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HomeMy WebLinkAbout026-1109-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Sa" and Building Division INSPECTION REPORT sanitary Permit No: (ATTACH TO PERMIT) 515070 0 GENERAL INFORMATION 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: Lazaris, Joanne I Richmond, Town of 026- 1109 -10 -000 CST BM Elev: Insp. BM Elev: BM Descr' do Section/Town /Range /Map No: /Ox - U I /61t) , b /* 04.30.18.609 TANK INFORMATION 9 tLEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic Benchmark 2.32 /6%, Dosing /- Alt. BM Aeration f/ Bldg. §eV ( S� Holding % St/Ht Inlet C Nt/d )j fy S p S Z i0 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet / Septic ju-' Dt Bottom / Dosing / �h �• Header /Man. e w M y •(gip/ '73 Q uWw U 70 Aeration Dist. Pipe Liz 9-S-1 43, z _ � Ct `7 Holding Bot_ Sim nn o� OIL t / Final Grade �� 9� / &/ PUMP /SIPHON INFORMATION �j� "T Manufacturer Demand St Cover GPM ' v f Z' 7 Model Number TDH Lift Friction Loss P<terfi Head TDH Ft ( `� Forcemain Length Dia. Dist. to II SOIL ABSORPTION SYSTEM or BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 j /_ d ' 1 ./ 1 SETBACK SYSTEM TO 1 � P/L JBLDG IWELL LAKE /STREAM CHING Manu actors . /'/ / e ► IN CHA R OR ` r Ty p Of System: + S� � + fi ' / UNI Model Number: DI TRIBUTION SYSTEM 1 1- eade Manifold De Size x Hole Spacing ent Air Intake 4 /1 Pipe(s) 11 I ' — Length Dia Length Dia Spacing SC �1�f✓f / rte SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center (��'�L Bed/Trench Edges Topsoil Yes D No ❑ Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / 0 L9 Inspection #2: Location: 1184 Carroll Street New Richmond, WI 5400117 � (NE ) 1/4 SE 1/4 4 T30NR188 Viebrocks River Valley Addition Parcel No: 04.30.18.609 1.) Alt BM Description 11 Cdw�" ��' S I ty� / IfW r t I 2. 9 sewer length rl�ll f p VC Bldg - L �/D ('� �� %�'� Z.et�V� Q�` S J - amount of cover -� 2 � a( W4 Plan revision Required? Yes / /bi Z / __ Use other side for additional information. No [ �4l Date Ins epctors Signatur Cert . No. 1 SBD -6710 (R.3197) i COI M ,W.4PV Safety and Buildings Division county 201 W. Washington Ave., P.O. Box 7162 l on h isconsin Madison, WI 53707-7162 Sanitary Permit Number 06 be filled in by CD-) of conuneroo 5/5 nM Sanitary Permit Applicatio` n I, accordance with s Corona. 83.21(2), %rm Adm. Code, suMmloion of this Iona to the appropriate u k is roeprired prior to obtaining a sanitary permit. Note: Application forms for state -otgmed 1 Project OfdifTerdN than smiling add<'ess) submitted to the Department of Commexee. Personal information from provide may be used for secondary � / / 8� /4 p uTLIOM in acoordatta with the Law, s. 15. 1 m Stats. / (� Cam- J L Applicatiou itatormatioa - Phmtae Print Alt a Ply Owoer'a Name � Property Owmes Ma kg Ply w 1 19 . 4 ra r r'O t( • Govt tat Cih' state PLAN I OFFICE -M S Y S £ yti Section ,�, t s tJ 1 11 S J (7 T N+ R E o C/ II. Type of wing (cheek an that Lot # - t or Family- N- AcrofB�n - - 1 Subdivision Name �0.G.Q�r1nG Block# �J i0-Q/' �Qw dC1. O Public/Comn=cW - Describe Use O City of CSM Number O Village of ❑State Owned - Describe Use Town of y YA()Vlj- :3 (no �/A III. Type of Permit: ( Check o on Ihm A. Complete line B if applicable) A © New System xRrplaexmerrt System O Treatmeut H ling Tank Replacement Only O Other wilifcatum to Exatmg System (-0-) B. O Permit Renewal Permit Revision O Change of Phu_ Ibex O it Perm Traffi6er to New I iat "tOta Permit Number and Dare issued Before Expiration owner 44 07 - 7 - I � /2 IV. Type ofPOWTS Com t/Devk*: Check all brat a ppW