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HomeMy WebLinkAbout032-2181-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix ' Safety-and Building Division INSPECTION REPORT Sanitary Permit No: 515257 GEYV06L INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: city Village X Township Parcel Tax No: tY 9 P Warner, Lawrence J. & Susan I Somerset, Town of 032 - 2181 -20 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: /dQ 9M I 6-01 01.31.19.1544 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. !^ , Zd /CID • /n, Septic Benchmark LAJ F; l /C OQ Z. oc, fOz ice, Dosing k / Alt. BM < Bldg. Sewer F ;' I c� � c� EC. y, StS �l S • 7 Holding St/Ht Inlet / 3lp `t g'� \ TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Ve to Air In ke OAD Dt Inlet V _ La— Septic �;,56 7$ /5 Dt Bottom Dosing 7 79' / Header /Man. Z 060 I V. /Y Aeration Dist. Pipe Holding Bot. System O� Z, 97. S PUMP /SIPHON INFORMATION Final Grade Manufacturer U GP Demand St Cover / ` �.5 $ G L G , T 7 Model Number �1C / / �Z. 9 ✓ �• �� y� TDH Lift ` �� Friction Lo System Hea �� TDH Ft Forcemain Lengt f I Dia. IJ Z - 78 Dist. to Well / SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of enc PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS -7s SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Ct J / ✓ CHAMBER OR / S7 UNIT Model Number: DISTRIBUTION SYSTEM e ' Header /Manifsld / Distribution / x Hole Size i I x Hole Spacing It, VAir Intake Pipe(s) / 3 _ ,/ 1 Length 3 Di Z Length 37.5 Dia Spacing 3 $ ZZ /� '^�� SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only f G Depth Over Depth Over xx Depth of xx Seeded /Sodded d Mul hed Bed/Trench Center Bed/Trench Edges Topsoil � I P+ Yes 0 No Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / 77_'5 Inspection #2: Location: 2320 76th Street SOMERSET WI 54025 (SW 1/4 SE 1/4 1 T31 R1 9W) Woodland M adows 20 Parcel N 01 31 191544 1.) Alt BM Description n �/v / I 2.) Bldg sewer length = 7 b � r ` ,s '�' d w (,�"' - amount of cover D t/` a.QX• �. O C.r S D u�, Plan revision Required? 0 Yes >(No � � - 1 ? Use other side for additional information. C ___�__)1 ' Date Insepctor' Signatur Cart. No. SBD -6710 (R.3l97) ' $ Safet a s Division County commerce.wi.gov y nd Buildings 162 .S'f • �� X 201 W. Washin isconsin 4 162 Sanitary Permit Number (to be filled in by Co.) Stau Tra aetion P'� Sanitary Permit A placation /�G `�'// In accordance with s. Comm. 83.2 10). Wis. Adm. Code, submiss n of thor�it tt aatc goy rnmental unit is required prior to obtaining a sanitary permit. Note: A plicatton nrms for state•nm.ned P vTS arc I project Address (if different than address) ��- x d fnr condar. �� submitted to the Department of Commerce. Personal informs ion yo r �/ ��� p urposes in accordance with the Privacy Lamy, s. l S.n� I m , $tat 1 0 I. A lieation informilti n - Please Print All Inf iati parcel a Property Owner's Name 4a/resoL'" :7 44&-e .. / - 26-600 Property Owner's Mailing Address / Property Location / , / �� 2 32v � �� Govt. Lot City. State Zip Code Phone Number S(y v.. � ' /•. Section C circle onSj 4IY�� y bV J D 2 T 3 1: R E o ��S(J Ii. Type of Building (check all that apply) Lot x Zv Subdivision Name nr 2 Family Dwelling - Number of Bedroom / LN • tAk Block ++ �� A ❑ Public /Commercial - Describe Use ❑ c1 %I of / C$M Number ❑ Village of ' C) State Owned - Describe Use 75 Tom.