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HomeMy WebLinkAbout026-1002-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Budding Division INSPECTION REPORT Sanitary Permit No: 506164 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: Earley, Dennis I Richmond, Town of 026- 1002 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No: ct, \ 01.30.18.11 D TANK INFORMATION S ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark LL C �•�1�.- /ZSd f�.3g iob• 1�ot� �o L IM a i'C ✓� Alt. BM(' / • C Aeration V Bldg. Sewer 7 c M • 03 Holding St/Ht Inlet 9 •7 - 9 7 TANK SETBACK INFORMATION St/Ht Outlet •°� 3 `J7 -` f S TANK TO P WELL ; BLD Vent to Air Intake ROAD Dt Inlet Septic 45 Z.'7 Z5 _ Dt Bottom ` Dosing Header /Man. Aeration Dist. Pipe /a.$? X15 -51 Holding Bot. System WI 7L 474 -G/ o PUMP /SIPHON INFORMATION Final Grade 2. /C61 't( Manufacturer Demand St Cover ` GPM Diu L Al -11,0 /n 6 Z Model Number TDH Li Friction Loss Syste d TDH Forcemai a. Dist. to Well ::Jl SOIL ABSORPTION SYSTEM BED /TRENCH Width Length / No. Of Trenches PIT DIIU� IONS No. Of P\ Inside Dia Liquid Depth DIMENSIONS 3 �]y� SETBACK SYSTEM TO /V P/L BLDG LAKE /STREAM LEACHING Manufacturer: �/ INFORMATION � CHAMBER OR G 6 _j Type Of System: / / UNIT ((r 51 � 2 3 Model Number: vv-)e J vW / DISTRIBUTION SYSTEM A.4 q4-9 Header /Manifo;d Distribution Hole Size Hole Spacing Ve t e to it Intake Pipe(s) C I-L.J @ e C/� Length Dia� Length Dia \ Spacing I x x \ \ SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over ! Depth Over xx Depth of xx Seeded /Sodded r Mulched Bed /Trench Center 5.5 Bed /Trench Edges \ Topsoil \ Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1407 County Road GG New Richmond, W 5401AW 1/4 SV�Vp.1A 1 T30N R18W) NA Lot Parcel No: 01.30.18.11D � iL, Gov Taw�f� i.Je_ }1 1.) Alt BM Description = V 2.) Bldg sewer length = y5 9 I L t� j _ ✓` - amount of cover = f 14 4 7— eC,t d cXZ�, Plan revision Required? Yes No C , Use other side for additional information. I - - -� Date Insepctor' ignature Cert. No. SBD -6710 (R.3/97) f t c . Safety and Buildings Division county ■ 201 W. Washington Ave., P.O. Box 7162 Madison, Wt 53707 -7162 Sanitary Permit Number (to be filled ' by Co J ■ 515 I ( LJ Sanitary Permit Application State Transection In accordance with s. Comm 83.21(2}, Wis. Adm. Code, submission of this form to the appropriate governmental /" unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than nailing address) submitted to the Department of Commerce. Personal information you provide rabbe for secondary I 8 7 purposes in accordance with the Privacy Law, a. 15. 1 m , Stars. I. A cation Informatioa — Please Print All Iaf tion Parcel # ' NzN Owner's Nana / ED Property Owner's Mailing AddrT MAY 0 1 2007 C' � Govt. Lot City, State '' _ Zip Code Ph N ber ' ' I ! Y. er. Y, Section I - ) k W `� I taC_ k COUNTY o T N; REor H. Type of Building check all that apply) r Gx , Subdivision Name 1 or2 Family Dwelling - Numberof Bedrooms --- - _ _ -_ -- - lock # ❑ Public/Commercial - Describe Use ❑ City of CSM Number ❑ Village of — ❑ State Owned - Describe Use "Town of III. Type ermit: (Check o y on line A. Complete line B if applicable) A. ❑ New System lacement System ❑ Treatirmt/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal 11 Permit Revision ❑ Change of Plumber [I permit Transfer to New Before Expiration Owner IV. Type of POWTS SysqWCom t/Device: Check all that appl X Non-PressurizedIn-Ground ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: DesipflowWd)A Design Soil Application Ra� Dispersal Area u>red (sf� Dispersal 6ea ( ��l t 7 �� JJ 7 ✓ (_I I evption 7 VI. Tank Info Capacity in Total # of Manufacturer B Gallons Gallons Units E New Tanks Existing Tanks /n� / / / r'•I g sing - Chamber_. c HoWingTank 'na - Do - - - - - - VII. Res aibility Statement- 1, the nsidersigised, assltm lity for installation of the POWTS wn on a attached Putts Phr 's Name (Print) PI 's Si l Business Phone Number rl ' •^_S Ifs -Sf3 Pl;nk (Street, city, statel C 5 ©! If onn artment Use Onl Permit Fee Date I Issuing t Signature Approved tsappry $ �,J r Given son for Denial / �C ` »D 5; Z 6 -7 IX. Condi ' easons for Disapproval i A na of � ��. 6lh S �-,L a �.YS Sep tank, filter and � �`(� � n dispersal cell must all be services / maintakied as per management plan provided by plumber. 