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I P 7 ,FURMATION ommerce PRIVATE SEWAGE SYSTEM County: St. Croix n INSPECTION REPORT Sanitary Permit No: 42070 0 (ATTACH TO PERMIT) State Plan I No: rovide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 7� Name: City Village X Township Parcel Tax Midu, _ Krist I Somerset Township 032 - 2124 -70 -000 CST BM Elev: Insp. SM Elev: BM Description: Section/Town /Range /Map No: 10 6�0 / 0 tgh'! 1Vac. Vh'4 p 1 05.30.19.1115 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark /-� Sa -Z v�ls• "- 6 a - O Dosing A A L EM cb6 5 1; Cm✓ Aeration Bldg. Sewer 7S /Od Holding St/Ht Islet_ TANK SETBACK INFORMATION St /Ht Outlet TANK TO " P /L WE BLDG. Vent to Air Intake ROAD Dt Inlet Septic I , r C fyr� iAW Dt Bottom / r 7 Dosing I 11 He� r/g Mari 6 r Aeration Dist. Pipe - S. 1 66 - d Holding Bot. System 0 I O CL. 1 (� f 1. / r/ Final PUMP /SIPHON INFORMATION 3,5 Z. Manufacturer Demand S t C GPM S l" Model Number -, 1 0 l TDH Lift j F � ricti n Loss System H d TDH , Ft I Force iain Lengt h� Dia r, Dist. to well w � ` SOlt ABIbRPTION SYSTEM BED/TRENCH Width _ Length 7 No. Of Trgn hq es PIT DtMENSI o. Of Pits Inside Dia. � Liquid Depth DIMENSIONS 77 Q _"( SETBACK SYSTEM TO P/LW JBLDG WEL LAKE /STREAM ACH Manufacturer: INFORM ATION CH R OR Ty ,e Of Sy stem- ( p / > i /' T ,`� Model Number: DISTRIBUTION SYSTEM HeaderlMa ifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pies � N / ,5 2 [, � [ N Length Dia Length_ Dia •�C.— Spacing >?j Z `T SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center �'� Bed/Trench Edges Topsoil Yes [] No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:/ / 3 Inspection #2: jy / I l Location: 442 172nd Ave Somerset SW 1/4 SW 1/4 5 T30N R19W ( ) "� WI 54025 Chabre Lot 7 u Parcel No: 05.30.19.1115 � 23S fi /�- — II leu► �h 1.) Alt BM Description= S �'t'j te' C-0 , D U �� Y A ( t7��� 2.) Bldg sewer length = " �j * frS4 4"L/k, I Pt ` `� - amount of cover = wst-l�e 3 3 Plan revision Required? Yes VO � '03- Use other side for additional information. SBD -6710 (R.3/97) Date Insepctod Signature Cart. No. PLOT PLAN PROJECT Krist Midbrod ADDRESS 1351 Cottaae Drive Stillwater Mn 55082 SW 1/4 SW 1/4s 5 /T 30 N/R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/5/03 BEDROOM 4 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of nail in tree ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL •H.R.P. Same as Benchmark p SYSTEM ELEVATION 99.7' 5 OV Property Line Scale = /4" = 10' - 1 04 Area 15' Below ' System is to remain N �t� undisturbed Q. D 4% s lop 96, Well is to meet all B - 3 setbacks found in 98' M. Comm. 83 B -2 100 U Cu 7S' Combo B -1 Pro 4 Bedroom House Grading is to be done to divert run -off away from system Tank is to be properly bedded and provided with lockdown covers with approved warning labels r NCH LINE :E SHEET 1 p� 235.23' I • . N Ow l a 1 O' W e20.2a I I ® \� 0 w ... a N `W ..::'...... n r � tier• r � �. � + �: rZ y:: ��: �: �� : ::::.:.:.:.:.:�::���:�::�::::�: b �I I ►:��:: 1 I ............... �, •� cp v N N m I w . / L i AL �? Z Z m 33' W. z;i.;:::;:;:: 4i ::::::::: :::::::::.::::::::::::::::::::: � : * ' ::> N �� .�Jt 1,11 � iii i i♦ , i 1 11 • • . 11 '� • �i 1 ii1� i �� 1� •1 1 1 1 1 1 1 � � 1,11 i � 1 111 1 mill op OF /.�/ 4% > 1 - M ni .�.; amn 11 " ;///1/// • • / >. AS . i r �//, o f o rv , � J • j r Sakty=dBwk COMY 201 W Washinpon Ave., P.Q. Boot 7M N vis Macbon,WI 5707 - 7082 S�YFemftNomba(tobe5l�edjm OL) Department of Commerce Sanitary Permit App �°'°` � ,oa�� Bris.Adm.Ccde, PP D �� s7�d nWbe and forsocom%WpmpoaesF ,a1i.01(ixm) ptoDeaAddrraaGf mtwasa aadr�j L Application lAfGfnmtigu - Plem Print AUIaf wd Av-e— piopetty(vaer'sName O i X COUNTY Pstcei -1 i of Bioct Z0,1JING OFFICE G3�� o f (� - '�'�(r� T pmpertyownses Add= Pr°p°<h'L°a°°a Secdo, phoucNmober )J spa w 1 l II, of Busftg(dmx*an eat apply) r/ ` -- N■me Mink am or2 Family D - NmabcrofBedmma ❑ Pwmdco=uwcjd Dwc&euse ".4 8 x 7S' ❑softoweed— Doctmeum j i� " ❑CSY ❑via III. TZpa otpersaft (Check only ow box of JIM A. Complete JIM B RappRat U) A r O ❑ T kRepte --M0* ❑ odKCb4o ontuP�dsHoeSys�u B. O pomkRcaeaal pamkRW WD ❑ Q=VOf OPOmitTna8*rtaNew Harp avjouspamiRNm�baaeanmelrsaed BefimExpkmfm pae oamer IV. TVW of POWTS �+c -t�'�dc a8 that ❑ Naafi ft4=od /E1 > 24hL ofs aftWend O bfomd <24 bL efarimble sort O AtdirO& ❑ Siogte pas Scrod F§w ❑ Cbodmcftd 0 poeamti ea Bo CYaoad O -Toot ©P=I FMW ❑ Aaob= Traummt tb* O ltec =&Mg Smd Fo , - twat pater [1L=cbioXChmbw ODdP EI C' v "M ❑ ( V. `smlufffumAm N (stj SYstcmEkv� Apps. Db�ewt = ! � 7 6 � 7 a DesipSO m Told smba ff Soto Seed Fier Pb c VL Ta & U& GO= ofd aereoe Cossbwmd Gauss Tnks Tuft JI setGeargldss3'set Z AewldeTlntsopRu Daft VII. S�att - tk attlee slrara oa me atbKled ply Bbm�a'aNa�re() bps z B pfioneNwaber �7Zg�V pbmber'sAddrms �'► ) . U SBGWY ViII. 0 , Flee) Fbc bkcbKUs ) L s , 6 �a Q owmrGmm Reason fm Denid Cans ofApproVORraroos few �• vH S '4x'�/, , B s� d � c OJS 23 wo a N=taerec our fsrth'" "m e+ 6(/> I hp - SBD -639E (EL W02) Cl�-� Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 Visconsin www.vAsconsin.gov .vAs c onsin.gov .wisonsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary May 19, 2003 CUST ID No.226900 ATTIC• POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/19/2005 Identifieation Numbers Transaction ID No. 865770 SITE: Site ID No. 655991 Krist Midbrod Please refer to both identification'n 172ND Ave above, in all correspondence with the: agen Town of Somerset'_ St Croix County SW1 /4, SW1 /4, S5, T30N, R19W t 0 �t�p FOR: OF SAS Description: New Mound, 600 GPD Object Type: POWT System Regulated Object ID No.: 892637 Revision SEA GO 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. 