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HomeMy WebLinkAbout018-1024-70-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes Privacy Law, s 15 04 (1)(m)I PermitHolders Name' City Village Township Hunter Davidson I TOWN OF HAMMOND TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic DosingPal I Holden TANK SETBACK INFORMATION TANK TO I PIL I WELL I BLDG I Vent to Air Intake RC1AD Iaepuc I> S29 r I �. �Q r I 3� Dosing t r u CI l PUMP/SIPHON INFORMATION PEW.W.1 Manufacturer a G ti I Model Number 2p / U TDH Li A. •l l Friction Loss lID System Head J �r 4s—s TDH Ft r Forcemain LeNI Dia tI Dist to Wel> 570 ev.0 �aecvtei��rtaew�-y��,r. DATA STATION BS HI FS ELEV Benchmark /t Alt B jkkK G Bldg Sewer :S 9s�3 St/Ht Inlet r � 93• SUHt Outlet D47 � a l S�yi 3- 24 Dt Bottom 1 (. I�I 599 y/ (• T3 Header/Man. 2 S r�� Dist. Pipe SD Z, cm l o Bot System N'D 34'a � Final GradeHt-C over ,cl 7" LS t.3 BED RENOFi NSIONS Width ®� Length � No Of ircwepeb �Q.�S PIT DIMENSIONS No Of Pds Insitle Dia it Depth SETBACK INFORMATION SYSTEM TO PIL BLDG WELL) LAKE/STREAM LEACHING CHAMBER OR UNIT M facturer Type Of System / / 5 Model Num DISTRIBUTION SYSTEM Header/Mando� 1 Distnbu0on / I f II I Pip x Hole?¢e /f x Hole Spacing Vent yo Av Intake` uV� .� l' Leng[h Dia 9s) P g i.� Len th Dia i� S acin /�Z Q.�Ji 2. 10 T""�c SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only yk I ---/'— Depth 9 e Depth Over xx Depth of 1a Seeded/Sodded n Mulched erTtl'Ferrter 'J [ n r ((,, w I Bed(Trench Edges hpsatl , -Z yes _' Na IXYes D No fill 4n<JJ ( COMMENTS: (Include code discrepancies, persons present, etc) Inspection #1 to " L- Inspection #2. Location: 200TH AVM � 6nT La, 2-1 1.) Alt BM Desch. = j//jj..�t�l-- 5tp [�� 1 0 2.) Bldg sewer length = 3 (�5 � t " �{•W�.� // I n -amount of/cover = 3G/1ti 3) 2S0 ,rtser5 &� to a,y�L. tt"11188&7I1fFFF--�%"�WtJ� L Plan revision Required? ❑ Yes No to / Z U other side for additional information. �D I ) 6710 (R 3197) Date Insepctors Signature r oM OT4*� Cert No 'fls�`� L u 4822 Madison Yazds Way Madison, W1 53705 s 1U� 2 P.O. Box 7162 Madison, WI53 -71 t ., Saaita>y Permit Application In accordance with 1(2), Wis. Adm. Code, submission of this form to the appr is required prior mstate­ownedto obtaining a sanitary permit. Note. Application fors for statewned PO 'TS we submitted to the Department of Safety and Professional Services. Personal information you pronde may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(l)(m), Stars. I. Ann6eation Information - Ple,aae Print All Tnfnrenatinn Permit Number (to be filled in by Co.) (le 3 3 97 b Zl )/CoG 7 - L dress (if different than mailing address) 107! Z�I " Property -ame �, / wkr 0AOCS01-. Parcel # -c e o v Property Owner's Mailing Address 10 7! ' o� Lt%d .S % Property Location l S3C� IZ. lei, l� Govt. Lot ,, '/.. N4ll '/., Section /Z T .? `i N R / E or(P City, State Xq 119 !!7 �v'Z Zip Code .$-'ele&e- Phone Number IL Type of Building (check all that apply) n1 m2 Family Dwelling -:Number of Bedrooms ❑Public/Commercial - Describe Use ❑State Owned- Describe Use AlLot -7 Zo ku-X, # Subdivision Name Block # City of I�village of L^!'own of /YQ n,i ren tJ CSM Number l�x"541, f fR/�Gr III. Type of PON17S Permit: (Check either "New" or "Replacement" and other applicable on tine A. Check one boa on line B. Complete line C if applicable.) A. ' [:]New System - 11., i �/ aeeplacement System Other Modification to Existing System (explain) ❑Additional Pretreatment Unit (explain) B' B [:]H.ldin Tank nln-Ground (conventional) [:]At -Grade Mound $ G r -� Individual Site Design Other Bn Type (explain) C. ❑Renewal Before Expiration8,J(?�, ❑Revision h ange of Plumber arensfer [o New Owner ovyj er-H List Previous Permit Number and Date Issued /�� W y pur �7 s• I /:,^I = 2/ Design Flow (gpd) Design Soil Application (g.pfd/sO Dispersal Area Required Dispersal Area Proposed (at) System Elevation (oC�n /,c^ QrT hoc? f5 �•OdSl LL �%,/7 Capacity in Total of Manufacturer Tank Information Gallons Gallons Units Milo— )5' 2's y � o $ u New Taws Existing Tanks r Holding Tac I / VS-C, 29C) 1 ' 1( Dosing Chamber 1 7,5­0 — i$'D 00q 6 O 0 V. Responsibility Statement- L the undersigned, assume respondbllity for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number 0Enn s P..'llr - 2/v7 1 ,f�6p'4G3-) 3.