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HomeMy WebLinkAbout030-1099-10-000 r - Wisconsin Depart�,ientaf Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division ` INSPECTION REPORT sanitary Permit 463456 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)). rj Permit Holder's Name: City Village X Township Parcel Tax No: Gunderzik, Tami I St. Joseph, Town of 030 - 1099 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 1 4-0 /� L' 13 /'L^- 33.30.19.356A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 2`t 3• o o __ 1 0 J' 6 Septic Benchmark Dosing �� Alt. BM Aeration �) Bldg. Sewer Holding / St/Ht Inlet Z TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet J Septic ' , Dt Bottom 7 v Dosing i Header//Man. (/ Aeration Dist. Pipe Holding Bot. System PUMP /SIPHON INFORMATION $12¢. Final Grade 14 Manufacturer Demand St Cov r GPM Model Number ( , (E- , / M c�� 3?/ /� �.� , TDH Lift ' ,d Friction� s� Syste — Held TD! �.t C� 7 p( Forc rnain Lei h / Dia. Dist. to Well Z pO V � ► d SOIL AB ORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S SETBACK SYSTEM TO J P/L Vj I B WELL LAKEJSTREAM CHING Manufacturer: INFORMATION CHA E Type / / Model Number: 12. DISTqff4H19N SYSTEM A .Os-.nL� Header/ nifol I D istribute — on�� J x Hole Size x Hole Spacing V ent o Air Intake Ilb Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of j xx Mulched Bed /Trench Center Bed /T T 7 � ded rench Edges Topsoil Yes No Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: Z Z / 0 5 inspection #2: i7S Location: 594 128th Avenue Hudson, W Q ..�� t 54016 (NE 1/4 NE 1/4 33 T30N R19W) NA Lot 4 ! �vA Parcel No: 33.30.19.356A 1.) Alt BM Description = ► oe J­6 ,6A 2.) Bldg sewer length - amount of cover — Ot p �`� �O �yQ2� ,Q60t✓� G Plan revision Required? Yes No p 2 05' / Y Use other side for additional information. -- Date �Insepctor's Signature Cert. 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(.f `v 4 � SOfL EVALUATION REPORT �� Pa in accordance with oomm /5, Wle. Adm. Code OFFICE Cpl, ba p+ vavar na s M „ wn a ,J2 x acne, in aa.. Pion awie 1 iei�dt, e�,c not fmilad U veroral and l a tm velalsnce point tom, & m cM an and Perod on. - roaw elope. awls a diner+po+e nett# anew, andlocadon and auana,o nearest road- 0 k-10 — /t7 � memo perm an bro meffm Date �+dew�Menrw rs+lr anp M �,or r�oe.i,l' rwP�K c�� far. �,SDff rl UN1 ` Ptowly oww Pic" V Locanon f G&A Lot PVC U4 oC,PI a T 7y r , N R E Plowito s Lot a I woo Al sodd Name or CSMN Cite Vftapa ERTOW11 Nearost c 3 - 0 NOW 01 NCO COde deMAd Mart slow nits 0PApiacesnard ❑ weft oroomtnardel - Desaer Print eratattal Nes T 1 I Flood Plain dwelion it applicable N R Cor�..�elew 9.�.ov [� P� clreta,e eYrlaO• elay. ���,¢_ �. Deplh b � raov► �,_, In, � Nodeett Depth OdWrrnl ltadoc Oesariptlon Tereus Suers OOrMWanp tj0uttdatr Roots n. K%Nt§4 Qu. fet Con. Color S. 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Taatias Shuoaraa OorrmO�noo Rats r Id Unod Ou. S't Cap! color Gr St Slt Roola .�1 30 T=S .30;5 not - E>fwrR a� = BOD cap s � and TSS < 3p nigiL CMDIG'Ya If You uftd amimmm to w4m swim or — �-=• --' at 6N -M6 -3151 or 7r1r GwX4.sn7. alf.ar. f...p Ed ud6S :90 Seel tz •unf 'ON XUJ PAGE „ I LOT* LEGAL '�T 3QMR 1`IE(OR i SCALE: I» BM l ELEVATION _ o �c 9M i DescRIPTION 4,, L_ 1 ,44n'c tynJlr6- DM 2 EL xvAT1oN 5 6 C , j BM 2 DESGR)PTION --- SYSTEM ELEVATIO -__ Y�S� SYSTEM TYPE IM ito /►d K •� Y V V SIGNATURE - .- - -,�, • "-r te ___- DATE �- r fYJ VH a i,n)j N V A Safety and Buildings Division County ISConsin 201 W. Washington Ave., P.O. Box 7162 5 , Madison, Wl 53707 — 7162 Sanitary Permit Number (to be filled ' Co.) Department of Commerce (608)266 -3151 Lt 3 S� C�S Sanitary Permit Application State Plan I.D. Number 1& 0 3 In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, sI5.04(1)(m) Project Address (if different than mailing address) 1. Application Information - Please Print All Information 5_y CJ 7� /f V Property Owner's Name A Parcel # / Lot # Block # r / 3 o Property Owner's Mailing dress Property Locat / ion �t / /V2� /^/f � ' /., L�'1� Section — City, State Zip Code Phone Number C yy�� circle e) T 3 a ; RE II. Type of Building (check all that apply) C �2 Subdivision Name CS umber Oy� K 1 or 2 Family Dwelling - Number of Bedrooms El Public/Commercial - Describe Use Up4 ❑ State Owned - Describe Use ❑City_❑Village,Township of sT. � III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' New S stem y El Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System B. ❑ Permit Rene enmit Revision 13 Change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner d5 IV. Type of POWTS System: Check all that appl ❑ Non — Pressurized In- Ground g Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gra less Pipe ❑ Other (ex la1n ) t tr V. Dispersal/Treatment Area Information: a Design Flow (gpd) ign oil Application R f) Dispersal Area ed (st) Dispersal Area Prop, Of) System Elevation r0f) -� aC�2� oc� r 98 �s VI. Tank Info apacity in Number Manufacturer PrQfab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank y � Aerobic Treatment Unit V ! r Dosing Chamber O o �Q 0 VII. Responsibility Statement- I, the undersigned, assume responsibility for ' allation of the POWTS shown on the attached plans. Plu er Na (Print) Plum s Sign ure /MPRS Number Business Phone Number urn Phimber's Address (Street, City, State, ode) � „G S VI County/ e artment Use Onl Approved ❑ Disapproved Sanitary Permit Fcludes Groundwater t Issue Is mg Age Signature at ee innQs) Surcharge Fee) /_© QU Q�22 0S Q ❑Owner Given Reason for D enial --(( ((f . -� O IX. Conditions of Approval /Reasons for Disapproval n `r� �� TEM R: eptic tank, effluent nt filter and dispersal cell must all be serviced /main d Q lM per management plan provided by plumber. Al 2. All setback requirements must be maintaine � as per applicable code /ordinances. Gts� �hc� (ht �Id wa?XWa , Attach complete plans (to t /he C1oun,, or the ays on pa ^�,(i/ er not less than 81 x l tin t!