Replacernert Punic or - it.
Parent mriat ate outwash Flood Plain ei'evation If applicable
Genml co rnerts H ole dug near existing system to determi condemning of system for grant purposes -
and recormiendations:
Water depth in pipe was at 4 feet.
1 Bo*g # 0 Borft ❑ Q Pit Ground surface elev. 97.40 ft. Depth to NruMrg factor 3b in. Applical Ra>3e
Horizon Depth Dominant Color Redox Description Texture SUnrcltxe Consistence Boundary Roots GPDIIF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - EM1 '
36-48 10YR3 /4 Of 10YR6/1 & 10YR4/6 sil 2fabk mfr aw 2vf-m
48 -74 10YRY4 f2f 10YR4/6 fs we mvfr _ --
# ❑ Borin9
F El Pit Ground surface elev. ft. Depth to knifing factor in. Sol Appikshon Rate
Horizon Depth Dominant Color Redox Description Texture Struckm Consistence Boundary Roots GPDff
in. Munseell Qu. Sz. Cont. color Gr. Sz. Sh. *EfM *Effir2
* Effluent #1 = BOD > 30 < 220 mq& and TSS >30:5 ISO mg/L ' Eflkint 82 = BOD 130 mglL and TSS _< 30 mglL
CST Name (Please PrinQ � CST ber
M Jo Hollister Signature Num
224832
Address Dale Evaluation Conducted Telephone Nurnber
W9875 690th Avenue, River Falls, W1 54022 02 - 10 - 04 (715) 426 -1775
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Combination Sept.;ic:,Tank and
PUMP CHAM6ER CR05s SECTION *jo SPECIFIC. U
VEIJ7 CAP WEATHEK PiL00F
JutiCTI011 6OX .
ti`C.I. VENT PIPC
LOCKIN
IPPR0 ':' G
' —TO' fRQM OQOR, h1AlJfiaLE COVEK !- Vl'S�'�
wARN1 `ABEL..
.lItJ00W OR F9E5H couDU�T
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�.; PROVIDE I - - - --
!1lLET „' _ "AIRTIGHT SEAL
zt-"FFk.�• APPROVED JOWT:
APPROVED Jo
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IPEOR n
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w /c.>= P Tank constru ( I ALP.RM
shall comply with ! II
ILHR <,3.15 and 83.20 a I !
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PUMP
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RISER F-MT PE.KI~11T(ED OIJLJ IF TAUK MAlJUFAGTURER HAS SUCH APPROVAL azDOING
SEPTIC F SPECIFICA_rJ0JS
DOSE
PER DA
InJ15L C- L1�J�1��1 IJUMf3ER OF DOSES:
B
Tn�1kS MA►JUFACTURCR.:
TAIJK a1ZE; 6A,.L0QS D05E VOLUME l
S - IV
ALACRM "QUFACTURl`R:
O t l 1 -J NCLUDIW1 bAGKfLOW: GACLON5
MODEL kJUMOER: 10l CAPACITIES: A- � / " ?CHE5 OK 5ALLOU5
ZWITCH T�PL: I"Ie_)Z: \`-'"I 5 = I I)j cHES'oR r�Z ri LLOUS
1 �2 S C= _ / IUGNES OR /R ' Z�LLOLIS
i F'UMP MAI.JUFAGTUREK: (2� (O
MODEL 1JUMDER: /�vE vD 1) NGHES OR � _ 0ALLOMS
5WITCH T'JPE: w1 ��( iJOT£: PUMP AMI) ALARM ARC TU OL
GPM IN5TALLED C)Q SEPARI�TE CIRCUITS
M lAl IMUM DISC.KARGE R ATE
VEKT DIFFEK[KICE DETWEELI PUMP OFF AWC- 015TRIbUTIOU PIPE.. Z FEET
+ KIWMUM UETWORK SUPPLY PUSSURE , ; ... , , FEET
_� FEET OF FORCE MAIN X 0 0 Y0fL FKICTtou FACTOR - - 431 L FEET
TOTAL 0� JAMIC HZAC) = FEET
As per, manufacturer g a kin.