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 "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10691 -P ( N.01 101) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10706 -P (N.01 101). • 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. Note • The bottom of the distribution cell shall be level per the Mound Component Manual. The "D" dimension sha ll be a minimum of 12 ". 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. y SHAUN R BIRD Page 2 5/19/03 • 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 installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 60.00 a Fee Received $ 60.00 Balance Due $ 0.00 Patricia L Shando POWTS Plan Reviewer, Inte ted Services �ViS ''MART code�i33 O,. �.nwrorxMMiwr„ azn. nu*ra,,. +�:�uai (715) 634 -7810, Fax: (715) 634-5150, M -f 7:45 am - 4:30 pm pshandorf @commerce.state.wi.us cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 5/5/03 Owner:Krist Midbrod Location: SW 1/4 SW 1/4 S 5 T30 N,R 19W Lot 7 Chabre Somerset System type: Mound System y Manuals Used: Mound Component Manual version 2.0 (01/31) Pressure Distribution Manual version 2.0 (01/31) t ' �Okct Page# 1. Cover Page ,ND�E 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7 -9. Maintance and Contigency plan 10 -12 Soil test Signature License number 2 900 5/5/03 PLOT PLAN PROJECT Krist Midbrod ADDRESS 1351 Cottaae Drive Stillwater Mn 55082 SW 1/4 SW 1/4s 5 /T 30 N/R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/5/03 BEDROOM 4 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of nail in tree ASSUME ELEVATION 100° Filter Zabel A -100 ❑ BOREHOLE (DWELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 99.7 t>� �d. 7 ��- 1 "-'!/ 250' 4zv . Property Line Scale = 1 /4 11 = 10' Area 15' Below Do- System is to remain ^� undisturbed o. D CD 14% Slop 96' Well is to meet all setbacks found in 98' B-3 B.M. ' Comm. 83 B -2 100 Huffcutt Combo B -1 Pro 4 Bedroom House Grading is to be done to divert run -off away from system Tank is to be properly bedded and provided with lockdown covers with approved warning labels LC.71b' 4Gi no r Date Non -Woven Filter Fabric 4" Observation Pipe Perforated Distribution Pope Below Filter Fabric P _ ASIM C -33 Sand G Topsoil __µ = == - -- f 1 -- ` � ti �i Slope Bed Of E��— 2 - Force Main Flowed Drain Rock From Pump Layer 0 1 Cress Section Of A Mound - Sys Using E A Bed For The Absorption Area F G / A Ft. H s s Ft. r �d• Ft.- SQO 3 Ft. L Ft. e krnui os rr W L 40bservolion Pipe--,,,. 0. ° A ` --------------- - - - - -- I Force Moin W 0— -- - - - --- From Pump Distribution Bed Of / — 2 k Pipe Drain RocK I 4 Observation Pipe Permoneril Morker Pipe or Rods Pion View Of Mound Using A Bed For The Absorptio Areo PAGE OF Perforated Pipe Detoit 0 1 i End V„ {Pertero +ed PVC P +pe o NO td On bottom. Ar E49611 Are EAudny gpocee -�' '-%A P • a £ PVC Force Moir 5 FtAST OOLL t"X"' -re Gonntc }�o t' PVC Moniiotd Pipe Distriou+son Pipe l tcr/L Distribution Pipe layout 7 .2 Ft. R Fi. X a?, Inches ` Inches Signed: Hole Diameter���Inch Lateral a Inch(es) License Number: Manifold_ Inches Date: Force Main " —�—�_ Inches # of holes /pipe / Invert Elevation of Laterals SEPTIC TANK S PUMP AND SPECIFICATIONS C1iAMBER CROSS SECTION NEArWRPR00F y ++ Cl VENT PIPE 12" MIN. AS OV E GRADE JUNCTION BOX APPROVED gg' FROM DOOR, WINDOW OR WITH CONDUIT MANHOLE COVER FRESH AIR INTAKE W/ PADLOCK 6 --WARNING LABEL FINISHED GRADE w" MIN. ` "K.w. sy b. 18" IN . N C.s. piN"fRt�►� � t, t8~ M1N• 1'Itt INLET ! GAS- WATER TIGHT SEALS - T - TIGHT, +. '�1pPR0iIfED A SEAL • ,DINTS WITH FILTER �_ LM 1N'PROYED PIPE • APPROVED -T- ON SOLID SOIL PIPE 3' C t ' ONM SOIL SOLID PUMP OFF ELEV . l � -FT T. D OFF 3" APP ROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOS E N UMBER DOSES PER DAX: � NU TANK MANUFACTURED r SEPTIC IZ� GAL. DOSE VOLUME FLOWSACKK: Ghl TANK SIZES: DOSE :n GAL. QAL- ^4 .2 A = o'L' � INCHES = Q ALARM MANUFAC l3RER: L g = _.?_ INCHES = GAL. MODEL NUMBER �, /�, n.e,r 1�GAL. SWITCH TYPE: _ C = 7 �,....., INCHES = �. MANUFACTURER: P /- PUMP MANY ER: j D = (� INCHES GAL - a ��- MODEL SWITCH UTY� � 16.23 wAC GPM PUMP t ALARM WIRING AS PER ILdiR E IRED DISCHARGE RATE PIPE FEET'S REQUIRED EET VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRII�TION s .. FEET j FT/ IiD FT T. • FRICTION FACTOR • - • FEET +MINIMUM F £T A'"' X — TOTAL DYNAMIC HEAD < �° WIDTH �L ; DIAMETER SIONS OF PUMt' TANK: LEWG1'ti �- INTERNAL DIMEN LIQUID LICENSE NUMBER = DATE: SIGNED: I /SS TOTAL DYNAMIC HEAD /CAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DEWATERING MODEL 152/153 w MODEL 152 153 50 Feet Meters Gal. Liters Gal. Liters 153 5 1.5 69 261 77 291 40 10 3.1 61 231 70 265 12 152 15 4,6 53 201 61 231 �g 20 6.1 44 167 52 197 30 25 7.6 34 129 42 159 8 30 9.1 23 87 33 125 ° 20 35 10.7 -- -- 22 85 0 40 12.2 -- -- 11 42 4 Lock Valve: 38.0 Ft. (11.6m) 44.0 Ft. (13.445) 10 014508 0 20 60 80 100 GALLONS 6 1/4 LITERS 0 80 160 240 320 - 3 27/32 4 5/8 FLOW PER MINUTE 3 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS _ • Tuned dosing panels available. ® 3 27/32 • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase ' systems. • Double piggyback variable level float sNntches are available for variable II Level long and shat cycle controls. ' • gear Qwik43ox available for outdoor installations. See FM1420. • Over 13O (54 °C.) special quotation required. 