•n of r J 111. Type of Permit: (Check only one boa on line A. Complete line B if applicable) A. I ❑Other Modification to Existing System (explain) New System ❑ Replacement System ❑ Treatment /Holding Tank Rep acement Only e _ B. C1 Permit Renewal Permit Revision ❑ Change of Plumber ❑ Pctmu Translcr In �'cmm List Previous permit Number and Date Issued Before Expiration '�• Owner 17 Tv e oC POWTS System /Com ome'hUDcyice: Check fill that a Iv C. I] Non-Pressurized In- Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in of suitable soil Mound < 24 in. of suitable soil / ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) a V. Dis ersal/i'reatment Area Information: Design Flow (gpd) Design Soil Application R. pdsf) Dispersal Area Required (sl) Dispersal Area Proposed 0 System Elevation / al�c ` 4 -7 co 750 1 97 S0 ✓ \r1. Tank Info Capacity in Total M of Manufacturer Gallons Gallons Units .0 N u U New Tanks, Existing Tanks !� n V N N y v a Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned, a3sume responsibility (or installation or the PO\VTS shown on the attached plans. Plumber's Name (Print) bar's Signature MP /MPRS Number Business Phone Number r / PI Plumbers. Address (Street, City. Stale. Zip Code) I- f 3 ��d��.�.� Gvl Sya� 3 V111. ount e nrtment,Usc Onl Approved Dtsa d Permit Fee Date I sued Issuing nt Signal e ❑ iven Ras Denial ns • a r vat [X. Condih aso for Dls pp o �/� � r �f qrt, ,t Rent Per and 3) C.�r�a f7orad • � 1 dispersal cell must all be services / maintained W1,{ ��; g e,r+�•. • �" '. as per management plan provided by plumber. 2.: AX !s**Clc•regW [ethertts must.be maim ai ned t Auaeh to complete plans fnr, the system anti submit to the County only on paper not less than a IA s I t inches in site I SBD -6398 (R. 01/07) Valid thry 01/09 0 �i 1 � 1 N f 1 �a Safety and Buildings 141 NW BARSTOW ST FL 4TH commerce .Wl.gov WAUKESHA WI 53188 -3789 Contact Through Relay �scons�n www. commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Aaron Olver, Secretary October 19, 2010 CUST ID No. 267985 ATTN.• POWTS Inspector MICHAEL J MYERS ZONING OFFICE NORTHLAND PLUMBING INC ST CROIX COUNTY SPIA 2943 130TH AVE 1101 CARMICHAEL RD GLENWOOD CITY WI 54013 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/19/2012 Identification Numbers Transaction ID No. 1864804 SITE: Site ID No. 756440 Larry Warner Please refer to both identification numbers, 2320 76TH St above, in all correspondence with the agency, Town of Somerset, 54025 St Croix County SWl/4, SETA, S1, T3 IN, R19W Lot: 20, Subdivision: Woodland Meadows FOR: Description: Mound, 3 bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1284488 Maintenance required; 450 GPD Flow rate; 29 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /O1), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 /01); Effluent Filter 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: This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD - 10691 -P (N.01 /01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD - 10706-P (N.01 /01). In the event this soil absorption system or any of its component parts malfunctions so as tope ?4th hazard, the property owner must follow the contingency plan as described in the approve lans. fka, 0IP' o� must comply with the operation, maintenance and monitoring duties as described in se ion V��l component manual. A copy of this information must be given to the owner upon completion e proJ�t F f�.. y All holding/treatment tanks are to comply with Comm. 84.25(7)(a). Op 'P Maintenance information ust be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the fi - for cleaning must be provided per Comm 84 product approval conditions. MICHAEL J MYERS Page 2 10/19/2010 A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Julia Lewis - Osborne POWTS Reviewer 2 , Integrated Services WiSMART code: 7633 (262) 397 -6005, Fax: (608) 283 -7481 julia.lewis @wisconsin.gov Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. "Construction business" means a trade that installs, alters or repairs any building