�'lXir G� 1� W �rf `,� ��LZf7�rvilF� � Ir"W�' � • v`L�f C��«��� • � � Z D -6398 0103) v S �� alfwtl r - o s 7,f 9 ,3or zs v� 3 -3X 57 P a y ',— g Safety and Buildings commerce.wi. OV 10541N RANCH ROAD g HAYWARD WI 54843 TDD #: (608) 264 -8777 i!�S, onsin www.commerce.wi.gov /sb/ nt of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary August 02, 2005 CUST ID No.220357 ATTN: POWTS Inspector BRADY J UTGARD ZONING OFFICE UTGARD PLUMBING & HEATING ST CROIX COUNTY SPIA 110 KELLER AVE N APT 112 1101 CARMICHAEL RD AMERY WI 54001 -1034 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/02/2007 Identification Numbers Transaction ID No. 1160368 SITE: Site ID No. 697354 Tami Gunderzik Please refer to both identification numbers, 60TH St above, in all correspondence with the agency. Town of Saint Joseph St Croix County NE1 /4, NE1/4, S33, T30N, R19W FOR: Description: New mound, 4 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1014673• evision; aintenance required; 600 GPD Flow rate; 17 in Soil minimum depth to limiting factor from original grade; s :Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes 1 � 1 and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in »R 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. S The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the design manuals noted above. • 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. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. Key Item(s) • This approval is for a revision to previously approved Transaction number 1160368. The approved changes are: the dispersal_ component and septic tank/pump tank are in a different area. A new soil test and bench mark have been provided. See plans. • These approved plans will replace the previously approved plans. No portion of the of the original approval is valid. • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. BRADY J UTGARD Page 2 8/2/2065 Note • The bottom of the distribution cell shall be level per the Mound Component Manual. he "D" dimension shall be a minimum of 19 ". The maximum finished slope of the mound surface shall be equal to or less than 3:1 per the Mound Component Manual. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(1). Consult the Department of Natural Resources for well setbacks and exceptions to the setbacks. 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 /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 sh ide a copy of this letter to the owner and any others who are responsible for the installation, operation mainten a of the POWTS. Si e y, Fee Required $ 75.00 Fee Received $ 75.00 Balance Due $ 0.00 Patricia L orf POWTS Plan Reviewer Integrate ervices WiSMART code: 7633 (715) 634 -7810, Fax: (7 634- 50 , M -f 7:45 am - 4:30 pm pshandorf@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: TAM[ GUNDERZIK Owner's Name: TAMI GUNDERZIK Owner's Address: 811 FOXTREE LN. HUDSON, WI 54016 Legal Description: NE1 /4 NE1 /4 S33 T30 NR19 W Township: ST. JOSEPH County: ST. CROIX Subdivision Name: CSM VOL. 12 PG. 3467 A ;N o} Lot Number: 4 Block Number: N/A E COM 1�QtNO Parcel I.D. Number: 630 - 1099 -10 -000 cME N r Plan Transaction No.: CE ONp Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 PLOT PLAN Page 9 soil test Designer: BRADY UTGARD License Number: 220357 Date: 07/1W5 Phone Number: 715 - 268 -6995 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 3.11 (R. 06/01) Page 1 of 9 i y l ,� 1�13o x� X 3 t3f"® o 57 g 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 400.00 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. 600.00 Design Flow (gpd) 9.00 Site Slope ( %) 97.00 Contour Line Elevation (ft) 17.00 Depth to Limiting Factor (in) o2 „ 0.50 In -situ Soil Application Rate (gpd/ft')- VC �'d �`'P 9 Distribution Cell Information 75.001 Dispersal Cell Length Along Contour (ft) = 8,00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft 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) C Center or End Manifold 4.00 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.188 Orifice Diameter (in) (e.g. 0.25) 2.50 Estimated Orifice Spacing (ft) = 10.00 ft /orifice 2.00 Forcemain Diameter (in) // 160.00 Forcemain Length (ft) Does the forcemain drain back? Y 88.50 Pump Tank Elevation (ft) Enter Y or N 3.25 System Head (ft) x 1.3 26.10 Forcemain Drainback (gal) 9.83 Vertical Lift (ft) 46.75 5x Void Volume (gal) 5.12 Friction Loss (ft) 72.85 Minimum Dose Volume (gal) 18.20 Total Dynamic Head (ft) 39.32 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 1.00 1.50 x 1.25 x X 2.00 x X 1.50 x 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information 800.00 Total Tank Capacity (gal) 1200.00 Septic Tank Capacity (gal) 35.97 Total Working Liquid Depth (in) WIESER _Manufacturer 22.24 gal /in (enter result in cell 649) Dose Tank Information Effluent Filter Information 800.001 Dose Tank Capacity (gal) JZabel Filter Manufacturer 22.241 Dose Tank Volume (gal /in) A100 Filter Model Number WIESER I Manufacturer Project: TAMI GUNDERZIK Page 2 of 9 Mound Plan View T 1/10 B • Observation Pipe �' J K: .....:....:.. _} .... .. ..... ....... z L Mound Component Dimensions A 8.00 ft E 27.64 in H 1.00 ft K 11.14 ft B 75.00 ft F 9.25 in z 14.69 ft L 97.29 ft D 19.00in G 0.50ft J 6.74ft W 29.43ft 600.00 (ft Dispersal Cell Area 1701.63 (ft Basal Area Available 8.00 (gpd /ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 100.35 (ft) —► ,.,, ,,... ♦ H F Dispersal Cell 99.08 (ft) Lateral 98.58 (ft)—► — Invert DispersahGell t Elevation E D yi - ._... r. .. ?::.., J'J .v . . _ ?: `). ? :y .. ? rl �. l ,� J. ;, ,;. ; ?, ; ; '; ; : `i .