V Nw,P ressurtzcd Imt3round O Pressutiaed In�'rroeard O At-Grade O Mound> 24 m cf suitable sal O Mound <24 in. of suitable soil O Ilokling T� Dispersal Component (explain ❑ Prexreahrremt Device (explain V. pkpersaMeaftaent Area Ief t>t08: Design Flow (gpd) Design Soil Apphbkbm Rate(gpdafl Diapend Area Required ( Kasai Area (s) System Elevation IOP 5 0 00 1 93 VL Tank Info qty in T # of Mamdbcwm Gallons Gallons Units NCWT*nka EdsftTmks $ v m rn w P, "rwg Tank ; O O C) �. I © k „ r VII. xeapotaaibiGty Statement- I, the aaderaigned, assume respausWity for installation of the POWYS the attaehed Business Phones Member Name Phm*Ws Si ! u Q3 7 IS �`3S Phm *Ws Addmss (Street, City, State, Zip Code) _ �J '^ a t Use Only Permit Fee Dates R Denial y7 • & Z' d 1 Ix Co>a 4t mom for Disapproval 3) 676 � 4 i 4 4 .n�o rl 1. Septic tank, effluent filter and dispersal cell must all be servk:es / maintained PC, LO bLa . asrper management plan provided by plumber. 2. AN'tl6hw* requirements must be maintained Attach to eomPkte idam roc �e s�•ste® acct sobaaH to me (:eoat9 aey on PaPn' not las Uua 5 to = 1 t tnsha to sine S13D -6398 (R. 01/07) Valid thm 01109 r � Chi r (, 1s7 C o fx V <<210 roC�S R'l v 04 � loo cam\ S.Ca��iC ,�`cG�s /�t✓��t�so�.� ALI'C 3 `Y°rn �szA� ac) 1 5 a 9P �n 1 i / C Lecopy ( I P10 u P nn� �ckzc�, n N � I� S� �T30N�PI8' `` n U ctl ( v �f �` �IDrcC� S ` 1� �V�r � �� Sj- iC.,U`c.a5ars /pj�� lok -Sa� �ar � OA(o ,Ilo9 -)o- b"Dc 3 `t°�r (Qo rg LO S •eC`� o ►�s z ��o u� �t(`s r n S 5 \ �¢ vr� \ c� I�x v�0►�1 �1 n..Bvtb,. s l /a at Z P � � L q1 1- 1 � Wisconsin Department of Comme SOIL EVALUATION REPORT Page t of 3 Division of Safety and Buiidi�gs Y accordance with Comm 85, Wis. Adm. Code Attach comp lete site p lan pape lZrress than 8 1/2 x 11 inches in size. �— County t ze. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. //0? . 60C) Please print aft inform ��/ ewed b y ate Personal Information you provide may be used for secondary wy Q s. 15.04 ( (m))• 6 Z 2009 Prop 6 7 Property Owner Q erty Location Govt Lot A) � 114 114 S T30 N R or) W Property Owner's ding Address ST CxOlx COUNTY Lot # Block Subd. ame or CSM# PINING & ZONING OF �IC N ` I I U % Q � 1�2 1�0� City State Zip Code Phone Number ❑ City ❑ Village gown Nearest Road I c s ) C lu ❑ New Construction Use. ( Residential i Number of bedrooms 3 Code derived design flow rate _ N J d GPD Replacement ❑ Public or commercial - Describe: Parent material 0 � Wry e_ {► Flood Plain elevation if applicable A) /a ft General comments and recommendations: S ! p 3 d pcs--2 T l 0 Boring # ❑ Boring Cj p ® pit Ground surface elev. / 7, D ft Depth to limiting factor 9fO in. Soll Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDiftz AA In. Munseli Qu. Sz. Cott Color Gr. Sz. Sh. Jr •Eff#1 'Eff#2 /114 r S ^T r �o a - �o. stns ,-� /o s s Pq R] pit Ground surface elev. W- ft Depth to limiting fact in. Soil Application Rate Horizon Depth Dominant Color Redoc Description Texture Structure Consistence Boundary Roots GPDM in. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 I r3 1 . 1 ors 4 54 r.+ VS A f , t l • !d Sil I. I 2 • EfflueM #1 = SOD, > 30 < 220 mg/L and TSS >.V 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name Print) Sign CST Number - �.