2. All setback requirements must be maintained ibe system and submit to the County only on paper not less than 8112 s 11 inehes to she SBD -639$ (R. 01/07) Valid thru 01/09 � y o 7 C� � Gam- y ` S ��c�vh�,� r C� � x 1 -� O jv •� � � Chun o A �, � � 7 g:.,�! o,A to ;L —.3 c7 _ U n U LIZ vac qb C.�) e Q s 7 moo' -3c . -®/ a U) M � o � A 7 OT - Pi Ct r\. k4 0 r X y 1 ntvy\ c)r) N , Ghvn oA cl, ko ub / �� „ o r to - /W a -mod o v qb , c) ej 9 7 1 .Se c� C , ov,.s Gz--��o Lo ��- -- 3 _off i3 m - b otO Ar r U1 4 O • q i� A Wisconsin Department of Commerce SOIL EVA6Q ATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Ad Code r Attach complete site plan on paper not less than 8 1/2 x 11 inches in Plan t C � n ��' 1 � include, but not limited to: vertical and horizontal reference point (BM), dire n an Parcel I.D. percent slope, scale or dimensions, north arro st ro Please print all i forma ion. R e vie ed by Date Personal information you provide maybe used for se ndary purposes (Priva Law, s. 15. (1) (m)). 7 2 PropertxOwner Property Location ) ar - ovt. q S( /4, A T 30 N R r E (or w Property Owner's Mailing Addre Lot # Block # I Subd. Name or CSM# City to 'p Code Phone Number ❑ City ❑ Village - &Mwn Nearest Road ❑ New Construction Useesidential / Number of bedrooms Code derived design flow rate GPD Replacement //❑ P or co mercial - Describe: Parent material Flood Plain elevation iifapplicable General comments y /3G /aw 9 r 0,� 0-t; �' I and recommendations: System Type System Elevation F-11 Boring # E] Boring g� �j'f) 9 Pit Ground surface elev. ft. Depth to limiting factor _ / Min. Soil Appli cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I - Eff#2 .3 �� . ,✓, /s? Fa-1 Boring # ❑ Boring 2 Pit Ground surface ele /�7ft. Depth to limiting factor ✓ e in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0 -11 O 3 ---� S r' " 0 .3 ►r l� Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg& and TSS < 30 mg/L CST Name (Please PnnO Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 540 17 �' o — 715- 246 -4516 � 1 Property Owner _ °. Parcel ID # Page of IZ Bori # Boring R x _' 00 pit Ground surface eley -% v � "` Depth to limiting factor 0 � y in. Soil Applicati on Rate Horizon Depth Dominant Color Redox Descripton Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 - 31 -- nJl- "o _ v a Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. — go — ilApplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff #1 I 'Eff#2 E Boring # ❑ Boring El pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon 'depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDfff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Eff#1 'Eff#2 Effluent #1 = BOD, > 30 < 220 mg& and TSS >30 < 150 mg& ' Effluent #2 = BOD < 30 mg& 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. SBD -8330 (8.6(00) r - + a 3 Property Owner Parcel ID # Page '`g ° Bones '�- Pit Ground surface eley/Il1L! '! it Depth to limiting facto' L jn. Sol Rate Horizon Depth Dominant Redox Description Texture Structure Consistence Boundary Roots GPD1f� in. Munsell Qu. Sz. Cont Color Gr. Sz Sh. 'Eff#1 - E8#2 r Boring # ❑ Boring ft. to I - - factor �,. F ❑Pit Ground surface elev. � 9 Sol A Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDffP in. Munsell Qu. Sz Cont. Color Gr. Sz Sh. 'Etf#1 `Eff#2 ❑ Boring# ° Boring Ground surface elev. ft. Depth to limiting factor in. C1 Pit . Sol Applicoon Rate . Horimn -Nsplh Dw inaM Color Redox Description. Texture Stnu lure Consistence Boundary Roots GPDRF in. Munsell Qu. Sz Cont Color Gr. Sz Sh. -Etf#1 -092 Effluent #1 = SOD, > 30 _< 220 mgfL and TSS >30 150 nV& ' Effluent 42 = SOE a : 5 30 nV& and TSS <_ 30 nWL y 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- 2648777. S8D M Q"W) Soil Test Plot Plan j Project Name Dennis Early Shaun Bi Address 1407 Cty Rd G New Richmond Wi 54017 CSTM 26900 Lot -- ---- Subdivision ------ -- Date 4/20/07 S W 1/4 S W 1/4S 1 T 30 N /R W Township Richmond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of Walkout System Elevation 94.8/94.7 *HRPSame as Benchmark Cty Rd G Well 150' Property Line Existing 4 Bedroom 35' House B.M. 0 ' 50' Scale is 1" = 40' ST unless otherwise 10' noted DW DW 30' B -3 100.5' 2% Slope r—l-v 45 ' 15' 98.5' B -2 90' B -1 15' 192' pro line 25' EZ1203H - � •• ves7evo �::,,= .,,r; ti�•.veT.. e I2 wvv a r� i r ^ vve 24 '1 v • ♦ �' ' »' w A vvv 4.625' v w t - � ` o o ovv www _ ; 1 et 1/2 Circ. = 18.84" vvw vvv vvv evv vev