__ :,, �_: l __ _ , J -,i tJ ; � t 4 - :'• •{ X C ., _ `. •., a•K: ` _' .: . _ )..: .. . '. �.. !. J. 97.00 (ft) Contour Elevation 9.0 % Site Slope Geotextile Fabric Cover Shading Key m $ T Dispersal Cell See lateral details on Q _Topsoil Cap o 1.5 ft • . .. Page 4 for number, size, Subsoil Cap ; r and spacing of laterals. ASTM C33 Sand :;•: F Laterals are equally Tilled Layer c 0 0.5 ft :•' Typical Lateral spaced from the 05 Lr:d Aggregate c •;5• distribution cell's *. •. ,. A' centerline in the distribution cell (AxB). Project: TAMI GUNDERZIK Page 3 of 9 Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at any point. Laterals ate identical I f P � •= Turn -up wiball valve or IE X 1+W2 I W241 Laterals & force main of PVC Sch 40 of eanoutplug per COMM Table 84.30.5 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.188 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 36.69 ft Orifices per Lateral 15 Lateral Spacing (S) 4.00 ft Orifice Density 10.00 ft /orifice Lateral Flow Rate 9.83 gpm Manifold Length 4.00 ft System Flow Rate 39.32 gpm Manifold Diameter 2.00 in Total Dynamic Head 18.20 ft Forcemain Velocity 4.02 ft/sec Dose Tank Information Locking cover with warning label and locking device and Electrical as per NEC 300 and - -► sealed watertight Comm 16.28 WAC Disconnect 4 in. min. Tank component is properly vented zz Alternate outlet location Forcemain diameter WIESER Manufacturer 2 in Ca aci 800.00 Gallons — T Volume 22.24 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 21.70 482.51 C B 2.00 44.48 —t Pump off e levation (ft) C 3.28 72.85 89.25 D 9.00 200.16 D Total 35.97 800.00 Dose tank elevat 3" Bedding un er tank. �— 88.50 Alarm Manuafacturer LEVEL Alarm Model Number DLV Pump Manufacturer GO ILDS Pump Model Number FE —05 Pump Must Deliver I 39.32 gpm at 18.20 ft TDH Project: TAM[ GUNDERZIK Page 4 of 9 Mound Svstem Maintenance and Operation Specifications Service Provider's Name UTGARD PLUMBING - Phone 715 - 268 -6995 POWTS Regulator's Name ST. CROIX COUNTY ZONING Phone 715 - 386 -4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 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 every 1.5 years Mound Ins t for ponding and seepage once every 3 ears 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 Fi nished •�������������� •��������������• 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: TAMI GUNDERZIK Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.64, 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 finer 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 shalt 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. Colo 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 specked 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. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or laced to keep eep 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: TAMI GUNDERZIK Page 6 of 9 M GOULDS PUMPS 7 ubmersible Effluent Pump i MODEL 3871 EPO4 & EP05 Series APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication and efficient improved performance. construction. • Effluent systems heat transfer. ■ Casing and Base: Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farm operation. Auto superior strength and corrosion Farms manual o • Farm Heav duty sum p resistance. a A. Y p matic models include C Canadian Standards Association File # LR38549 • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron • Dewatering assembled and preset at the for efficient heat transfer Goulds Pumps is ISO 9001 Registered. factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic • Solids handling capability: FEATURES cover with integral handle and 3 /4" maximum, float switch attachment points. ■ EPO4 Impeller: Thermop ►as- • Capacities: up to 60 GPM, tic semi -open design with 0 Power Cable: Severe duty • Total heads: up to 31 feet. pump out vanes for mechanical rated oil and water resistant. • Discharge size: 1' /z" NPT, seal protection. • Mechanical seal: carbon - rotary/ceramic stationary, BUNA -N elastomers. • Temperature: 104 °F (40 continuous 140 (60 Intermittent. METERS FEET • Fasteners: 300 series to stainless steel. s Capable of running 9 __ ._- .. ,.. ,__ _ _. _ _ _ . — i • cdomwithout damage to 30 r s GPM dry 9 p z.s v zs; z a Motor: _ • EPO4 Single phase: 0.4 HP, v 6 20 ` &Z 115 or 230 V, 60 Hz, 1550 a RPM, built in overload with > 5 automatic reset. a 15 _ • EP05 Single phase: 0.5 HP, 4 EP05 115 V or 230V, 60 Hz, 1550 ° 3 tok_- __ ........... . . RPM, built in overload with automatic reset. 2 �9,0� EPO4 • Power cord: 10 foot standard length, 16/3 1 SJTW with three prong grounding plug. Optional 20 0 0 1 _.__..._- foot length, 16/3 SJTW with 0 10 20 30 40 50 GPM three prong grounding plug ' (standard on EP05). 0 2 4 6 8 10 tz m /h CAPACITY Goulds Pumps 2003 Goulds Pumps (� Effect 83871 ` ITT Industries 63871 I PREPARED FOR: LEGEND TAMI GUNDERZIK FO , W 54016 LN HU DSON, WI ALUMINUM COUNTY SECTION HUDSON, CORNER MONUMENT FOUND O 1" X 24" IRON PIPE SET WEIGHING 1.68 LBS. PER LINEAR FOOT 0 2" IRON PIPE FOUND PARCEL DESCRIPTI ❑N 0 1" IRON PIPE FOUND A parcel of land, located in part of 33, T30N, R19W, Town of St. Joseph, St part of Lot 5 of Certified Survey Mc at the St. Croix County Register of follows; _ 1 r Commencing at the NE corner of sal 3 along the east line of the NE1 /4, of - - -- N89 °20'17 'W, along the south line of'U --- RVEY M section, 93.34 feet to the centerline ------------------- 388.44 foot radius curve, concavePG. 2770 measures 29 °59'05', whose chord bears ------------ - - - - -- NE COR feet; thence northerly along the a -L IN * SEC 33 203.28 feet to-the point of tangent-------- - centerline, 135.44 feet to the SE corL__PG.