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HomeMy WebLinkAbout002-1002-70-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)], Permit Holder's Name: Anthony & Michelle Lee City Village Township TOWN OF BALDWIN CST BM Elev: Insp. BM Elev: BM Description: T 4 s;�- TANK INFORMATION t ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic W Dosing 1�" �oya po g0e> Aeration r C G - t U - 5'vn4 G�+ t TANK SETBACK INFORMATION TANK TO P/L W WELL BLDG. Vent to Air Intake ROAD Septic -� ^� � � � I Dosing Aeration Holding PUMP/SIPHON INFORMATION I «?IQ�"�'' 3Z• 7 � Manufacturer 7 �e/ I �, GPM Demand Model Number LC L1� TDH Lift 206,W9 • 8 Friction Loss Syste Hea TDH Ft $o •5� 3z.1-7 Forcemain Le th Dia. Dist. to Well �Dio (Fp' SOIL ABSORPTION SYSTEM County: St. Croix Sanitary Permit No: 617765 State Plan ID No: Parcel Tax No: 002-1002-70-000 Section/Town/Range/Map No: 02829016022A Q5.53 STATION BS HI FS ELEV. Benchmark 2 N raz• l Ora IBM Bldg. Sewer ►t.�z 83.E t SUHt Inlet SUHt Outlet Dt Inlet Dt Bottom 16,vo �79.53 Header/Man. Dist. Pipe Z, 1 )oo,3S Bot. System 4W - Final Grade St Cover% F t (" (0C 46 UCI .O?J O t!o >►� �a� �. 55 97 90 BED/TRENCH DIMENSIONS Wid h � � 5 � Length /_0` LvQt c as Z PIT DIMENSIONS No. Of Pits Inside D' Liquid Depth SETBACKEEIIII INFORMATION SYSTEM TO P/L JBLDG WELL LAKE TR Aml LEq HIN CH BER R UNIT fact rer: roodel Type Of System: �gjq� our I ��.n , JCS �0� Nu ber� DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size 5 l% x Hole Spacing Vent to Air Intake —�G Pipe(s) Length 3.L 4-� Dia Length �� Dia Spacing �' `+ RV �y► L SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only fir- 0010 Depth ever j t=bo4f%EC)1 Depth Over xx Depth of jxxSeed cled xx Mulched Bedg:rspoh Center26 ® Bed/Trench Edges 7 N%% Topsoil i2 , IX Yes [j No Yes Qp No COMMENTS: (Include code discrepencies, persons present, etc.) Location:1191250THST 1.) Alt BM Description = F �4t.1" 2.) Bldg sewer length = iq a% - n5u ? y2 amount of cover = ) Plan revision Required? ❑i Yes lNo 5 Z Use other side for additional information. Date SBD-6710 (R.3/97) L Inspection #1: 5 1 Z 2p ► bI.+S Inspection #2: Oa � Cert. No. i zjarety ana tiutlaings Division 201 W. Washington Ave., P.O. Box 7162 Madison, WI 53707-71F2 �n�9s4 ��L. (. d`6 N J. , .J k it Applica a w, n accordance �ith $ 383tZ1�2), Mailm. Code, submission of this form to the a required prior�'to obtaining a sanitary permit. Note: Application forms for state-ownedpro late S a ersubmitT unit p POWTS are submitted to he Department of Safety and Professional Servies. Personal information you provide may be used for secondary ItIMAORn f Smelly oration —Please Print All InfoAMU tia 'roperty Qwner's flailing Ad( tY,State liiJ'106 LEIILA ST V I 4 15D7u IL Type of Building (check all that apply) ,l or 2 Family Dwelling— Number of Bedrooms p� �.4 , ❑ Public/Commercial — Describe Use ❑ State Owned —Describe Use III. Type of Permit: A' ❑ New System B• ❑ Pemtit Renewal Before Expiration ek only one box on tine Replacement System ❑ Perntit Revision Block t r� / 11/ ( V r C t_�C- IbC�- �u 00() ati Property Locon A LQt r iN t/,, J�"K+ Section > (circle one) T ei N; R /� ` E or W ❑ Treatntent/Holding Tank Replacement Only ❑ Change of Alumber I ❑ Petmit Transfer to New Owner il ❑ City of ❑ Village of Town of {YAL1DW I ice' ❑ Qdter Modification m Existing System (explain) List • • ■ � �■ r....ry t n � stemn,om onenvuevices Check all that A 1 ❑ Non -Pressurized In Ground ❑Pressurized in -Ground ❑��Att-Grade ❑ Mound > 24 in, of suitable sot Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (expl n /� iVl tAT S P ❑Pretreatment Device (explain} V. Disnersal/Treatment Arpu Infnrmn+in... ---�Fw• • •w" �esrw I �G„gn oua aftppucauon xe[etgpdsf) � Dispersal Area Required (sf) Dispersal Area P�gposed (sfl System Ei VL Tank Info I Canac1ty in tiallons Gallons Units � � w New Tanks � . Existing Tanks U a or Holding Tank S�ev ( 0 - I �' Res onsibility Statement- I, the undersigned, assume responsibility for ins 1lalion of the ➢OWTS shown on the attached plans. Plumber's Name (Print) Plumber's Sign MP R u bar Business Phone Number T �1- i� j/ -( ZZ3zwZ_ 715 ti191-:34158 Plumber's Address (Street, City, State, Zip Code) � pproved ❑ Disappri)v Permit Fee Date ued Issuing ant Signature r teen Reason for Denial S � ✓� `/ /� �� IX, CoIV V 1 al/�i 11sons For Disapproval c an ust i er an J � (��q�„�, t �- s (� dispersal cell must be serviced / maintained W G`'G. as per management plan provided by plumber. Gi iF. i 0% t.