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HomeMy WebLinkAbout024-1020-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety avid Building Division ` INSPECTION REPORT Sanitary Permit No: 488088 0 ATTACH TO PERMIT) GENERAL INFORMATION ( ate Plan ID No: r � • � Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). > ru = 'I 'r�+� • I �•/ Permit Holder's Name: city Village X Township Parcel Tax No: Case , Ted I Pleasant Valley, Town of 024 - 1020 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: l ,�� l' !i .f', ` ✓ ;< I v, ._, 16.28.17.1128 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER „ l CAPACITY STATION BS HI FS ELEV. _ , fop Septic Benchmark 1 Dosing 4 , Alt. BM Aeration Bldg. Sewer 1z • _ r ze of Ji ng St t Inl I� Sn 92.s� S t7Ht Outle TANK SETBACK INFORMATION F,,,n TANK TO P7E__ __VVELL BLDG. V ent o Air Intake ROAD 1 Yt Inl g Bottom r 4 ea er an. A eration D ist . Pipe 3S S'D o ing Bo t. bystern 2 a Z-0 PUMP/SIPHON INFORMATION fjr a. ' t ' 4 f i anu ac urer eman over S� , �- ` 5ti 6_ GPM vn: v e m oael numoer I rlc ion OSs yS em H ead , c in ng i rr r I �..;; iySTEM VVIU 11 gill I am== rm INU. V1 T ii ibiUU Uld. fiquid Duplif DIMENSIONS C X Flu . INFORMATION CHAMB OR UNIT`,, 11 I-Ulu JA PdChly 'I LU �11 11 ­11 i . Length �` Dia y.C? Length `7 't ':� -f Dia -' r Spacing._ �' ^y +I VEK x Pressure Systems Only xx Mound Or At - Grade Systems Only p JAA Dept! I of - . ­ .. I x Mulched Bed/Trench Center Bed/Trench Edges Topsoil 1 Yes No Yes No J r� i =7 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #'L: i %A .> S o ` LC "C�'�; Inspection #2: Z 8.17.1126 Location: 1782 30th Avenue Hammond, WI 54015 (SE 1/4 SE 1/4 16 T28N R17W) Nit to rcel yo: 1 i 1.) Alt BM Description 2.) Bldg sewer length = tj ' -amount of cover= I " o ? .►'* �Si `_ .r —,'' 1 y - - ___ _- _ } ---- it _ � , \ f � � Plan revision Required J Yes No � � I — �w , •4 f' t ! ^� � - — Use other side for additional Information. b,_ { SBD -6710 (R.3/97) ' afety and Buildings Division County 20 tn � , � )�� diso WI 5 RECEiV E D itary Permit Number (to be filled in by Co.) vscons�n ) 266-3151 /��i O p p Department of Commerce r 0 0 C) Sanitary Permit App ' a io 0 2 2006 a Plan I Number In accord with Comm 83.2 1, Wis. Adm. Code, personal info lion you provide / maybe used for secondary purposes Privacy Law, sl 0 CROIX COUNTY 1� Address (if different mailing address) I. Application Information — Please Print All Information t Z 3 0" A\tc-- . Property Owner's Name � -Par 1 # Lot # BI k # S / Property Owner's Mailing Address Property tion City, State Zip Code Phone Number � �•. Section rrcle e N; II. Type T E W ilding (check all that app S .t..; e CSM Number or 2 Family Dwelling — Number of Bedrooms W /`� El Public /Commercial — Describe Use P 9 ❑ State Owned — Describe Use City ❑Village shi of a III. Type o f Permit: (Check only one box on line A. Complete line B if applicable) A. S stem ❑ R e p lacement _ „_ y ep S ystem ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System B- El Previous Permit Number and Date Issued ❑ Permit Renewal ❑Permit Revision ❑Change of El Permit Transfer to New Before Expiration Plumber Owner IV. Type ofP System: C k all that apply) 2- - o- &to 2 ❑ Non — Pressurized In -Ground nd > 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 ❑ Leaching Chamber ip Line ❑ Gra 1 -less Pipe ❑ Other (explain) V. Dis ersaVrreatment Area Information: 1( ­4 D, = . o 12, --j = 1 0 2.4 f Design Flow (gpd) Design Soil Application Rate(gpdsf) ispersal Area Required (sf) Dispersal Area Pro sed sf) System Elevation yam �-� / J 5 � d VI. Tank Info Capacity in Total Number Manufacturer fab Site Steel Fiber Plastic Gallons Gallons of Units to12a.