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HomeMy WebLinkAbout026-1306-00-067 Si PA10 co1711n1eIfCe.VVhgoV Safety and Buildings Division County 201 W. Washington Ave. P.O. Box 7162 i s eo n n Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) Department of t;ommerce 5115 Z t o Sanitary Permit Application State Transaction Number 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 POWT Project Address (if different than mailing address) nt f Commerce. Personal information you p rovide may be u onda submitted to the Departure o Co Y P y 9 p-3 /S,2 ivo /GVE p urposes in accordance with the Privacy Law, s. 15.04 1 m , Stats. 1. A plication Information - Please Print All Information Property Owner's Name Parcel # Property Owner's Mailing Address O�OouNo 1 operty Location / 10 7 4 AL Z 1 2 a ? Sj.GR ovt. Lot [/ City, State Zip Code P /., Section _ circle o T 0 0 + - T ? _ N; R_ J E o W IL Type of Building (c eck all that apply) Lot /� Subdivision Name >� t or 2 Family Dweltitig= Numtierof Bedrooms � Bloc - ❑ Public/Commercial - Describe Use 1C k ❑ City of C1 State Owned - Describe Use P i ck Vl%.— CSM Number ❑ Village of ®Town of le .v/►20nvgo -- Ill. Type of Permit: (Check onl one box on line A. Complete line B if applicable) A. New System 11 Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner ^ F,'( IV. Type of POWTS System/Component/Device.- Check all that a 1 ® N - Pressurized "round ❑ 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. Disp ersal/Treat ent Area Information: Design flow (gpd) Design Soil Application Raye(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed f) System Elevation 60 ? 7 J ^ y)7. VI. Tank Info Capacity in Total # of Manu cturer U Gallons Gallons Units U � °� H New Tanks Existing Tanks d C __ : a A w y rn • w C7 n. Septic or Holding Tank Dosing Chamber n , / VII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Si ature MP/MPRS Number Business Phone Number J /S Plumbofs Address (Street, City, State, Zip Code) ar jr n VIII. County /De artment Use Onl Approved 1 61sappmv Per/miit Fee Date is ued Issuing g t Signature even Reason for De I $ r 75 IX. Conditigla6#E40VNqWeasons for Disapproval 3� / Q J f ohs D / 1 e �� ' I Z g p 1. Septic tank, effluent fitter and / G� d� f t" !� i` dispersal cell must all bg spa yiees / maintained as per management plan provided by plumber. A-k 2. AN setback requirements must be maintai 94 �) .1 4 pPd - 4eiJ awAer r . Attach to complete plaits for the system and submit to the County 61y on paper not less than 8 In 11 inches in ize A, 9fine SBD -6398 (R. 01/07) Valid thru 01/09 ••ria YI' AZ r. #. �1.: T P,." PHo P� o. E «v - 99.61 - - -. Pmt * cam iECT10N Pt.Mr< 70o of t atmyc. TR ANS colzm,i /1 / i o' 1!IdI1rMM'p NI T Uv•oo "— qe�, y � /3 `//°✓C Er'�'LdEM 4.vc - lE jo y � • TS � l / ►jFST A oAWY Lr vt - - _ .s9 sz nPr /9'` u.9lo dkrvEWAY - Agao.sFQ ✓E LL / / Joo SFTBAeK LSNf FRuM all' In • OF Wj"ow A!rveA 1No' PVC /./WE Arm So' Jo / Y ;Or SCNEi S'P - f4ervg &"AGE r � vkrrrr YkJI "LeiLVCO Cov�f•4 y /3E[9/tuaM / "�Y /dLfvf ?SO Aaesm Ls'./tdtrnw7YuN S'EPL2[ fi°�na GYAmaxt 7Ar✓K /tfsz[)E.vcE WTU 4oc i 5.13 ErYlridNJ E Af r P.Q vPe�RrY �1NL l `rmot ANO..fm/owT A4T1P �( Ja4FOvE0 Pv/tCN Y y IO ✓G SbYra 1�0 .C�it�G .1�FwE,Q &O 'lAw" ONSuM O F w SAA- OA1 lavF,a Ai✓o ovc, APO J 1 0 Ram Saar /'3huA� /.