■./1 444oks6QQ( µ-r. 2. All setback requirements must be maintained I/ as per applicable code/ordinances. A4 6 Attach to complete plans for the system and mit to the County onl on paper not Ieaa than 8 iti l i ine es iu size Pe.�. Gal�z ' SBD-6398 (R 11/11) , Plot Plan PROPERTY OWNER, /VIARiL4AJ L North up 40 FT. (apt viirhere noted) 1� = hackhoe pit I " 8M=17te a= N Sao. va �t ____-- No i 6�►1 Sst S ai;t Cog R-06014 r COMATy TOP OF POC P112L 0 � 4.,4jj6N1 wIS5-j�k 1Zno/8G1'Jr�2t1�L0lt� eR4csit � 2a�K URIVER JAy IL I �L•h hJhJ� s T t� ; ��, (� �� � i •� �gpn�tr.�rE^r DIVISION OF INDUSTRY SERVICES °(P 2331 SAN LUIS PL 7� GREEN BAY WI 54304-5211 D s Contact Through Relay P S► http://dsps,wi.gov/programs/industry-services �� www.wisconsin.gov Tony Evers -Governor Dawn Crim -Secretary August 26, 2019 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2021-08-26 Plan Review: PWTS-081901665-C MARY JO HLJPPERT 28497 King Arthurs Ct Danbury WI 54830 SITE: ANTHONY LEE 1191 250TH STR> 1_;' I Town of GAP*� 15 c# 10 Saint Croix County Total Amount: $250.00 FOR: Geomat Mound Component Manual —Edition 1 In -Ground Soil Absorption Component Manual — Ver 2.0, sBD-l000s-P (lv. 01/0l, R l0/12) Maintenance The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose organic material to be removed from mound area. • Prior to construction of the dispersal area, check the moisture_ content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil Prover soil moisture content can be determined by rolling a soil sample between the hands If it rolls into a 1/4- inch wire the site is too wet to prepare If it crumbles site preparation can proceed If the site is too wet to prepare do not proceed until it dries. • Abandon Existing System per SPS 383.33 • Pump Floats to be set and verified per approved plan. Any changes may result in pump resizina to meet TDH and GPM Specifications. • Divert surface water from POWTS Area. • All piping shall conform to SPS Table 384.30-3 and SPS Table HUM • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Well setbacks to meet chs. NR 811 & 812. • Areas that are occupied with rock fragments, tree roots, stumps and boulders reduce the amount of soil available for proper treatment. If no other site is available, trees in the basal area of the mound must be cut off at ground level. A larger fill area is necessary when any of the above conditions are encountered, to provide sufficient infiltrative area. Owner Responsibilities The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1). In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation/operation. In granting this approval the Division PI A y Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2)3 nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Trrh��anks, r/.arrr �.a�r,� aL�eeof POWTS Plan Reviewer— Wastewater Specialist Department of Safety & Professional Services Division of Industry Services email• tim.vanderleestc,wisconsin.govv Cell: 60&516-6134 Mound and Pressure Distribution Component Design Site Information W Residential or Commercial Design FF N ISD Required? 