Loading...
HomeMy WebLinkAbout030-2114-50-000 r. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division ' INSPECTION REPORT Sanitary Permit No: 463187 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Everson, Bill & Brenda I St. Joseph Township 030 - 2114 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: n _ Section/Town /Range /Map No: 13 Z. 'c�� t �S1 31.30.19.942 TANK INFORMATION ELEVATION DATA 5', (,p `y3 13 z . 4 I TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic i t, r 1 ^, Benchmark � � y 5 613' 3 2 . Dosing W (` 5 Alt. BM ezvk, Goon -- /0.05 9277 .ys Aecztico / Bldg. Sewer O f Z6 Holding St/Ht Inlet q g i9 9 � TANK SETBACK INFORMATION SVHt Outlet � 1 , TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic -7 1 f Dt Bottom Dosing y c C) � 50 �� r �� Header /Man. 7 J ul . 1 �/3s , (v 1 Aeration J __....._ Dist. Pipe _ "S 1 935 - 01 Holding _,........ Bot. System -- 3 . o 935 / PUMP /SIPHON INFORMATION Final Grade Z _ O 9 �p Manufacturer r Demand St Cover dK l GPM 1�.� ClZ7. rI Model Number 5 - Z 1,6 3 Z 9 3 m r TDH Lift ,y Friction Loss System Head T Ft Z,0.9 I , c�5 -56 717 .49 Forcemain Length,,,,,/ I Dia. Z i J I Dist.towell 7 c0 1 SOIL ABSORPTION SYSTEM J BEDITRENCH Width / Length No. Of Trenc s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS C Q 6P \ \� \ SETBACK SYSTEM TO J P/L ' � J BLDG IWELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Type Of System: 1 - 7 AJ 4, UNIT Model Number. � B DISTRIBUTION SYSTEM Header /Manifo� c �� Distribution �/ / x Hole Size ) I x Hole Spacing Ven to Air Intake Length Dia Lengt Dia Spacin 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 Bed/Trench Edges i Topsoil (', 1� g No es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: JJ/9 4 4 Inspection #2: Location: 338 White Eagle Trail Hudson, WI 54016 (SE 1/4 NW 1/4 31 T30N 9W) White Eagle Lot 25 _ Parcel No: 31.30.19.942 1.) Alt BM Description 13; y4u,0,2,rc� 2.) Bldg sewer length= S ;` d j - amount of cover = It Cfop— 1 j C® Plan revision Required? Yes �o i Use other side for additional informa L ___ SBD -6710 (R.3/97) Date Insepctor's S' ature Ce . No. � Safety and Buildings Di ision County I Washington Ave., P X,7162 St. Croix Mason, WI 5370 - 7162 Sanitary Permit Number (to be filled in by Co.) DOns,l� Department of Commerce ��; 266- 51 3 / F-7 a � to Plan I.D. Number Al 7 7 z (oS Sanitary Permit Apph �,� In accord with Comm 83.21, Wis. Adm. Code, personal informat' n you ride /' � � - 7 9 O may be used for secondary purposes Privacy Law, sl5. )(m)`- _d Project A ress (if different than mailing address) I. Application Information - Please Print All Information �ti� ' , ✓ Lf/�Fr� d �ffbc C Property Owner's Name ^a; - Parcel #0 30 Lot # Block # Bill &Brenda Everson z D o o 25 Property Owner's Mailing Address Property Location 7014 Union Terrace Lane North SE NW City, State Zip Code Phone Number Section 31 Maple Grove, MN 55369 (763) 425 -5586 30 4 circle one) T N; R r II. Type of Building (check all that apply) 5 UU W , . 3 j a t or 2 Family Dwelling - Number of Bedrooms 3 - - C v- Subdivision Name CSM Number Public /Commercial - Describe Use W hite Eagle ❑ State Owned - Describe Use []City []Village []Township of St. Joseph I11. Type of Permit: (Check only one box on line A. Complete line B if applicable) p 30 A. 0 New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only [3 Other Modification to Existing System B. 11 Permit Renewal ❑Permit Revision 13 Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner 1 I IV. Type of POWTS System: Check all that apply) >< SO - ❑ Non - Pressurized In- Ground ❑° Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter 13 Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber 13 Drip Line Cl Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: 