� - - /OD C fI o Crete Constructed Glass New E)dsting Tanks Tanks T` Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement I, the undersigns , A responsibility for installation of the POWTS shown on the attached plans. Plttmbyt's Name (Print) Plumber' i e MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip, ) i VIII. Coun /De artment Use Onl Approved ❑ Di roved Sanitary Permit Fee (includes Groundwater Date Issued Issuin Agent S' ature (No tamps) Surcharge Fee) _ El eason or ti — b� D 5, 2M2 IX. Conditions o ro UR SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x I1 inches in size SBD -6398 (R. 01/03) PLOT PLAN PROJECT Ted Casev ADDRESS 1529 120th Ave Amery Wi 54001 SE ' 1/4 SE 1/4S 16 /T 28 N/R 17 W TOWN Pleasant Valley COUNTY ST. CROIX SYSTEM ELEVATION 103.4' F] BOREHOLE BEDROOM 3 CONVENTIONAL AT -GRADE 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 456 # of chambers none BENCHMARK V.R.P. Top of Nail in tree ASSUME ELEVATION 100' Filter Zabel A -100 498' Property Line 102.4' Scale = 1/4" = 10 102' B -4 101' ❑ B -5 Grading is to be done B-3 to divert run -off away from system 7% Slope Well is to meet all setbacks found in Comm. 83 Property Area 15' below system B-2 B -1 Line is to remain undisturbed Huffcutt Combo Tank Tank is to be properly bedded and provided with Pro 3 lockdown covers with approved warning labels Bedroom House B. M. ^Alt. B.M. Property Line I, 104.8' Top of Nail in wood 634' Property Line post COP 30th Ave Safety and Buildings 10541N RANCH ROAD commerce .Wi.gov HAYWARD WI 54843 TDD #: (608) 264 -8777 i sco n s i n www.commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary February 27, 2006 CUST ID No. 226900 ATTN.• POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 02/27/2008 Identification Numbers Transaction ID No. 1245644 SITE: Site ID No. 709863 Ted Casey Please refer to both identification numbers, 30TH Ave above, in all correspondence with the agency. Town of Pleasant Valley St Croix County SE1 /4, SE1/4, S16, T28N, R17W Lot: 1, FOR: Description: New mound, 3 bedroom residence p.o W Object Type: POWTS Component Manual Regulated Object ID No.: 1063723 Cpndit� Maintenance required; 450 GPD Flow rate; 31 in Soil minimum depth to limiting factor from original grade; A � System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /O1), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 /O1) ENT SAfl« 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. SEE CORRF No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the design manuals noted above. • In the event this soil absorption system or any of its component parts malfunctions so as to create a 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. Key Item(s) • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. 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 2/27/2006 • 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. • Consult the Department of Natural Resources for Maintain well and waterline set backs per COMM 83.43(8)(i). p well setbacks and other regulations and exceptions. 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 addresse vide a copy of this letter to the owner and any others who are responsible for the installation, operati or mainten ce of the POWTS. Since Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Patricia L Shando POWTS Plan Re vie grated Services WiSMART code: 7633 (715) 634 -7810, Fax: (715) 634-5150, M -f 7:45 am - 4:30 pm pshandorf @commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 2/20/06 Owneffed Casey Location:SE1 /4 SE1 /4 S16 T28 N,R17 W Lot 1 30th Ave Pleasant Valley System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) illy Pressure Distribution Manual Version 2.0 (01/31) �v Page# �� co ERGE , o e LDS Ca 1. Cover Page _ 2. Mound Plot Plan ; PONS 3. Mound Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7 -8. Maintance and Contigency plan 9 -11. Soil test Shaun Bird Signature f License nu er 226900 PLOT PLAN PROJECT Ted Casev ADDRESS 1529 120th Ave Amery Wi 54001 SE '1/4 SE 1 /4S 16 /T 28 N/R 17 W TOWN Pleasant Valley COUNTY ST. CROIX SYSTEM ELEVATION 103.4' ❑ BOREHOLE 3 BEDROOM CONVENTIONAL AT -GRADE 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 456 # of chambers none BENCHMARK V.R.P. Top of Nail in tree ASSUME ELEVATION 100' Filter Zabel A -100 AL 498 Property Line 102.4' Scale = 1/4" = 10 102' B -4 101' B -5 B-3 Grading is to be done to divert run -off away from system 7% Slope Well is to meet all setbacks found in Comm. 83 Property Area 15' below system B-2 B - 1 Line is to remain undisturbed Huffcutt Combo Tank Tank is to be properly bedded and provided with Pro 3 lockdown covers with approved warning labels Bedroom House B. M. A Alt. B.M. Property Line I, 104.8' Top of Nail in wood 634' Property Line post 30th Ave Designer_ No Date Non —Woven Filter Fabric 4" Observation Pipe Perforated ,DistribvIlon Pipe Below Filter Fabric ASTK C -33 Sand —� — - ; H G " Topsoil Q 4_ \ 1 70i 7. Slope lowed £zed Ot; — 2 % Force Main f� 2 From Pump Layer Drain Pock n 1 , CrCSS Section Of A Mound S sttm Usin F A Bed For The Absorption Area G _ A _ Ft. h K Ft. L Ft. E L ------ � 'Observation Pipe --N -- ------ - - - - -- --------------------- - - - - -- -- _ A �� - - - -- 1 Main ° } ------------ - - - - -- - - -- From Pump t o �. ..�/ .�— Distribution Bed Of / — 2 z Pipe Drain Rock I 4 Observation Pipe -C�:_.�?�ck� Permanent Marker pipe or Rods Pion View Of Mound Uring A Bed For The Absorption Area PAG E,,,,_,,, OF i pertora!ed Pipe Oetoii 1 End `,+ie„ *' �Ferioro:ta RJ4 P•Dt aot �ao`o� L C ti0fes Lozated On 601:om. ��✓� 0.5 Are EquanY $p osed Pvc Forts M aw F iRS T tleLL 'C t-n GvrtntG }�cn f v Fvc / Mcruigtd ?ice L, ,Jf ri5lriDUa�C} \ Pipe 1 71 /y- Distribution P iae layo P � Ft. (.? Fj. t f X k i Inches y r- _.. inc hes Hole Diameter g '� 17 inch Signed Lateral Al 2 — - Inch L icense N umber: "fan i f ©I d Inches Bate: Force Main L– inches # of holes /pipe :avert Eiegtion of lateralsr'' "Ft. 3 �p� CZi ICAT IONS M P SEPTIC - RAD - T: z -ot4 BOX APPROVED j u 14CT MANHOLE CCJ zn - -PNDU'T NT F oR F AD Doov, w LABE r ' j - 7 TrJ INTAKE fA D GRAD 1 N LL-1 GAS- • ROVED JOINTS WIT W,k TER TIGHT APMYED PIPE 31 09m ON S GLjo SOIL App ROVED PIPE V /�lf_ T - am pul4p OFF SOIL -rR ------ ?AD j j F,-, DO's E�_s DAY:: k to-, S _ D05E lt= _Y�: r-PITIC R V - Ac TU F 5GAL T , GAI, I AN 5_'TNCHf:5 DOSE: SE PTIC GAL, A GA'-- AlAX1 MO DEL JIUMWER 3:NCH GAL - - 23 LiAC ,-UHF lif AS n0D El I TCH TYPE: :1 EL C) ON - f LET AND - - f E ET -�IrT 0_9 PAC f ()R �JFFER'ENC - -,Rl_ - VERTICAL I 5jjPFLY Ff' mTC, Fz£ , EMI Z)Y - - i A TE FOR-C W[Ey jlD GTAL p,R kjirtiJJTE . C� HEAD CAPACITY OLRVE E7 i AND DEYIATERINS 159 1 MODEL 152/j53 i o L) El- _77 Liters I UO.- I e rs 2- � IL Feet 50 �12 6 I 5 1 61 1 231 70 1 2651 231 11 4. 53 j 2U11 i 6` 1 5 -L--4—' i 1 2 40 -� 1 14 S7 1 : 5 2 42 5 1 34 1 29 30 - 9 , 1 9-, 87 33 1 v i 3 ---------- i 2 2 l –7 2 .2 20 i 4 20 40 60 PO GALLONS LITERS 0 80 1:60 240 T i F—T--T i I 3z 27 PER M E FLOW PLICATIO SPECIAL AP NS 9 CONSULT FACTORY FOR S 3 � • Timed dosing Pan ds available. available and s w�th I alterna for duplex systems, are • Electrica an alarm. single phase • Variable level control switches are available for controlling systems ariable itches are available for Double P199Y bacK variable level float switches level long and short cycle controls. See FM1420- • Sealed Qwik-Box available for ou tdoor installations • Over 130 ° F. (54 °CJ special q required. 