� dQs3 Address Date Evaluation Conducted Telephone Number kke AAMnnj s t S ' 0 7rsa !vS/ r Property Owner OQ v1 f` Parcel ID # Page of ®Bor ing # 11 Boring 9G r q Pit Ground surface elev. ft. Depth to limiting factor �' 9 � in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Sal Ap plication Rate In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0 /OYr A � � 6Ak M7r 1 3 , a l - Q4 Ao r 1 Al n rQ— S, / 5bk h% /D r• 6 b /L dri2 S F � # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 F Ong # ❑ Ong ❑ Pit Ground surface elev. ft Depth to limiting factor in. Soil cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efi#1 *Eff#2 ' Effluent #1 = BOD, > 30 220 mg/t and TSS >30 < 150 mgll. ' Effluent #2 = SOD < 30 mgn- and TSS c 3o rtglL The Department of Co mnerce 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 60 8-2648777. SBDOMMM f Property Owner10-OL t`� Parcel ID # F S -1 Page � of B � 9 E] Boring Pit Ground surface elev. 9!o P 9 it. Depth to limiting factor 9 �a in. Horizon Depth Dominant Color Soil Application Rate Redo x Desert bon Texture xture Structure Consistence Boundary Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *EfM *EtfQ - /° Al n rvZ s , / . a 5bk f lr-° C, ., , to Ib ia� 66 M&A.Q- S o rn s M� a Boring # [] Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant color Redox Description Texture Structure Consistence Roots GPDfftz In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efl1#1 'Effti'2 Boring # ❑ Bonng Ground surface elev. ft ❑ Pit Depth 30 limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots . GPO/W In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 •Eff#2 * Effluent #1 = BOD > 30 < 220 mgr- and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777. ssnss30VL"oj i 20 �U� �t0" ot V\ cG�YY1 ®ne / �'T" ��� � / RIG�NVIo'Ytt � S��C►^o t.k Nor Qkn4 b ( lot U i ca 6 � ' �aaQ i Tom" • ` `�-� A e ll 0 QA Q L °1J o � I 316 la` r ©�i1l�Sl U IS i t li Co rvo I� s i� t Cpl "A Ut FF EZ1203H e9e vaa0 " •`� VOa00aa . bPeavae � st ��t: ~ � •• aeVOavOa vev -..• -•..- .:::...- 'aevavev 12tt . . _,: . 000 '� -e ��,y:;•. .��w s. FVa: " 'Vav 4 1 vvv vev 4 .625 " vva VIVw aea . 1/2 Clrc. = 18.84" sav evv eP9 O'ee evv vvv vvv vev av e' -r a -a v - 9e vaeV�' - a- t aevaa77aVVa V e- Vea eaa V, wwVwwwww wwwww VevvVV�' avaOVeV wVVwa VVVV'O Vb va aww"W P 24t'—'�- Boncim 36" 12 -I /2" DIA. (tyP.) Void Volume Soil Interface Area Its. jg & - � �•( Void Coefficient in Aggregate given at 57.4%. Sidewail (2 Sidewalls) 2 * i -84in = 3.14 O-D. of 4" pipe — 4.625 inches 2i 125m Ift Void volume per linear fL = 3.14 • tft - 0,117 ft' Bottom 2.00 ft �! T - O.D. of cenitrcytindtr — T2.5 inches Total Soil interface Area 5.14 SQ. Void volume in aggregate of center cylinder — 3.14 • 6.25in 27.10 • n lMio �I2bf tftl (127;0 /ft ) 2 ) !'.574—.422 7 fe O.D. of outside cylinders = 12 inches Projected Trench Arco Void volume in outside cylinders — 2.3.1 bta 574-.901 ft; Sidewall Height = 12 in. *2 = 2,00 Sq.Ft. `72Z ft) Void vol Sodom = 36 in. = 3.00 Sq.Ft. ttmcnt bottom between cylinders MU - 24m bm 6i° }_(3 1 .( I ft 12in r ftj 4 2ia1 ft} � ' 0.215 W Projected Trench Aren = 5.00 Sq.Ft. Void volume at outside bottom corners (12 of void volume between cylinders) 0 -21 ! 2 = 0.10$ re Total void volume — 0.117 + 0.422 + 0.901 + 0.215 + 0.108 = 1 -763 cubic ft ! ft Gallons per ft = 1.763 X 7.48 - 132 cations Per linear ft. t( 3 L k` o S EPA Aggregate Trench System ED 203H Z LOw Rin§ - Industrial Group 65 Indus#.riol Pork Rd. Oakland, TN 38060 Scue ME wwb EZ7 3►+ —,es, sHEEf: , oft tl�z7 —o, i POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner r S Septic Tank Capacity O al 13 NA aza Permit � Septic Tank Manufacturer r ❑ NA DESIGN PARAMETERS !effluent Filter Manufacturer PCA D D NA Number of Bedrooms ❑ NA Effluent Fitter Model D NA Number of Public Facility Units 0 NA' Pump Tank Capacity a l ❑ NA Estimated flow (average) 3 al/da Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) 5O g al/day Pump Manufacturer ❑ NA Soli Application Rate aUdaylftz Pump Model 0 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 ❑ Disinfection ❑ Other: _RreAreated_EfSuent_Qu ge s Sal Csll(s) -- - - - - - - - 13 KA Biochemical Oxygen Demand (BBD.) 530 mg/L Xin- Ground (gravity) ❑ 1n -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. 