element, component, material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the delivery of building supplies or materials, or the manufacture of a building product not on the building site. For further information, go to our website: www. commerce. wi. uov/ SB/ SB- BuildingContractorProgram.html 1 1 Mound System Cover Page pa 1 of 7 RECEIVED MIESER CD ®CRETE OCT 12 2010 SAFETY &BUILDINGS Project Name: Warner -mound Owner's Name Lary Warner Owners Address 2320 76th St. Somerset, WI 54025 I Legal Description sw • %, se v Y4 Sec 1 T 31 N, R 19 w _� Township Somerset County Saint Croix �' Subdivision Woodland Meadows Lot# 20 ParcellD# 032 - 2181 -20 -000 Table of Contents p9- 1 Cover page 2 Mound Sizing Calculations 3 Pressure Distribution Layout and Dynamics 4 Dose Tank 5 Management and Contingency Plan 6 Plot Map 7 Pump Curve total # of pages: 7 Designer Name: Michael J. Myers j MP /License #: 267985 Date: 10/9/10 Ph. #: 715 - 265 -4115 Signature: q �� Mound System Design Methods Used d ? per "Mound Component Manual For Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD- 10691 -P (N.01/01) -X) G Q o �F per" Pressure Distribution Component manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD- 10708 -P (N Q1l0 acs Spreadsheet provided by: 3bAdvisement N12486 220th St, Boyceville, WI 54725 Ph: 715 - 843 -6068 email: 3ba@ Corn Mound System Page 2 of 7 ' Mound Sizing Calculations Project Name: Wamer -mound Site Conditions Design of Entire Fill Project Type: i or 2 Family Dwelling Cell depth at upslope edge (D): 18.0 in. % Slope: 3 % Cell depth at downslope edge (E): 20.2 in. # of Bedrooms: 3 Distribution cell depth (F): 9.5 in. Depth to limiting factor. 18 in. Cover thickness over edge (G): 6 in. Absorbtion rate of fill material: 1 gal /ft /day Cover thickness over center (H): 12 in. Absorbtion rate of in -situ soil: 0.6 gal /ft /day End slope width (K): 10.2 ft. Effluent quality Efr #i I Iv I Fill length (L): 95.4 ft. Max BOD effluent value: 220 mg /l Upslope width (J): 7.7 ft. Max TSS effluent value: 150 mg /l Downslope width (Toe) (1): 9.9 ft. Fill Width (W): 23.6 ft. Design of the Distribution Cell Basal Area System Design Flow: 450.0 gal /day Basal area required: 750 ft Distribution cell width (A): 6.00 ft Basal area available: 1193 ft Distribution cell length (B): 7 701 ft Area of Distribution Cell: 450.0 ft Observation Pipes Contour Elevation of Mound: 96.00 ft Location from end of cell (Z): 12.5 ft System Elevation of Mound: 97.50 ft Final Grade of Mound: 99.29 ft Mound Plan View (]bservation Pipes W K Distribution Cell A T B k—K I Tilled AreaJFll Material L ' Mound Cross Section Final Grade Observation Pipe Synthetic Fabric H G Distribution Cell System Elevation a F 1 Cover Materials 3 Fill Material Invert Tilled Area 1 —Slope ` ``— Forcemain System Contour Notes: Fill material to consist of ASTM C33 Sand Distribution cell aggregate to comply with Comm 84.30(6)(1) Synthetic Fabric covering on cell per Comm 84.30(6)(9) Distribution Cell to have minimum 6" aggregate below lateral and 2" above. Mound System Page 3 of Pressure Distribution Calculations Project Name: Warner -mound Lateral Layout Lateral /Manifold Design Lateral elevation: 98.0 ft Lateral diameter. In. Rows of Laterals: 2 • Lateral spacing (S): ft Manifold type: center • Lateral to cell edge: 1.5 ft Orifice diameter: 0 .125 • In. Lateral discharge rate: 8.24 gpm # of Laterals: 4 System discharge rate: 32.95 gpm Distal Pressure: 5 ft Manifold diameter: 2 • In. Lateral Length: 37 ft Manifold length: 3 ft Orifice Spacing/Distribution Forcemain Friction Loss Orifice spacing (X): 22.77 Inches Forcemain length: 80 ft Orifices per lateral: 20 Forcemain diameter: 2 • 1n. Avg. fe /Orifice: 5.63 fe