11521153 Series i 4 ' -.5 Control Selection Du ieX 152H53 MODE � Mode Am S I Sim lex i Model VPAS—Ph M"Ie 85 Non 1 115 1 Inrju 20r3 I N152 8.5 si,1152 1 1 Auto Non 43 1 2.r3 E152 230 1 Aum 4.3 included or SELECTION GUIDE a 230 1 Non 10.5 1 20r3 N153 116 k. Auto 10.5 Included 2w 3 1. Singe piggy1back variable level fl switch or double piggybacK variable level float w53 ils 5.3 1 E163 � 2or3 230 1 Non ter to FMC477- a uto BE153 230 1 3 1 inciudea 2or 3 sswitch. Re 2. See Ft.,10712 for correct model model of Electrical Alternator E-Pa duplex (3) Ali installation of controls, p should be done by 8 qualified 3, Variable leve con switch 10-0225 used asaconirolactivalor, specify tro l sro tection devices and wirin j ihe most or (4 float System. and Safety Codes should be folowed inc licensed e lectrician. All elOdficW Act (OSHA). recent National Electric C0119 (NEC)andthe o Safety land Health R ESE RVE T\Lo VE pOWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. Box 16347 Louisville KY 40256-0347 ManuMclurm 01 - ro: 3649 Caila Run POad 1 1YE F 91 y to � � 40211 (50217. 8-2 - 1 FAX (502177a - 3634 ht,P.11,WW.zoajjer.CoM C Copyright 2004 Zoeller Co. All r ights reserved. _ MANAGEMENT PLAN Page °t POWTS 0Vjt M'NUA` 8� MANA SYSTEM SPEGiFICATIONS tic Tank capacity /LT 172 al ❑ NA Sep purer' ! NA (L INFORMATION � � . • �Wtic Tart. Mangy 13 NA Permit. f Effluent Filter Manuf`actura' p f+lA ETER$ [� NA Effluent Filter Model )>:SIGN PALM'�v a t o NA Number of Bedraans � 'Pump Tank Oapac�tY ,. ,. � Units aVda p Tank Manufacturer f� p NA Humber of J� .�1 aver'a9e) aVd Pump Manufa ,rl /. 2—E3 NA Ddmated flow Des19n flaw (P }• ( mat X j avcia /ftz Pump model L pretreatment Unit 0 Peat Filter Soll APpbon Rate Monthly average' C3 SancVGrdvel Fier � ❑ Wetland 1nfluentlEffluent Quality FOG) �i0 mg[- Q Mechanical Aeration L] Other Fats 00 Grease FO S?20 mg n, ❑ Disinfec�on f3iochem�l Oxygen Demand ( 5150 m n Manufac�rer Total Suspended Slid o s (TSS) Monthly average" Dispersal Cell(s) C, i (pressurized) ❑ In -ground (gmV -- - P lated Effluent Quality SODS) .530 M9 L3 At-grade ❑ O - B•tocherrtical Oxygen Demand ( 530 m g ❑ pri ine S Solids (TS) r0� (ft0n_* 'mtiercian waste"ter and Total Suspe eometric mean} 51 d` dull pOml values typ scar for do Fecal Conform (9 Y i diameter �kerquent S ter_ septic tYPIr for R� ate4 Mazimurn Effluent Particle Size . Service Frequency MAINTENANCE SCHEDULE ar(s) (Maximum 3 yrs.) E vent '� p monthse Service E �–� At feast once even/ ird (4) of tank volurne a and scum equals ane-th inspect condition of tank(s) Vvhen combined sludge earls) (M�dmum 3 Yrs ) © month Pump out contents of tank(s) At le ast once every ar ( s ) rsad cetl(s) ,✓ p m ❑ months O NA inspect Qispe At least once every r r t s l s Clean effluent filter At least once every — e ar(s) O NA ❑ months Y inspect PUMP, Pump controls & alarm At least once every 0 NA csis an d Pnr ❑months ill year(s) Flush late pressure test At least once every C3 months ID Year(s) ❑ NA me r At least Once every Other licenses or n one of the fol[Owing Maintainer $eptage ( NAZ+I� INSTRUCTIONS irs shall be made by an indivlduai ttspeCtOr ppWre missing or broken O f tanks and disper's2i ce r Restricted Sewer Pfl s to identify any back up inspe as Master plumber visual inspection of the tank() m and t0 check for any t levels ce�flCations: Master Plumber ns must include a e and pee'cted to check tlle effluen operator. Tank ins asure the volume of combined slut �e POndrng of effluent on the hardwarO. JdenW any � or teaks, me The dis persal cel l( s ) $ shall be visually ins authority round sv � of effluent an tf ground surface - to c or pondin9 of effluent on the g for any Ponding lume, the rate notification of the local regular in the observation Pipes and a alTing Condroon and requires the Immed ird %) or MOre Of the tank NR ground surface may indicate a fay ing u rn in any tank equals o ne - th ird Sed o f in accordance with mbined accumutation of sludge and seu O erator and dispo When the W k shall be m rnoved by a $eptage Servicing P ment components, and anY entire contents of the tan onents, pretreatt g Maintainer - 113, yyrjaconsin Administrative Code• ressurized pDWTS C°mp rformed aY a �f pOYYT m.Chanical or p co mpletion of any service The m �nricing o at intervals of 12 months or l ess shall be O f effluent filters, pz of comp o#hermaintenance or monitoring local fegulatory a ulfiority witfiin 1� days . shad be provided to the eructs or other A service repast presence of painting P s for the P e START Up AN [) OPERATION S check treatrrleclt tank( ersal cell(s). if high concentratns ar For new constNCfion• p or prior to use of the POD s andl damage mage the disP rator Prior to use - e the rment proceS to a servicing Pe OtecW have the contents of the tank( a rep 9 0 chemicals that may impact teat removed by -- .- r - 4 + Page of up Steal( not occur ump tanks when 5oi1 conditions are frozen at the infiltrative surface- is restored the eX02SS System start 1- E above normal highwater levels. vAen power During tamer ou pump wastewater w ill be discharged to the disPersal cell(sl in one large dose, overloading the pum p tank removed y ae backup or surface disdiarge of effluent To avoid this situation have the contents of the pump by o p era tor Prior restodn3 power to the effluent pump ar contact a Plumber or POVYTS Maintainer to $eplage ServicinS p� um Controls to restore normal levels within assist in manually Operating the P the pump tank p vehicles Over tanks and dispersal Cells. Do not drive or park over, or otherwise disturb or compact Do not drive or panic mound mound or at -grade soil absorption a rea_ the area within 15 feet down slope of anY Hatton of the fol(ativing from the wastewater stream may improve the performance and prolong the Gfe Reduction or -eluni ci arette butts; condoms; cotton swabs; degreasers: dental floss; diapers, of the POWTS: antibiotics; baby wipes. utn water, fruit and vegetable peelings; Sasoline; grease, herbicides; meat disinfectants; fat- founda6 n drain (SUMP P ns ; and water softener brine. sue; medx�ons; on; painting products, pesticides; sanitary napkins: tampo ABANDONWENT ermattentlY taken out of service the following steps shall be taken to Insure that the When the pOWTS fails andfor is p system is properly and safely abandoned in compliance with ch_ Comm 83.33, Wiscons �seated_ All piping to tanks and pits shall be disconnected a Code. connected and the is Of openings y Of Servicing Operator. The contents of all tanks and pits Shall be removed and removed or their cx�vers removed and the void space ty rry After pumping, all tanks and pits shall be excavated and remo filled with soil, gravel or another inert solid material. COMMNGENCY PLAN the following measures have been, or must be taken, to provide a code if the POWTTS fails and cannot be rep compliant re placement system: uated and m t soil O A suitable repiacementatea a been aea d be Pro f o dsturrba loca and Compact a d t should not absorption system. The replacement from existing and proposed structure, lot lines and wefts- Failure to be infringed upon by required setbacks rid i protect the replacement area will re sult in the need for a new L as sn - at that timetab�h a suitable replacement area_ Replacement systems must comp 1 y O A suitable replacement area is not available due las t setback and/or eso t to ep ace so the failed POYYTSng advances in POYVTS technology a holding tank installed as a may be ntify` a suitable replacement area Upo failure of the POWTS a soil and -The site has not been evaluated to ide 9 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 repiace the tailed poWT - S_ bio nd and at -grade soil absorption systems may be reconstructed l p in th fe rule n effect at that tim at �' t infiltiat ve surface. Reconstructions of such systems must comply win ccYVARiVINU'» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAfN LETHAL GAS GtRC M DEATH MAY OXY GEN. DO NOT ENTER A SFPTiC, PUMP OR OTHER TREATMENT TANK UNDER AKY RESULT_ RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY SE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS POYYTS INSTALLER �-- Namely EN ,! -- % f'' fDhone !,-) LOCAL REGULATORY AUTHORITY SEPTAGE SERVICING OPERATOR PU PER Agency Name �` , � ~; (f Phone ?his cowment was Gutted try the staffs of the Green Lake, Marquette and Wausftara CounCf Zoning and Sanitation 2gU :�Js o cumcnr does i) d)�(f ad 83Sd(1 }. (2) & (3). Wisconsin Admrnls�ti� C� t nts of c h- Comm 83.22(2)(b)( ( (1J0 ) the minimum n3qui[BtT1e GMW guarantee the performance of the POWTS. N isconsir,Department of Commerce ` �R�C7i0 IL AND SITE EVALUATION Page I of 3 ` Division of Safety and Buildings rd with Comm 83.05, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than 8'/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. — Parcel I.D.# APPLICANT INFORMATION - P/e , ripr> i i rmation. 42i°- Personal information you provide maybe used rrtziaryrpurposes'(PdvaLy,Law, s. 15.04 (1) (m)). Review y DatQ Property Owner y I Property Location Casey, Ted / Govt, Lot SE 1/4 SE 1/4 S 16 T 28 N 17 W Pro Owner's Mailing Address I r. A Lot # Block # Subd. Name or CSM# / 3 1529 120th Ave. S endm�� City SW Zi Code PhoheNumber ❑ City ❑ Vill ®Town eares ad Amery 5W001 - 715 -483 -9456 Pleasant Valley 30Th Ave. Z New Construction Use: Residential / Number of drooms 4 ❑Addition to existing building Replacement F Publip gr commerc' escribe Code Derived daily flow 600 gpd __. Recommended design loading rate • bed, gpd /ft 5 trench, gpd /ft Absorption area required 1500 bed, ft" 1200 trench, ft Maximum design loading rate - bed, gpd /ft • t rench, gpd /ft Recommended infiltration surface elevation(s) 103.5 ft (as referred to site plan benchmar Additional design / site consideration install 4 'x 125' rock bed mound on 102.5 contour as upslope edge of rock w/ 1' sand fill Parent material till Flood plai n elevation, if applicable NA ft S= Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system ❑ ®U ® S U ❑ S ®U ❑ S® U ❑ S® U S X U Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 Boring# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0 -4 7.5YR 4/3 - sl 2 m gr mvfr cs 2f1m .5 .6 m.. 2 4 -10 7.5YR 4/3 - sl 2 f sbk mvfr cs lm .5 .6 Ground 3 10 -33 7.5YR 4/4 - scl 2 m sbk mvfr cs if .4 .5 elev 102.4 ft 4 33 -70 7.5YR 4/4 f2d 5YR 5/8 SO 0 m mfr - - NP .2 Depth to limiting factor 33" Remarks: occasional gr & cob below 33 + occasional 5YR 4/4 sl inclusions 2 1 0 -3 7.5YR 4/3 - sl 2 m gr mvfr cs 2flm .5 .6 2 3 -9 7.5YR 4/3 - sl 2 f sbk mvfr cs lm .5 .6 Ground 3 9 7 30 7.5YR 4/4 - SO 2 m sbk mvfr cw lm .4 .5 elev 5YR 6/3 101.0 ft 4 30 -66 7.5YR 4/4 c t2d 5YR 5/8 scl 0 m mfr - - NP .2 Depth to limiting factor 30" Remarks: CST Name (Please Print) Signature: Telephone No. Henry F. Grote 715 - 665 -2681 Address C ertif ied Soil Testing Dato CST Number Ref # P.O Box 57, Knapp, WI 54749 3/21/2000 222774 1071 l Y PROPERTY OWNER: Casey, Ted SOIL DESCRIPTION REPORT Page ? of : , PARCEL I.D.# Certified Soil eT sting Horizon Depth Dominant Color Mottles Texture Structure onsistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Conf Color Gr. Sz. Sh. Bed Trench 3'. 