__2 / Map recorded in Volume 10, Page 2770,6.01'2411W of Deeds office; thence N86 *01'24'W, c 33.48 - / + 33.48 feet to the westerly right- of- v curvature of a 1120.54 foot radius -- central angle measures 15 °50'54 ', whc_ C. �/ ^ . measures 308.96 feet; thence westerl o��0 F_; ;b r, the southerly line of a parcel desc wi �' nl� above said office, 309.95 feet to S78 °07'42"W, 8.58' feet to the southE I—I Survey Map recorded in Volume 12, thence continuing S78 °07'42 "W, along =! I w 275.22 feet to the most southerly c point of beginning; thence continuing cD_� N00 °00'00 "E, 110.20 feet to the weste ° UJ S36 °57'43 E, along said westerly Line,39.20'17 �'W I z beginning. Above parcel contains 0.091 subject to all covenants, restrictions 3.34 Q ` w Above described parcel to be sold to 31 cn o .� o I I, Douglas J. Zahler, Registered Wisconsin Land E1 4 COR that the above described and napped property SEC 33 Map No. 98 -103 under My direct supervision and that this map i Drawn By. ED FLANUM to scale of the boundaries to the best of My ' C- I t JUL 2 71998 6 K 4 A + ,.• a ST. CROIX COUNTY SURVEYOR'S RECORD 580929 MATCH LINE I (See Sheet 2) o0 Or o N V1 • 0 C ft W O (D m (n Q N � Ir _N j N 10 V F 11 - A rn ICS : -T%I No ``4� 303.03' ICn 0 O % IC b mow° ,� �c`, S00 °53'37 "W i3 1 - h IZ 'S 10 �cb . X% 0 1- O-- ir I—I % 'l,� Ir I� (D I — I f-- W IF--' I 0 1---i IkA U 0 00 !a O 6 � ^' i0 17v IN 1� ~ c �o r `� F O I %_n IC7 'C Ir o _ im O v N n Ir IC _ W N -1 1- p ICJ "J k.0 o N o a rn -� N m I� I IC/) I-h IC/) lJ1 N F,. E w o f n w 0� o N vl u' N IZ 13 0 rm = t, - p En (D C W y.6� O N J g �- Cb �\ O7 uo ~ O x,06 L 1 IVl ~ 6£ p I N ' O 99 li 9 W W 0� C 3u05�ZLo80S rr tri z ICn W z S i IF- m i 1 00 °' o IN i3 Ir rt � � -', H u, ° IO I- I O :3' T I _ I Ic7 rF W c I I o - Iv I — I (D ILO IC/) I-�1 F .............� �1 N I N II °V rrl w ^' i � I I m 10 I W t� N I m � 1 IN I� Cn 1 0 60TH STREET �-- �- _ _ --. (D 3 i I T _ m ' OD O 1315.98' z CM rn 1315.98 z W , r.� S00 °53'37 "W is N w° �, ; W ° S00 °53'37"W Z to , ° to :o "' ° East 1 i line of the NE1 /4 LOT 1 woo CD LOT 4 ;U 6_/_1_5_47 Bearings are referenced to the east W �' - C S M 3 / 758 line of the NE114 0o Sect��on 33 , 0 F, CD C.S.M. _ assumed to bear S00 53 37 W. fi 0 FJ. O W W rt O to C' `'f s l <' m o k• _ - c t LJ C N S { (:� O "O N .Z7 O O fD 7 t� [1 W O �" r^ ' 3."1 ,�1 -. w :ti C CD F O 7 7 7 7 C rz r- no to t3d :3 0 t1i : 2 - - C - ) -3 44 N ',, O '7 C C C Q 0. tJ F p ' CD O a ° 0 a a 0 tIj Ct N 7 E3 v 1 7 to O ' O O i ED 12 0 to -' y a J� � �� 12 1998 ,' o � Register H SHEET 1 OF 2 SHEETS Cron 00, K1 Vol. 12 Page 3467 � W JUL 2 7 1998 ST. CROIX COUNTY SURVEYOR'S RECORD This instrument drafted by Fran Bleskacek Proj. No. 96 -59 �r Bearings are referenced to the east ;� 00 line of the NE1 /4 of Section 33, PI assumed to bear S00 ° 53 1 37 "W. y rf' -. «• '.'!.' .:�.;. t ¢+ C (D •r; I xi b N. k n 0 H M ' 0 � n Oz s; txj O � t-n n� Z N LOT 1 0 M w o W o to z "� "� C.S.M. 8/2264 P. M W F, �- — Z M � O L � C O WNW o tZ 70 O w - , M `.� o O O I'--� (D T w O b.•+ 22 f����F C z NO3 009139 "E I m � v 320.44' - - f \ I ry - t• z M M Ln O < I—I Co v o i W 1� M - rnG trn -j ° • ° io IC7 61 m 1. o z 10� Ir' 3 CD � E o II-- IOC z � 12 l=i Its io N IN IC/) N N O ~ cn z O W o to - m OD F to to O C O 00 0-1- rt o N w a oo a o m 0 On W tn 0 P — w -h -n 0 -n Vl o It • ct • o z � � fD �"' ui IQ) In � z m a_° O 00 M I I-- ICS 10 0 o � 10 13 � to I- II � Ct o : o O CD W t1 m 0 N Z O C) p Fi ,�_ ___ ___ z Z O N Ln °N O W MATCH LINE w w l� _ " -' (See Sheet 1) H N ko 3 m ' 0 0 N � Oy Eim 0 n " -a �m 0 o = O , m M SHEET 2 OF 2 SHEETS Vol. 12 Page 3467 Parcel #: 030 - 1099 -10 -000 08/22/2005 09:44 AM PAGE 1 OF 2 Alt. Parcel #: 33.30.19.356A 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 - - ax Address: Owner(s): O - Current Owner, C - Current Co-Owner C O O - GUNDERZIK, MICHAEL R & TAMARA A MICHAEL R & TAMARA A GUNDERZIK 811 FOX TREE LA N HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 594 128TH AVE SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.700 Plat: 0688 -CSM 12/3467 SEC 33 T30N R19W NE NE BEING LOT 4 CSM Block/Condo Bldg: LOT 4 12/3467 ALSO PT LOT 5 COM NE COR SEC 33;TH S 00 DEG W 1315.98';TH N 89 DEG W Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 93.34';TH NLY 203.28';TH N 13 DEG E 33- 30N -19W 135.44 FT;TH N 86 DEG W 33.48';TH WLY 309.95';TH S 78 DEG W 8.58 ;TH S 78 DEG more Notes: Parcel History: Date Doc # Vol /Page Type 08/05/1998 584454 1346/70 WD 07/23/1997 1205/223 WD 07/23/1997 818/588 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.700 72,800 0 72,800 NO Totals for 2005: General Property 3.700 72,800 0 72,800 Woodland 0.000 0 0 Totals for 2004: General Property 3.700 72,800 0 72,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 030- 1099 -10 -000 08/22/2005 09:44 AM P 2 OF 2 Legal Description: cont. 9 P W 275.22' POB;TH S 78 DEG W 73.16';TH N 00 DEG E 110.20';TH S 36 DEG E 119.08'POB Safety and Buildings Division Coun5� '/ 201 W - W. Washington Ave., P.O. Box 7162 • 1 Iseonsin Maatsat WI Sanitary Perm' umber (to be filled in by Co.) Department of Commerce g)RM_1\j Z4 3 s�2 Sanitary Permit Appli a State PI I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal in do prod maybe used for secondary purposes Privacy Law, 15.04( p Pro' t Address (if different than mailing address) 1. Application Information -Please Print All Information ZONING OFFIC 7 Property Owner's Name I # Lot # Block # Property Owner's Mailing A ress Property Location /l y,, r /., Section 3 A _ JLv,, _ State ? Zip Code / Phone Number #� �! 