� z /4o" S i A,>-r I �r i Svuo / Approved ❑ Disapproved -7 p """•••e'•e` ❑ Owner Given Reason for Denial $ `?. oo g k U 1' Conditions of Approval/Reasaaafeov /( f( ` i +� 1 r .t. G �/b�q C st,•-f ! �'t SYSTEM OWNER; l -:: i:re efFjuept fisrlte and P ei I_ 44l fh�C p�rKr'�"' � -1 � d..:nesai rege npe to evl ed,melbypud 1. n.{ ! v�KdO/�t�U �- o: �,.,r rana.le n,ent plan pmvidW M plumber. �f r . ;A3 5yS�twl i9G 2rJ's:•tu tit rtpwremenls must be mOrdafRNtl a'1 `X� J 1 11,111able rederptmnentab: 5 Al Rw Sat4c- i-Ar.K Mus bC � ZS t fro g"[, N�.w Adl,nJ M� he. V rat 1.y` gtta�h 1 lete pla or the system and ss beat the County a ly on paper not 1 than s is x 11 inch ie size 1 k S IC`��' SV+^r0 -✓ewe nvt C.g6� Bk Sre L S✓vt Az?k Vito f � SB -6398 . �� �e su�r� �✓ow` lae Drl dewhSlE�G Sic � � r f t-rn•� Q fG' 1yR y Sro� "� F` y/4Al2L �j �mt1 4r'rS� k'.�i: 2ol DIVISION OF INDUSTRY SERVICES 10541 N RANCH RD HAYWARD WI 54843-W2 Contact Through Relay http Iltlsps.wi.gov/programstindustry-serwcee vnew wismnvn gov e - Tony Even -Governor Dawn Crim - Secretary July 19, 2021 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES:2023-7-19 Plan Review: PWTS- 072101667-C Dennis Gile 352 14011 St Amery, WI SITE: Scott Mortel 1071 200th St Town of Hammond St Croix County SW Y44 NW Y4 S12 T29N R17W FOR: Description: 4 Bedroom — 600 GPD —10" to limiting factor- Effluent Filter - Maintenance required. Mound Component Manual — Ver. 2.0, SBD- 10691-P (N.01/01, R 10/12) Pressure Distribution Component Manual — Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • The site shall be properly prepared prior to plowing. Any grasses longer than 6" shall be cut short and removed. To avoid matting, any leaves or loose organic matter shall be raked up and removed. Cut trees and shrubs flush to the ground and leave stumps. Avoid operating equipment on the Mound site. If necessary, use only tracked equipment, during dry conditions, with minimal passes, to avoid compaction. • Components and soil removed from an existing drain field shall be properly disposed of so that there is no risk to public or environmental health. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. • A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is operated and maintained in accordance with this chapter and the approved management plan under s. SPS 383.54(1). In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Joshua Rowley POWTS Plan Reviewer, Division of Industry Services (715)813-9111 Joshua rowlev@wisconsin.gov 2L Z/v 10 d APPLICATION! REVIEW 3y. Dcmplate all pages- _ $ - HOTS. Personal informatics you p1VAde may be uMod for a^cnncary nurposos [Privacy Le:vs '5041'%'Vn1 i] Plans to be E-fifed. Provide SharePoirt 'Jsor n-,c- Private Onsite Wastewater Treatment Systems c\95ion of Industry Services 'ter nice etr t:.c, oriole eui ',vabsite a,t I__ -- Several wunties have been delegated re; iaul aoil;nr;::; ic. •r;e^d o: a-. IIeU � "r Indunzly ,er.ices- Fora current list of those ocunt,cs and ihcir despna6on check our wcbsdt ¢�t 1. Project Information - Fifl in I known informaton. eroiect'site Name: C 0/ l / r 7r''- % C Location, Number S Sheet of projec roir unkaoc;n, inwcatec scores! -oac' Legal "If-srriplicn: ,S W County ❑city 71Village ❑ Torun of. 1,14 rylthCr 1 cf 2. After plans are reviewed, please. (check all t±iat apply; Confirmation or assignment to a reviewer- r; ns , cti 'n r_�•ims f: elated Trans. ID. Z;tirr.ated Completion Data. _ To vor oiFce of choice below -,avwar:- La Crosse, ^reen Say i' C Ga!I Ottsiomer 1, 2 (circle number?' ;?OT= 'G'e i eser: e the right to re -distribute plans to another office if Hequestntg party will pick uJ 'needed ?n rcasonahly halanna turnaround times Check for a:•:ulabtiity and nest available feView date ❑ Mail plans to customer 1. 