13 NA Other ❑ NA * Values typical for domestic wastewater and septic tank effluent_ Other 0 NA MAMTENAN SCHE DULE Service Event Service Frequency Inspect condition of lank(s) At least once every: 13 months} (Maximum 3 years) ❑ NA earls} Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA ❑ month(s) inspect dispersal cell(s) At least once every: years) (Maximum 3 years) ❑ NA Clean effluent filter At least one every: Q month D NA years) . ❑ monthts) Inspect pump, pump controls & alarm At least once every: y ear(s) ❑ NA Flush laterals and pressure test At least once every: 0 month(s) DNA ❑ yearis) Other. At least once every: ❑ year(s) Q NA Other: 0 NA I MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the fo(lowi ng lip or rations: 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 (Y3) 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. AN other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to local regulatory authority within 10 days of completion of any see event. I Page „J. 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 cots of the tanks) 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 d'a angod to the dispersal caff(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 remirAid 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 control to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal calls. 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. Redtnction or of the fallowing from the wastewater.stream may improve the performance and prolong the He of the POWTS: antibiotics; baby wipes: cigarette butts: condoms; cotton swabs; deters: dental floss; diapers: disinfectants; fat: foundation drain (sump pump) water, fruit and vegetable pigs: gam: greass; herbicides: meat scraps: medications; oll; painting products: pesticides: sanitary napkins; tampons; and water softener brine. ABANDONNU39T When the POWTS fails and /or is permanently taken out, of service the following steps shall be talon to insure that the system is properly and safety abandoned in compliance.. witfi chapter Comm 83.33, Administrative Code: • AN piping to tanks.and pits shag be disconnected and the abandoned pipe openings sealed. • The contents of an tanks and pits shall be removed and properly disposed of by a Septags Servicing Operator. • After pumping, ail tanks and pits shag be excavated and removed or their covers ranoved and the void space filled with soil, gravel or another Inert sold materiel. CONi'94GENCY PLAN If the POWTS fell and cannot be repaired the following- measures; have been, or must be taken, to provide a code caompiiant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a repiacemecnt soli._absorption system. The replacemarnt area should. be protected from disturbance and compaction and should not be infringed upon by required setbacks from exVgbg and proposed structure, lot -Imes and wells. Failure to protect'the replacement lea will result in the need for a new soll and site evaluation to establish a.suitable r"laceunernt area. Replacement systems must comply with the rules in effect at that tine. ❑ A suitable replacement area is not available due to setback and/or soli Cunitations. 