1 715 - - 7CC T N, R�Ecle 9@e) IL Type of Building (check all that apply) Subdiuon Nt / SM Nu 7 A , or 2 Family Dwelling - Number of Bedrooms � T (y-L v V✓ h- l ❑ Public/Commercial -Describe Use ❑ State Owned - Describe Use ❑City_ ❑Village ownship of III. Type of Permit: (Check only one box on line A. Cemplete line B if appy le) A, XNew System ❑ Replacement System ❑ T ent/Holding Tank R lacement Only ❑ Other Modification to Existing Syste B. ❑ Permit Renewal ❑ Permit Revision ❑ Chang f ❑ Pe it Transfer to New List Previ P it u ed Before Expiration Plumber O r IV. of POWTS System: Check all that apjj 0 — O 10 —OOb • 356 ❑ Non - Pressurized In -Ground Mound > 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In -Ground ❑ Holding Tank ❑ P t ilter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber Drip Line Gravel -I s Pipe ❑ Other (e lain) n V. Dispersaffireatment Area Information: )C7 _ pps�i Design Flow (gpd) Design Soil Applicat n Rate(gpdsf) ispersal A R uired (sf) Dispersal Area Proposed (sf) System Elevation r < C� C VI. Tank Info Capacity in Total Number Ma facturer \ Prefab Site Steel Fiber Plastic Gallons Gallons of Units to �_ / Concrete Constructed Glass New I Existing Tanks Tanks Septic or Holding Tank ADO r) , Co / t Aerobic Treatment Unit Dosing Chamber / VII. Responsibility Statement- I, the undersigned, assu pousibility for in tallation o e POWTS shown on the attached plans. Plumbe�Name (Print) Si ature - PRS Nu r Business Phone Number Plumber's Address (Street, City, State, Zi e) t f VIII. Coun /De artment Use Onl Approved ❑ =Gi � Sanitary Permit Fee (i un ludes md Da Issued Issuin Agent Signature ( Stamps) Surcharge Fee) '7 -' ❑ L IX. Conditions of Approval /Reasons fo7n pproval SYSTEM OWNER: 1 Septic tank, effluent filter dispe rsal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applica41t; code /ordinances. Attach eomplete plans (to the County only) for the system on paper not less than 812 x 11 inches in size SBD -6398 (R. 01/03) 13M a = /oa l� Nom`- - 3 / sa ., ao y �6�y d og O G . g � Safety and Buildings 10541N RANCH ROAD co mmeree.W i.90V HAYWARD WI 54843 TDD #: (608) 264 -8777 s co n s i n www.commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary April 27, 2005 CUST ID No.220357 ATTN.• POWTS Inspector BRADY J UTGARD ZONING OFFICE UTGARD PLUMBING & HEATING ST CROIX COUNTY SPIA 110 KELLER AVE N APT 112 1101 CARMICHAEL RD AMERY WI 54001 -1034 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 04/27/2007 Transaction ID No. 1131064 SITE: Site ID No. 697354 Tami Gunderzik Please refer to both identification numbers, 60TH St above, in all comes ondence with the agency. Town of Saint Joseph St Croix County NE1 /4, NE1 /4, S33, T30N, R19W FOR: Description: New mound, 4 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1014673 Maintenance required; 600 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01) 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 Con di. i chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. 1 No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, A ,`� stats. RTMFM 0 OF SAFEf The following conditions shall be met during construction or installation and prior to occupancy or use: SEE CORRE` General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the' design manuals noted above. • 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. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. Key Item(s) • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. l � BRADY J UTGARD Page 2 4/27/2005 • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(1). Consult the Department of Natural Resources for well setbacks and exceptions to the setbacks. 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 /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 A(715) tallation, operation enance of the POWTS. cerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 ricia L rf WTS Plan Reviewer, , In t grate Services WiSMART code: 7633 634 -7810, Fax: (715) 150 , M -f 7:45 am - 4:30 pm pshandorf @commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 i e MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: TAMI GUNDERZIK Owner's Name: TAMI GUNDERZICK Owner's Address: 811 FOXTREE LN. HUDSON, WI 54016 Legal Description: NE 114 NE 114 S33 T30 NR 19 W Township: ST. JOSEPH County: ST. CROIX Subdivision Name: CSM VOL. 12 PG. 3467 Lot Number: 4 Block Number: N/A Parcel I.D. Number: N/A T.S. Plan Transaction No.: 630 - 1099 -10 -000 via IV Page 1 Index and title V RC Page 2 Data entry T AND B INGS Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications ;PONDEN Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 PLOT PLAN ) Page 9 soil test Designer: BRADY UTGARD License Number: 220357 Date: 04 /13/05 Phone Number: 715- 268 -6995 Signature: Designed ursuant to the Mound Component anual 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 3.11 (R. 06/01) Page 1 of 9 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 400.00 Estimated Wastewater Flow (gpd) Table 83 -443 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) caiform of <- 36 inches. 600.00 Design Flow (gpd) 16.00 Site Slope ( %) 97.80 Contour Line Elevation (ft) 24.00 Depth to Limiting Factor (in) 0.50 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 75.001 Dispersal Cell Length Along Contour (ft) = 8.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft 2 ) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest nt FY in the distribution Pressure Disribution Information network? Enter Y or N (c or e) C Center or End Manifold 4.00 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.188 Orifice Diameter (in) (e.g. 0.25) 2.50 Estimated Orifice Spacing (ft) = 10.00 ft /orifice 2.00 Forcemain Diameter (in) 75.00 Forcemain Length (ft) Does the forcemain drain back? Y 87.00 Pump Tank Elevation (ft) Enter Y or N 3.25 System Head (ft) x 1.3 12.23 Forcemain Drainback (gal) 11.55 Vertical Lift (ft) 46.75 5x Void Volume (gal) 2.40 Friction Loss (ft) 58.98 Minimum Dose Volume (gal) 17.20 Total Dynamic Head (ft) 39.32 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia, options choice in. dia. options choice 0.75 1.25 1.00 1.50 x 1.25 x X 2.00 x X 1.50 x 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information 800.00 Total Tank Capacity (gal) 1k Capacity (gal) 35.97 Total Working Liquid Depth (in) Manufacturer 22. 