2 (circle nu;nje;; ' i -P.erers is ous',asv.; r,m "e!e,c. 3" Complete thefollowing desionerlowneelrequestinn inro"llool ! If i:fe'no c'rark oo;r,s e: hei: Gasigner, owner or requesting parry is the same to avoid repeating information. Information (Customer 1) -i=V Or tnoPicas, 9pnciry Ep;ow (Customer 2) DSoS sr name -, e Lest Name /5, - Gustoner NumberNa 3sz i ye. sT _ City qq Slate :'ale zip-4 !n dipiF) tii Phone Number, E-mail address Ccl, phon: Nunvci mail address Cell phone i (area code) a,_"- :(JE, /oc—_7_ --- Check t: applicable -- �- -. - ---- 'I f• +� -� 4 :: is - or cpcc:f`, releuonsh,p i O.vner -i :• na L! U`her - specify :ela! onshg_ Information and Plan Submittal Checklist=. PO',!TE {.re-3-1.eduhnp Is tci a,a Jao!e. PIen5 trill be, asslyned to a Ieviet:Br after receipt at a DSPS office" Submittals recelveti!-lay by ?Ssicr'r'i -J 0"i:;.ES Sihet';^,ar ,hie ieC-IVI.^,0 office d'epelndinQ Cri reviewe(,31'Sh2bLlty Submittal checklists can be found in each apo!ica6lc- xmpo^_:�: :nano=.I app=au',p or: the PObd TS Pubimahcns pace. yo •- - _ u may email technical code questions 10 Hayward DSPS LaCrassa droa 65P� F 1 7541 N Ranch Rd i 3,;- r-cireidc :. ? Hayward VA5,1863 ,-r,', ;try;' 1 '15-Gad-4870 Fax: 715-034.5150 raF iiJ3-7bo °:; iti �cmati:CC_c„s c.wa_scr.c-d�.rferr�a for, �=mar:t _i:,"", '' - Make ChOCIM Payable to: Division of IndustrySer,dcea— nn Che�ic box to in voice designer a o Lin_ :: Designer Signature SPS-io577 (R 5,118) I Green Say DSPS 331 San Luis Taco Green Say, V.il 54304 y20�102-5'50 i max 920-492 6604 -- Snail: o rn,L AP/IOUNT DUE $ 2-CC Review Code 7633 5. POYM3UWrfTAL(Mecaall ma[apply- lmompletemrmsmaYImitlnpro-5smgGelay5. �N P cc me Tremm<nl Onn,,, - -- nOhlnr nnlD.-----❑Tnnk FDplaam<-=,Only-- -- - — RITLACEMENT Commerelal System ❑ :.: osintec n ua, Q n^d s+uvaM s.n•• 9Y9TEPA TYPE(91 NOTE- aupmlt aspu, eon, ....m nlhe anal smilr Pa. —_ ❑- innlston to previously opprwea plan a,<.na„•m,< .�_m:r_D„u, •!„p�•ayara,n'< 385.Do ❑ SBaeN121180Ut ReWmv (I.e replacemMt of a SepbC mpk. Addition of an effluent toter or pfolreatment dev!re to an existing tysmm, etc.) 5801hr Ya"'ovea �Camp<roM \Mln,nr '� IiaCln-� ...r , 375 �_ 4o::nnra me Vrxi01N1 rrr��r❑a..sttAI.prada Component umual -Ver. 20. Salo--10853 iPJ 03,31 F is it "a s:a"'alter .ro-r nj u �Irvgicund Ccrnponenl 6:a.1-Ye, 20. Sae 10705-P IN 01'0' 11 ^-121 _•:!':rs Pbf;a; necrnn .ySln. era 0occf1w crcpaaed tyslem Mwmd Component WnuM -Ver. 2.0. SBD 10391 P IN 0:01. R I0"=1 dg ❑onas,aa 0darbulon Ccvmm,,ant manim?-V.-Z0 S50-'07f>1 P N Dr,O' F. I, ill - �i�J c. rl... 5250001 El Omit. -plm=e .p••:h. .. - :.i?9 pit: $32300 '+'Tt-5T]naa ca00 CC I ❑ salt BaSetl lndrdduai 51te Oe5%n' ❑ At bade ❑ non-casunaet In-pnuma Pressul[W tn-oro0rm tdcuro' CiucraJ YJaNanJr ' l7CCUIr1Fn:aiM rms by IxOVItl¢tl Ic support Iraamssnt are: dii0a5a! dal.n'5 r ^ %?a2;t ;¢roman! Ivan0.: alienala ta. tho Amt-pand aXaM weir^1:nq co: anwn!c red, `^-s epn. a, ,<d.n+.91 papem. ..a.amh .dd.:. swl %r8a 1ac8:n85' ❑ IJa" Tank Oampcnanl 6fanual. ver. 20. SOD. m250.e a! C" C j pre.'rcuA: apprP'.Cd urea, s. Sp S ES-f0!2?a pl Jn Jaagnree,mrw^ hDn emponanl uar,. anal use of comaananlr :u;Xmr: arwwa ,ann., A Id l -.1,_.b DUI tlD;'n j �3s a-sle'::nler flc-. of Ihr. n:aacsed e,nlem -�P(` ut-:) pv- ,r bell SaeO !YJ 1C.;1-2 COD apt, SODOM Z �01-S 000 god STSO V, artt.w t^an 5 OJ?goo s:x�Go . ; s0 ee for e?cu gallw ova 50Y gpo Ila:omg li.,s pr l.Ir5:: i,pl: m'J '.Yonce, F 8aZ r)CGlr,n 32e In l�h: Cea,gn .axe,.nk-lfor of,h-. iae.:3'ef !::-'tl flCJatGG 64': 5a G.11im pv9 .a'. ' Nonmlale omaa Commareal and RaidditMod Bolding mn!s Ital wn,p,rcr ul r_ 0,,i zlanu;. arN Ira. an as8mxsd trey 0av of lase Ipan 3000 gaCans p•_r Ca: mrnl ce Ild.'nrven to A- -- a;,ropdnte go'.emmenlwf unit for re'nmv instead of Un, 0cpx;Cnen!. fsee Sn5 3-7 J213+.a' 5 Ow Opt, u•Irss 59000 enar- Qs6000 grea!e:.nan lo.DDO gpe 522500 ❑Holdng TaN: IptlIflf7V81Unit, :p!g0.945aa G,$ad I,J,.DC?y::,a:u!.af-- r.T� �"a%;nuW`Cs:r:'•.MIq S^.e G9'4'LCICe IenYS fIGT mmgled:.astt..xla+ em 1 a:Ip,-F ae;m:acjncers Sc5 H4ID t21 or!31 PlLese SpecdY _ t., 13eSSp '.a=;xv:M'er Oar or the DMICCe^. 