400.00' Estimated Wastewater Flow (gpd) 1.50?, Peaking Factor (e.g. 1.5 =150%) 600.00 Design Flow (gpd) 8.001 Site Slope (%) 97.90! Installation Contour Line Elevation (ft) 12.00Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpd/ft) 86.00 Contour Length Available (ft) Distribution Cell Information 6.50 Cell Width (ft) 3,25, 6.5 or 9,75 Only 60.00, Designer Input Cell Length (ft) 2.00 Dispersal Cell Design Loading Rate (gpd/ft2) 60.00 Dispersal Cell Length Required (ft) 2... Influent Wastewater Quality (1 or 2) Pressure Distribution Information E; Center or End Manifold Are the laterals the highest point 2 Number of Laterals in the distribution Y 3.25 Lateral Spacing (ft) network? 49.91 Forcemain Drainback (gal) If N above, enter the elevation (ft) 0.50 Forcemain Filter Loss (ft) of the highest point. 2.00; Forcemain Diameter (in) 306.00 Forcemain Length (ft) Does the forcemain drain back?'; Y 81.00 Inside Pump Tank Elevation (ft) 0.156 2.00 4.55 18,31 6,80 30,17 94,61 144.52 32.31 Orifice Diameter (in) (e.g. 0.25) F T 5 Estimated Orifice Spacing (ft) = 6.50 ft2/orifice System Head (ft) x 1.3 Vertical Lift (ft) riction Loss (ft) otal Dynamic Head (ft) x Void Volume (gal) M S inimum Dose Volume (gal) ystem Demand (gpm) Diameter Selection Lateral Diameter Selection in. dia. options _ choice 0.75 1,00 1,25 1,50 x ZOO x x 3,00 x Manifold Diameter Selection in. dia. options choice 1,25 x 1,50 x x 2, 00 3,00 Manufacturer Informs Ion- - Treatment Tank Information Effluent Filter Info_rm_a_tion 1200,00 Septic Tank Capacity (gal) ! Lifetime Filter LLC filter Manufacturer Wieser Concrete Products, Inc. Manufacturer LT 1/8 Filter Model Number Dose Tank Information Gallons/Inch Calculator ' 800.00'Dose Tank Capacity (gal) - 'Total Tank Capacity (gal) 22.24 Dose Tank Volume (gaUin) Total Working Liquid Depth (in) Murh P y 'Manufacturer J gal/in (enter result in cell DoseTankVolume) Project: ANTHONY LEE Page 2 of 16 Manifold Diameter Selection in. dia. options choice 1,25 x 1,50 x x 2, 00 3,00 Manufacturer Informs Ion- - Treatment Tank Information Effluent Filter Info_rm_a_tion 1200,00 Septic Tank Capacity (gal) ! Lifetime Filter LLC filter Manufacturer Wieser Concrete Products, Inc. Manufacturer LT 1/8 Filter Model Number Dose Tank Information Gallons/Inch Calculator ' 800.00'Dose Tank Capacity (gal) - 'Total Tank Capacity (gal) 22.24 Dose Tank Volume (gaUin) Total Working Liquid Depth (in) Murh P y 'Manufacturer J gal/in (enter result in cell DoseTankVolume) Project: ANTHONY LEE Page 2 of 16 MOUND AND Owner Info Project Name: owner's Name: Owner's Address: Residential Application INDEX AND TITLE PAGE ANTHONY LEE MARILYN BOL ESTATE 312 HANSON STREET WOODVILLE, WI 54028 COMPONENT Property Info oqW Property Address: Legal Description: Township Subdivision Name: Lot Number: parcel I.D. Number: pIan Transaction No.: index Pages 1191 250TH STREET NW NW S CADY 2 T 29 N R 16 W County: ST. CROIX NA NA Block Number: 002 - 1002 - 70 - 000 NA CSM#: NA Page 1 Index and title Page 9 Tank cross sections Page 2 Data entry Page 10 Plot plan Page 3 GeoMat mound drawings Page 11 Soil test Page 4 Lateral and dose tank Page 12 " Page 5 Distribution media Page 13 " " Page 6 System maintenance specifications Page 14 Soil test page 7 Management and contingency plan Page 15 " " Page 8 Pump curve and specifications Page 16 Aerial MARY JO HUPPERT Lice a Number: 1859-007 Date: 08/23/19 t"'" :: g honet�1'fer' !>115.426-1775 r — ..�'� Je/ `V•✓.: Signature: c `�; , o .� - -- - Designer S -- ° Mate of Wire pr°ov4111 lmp: IV HUPFERT D 1859 dose RIVER FALLS,! r �0 4 Designed Pursuant to the �f, Synergy Systems L.L-C., GeoMat Mound Component Manual SSWMP Publication 9.6 Design of Pressure Distribution Networks for S�=SapIS' `181) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01, R. 10/12) GeoMat Mound Edition 1, 2017 Page 1 of 16 Mound Plan View Observation Pipe .6 I......... , . B•' Ir L nd Component Di Down slope toe extension made. A 6,50 ft E qin Hff6065 ft K 10.5360.00 ft F in, ,, 1 ft L 81.06 % 12.00 in G ft J ft W 31 65 (.� 11 ;J.� •-r- � �` �►I p� - 390.00 (ft2) Dispersal Cell Area 1500.00 (ft) Basal Area Available 10.00 (gpd/ft) Linear Loading Rate 6.