v vv v7 vv7vOvv7 v7 vvvv v'Tv v vvvvT4 v Ovvvv vvvvvvv vvv' v vvvvl77ve Tv T v4e v7e�' -. vvvo9vP 7 vvvvOVOVV9te40 7 vv 7 vv- A Bo Mm lt_ 36 12-1/2" DIA. (tYP,) y4W Volume Soil Interface erg hLIR, EL %q � Void Coeffu"'d in Aggregate given at 57.4%. Sidewall (2 Sidawails) 2 * 18.84in 3.14 O.B. of 4" Pipe - 4.625 inches l2in Void volume per linear ft - 3.14 • rr 2.3125ia fr -0.117 EN Bottom 2.00 2.00 t 12at/ft ) t O,D. ofc- terryiinder -123 inches TOW it Interface Area S.) 4 SQ. . Void volume in a cyl inder ( 6.25a 11Sz&'+teofcenter =�3.ta'! t2n�rft) - 3.14' 12' 1 ��.374=.422 fN O,D, of outside cYbuders- 12 inches ` I / Projected Trench Area Void volume in outside cyfindcrt = z • 3. t 172;1 — ft) • • "POI fN SidewalI Height = 12 in. •2 - 2.00 Sq.Ft. Bottom = 36 in. = 3.00 Sq.Ft. Void volume at bottom between cylinders = �( 24if 6in 4 I 12i -M) `t2;1ft) '0215 ft' Projected Trench Area 5.00 Sq.Ft Void volume at outside bottom comers (1/2 of void volume between cylinders) 0,215 I2 - 0.108 ft. Total void volume - 0.117 + 0, 422 + 0. 901 + 0.215 * 0.108 > L 763 cubic ft I ft Gallons per tt _ 1,763 X 7.48 - 13.2 ealions Per linear rt 3 to X [U` = 50 EPS Aggregate Trench System EZ1203H EZ ZOw Rin§- Epciustrial Group 65 industrial Park Rd. - Oakland, TN 1$060 SCALE FU NAU& EZ1203H--"I. SNW. 1 at t 11 -Z7-01 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _J_ of FILE INFORMATION SYSTEM SPECIFICATIONS Owner c Septic Tank Capacity a l ❑ NA Permit 0 Septic Tank Manufacturer �, � ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model L ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) L g al/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) al /day Pump Manufacturer ❑ NA Soil Application Rate o7 gal/day/ft2 Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L Q Disinfection © Other: - Prbtr"ted.Effluent.-Qu rhfy veage < . - -- - — - � - � � � -v--�v spefs$(- C- ell(s)- - _ _ _ Biochemical Oxygen Demand (BOD 530 mg /L In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA At - Grade ❑ Mound Fecal Coliform (geometric mean) 510° cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTEN SCHE DULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) E3 NA ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell years) s) At least once every: ❑ mc ar(s) ) (Maximum 3 years) 13 NA Clean effluent filter At least once every: month(s) ❑ NA year(s) Inspect pump, pump controls & alarm At least once every: ❑ ❑ ye ar(s mo ) ) m ) ❑ NA Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ 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; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to 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 tank equals one -third (Y 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 filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the 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 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, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump 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 controls 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) water; 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 properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits 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 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 soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. tions ❑ A suitable replacement area is not available due to setback and /o r soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. 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. Reconstruction of s uch systems must comply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTAL POWTS MAINTAINER Name c Name Phone t Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name w rp t 4�! r) i h Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)0►(d) &1f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. of START UP AND OPERATION Page For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the 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 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, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Se toe Servicing Operator prior to restoring P 9 9 P P 9 power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls 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) water; 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 properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits 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 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 soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. 