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=— Quick4
STANDARD CHAMBER
52"
Qu1ck4 Standard Chamber 48"
(EFFECTIVE LENGTH)
6 _
12
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0 109
S"
34" SIDE VIEW
SECTION VIEW
MultiPort End Cap
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16"
12"
34" SIDE VIEW TOP VIEW
FRONT VIEW
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INFILTRATOR SYSTEMS. INC. STANDARD LIMITED WARRANTY
(a) The structural integdty of each chamber, and plate, wedge and other accessory manufactured by Infiltrator ( "Units7, when installed and operated
in a leachfield of an onsite septic system in accordance with Infiltrator's instructions, is warranted to the original purchaser ("Holder") against detective
materials and workmanship for one year from the date that the septic permit is issued for the septic system containing the Units; provided, however,
that if a septic permit is not required try applicable law, the warranty period will begin upon the date that installation of the septic system commences.
To exercise its warranty rights, Holder must notify Infiltrator in writing at its Corporate Headquarters in Old Saybrook, Connecticut within fifteen If 5) . •
days of the alleged defect. Infiltrator will supply replacement Units for Units determined by Infiltrator to be covered by this Limited Warranty.
IndlVator's liability specifically excludes the cost of removal and/or installation of the Units. O
R
(b) THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT SYSTEMS INC
TO THE UNITS, INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.
(c) This Limited Warranty shall be void if any part of the chamber system is manufactured by anyone other than Infiltrator The Limited Warranty does
not extend to incidental, consequential, special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, including loss of Environmental Onsite
Wastewater Solutions"
production and profits, labor and materials, overhead costs, or other losses or expenses incurred by the Holder or any third party. Specifically
excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear, alteration, accident, misuse, abuse or neglect of
the Units; the Units being subjected to vahicte traffic or other conditions which are not permitted by the installation instructions; failure to maintain the 6 Business Park
Road • P.O. Box 768
minimum ground covers set forth in the installation instructions; the placement of improper materials into the system containing the Units; failure of
the Units or the septic system due to improper siting or improper sizing, excessive water usage, improper grease disposal, or improper operation; or Old Saybrook, CT 06475
r mm a y rr otthe event not caused by Infiftratw. This Limited Warranty shall be void if the Holder fails to comply with all of the tennis set forth in this Limited 860- 577 -7000
•FAX 860 - 577 -7001
Further, in no event shall Infiltrator be responsible for any loss or damage to the Holder, the Units, or any third party resulting from installation or ship- 800_221
meet, or from any product Ilabillry claims of Holder or any third parry. For this Limited Warranty to apply, the Units must be installed in accordance
with all site conditions required by state and local codes; all other applicable laws; and Infiltrator's installation instructions.
(d) No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any parry other than the odgi-
nail Holier.
The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of states and counties have different warranty require-
ments. Any purchaser of Units should contact Infiltrator's Corporate Headquarters in Old Saybrook, Connecticut, prior to such purchase, to obtain a
copy of the applicable warranty, and should carefully read that warranty prior to the purchase of Units.
U.S, Patents: 4,759,661; 5,017,041; 5,156,488; 5,336,017; 5,401,116; 5,401,459; 5,511,903; 5,716,163; 5,588,778; 5,839,844
Canadian Patents: 1,329,959; 2,004,564 Other patents pending.
Infiltrator, Equalizer and SideWinder are registered trademarks of Infiltrator Systems Inc. Infiltrator is a registered trademark in France. Infiltrator Systems Inc. RECYCLED
PAPER
is a registered trademark in Mexico. Contour, Contour Swivel Connection, Microl-eaching, PolyTuff, SnapLock, ChamberSpacer, Posil-ock, QuickCut, QuickPlay
and Quick4 are trademarks of Infiltrator Systems Inc. 0 2003 Infiltrator Systems Inc. Printed in U.S.A. 0011203HP -0
M E40 Series M
4/10 HP Effluent
and Drain Water Pumps
Performance Curve
MODEL ME40 EFFLUENT PUMP
CAPACITY LITERS PER MINUTE
0 50 100 150 200 250 300 350
40 12
35
10 to
30
L
"Z 25 8 Z
Z
� H
t 20 6
J
< 15
0 4 O
�1
5 2
0 0
0 10 2 30 40 50 60 70 80 90 100
CAPACITY GALLONS PER MINUTE
F.E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805 -1923
419/289 -1144 FAX 419/289 -6658 Telex 98 -7443
K3326 7/91 Printed in U..� A.