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View GeoMat Dispersal Area Observation Pipe 12" ASTM C 33 sand as GeoMat required for Geo Mat —� Distribution Cell component 61 GeoMat + 12" ASTM C-33 sand 101.15 Finish Grade �"� , /'� 99-98 Lateral Invert Elevation � � - 98.90 Dispersal Cell Elevation / Project: Tilled Area emain Forc In situ soil In situ soil Shading Key Topsoil Cap Subsoil Cap ASTM C 33 sand (F) ASTM C 33 sand (D) Tilled Layer Geo Mat Cover Material Slope Contour Elevation See details on page 4 for number, size, and spacing of laterals. ANTHONY LEE 97.90 Page 3 of 16 End Connection Latera or 1st orifice located at Z orifices point down i p laterals & force main of PVC Sch 40 per SPS Table Number of Laterals Lateral Diameter Lateral Length (P) Lateral End (Z) Lateral Spacing (S) Lateral Flow Rate System Flow Rate Dose Tank information Project: 2 2.00 59.00 1.00 3.25 16.16 32.31 Orifice Diameter in Orifice Spacing N ft Orifices per Lateral ft Orifice Density ft Manifold Length gp gp m Manifold Diameter m Forcemain Velocity Locking cover kith Is;lming L•dui. locking device and eater tight seal IElcctrical Mis as per NFC 30t1 and SPS 316'S tl Finkhed Gr=de.._�l.f-1 Clean out Pipe wires From Bleclric source Sim /Tech Filter STF 100 1/16 P51 Piltvr--� I n��s tits p alld hater A: light gasket i illigh waterahlnn �I Pump (Al Float Pump Off Float Dimension Inches Gallons A 19.47 433.08 B 2.00 44.48 C 6.50 _ 8.00' 35.97 144.52 D 177.92 Total 800.00 Filter Manufacturer Sim /Tech Filter Filter Mod el Number STF 100 1/16 arm Manufacturer jSJE Rhombus Al Alarm Model Number :AD ram 4" Vctlted Cover Disconnect _ Optional ball to control.pc enlu¢nlbein! 0.156 ZOO 30 6.50 3.25 2.00 3.30 >olid )!round � N'mp Lolc or and I Funlco .Ipu.n, do%wc 31 Pump in ft ice ft ft/sec RZ/orif in Forcemain diameter 2 in. � Pump off elevation (H) 81.67 Dose tank elevation (ft) 81.00 Mu h Capaci 800.00 Volume 22.24 gal/inch Pump Manufacturer Zoeller Com_ pany Pump Model Number 1 1401 Pump Must Deliver 32.31 gpm at 30.17 ft TDH Note: Switches containing mercury may not be used in this system. ANTHONY LEE Page 4 of 16 .�,�, •• a 8- e -19 GeoMat Distribution Cell Media Layout 6.50 Cell Width (ft) 1.63 Sidewall to Lateral (ft) Distribution Cell Cross-section Arrangements Component Legend Distribution Pipe With Pressure Lateral L.J Orifice Shield Turnup Enclosure — — — — — Pressure Lateral GeoMat is covered with approved geotextile fabric as per the their product approval. Distribution Cell Plan View Layout -Typical 6.50 Cell Width - A (ft) 60.00 Cell Length - B (ft) End Connection Lateral Layout Diagram Pipe Dia. Typical Dispersal Cell Sand Fill Recommended 1 c3i s.na 4 Distribution Lateral �� Orifice Shield Approved Infiltrative Fabric GeoMat Component Infiltrative Surface/Plow Layer - . -- LicitiryFY.Lr Observation pes / Water Tiebt� O Toilet Flange I n \� Rebar lots c 1" Min �I I Install at i —I 1 nd/Geo 11' Min TF--: /3" I lain Die Rr., i �IAYL.RCIIJUM0 01iAR�— hTASR,fGjl�il>;rYrGtm�.�- �-- '� Shading Key Topsoil Cap Z �_� Subsoil Cap ASTM C 33 sand (F) —1 ASTM C 33 sand (D) S Tilled Layer G Geo Mat See details on page 4 for number, size, and spacing of laterals. Project: ANTHONY LEE Page 5 of 16 Mound and Service Provider's NameIJEFF FOX POWTS Regulator's Name St Croix County SPIA - Zoning Office Design Flow -Peak 600 Estimated Flow - Average 400 Septic Tank Capacity 1200 Soil Absorption Component Size 390 Type of Wastewater Domestic Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound System Ftow and Load Parameters Phone 715-755-2461 Phone; (715) 3864680 ptl Maximum Influent Particle Size 1/8 in pd Maximum BOD5 30 mg/L al Maximum TSS 30 _ mg/L z Maximum FOG 10 mg/L Maximum Fecal Coliform 10E4 cfu/100 mL Service Frequency Inspect and/or service once every 3 ears Inspect and clean as necessary at least once every 3 years Test once every 3 years Should test periodically Laterals should be flushed and pressure tested every 3 years Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap and are secured in as shown in the Synergy Systems GeoMat Mound Component Manual Version 1, 2017, 2. Dispersal cell media conforms to GeoMat products approved for use with the Synergy Systems GeoMat Mound Component Manual Version 1, 2017. Media is covered with an approved geotextile fabric. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. 6-8" Diameter Lawn Sprinkler Box Lateral Ends at Last Orifice Where Distribution Lateral Lateral Turn -up Detail Finished Grade \ /% Lateral Cleanout 2.5 Feet Threaded Cleanout Plug or Ball Valve �� Long Sweep 90 or Two �`45 Degree Bends Same Diameter as Lateral Project: ANTHONY !EE Page 6 of 16 0• General This system shall be operated in accordance with SPS 382-84 Wis, Adm. Code, and shall maintained in accordance with its' component manuals [Synergy Systems L.L,C., Geomat Mound Component Manual version 1, 2017, Pressure Distribution Component Manual Ver, 2.0 SBDA0706-1? (N. 01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 84nches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis, Adm, Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner as to when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank, The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Wisconsin Department of Commerce. Pump Tank The dosing (pump) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. If the force main has a weep hole, it should be noted if it is functional during pump operation, and if not, it should be cleaned. *****No one should ever enter a septic or dose tank since dangerous gases may be present that could cause death.*"** Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration: Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October -February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD,, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 10^ cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 3 years. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding: Ponding levels shall be reported to the owner; and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: ANTHONYLEE Page 7 of 16 r) 14 t 40, 4140 1 L- P2_'n MINUTE i, l TOTAL DYNAMIC HEAP-- PER MINUTE EFFLUENT AND DEWA7ERING FL Meters Gol. Ltra 5 152 91 3" 10 3.05 64 316 15 457 76 26a 20 510 fia z57 �5 7.62 559 223 30 9.IA 49 I65 10,67 3a SK i6 12,19 21 79 �5 1372 5 19 1ac>' Vokc � — t6 I10 320 400 O10940 - FJectricalaltematorsforduplexsysteMs an alarm, areavaifabteand suppttedwtth alarms. Iare Mechanicalalternators, forduplexsystemsavalfablewithorwithout • Control alarm systems are available for i phase pumps used in simplexsystem. See FM0732 • Variable level control switches are ava systems, liable for eonirolfmg single phase • Double piggyback variable level float switches are available for ►'ariabfe level long cycle controls. Sea►ed QmI43ox available for outdoor instaf(ations See FM1420. Over 130°F. {54°C.} s )edal quotation required. Refer to FM1806 for20p° F. app9cafions. 3 1/E 6 114 3 0/a SK1524A 1 ,'—^ 1 l 1. Single pi99Ybadt �� level Boat swtfdl or' — i1Datswitch. Refer to FA40477.� Pi99ytladr variatde level 2 MWWW 81temainr A! -Pak 10.0072 or IM075. 3. See F MO712 for correct model of Electrical Al for E Pak. 5. 3) or sy� l"Musedasacwltrotactivainr.specity duplex 0 ouur (} hole J-Pak, jtirK�ion } M for watertight connecffon or wireddn simplex f P operation,1"wz .."� c414U 230 1 � ."-" lor7&5 2ar384 BN 4D Bl<t4f40 ii5 1 7.5 iw185 2or3d4 BE14D BE4140 23D 1 ib0 f a 185 .. Non 7S 16r185 2or3&4 I I l 2or384 ' 1Y1111 Op6pn2l0Ww oa1W1 Fsl'n&O1°*6gbt°+'ala'v,NEAtAfort�ItA4X _ I, - - - -_ ._--- - -_-- - - -- _ For unusual conditions a reserve safety factors a Jlrleered ' , Into (no design of every Zoeller pump. `&. , xv scut ts3ri *9102YM 3649 CaW ffM RWV> +Aadnrersof.. LO*r*, KY 40211-1961 _ - 1502)77&2731.11 gn~iaurrpoacE - -- - ---*FA {504774M4 4Auruy L D - a--: - -- y Q 1 �anod-. sop W 0.' 