1 152N53 Series 12 /e 1 election F Volts•Plt Mo 5 t/a 115 1 Non lL5 1 2w3 115 1 Auto 8.5 ht 2 w 3 230 1 Non 43 1 2w 3 230 1 Auto 4.3 N►chrded 2w3 115 1 Nor+ 105 1 2w3 SELECTION GUIDE 81 115 1 Aub 10.5 Included 2w3 E153 230 1 Non 5.3 1 2 w 3 1. Single piggyback var"rabie level float switch or dot ble piggyback vanable level float BE153 230 1 Auto 5.3 Whided 2w3 switch. Refer IDFM0477. o CAUTION 2. See FMO712 for correct modal of Electrical AkemaWr E -Pak Ag installation of ewdrois, pin devices and +wiring should be dorm by a qualified 3. Vana* IwM Control switch 1"225 used as a Control activator, sped duplex (3) kneed etecMgan. Ali etecbical and safely codes should be followed including the rrwst or (4) float System recent National EWCW Code (NEC) and the oavpationid saf ty and Health Act (oSNA} RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL To. p o. BOX 16.'347 Lousn7e,KY 402560347 Maradaclurersof.. SRIP To. 3649 Cane Run Road L p l.ouisvik KY 40211-1961 JJ6QtlTY S. �vc1< /939 pttp;//twww.zaeil P f 504 778-273 A5 7744 -M4 rum ercom a Copyright 2000 Zoeller Co. All rights reserved. I Maintenance and Contingency Plan for a Mound System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Dose Chamber is to be pumped at the same time as the septic tank. 3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 4. Once every 3 years the mound is to be inspected via the inspections pipes in the at- grade. The laterals are to be inspected via the cleanouts. 5. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 6. Pump and electrical components are to be checked at the time of the pumping. 7. Owner agrees to leave the area 15' below mound undisturbed. 8. The owner agrees to save this plan. 9. Trees, shrubs, and other similiar vegitation are not be planted on system. The system is not be driven over. 10. Effluent Quality is not to excede the requirements found in Comm. 83 Contingency Plan 1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if needed, then bypass pump float and try pump without float. If this works, float is bad, replace float. If pump still does not work, check power at the pump with a electrical device such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is power, then pump is bad and needs to be replaced by a plumber. 2. If mound fails, determine cause of failure, test another area or remove pipe and sewer rock, retill soil, install new mound system. 3. Replace any other failing components as needed. Important Phone Numbers Plumber: Shaun Bird 715 - 246 -4516 Pumper: Tom Mondor 715 - 246 -5148 St. Croix County Zoning 715 - 386 -4680 Property Owner _ Parcel ID # Page of a Boring # ❑Boring �- S� j Pit Ground surface elev. '� ft . Depth to limiting factor � ,� m. Soil ligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 F Boring # ❑ 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/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 •Eff#2 F-1 Boring # E] 11 pit Boring Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mgll- and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If ou need assistance to access services or P 9 PP tY P Y need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD- 8330 (R.W00) . I Soil Test Plot ;Ian Project Name Krist Midbrod a it Address 1351 Cottage Drive Stillwater Mn 55082 TM #226900 Lot 7 Subdivision Chabre Da /5/03 S W 1/4 S W 1/4S 5 T 30 N /1319 W Township Somerset ❑ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of nail in tree System Elevation 99.7' *HRPSame as Benchmark Alt. BM Top of 2" Pipe @ 99.8' 250' Property Line Scale = 1/4" = 10' 1 V N CL D CD 14% Slope 96' 98' B-3 B.M. B -2 100 LS B-1 Alt. B.M. Pro 4 Bedroom House I Safety and Buildings Division County v// W 201 W. Washington Ave., P.O. Box 7082 , L r l x Madison, WI 53707 - 7082 Sanitary Permit Number (to be filled in by Co.) S�O1�Si�� Department of Commerce (608) 261 - 6546 O 7 D Sanitary Permit Application State Plan I.D. Number �} In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide S. - 4 - 9 1 11 5? 1 maybe used for secondary purposes Privacy Law, sl5.04(Ixm) Project Address (if different than mailing address) I. Application Information - Please Print All Information L1q �_ I - U- J, AH . X32 -212 o - QYX� Property Owner's Name Parcel # Lot # Block # r�l .�� /22 1 S 30 . Property Owner's Mailing Address roperty Location RECEIVED �- City, State Zip Code Phone Number ��* b Section 5.SG� FEB 2 4 2003 II. Type of Building (check all that apply) Z/�� or2FamilyDwelling- NumberofBedrooms ST.CROIXCOUNTY uubbddivt�si nName CSbiNumber ❑ Public/Commercial - Describe Use ❑ State Owned - Describe Use ❑City r la Towns o III. Type of Permit: (Check on a box on It A. Comp applic ell A. System y ❑ ❑ fa:nent S ent/I- Iolding Rep nit Only Modif n tsting System B. El Permit Renewal ❑ Permi evision El C of ❑ P . t sfe New ist Pre Permi Number and Date Issued Before Expiration Plu Owner IV. Type of POWTS System: (Chea all th 1 1'- Ca- LtJ S u1� - ❑ Non - Pressurized In- Ground o n. of suitable soil El Mound < 24 in. of suitable soil ` ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In and olding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter El Recirculating Synthetic Media Filter ❑ Llphing Cham Dip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Inform n: 6 4PU A-- 5 Z? Design Flow (gpd) Design Soil Applicat