6 .0 = Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal wired (sf) Dispersal Area Proposed (sf) System Elevation 450 0.5 �{SO 450 Q� VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Uni l�TlQ �_� Concrete Constructed Glass New Existing N Tanks Tanks Septic or Holding Tank 1000 1000 1 Weiser x Aerobic Treatment Unit Dosing Chamber 650 650 1 Weiser x VII. Responsibility Statement- I, the undersigned, assume respon 'bility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Roger Nelson Zgglj MP 226497 715 - 273 -4444 Plumber's Address (Street, City, State, Zip Cod 122 East Summit Avenue Ellsworth, WI 54011 VIII. County/Department Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuin Agent Signature (No Stamps) Surcharge Fee) El Owner Given Reason for Denial IR. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and F ` ` Y�` dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances Attach complete plans (to the County only) for the system on paper not less than BV2 x 11 inches in size SBD -6398 (R. 01/03) APR -12 -2005 16 :28 FERGUSON ENT HUDSON 715 386 6144 P.01 RGOULDS PUMPS Submersible Effluent Pump PE ftOwn PUMP SPECIFICATIONS MOTOR FEATURES Pump — General; General: ■ Corrosion resistant • Discharge: 1'A" NPT • Single phase construction. • Temperature: 104•F (40 °C) • 60 Hertz ■ Cast iron body. maximum, continuous when • 115 and 230 volts ■ Thermoplastic impeller and fully submerged. • Built -in thermal overload pro- cover, • Solids handling: 1 /2" tection with automatic reset. ■ Upper sleeve and lower maximum sphere. • Class g insulation. heavy duty ball bearing APPLICATIONS • Automatic models include a • Oil - filled design. construction. float switch. • High strength carbon steel ■ Motor is permanently Specially designed for the a Manual models available, shaft. lubricated for extended following uses: • Pumping range: see PE31 Motor service life. • Mound Systems performance chart or curve, • .33 HP, 3000 RPM ■ Powered for continuous • Effluent/Dosing Systems PE31 Pump: • 115 volts operation. • low Pressure Pipe Systems • Maximum rapacity: 53 GPM • Shaded pole design ■ All ratings are within the • Basement Draining • Maximum head: 25' TDH PE41 Motor working limits of the motor. `� .. • Heavy Duty Sump/ PE41 Pump: • .40 HP, 3400 RPM ■ Quick disconnect power Dewatering • Maximum capacity: 61 GPM • 115 and 230 volts cord, 20' standard length, • Maximum head: 29' TDH • PSC design heavy duty 16/3 S)TW with E51 Pump; PE51 Motor: plug. 115 or 230 volt grounding P • Maximum capacity: 70 GPM • .50 HP, 3400 RPM ■ Complete unit is heavy duty, • Maximum head: 37' TDH • 115 and 230 volts • PSC design portable and compact. METERS F ■ Mechanical seal is carbon, 1 r- --,' �� • ceramic, BUNA and stainless PE51 j I - j I moDiI : PE31, Pf41, PE5t steel, I I HP: 133. ■ Stainless steel fasteners. 2 GPM j' I ' I AGENCY USTINGS 30 •P E4 i 1 FT i u i i i � I• I I' i i 1 L . I' I I• Cks 20 I .... F -; j •! I - I I i I I Tested to UL 778 and CSA 222108 Standards I By Canadian 5t3n&v& Assodwon File #Ma5C9 10 T' ' ' .,� I 'I I I I • I � � t . � , ' ` ^ I ' Goulds PUMPS is ISO 9001 Registered 7 17 � I I 5 �� I ' � i i I•i j 1 I ' I i i, 0 10 2d 30 40 50 6o 70 GPM 80 0 5 1 0 15 m Goulds Pumps ® 2004 nT Water Technology, in- CAPACITY Effective June, 2oo4 9PE3 7141 <& !TT Industries I ♦� N or *A �o of ?foe 9gH 9 ��ML T�«L•�� sins o cc SEE CORRESPONDENCE r� L3 /I72 = 9_ S 2_y -2 x.1,74 9 Pvc p�� GV EssE�p / c�oc /6 So T C;0 1?