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' I I I I > III I> o II I _o „9E ` `n �038 SV 0 a z W W a W N N W W 0 JKr;f; !° legal uescripiian^ m "` -_.__• � LPL I o 1% Ff w tgo 4 A � Z TOP OF PUS -Pr •fir r t l:%/0 F "F �i Si y l 7 t t slt Li?. <ri p}t /rFt:'k1�'�Pi�.t_„ J t• . �,�r� f=' � ... �,€'i�`��i, -�: Ntaifing Address Property Address CIS,/S�� }� ��.� lf� 1 I� �!1 Parcel Identification l�jumber OCS�. ` sT. cxa1� cotm� SEPTIC TAI�rP I��4Il��ANCE ACrREET/�,NT AID OWl�ERSHIP CERTIFICATION FORM �11DW1 i � � W � 5 (Verification required from Planning & Zoning Depar`ment for new construction.) vC� Z- �� I�G_4L DESC`R1pT`ION ' �� E; Prope�� Locai�on �� % . �HII/4 ;Sec, � ; T �� N R � �c V,T, Town of ���"�'.I I� k �: Subdivision Plat Certified S�e�T Map # Warranty Deed `;' Spec house � yes � no Volume (before 200'�Volume Lot lines identifiable 0 yes � no SYSTEM l�Z4Il�'TEI�ANC`E AI�'D OWl!'ER CERTIFICATION Lot # Page # Page.# improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping ovt the septic tans: every three years or sooner, if needed, by a licensed pumper. What you put into %ae s}'stem can affect the function of the septic tans; as a treatment stage in the waste aisposal system Owner maintenance responsrbilities are specified in §SPS. 38352(1) and in Chapter 12 - St Croix County Sanitary Ordinance. The property owner agrees to submit to St_ CIOIx County Planning & Zoning Department a certification form, signed by the _ owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifSdag that (I) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tanl; 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 Safety And Professional Ser�dces and the Department of Natural Resources, State of gTLsconsin. Certification stating that your septic system has been maintained must be completed and ret�nned to the St Croix County Planning &Zoning Department within 30 days of the three year expiration date. Uwe certify that ail statements on this fowl are true to the best of mylour losowledge. Uwe am/are the owners) of the property described above, by virtue ollf a w/affanty deed recorded m Register of Deeds Office. Nttmber of be ooms � I Y SIGMA OF PLIC.ANT'(S) DATE ***Any information that is misrepresented may result in the sanitary permit being rewked by the Planning & Zo�ng Deparfznent. *** include with this application a recorded waaanty deed from the Register of Deeds Office and a copy of the c ztified survey map ii reference is made in the waa�ant3� deed. (REV. P4/I�) i Wisconsin Department of Safety and Professional Services Division of Industry Services SOIL EVALUATION REPORT In accordance with SPS 385, Ms. Adm, Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must 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. Please print all information. Personal information you provide may be used for seronda purposes Priva La 15 Page 1 of 3 County ST CROIX Parcell.D. 002A 002-70-000 Reviewed by Date) / .04 1 m ❑ New Construction Use: ®Residential / Numberof bedrooms 3 Code derived design flow rate 450 GPD ® Replacement ❑ Public or commercial — Describe: Parent material Glacial Drift and Loess Flood Plan elevation if applicable NA, ft. General comments and recommendations: Recommend a holding tank. Soils are insufficient for "A + 4" mound. Boring # ❑Boring ® Pit Ground surf ce elev. 95.7 . Depth to limiting factor 17 in. � Soil A plicatior Horizon ;Depth Dominant Color Redox DescriptionTexture S re Consistence Boundary Roots GPD/Ft Munsell Qu. Az. Cont. Color Gr. Sh. 7.5YR 413 — sit 2fgr mfr gw 2vfER!TO,3 2 8-17 7.5YR 414 — cl 2fabk mfr dw 1vf3 17-30 7.SYR 4/6 fif 7.5YR 5/8 & f2f7.5YR5/3 scl lfabk mfr dw 1vf 4 30.47 7.5YR 4/4 — gris Os9 mfr — 0.7 1.6 5 47-56 5YR 4/4 f1d 7.5YR 518 & scl Om f2d 7.5YR 613 ml — 0.0 0.0 Rate 2❑ Boring # ❑Boring ® Pit Ground surface elev. 95.2 ft. Depth to