Friction loss in forcemain: 1.845 ft Lateral Side View Manifold Lateral Lateral x x x x x x x x x x x x � 2 Lateral Length Lateral Length Lateral Plan View Lateral Length Turn -up w /ball valve or cleanout plug n o S 0 v Orifices on bottom of lateral equally spaced with PVC laterals and forcemain to comply w specifications per Comm 84.30(2Xe) Facemain connection via tee or cross to manifold at any point Clean Out Detail Observation Pipes Clean -out plug inal Grade or ball valve Water tight cap or plug Lawn Sprinkler Box lot Note: Closet Collar 6" Minimum rn W be used in Long Sweep 90 p1we of W bar or two 457 3M' Bar Ladernl Mound System Page a a 7 Septic, Pump and Dose Tank Project: Warner-mound Tank Information Dosage Volume Pump tank manufacturer. Wieser Concrete Forcemain drains back to tank? OQ yes O No Pump tank size/model: W1000 /650 -MR Lateral void volume: 15.6 gal Pump tank gal /inch: 17 Dosage to absorbtion Cell: 78.2 gal Actual Pump Tank Volume: 646 gal Forcemain volume: 13.9 gal Tank bottom elevation (inside): 77 9701 ft Total dosage: 92.2 gal Septic tank size /model: wi000 /650 -MR Pump and Filter Total Dynamic Head Pump Manufacturer: Goulds Are laterals highest point? y Pump Model: PE51 P1 if not, enter highest elevation: 0 ft Effluent Filter: Polylock 525 System head (distal x 1.3) 6.50 ft Vertical Lift ( "D" to lateral) 7.33 ft Note: Access opening of sufficient size to be provided to allow removal of filter. opening to terminate at or above grade. Friction loss in forcemain: 1.85 ft Pressure loss from filter. r_� ft Total dynamic head (TDH): 15.68 ft Pump Tank Diagram Dose Tank Levels [Watertight Locking Cover In. Gal 4 Inch Y With Warning Label Minimum finished A Reserve 22.6 383.8 Grade g pump off to Alarm 2.0 34.0 Altemate C Total Dosage 5.4 92.2 Outlet Location Efect per Comm D Effluent depth for pump 8.0 136.0 16.28 and Total Capacity: 38.0 646.0 NEC 300 Weep Hole A or Anti - Siphon B Device C —=Q Pump must be capable of 33.0 GPM and head pressure of: 15.7 Feet Mound System Management Plan pursuant to comm 83.54 W. A. C. page 5 of 7 Owner's Responsibility: The component owner is responsible for the operation and maintenance of the component. The county, department or POWTS service contractor may make periodic inspections of the components, checking for surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary maintenance reports to the appropriate jurisdiction and /or the department. Septic Tank: Septic tank(s) are to be inspected routinely and maintained by department approved individuals when necessary in accordance with their approvals. The use of chemical/biological "treatments" is not required or recommended. If such additives are used, make sure they are approved by Department of Commerce, Safety and Buildings Div.. Effluent filters are to be removed & cleaned as necessary, with provisions to keep solids from passing the septic during removal. No more than 1/3 of the usable tank volume may be occupied by sludge /scum. 3 year inspection: If tank has greater than 1/3 volume sludge, tank contents must be emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified of when pumping should be done as to not exceed 1/3 sludge volume. Septic tank should be routinely inspected to be watertight and of good repair. Pump/Dose Tank If an effluent filter has been installed in the pump /dose tank, it must be removed & cleaned as necessary, with provisions to keep solids from passing to the mound component during removal. The pump, float switches and alarms must be inspected at least every three years for proper operation. Pump /dose tank should be routinely inspected to be watertight and of good repair. Mound and Lateral System The mound system