*4 A Safety and Buildings ` 4003 N KINNEY COULEE RD commerce.wi.gov LACROSSE WI 54601 -1831 ■ ■ TDD #: (608) 264 -8777 i sco n s i n www.commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary October 28, 2004 CUST ID No.226497 ATTN: POWTS Inspector ROGER D NELSON ZONING OFFICE NELSON PLUMBING ST CROIX COUNTY SPIA 122 E SUMMIT AVE 1101 CARMICHAEL RD ELLSWORTH WI 54011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/28/2006 Identification Numbers Transaction ID No. 1077265 SITE: Site ID No. 691790 Bill & Brenda Everson Please refer to both identification numbers, Lot 25, Sub. Div. White Eagle above, in all correspondence with the agency. Town of Saint Joseph St Croix County SE1 /4, NW1 /4, S31, T30N, R19W FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 989815 Maintenance required; 450 GPD Flow rate; 30 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 101); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. COnd 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. AP12T The following conditions shall be met during construction or installation and prior to occupancy or use: DEPARTMFNI General Approval Requirements: OF •This system is to be constructed and located in accordance with the enclosed approved plans and with the SEE CORRE Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /O1) and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST (01/81) • Access to the filter for cleaning must be provided per Comm 84 product approval conditions. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required • Comm 83.42(8)(c). Frost Protection. All POWTS components shall be protected from freezing temperatures that could detrimentally affect component operation to provide wastewater conveyance, treatment or dispersal. Wise. Adm. Code. See Comm. 82.30(11)(c). for construction limits, methods and procedures. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c ROGER D NELSON Page 2 10/28/2004 • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) 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. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 /� Fee Received $ 175.00 C / i / & o Balance Due $ 0.00 Charles L Bratz 7 POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 i 'AFC sqc oc F , �s F® MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIG�� A DO Residential Application 0, INDEX �A INDEX AND TITLE PAGE v O Project Name: Everson 3 bedroom Mound Owner's Name: Bill & Brenda Everson Owner's Address: 7014 Union Terrace Lane North Maple Grove, MN 55369 Job address: Legal Description: SE 1/4, NW 1/4, S 31, T 30 N R 19 W Township: St. Joseph County: St. Croix Subdivision Name: White Eagle Lot Number: 25 Block Number: Parcel I.D. Number: Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications tflp{ ��ItjJ Page 6 Management and contingency plan A 0 Page 7 Pump curve and specifications Page 8 Plot Plan , OF Y C v INGS SP ONDC-N C E Designer: Roger Nelson License Number: MP 226497 Date: 10/21/04 Phone Number: 715 - 273 -4444 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 4.0 (R. 04/03) Page 1 of 8 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) r Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 83 -44 -3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of - 36 inches. 450.00 Design Flow (gpd) 7.00 Site Slope ( %) 934.00 Contour Line Elevation (ft) 30.00 Depth to Limiting Factor (in) 0.50 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 50.00 Dispersal Cell Length Along Contour (ft) = 9.