limiting factor 0 in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil AGPD/Fn Ra1 t In. Munsell Qu, Az. Cont. Color Gr, Sz, Sh. 1 0-10 7.5YR 4/3 -- `Eff#1 'Eff#2 sit 2fgr mfr gs 2f 0.6 0.8 2 10A4 10YR 4/4 f1d 7.5YR 5/8 & Y1d 7.5YR 5/3 sil 2fabk mfr db lvf 0.6 0.8 3 14-26 7.5YR 4/4 m1d 7.5YR 5/6 & m2d 7.5YR 6/3 sil 2fabk mfr dw 1vf 0.6 0.8 4 26-36 7.5YR 4/6 c1d 7.5YR 5/8 & c2d 7.5YR 5/3 scl tfabk mfr dw — 0.2 0.3 5 36-50 5YR 4/4 m I d 7.5YR 5/8 & _ m2d 7.5YR 513 scl Om mfi — — 0.0 0.0 ` Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30 s 150 ' E t #2 = BOD, > 30 5 220 2 and TSS > 30 5 150 mq/L CST Name (Please Print) Signatur CHRIS FREDERICKS CST Number Address - 71618 Date Evaluati Conducted Telephone Number 4994112Ave Clayton, WI 54004 6/11/19 _ 715.419t%27 644el 2j Boring # ❑ Boring ® Pit Ground surface elev. 93.3 ft. Depth to limiting factor 0 in. Horizon 1 Depth In, OA0 Dominant Color Munsell 7.5YR4/3 Redox Description Qu, Az, Cont. Color — Texture sil Structure Gr, Sz. Sh. 2fgr Consistence mfr Boundary gs Roots 2vf mull n rllltitlliVll RtlIC GPD/Ftz `Eff#1 0.6 °Eff#2 0.8 2 10-11 10YR 4/4 f1d 7.5YR 5/8 & f2d 7.5YR 5/3 sil 2fabk mfr db 1vF 0.6 0.8 3 11-20 7.5YR 414 mid 7.5YR 516 & m2d 7.5YR 6/3 sit 2fabk mfr dw tvf 0.6 0.8 4 _ 20-37 7.5YR 4/6 eld 7.5YR 5/8 & c2d 7.5YR 5/3 scl lfabk mfr dw — 0.2 0.3 5 3749 5YR 4/4 mid 7.5YR 5/8 & m2d 7.5YR 5/3 scl Om mfi — — 0.0 0.0 aBoring # ❑ Boring ® Pit Ground surface elev. 87.3 ft. Depth to limiting factor 0 in. JVII nrl�Jlll:tluV1) RdIC Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary MOMS GPD/Ft2 In. Munsell Qu, Az, Cont. Color Gr, Sz. Sh. `Eft#1 'Efi#2 1 0-9 7.5YR 4/3 sil 21gr mfr gs 2m 0.6 0.8 2 3-13 10YR 4/4 f1d 7.5YR 5/8 & f2d 7.5YR 513 sit 2fabk mfr gw 1m 0.6 0.8 3 13-25 7.5YR 4/4 mid 7.5YR 5/6 & sit 2fabk mfr dw 1f 0.6 0.8 m2d 7.5YR 6/3 4 25-36 7.5YR 416 c1d 7.5YR 5/8 & scl ifabk mfr dw — 0.2 0.3 c2d 7.5YR 513 5 36-50 5YR 4/4 mid 7.5YR 518 & m2d 7.5YR 5/3 scl Om mfi — — 0.0 0.0 ❑ Boring # ❑ Boring ❑ Pit Ground surface efev. ft. Depth to limfing factor in. Soil AI ootication Rate I Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. ConL Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ftz `Efi#1 Eff#2 ' Effluent #1 = BOD, > 30 s 220 mglL and TSS > 30 5150 mg/L " EfOuent #2 = BOD, > 30 s 220 mgJL and TSS > 30 <_ 150 mglL � ; : �w. ,. _. d i` —. �_�__ �-.. � ,r , ,' � - �. Cj�"' �-' V 't` , . ��` "' 'f i i ��. Y. � a. � � '„C: 1 _ _-_—__.-� `� t C � f f - � �� I ff i � " '__ i „ t: 4 . , ,. � y Wisconsin Department of Safety and Professional Services Division of Industry Services SOIL EVALUATION REPORT Page I of 3 in accordance with SPS 383, Wis. Adm, Code Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County ST. CROIX 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. 002 - 1002 - 70 - 000 Please print all information, Reviewed b Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). PropertyOwner L� IL-- � I Property Location ✓ MARILYN BOL ESTATE (Buyer: Anthony Lee) Govt. Lot --- NW 1/4 NW 1/4 S T 29 N R 16 E (or)�W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# 312 Hanson St. City State Zip Code Phone Number OCIty Village Town Nearest Road Woodville, WI 54028 ( 715) 928 - 1881 R A i n1li m I 250th Street LJ New Construction Use Residential / Number of bedrooms 4 Code derived design now rate 600 GPD Replacement ❑ Public or commercial - Describe: Parent material sandy outwash Flood Plain elevation if applicable _ ft. NA General comments Mound Systein -- 2.0 ft. sand fill - 0.4c loading rate -- GEOMAT SYSTEM — 2.0 LOADING RATE -- PIT AND and recommendations: � BORING CONDUCTED TO I IEND AREA FROM TEST DATED 06-11-19. Other borings conducted around the dwelling were consistent w/FoB and MaB soil series. Upper comer was sandy outwash/CoC series. PROPERTY ADDRESS: 1191 250TH STREET Boring # u Boring — no Pit Ground surface elev. 96.93 ft. Depth to limiting factor 12 in. Horizon I