component must remain free of ponded surface water prior to pump operation. If 4 inches or more water level is detected in the observation pipes, the owner must be notified of possible problemstfailure. The designed daily flow capabilities of the component should never be exceeded. Trees and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the component. Activities OTHER than mowing/maintenance (i.e. excessive walking, pets, vehicles, etc...) could compress the component and reduce its absorbtion capabilities and/or possibly cause it to freeze in winter conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the cleanout points at each end of the component to remove scum that may clog orifices. Performance Monitoring: Performance monitoring must be done at least once every three years following the installation or at the time of a problem, complaint, or failure. Contingency Plan: If the septic tank, pump tank or any of their components therein (including floats, alarms, pumps, etc) become defective, the defective tank or component must be replaced immediately to ensure that the system can operate as designed. If the mound component cannot accept wastewater or ponds wastewater to the surface, the component must be repaired or replaced in it's current location by either: extending basal toe to provide added absorbtion area; or by removing the clogged bacterial mat,aggregate cell, and distribution piping within the mound and replacing said components in order to return system to proper working order as required. a- r , 2 , 1 1a ri x I a I I I I� -�o e 3 � � h JJ w W O IL I Ix r u 4 3 �- o it " � ` r [qGOULDS PUMPS Submersible Effluent Pump PE , DFL1RMT MP SPECIFICATIONS MOTOR FEATURES Pump — General: General: ■ Corrosion resistant • Discharge: 1'A" NPT • Single phase construction. • Temperature: 104 °F (40 °C) • 60 Hertz ■ Cast iron body. maximum, continuous when • 115 and 230 volts ■ Thermoplastic impeller and fully submerged. • Built-in thermal overload pro- cover. • Solids handling: 1 /2" tection with automatic reset. ■ Upper sleeve and lower maximum sphere. • Class B insulation. heavy duty ball bearing • Automatic models include a • Oil -filled design. construction. APPLICATIONS float switch. • High strength carbon steel ■ Motor is permanently • Manual models available. shaft. lubricated for extended Specially designed for the following uses: Pumping range: see PE31 Motor: service life. • Mound Systems performance chart or curve. • .33 HP, 3000 RPM ■ Powered for continuous • operation. Effluent/Dosing Systems PE31 Pump: • 115 volts • Low Pressure Pipe Systems Maximum capacity: 53 GPM • Shaded pole design Al orking limits of th motor. • Basement Draining • Maximum head: 25: TDH PE41 Motor: ■ Quick disconnect power • Heavy Duty Sump/ PE41 Pump: • .40 HP, 3400 RPM cord, 20' standard length, Dewatering • Maximum capacity: 61 GPM • 115 and 230 volts heavy duty 16/3 S1TW with • Maximum head: 29' TDH • PSC design 115 or 230 volt grounding PE51 Pump: PE51 Motor: plug. • Maximum capacity: 70 GPM • .50 HP, 3400 RPM ■ Complete unit is heavy duty, • Maximum head: 37' TDH • 115 and 230 volts portable and compact. • PSC design ■ Mechanical seal is carbon, METERS FEET ceramic, BUNA and stainless 40 - PE51- . - MODELS: PE31. PE41, PE51 I steel. HP: .33, .40, .50 ■ Stainless steel fasteners. 10 - _ _, _ , - ► 2 GPM I AGENCY LISTINGS 30 - -a — 1 FT w 25 7 C� Tested to UL 778 and } -- CSA 22.2108 Standards Q �: By Canadian Standards Association 15 _ - -- File #LR38549 0 L Goulds Pumps is ISO 9001 Registered. 