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 su ch s must comply with the rules in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS 'INSTAL POWTS MAINTAINER Nam ® 1 , Name Phone t Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROI K COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/BuyerQ Mailing Address 1� C� cL GG7 N 'A w- .S 0 Property Address _f�a__ (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number QA to --1 DO :1 _� c) -Dc LEGAL DESCRIPTION � la W '/a ,Sec. �� T N R�W, Town of Property Location _ W , S i ('' 4) 4� Subdivision , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # __.� �� , Volume 7� , Page # ©_ . Spec house yes C Lot lines identifiable (:�;) 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 SL 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. Uwe, tie; 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 Come 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. Uwe am/are the owner(s) of the property described above, by virine of a warranty deed recorded in Register of Deeds Office. Number of bedrooms r , ,2*/'257 SIGNATURE OF LICA S) DATE ***Any information that is misrepresented may result im 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 referenKx is wade in the warranty deed. (REV. 08/)5 • S N LAND SURVEYING HUDSON , WISCONSIN 54016 (7 15) 386. Name First Federal Savings & Loan of LaCrosse 201 South Second Street Address Hudson, Wi . 54016 Description Part of the SA of the SWa of Section 1, T30N, R18W, St. Croix County, Wisconsin. Dennis Earley PLAT DRAWING This is not a complete Land Survey N C.T.H. "GG" 96' N W E to S 96' buried telephone 22' N I - �, 38' C2 N house & garage O1 u, 6 cn 0 1 t 4 i overhead electric ' 192' w ximae 'The location of improvements on this draTheg1aredimensionstarentaken fromd on a vlsuai inspection of the premises. recorded plats and deeds of county records. This drawing is for informational purposes only and should NOT be used as a complete Land Survey First Federal of LaCrosse has agreed to waive the minimum standards of AE - 89 -01 -471. map No. December 8, 1989 Drawn By DJZ 1 = 30' ;, t Scale • C0C4UMENT NO. 1NARRANTY DEED ♦MIe 90 R6s2RV9D FOR Rsconoe «s DATA I 43"05 M3TATE BAR OF WISCONSIN FORM 2-19811 ST. am _.... - Nov. 4, 1987 ..... ... ........ ... .......... _ ................. ... .... _ _ .... - d 8:30 AM Kathleen A. Earley, a single wanan .... .. ................ .... l conveys and warrants to . Dennis _K. Earle} si �dw of av � r a_ si le� atan �._• _ ..- _. ... ..... ......... ....... _......... , t- 4 r,'+' IE FARMERS CREDIT U" _ _.... ... _ .... 455, South Knowles _ _ _ ._ .. __.. ..... . ... ... P.O. Box 269 rib the following described real estate in .... ....... St..CFoix .. ....... ...... •.. Count), @W Richmond W i 5401 State of Wisconsin: Tax Parcel No: .............................. A parcel of land located in the Southwest Quarter (SW %) of the Southwest Quarter (SW k) of Section One (1), Township Thirty (30) North, Range Eighteen (18) West, described as follows: Camtencing at a point 33 feet South and 513 feet East of the Northwest corner of said SWk of the SWk as the point of Beginning; thence South and parallel to the West line of said SWk of SW k a distance of 175 feet; thence East and parallel to the North line of said SW k of SW k a distance of 96 feet; thence North and parallel to the West line of said SW k of SW k a distance of 175 feet; thence West and parallel to the North line of said SW k of SW # a distance of 96 feet to the point of beginning. Containing .38 acres. ALSO S_ FM A parcel of land located in the Southwest Quarter (SW k) of the Southwest Quarter (SW 'k) of Section one (1), Township Thirty (30) North, Range Eighteen (18) West, Described as follows: Commencing at a point 58 feet South and 417 feet East of the Northwest corner of said SW k of the SW k as the point of beginning; thence South and parallel to the West line of Said SW k of the SW k a distance of 150 feet; thence East and parallel This .._ .... 13 ................ homestead property. to the North line of said SW k ofthe SW k a (is) (is not) distance of 96 feet; thence North and parallel to the West line of said SW k of SW k a distance Exception to warranties: of 150 feet; thence West and parallel to the North Recorded easements. line of said SW k of SW k a distance of % feet to the point of beginning.Containing .33 acres. Dated this .. __. 31St--- ----- - - - - -- - - - - -- day of --- _ October -_... _ .. __.. - ...... 15 -87... 2GQ'etz'- ! 0 .(SEAL) .... ... ...... (SEAL) Kathleen A. Earley ............... . . . ... ' .... ------- .. ------ __.. .... ..(SEAL) _ .. ...... . ..... .(SEAL) AUTH13NTICATION ACSNOWLEDGMBNT Signature (s) ............................. .......... ..... ................ STATE OF WISCONSIN ss ..........-•----•--------------------------••---. ....- •---- ...- •--- •- ••--- - - -• -• St Croix ...................................... County. authenticated this ........ day of --------------------------- 19...... Personally came before me this __ 118t.....day of ..... .....October ............. ...... 19.87... the above named ..........-•---------------- •- -- •--- ...•.................. •-- •- ••--- •••••._..... ............... 1(dthleen.A..-.EaC1ey............................ ••-••---• ...........................•-•------- -•--- --- •--- -........- --• --- -- .......................................... ..................................... TITLE: MEMBER STATE BAR OF WISCONSIN (If not ............................................................ authorized by 1 706.06, Wis. State.) to me known to be the person ............ who executed the foregoing instrument and acknowle Ali THIS INSTRUMENT WAS DRAFTED BY ��,, D• ♦j _4 ;o k ..... W ......... . . . . .• •............John..D,,.. Walsh..---- ••......- •- •• -.... . • John- D_ 1�1a1�Ct;+ � '• a ......................•--.....-•----..... ...............-•-••-•••-•••- -- Notary Public ......... nt s. (Signatures may be authenticated or acknowledged. Both My Commission is perm (If not, ;}tate expit t are not necessary.) - • date: ........ Dec ..... V �L 1989 •) L J' r �� •N&," of persons signing in any capacity should be typed or printed below their signatures. ♦ ♦j� ;;,,, Q ,`,a�� WARVANTY DYED STATE BAR OF WISCONSIN Wisconsin Legal Blank Cu. Inr FORAM No. 2-- 1,92 ?i .:wsu kec, Wis. • wisconsin Department of Commerce SOIL EVALUATION REPORT Page of : L Divition of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code CountyS_1_ C 1 Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not t{mited to: vertical and horizontal reference point (BM), direction and Parcel I.D. �1 �n percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Q o� 6 fUi7� ' ✓" Please. print all Information Reviewed by Date Personal information you provide may be used for secondary Purposes (Privacy taw. s. 15.04 (1) (m)). wner Property Location Govt. Lot /4 � T �0 S(, !4 S N R � � E ( W Property Owner's Mailing Addre Lot # Block # Subd. Name or CSM# y Code phone Number Q City ❑ Village ><own Nearest Road u 5 L) ❑ New Construction Use -eesidential /Number of bedrooms Code derived design flow rate GPD Replacement //❑ P__ublic or merciai - Describe: ft Parent material Flood Plain elevation iIfapplicable and moor mandations: 4 , 7 System Type r' System Elevation Boring Pit Ground surface elev. ft. Depth to limiting factor _ Ll�� Min. Rate Horizon Depth Dominant nc 'Eff#1 Redox Description Texture Structure Consistence Boundary Roots I * Eff#2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 5 �± m s 0 Boring Fa-1 9 # . Pit Ground surface ele, 1 _L ! ft• Depth to limiting factor in• c A Rate horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 'Eff#2 t 0 - D Efttuertt #1 = BOD > 301220 mg/L and TSS >30 =150 mgA -Effluent #2 = BOD = 30 mg& and TSS 1 30 nWL CST Nam pease P" Sig `,� CST Number Bird Plumbing, Inc. Shaun Bird 226900 dress Date Evaluation Conducted Telephone Number Ad 1008 192nd Ave, New Richmond, W 1 54017 ° (:2 0 —'6) ? 715- 246 -4516 r Soil Test Plot Pla4Bi. 3 Project Name Dennis Early Sha Address 1 407 Cty Rd G New Richmond Wi 54017 CST0 Lot ------ Subdivision Date 4/20/07 S W 1/ S4 W 1/4S 1 T 30 N /11 W Township Richmond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of Walkout System Elevation 94.8/94.7 *HRPSame as Benchmark Cty Rd G Well 150' Property Line Existing 4 5' Bedroom House B.M. 0 ' 50' Scale is 1" = 40' ST unless otherwise 10' noted DW DW 30' B -3 100.5' 2% Slope 45' 15' 98.5' B -2 90 , B -1 15' 192' proDerty line 25'