1 0 -3 7.5YR 4/3 - sl 2 m gr mvfr cs 2fl m .5 .6 2 3 -9 7.5YR 4/3 - sl 2 f sbk mvfr cs lm .5 .6 Ground elev 3 9 -34 7.5YR 4/4 - scl 2 m sbk mvfr cs IM .4 .5 102.0 ft 4 34 -44 7.5YR 4/4 f2d 7.5YR 6/3 scl 0 m mfr cs lm NP .2 Depth to limiting 5 44 -58 7.5YR 5/6 flp 5YR 5/8 fs 0 sg ml cs - .5 .6 factor 34 c 6 58 -70 7.5YR 4/4 7.5YR ' 6/3 sl 0 m mfr - - .3 .4 Remarks: norizon is is M EMO i i w Van as of mcos 4 1 0 -3 7.5YR 4/3 - sl 2 m gr mvfr cs 2flm .5 .6 2 3 -9 7.5YR 4/3 - sl 2 f sbk mvfr cs IM .5 .6 Groun elev 3 9 -31 7.5YR 4/4 - scl 2 m sbk mvfr cs lm .4 .5 102.6 ft 4 31 -72 7.5YR 4/4 c3d 7.5YR 6/3 scl 0 m mfr - - NP .2 Depth to limiting factor 31" Remarks: st a seep 5 1 0 -3 7.5YR 4/3 - sl 2 m gr mvfr cs 2flm .5 .6 2 3 -9 7. - sl 2 f sbk mvfr cs lm .5 .6 Ground elev 3 9 -34 7.5YR 4/4 - scl 2 m sbk mvfr cs lm .4 .5 100.6 ft 4 34 -69 7.5YR 4/4 c3d 7.5YR 6/3 scl 0 m mfr - - NP .2 Depth to limiting factor 34" Remarks: st a seep ; percnezi wa er tawe o serve Ground elev Depth to limiting factor Remarks: I f 1 s— rA e ' 3 Y tA 0 �-- d ci J D a 4 c0 y � o j �f 9 ^ 3 0 y N 0 v d � ((d — 0 .� Cl r t , Parcel # : 024 - 1 020 -30 -000 01/05/2005 03:33 PM PAGE 1 OF 1 Alt. Parcel #: 16.28.17.1126 024 - TOWN OF PLEASANT VALLEY Current 1XI ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): ` = Current Owner * CASEY, THEODORE B THEODORE B CASEY � PO BOX 272 HAMMOND WI 54015 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 0231 BALDWIN- WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 8.643 Plat: 1082 -CSM 14/3894 SEC 16 T28N R17W SE SE LOT 1 CSM 14/3894 Block/Condo Bldg: LOT 1 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 16- 28N -17W SE SE Notes: Parcel History: Date Doc # Vol /Page Type 02/22/2001 639036 1590/329 QC 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 25178 Use Value Assessment Valuations Last Changed: 05/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.000 20,000 0 20,000 NO AGRICULTURAL G4 4.643 600 0 600 NO Totals for 2004: General Property 8.643 20,600 0 20,600 Woodland 0.000 0 0 Totals for 2003: General Property 8.643 20,600 0 20,600 Woodland 0.000 0 0 Lottery Credit Claim Count: 1 Certification Date: Batch M 139 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 (VI F ILED n SEP - 6 2000 s2 b�:06 ST.. Ma cool y StlRVEI'f)R'S RECORD at, 1AA CERTIFIED SURVEY. WILLIAM AND BARBARA CASEY Part of the Southeast 414 of the Southeast 414 of Section 4E, Township 28 North, Range 17 West, Town of Pleasant. Valley, St. Croix County, Wisconsin. APPROVED ST. CROIX COUNTY Planning Zoning and Parks Committee h UNPLA LANDS ni N 90 . 00'00"E 498.32' JUL 14 2000 N ° If not recorded within 30 days of approval date approval shall be 2 null and void Q Q ° A J N Z FENCE f TYPICAL) Q E 114 CORNER SEC. 18, T 28 N, R 17 W S 90 00" W 84:27' o {P.K. NAIL FOUND) 0 a j w LOT 1 co z = v . UNP LANDS a I QI N 8.643ACRES ~ 376,506 SQ. FT Z � ri ..I &343 ACRES EXC. ROAD R.O.W. LtI N 90 660.65' U N 1 363,414 SQ. FT. 1.2 o O - 6fd.S5 rr100= • �� QI t- LO �o A Q C) h S EPTIC LOT . i LU Ix 2 C 257,238 SO. FT i r� W Q W. SHED 5.001 ACRES EXC. ROAD R 2 z 2 h 217.852 SQ. FT. W s� ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM O wnerBu Y er I Mailing Address / S 2 - Property Address �� Z d �9d'e— (Verification required from Planning & Zoning Department for new constru v C. City /State Parcel Identification Number ZaB rr � LEGAL DESCRIPTION Property Location ;� r 1/ , Sec. I , T N RIDW, Town of ` Q"r , � . Subdivision Lot # // / z y C 0 , Voluma� , Page # ✓ sy'/ Certified Survey Map �/' / � # v � G� 3 V Volume/ Page # Spec house yes no) Lot lines identifiabl yes no \o 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 necessary), wastewater disposal system is in proper operating condition and/or (2) after Inspection and pumping (if n ary) 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. Uwe 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. SIGNATU F APPLICANT(S) DATE * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** the Register of Deeds Office and a co of the certified survey map if d warrant deed from PY de with this application a recorded g Include pp Y reference is made in the warranty deed. (REV. 08/05) STATE BAR OF WISCONSIN FORM 3 - 1982 ri +� srwce RE9ERV�� DOCUMENT NO. QUIT CLAIM DE KA THLEEN EGISTER OF DEEDS 1590x ST. CROIX CO. , WI RECEIVED FOR RECORD I 02- 22-2001 10:45 AM William D Casey and Barbara H Casev Q UIT XEMPTT CLAIM D EED 6 CERT COPY FEE: COPY FEE: TRANSFER FEE: quit- claims to Theodore B Casey, a single person - — RECORDING FEE: 10.00 PAGES:. 