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 kwate a suitable replacement area. U no replacement area is avallablo a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade WN systems may be reconstructed in piece following removal of the bionM at the -i surface. Reconstruic .of su r st a F ith the rules.in effect lane - - — <<WARNI NCs> >' PUMP AND OTHER TREATNENT TANKS MAY CONTAIN LETHAL BASSES AND /OR INSULT OXYGEN. DO NOT -ENTER A SE `IW PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON PROM THE NNTE(BOR OF A TANK MAY 13E DIFFICULT OR IMPOSSIBLE.. ADDITIONAL COMOAENTS POWTS M{STALLHi. POWTS MAINTAINER Name S Nave Phone – 7'r J Sl Phone smAsE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name IL (` r 90r) I Phone Phone S This doaxnent was drafted i oompliancs with chapter Comm 83.22(2)(b)(t )(d) &(f) and 83.5401. (2) & (3), Wisconsin Adtr inistriNd" Code. START UP AND OPERATION Page of For new construction, prior to use of the POWTS check ,treatment tanktal for the presence of .painting products or other chemiceis that may impede the treatment process and /or damage the dispersal cell {s1. ff high concentrations are detected have the contents of the tankls) 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 highwafer levels. When power is restored the excess wastewater will be discharged to the dispersal ceQls) In one large dose, overloading the CAW and may result in the backup or. sur ftm 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 eGminatiion of the following from the wastewater,stream may improve the performance and prolong the -life of the POWTS: wmnbiotics; baby wipes; dome butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; most scraps; medicattons; 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 comptice._wiRh iioapter Comm 83.33. Wmoor Code: • AN 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 shag be excavated and removed or their covers removed and the void space filled with soil, gravel or another Inert solid mate". tIfiNTINGENCY 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 exiting and proposed structure. lot -lines and wells. Failure to protect'the replacement area will result in the need for anew sob and site evaluation to establish a.su"rtable replacement area. Replacement systems.must comply with the rules in effect at that t1 me. 13 A suitable. replacement area is not available due to setback and/or soil limitations. Barring advances In POWTS technology.a holding tank maybe installed as a last resort to replace the failed POWTS. L] 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 repiac oment area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. D Mound and at -grade soil::_ absorption systems may be reconstructed in place following removal of the biomat at the ,` Reconsl,ruc : of:- .su frmu =c x vlth:the rutps-&n effect that I me Imo•;.. < <WARNING> > SE"TIC. PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT 'BITER A SEP'11C. PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. MSCUE OF A -PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.. ADDITIONAL COMMENTS POWTS_ P01NTIs MAINTAINER Name t S Name PhoneS f Phone ��S l SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name N r f Phone Phone S This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.64(1), (2) & (3), Wisconsin Administrative Code. / o a 40 8 ^ Z � oo Z4p A ;� I�7 8 5 , f f C s m D z ^a • sJ��. ° y1N a «o O z E mm ^,, "'^ n• ITI 3rS m Vl t°p _p OO 1 ^ y 8 �fr �� �o38 ID °�4 >'�zm�> c •i I �.• I �,r 'L -. 3:�k � t�� •�� 7 = 3 s "NO+F1G o :• i s - m ° Or. . c an •71 I N I w 10 D JCL J m0 °i Im .