&VIC : LQA9 I Q uzc1< 5'•1'rv+Naq�o (..�GO��� _ �� r�T� �,E i14N�C►: -- O,dSrA Ay7on1'/vs/�s. 7i✓tt�•e A% move Gzvoe uceMW. 2 9 92ZL? —.--- f:/►asH 644at x OAS: " 9 �7AKS�ra.�► 96 "OoVFR �' �'i° ✓C J'.yG°t © 5r oft MST" BY: (IFFBCTIVE LOOV" a gm I�II�IWW�k -- - LvVtAr - e �? AL Ya UO SIO� VIEW T/lENCN FiCuva .�L6liivTSoiv /DER Tw view Sam 7047 MuitiPort End Cap f w6w T-- I I I ri ,z. ,Ir ..Z/Vf1'LTi�ToyQ SY.iTFA/J .Z� A 2199 Wisconsin Department of Commerce SOIL EVALUATION REPORT - -a- 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8 % County St. 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 026 - 1306 - - 067 Please print all information. eview Date Personal information you provide may be u 04 J (1) (m)). (a Property Owner operty Location 1st National Community Bank vt. Lot SE 1/4 SE 1/4 S 18 T 30 N R 18 W Property Owner's Mailing Address ECo 0 0 I t # Block # Subd. Name or CSM# 109 E. 2nd Street 67 Glens Of Willow River City State Z j City Village 0 Town Nearest Road Hudson WI KING & ZONING OFFIC Richmond I 152Nd Ave. tiI New Construction Use: �fi Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement J Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable Na General comments and r commendations: Site suitable for conventional POWTS / sing ' 0.7 gpd sq. loading rate. Recommended tem elev. _ Gb T -c 93.00 i 300 �Q 1I Boring # I Boring Pit Ground Surface elev. 98.02 ft. Depth to limiting factor >120" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -9 1Oyr3/3 none sit 2fgr mvfr as 2vf,fm 0.6 0.8 2 9 -18 1Oyr4/4 none sit 2fsbk mfr gw 1vf,f 0.6 0.8 3 18 -21 1Oyr4/4 none sl 2msbk mfr cW 1vf 0.6 1.0 4 21 -31 7.5yr4/6 none Is Osg ml aw 1vf 0.7 1.6 31 -120 1Oyr5/6 none s Osg ml - - 0.7 1.6 Horizons #4 & 5 consist of stratified layers of various grades of sand. Loading rates reflect most restrictive permeability found within horizons. Boring # I Boring f Pit Ground Surface elev. 97.73 ft. Depth to limiting factor >109" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I - E 2 1 0 -10 1Oyr3/3 none sit 2fgr mvfr as 2vf,fm 0.6 0.8 2 10 -17 1Oyr4/4 none sic[ 2fsbk mfr gw 1vf,f 0.4 0.6 3 17 -20 7.5yr4/6 none sl 2msbk mfr cw 1vf 0.6 0.8 4 20 -42 7.5yr4/6 none Ifs,ls,fs Osg ml aw 1vf 0.5 1.0 5 42 -54 10yr5/6 none fs /s Osg ml aw - 0.5 1.0 6 54 -109 1 Oyr5 /6 a trat gr s 0 sg dl - - 0.7 1.6 Horizons #4 & 5 consist of stratified la s of variou grades of sand. Loading ratei most restrictive permeability found within horizons. * Effluent #1 = BOD 5 > 30 < 220 mg /L nd TSS >30 < 50 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L CST Name (Please Print) Signat e: CST Number pson James K. Thom 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 12/3/2009 715- 248 -7767 i Property Owner 1st National Community Bank Parcel ID # 026 - 1306 -00 -067 Page 2 of 3 3] Boring # Boring V Pit Ground Surface elev. 98.33 ft. Depth to limiting factor >111" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -11 1Oyr4/3 none sl &Is fill na na na 2vf,f na na 2 11 -19 1Oyr3/3 none sil 2fsbk mfr gw 1vf,f 0.6 0.8 3 19 -29 7.5yr4/4 none sl 2msbk mfr cw 1vf 0.6 1.0 4 29 -36 7.5yr4/6 none Is Osg ml aw 1 of 0.7 1.6 5 36 -43 