Rate( dsf) �� Dispersal Area Required (so Dispersal Area Proposed 0- 0 1 f) System Elevation �oO6900 1 0-F'; ( ° ' &co tax 910 s VI. Tank Info Capacity Irotal Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Ift1lons of Units Concrete Constructed Glass New Existing /Al- -`��' Tanks Tanks Septic or Holding Tank S Aerobic Treatment Unit [losing Chamber VII. Responsibility Statement- I, the undersign , a e responsibility for installation of the PO TS shown on the attached plans. Plumber's Name (Print) Plumber' i re MP/MPRS Number Business Phone Number Plumber's Address (Street, City,, Stoat /e', Z' 7 / 2 VIII. County/Departme Use Only Approved ❑Disapproved � C nditions of Approval/Reasons for Disapproval Sanitary Permit Fee (includes Groundwater at Issued mg nt Signature o Stamp-) Surcharge Fee) d/ 3 p ❑ Owner Given Reason for Denial � Q I ( � ,- ,•�.�t.� -�� O/�� !,� /�. p " in Myt, v ��G(tYt�/ i'►�U�J.tt ui /G� w..S-��.G ����v (2�2�n3 � ��.f� W /o i"4 !44_�- 4kavn dyv ��. C�yw. -» • �3. �f3— / Attach complete plans (to the County only) for the system on paper not less than 81/2 s 11 inches in size SBD -6398 (R. 08/02) ►' ...:> r. v• �� �.� � �� �. ��� � �;: ,. k '� t a^ ..� PLOT PLAN PROJECT Krist Midbrod ADDRESS 1351 Cottaae Drive Stillwater Mn 55082 SW 1/4 SW 1/4s 5 /T 30 N/R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 2/17/03 BEDROOM 4 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND xxx SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100° Filter Zabel A -100 ❑ BOREHOLE O WELL « H.R.P. Same as Benchmark SYSTEM ELEVATI 96.T B. M. ' Pro e ty Line Tank is to be properly bedded and provided 94 95 , Icy with lockdown covers 9 with approved warning labels B -2 -7 � 0 V cu Huffcutt Combo Tank cn Pro 4 Bedroom 6 % House Slope 0 Well is to meet all setback found in Comm. ce B-3 Area 15' Below 83 System is to remain undisturbed Grading is to be done to _ divert run -off away fu _ 1 from system 0 _ m Scale = 1/4 = 10' cD 1 11— q0 . 172nd Ave Safety and Buildings ' 10541N RANCH ROAD HAYWARD WI 54843 TD #: (608) 264 -8777 erc ,�cOans n www.wisconsin.gov .wis c ons .wisonsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary February 20, 2003 CUST ID No.226900 ATTN.• POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 02/20/2005 Identification Numbers Transaction ID No. 841589 SITE: Site ID No. 655991 Krist Midbrod Please refer to both identification numbers, 172ND Ave above, in all correspondence with the agency. Town of Somerset St Croix County SW1 /4, SW1/4, S5 T N R1 9W r FOew mound, 600 GP ' Object ype: System Regulated Object ID No.: 892637 a 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. 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 "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10691 -P ( N.01 /01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10706 -P (N.01 101). • 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, t he 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 Te owner upon completion of the protect. Note • The bottom of the distribution cell shall be level per the Mound Component Manual with a minimum of 12" sand fill per plans. • 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. SHAUN R BIRD Page 2 2/20/03 • 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 shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or Z634-5150, the POWTS. Sin a y, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 - Patricia L POWTS Plan Review r , ces (715) 634 -7810, Fax: (7 -F 7:45 am - 4:30 pm pshandorf@commerce.state.wi.us cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 2/31/03 Owner: Krist Midbrod Location: Lot 7 Chabre System type: Mound System i•T.S' Manuals Used: Mound Component Manual version 2.0 (01/31) Pressure Distribution Manual version 2.0 (01/31) cE j D p ILD Page# 1. Cover Page RESP0 ENG 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7 -9. Maintance and Conti ncy plan 10 -12 Soil test I Signature License number 26900 2/17/03 PLOT PLAN PROJECT Krist Midbrod ADDRESS 1351 Cottaae Drive Stillwater Mn 55082 SW 1/4 SW 1/4s 5 /T 30 N/R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 2/17/03 BEDROOM 4 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark SYSTEM ELEVATI B . Prope Line Tank is to be properly bedded and provided 9 4 95 I with lockdown covers 9 with approved warning labels - B -2 70 0 _0 CD Huffcutt Combo Tank r CD Pro 4 Bedroom 6 % House Slope a �0 Well is to meet all setback found in Comm. B-3 Area 15' Below 83 System is to remain undisturbed Grading is to be done to ` divert run -off away _ 1 from system 0 CD Scale = 1/4 = 10' CD g0,F 172nd Ave Designer so Date Non -Woven Filter Fabric 4" Observation Pipe Perforated Below Filter Fabric Distribution Pipe AS'M C -33 Sand 4 Topsoil _4 _ == -- -- G % 7' �j E STOPS Bed Of jg 2 t Force Ma . Plowed Drain Rock from Pump Layer Crass Section Of A Mound - Sy stem Using F E. �S A Bed For The Absorption Area G 7- A Ft. ti 1 ' T / lad Ft. j J Z' Ft. �pv�'Ir K�� Ft. i L Ft. ` k �n � 7- Ft: w 0 L 40bservation Pipe -� IE! JK 0 A 9 Force Main W cn i° - - --- -- - - -- _ - - - - -- From Pump - - -- 3 �. O Distribution Bed Of a pipe Drain RocK I \ 4 Observation Pipe Permanent Marker Pi pe or Rods Plan View Of Mound Using A Bed For The Absorption Area PAGE_ _OF^,,.