Depth in. 0-6 Dominant Color Munsell I0YR3/2 Redox Description Qu. Sz. Cont. Color Texture sil Structure Gr, Sz. Sh. 2fsbk&gr Consistence ds Boundary cs Roots 2vf-m Soil A lication Rate GPDlfF *Eff#1 0.6 *Eff#2 0.8 2 6-12 10YR4/4 sil I fsbk& I fpl ds as 1 of-m 0.4c 0.6 3 12-16 1OYR4/4 flf 10YR4/6 sil 1fPl - - ds -- -- 0.4c 0.6 (some gr.) r-r 3 � Boring # {J Boring 97.93 14 Horizon 1 2 Depth in. 0-8 &14 Dominant Color Munsell 10YR3/2 10YR4/4 Redox Description Qu. Sz. Cont. Color - ---- Texture sil - sil Structure Gr. Sz. Sh. 2fsbk&gr lfsbk&pl Consistence ds ds Boundary -- -- Roots — __ Soli A plication Rate GPD/itz *Eff#1 0.6 0.4c *Eff#2 0.8 0.6 3 14-17 IOYR4/4 r1r10YR4/6 sil Ifpl ds -- 0.4c 0.6 (some gr.) i as Gov � IOU mgiL ` tttluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) � Si CST Number MARY JO HUPPERT Hollistcrs Soil Testin &Dcsi n) �l 224832 Address Date EvaluatibIff Conducted Telephone Number 28497 King Arthur's Court, Danbury, WI 54830 06 - 27 & 07 - 037 2019 715-426-1775 0 $-1(n—I '? iillL,t � 1GL,9��'93 0(1107113) F zu � PROPEP.i Y OWNER: " - 40 CT. (except where noted) legal Description:A VJ - h e bac i;)J1�k;opit : t- w.- North F. cl t C n 8 } r L)� P IFKOM 'Pap�VICIO I- /I \, e e.T; ff • h L� � P\, I IIIIIII IIIIPIIVIIIIuIII State Bar of Wisconsin Form 5-2003 PERSONAL REPRESENTATIVE'S DEED Document Number THIS DEED, made between David Bol Document Name as Personal Representative of the Estate of Marilvn I. Bol ("Decedent") ("Grantor", whether one or more), and Anthony Austin Lee and Michelle E. Lee, husband and wife as survivorship marital property ("Grantee," whether one or more), Grantor conveys to Grantee, without warranty, the following described real estate, together with the rents, profits, fixtures and other appurtenant interest, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): See attached Exhibit "A" for Legal Description 1087739 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI 08/30/2019 12:29 PM EXEMPT#: REC FEE TRANS FEE Recording Area Name and Retum Address 30.00 300.00 PAGES: 2 WESTconsin Title Services P.O. Box ti07 Hudson, WI5401ti ooz•looa-7o-o00 Parcel Identification Number (PIN) This is homestead property. (is) (is not) G'�i Personal Representative by this Deed does convey to Grantee all of the estate and interest in the Property which Decedent had immediately prior to Decedent's death, and all of the estate and interest in the Property which the Personal Representative has since acquired. Datec By: *David A. Bol, Personal Representative AUTHENTICATION ;�' ,� J� �AR/Cy •' :;, ACKNOWLEDGMENT Signatures) authenticated on TTI'LE: MEMBER STATE BAR OF (If not, authorized by Wis.Stat § 706.06) (SEAL) ' `� ' • � �p �• �� STATE OF WISCONSIN ) �C-�• * ) ss. G •; � ~COUNTY OF ST. CROIX ) '� >= - � - � � Personally came before me on Aueust 28 2019 the above- )h 4Y,' THIS INSTRUMENT DRAFTED BY: Tony R. Schrader, Attorney (715) 235-3403 File No. ST-19-01 l93 named Estate of Marilvn I. Bol by David A. Bol, Personal Representative to me known to be the persons) who executed the foregoing instrument and acknowledged the same. Notary Public, State of Wisconsin My Commission expires: I/22/23 (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. PERSONAL REPRESENTATIVE'S DEED ©2003 STATE BAR OF WISCONSIN FORM N0.5-2003 '"Type name below signatures. St. Croix County 1087739 Page 1 of 2 EXHIBIT "A" LEGAL DESCRIPTION Part of the Northwest Quarter (NW'/o) of the Northwest Quarter (NW L/a) of Section Two (2), Township Twenty-nine (29) North, Range Sixteen (16) West, Town of Baldwin, St. Croix County, Wisconsin, described as follows: Commencing at the Northwest corner of Section Two (2), Township Twenty-nine (29) North, Range Sixteen (16) West; thence South along the Section line 37 rods; thence East 21.5 rods; thence North 37 rods; thence West 21.5 rods to place of beginning. File No. S1'-19-01193 St. Croix County 1087739 Page 2 of 2