5 -- 0 O O 10 20 30 40 50 60 70 GPM 80 0 5 1 1,5 m3 /h Goulds Pumps CAPACITY ® 2004 ITT Water Technology, Inc. Effective June, 2 004 ITT Industries BPE31 /41 14 sconsin SOIL EVALUATION REPORT #77 Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings Northland Plumbing, Inc. Attach complete site Ian on paper not less than 8% x 11 inches in size. Plan must County p P p pe St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 032 -21 1- 20-000 Please print all infortnattion. Reviewed Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). a4kniOn Property Owner Property Location Larry Wamer Govt. Lot S 1/4, 1/4, S1, T31N, R19W Property Owner's Mailing Address Lot # I Block # I Subd. Name or CSM# 2320 76th St 20 Woodland Meadows City State Zip Code Phone Number City ❑ Village ® Town Nearest Road Somerset WI 1 54025 1 Somerset I 76Th St ® New Construction Use: ® Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ❑ Replacement ❑ Public or commercial - Describe Parent material Glacial Till 4 Flood plain elevation, if applicable A ft. General comments and recommendations: F-1 I Boring # Boring ® Pit Ground surface elev. 95.92 ft. Depth to limiting factor 19 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNe in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff*1 'EfN2 1 0-6 10YR3 /2 sil 3sbk mvfr Cs 2f .6 .8 2 6-12 10YR4 /3 sil 3sbk mvfr C5 2m .6 .8 3 12 -19 10YR4 16 SO 2sbk mvfr Cs 21' .6 .8 4 19 -32 10YR4/6 sid isbk mfi Cs if .2 .3 5 32 -62 7.5YR5/6 sc Om mefi Cs 0.0 0.0 F ❑ Boring ring # Pit Ground surface elev. 97.26 ft. Depth to limiting factor 18 in. ® 9 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etr*1 •E1f*2 1 0-7 10YR3 /2 sil 3sbk mvfr Cs 12m .6 .8 2 7 -18 10YR4 /3 sil 3sbk mvfr Cs .6 .8 3 18 -29 10YR5/6 sd lsbk mfi cs if .2 .3 4 29 -79 7.5YR5/6 SC Om mefi Cs 0.0 0.0 Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD 5.30 mg/L and TSS s.30 mg/L CST Name (Please Print) CST Number A;Z% Michael J. Myers 267985 Address Northland Plumbing, Inc. Date Evaluation Conducted Telephone Number 2943130th Ave Glenwood City, WI 54013 10/4/10 715- 265 -4115 SBD4330 (8.07/00) Property Owner Larry Way Parcel ID # 032 - 2181 - 204000 Page 2 of 3< - Boring # E] Boring ® Pit Ground surface elev. 96.00 ft. Depth to limiting factor 19 in. ISO Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I *Ef 2 1 0 -7 10YR3 /2 SiI 3sbk mvfr CS 2f .6 .8 2 7 -19 10YR4/3 SO 3sbk mvfr CS 2m .6 .8 3 19 -32 10YR5 /6 sd 1sbk mfi CS if .2 .3 4 32 -58 7.5YR5/6 sc Om mefi CS 0.0 0.0 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. Property Owner Larry Wamer Parcel ID # 032- 2181 -20 -000 Page 2 of 3'� F 3 ❑ Boring ,Boring # ® Pit Ground surface elev. 96.00 ft. Depth to limiting factor 19 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efr# `Eff#2 1 0 -7 10YR3 /2 sil 3sbk mvfr Cs 2f .6 .8 2 7 -19 10YR4/3 sil 3sbk mvfr Cs 2m .6 .8 3 19 -32 10YR5 /6 sd isbk mfi Cs if .2 .3 4 32 -58 7.5YR5/6 SC Om mefi Cs 0.0 0.0 * 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. n.... noon n, nn.nn :..J1.1.. —J M.....4:.... • —� i 1 I Vl% li r � 1 � � I .o MI ►I s 3 Z N a oy ,, Safety and Buildings Division County commerce.wi.gov 201 W. Washings ve., P.O. Box 7162 S(r X e o n s i n h4adison, 37 71 G2 T rary Permyslumber (to be filled in by Co.) i s Department or Commerce e Transaction Is Number Sanitary Permit Applicatio �7�'2 nce with S. Comm. 83.21(2), Wis. Adm. Coe, submission of this form the he app late govt menta In accords d bi WT are ol Address (if different thanmailing address) unit is required prior to obtaining a sanitary pemtit. Note: Application forms for state•n%yn PO S submined to the Department of Commerce. Personal information you p r aide may he used for tonda - /� �/ r ?I u ses in accordance with the Privacy Ln %v. s. 15 04 0)( 111 ). Stall ✓ I. A ligation Information — Please Print .UI Information Parcel a Properly