1Oyr5/6 none ms &cos Osg ml aw - 0.5 1.0 6 43 -111 1Oyr5/6 none s 0 sg dl - - 0.7 1.6 Horizon #5 consists of stratified layers of medium & coarse sand. Loading rate reduced to reflect restricted permiability of horizon associated with textural changes. it lab F-1 Boring # I Boring � _f Pit Ground Surface elev. ft. Depth to limiting ctor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # I Boring -f Pit Ground Surface elev, ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 5 > 30 < 220 mg /L 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. SBD -8330 (R.07 /00) A.C.E. Soil & Site Evaluations a k ' fb. �J./ .: ToF o{Pkon2 IS,ZV Avc. 'c. (� ����I4�i CvmMwni trn. ^S�rP7l�. ff r sum c� \'� G7 /af��t4e �ns11��1°v� 48.E jc Cam Sc�YSEyS Sc c. /8, T, �OrL .(? /BUJ 7 °F ,�) ./ '� o16 / 3a'o oa - o 7. 5- of 0 bo w lo 83 IX o � / 1 t s3s ACRES c 1 67.012 SO. FT. LBO-934.0 Z�25. ��io �\\� \�\ • o LOT 66 / �J�'� \ 1� HWE- �I 9 / 1 � , ! AREA TO THREAD OF RIVER 949.0 /. �' �\ � 8 1 1 �I AREA TO ACRES .S. 1 Z 2.2t ACRES y ?� 1 1 � LBO -934. , ti LOT 67 / `s? AREA TO THREAD / / �r� p ��y OF RIVER / / ry ('� ?.� y�►N 1 1 ' yak 2.Ot ACRES 'ry il > X 1.7 ACRES / A& 'a6 '�j� 'I. LBO (SEE NOTE) / AREA TO 68 ,s\ THREAD .,�- w1 , // .. OF RIVER 4 6.\ ST O'p "�•" € /r" / „h 20t ACRES cr AREA TO DHWM �4 .0p4T ` ,\�/ / �"�' i.St ACRES 10,1 •�` L80 / (SEE NOTEI y 4 LOT 69 ;` ,\ `�;Z.>S. / •.� , AREA TO THREAD / �• ,� OF RIVER ,�� �� moo• y /� ` '�'�p �. 21t ACRES ° �� ,(` .•��,. AREA TO OHWM ��•., BA/ +� 1.9t ACRES Q `�� C�c•' o' y .952.7' LBO (SEE NOTE) AR noN ION - O`y \ \` DOOR ELEVATION. � OBMVA71ON RENT - ENCUMBERS THE SEE NOTES q —(r OIV``� 1NEEN THIS LINE AND THE `. ONSE R 71 O SHEET 3 FOR LAND USE REQUIREMENTS. R MARK AS \ N LAND SURVEYING. VISION ARE SUBJECT TO A LB-O- NOTE. STRUCTURES ON LOTS 67 -69 MAY THE ORDINARY MGM WA S BE SUBJECT TO MULTIPLE LB.O. (LOWEST BUILDING DST LOTS THIS SETBACK EA AND WILL NOT AFFECT OPENING) RESTRICTIONS DEPENDING UPON THE OWM. THIS SETBACK PLACEMENT OF THE STRUCTURE ON EACH LOT. AN ON THE LOCATION OF LB.D. OF 95.5.0' MAY BE APPLICABLE AS A RESULT y 39. 40. 41 AND 50. AN OF DRAINAGE PATTERNS AND ASSOCIATED UNNARY MGM WATER MARK CONSTRUCTED DITCHES ALONG 152ND AVENUE. AN i DOT BUILDING SETBACK LB- OF 934.0' MAY BE APPLICABLE AS A RESULT A CROIX COUNTY ZONING OFn FROM THE HALLOW RVER. RESOURCES BEFORE BUILDER SHALL BE RESPONSIBLE FOR DETERMINING PROPER STRUCTURE ELEVATION AND APPROPRIATE SITE GRADING. i lil 'WIDE � 1011N) b 1/01/2006 SHEET 2 OF 4 SHEETS e: POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _ of FILE INFORMATION SYSTEM SPECIFICATIONS Owner — Septic Tank Capacity a l ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer o ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model — ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA Estimated flow (average) al /day Pump Tank Manufacturer _ ❑ NA Design flow (peak), (Estimated x 1.5) X0 p al /day Pump Manufacturer ❑ NA Soil Application Rate g al/day/ft 2 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 ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA 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 mea 510 cfu /100m1 ❑ 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: JI NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA ® year(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y,) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: [3 months) (Maximum 3 years) ❑ NA ® year(s) Clean effluent filter At least once every: ® month(s) ❑ NA ❑ year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) 21 yeaarr((ss) ) ❑ NA Flush laterals and pressure test At least once every: ❑ month ❑ year(s) IN NA sl 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 tanks) 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. I 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 :512 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. GMW (4/01) Page -. ,I — 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: IM 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 df the POWTS a soil and site evaluation must be performed to locate a suitable _replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > 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 INSTALLER POWTS MAINTAINER Name T Name 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. I 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: IM 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 df the POWTS a soil and site evaluation must be performed to locate a suitable . replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. • Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR 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 INSTALLER POWTS MAINTAINER Name T Name _ , Phone Phone _ SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name CQV 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. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/r /`� �� �h f C �'1•►�t �•c n �'t<� K Mailing Address C 1_�V X 'S' % S Property Address V t' , lV e h'►"r4 , �t/� • � S�� ( required from Planning & oning Department for new construc on.) City /State N�� I t G� �''4� �� Parcel Identification Number jQ 26 -• 1 34160 LEGAL DESCRIPTION Property Location 1 /60 , t/a , Sec. , T 3 d N RAW, Town of tZ i A Subdivision t� � -r•► a a W il! d Lt 9-1 r/ t'°"tol , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # / ��' -S�� , Volume , Page # Spec house no Lot lines identifiable V no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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. Uwe 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 virtu of a warranty deed recorded in Register of Deeds Office. umber of bedrooms -"� n "info nnation OF APPLICANTS) DATE srepresented 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. 08105) Q" CROIX COUN" TC]c 0 PLANNING & ZONING December 8, 2009 (� v t ZY First National Community Bank P.O. Box 89 New Richmond, WI 54017 Attn: Steve West, Landsted Companies LLC Code Administrat Re: Land Use Permit for Filling and Grading in the Shoreland District 715 -386 -4680 993 152 " Ave., Lot 67 in the Glens of Willow River Subdivision Land Information Parcel #18.30.18.1674, Town of Richmond Planning 715- 386 -4674 Dear Mr. West: Real Prope This letter confirms zoning approval according to the plans you have submitted for 715 -3 677 filling and grading an area of approximately 9,940 square feet within 300 feet of the Ordinary High Water Mark (OHWM) of the Willow River to