24 gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Inf ormation 800.00 Dose Tank Capacity (gal) Zabel Filter Manufacturer 22.24 Dose Tank Volume (gal /in) IA100 Filter Model Number WIESER Manufacturer Project: TAMI GUNDERZIK Page 2 of 9 Mound Plan View t 1 / B . ' observation Pipe 3 J W ••g• • F — 0 Q � , ............... L Mound Component Dimensions A 8.00 ft E 27.36 in H 1.00 ft K 10.23 ft B 75.00 ft F 9.25 in z 20.49 ft L 95.47 ft D 12.00 in G 0.50 ft J 4.60 ft W 33.09 ft 600.00 (ft Dispersal Cell Area 1 2136.42 (ft Basal Area Available 8.00 (gpd /ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 100.57 (ft) —� H 2 rriiirir,. G j F rt> -rrrr . Dispersal Cell 99.30 (ft) Lateral 98.80 (ft) — Invert Dispersal Cell Elevation E ' D' t '' ' '•. '.f••[ ' _!'.:.,. • .�:. _.],, 1.., ,��,;] 3 • ;ice {, - i. ~ ]. i. .' ' A A. • • . i, •' '] `i ']..4 AA 97.80 (ft) Contour Elevation 16.0 % Site Slope Geotextile Fabric Cover Shading Key T Dispersal Cell See lateral details on Q _ Topsoil Cap 1.5 ft 5 • . • . Page 4 for number, size, {5 ..,.. Subsoil Cap ° :•'r•r.r:'.� and spacing of laterals. ASTM C33 Sand `° �' :�''.' .:'r'' � F Laterals are equally • Typical • ] .. Tilled Layer c 0.5 ft Lateral., spaced from the 5 Aggregate a c : fir;;:; ?;5 I distribution cell's A '__ - { - centerline in the distribution cell (AxB). Project: TAMI GUNDERZIK Page 3 of 9 Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at ang point. Laterals are identical , P s •= Turn -up vWbal l valve or If X —+I+W2 I 02+I Laterals & force main of PVC Sch 40 oleanoutplug per COMM Table 84.30.5 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.188 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 36.69 ft Orifices per Lateral 15 Lateral Spacing (S) 4.00 ft Orifice Density 10.00 ft /orifice Lateral Flow Rate gpm Manifold Length 4.00 ft System Flow Rate taft gpm Manifold Diameter 2.00 in Total Dynamic Head Forcemain Velocity 4.02 ft/sec Dose Tank Information Locking cover with warning label and locking device and Electrical as per NEC 300 and -► sealed watertight Comm 16.28 WAC 4 in. min. Disconnect Tank component is properly vented iz; :.: E-- Alternate otrtlet location main diameter WIESER Manufacturer 2 in Ca aci 800.00 Gallons _t Volume 22.24 gal /inch A Weep Hole or anti - Dimension Inches Gallons B siphon device A 22.32 496.38 B 2.00 44.48 C F ♦ ump df e levation (ft) C 2.65 58.98 87.75 D 9.00 200.16 D Total 35.97 800.00 Dose tank elevatf 3" Bedding un er tank. Alarm Manuafacturer LEVEL Alarm Model Number DLV Pump Manufacturer GOULDS Pump Model Number EP05 Pump Must Deliver 39.32 gpm at 1 17.20 ft TDH Project: TAMI GUNDERZIK Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name UTGARD PLUMBING Phone 715 - 268 -6995 POWTS Regulator's Name ST. CROIX ZONING Phone 715 - 386 -4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1200 gal Maximum TSS 150 mg /L Soil Absorption Component Size 600 ft 2 Maximum FOG 30 mg/L Type of Wastewaterl 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 ins 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 every 1.5 years Mound Inspect 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 U. Lateral Long P Swee 90 or Two 45 Degree Bends Same Diameter as Lateral Project: TAMI GUNDERZIK Page 5 of 9 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, 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 fitter 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 fitter 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 fitter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution Svstem 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 9 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. Continuencv Plan If the septic tank or any of its components become defective the tank or component shall be operating condition pones repaired or replaced to keep the system in proper 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: TAMI GUNDERZIK Page 6 of 9 Goulds Submersible Effluent Pump 3871 EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. • Homes components. ■Motor Cover: Thermoplas • Farms Motor: Available for automatic and tic cover with integral handle •Heavy duty sump 0 EPO4 Single phase: 0.4 HP manual operation. Automatic and float switch attachment ' • Water transfer 115 or 230 V. 60 Hz, 1550 , p models include Mechanical points. • Dewatering RPM, built in overload with Float Switch assembled and ■ Power Cable: Severe duty automatic reset. preset at the factory. rated oil and water resistant. SPECIFICATIONS • EP05 Single phase: 0.5 HP, ■ Bearings: Upper and lower 115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing Pump: EPO4 built in overload with construction. • Solids handling capability: automatic reset. ■ EPO4 Impeller: Thermo 3 /4" maximum. • Power cord: 10 foot plastic Semi open design AGENCY LISTING • Capacities: up to 55 GPM. standard length, 16/3 SJTO with pump out vanes for • Total heads: up to 24 feet. with three prong grounding mechanical seal protection. " Canadian Standards Association • Discharge size: 1 NPT. plug. Optional 20 foot ■ EP05 Impeller: Thermo- • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for (CSA listed model numbers rotary/ceramic - stationary, three prong grounding plug improved performance. end in "F" or "AC ".) BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET _ stainless steel. 