Owner's Name Y 7 0 3z -,,1 J/ -.2 o - 6�Z Property Location /• / �`/ 1 Property Owner's Mailing Address C , q �UE�NNNG Govt. Lot Zip Code Pho O �Le v., _ ' /•. Section city, state Aw � �� 1CF (circle one 11. Type of Building (check all that f apply) f1 Lot x u �� Subdivision Name 0D I or 2 Family Dwelling - Number of Bedroon Block u I lG 1 ❑Public/Commercial - Describe Use ,ti. �� C1 Cm of O G ❑ S. Number Village o �f r ❑ State Owned - Describe Usc o ErT o,vn of III. Type of Permit: (Check only one box on line omplete line B if applies j A ' New System ❑Replacement System ❑ Tre nt /Holding Tank placement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal O Pcimit Revision C3 Change or Plum O Pctmit Transfer to N'ew R Before Expiration ° tuner IV. Type of POWTS System /Com oncitt/Device: Check all that lv ❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Gra C1 Mound > 2 of suitable soil Mound < 24 in of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) etreatment Device (explain) t V. Dispersal/Treatment Area Information: w k Design Flo- (gpd) Design Soil .4p licat' m Rntc(gpdsf) Di ersal Area Requir (st) Disper Area Proposed (sO System Elevation D 2 / �Q / • o /l - 75 -0 y5a 75 V1. Tank Info Capacity in Total of t c Gallons Gallons Units a 8 0 = New Tanks, Existing Tanks �� 5 V y H in v y Septic or Holding Tank V' ptyQ ��E fZ /�',�C .. Dosing Chamber VII. Responsibility Statement- 1, the undersign d, ahume responsihility for installation of the PO %VTS shown on the attached plans. Plumber's Name (Print) PI mber's Signature MP /MPRS Number Business Phone Number Plumber's Address (Street, City. State. Zip Code) Z `/3 / o 7 '�- -c 'mac -�e�. ,o�� 6 - 1` Y tc, / s VIII. unto/Department Use Only Permit Fee Date jss d Iss ing Agent ignat e C Approved ❑ Disapproved S C ❑ Owner Given Reason for Denial 2 val/Reasons for Disap ,�i2 2NG SYSTEM Co nditions pP roval ?� ZOD'�' � � �/►? /�6�" . 1 Septic tank, effluent filter and �Zfl�'► ��`r'_ �OYt'�vN -� dispersal cell must all be serviced / maintained as per management plan provided by plumber. ro t 1 em and snbrnit in the C u tv my n paptr no t�s t an IR x l l i t es In Silt as peF applicable code /ordinances. vtt� SBD -6398 (R. 01/07) Valid thru 01/09 L i s I pJ CA AC i I i y C �vEll o j „ i �� P4 Oo � P9 r � Safety and Buildings ' 141 NW BARSTOW ST FL 4TH commerce.wi.gov WAUKESHA WI 53188 -3789 Contact Through Relay sco ns i n www,commerr,e.vA.gov /sb/ Department of Commerce vuvuw.wisconsin.gov Jim Doyle, Governor Aaron Olver, Secretary May 07, 2010 CUST ID No. 267985 ATTIC POWTS Inspector MICHAEL J MYERS ZONING OFFICE NORTHLAND PLUMBING INC ST CROIX COUNTY SPIA 2943 130TH AVE 1101 CARMICHAEL RD GLENWOOD CITY WI 54013 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/07/2012 Identification NumBers Transaction ID No. 1792521 SITE: Site ID No. 756440 Larry Warner Please refer to both identficatiof numbers, 76TH St above, in all correspondence with;the Town of Somerset St Croix County SWl /4, SE1 /4, S1, T31N, R19W i Lot: 20, Subdivision: Woodland Meadows FOR: Description: Mound, 3 Bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1265188 Maintenance required; 450 GPD Flow rate; 22 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01101); Effluent Filter 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: This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD- 10706 -P (N.01 /01). In the event this soil absorption system or any of its component parts malfunctions so as to create a al#b rd, the property owner must follow the contingency plan as described in the approved plans. In additio must comply e g 1 y with the operation, maintenance and monitoring duties as described in section m d