_SW� PI C-4–C–AJ, 4 6(_
Private Onsite Wastewater Treatment System Management Plan
Septic Tank And Gravity In- Ground Soil Absorption Component
Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment
System (POWTS) shall include information and procedures for maintaining the system within
the parameters of Comm 83 and 84, and the conditions of approval by the department, agent,
or governmental unit. The approved plans and permits for system are on file at the county
zoning or health department.
This complies management Ian lies with Comm 83.54, Wis, Adm. Code, and the In- Ground
9 p p
Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD-
10567 -P (R.6199).
Table 1: System Design Speci
Y 9
Sanitary Permit Number 4530 5
Number of Bedrooms
Design Flow - Peak (gpd)
Estimated Flow - Average (gpd) cp
Septic Tank Capacity (gal) S ,
Soil Absorption Component Size (ft
Type of Wastewater Do estic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Compon2pt
Design Flow - Peak (gpd) ?DO M
Maximum Influent Particle Size (in 1
Maximum BOD (mg /L) 220
Maximum TSS (mg /L) 150
Table 3: Maintenance Schedule
Septic Tank Inspect and /or service once every 3 years
Outlet Filter Inspect once a year and clean at least once every 3 years
Soil Absorption Component Inspect once every 3 years
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 (Servicing Septic or Holding Tanks, Pumping Chambers, Grease
Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable
Restrooms).
The operating condition of the se and outlet filter shall be assessed at least
once every 3 years by inspection. a outlet filte shall be cleaned as necessary to ensure
proper operation The filter cartridge s ou 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
i
Management Plan for a Septic Tank and Soil Absorption Component
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 scum and sludge 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 an 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.
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 the tank.
No one should enter a septic or other treatment or holding tank for
any reason without being in full compliance with OSHA standards for
entering a confined space. The atmosphere within the septic or other
treatment of holding tank may contain lethal gases, and rescue of a
person from the interior of the tank may be difficult or impossible.
Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the
tank is no longer used as a POWTS component.
Soil Absorption Component
The soil absorption component serving this structure is designed to accept domestic
wastewater from a residential facility. The limits of operation of this component are shown in
Table 2.
The longevity of a soil absorption component depends greatly on proper and timely
maintenance, and system use within or below the limits of reliable operation. Good water
conservation practices by all occupants and the installation of water conserving plumbing
fixtures are key factors in extending the useful life of this component.
The soil absorption component's operation must be assessed by inspection at least
once every three years. The inspection shall include recording the levels of ponding, if any, in
the observation pipes, and a visual inspection for any evidence of surface seepage or discharge
from the component. On steeply sloping sites, areas of erosion should be identified and
reported to the owner for repair. The surface discharge of domestic wastewater or sewage
from the system is prohibited and considered a human health hazard.
Traffic around or over the soil absorption component should be avoided particularly
during winter months. The compaction or removal of snow cover over the component may lead
to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or
impossible to repair until weather conditions improve. In general, soil compaction over this
component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to
more intense, and earlier, organic clogging of the soil.
2
Management Plan for a Septic Tank and Soil Absorption Component
Plantings of deep - rooted trees and shrubs directly over or within ten feet of the
component should be avoided since root intrusion into the component may obstruct wastewater
flow.
Pt 19 6 7/s - 27 3�Y Y--
S" Coo K CO Z -oN t�
IV 49
3
03/19/2004 10:35 17154259559 LUND BUILDERS PAGE 01
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address 1 7 q C f,, R
Property Address
(Verification required from Planning Department for new construction)
City /State Parcel Identification Number QaZz00y 5
L1H;GAL DESCRIF�I"ION�
Property Location '_ y,, Sec. _3L, T ?f_ N- R.L� W, Town of e-
Subdivision Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # 75 8 �9 , Volume , Page # � ---
Spec house D yes no Lot lines identifiable ® yes D no
TEM 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 certificatiou 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 113 full of sludge,
Uwe, 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
days of the three year expiration date.
3 l la 1O`4
SIG ATURE OP AP LICANT DATE
OWNER CERTIFICA'T'ION
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.