1 the following described real estate in St. Croix County, RETURN To: Darlene M. Cobian State of Wisconsin: Briggs and Morgan 332 Minnesota Street 2200 First National Bank Building St. Paul, MN 55101 Tax Parcel No. 024102030 000 Lot lof ertified Survey Map recorded as Document 626406, Volume 14, Page 3894, files of Registrar of Deeds, County of St. Croix, together with all hereditaments and appurtenances belonging thereto. Consideration for this conveyance is less than $500.00. This is not homestead property. (is)(is not) Dated this "[ `= day of /q'/ - ^'--� 2000. (SEAL) 1 60-9 f (SEAL) Wilton D. Casey * (SEAL) - & - a4 la* Barbara H. Casey * (SEAL) i x ,yy'� AUTHENTICATION ACKNOM4,"Cs14 Signatures) STATE OF WISCONSIN �Yi C ✓,� 2000. k e< COUNTY tcd this day of � ems'- -- authenticated '\1 Personally came before me this day of * kblseMkay 2000, the above named William D Casey and Barbara H Csev TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Slats.) to me known to be the person s who executed the foregoing THIS INSTRUMENT WAS DRAFTED BY instrument and acknowledge the same. Briggs and Morgan P.A. 332 Minnesota Street [*Nam First National Bank Building N otary Public Y� County d2OOO 1 aul. MN 5 Na5101 Date: 1 { t - O natures may be authenticated or acknowledged. Both are not ssary) of persons signing in any capacity should be typed or printed below their signatures. 1214348.1 , c� f FILED GZ6406 / JUL 1 4 2000 KA t S eNo OWW: 1p CERTIFIED SURVEY - MAP WILLIAM AND - BARBARA CASEY Part of the Southeast 114 of the Southeast 114 of Section 16, Township 28 North, Range 17 West, Town of Pleasant Valley, St. Croix County, Wisconsin. - APPROVED ST. 1 00UNTY Planning Zoning and Parks Committee 1n UNPLA LANDS � N 90 00" E 498.32' .JUL 14 2000 o if not recorded within 30 days of approval date approval shall be null and vold Q FENCE f TYPICAL) � - 2 W o 3 E 114 CORNER SEC. 18, T 28 N, R 17 W (P.K. NAIL FOUNO) S 90' 00' 00" W 84.27' a 0 j 2 a LOT 1 � � I MPLATT LANDS a Q N 8. ACR °p 0, Z► 376,506 SQ. FT. , Cn + 8.343 ACRES EXC. ROAD R.O.W W 1 N 90' 00'00" E 660.65' 4 U N 'a) 363,4!4 SQ. FT. W + I 0 eh o 610.65' l00= ti o L QI Q d SEPTIC 5.905 ACRES 1 g� Q v 2 257.238 SO. FT W SHED 3.001 ACRES EXC. ROAD R. 0. W 3 217,852 SQ. FT. � W � V � I ,4 ROAD SETBACK LINE o 7 DAaLWG 1 9125.1 to , I 1540.53' c N 89' 54' 35" E 1030.92 50' 1. , Z ti _ g --�1 c i 414.06' �— 616.86' — 414.05' 1 081.46' 667.41' S OUTH LINE SE 114 CENTE N 90 "1V 2621.99' 40' 41. C f — S 114 CORNER SEC. 16 T 28 N, R 17 W UNP L 81.2g (P. K. NAX FOUND) SE CORNER SEG ! a T28 N R tT 1W� . (SERNTSEN CAP FOUND) SCALE I" a 200' O 100' 200' 300 400' 300' 600' AN bearings referenced to the South line of the Southeast 114 of Sedim 16, Township 28 North, Range 17 West, - LEGEND assumed N 90 OOW W • - Indicates 1 "x 24" iron pipe weighing 1_13lbs.Ain. ft. set. ��►G0Na� Indicates soil boring for proposed septic site. y1 �► This instrument drafted by Laurence W. Murphy W URE Dated: April 24, 2000 1 i "Revised this 12th day of July, 2000." VA Owner's Address: 1790 30Th Ave. LAND Hammond, W1 54015 nl SHEET I OF 2 Vol. 14 Page 3894 Z =fO Z.133HS b68£ a5ed b t ' I 0 1 , S pNd1 ` " . 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