°•F.z> 1K np C ., ' u1 P � N Iw• C: a•: b•et° T - Y j -ii ." oPm i> E >' ,1 •a m 1 1 .° o �.. 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CROIX COUNTY SErnC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer A (\ \C L a Z a r ', S Mailing Address [ _ eCx r r o Sty .o N -Q W t� i C k m o /) j �C� © Property Address — (Verification required from Planning & Zoning Department for new construction.) City/State ) ,Q 1� Q C Parcel Identification Number Ile /6 _ 'n6 4 LEGAL DESCRIPTION Property Location _NX--' '/4 , S� ' /4 , Sec. T,30 N R W, Town of Subdivision ' S �✓� Lot # Certified Survey Map # ,t `? z, / 5 , Volume , Page # _. Warranty Deed # , Volume , Page # Spec house yes Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified is §Comm. 83.52(l) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 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 virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms `� SIGNATURE OTAP ICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) i C3'll' ti`+ C-.CP STATE [.AR of 1V ISGb"Sara — FoRLL a i { 4vyS 4wLC3ENYr_Q C4 f RE2:S4R'S�e(4 QiT - n T13ds Deed., ms� bOlMOMm _.$���a3)__� ..1�`��t ..�ll --- --- CF{lCrz ._ .. Grantor 'Rec' for Rroord rlus lst ----•---•------- a" Jack A, Laza ,arid. cloy of .ega.. AD. 19- wifQ .Ss joint tgmants - ---- - -- - .. -- --- --•-- ci +3.:38 A IIA. ............. ' r ---- - ------------ __ _Grantee. WjtrteSSseth 1b1.c the said Grantor, far a valuable Lx,asi erafiion 4tf. ameds ww..dol:lar .and 4€her gored. amd coracrss to Gr nue a the followbag deStr€bed rzal er_tlate in __.St —CmIx ---- - ------- .cers.wa. Tv, �u1LtT. Saatic oC SViscva5.ca: wt 10 of vjEBpjwK Rr AR v ALLE y vi.eil FKDDrr jam, Town of New Ri chinmd . . 5t. Croix County, WI; Tait Rey No ... .------------------- -----•--------- TRAN SFER. FE Tbia .,.ia..11Qt ......... .. borummad property. (is) 6a mnl Tag*Zher wit.) %at and sizatular the herrditz -ncnte an,? opportenances thereunto belonginra; true). �a��r'oX. . ... ..........._....... warrants that the bile is goad, indefeasible in fee simple- and free and clear e+: ermuinbrane-m excer-t easements and restrictims of record and wiJ! we--cent 2nd deread that aaslue. Dated this .......... . .._. .. ... ... dmya o- ----- CvII tti ••-• .............. °_........... ip.7�... ........ ............. .............. . .... __.( SEAL) `^ - .L� ...................... (SEAL) ....... .......... ..................••. -- ......_.... .............. (SEAL) AUTHENTICATION ACKNTOWII.EDGMENT S'r.gne,tures authenticated this -- - - - -- -- - ------ dray of STATE. OF WISCOA:SIN ` .. --•-- -- - ... .... ........ iA- ..... 1 . POLK ss. ----- ----- --- -- -- - --- -- County ............ .......... ..... ._ -.. ..- . --- ..._ .- _... -... Personally came before :.,e, this _..27 ...... Aay of e DecembL -r, -1978._ the above named _YAa . ,j.. - - . _. ... . ------ •-----• --- - -- -- ------ TITLE• : MEMBER STATE BAR OF WISCONSIN Viebrock_. - ------ --- - - --- --_----_---_------- (If rot, ..- . .. .. ---- .. "- -- ----- .......... ......... _ ...... .... . .. .." -- " -.. authorized by § 706.06, Wis. Slam.) - .. ... ........... .. ......... -- --- --- ---- - - - --------------- - THIS IASTRUMEt1T WAS DRArTEO 81 to me known t,a be the Ferson .. who executer) the foregoing instTu 49I1Mnt_ and rcknowled a the same. Maki_ & - Ludvigson, .Attorneys - -at Law.. Osceola : .,�cfisccsais;! n....54u20Z'c„! - �_.. - -. ------ _ .. -._ MatSeella -L. Howes a uthenticated Notary $'ubli'c . -... _ . -:Fbl .: .......... ... County. Wis. (Signatures may be . er Ttcknowlrrlgeil. Both are not nceessarc.; My Co ninission is pa:rmnne:tj.:' (If not, state cr.piration date: •NwTm 9P (1lt6pDS 6�gDIDQ )n Err uD�<i!y �itnUld 1N LFDC.I Cc pCi U:t'd tGIOA" Lhefr %�IRDDfUrn, _ WARRANTY DEED STATF. SAM OF VVISCONSM ,vi —ni. 1—C.1 lily Dl. C, 1., -. -_ -- FORM No -1 — 1B7 _ Milme km WE,. Vj.b33797) l 0 ?