3;'SIEm' .S t ell GO P Dor :n enuaen mxr ao.,..idea b mpnal 1.1 clI M. It wlall p COD 54= SM, 00 please meLrde all eels aDchcne. Iri mPar!s Icchtiw onpxq. Icaeorch ez:clvs - _ o e:Ow loan ,0 GOD 2p :-SU ci ❑ eD.l Snnaeun cli, m,nma, rtapn lulling eollllrvrnrrn l>pasl ❑inlsr ai:.:. er,e:,:..: U Capenmenlm eOsan fvo ame admounal Iter Sudolil le prlor approval from a cectton rhmf it required far a.Tilly rovlel^ ., .Idm ma rr:Dn,y .v, DD c t,dD-.- Inn a pnpritu.taw fat K dtuhle the nanrlal rawalv'ea SPS.10577rR t1151 ... -I--1ap^12,, narcais,, r tits lis-.0 act, T, en:e: Tolel rcorvJ^u !^ "le neDTec; :101181! weir. S w MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: SCOT MORTEL Owner's Name: SCOTT MORTEL Owner's Address: 1071 200 TH ST BALDWIN WI 54002 Legal Description: SW NW S12 T 29 N R 17 W Township: HAMMOND County: ST. CROIX Subdivision Name: Lot Number. Block Number: Conditionally APPROVED Parcel I.D Number: 18-1024-7--000 DEPT OF SAFETY AND PROFESSIONAL SERVICES Plan Transaction No.: DIVISION OF INDUSTRY SERVICES Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Y !d �!2 Inoex and title �'�` " ""i Data entry Mound drawings Lateral and dose tank SEE CORRESPONDENCE System maintenance specifications Management and contingency plan Pand specifications Designer: DENNIS GILLE License Number. 221471 Date: 06/29/21 Phone Number: 716-268-6637 Signature: Designed Pursuant to the Mound Component Manual for POVJTS Version 2.0 SBD-10691-P (N. 01/01: R. 10/12), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01181) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01, R. 10/12) Version 7.0 (R. 11/12) Page 1 of 7 Mound and Pressure Distribution Component Design Site Information c Residential or Commercial Design 400.00 Estimated Wastewater Flow gpd) 1.50 Peaking Factor (e 9 1 5 = 150% 600.00 Design Flow (gpd) 3.00 Site Slope (%) 95.00 Contour Line Elevatior) (ft) 10.00 Depth to Limiting Factor (in) 0.60 In -situ Soil Application Rate (gpd/ft`; Distribution Cell Information 75.00 Dispersal Cell Length Along Gontour (ft) _ 1.00 Dispersal Cell Desigr Loading Rate (gpd/ft�) 1 Influent Wastewater Quality ; l o, 2) Note Sand fiii (D) calculations assume a Table 38344-3 in -situ soil treatment for fecal colifonn of <= 36 inches F777T00 Cell Width (ft) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? 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. 0.156 Orifice Diameter ( n) 2.00 Orifice Spacing (ft) = 8 33 ft`/orifice 2.00 Forcemain Diameter (in) 80.00 Forcemain Length (ft) Does the Forcemain drain back? Y 85.00 Pump Tank Elevation lift, 4.551 System Head (ft) x 1 3 12 171 Vertical Lift (ft) 2491 Friction Loss (ft) 0.00 In -line Filter Loss (ft) 19.211 Total Dynamic Head (ft) Treatment Tank Information 1200.00 Septic Tank Capacity igal) HUFFCUTT Manufacturer Dose Tank Information 750 00 Dose Tank Capacity (gal) 12.77 Dose Tank Volume (galyin) HUFFCUTT Manufacturer 13.05 Forcemain Drainback (gal) F 67 44 5x Void Volume (gal) 80.49 Minimum Dose Volume (gal) 38 77 System Demand (gpm) in ilia. options I choice 25 x 1 56 x X 200 Gallons/Inch Calculator 750 00 Total Tank Capacity (gal) 47 00 Total Working Liquid Depth (in) 15 95gal/in (enter result in cell B49) Effluent Filter Information oolyiok Filter Manufacturer p1525 Filter Model Number Project: SCOTT MORTEL Page 2 of 7 Mound Plan and Cross Section Views 6 Mound Component Dimensions A 8.00 ft E 28.88 in H r—MN ft K 12.24 ft B 75 00 ft F 9.50 Ir- 1ft L 99.47 ft D 26.00 In G 0.50 ft ! ft N 29.71 ft 600,00 (ft") Dispersal Celi Area 1514.42 (ft`) Basal Area Available 8,00 1 (gpdtft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 98.96 (ft) G T H SF Dispersal Car! 97.67 (ft) Lateral 97.17 (ft)--►• — Invert Dispersal Cell Q Elevation E D 95.00 (ft) Contour Elevation 3.0 OA Site Slope Geotextile Fabric Cover Shading Key o n— Dispersal Cell See lateral details on or Topsoil Cap a a 1.5 ft Page 4 for number, size, Subsoil Cap m a I � T and spacing of laterals. Laterals are equally Q ASTM C33 Sand F Tilled La er I spaced from the ri. ft y n„rYP100118terEl a i distribution cell's © Aggregate < o + centerline in the A distribution cell (AxB). Project: SCOTT MORTEL Page 3 of 7 Center Connection Lateral Layout Diagram i' F'------' I S •=Tvr�-up•r.i lt•al: ,•ah.a or J�+ .i I _ _ . ;� 1:..,. Lat=1;+:[ _ rVr: 2r;ii aY'.