- Perforated PiPf ()et*if �0 j End View C Perfororea i PVC P-Pe MOles located on 801 Are Equdny S �kQA 01.4[;C I R P+ ,�5 PVC f=orce A1Qaw i , FtRST tAO1.L ATWT VG C - ' 16 " 4 ' ;Or PVC morifotd Pipe �� s , f� OiSfriovi�on - Pipe 1 Gc r 2 �'t -/as - Distribution Pipe Layout P Ft R R. Inches Y Inches Signed: Hole Diameter Inch �° � License Number: : Lateral Inch (es) Manifold " e;� Inches Oate . Force Main " �- Inches I of holes/pipe Invert Elevation of Lateral /,--� Ft. rage Utz_ SPECIFICATIO SEPTIC TANK & rUMr C t {AMBER CROSS SECTION AND WEATHERPROOF APPROVED + Cl VENT PIPE 12" MIN- ABOVE GRADE JUNCTION BOX WITH CONDUIT MANHOLE COVER 2: 25' FROM DOOR, WINDOW OR Wl PADLOCK 6 FRESH AIR INTAKE WARNING LABEL FINISHED GRADE . MIN N S. D. le" IN. C.Z. aw i, l9 PItE INLET '• GAS- WATER TIGHT SEALS "�" TIGHT . A SEAL JOINTS WI F ILI ER ALM ApMROVEO 3 O APPROVED -f , ON SOLID SOIL PIPE ONTO SOLID 81dZFT. — t OFF SOIL PUMP OFF ELEV . D 3" APPROVED BEDDING UNDER TANK C049RETE PAD SPECIFICATIONS SEPTIC / DOSE NUMBER DOSES PER DAY: 5 TANK MANUFACTURER: TANK s IZES : SEPTIC 4 / 0 47 s . GAL. DOSE VOLUME FH�BACKx•. / L. _ DOSE GAL INCHES = J61' GAL CAPACITIES: A - ALARM MANUFACTURER: MODEL NUMBER: g = 2 INCHES = ..�_��____ GAL SWITCH TYPE: PUMP MANUFACTURER: � C = �•� INCHES = Io?� ��►I MODEL NUMBER. - y✓ D = INCHES x 1 D G A1 SWITCH TYPE: REQUIRED DISCHARGE RATE _� GPM PUMP 8 ALARM WIRING AS PER ILHR 16.23 w • - . FEET . F VERTICAL DIFFERENCE BETWEEN FEET PUMP OFF AND DISTRIBUTION PIPE ! F + MINIMUM NETWORK SUPPLY PR SURE . • ' ' l FEET + �_ FEET FORCEMAIN X � FT /100 F TOTAL I DYNAMIC A HEAD =• FEET A NK: LENGTH / iJ WIDTH t? ; DIAMETER DIMENSIONS OF PUMP T ii INTERNAL LIQUID DEPTH SIGNED: LICENSE NUMBER: DATE: 1/88 TOTAL DYNAMIC HEAD /CAPACITY HEAD .CAPACITY CURVE PER MINUTE EFFLUENT AND DEWATERING MODEL 152/153 La lz w MODEL 152 153 :2 L2 Feet Meters Gal. Liters Gol. Liters 153 5 1.5 69 261 77 291 12 40 152 10 3.1 61 231 70 265 15 4.6 53 201 61 231 _ 20 6.1 44 167 52 197 U 30 8 25 7.6 34 129 42 159 0 30 9.1 23 87 33 125 Q 20 35 103 -- -- 22 85 40 12.2 -- 11 42 4 Lock Valve: 38.0 Ft. (11.6m) 44.0 R. (13.4m) 10 014500 _ 0 20 4 60 80 100 GALLONS LITERS 0 80 160 240 320 6 1/4 3 27/32 45/8 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS 3 27'32 • Timed dosing panels available. • Electrical alternators, for duplex systems, are available and supplied vAth 3 27/32 an ala rn. • VariaMe level control switches are available for controlling single phase systems• r • Double piggyback variable level float switches are available for varable level "and short cycle controls. • Sealed Qwik -Banc available for ouldoor installalions. See FM1420. • Over 130•F. (54 °C.) special quotation required. 1511153 Series 12 1/6 152H53 MODELS CARRol selection Yodel Volts -Ph No N152 115 1 Non 8.5 1 2or3 51/8 BM52 115 1 Auto 8.5 tnduded 2or3 E152 230 1 Non 4.3 1 2or3 sx20e4 BE152 230 1 Aldo 4.3 hriuded 2or3 K 115 1 Non 10.5 1 2or3 115 1 A 10.5 4Kiuded 2or3 SELECTION GUIDE 230 1 Non 5.3 2or3 230 1 Aub 5 3 b 2or3 1 • �9� piggyback variable level floatwAlch or double piggyback Venable level Boat swilch. Refer lo FMO477. o CAUTION 1 2. See FMO712 for coned model of Electrical Alternator E-Pak AU insislta6on of controls, protection devices and wiring should be done by a qualified licensed deciricion. AN electrical and safety codes should be fonovred includtng #is most 3. Variable letrel cattrd slvitcl f 0-0225 used as a coned activates, specify duplex (3) recent National Electric Code ( NEC) and the Occupational SaIdy and Heatlh Ad (OSHA} or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. AML TO: P.O. BOX 18317 LorisftKY 4025 -017 AlsoWadwarsof.. SW TO.- 3649 Cane Run Road Lo isAe KY 40111 -1981 ZIW y pINM httpY)1 Cram ) P !O f5oa 77e2'a''' (aogs�sPr>A� FAX(502)774a94 0 Copvright 2000 Zoeller Co. All rights reserved. Winsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in Coun ty include, but not limited to: vertical and horizontal referen In F " Parcel I.D. W2 percent slope, scale or dimensions, north arrow, and locati n and a es' rroad. 0 32• Z( Cl 7 —X' b Please print all informatl n, (� (� evie Date �/ Personal information you provide may be used for secondary s (PnyA �64- v` -02 Q 4. a 7 3 Property Owner ST. CR X �81ty� l�n�a tlon / • / / ZONi gWEtti E 1/4 L�14 S T , R E ( ) Property Owner's Mailing Address Lo 7 # Block # Suub or CSM# City State p Code Phone Number ❑ City ❑ Village Town Nearest Ro i S (6-2-16461,1-12J- 07 New Construction Use: KResidential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement Public or mm erclai cribe: /Y Parent material y a Flood Plain elevation if applicable A,- /'4r ft. General comment AA and recommendations: a j h a ova - Gi'Ap bz d acre &'ez -- vYi o'' Boring M ng # V, Pit Ground surface elev / ft. Depth to limiting factor in. Sa'I Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF In. Munsefl Qu. Sz. Cont. Colo Gr. Sz. Sh. •Eff#1 'Eff#2 O- 2 LZ s , ® Boring # Boring a Pit Ground surface el—y Z — ft. Depth to limiting facto to Soil Application Rate Horizon Depth . Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Colo Gr. Sz. Sh. •Efr#1 •Efr#2 �1 2 Y, 3 z S , " AI J4 •Effluent #1 = BOD > 30 220 >30 < 150 mg/t. ' Effluent #2 = BOD < 30 mg/L and TSS 1 30 mg/L F (Please Print) Signature CST Number Address Date Evaluation Conducted Teleplibhe Number i Property Owner Il iel ST1 Parcel ID # 03 Z 7-12 70' Page of 2 # Boring ring �:it Ground surface elev. ft. Depth to limiting factor �0 in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 a 3Q S, 12 a Boring ° Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 E Boring # Boring ° Cl Pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description. Texture Stnxcuure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. sao.uw trt.rnoor Soil Test Plot Plan Project Name Krist Midbrod Shaun i Address 1351 Cottage Drive Stillwater Mn 55082 M #226900 Lot 7 Subdivision Chabre Date 12/31/02 S W 1/4 S W 1/4S 5 T 30 N/R 19 W Township Somerset Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post System Elevation 96.7' *HRPSame as Benchmark 1LAM Top of Survey Iron @ 96.2' 235' Property Line 94' 95' B.M. 96' B -2 180' 1Q p/ 6% Slope 80' -3 0 30' 50' Pro 4 Bedroom House 40 -moo B -1 a� a a �o 172nd Ave •014c 6niwi rMpartment of Commerce S OIL AND SITE EVALUATION Division of Safety and Buildings - Page o Bureau of Integrated Services in accordance wjt�f�Qrrlrt� 83.09;1iVis. Adm. Code ` County Attach complete site plan on paper not less than 8 1/2 x 11 inches Size Plan�rst - include, but not limited to: vertical and horizontal reference point M) 'directiori and E percent slope, scale or dimensions, north arrow, and location an distance ` to nearest road parcel I.D. # APPLICANT INFORMATION - Please print all information. Review by Date Personal information you provide may be used for secondary purposes (Privacy Law, s OV Property Owner Property Location' �' r v —j-- Govt. Lots, 1/4S� 1 /4,S ,� T3 p ,N,R (C� E (or� Property Owner's Mailing Address L'otv Block# Subd. Name or CSM# 0-N r::5, b9_E City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road seas (,sS I SgOJ6 (7)5 )5"/`f-67 ►^ r. t A New Construction Use: ,Residential /Number of bedrooms Addition to existing building E] Replacement C LJ Public or commercial - Describe: Code derived daily flow & O gpd Recommended design loading rate bed, gpd/ft __ trench, gpd/ft Absorption area required $5_7 bed, ft 7 S - C ) trench, ft2 Maximum design loading rate - � bed, gpd /ft ^trench, gpd/ft Recommended infiltration surface elevation(s) q 7 U C ft (as referred to site plan benchmark) Additional design /site considerations Parent material �� I Flood plain elevation, if applicable ,/��/¢ ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S Eg U ko S ❑ U ❑ S O U I ❑ S gf U I ❑ S �g U ❑ S 9t U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD/ft2 heo) 9 Texture Consistence Boundary Roots #z; in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench Lei 4 S L Ground 5 r elev. q q19 Depth to limiting factor S� in. Remarks: Boring # l © -fb• l0 Z Z Io - hD 6 — 5 L Ground elev. 6, to ft, Depth to limiting faMor , in. Remarks: CST Name (Please Print) signatur Telephone No. Address - Date CST Number 66 _5 (!!�6 o SOIL DESCRIPTION REPORT PROPERTY OWNER ���� Page Z of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 vr; in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench f io 3 S;� z er L F Z -z io 4 Ground O. R y /6 �• S H FR LS � Depth to limiting factor o __in. Z� Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # E Ground elev. ft. ' Depth to limiting factor in. Remarks: Boring # a? f Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) PAGE�OF 3 NAME LOT# - 7 LEGAL DESCRIPTION Scw ' /4Sw' /4 S 5 T acj N R /CIE (or) O SCALE: I"= 16c) f BM 1 ELEVATION ( 6 U BM 1 DESCRIPTION "z "� tai k wIF /o ff BM 2 ELEVATION BM 2 DESCRIPTION aoQ4 L "JOuc P:a��oFl.at a SYSTEM ELEVATION ! �• y t X ALTERNATE ELEVATION CONTOUR ELEVATION L7G • O . N. 3 a� SIGNATURE DATE b sT cRoix covN Y - CTANK -MAnnw UNCS AOREMONr . AND = Foiuvi TECATION HIP CBR OVVNBItS 4 )wnmSuYcr y''l 55682. r,�_ itt A d&vo - ftwaty �ve�aaan &M PI Dvutmmd new ) So,� wP parcel Identification Number 3 4 1. S c tyxtate i S Lu' ^�►� �RgCRIP1�ON 2 1 C / , W, Town of Locate Lot Subdivision � r .� . Vobimo . Page # Cued SwveY Map # -. - wanarty Deed # 6 �� Vow j # S house 0 Lot litres ideatifiab Y� 0 3310 P� bnpogmwe audma �7 c i f r y a p� W Yw� bw*e tmkemythwc of flee sepfic tads as a fteauncit ~ in due waste cm affed &C farm, sib by Se owmr mod by a M PM Pcrw -� , � aab®omt so St: Zoning Dom a c . _ tbat(i)tlrewasysbem is in propcz veaft coodbim wdlbr M a W pee wwwdivow sysmnwi& fire ww&tds home �d �e abmre t agpee to of c3oaon�s����g,�,o,�,�e afw' fay. us'tbe mmcbe��a�dt dOSOS.Cum oo g Or wAm 30 g your &P of 8see year Z / ) r c DATE r SIGRATM OF AYPUC.AM OW Tvx" �R gj�e,TI0N our �,wlodge. I (are) am (me) the ownu(s) Of -- on this form ate tma ft but of my ( ) Sh%at I b of a w wamty deed m ` of Deeds Office- dw=lml DATE OF A S iUE$ �'PLI that � mgy result in the say pcmg b mg wvob- -d by the Zoning D in s.ss*s A faamoahon deed f rom the of Deeds OW ss Include with this appikatlow a wed survey if n�tux is made m the wanauty d eed " POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pam_ jot FItE INFORMATION 4 SYSTEM SPECIFICATIONS Owner t Septic Tank Capant jl .S .�' a l 0 NA Pertffdt #. d 0 0 Septic Tank Manufacturer NA DESIGN PARAMETERS Efliuernt FMer Manufacdrner 13 NA Number of Bedrooms Etter FMer Model a NA Numlw of Commercial Uric Pump Tank CapadW gal ❑ NA Es timat ed flow (average) Pump Tank Manufacer JI ❑ NA I Design ►(per (E8*TwW x 1.5) Pi:n* M=dgctUrer ❑ NA Sol Application Rate Pump Model 1 8^11 2- D Influer�Efftttertt Quality Montt>ty average' Pralrealment Unit NA F ats, 01 & Grease (FOG) --.30 mglL 0 SandlGwet FRw ❑ Peat FRw Biochemical Oxygen Demand (BOD 5220 mg/L a Mled»ical Aerabon ❑Wetland Total Solids (TSS) 5150 a n tion ❑Other. Maunufadur+er Pretreated Effluent Quality MOnthlY " Dispersal Cell(s) Rioclornical Oxygen Demand (1300 S30 mg/L ❑ IrKp and Wavily) 131 (pressurized) Total Suspended Solids (TSS) 530 mg/L O At-grade and Fecal Co6form (geometric mean) 510 du/100ml ❑ Drip.4ne ❑Other Maximum Effluent Particle Size K inch diameter values typical for domedlc (n«� .