— a P'j"j 3 /1i /Oy
S! A TURF OF APP /CANT DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.'" ••'
•' Inchide 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
03/23/2004 10 :14 17154259559 LUND BUILDERS PAGE 01
U 2528P 134
7nr6E344
STATE BAR OF WISCONSIN FORM 1 -2000
WARRANTY DEED KATHLEEN H. WALSH
Document Number RTGI TER OF DEEDI
This Deed, made between Todd Robey and Patricia E. RECEIVED FOR RECORD
RobeY, husbArtd and wife
03/17/2e94 10: 00Ah
Grantor, WARRANTY DEED
and Sohn D. Pi
RLSnpo and June M. Pietonz)ol , Husband EXENAT #
and wife as survivorship marital property REC FEE: 13.00
TRAKS FEE: 1080.00
Grantee, COPY FETE:
Grantor, for a valuable consideration, conveys to Grantee the following CC FEE:
described real estate in tat. Croix
County, State of PAGES: 2
Wisconsin (the "Property ") (if more space is needed, please attach addendum):
Sera attached addendum
;recording Area
Name and Return Address
ItMM ITTAUS STATE &0=
Y.O. t,.::t9[ a9
gym FAI" W1 um
022- 2004 -40 -000
Parcel Identification Number (PIN)
Together with all appurtenant rights, title and interests. This is homcswad property.
(is) (is not)
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
Roadways, Easements, and Restrictions of Record.
Dated this 26th day of Fabruez- __ 2004
* Todd E. RobeY ePAtriaia E. Robe
k �
AUTHENTICATION ACKNOWLEDGMENT
STATE Of WISCONSIN )
Signatures) ) ss
V. Palm St.- Croix County. )
authenticated this day of �� Personally came before me this day of
Fehruary , the above named
11s Todd r �Robey and
s _
TITLE: MEMBER STATE BAR OF WiSCONSTN Patricia ?t. Robov
(if not, to me known tg be the person a who executed
authorizcd by §706.06, Wis. Slats,) the tore tnst e t an n Icdgcd the same.
THIS INSTRUMENT WAS DRAFTED BY
m
Michael W. Foreoki At:tornov Not Public, State of Wisconsin
Eau Claire, Wisconsin My Commission is permanent, ([f not, state expiration date:
St natures ma be authenticated or acknowled d. Both are trot neces or i
'Names of persons signing in any Capacity must be typed or printed below their signature.
WARRANTY DEED STATF. BAR OF WISCONSIN FORM No. 1-2000
ttorney Michael H Foreeki 1830 Brackett Ave, Eau Claire WI $470t -4627
Phone: (715) 835 -3029 Fax: (715) 835 -4112 Michael H. Forecki T5638670.7,FX
Pfeduced w"h Z W&M N by RE ForynsNiL LLC 4025 Fifteen M44 Rood, Clinton Tawnahp, Michigan 46036, M W) 393460.5
i
03/1912004 10:35 17154259559 LUND BUILDERS PAGE 02
d
Addendum to Warranty Deed
Legal Description:
The South Half of the Southwest Quarter (S% of SW' /.), Section 36, Township 28 North,
Range 18 West, lying East of the centerline of Cottonwood Lane and a parcel of land
located in part of the NW' /4 of SW% of Section 36, Township 28 North, Range 18 West,
Town of Kinnickinnic, further described as follows: Commencing at the SW comer of
Section 36; thence N.00 °07'36 "W., along the West line of the SW'h, 1317.95 feet to the
South line of the NW' /. of SW' /.; thence N.89 °55'56 "E., along the South line of the NW %, of
SW %, 461.27 feet to the point of beginning; thence continuing N.89 "E., along said
South line, 225.71 feet; thence N,48 0 20'37 "W., 174.71 feet to the centerline of a town road
(Cottonwood Lane) also being the point on curve of a 1350.00 foot radius curve, concave
Northwesterly, whose central angle measures 06 °23'04 ", whose chord bears
S.39°1627"W., and measures 150.35 feet; thence Southwesterly, along the arc of said
curve and said centerline, 150.43 feet to the point of beginning, The parcel above is to be
included with the S' /2 of SWY< of said Section, lying Southerly of the centerline of a town
road (Cottonwood Lane)