�� J � M ■ 2 k � f (° 7\( 0 k S 1ƒ f B �- z C ° a 4 k 7 _P ■ C w 0 0\ C! i ¢ \ § 2 ) A R / � � CD / § � 3 § o / q E E o - � o k � /� a ■ � \ 3 / / ¢ 2 � 3 0 ® $ \ } « to 8 a n r■ CD ) � E & � / k k k } \ 1 -31 ■ C ■ ƒ ƒ 7 ƒEV "Q 7 z m % z Q. z = z f / 0 / \ / ® J R - CD CL � \ ( 3 z co � ■ o E a ■ z m § X & 0 # z 9 ƒ /) A. E § 7 2 § @ to 2 § % : « � � 7 ± / z C C) $ § . ƒ � � o k � � § 2 � # I ; � < 7 0 B G \ « 2 . � � St. Croix County Final Property Report Page 1 of 1 St. Croix County 2006 Property Report ` 0 Print Report Generated: 11/14/2006 12:20:54 Data - Updated: 11/14/2006 1:00:00 AM PARCEL COMPUTER NPARCEL M AP NUMB 2002 2003 2004 2005 2006 < -- Click on the year to select the annual record. (* & dark red = delinquent) Property Description Billing Information Municipality: 026 - TOWN OF RICHMOND Name / Attn.: JOANNE M LAZARIS Document Number: Address: 1184 CARROLL ST Volume & Page: V, P Public Land Survey: SECTION 4 T30N R18W City, State, Zip: NEW RICHMOND, WI 54017 Quarter: Country: USA QQ / Tract: Ownership Plat: VIEBROCK'S RIVER VALLEY VIEW Primary Owner: JOANNE M LAZARIS Description: SEC 4 T30N R18W OT VIE - Rl} OCK RIVER VALLEY VIEW Secondary Owner: ADDITI N T tall Acres: .39 ACRES Site Address: 1184 CARROLL ST Assessed Value Other Valuation Date 6/20/2002 Fair Market Value: 0 Assessment Type Acres Land Improved Total Assessment Ratio: 0.0000 Value Value Value Net Assess. Val. Rate: 0 G1 - RESIDENTIAL .39 22,500 83,000 105,500 School District: 3962 -NEW RICHMOND Totals - -> .39 22,500 83,000 105,500 Tax Installment Dates Tax Detail Period Date Due Amount Category Tax Paid Balance 1 0.00 Amounts Due 2 0.00 Real Estate Tax Due 0.00 Total Taxes - -> 0.00 Lottery Credit ( -) 0.00 Tax Payment History Net Property Tax 0.00 0.00 0.00 Date Paid Receipt Number Amount Special Assessments 0.00 0.00 0.00 NONE Special Charges 0.00 0.00 0.00 Delinquent Charges 0.00 0.00 0.00 Specials Private Forest Crop 0.00 0.00 0.00 Category Amount Woodland Tax Law 0.00 0.00 0.00 NONE Managed Forest Lands 0.00 0.00 0.00 Penalties 0.00 0.00 Interest 0.00 0100 Totals - -> 0.00 0.00 0.00 http: //72.21. 230.178 /website/LRPortal /total _process. asp ?IDValue = 026 - 1109 -10- 000 &SE... 11/14/2006 •• • AS BUILT SANITARY SYSTEM REPORT ' dER ! /� f , TOWNSHIP �� �,r l SEC. T �:3� A J W O. RESS� , ST. CROIX COUNTY, WISCONSIN. _ _ 3DIVISION / n ,/ i , LOT LOT SIZE PLAN VIEW -Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM . t 15' 31 , � r S ?' ?TIC TANK(S) MFGR. �L,/�7: �" CONCRETE STEEL`` NO. of rings on cover / Depth n' DRY WELL `NCHES NO. of width length area D no. of lines Z width z_ - length � area depth to top of pipe ' 4K RATE S AREA REQUIRED �,�.� �r " AREA AS BUILT 'sciaimer: The inspection of this system by St. Croix County does not imply complete . pliance with State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liability for :;tem operation. However, if failure is noted the County will make every effort to �zermine cause of failure. w 'BASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. • INSPECTOR DATED �r��,� PLUMBER ON JOB LICENSE NUMBER {{ y . I 1 REPORT OF ITISPFCTION-- I:dDIVIDUAL SEI•TAGE llISPOSAI, SYSTF.T -i Sanitary Permit 7 cP • r State Septic 1� T&VINSHIP t. Croix County SEPTIC TA'II: Size