— wastewamr and sepgctankalrWent. •• Values typical for pretreated wnftw dw MAINTENANCE SCHEDULE Service Event Service Frequency Insp cond'ubon of tank(s) At least once every O months >e6ear(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume insped dispersal cell(s) At least once every ❑ months s) (Maximum 3 yrs.) Clean effluent fdw At least once every a months . s) Inspect pump, pump controls & alarm At least once every a months s) o NA Flush laterals and pressure test At least once every 3 ❑ months s) 0 NA odor. At least once every 0 months 13 year(s) o NA over a months a 13 NA At once every Year( s) MAINTENANCE INSTRUCTIONS InspeWons of tanks and dispersal caft shall be made by an kjWdual =yi<ng one of the following licenses or CNWCBW= Master Plumber. Master Plumber Restricted Sewer. POWTS Inspector. POVM Malntsirw, Septage ServlcftOperator Tank inspections must include a visual inspection of the ferdc(s) to iderWy ashy missing " Woken hardwar% klenbfy any cocks or leaks. measure the volume of combined sludge and scum and to check for arty back up or pondirng of effluent on the ground surface The dispersal cel(s) shall be vlsualy inspected to check the effluent levels in the observation pipes and to check for any pond"ung of effluent our the ground surface. The pondiing of effluent on the ground surface may mftate a failing condition and requires the immedlate notification of the local regulatory authoritY- Where the combined accumulation of sludge and scum in any tank equals one - third (X,) or more of the tank volume. the entire contents o the tonic f shall be removed by a Septage S9 Operator and disposed of in accordance with ch. NR 113 Wisconsin Administrative Code. The servicing of effluent filters. mechanical or pressurized POWTS components. pretreaWnent components. and any other mehlenance or monitoring at intervals of 12 months or less small be performed by a certified POWTS Maintainer. A service report shall be provided to the brat regulatory aufhorily within 10 days of completion of any service event START UP AND OPERATION For new construction, prior to use of the POWTS check , treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal CAP). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shad not occur wtwn sol'condfi re ons a *oxen at the infiltrative surface. P' 9 e 7, or 7 / 9 f �+ PAP i may fill above normal lug r&-Aw levels. When power is restored the excess wastewater will be discharged to the etspetsal cal(s) in one large dose. overloading @he cel(s) and may MSW in the bac tip or surface dbdugp of aMpM To avoid this sdua6on have the contents of the primp tank removed by a Septage Servking Operator pror b restoring power b the effluent pump or contact a Pluantrer- or POWTS Lftitainer to assist in 1118MM dy opereti[g the ptanp Controls to restore normal levels within the pump tank Do not drive or park vehicles over tanks and disperse! cells. Do not dire or park over, or otherwise distwb or Compact, the area within 15 Beet down dope of any mound or at -grade sol absorption area Reduction "elimination of the following from the wasteurAer stream may Improve the performance and prolong the fife of the POWM anW)WW babyv -gganetta condoms; cotton swabs; degreasers~ dental Ross: drape drslnfe fat fount al;on dialn (stoup pump) vrate; fns and vegetable peehllrgs; gasotln mr g herbicides; meat meftdlons; at Oibft PmdntK Pte: sanitary napkins: tamrpons; - and water doltarter biw ABANDONMENT VVIM the POVIfi'S tads and/or is pemhanently.takean out of service the Mowing steps std toe taken to kmsute that the systern is properly and safety abandoned In complia with ch. Comm 83.33. Wisconsin Admirdstrative Code: • AN OOV to tanks and pits dug be disconnected and the abandoned pipe openings sealed. • The contents of all taNcs and pits shad be removed and property disposed of by a Septage Servkfng Operator. • Ate pumping. all taroks and pits shal be excavated and removed or their covers removed and the void space tiled with sok graved or anodw Inert solid material. CONTINGENCY PLAN If the POWTS Pals and cannot be MP8hW the following measures have been. or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utT¢ed for the location of a replacement soft absorption system. The replacement area should be protected from disturbance and compaction and should not be infrlged upon by required setbacks from existing and proposed shuc Lure. lot Oros and weds. Failure to protect the replacement area WE result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules In effect at that time. ❑ A writable replacement area Is not available due to setback and/or soft limitations. Bering advances in POWTS nology a f wk ft tank may be installed as a last resqftV replace failed PWM. •i idvo ' of e m a nit as resort to toe the fail OVVTS. nil and at -grade sod absorption dystens may be reconstructed o pie Mowing removal of the biornoi at the Infiltrative surface. Reoornstructions of such systems must comply with the rules in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT.. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER A POWTS MAINTAINER Name Name Plante SEPTAGE SERVICING OPERATOR EYMMM LOCAL REGULATORY AUTHORITY Name Agency Phete ..