`•r!-;;il F.r.., Number of Laterals Lateral Diameter Lateral Length (P) Lateral Spacing (S) Lateral Flow Rate System Flow Rate Total Dynamic Head Orifice Diameter Orifice Spacing (X) Orifices Per Lateral Orifice Density Manifold Leng1n Manifold Diameter Forcemain Velocity Dose Tank information Electrical as per NEC 300 and —"-'"0 SPS 316-300 WAC Tank component is properly vented HUFFCUTT Capacityl 75000 Volume 1 12.77 Manufacturer Gallons gal/inch Dimension Inches Gallons A 44.43 — 567.351 8 2 DO 25.54 C D Total 6.30 6.00 58.73 80.49: 76.62 750 00 Alarm Manuafacturer level alarm Alarm Model Number dvi Pump Manufacturer ZOELLER Pump Model Number N140 Pump Must Deliver 1 88771gprr. at 1 19.21 IftTDH Locking cover with warning iabel and locking device and sealed watertight 4 in. min. E-- Afternate outlet location Forcemain diameter ---1 2 in. Weep hole or anti - siphon device off elevation (ft) 85.50 Dose tank elevation (R) 85.00 Project: SCOTT MORTEL Page 4 of 7 Mound System Maintenance and Operation Specifications Service Provider's Name %;ILLE T RKING Phone 715-268-6637 POWTS Regulator's Name ST CR.OIX C T Y 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 40 , gpd Maximum BODS!E220 mg/L Septic Tank Capacityg-- gal Maximum TSS60 mg/L Soil Absorption Component Size 600 ft' Maximum FOG 0 mg/L Type of Wastewater Domestic Maximum Fecal Confornm0E4 cfu/100 mL Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Service Frequency Inspect andlor service once every 3 years Shouid inspect and clean at least once every 3 years Tes: once every 3 years Should test monthly Laterals shou,d be flusned and pressure tested every 3 years Inspect for bonding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials cen*orm tc Table SPS 384.30 have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384 :30 (6)(1;, Wis Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384. Wis. Adm Code- 4 Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent sod 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 l I i Distribution Long Sweep 90 or Two 1 45 Decree Bends Same Diameter as Lateral Project. SCOTT MORTEL Page 5 of 7 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance wrh SPS 382-84 Wis Adm Code and shall maintained in accordance with rts' component manuals (SBD-10691-P IN 01101, R. 10l12). SSWMP Publication 9.6 (01181), and Pressure Distribution Component Manual Ver. 2 0 SBD- 10706-13 (N 01/01, R. 10/12)) 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 SPS 383 33, Ws 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 seated watertight upon the cocpletion 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 t0 prevent accidental or unauthorized enty into a ianK 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 fitter 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 fitter 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 Titer alarms may indicate surge flows or an impending continuous alarm The septic tank shall have its contents removed when the volume of slid^ye and scum in the tank exceeds 113 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment maintenance personnel shall advise the owner of when the next Service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required However, if such products are used they shall be approved for septic tank use by the Department of Commerce Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years All switches, alarms and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound Plantings maybe 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 recommendec since sou 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 BODr. 150 mg/L TSS, and 30 mglL FOG for septic tank effluent or 30 mg/L BOD,, 30 ni TSS. 10 