1° a� • Capable of running dry without damage to s 30 + components. — ► SGPM Pump: EP05 a 2sFT • Solids handling capability: 0 25 -- _. . /4 maximum, a 7 • Capacities: up to 60 GPM. _ • Total heads: up to 31 feet. U s 2 °' • Discharge size: 1 NPT. a Z 5 �7 Q • Mechanical seal: carbon—o t5 rotary/ceramic - stationary, BUNA -N elastomers. 4 • Temperature: ° EP05 104 °F (40 °C) continuous 3 to 140 °F (60 °C) intermittent. 2 EPO4 5 (� c <J�� ' 31 , 30 P 7 I ° 0 0 10 i 20 30 40 50 GPM z- ° 2 4 s a 10 12 ml /h CAPACITY 1995 Goulds Pumps Effective May, 1995 83871 l��f0 S c�..QsL 3 ' 1 BA f3 i3 - / L do g a -75 aa` S I 2 4 w isloonsin *1630 SOIL EVALUATION REPORT Dept of COw ww in accordance with Comm t)5. Wits. Adm. Cade Page 1 of 3 Division of Safety and Buildings Steep Sal Service, Inc. in clude. tw to: VON and horizon SL C i t not mnftd tal e x. �efe.ena In spa Plan nwst Point (BMA. direr�on and roix Oercent skrpe, sale a dirrsnsionc, north &now, and kialion and distance to neatest road. Parcel l.D. - Pdwaq�. 6 _ /C� / - /G coy PenrorrN s mar YOU Provide may be and for wwn"y purposes (h aW Lwx 2.15.ua (1) (m)). Reviewed By Dame Property Owrrar Ptoper(p �� Terri Gwxkrz* Ln Govt lot na NE1/4, NIE1I4. 533, T<JOht, R19W 811 f0ottrte Property b wnefs tttailing Address Lot* Bb* * Subd. Name or CSMI► city 4 na CSM Vol. 12, Pg 3467 state Zip Cale Phone Nurrrber City n village M Town Nearest Rood O^ WI 54015 1 7 15.381 - 5396 suoseph I 60Th St New Construction Use: Residential f Number of bedrooms 4 Code derived design flow rate 600 GPO U R&piaaenleni IJ Pnbic or convnercial - Oesoribe: na Parent material Pitted Glacial Drill Flood Plain elevation, if applicable na R �.- Mound design, system elevation 98.808 based on contouir line elevation 97.808. E �. 01OM Pk Ground surface •lev. 94.60 ,< oepttt to lirnitsg racmr 112 in. Appia6on wee Horizon Depth Dominant Color Redaoc SWUckwe onsistwoo in. Munsed Ou. Sz Coon Te,dure Boundary Roots 1 0 6 l0yr 3/2 none - oa<z sil 2msbk mfr cs lvf .6 .8 2 14-38 10yr4 /4 none sSki 2msbk mfr 6 na .4 6 3 38-52 10F4 /4 Pfd 7.5n5/6 Sid 2rnsbk mfr taw ne .4 .6 4 52-70 7.5w4/4 none $I 2msbk mfr . – - taw na .6 1.0 S 70.112 -_ 7.Syr4/6 rforte 51/15 2�bk , „a no .7 2.6 * n Bating m Pt Ground aurfa0e ekv. 94.60 fL factor Horizon ff Color Redaar Desc �Dn+ tO *� 32 in. Sal Appicaaon Rate Nl Ta+dure Slrttctrrle and Boundary Roals GPDAP Qu. Sz. Cont. Color _ 1 /2 none 'Friel . cs i 2 /4 none slid 2rnsbk - mfr -- — cs na .4 .6 3 32-64 10yr4/4 c2d 7.9yr5/6 Sid 2msbk mfr 9w rw .4 .6 4 6472 7.Syr4/4 c2d 7.5yr5/6 sl 2msbk mfr na na 6 1.0 I toll+ ant *1 = Bp0 s > 9p < �p my& and TSS >30 1 SO mgA- ' Effluent 112 =Epp E30 MWl and TSS S mglt CST Name (Please Print)Sgftapure CST 0S1ltd J. � Number Address – 2489.56 Staei s Sort swvice, Date Evaluation Conducted Telephone Number 994 200th St Baldwin. Wt 54M 415!2005 715- 760.0347 t Property Owner Tami Gunderzik _ PorcW ID x __. Page _3 _of 3 F31 Boring 0 I 1 Bonne I� Pit Ground surface elev. 93.50 ft Depth to i-OV factor 24 in. oil Apps RM Horizon Depth Dominant Color Radon Description Texture Structure C41 Boundary Roots WON in. munsell Ou. Sr- Cont. Color Gr. Sr- Sh. lim -pea¢ 1 0-12 10yr 3/2 none sit 2msbk mfr Cs 1vf .6 .8 2 12-24 1Oyr4 /4 none sid 2msbk mfr gw na .4 .6 3 24-39 1Oyr4 /4 c2d 7.5yr5 /6 Sid 2msbk mfr a na .4 .6 4 39 7.Syr4/4 Qd 7.5yr5 /6 si Om mfi na na 2 .6 s � 1 Boring Li Ptf Ground snxfaoe elev. R. Depth to Ymitinng hixor in. oil Appicstbn Rat Horizon Depth Dominant Color Redox Description Texture Strum" Cons' I Boundary RAOts GPDAF in. munsell Qu_ Sz cant. Color Gr. SL Sh -Eclat 'Eles2 F f �� U Pit Ground surface elev. R. Depth to lirn*v factor lo. Application Horizon Depth Dominant Color Redox Description Texture Structure Consislence Boundary Roots GPDIRe in. Mansell Ou. SZ Cont. Color Gr. Sr Sh. •Effret 'Etllt2 £fttuent *1 a 800 30 -c 220 mgrl. and TSS >30 < 150 m9A. ' Effluent s2 = ROD 1.30 my/L and TSS _30 mq& The Depaftai at of Coauneree is an equal opportunity service provider and employer. If you need assisumce to acorn services or need material in an alternate format, please contact the department ai 608 - 266-31 S I cr TTY 608 -264 -8777. sae sew nrmroo� sewers Sdn See110e. Lrc. STEEL'S SOIL, SERVICE INC 3 of 3 David J. Steel _ r/,tnr ;9u,7,& er2i'/v 994 20d' St. CST- POWTSM NE1 /4,NE1 /4,S33,T30N,R19W 11aldwiN W154002 Lic. #248956 Town of St. Joseph, St Croix Co. Cell.(715) 760 -0347 CSM Vol. 12 Pg 3467 Pax.(715) 684 -3449 Lot 4 Legmd N L " =40' ♦ = Benchmark Ele. 100.00 ft Top of 3/4" Steel pipe • = Alt Benchmark Ele. 100.00 ft Top of 3/4" Steel pipe •�-- ._-- _ � f �_ [3 =Borings Boring Elcvations �= B l - 99.60 ft B2 = 99.60 ft , // --� _ B3 - 93.50 ft rte rA _ _`` 0.00 ft G -o� c i1 flA5 , G 7' Z , �l w ��- �, NVI "sin SOI EVALUATION REPORT #1630 Department of Commerce in a ce with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings Steel's Soil Service, Inc. v Attach complete site plan on paper not less than 8% x 11 in a si . Plan must County St. Croix include, but not limited to: vertical and horizontal reference poi ion and percent slope, scale or dimensions, north arrow, and location an nearest road. Parcel I.D. t5� ` / o Please pi Reviewed By Date Personal information you provide may tm used frVjPYjEQ(Priv Law, s. 15.04 (1) (m)). Property Owner Property Location Tami Gunderzik APR 1 3 2nnq Govt. Lot na NE1 /4, NE1/ , S33, T30N, R19W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 811 Foxtree Ln ST. CROIX COUNTY 4 na CSM Vol. 12, Pg 3467 City Stat Zi I N City ❑ Village M Town Nearest Road Hudson WI 1 54016 1 715 - 381 - 5396 St.Joseph 1 60Th St Z New Construction Dce: ❑ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe na Parent material Pitted Glacial Drift Flood plain elevation, if applicable na ft. General