gallons. ',umber of Compartments Distance From: 1-jell ft, 12% or greater slope ft. Building ft. Wetlands f Illighwater ft. DISPOSAL SYST:1 Tile Field or Seepage Pit(s) Distance From: hell 0 ft. 12% or renter slope ft Building ft. Wetlands �' f FIELD Hiptiwater ft. Total length of lines ft. Number of lines Length of each line 41� ft. Distance between lines ft. Width of the trench a._ft. Total absorption area sq. ft. Depth of rock below the /2- in. Depth of rock over the Z in.. Cover _ nver.rock,, <• 1 Depth of tide below grade ,�5 in. ;lope of . trench n per 100 ft. Depth to Bedrock r ft. Depth to p,round water ft. PITS . Number of pits Out • c: meter ft. Depth below inlet ft. Gravel around p es no. Total absorption area sq. ft. , Square feet of see pet en bottom area required Squars feet of s epape a e required r . Inspected by: `+' � f Title °'— • n A rov ed ,r .P Date ,. 197. Rejected Date 197 r.r. EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN .53701 REPORT ON SOIL BORINGS AND PERCOLATION T S LOCATION: ' / /4, Section �_/, T.5- RASE- (or) W, Township or 1vntdpZfity Lot No. —,Block No. ! �� e ���kfl'iJ County Subdivision Name Owner's Name: Mailing Address: / ✓� %� TYPE OF OCCUPANCY: Residence Z ''� No. of Bedrooms Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION REPLACEMENT DATES OBSERVATIONS MADE: OIL BORINGS _,>%��,,�U TEST SOIL MAP SHEET — SOIL TYPE PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN /IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) Z 7 "S 7z I� 72 ,� S PLAN VIEW (Locate percolation tests,soi I bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indi to number of square feet of absorption area needed for building type and occupancy. 0,�5 a (, /3eo a'24*4,40" D Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. 90' a t N G c a ' / 3 Ic' 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name (print) Cer ification No. 'Z Address ` �' Name of installer if known CST Signature � COPY A —LOCAL AUTHORITY — P1.867 State and County State Permit # Permit Application County Per mit / # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: A16 B. OCATION: , v _ '/4, Section �t T_,WN, RA;5-E (or) W Lot# City_ Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE F C UPANCY : *Commercial Industrial Other (specify) Variance Single family Duplex No. of Bedrooms No. of Persons D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste Grinder YES 4,40 # of Bathrooms Automatic Washer '� YES NO Other (specify) E. SEPTIC TANK CAPACITY / Total gallons No. of tanks *Holding tank capacity Total gallons No. of tanks New Installation Addition Replacement _ Prefab Concrete *Poured in Place Steel 1/' Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) ,1,'_ 2) :_� 3) ,� Total Absorb Area i sq. ft. New ✓ Addition Replacement *Fill System Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length -45 z / Width , Depth b� /T Tile Depth 7 . ii No. of Lines Z Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land 0 - Z Distance from critical slope I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Certified Soil Tester, NAME C.S.T. # c` and other information obtained from �, ( uilder . Plumber's Signature MP /MPRSW# d �� Phone 4 --ye - - 5Y�- Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). Fj 1 Zel y ' l o' a �T��` )Z' Do Not Write in Space Below �R DEPARTMENT USE ONLY n Date of Application — � Fees Paid: Stat 10 1 O 0 Cou�kita Dat e Permit Issued/ (date) — /S 7 9 _issuing Agent Name Inspection Yes No Valid# Date Rec'd 1. county (whi a copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 6/11/76