mg/L FOG. and 104 dirt o() mL for highly treated effluent Influent flow may not exceed maxmum design flow specrfied in the permit for this installation The pressure distribution system is provided with a fiusrnng 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 yvhen a oressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occuced 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 ponaing Pondmg levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic faiiure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of Is Components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump pump controls alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in As' present location by increasing basai area if toe leakage occurs ur 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 Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: SCOTT MORTEL Page 6 of 7 a PROJECTS 4154 123rd STREET µ N.P.C.A. CEHRED PLANT HUFFCUTT CHIPPEWA FALLS, VI 54729 g 1,250/]50 GALLON ' R C O n C R E T E. 'RC (715) 723-7446 : (8001 924-1516 v MEMBER OF: (U PUMP OR SEPTIC TANK FA% (715) 723-7ll1 xwr.huffcutt.con s WONAL k'W"SW PRECAST CONCRETE AS93pAnON6 4�F HUFFCUTTI ® i,1,250 750 ----fi- OUTLET (TANK BI I _ATION. ONS Tj 5' ➢IA. M OWS PoMN1 RE MNT a MS WN ! r 22 2C H 14 I .9 4 FA C r r w PI IMP PEFORMANCE CURVE MODEL 140/4140/145/4146 75 70 � 1 65 -- i I I so I t i 55 50 I � I 45 V- 40-- 1 i I � 35 25 i \ _ 20 j ! 'WN --------------- i 1 t ,o I 5 �- i 146) 1401 4146 4140 GALLONS LITERS 0 10 20 30 1 1 40 50 60 70 Uu 9u 3C5•?q- 80 160 240 320 INSTALLATION INSTtRUI l IP"251PLIA623 FILT INSTALL MOM IN97WUrmoms `Ai ta me aumn of the septic tank- (9) Remm tonk aavgr 911d PUMP t2nit It neeaggar,Y- MAINTENANCE INSTRUCTIONS tiQ 41ni LSE VLIfIVISING ,)NHEN.FILTER.k51iE IOVEt1 "r` i 1 � i 3tav z: MA) nafioro in--Wil'cn, plpCd Cm ier ifousing on to me Outlet NIOR (B) mw,% sure thaf>2e housing. is poadoned So rite niter C3It be mmwou frurr thv 11An1% PRr mointanank:s and 'mmp 2. (A) Remove tank cover and Pump if nacessary. (a) ?ufi Inc filter Out at he hoilsirir. (C) Fhao offer=nl;mr ovEr it:e se�.L'c L-anK Make Sure all Softciy fzj`- =c:r nfo the Scars S- (A) iI Dwa GuQ a filter f (15) Insan the finer housing, making a c rtddge is proper L'nmp1ewly lf"T W on the wtidgo In the 0 th0 IfEar 06gn®d and in the houoing. stop 3,- (A) Insert the Star grhidge back Into the the hou g mafdng sure rite nitdr is prop- alighed and aamplatew ad. (B) Replace septic n!t cover Dennis Gille/Jacinda From: Becky Mortel <blmortell @mmm.com> Sent: Sunday, July 25, 2021 9:15 PM To: gille@amerytel.net; Gille Trucking & Excavating Subject: Mortel house drawing Baldwin, WI Half Bedroom Bath room Bedroom Stairs Bedroom Bedroom Full E Bathroom °o Diningro.4m L m Kitchen c J Porch Becky L. Mortel 2nd floor Main floor 1 ST Cx IU#. NTY SANITARY SYSTEM FileJseOtrty - OWNERSHIP/ADDRESS FORM �r�t Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. OWNER/BUYER iNFORMATi M Mailing Address _ /02/ moo -r 4 5'4 " City/State/Zip Qt�, v'. tam 5-yoo2 Phone Number (required) -7 f 5-- �//3 / _ 7,96 ) Email Address (required) k'1u i Uiv.. Parcel Identification Number - 010-1021t- 9p.- C)oo _ (found on the property tax bill) Property Location LLa 1/4 , Subdivision Plat: 1/4 , Sec. I Z- T -!AN RLW, Town of _ _� e� o d Lot # Certified Survey Map # / 7volume. Page # Warranty Deed # l � 3 t0 � (before 2006)Volume Page # Number of bedrooms _ Spec house O yes Cko Lot lines identifiable Wyes O nc y� ONCE USE ONLY Property Address `�x1ST'c ' ) (Verification of new address required from Community Development Department for new construction.) (Staff tnitiats) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified surrey map if reference is made in the warranty deed. Community Development Department- Land Use Division 715-386-4680 St. Croix County Government Center 715-245-42SO Fax _qd �sLQILggv 1101 Carmichael Road, Hudson, WI 54016 wwwsccwi.gQV File #: ST Cfzo iulVTv SANITARY SYSTEM FOfficeile Use Only — OWNERSHIP/ADDRESS FORM crmt212o27 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be