comments Mound design, system elevation 98.80ft based on contouir line elevation 97.80ft. and recommendations: - Boring # [ Boring 3�5 ® Pd Ground surface elev. 99.60 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color *Eff#1 *Eff#2 1 0 -14 10yr 3/2 none A 2msbk mfr cs 1vf .6 .8 2 14 -38 10yr4 /4 none Sid 2msbk mfr cs na .4 .6 3 _ 3 S- 10yr4/4 fl 7d 5yr5 6 sic[ 2msbk mfr gw na .4 .6 4 52 -70 7.5yr4/4 none sl 2msbk mfr gw na .6 1.0 5 70 -112 7.5yr4/6 none SVIs 2msbk mf na na .7 1.6 Boring # ❑ Boring ® Pit Ground surface elev. 99.60 ft. Depth to limiting factor 32 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color *Eff#1 *EfW 1 0 -10 10yr 3/2 none sil 2msbk mfr cs 1vf .6 .8 2 10 -32 10yr4 /4 none Sid 2msbk mfr cs na .4 .6 3 32 -64 10yr4 /4 c2 7.55 r5 /6 Sid 2msbk mfr gw na .4 .6 4 64 -72 7.5yr4/4 c2d 7.5yr5/6 sl 2msbk mfr na na .6 1.0 * Effluent #1 = BOD? 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD <_30 mg /L and TSS S mg/L CST Name (Please Print) Signature: CST Number David J. Steel 248956 Address Steel's Soil Service, Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 4/5/2005 715- 760 -0347 I Property Owner Tami Gunderzik Parcel ID # Page 2 of 3 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. 93.50 ft. Depth to limiting factor 24 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 -12 10yr 3/2 none sil 2msbk mfr CS 1vf .6 .8 2 12 -24 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 1 t-39 10yr4 /4 c2d 7.5yr5/6 sicl 2msbk mfr cs na .4 .6 4 39-48 7.5yr4/4 c2d 7.5yr5/6 sl om mfi na na .2 .6 F-1 Borin Boring # Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Borin Boring # Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten--- Boundary Roots GPD/ft 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 -S_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) Steel's Soil Sefvioe, Inc. —_ 1 L91l£ aged Z t - 1 0 A h is, M w SLS3HS Z 30 T SHSHS � !$ � 0 °' 9661 z ! nrnr 7 0 O n C 1 ° W N C C C d p O - O 0 Is 40 4 04 C 7 O O O C T O C K ,�2 - -,.. .. 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O en o MuL£. £SO OOS N: 4J W O C/I> -4 - -- A CNI N� 1 0 • A 70 •--it :ZI cm W M1 OI 1 " 1 I CV I N '�•-•1N H `r % F - 1 C/N CA. _ LL .0 �' L111 sN 1 �� •- p ••- •• • " ' -• M -•• OIi Oi o 1 1 `JI C...�1 �•1 W � tnl .-fl Z U � UI 1 H •O CDI 508°12'5 " - r-/ L ! 1 66 W •. 1 NI -- - 39 4 98' Oo h '' 3 U 1O ` _ o+ 0 0 0 tT w z U O'It N N W ° °` P4 P' T r .� �i Z1 rrNi � m c- .n ?• o O 0 44 "^{ C/)1 �.. �•1 H �' N tT io N O Ln t l n ..CO- AI 4J UI Lf'lI y O < a �rZ Q o a —it 01 CVI �1 OI W dl NI atf "T-. .- 0� dl r-Il o�D pi m 11� F N C N JI • F-1 ..4 x Lfll 44 w O U Nj 06.L£. £SOOOS y % e t =1 _l 6 0 �� t., z UI w w ~�6 h1` to _ m •,OI R/ OI o 0 6�Su'� cn N JI Noo `� 23 0 0 B1 � T3 N W I Z N g1 U v N a r (Z 40045 eaS) SNIT HOS�d(nI G M y � 1 i i r • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address (Verification required from Planning Department for new construction) � City/State �� n S �.� Parcel Identification Numbe r 0 122 - 1299-1 0 -00 LEGAL DESCRIPTION i /V 1 /4, Sec. 3 3 . T 3 Q N -R�W, Town of property Location � � /4, S ubdivision ��S S� i� Lot #• Certified Survey Map # Volume Z Page # 3 y (° � • Warranty Deed # , Volume .3 S/<� 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 - The property owner agrees to submit to St. Croix Zoning Department a certification form,, signed by the owner and by a masterplumber, journeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal 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 Zoning Office within 30 days of the three year expiration date. cf ' V ,2 SI P DATE C�NA CANT 7 I (we) certify c t all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. / S p O L ANT DATE v 77 -7 j 4 *** y tha ' s- represented may result in the sanitary permit being revoked by the Zoning Department. of Deeds office, ** Include with this a cation: a copy of the certified map if reeference is mad in the warranty deed PY � STATE BAR o+ WISCONSIN FORM 2 - /Q82 wv*mmaWxmueD � 000u�swrwo �1���� ��°��' � �� �&�� ^' -~~ JL"��K�.~=~���(y � Thomas W. Se' aod �onna Mae Seim, R |�f���-M uoomao3 aou -------' ----- ------------------------'---- | � ,. 'l0�����l ' -- - ��-�����-'---- ' � � - . ----' - ----- '~ 3 ^^.°1; u=.u^ ,i=I'|lo°vw des, nbeu^x/'vj,e.o --79� ----------- ^"" _---___'- _'__ _-__- `^^"'� Slate tit -- � =" � ^ � part of wEI/4 Nol/4 and the Nwl/4 NEl/4 Sec. 33-T30w-R19W described as follows; Lot 4 of Certified Survey Hap recorded � in Vol. 12 of Certified Survey , Maps, Page -- ' ' �----- � 3467^ Doc, No. 580929. Together with --- '--~^ a 66 foot wide private road easement . as shown on said Certified Survey 'Map. � ' � � ` ^ , ` ! ^ ^ � --------` ^---- ---4+ � __---' -°° u=t---- 98 ` �u ' ThomasW.Se1m_��~~~~ M ae Seim ---- ---------- --- '��u ^' ' � ��u|��Tx�aziow kcK1v'0%`k'uuu�cxr . Thomas W. Seim State of w'.c^u`^" �� ' - Donna Mae Se- - ^,. � . Krio�nm` t Og1aud - --- - —'- ' _- o''' c�-�'--'��uu , ,m --------'- - - '---- - ' � ' ~ ^^�(�^ ,L!)v, Kristiva Oglmnd mwryp"*.�� �^-" - , m^ ` .ut'"^u/um"�a."^:.w°��u | r ,y 4 �. ' � Y µ M .. �� a � at 2 .yr t.i 580929 M7►TCH LINE (5se Shoot 2) C4 ro + mi.'s, IC•? : K ime ' ° +a �L yS SOO 53 -� t7 O Ir Mn 11 f` td ry R ..,, O 2i ib N d is ic� I IhJ �� r VI °-+ w w e � L N If J Ir icss O ro ( rt go `A t0. „l y 1 9fi' Sb --- — iN r t N fv, w w 3 eC71 i r t1d ; + s IF� + fCn 1 "J rTi ° u ItV i3 1 ICO 13' i l--• •• � � � � C I f IfV �� Illl ��"" " 1� hr 1 1� IN MEET M 1315 98t 500 "W w �.+ S 1315.98' e v1 • O SOO LOT 1 c i- i N East 1 f ne of the N EIA n a Cs :�: _ .0b. Y " - -- Bearings are referenced to the east at line of the NE1 /4 of Section 33. , assumed to bear SOVS3 to to DO w t JUN 21998� � 3 SHE I OF 2 SHEET w M GD Vol .12 Page 3467