-� Plane This doct nest vas drafted by the smQs or ire GPM t.atre. Marc Mfr and Worsham county Zoning and Sw*aGm a9 Me 1 Thb doe meat meets the n**man m*bwnents or tit. Comm 8322(2 XIXd)&M and 83 -WI), (2) b (3). Mfboonski A*nkd ra#m Code. Use of tlds doawmA does not guarantee the performance of the POWTS. GMW (it) i . r TD (o Maintenance and Contingency Plan for a Mound System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. (IMAA,, 2. Dose Chamber is to be pumped at the same time as the septic tank. 3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 4. Once every 3 years the mound is to be inspected via the inspections pipes in the at- grade. The laterals are to be inspected via the cleanouts. 5. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 6. Pump and electrical components are to be checked at the time of the pumping. 7. Owner agrees to leave the area 15' below mound undisturbed. 8. The owner agrees to save this plan. 9. Trees, shrubs, and other similiar vegitation are not be planted on system. The system is not be driven over. 10. Effluent Quality is not to excede the requirements found in Comm. 83 Contingency Plan 1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if needed, then bypass pump float and try pump without float. If this works, float is bad, replace float. If pump still does not work, check power at the pump with a electrical device such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is power, then pump is bad and needs to be replaced by a plumber. 2. If mound fails, determine cause of failure, test another area or remove pipe and sewer rock, retill soil, install new mound system. 3. Replace any other failing components as needed. Important Phone Numbers Plumber: Shaun Bird 715 - 246 -4516 Pumper: Tom Mondor 715- 246 -5148 St. Croix County Zoning 715 - 386 -4680 I U 1907i' 228 DOCUMENT No. STATE BAR OF WISCONSIN FORM 1 -1982 68 X 273 WARRANTY DEED I REGIST H. WALSH T ER OF DEEDS j ST. CROIX CO,, MI Th is Deed, made between .......................... ............................... RECEIVED FOR RECORD 06 J= o. b S... ,. ... JQAtl son . ............................... 2 9: AN ........................................................................... ............................... .. NARARNTY DEED .................................................................... ............................... Grantor, EXEMPT # and ... Kris -t., dbx gad ... JOnni.fer..Midbrod,...huaband. REC FEE: 11.00 a,nd._ s, urvivszr.ah. l.p.. mar. iZ.al... pr.operty .............. TRANS FEE: 173.70 COPY FEE: ...... Grantee, CERT COPY FEE: _.. ...... ............ ............................... 1 Witnesseth That the said Grantor, for a valuable consideration...... PAGES: ...................... ........... . .................. ........................ ....... II conveys to Grantee the following described real estate in ..5.T.f .... C.rO_i..X Stillwater Title CO County, State of Wiaconain: PO BOX 206, Stillwater, v of 7, Plat of Chabre, Town of Somerset Tax Parcel No: 03Z- 21.24-70-400 St. Croix County, Wisconsin I I i I it This Is nOt -.- . homestead property. (is) (is not) I Together with all and singular the hereditaments and appurtenances thereunto belonging; And �I warrants that the title is good, indefeasible in tee simple and Tree and clear of encumbrances except j and will warrant and defend the same. Hated cnia . .... . day of ...._.._...laY... Z00.2. .................. ....I.....- ...I ............... ............... ............................... ......................(SEAL) 1. (.... lr!CS�i ✓.••.........'. — SEAL) • .......__...__ ................ ............................... .CQb...S•...J.Gn s.............................. ............................. ..............................( SEAL) ............ ............................... .........................(SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature (a) ....................................... I.................... STATE OF IM16268>NK Min ne�ota ................................................ ............................... aa. W4.$.h1.17St QD ......... County. authenticated this ........day of ........................... 19...... Personally came before me this ...Z th....day of _............_ .............._...._....... ...............,.............. . ..Ma.y.,.... 200 .2 ................... X9[....... the above named .,Jacob S, - _s ngl,e..person TITLE: MEMBER STATE BAR OF WISCONSIN .................................. ................................ .... ................ � ([f not . ....................... ...................... ............................... authorized by $ 706.06, Wis. State.) to me known to be the person ............ who executed the foregoing ins me t and ackno edge the same. 'I THIS INSTRUMENT WAS DRAFTED BY / / - 1 1 •... David M. Newberg, PO BOX 206 . .... ........................................ ............................... . - St - i t l water T ... MN 55-08. Z .............................. ......................... ... .. ................. ................................................ ............................... N c ••••••• only, i (Signatures may be authenticated or acknowledged. Both MY n is �e a expira are not necessary,) dat NOT PUBLIC -=N li � .. Commbslorc den. -84 :2996• •, 19.........) •Names of persons sisnina in any capacity should be typed or printed below their signatures. WARRANTY DEED STATE n RA OF WlaCO IN Wisconsin Lend Blank Co. Inc. N.