ent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the P -perty Files Scanned weblink. Owner/Buyer _ Mailing Address City/State/Zip _ Phone Number Email Address fir OWNER/BUYER INFORMATION /J G �.eGt/2 GJi r c5 Parcel Identification Number (found on the property tax bill) �l 1740 /$— IZV- 70 NEW SY EM: LEGAL DJ Property Location S 1/a , Ntv 1/a , Sec. /Z T Subdivision Plat: Certified Survey Map # Warranty Deed # W, Town of %1ati,.n e A #*� Vol 2006)Volume Number of bedrooms ��_ Spec house ❑ y B no OFFICE USE ONL New Property Address (Verification of new address required from Community (Staff Initials) / (Date) Lot # Page # Page # Lot lines identifiable O yes O no Department for new construction.) This form mXt be submitted with all Private Onsite Water Treatment System (POWTS) applications. New S ern: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified surve op if reference is made in the warranty deed. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd(@sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 wwwsccwi.00v �Sfi -a Qa Wisconsin Department of Safety and Professional Services i Page I of Division of Industry Services " X SOIL T _ O �_` Inaccordance with SPS 385, Wis. Adm. Code County 'j r Attach comp a site plan on BB��r'ry��,ftf�ss than 8 1f2 x 11 inches in size. Plan must include, I 1 but not limite to: verti�^�iddAzdntal referenc point (BM), direction and percent slope, Parcel I.D. �^7 scale or dimensions, ndRh arrow, and locSauon an distance to nearest road. I S -' O L,� ' / cam% (� -r U c J„c ��'Ple formation. Revjpwed b' Delta 18 2 t D j j �'1 it e Personal infonnati n e used for seconds purposes Pnvac Law, s. 15.04 1 m . Property Owner `, Property Location ❑ CC) r- -� � � Q 1.i, i` 4. �, Govt. Lot j(k j I/ i.r i % S � ,� T : ' G N R E (or) W Property Owners Mailing Address _ Lot # Block # Subd. I Nae or CSM# City State Zi Code Phone Number ❑ City ❑ Village ® Town earest Road BRLDLvI nl wr �Yoo;-� H!'lv Mop, D ❑ New Construction Use ® Residential! Numberof bedrooms Code denved design flow rate -f GPD �Replacerltent//tea Pu uc or coommercial-Describe: X Parent material V 1 1^/CJ Flood Plan elevation if applicable ft. General comments and recommendations 1 0 Leos 2 G " Sa Boring # ❑ Boring ip Pit Ground surface elev. Q�_ !.� „ Depth to limiting fa or lJ Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' 'Eff41 'Eff#2 -5 10 R 3 0 S; f Its w MI dw 2f Hr- _(0 2 5-lo �o�R z -S'1 I wp I rn( C-, S —Lq•CCb CLdS .S;f �.. 'SbK mfr Boring # ❑ Boring C J.Q I Pit Ground surface elev_.1 I lft. Depth to limiting factor `� in. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh Consistence Boundary Roots GPD/Ft? 'Eff#1 'Eff#2 I l()V e 'z s K Ml uJ f �o I -a5 !v. sow roFr - L� CST Name Qlease Print) Signature CST Number `� 2L 23�� cr cr rle Address S srrJ - h PSCeo la�T Date Evaluation Cod t d 9 / 'Z r (o Telephone Number 7f S 4r y d -Sly 0 SBD-8330 (R04/15) Boring # ❑ Baring pit U 1 i ® Pit Ground surfarz elev. _ R Depth to limiting factof In. Hod7w Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color I exture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ff •Efi#1 'Eff#2 / d':�rye, PsbY; _ i"r,? 44 W .yc .h 2 `/°( -YN Ist r, m VY) _ e , (o_ .8 -Zf3 ru yl� Czd s Rs/a �, 1-1 Boring # ❑ Boring ❑ PB Ground surface elev. —ft. Depth to Unniffng factor _ In. r . Horton Depth In. Dorninara Color Munsell Redo. D.s;ipton Qu. Az Cont. Color Texture Structure Gr. Sz Sh. Consistence Boundary Roots GPD/Ft' •F_ff#1 'Efi#2 ❑ Boring # ❑ Boring 0 Ph Ground surface elev. ft. Depth 10 grrriting factor — in. Rodox Description Texture Structure Consistence Ij Boundary Roots Soil Application HOAzOn Depth Dominant Color GPD/Fl� la I _ Mureell Qu. Az. Gon — I _ Gr. Sz.Sh. I •Eft#, 'E1 Effluent #1 - BOD, > 30 S 220 mg/L and TSS > 30 5 160 mg/L • Effluent #2 = BOD, > 30 S 220 mg/L and TSS > 30 S 150 mg/L �I 525 PRR�F� * �1- 70 VCIZT►cNI_ aM TOP OV- RETNIN/NG WALL_ = I CU O' = & AST bra IIoTTOMor SIDING ini' = O t--i t) \. 5 Q SNE n WELL Of, . 