construct a single - family Re cling dwelling, Private On -site Wastewater Treatment Systems ( POWTS) and driveway - 386 -4675 on the property referenced above in the Town of Richmond. Staff finds that the proposed project meets the spirit and intent of the St. Croix County Zoning Ordinance and Shoreland District with the following findings: 1. Filling and grading less than 10,000 square feet in area less than 300 feet from the OHWM on slopes less than 24.9 percent is allowed with a land use permit in the Shoreland District pursuant to Section 17.29(2)(c) of the St. Croix County Zoning Ordinance; 2. The filling and grading required for excavating the driveway and construction of a single - family dwelling located within 300 feet of the OHWM of the Willow River is subject to Shoreland zoning requirements. The private on -site wastewater treatment system ( POWTS) will be outside the 300' zone. The house will be above the floodplain elevation and will not be subject to Floodplain ordinance requirements. The proposed single - family dwelling and POWTS meet all required setbacks and dimensional standards provided in the St. Croix County Zoning Ordinance; 3. The applicant submitted an erosion control and storm water management plan featuring infiltration basins to receive discharge from impervious surface runoff. With conditions to install appropriate Best Management Practices (BMP) for sediment control e.g. silt fence or sediment "logs" between the construction area and the conservation easement above the river, to maintain erosion control measures until self- sustaining permanent vegetation is established on all disturbed areas, to prohibit the use of phosphorous fertilizer to establish and maintain a lawn, to implement the storm water management plan, and record a maintenance and monitoring agreement against the property for the infiltration structures, negative impacts to the water quality of the river will be minimized; ST. CROIX COUNTY GOVERNMENT CENTER 1 101 CARMICHAEL ROAD HUDSON, W1 54016 715 - 3864686 FAX PZ @CO.SAINT -CRO1X W1. US WWW.CO.SAINT- CROIX.WLUS d z 4 4. T n o e river a ow a propose ouse oca ion an wi i e sement is vegetated and will remain undisturbed. With conditions for maintaining the current I el of vegetative cover along the river bank to preserve wildlife habitat and provide further i ration of storm water runoff from the site, the natural beauty and ecology of the river will be p ted and consistent with the standards in the Shoreland District; 5. The r ;- roix County Land and Water Conservation Department has reviewed the plans and dis options for assimilating stormwater runoff from impervious surfaces. Steve Olson, Ru d Specialist, commented that the applicant has adequately addressed the increase Vol f stormwater runoff, that the proposed perimeter erosion control shall be maintained until the s as re- established self- sustaining vegetation, and the applicant shall record an affidavit on the d to the property to provide for long -term operation and maintenance of the infiltration basin 6. The onsin Department of Natural Resources has reviewed the plans and commented that if there wi be greater than 10, 000 sq ft of grading within 300' of the Willow River, the property