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ff ) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution F Y Pressure Disribution Information network? Enter Y or N (c or e) a Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 3 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 3.00 Estimated Orifice Spacing (ft) = 8.82 fe /orifice 2.00 Forcemain Diameter (in) 100.00 Forcemain Length (ft) Does the forcemain drain back? Y 915.50 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 16.31 Forcemain Drainback (gal) 18.67 Vertical Lift (ft) 29.65 5x Void Volume (gal) 1.00 Friction Loss (ft) 45.97 Minimum Dose Volume (gal) 26.17 Total Dynamic Head (ft) 21.01 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 x x 1.50 x x 1.25 x 2.00 1.50 x 3.00 2.00 x 3.00 x Gallonslinch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1000.001 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Weiser 800 - 325 -8456 1 Manufacturer I I gal/in (enter result in cell B49) Dose T ank Information Efflu Filter Infor mation 650.001 Dose Tank Capacity (gal) Zabel 1-800-221-574:fl Filter Manufacturer 17.001 Dose Tank Volume (gal/in) IA100 I Filter Model Number Weiser = Manufacturer Project: Everson 3 bedroom Mound Page 2 of 8 r Mound Plan View ------------------------------------- T 1/10B• . . J . . . . . . . . Observation Pipe — _ • :•: •r• : r•:•: r• r•:�: •:•r•: •: •r•r�:•r•: •:�: •rte W . � B. 1 . ..i -, .. •. . . .•. •. I L Mound Component Dimensions A 9.00 ft E 13.56 in H EAft ft K 7.70 ft B 50.00 ft F 9.00 in z ft L 65.39 ft D 6.00 in G 0.50 ft J ft W 22.38 450.00 (ff) Dispersal Cell Area 1 901.90 (ft Basal Area Available 9.00 (gpd /ft) Linear Loading Rate 5.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 936.25 (ft) �.... G * H rr:: �:��r:rf:r:l77rrrtrrfrr.•r:rrf. . F :: : Dispersal Cell 935.00 (ft) Lateral 934.50 (ft) -- 10- Invert Dispersal Cell :: :D t Elevation E .... ........... 4 934.00 (ft) Contour Elevation 7.0 %Site Slope Geotextile Fabric Cover Shading Key v _a. T Dispersal Cell See lateral details on Topsoil Cap a 1.5 ft •ti• • ' Page 4 for number, size, C r•: •: •r•: •r•r © • {'� Subsoil Cap a � 5 r; .: ti r and spacing of laterals. © `6 � '��••�••:ti:ti � ti��•��•� Laterals are equally ASTM C33 Sand 0 5 ft �ti'Typical Lateral F spaced from the distribution cell ® ® Tilled Layer c : -.• ..•.. -..- ..ti.ti:: ''' , •.,'.•ti s r•r•:• Aggregate c ••r•.••r•r•: centerline in the A distribution cell (Ax6). Project: Everson 3 bedroom Mound Page 3 of 8 End Connection Lateral Layout Diagram Center the laterals over the A & B dimension •— Turn -up vvlball value or olonn out plug P ' PForce dentical IE X 11 Holes drilled on the bottom of the lateral equally spaced 5 Laterals & force main of PVC Sch 40 (per COMM Table 84.30 -5) S onnection via tee or cross to manifold at any point. Number of Laterals 3 Orifice Diameter 0.125 in Lateral Diameter 1.00 in Orifice Spacing (X) 3.06 ft Lateral Length (P) 4845 ft Orifices per Lateral 17 Lateral Spacing (S) 3.00 ft Orifice Density 8.82 ft /orifice Lateral Flow Rate 7.00 gpm Manifold Length 6.00 ft System Flow Rate 21.01 gpm Manifold Diameter 1.50 in Total Dynamic Head 26.17 ft Forcemain Velocity 2.15 1 ft/sec Dose Tank Information Locking cover wfth warning label and locking device and J sealed watertight Electrical as per NEC 300 and -► Comm 16.28 WAC 4 in. min. Disconnect Tank component is properly vented : < Alternate outlet location _ Forcemain diameter Weiser 800 - 325 -8456 Manufacturer 2 in. Capacityl 650.00 Gallons Volume 17.00 gal /inch A _ Weep hole or anti- Dimension Inches Gallons B siphon device A 23.53 400.03 B 2.00 34.00 C P ump off elevation (ft) C 2.70 45.97 916.33 D 10.00 170.00 D Total 1 38.241 650.00 Dose elevation (ft) 3" Bedding un er tank. 915.50 Alarm Manuafacturer IS. J. Electro Systems Alarm Model Number 1101 HW Pump Manufacturer JMyers Pump Model Number ME 40 Pump Must Deliver 21.01 gpm at 26.17 ft TDH Project: Everson 3 bedroom Mound Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name Installed by Nelson Plumbing Phone 715 - 273 -4444 POWTS Regulator's Name St. Croix County Zonin Phone 715 - 386 -4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1000 gal Maximum TSS 150 mg /L Soil Absorption Component Size 450 ft' Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 years Moundl Ins ect for ponding and seepage once every 3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, 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. Lateral Turn -up Detail Finished ••............ ............... Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Everson 3 bedroom Mound Page 5 of 8 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, 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 8- inches 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, Slats. 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 of 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 Department of Commerce. Pump Tank The pump (dosing) 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. 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 BOD 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 18 months. 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 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continnency 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 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Everson 3 bedroom Mound Page 6 of 8 l s M E40 Series 4/10 HP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 ISO 200 250 300 350 40 IZ 35 10 W 30 e -rV H zs Z 20 6 4 O 10 ~ 2 5 O p 0 10 2 30 40 50 60 70 80 90 100 CAPACITY GALLONS PER MINUTE a� PM 1101 Myer; Parkway, Ashland, Ohio 44805 -1923 419/289-1144 FAX 419/289 -6658 Telex W74Q K3326 7/91 Printed in U.S.A. I r e� � o e t 47 �o VLr C ► rEPONDENCE o•�ryy c- • a� Girls = 932 , y' o, 0 'Oq 7•L %y PYc V, - A 3 2 , Y' .,� 7'',c�, ,� %y PVc � W E�sE�p / aac /6 So T4, ,E.. 'II ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FOR_M / Owner/Buyer �� L -/Z Mailing Address a Property Address 339 - fi — P-A f L Q� (Verification required from Planning Department for new construction.) City /State Parcel Identification Number QJ ?o ZZSC S O O d o LEGAL DESCRIPTION 7 Property Location V4 , N O V4 , Sec. , T J 0 N RN W, Town of Subdivision , Lot # C g Volume 2 5- Z l e# 0-03 Pa 6 g Warranty Deed # Volume , Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE 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 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. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Department within 30 s of three year expiration date. i Vy SICKATURE Or APPLICANT DATE OWNER CERTIFICATION I/we certify tements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described ab , by virtue deed recorded in Register of Deeds Office J � SIG OF APPLI DATE * * * * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. U 2521 P 003 75S I � KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., W1 STATE BAR OF WISCONSIN FORM 2- 2000 RECEIVED FOR RECORD Document Number WARRANTY DEED 03103/2004 01:30PN THIS DEED, made a evelopment, LLC, Grantor, WARRANTY r I DEED an illiam J. Everson and Brenda S. Everson, husband and wife, as Survivorship Marital Property, Grantee. REC FEE: 11.00 Grantor, for a valuable consideration, conveys and warrants to Grantee TRANS FEE: 569.70 y COPY FEE: the following described real estate in St. Croix County, State of Wisconsin: CC FEE: PAGES: 1 Parcel 1: of 25 bite Eagle, St. Croix County, Wisconsin. AND Parcel 2: Recording Area Together with a 33 foot joint driveway easement over Lot 24, White Eagle, Name and Return Address: St. Croix County, Wisconsin, as shown on the recorded plat thereof. Edina Realty Title, Inc. 400 S. 2 " St. — Suite 115 Exceptions to warranties: Hudson, WI 54016 Easements, restrictions and rights -of -way of record, if any. 423395 030 - 2114 -50 -000 Parcel Identification Number (PIN) This is not homestead property. Dated this 27th day of February, 2004. Preservation D elopt t, LLC B * William Block, Ma * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. authenticated this 27th a &A"lfuf!, Notary Public Personally came before me this February 27, 2004 the * above named William Block, Manager, Preservation Development, LLC to me known to be the person(s) who TITLE: MEMBER STATE BAR OF WISCONSIN executed the foregoing instrument and acknowledged the same. (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY *Di ne M. Barron Notary Public, State of Wisconsin Peterson, re Bergman — Steven H. Bruns My commission is permanent. (If not, state expiration date: 50 East Fi S treet, S Street, St. Paul, MN 5510 1 11/19/2006 j (Signatures may be authenticated or acknowledged. Both are not necessary.) 'Names of persons signing in any capacity must be typed or printed below their signature WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000 M t M • • /tom. • m Y �.• ;nY tow LO < CN 41 A% 41 ee • .. ow - -_� � �� - c �_ \7 _ � o � _ --, e 4 Wisc4 n De art, otofIndusby, SOIL AWD`SIT EVALUATION REPORT Page 1 of 3 Lattrand.Human Relations • Division of Safety & euik6ngs ta_accord with, JLHR 83.05, 'ws:'Ad W Code COUNTY -ST. cAZZUc - Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. �'��)� � APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE G•- �/ PROPERTY OWNER: C / o btvty S C%A Ps Pr - PROPERTY LOCATION _ - VZV CLw; 12-,rS'2.P• T.t0f S� 1/4 NW 1 /4,S3) T 30 ,N,R 1 ? E( W PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # PTL�oD o SE s> 6 9 I! - . VoFz . LA G G BLVD . W M rT ail G LF CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD ST. P�NL, W1N 5 S l01 (6S1) 0 � tt) - C�OI.F SZ- • M 9 tzr P� -O�o� (a3 szz- New Construction Use N Residential / Number of bedrooms 3 [ ] Addition to existing building ] Replacement [ ] Public or commercial describe Code derived daily flow y SO gpd Recommended design loading rate y bed, gpd/ft - trench, gpd4t Absorption area required 31 S bed, ft .31 S trench, ft Maximum design loading rate S bed, gpd/0 - 6 trench, gpd/ft Recommended infiltration surface elevation(s) °t 3S. O ft (as referred to site plan benchmark) Additional design/ site considerations S EL-, No'CC. P hG e Z CM \-" w /cV X k( ' 8 � Parent material G I,N_I t t\ t `l1 \.t` Flood plain elevation, if applicable N A It S = Suitable for system CONVENTIONAL OUND IN-GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitablefors stem [IS ®U S ❑U D ®U ❑S QU ❑S ®U ❑S ®U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Barxiary Roots Bed rriench r z ] c)- F3 10"l2�)Z Z 8 -30 cZ Ground 3 3u - 6S •S `1 IZ 31 y elev. °13Z� ft. Depth to limiting factor 30" Remarks: Boring # n dv S • S ` Ground elev. 39-6 S 31y °t 3Z-� ft. Depth to limiting factor �� 1 Remarks: COUN CS T Name.--Please Print Phone: Arthur L. We erer 715 - 42 5,- 01,65 egerer Soil Testing & Design Service -P.O. Box 74 River Fa11s,WX4 Signature: mber: i , 48- IZ3 ^ Z (�, Date: CST Nu t'. PROPERTY OWNER 2U)-T)OKI O wPSOIL DESCRIPTION REPORT , PARCEL I.D. # �� Boring # Horizon Depth Dominant Color Mottles Texture Structure In. Munsell Qu. Sz. Cont. Color Consistence Bourxla y Roots GPD /ft Gr. Sz. Sh. Bed T CS 3 O_ °S 10 `1 2 3!2 St 2`FS�lt tiv► 1 S. ti�`1R 316 Ground 3 33 - 1•S `� 2 � _ L w�-rz c,Y elev. a3 ft. Depth to limiting factor Remarks: ; Boring # s. ,.� Ground elev. ft. i Depth to { limiting tactor Remarks: Boring # •� >•� S� t U t .. � V Grounder y'1U 1+� S`L� SU t L-t O�C.4+ C� elev. ft. Depth to `f 5 Ll1T S L h't 1 limiting factor Remarks: ;. Boring # X` 3 • • U>J w lS` 0 C� 6 � S • U Ground ' S g LE elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) Page PLOT PLAN SCALE 1 "= CEO ! hti \ CO�Tp�Z sTl of rj =_ of S�•935.0� vM 1 fit. 43Z.y' ON 8 " "IGN 3l�l Jlq, PvQ, �1FN ►�1/�11'M ( 715 ) 42 110 0 5 7 6 CST Signature Date Signed Telephone No. CST #