4&x RETAINING w NFL. ?123,,�3 —. --- --- -- -- — q 6 N�-R, 3�0 Hc)o e nGQr A/c un4 -- .ate--- C.s i lz Z2-,i-3NP-3 Sc- G1,4/-2I $6ro�X COUNTY�` 1aCCvu��� NO, 633876 STATE SANITARY PERMIT t 01 I 7,00*^ s+ A ^ PR�Q7d+SN� ` OWNER PLUMBER TOWN OF LIC.# 7-7-14 1 SEC_9T l* ' R /? E/ V AND/OR LOT BLOCK SUBDIVISION CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (e) The sanitary permit is valid and maybe renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. ISSUING OFFICER - DATE UNLESS RENEWED AIN VIEW ZI THAT DATE VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI1/20) li16111N11!gV%I� State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Number 11 Document Name THIS DEED, made between Scott J. Mortel and Becky L. Mortel, husband and wife ("Grantor," whether one or and Scott J. Mortel and Becky L. Mortel, husband and wife as survivorship marital ("Grantee." whether one or more) Grantor, for a valuable cons oration, conveys to Grantee the following described real estate, together with thel n[s, profits, fixtures and other appurtenant interests, In St. Croix County, tale of Wisconsin ("Property") (if more space is needed, please attach addendum)\orless {{�� ` A parcel of land located in the SW'A of Section 12, I:w7M111Q 29 North, Range 17 Wes[, St Croix Countn described as follows. Beginning on the West line of Section 12 ap1320 feet South of the NW hi existing fence line, thence East a 5 feet; thence South para th sMtd Section line a distance of 625 feeest a ight angles a distance of 525 feet; thence North a distance of 625 feless to e point of beginning Grantor warrants that the title to the Property 1s good, iyprope fee simple an free and clear of encumbrances except: easements, restovenants o record; highway and street rights of way, and Municipardinanc and agreements entered under them; and further except reafee in the year of this conveyance. The purpose of this Deedisto create survivorship mariDated�t AUTHENTICA Signature(s) authenticated on TITLE: MEMHE TATE BAR OF WISCONSIN (If not, by Wis. Stat. § 706.06) 1111S INSTRUMENT DRAFTED BY. Loberg Law Office, LLP Jens H. Loberg ck, STATE OF PIERCE COUNTY Personally came before ine named, Scott J Mortel and be the persons who e.eect ackDot ylcA—ge'the same 1083241 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI 06/18/2019 03:55 PM EXEMPT#:BM REC FEE 30.00 PAGES: 1 Recording Area Name and Rewm Address Loberg Law Office, LLP 359 W Marn SI / Ellsworth, w9 54011 Notary Public, State of Wisconsin My Commission expires 7/2/2021 Identification Number (PIN) This is homestead property ss. 17, 2019, the abov,Y, Mortel, to rttp ktTg'wJf�'tp, ire o' g4nst� L2nrj - v iLie, N< O O a .: o, j 1 e•rl i a,".. (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: I HIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANT}DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 , Type name below signatures St Croix County 1083241 Page 1 of 1 State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Number I Document Name THIS DEED, made between Scott J. Mortel and Becky L. Mortel, spouses married to each other ("Grantor," whether one or more), and Hunter James Davidson, a single person ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): SEE EXHIBIT "A" ATTACHED HERETO 1136791 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 08/12/202110:23 AM EXEMPT#: REC FEE 30.00 TRANS FEE 1,395.00 PAGES: 3 **The above recording information verifies that this document has been electronically recorded & returned to the submitter Recording Area Name ana Kemm Aouress Title One Premier Group, Inc 906 Dominion Drive Hudson, WI 54016 018-1024-70-000 Parcel Identification Number (PIN) This is homestead property (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrance except: Roadways, Easements and Restrictions of Records. Dated Julv 30. 2021 ffl r 7 (SEAL) � �— (SEAL) Scott J. Mortel Becky L Mortel" (Signatures maybe authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 Type name below signatures. File No.. 380,43 Page 1 of 3 St. Croix County 1136791 Page 1 of 3