owner ill need to apply for a grading permit. There are mapped wetlands along the river as well, so property owner must prove they will not be disturbing or working in the wetlands and will e proper erosion control so sediment will not leave the site and head into the wetlands or the river. Also, if they disturb more than 1 acre with this project, a DNR storm water permit will be needed. ased on these findings, approval of the land use permit is subject to the following conditions: 1. The applicant shall be responsible for implementing the erosion control and storm water management plan submitted, and as provided in the conditions below. he applicant shall install silt fencing, straw waddles, and /or sediment logs as needed for control ntaminated runoff from the construction areas for the proposed house and POWTS. 3. T `applicant shall maintain all erosion and sediment control measures until permanent, self - taining vegetation is successfully established on all disturbed areas of the site. 4. phosphorous fertilizers shall be used on the disturbed areas of the site, unless a soil test nfirms that phosphorous is needed. 5. current level of native trees, shrubs, and groundcover along the river bank and within the eated conservation easement shall be maintained. 6. Wit 30 days of completing construction, the applicant shall execute and record an affidavit agai the property referencing the operation and maintenance plan for the stormwater infiltration struc with the Register of Deeds, and provide the Zoning Administrator with recorded copies of th documents. 7. Wit 60 days of completing construction, the applicant shall submit to the Zoning Administrator ph s of the completed project as viewed from all angles. The photographs must also show all water management measures and vegetation on the site. 0 ST. CROIX COUNTY GOVERNMENT CENTER 1 101 CARMICHAEL ROAD, HUDSON, Wi 54016 715 -386 -4686 FAx PZPCO. SAINT-CROIX. W/. US W W W. C O. SAI NT-C R O IX. W L U S J I This no ,,� . -.� �.� Iona � r� ���< �. �.M yam;, s ap `' oe a oA for 'any ,i cons ruc ion, s4ru , grading filling, or clearing of vegetation beyond the limits of this request. Your information will remain file in the St. Croix County Planning and Zoning Department. It is your responsibility to ensure mpliance with any other local, state, or federal rules or regulations. Please fee to contact me with any questions or concerns. Sincerely, Pamela Qui Zoning S ialist/Zoning Administrator Enc: and Use Permit Affidavit form c: Dean Albert, Building Inspector, Town of Richmond Steve Olson, St. Croix County Land and Water Conservation Department Carrie Stoltz, Wisconsin Department of Natural Resources 7C OPV ST. CROIX COUNTY GOVERNMENT CENTER 1 101 CARMICHAEL ROAD, HUDSON, W1 54016 715 - 3864686 FAX PZOCO. SAINT- CROIX. W1. US W W W . CO. SAI NT-C ROIX. W I. U S C 0 � o m Z p � O y p O O a 3 CL v • 3 w 3 � � o n %J 0, a Z .06� PAGE Z OF.� ' PUMP CHAMBER CROSS SECTIOW AfJ SPECIFICATIOAIS VEWT CAP - T °I "C.Y. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTIOW BOX MANHOLL COVER 9 15' FROM DOOR, IA "MIU. WINDOW OR FRESH i AIR INTAKE GRADE I 4" MIIJ. I • � �, IC "MIW. COWDUIT -- - - - - -- 19 "MI IAJI .F l" PROVIDE I t AIRTIGHT SEAL I III i ( I ° APPKOVEQ JOINT A i III APPROVED JOIA W /C.a. poPS:. I III L -ATEU PIPE w/ LNDIAiCe 3' ALARM I:XTENOIN6 3 ONTO SOLID SO OWTO 501.10 SC". I s I 1 I I ON C • I r P PUM--� --� • OFF • r t. 0 CONCRETE BLOCK 1 RISER EXIT PERMi91•ED OUL`J IF TANK MANUFACTURER HAS SUCH APPROVAL SPCC, IFI CAT IOh1S ?ol: ®TIC AA90 �4E� nQKS MANUFACTURER: t�1U1�16ER OF DOSES: — PER OAy TANK SIZE: 212 GALLONS DOSE VOLUME A LARM MANUFACTURER: SljA /Za' t2f cr. INC.LIIDIAIG OACICFLOW � GALLON ° MODEL UUM6ER: �DJQVV .;rAZV CAPACITIES: A =JeU-- Z.aNCHES OR C.ALLOU! SWITC" TVPC: /7zitwu /�crrvo�r�� d x al DD 1NCHES OR GY GALLON' pump MANU FACTURE R ..L�a��— C■ INCHES OR C+ALL01J MODEL NUMBER: i ,.Z�� A04— Z D f /So INCHES OR GALLON SWITCH TII►E: r..�WrgI��T�— NOTE: PUMP AWD ALARM ARE TO BE • PUMP DISCHARGE RATE .� S9 GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFEKEAICi lbt WGE111 PUMP OFF AND &uva7Y /3/1dxK . FEET + MIAIIMUM METWORK SUPPLY PRESSURE / .��.�� :. FEET $ •e00 FEET O F FORCE MAIN X F ij00rE FRICTIOU FACTOR.. •�f FEET = TOTAL OyWAMIC. HEAP = FEET IhITERIUAL DIMEUSIOMS OF TAUK: LEM&TH •UV ;WIDTH r .;LIQUID DEPTH • 1/oLvr�nE = /6./02 Giotc.o.u.t .�/t a•✓GV SIGUED: LICEWSE IJUMBER: A° DATE -117- A6E of of 3 X Goulds C mum PUMP 3885 Tag • Overload pmIle m ust smooth Operation. Silicon can be o perated continuously Specifically designed for the eatfed � an � r e � Upper and following uses: Slainiess. s Cafl; Cast iron volute lower heavy duty ball bearing • • Homes ' Bearings: ball1sarings type for maximum efficiency construction.' Upper and Wwa. 2' NPT4ischarge adaptable ■ PeM►et Cable: Severe duty • Trailer courts • p tort: 20 foot for slide rail systems. rated, od and water resistant. • Motels rd'%ngM (optional W Mgdo" 3"t KXW Epoxy seal on motor end Schools lei available • CARBIDE VS Stf provides secondary moisture • Hospitals sinpfe pun: CARBIDE seahg faces. barrier in case of outer jacket • • Ind • % and % NP— 1613 SJTO Stainless steel metal parts, damage and to prevent oil with 115 V or 2301/ three BUNA N elastomers. wig• prong pal• •'Yr1'r4 HP — 1413 STO with ■ Sba Corrosion�resisbud ■ ' Assures tenants Sealing Pmnp bard leads. � t�te9l. T o Solids handling capabilities: *%-I% % '/4 maximum. • i4-1'k HP —14/4 STO against component onentdAMP AINI CY LI M IIN ' ° with bare leads. On CSA Discharge size: 2' NPT. ag o I" models — 20 foot on accidental reverse rotation. Capacities: up to 128 GPM. ® Total heads: up to 123 feet &M and STW • ~. Fully submerged in TDH. are standard. high-grade turbine oil for ® Mechanical seat: silicon ipbrication and efficient heat knN carbide -rota ry seat/sdicon �T transfer. carbide- stationary seat, 300 r Gast iron, semi- ■ for Cordinoove series stainless steel metal won, l oerpump ratings are parts, BUNA -N elastomers. W vow for W seal m manuleCbumr's ° Temperature: Pr • Salamd for recommended working limits, 104 °F (40°C) continuous 140°F (60°C) intermittent. ' Fasteners: 300 series 90 sERIEs:3ass stainless steel. 1 s¢�: W soups ® Capable of running dry so RIM VARIOUS without damage to components. 70 SPi Motor 6o Sinow phase: HP, 115 V, 200 V, 230 V. 15 SD 60 Hz, 1750 RPM; % HP, 115 V, 60 Hz, 3500 RPM; +® 1 h HP —1'A HP, 230 V, 60 Hz, 3500 RPM. Built -in overload with auto matic reset. S ® Class B insulation. 10 IF Three phase: e'A HP —1'/i HP 20000/ p 0 460 4 °, 60 Hz, 3500 RPM. o.. 90 ,0 So 90 70 80 no 100 110 120 13OGM ® Class B insulation. 0 1 30M3/h CAPACITY ® lass Goulds Pumps, Irle. E*oc iw May, loos . 11 63985 PARTS G o A s Item No. Description 7 �1�1L:Jh�LihJU 1 Impeller 2 Casing 3 Mechanical seat 5 6 4 Shaft 5 Motor 4 Bearings - upper and 3 6 lower 8 3885 7 Power cable 8 0 -ring 1 2 _ � MODELS PERFORMANCE RATINGS (gallons per minute) Order No. HP Volts' Phase Max. Am . RPM 3e Heater Sim WL Ibs. WED511H WED511KH WE0311 L 115 9.4 WE0512H WE0712H WE1012H WE1512H 38H WE0512HH WE1512HH WE0312L 230 4.7 Order wEeM WE07 WE1038H WE1538H WE0538HH WE1538HH WE03111. WE0311M WE0532H WE0732H WE10320 WE1532H WE0532HH WE1532HH WE0318L y , 200 5.4 1750 56 N01. WED312L WE0312M WEe534H WE0734H WE1034H WE1534H WE0534HH WE15UHH WE0311M 115 9.4 WE831K WE0318M WE8518H WE0718H WE1018H WE051OHN WE0312M 230 1 4.7 WA HP 1 /1 ''A Y2 9 /• 1 1 1 /2 1 WE0318M 200 5.4 Rpm 1750 1 1750 3500 1 3500 3500 3500 1 3500 3500 WE0511 H 115 14.5 60 WE0512H 230 7.3 5 - - - - - - - WE0518H 200 8.4 10 80 1 65 - - - - 56 84 WE0538H 200 3.9 K32 15 60 57 69 1 90 104 128 1 53 82 WE0532H 230 3 3.4 K32 WE0534H 460 1.7 K21 20 36 45 60 83 98 122 48 77 WE0511HH 115 14.5 60 25 25 50 1 76 92 116 1 45 75 WE0512HH 230 1 7.3 N/A 30 38 1 67 85 109 40 72 WE0518HH 200 8.4 3 35 26 1 58 78 102 35 70 WE0538HH 200 3.8 K32 0 40 15 1 47 70 94 30 67 E0532HH 230 3 3.3 K31 WE0534HH 460 1.65 K21 45 36 62 86 25 64 U. WE0712H 230 10.0 0 50 25 52 77 18 60 AON WE0718H 200 1 11.5 WA = 55 17 42 67 12 58; WE0738H 9 /. 200 6.2� K49 _ 8 $2 56 3 54 WE0732H 230 3 5.4 K39 WE0734H 460 2.7 K28 70 ,° - 65 21 46 51 _ WE1012H 230 12.5 70 11 35 47 WE1018H 200 1 14.4 WA 75 25 43 WE1038H 1 200 8.1 K43 15 40 - WE1032H 230 3 7.0 K43 WE1034H - 4i3 - 01 3.5 K32 33 WE1512H 230 1 15.7 WA 100 24 WE1538H 200 10.6 K53 i10 15 WE1532H 230 3 9.2 K50 120 5 WE1534H 460 4.6 K36 - 1 230 1 15.0 W DIMENSIONS t HH 200 10.6 K53 HH 230 3 9.2 K50 (All dimensions are in inches. Do not use for construction purposes.) - H 460 4.6 K36 D' %z, 1 /z, 3 /a and 1 HP =15' • For 575 V consult factory. except for model WE0712H and WE1012H =1 "; 1 %2 HP =18" r ; METERS FEET .•......�,..... _ 120 _I - MODEL: 3� 885 3s SIZE: -V4 SOLIDS 12 110 WE1 3 � 30 1 0 ROTATION } 3 o a. 7. -- - _ 90 D' s' 801 2* NPT jjjjjj SGPM ' , 1 'f d - 5Fr 70 1 , _ i . -i._.. ._ _..;.. _ _ #- 1 � µ O R 50 ME KICK BACK -1 1 5 ! i . ^° EFFLUENT EJECTOR SYSTEM 10 30t Effluent ejector system Package Includes: Submersible Effluent Pump WE0311 L, 5 20 i ;. i + _ _ I �.__ offers ease Of ordering 12L or WE0311M,12M, WE0511HH, 12HH and installation. A single t ° ( r � -, Mechanical Level Control Switch r 0 0l _. �. _ .� _ L _ _' ._ _ ordering number specifies A2 -5 (115V), A2-6 (230V) o ,o zo 30 ao so eo 70 eo so 100 cPM a complete system designed Basin A7- 1801S, Basin Cover A8 -1822 _ o 10 20 ^+ for most residential and Check Valve A9-21 CAPACrTV commercial Sump and Order No.: SWE0311L, SWE0312L, _ effluent pump applications. SWE0311 M, SWEO312M, t GOULDS PUMPS INC. SWE051 1 HH, SWE0512HH. WATER TECHNOLOGIES GROUP SE NECA FALLS NEW YM 13148 SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. PRINTED IN U.S.A. 12