component manual. A copy of this information must be given to the owner upon completion F S/p D fp I RT r All holding/treatment tanks are to comply with Comm. 84.25(7)(a). V W Maintenance information must be given to the owner of the tank explaining that pen L g of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. MICHAEL J MYERS Page 2 5/7/2010 A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 rantin this approval the Division of Safe & Buildings reserves e ri ht to r uire g g pp the chan r additions o Safety g g � 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. rely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Julia Lewis - Osborne POWTS Reviewer 2, Integrated Services WfiwT ecxle: ?+ (262) 397 -6005, Fax: (608) 283 -7481 julia.lewis@wisconsin.gov Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. "Construction business" means a trade that installs, alters or repairs any building element, component, material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the delivery of building supplies or materials, or the manufacture of a building product not on the building site. For further information, go to our website: www. commerce. wi. gov/ SB/ SB- BuildingContractorProgrom.htnd Note: Effective March 29, 2010, we are consolidating our Shawano full- service office with our Green Bay office. Please address all plans, correspondence, mail, etc. related to previous Shawano services, for delivery after that date, to: Division of Safety & Buildings, 2331 San Luis Place, Green Bay, WI 54304. If calling moved Shawano staff after that date, call (920)492 -5601. i i Mound a K 1 of 6 System Cover Pag 9 WIESER CODCAETE Project Name: Wamer -Mound Owner's Name Larry Warner Owners Address 3385 Auger Ave White Bear Lake, MN 55110 Legal Description sw v %., SE • '/. Sec�� T 31 N, R 19 W Township Somerset RECEivEr) County Saint Croi APR 3 0 2010 Subdivision woodland Meadows SAFETY & BUILDINGS Lot# 20 Parcel ID# Table of Contents pg- 1 Cover page 2 Mound Sizing Calculations 3 Pressure Distribution Layout and Dynamics 4 Dose Tank 5 Management and Contingency Plan 6 Plot Map total # of pages: 6 Designer Name: Michael J. Myers MP /License #: 267985 Date: 4/27/10 Ph. #: 7A5-2654115 1, Signature: Mound System Design Methods Used :,y 0� per "Mound Component Manual For Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD- 10691 -P (N.01/01) ° gFfTy q �OM� �. per" Pressure Distribution Component manual for Private Onsde Wastewater Treatment Systems" (Version 2.0) SBD - 10706 -P (N 01/011 Spreadsheet provided by: 3bAdvisemem N12486 220th St, Boyceville, Wl 54725 Ph: 715-643.6068 email: 3baC3bed NcF . Mound System aa" z & e + Mound Sizing Calculations Project Name: Warner -Mound Site Con ditions Design of Entire Fill Project Type: 1 or 2 Family Dwelling Cell depth at upslope edge (D): 14.0 in. % Slope: 3 % Cell depth at downslope edge (E): 16.2 in. # of Bedrooms: 3 Distribution cell depth (F): 9.5 in. Depth to limiting factor: 22 in. Cover thickness over edge (G): 6 in. Absorbtion rate of fill material: 1 gaUft /day Cover thickness over center (H): 12 in. Absorbtion rate of in -situ soil: 0.6 ga a /day End slope width (K): 9.2 ft. Effluent quality Eff #1 • Fill length (L): 93.4 ft. Max BOD effluent value: 220 mg /l Upslope width (J): 6.8 ft. Max TSS effluent value: 150 mg /I Downslope width (Toe) (1): 8.8 ft. Fill Width (W): 21.6 ft. Design of the Distribution Cell Basal Area System Design Flow: 450.0 gal /day Basal area required: 750 ft Distribution cell width (A): 6.00 ft Basal area available: 1110 ft Distribution cell length (B): — 75 - . - Ol ft Area of Distribution Cell: 450.0 ft Observation Pipes Contour Elevation of Mound: 100.10 ft –., Location from end of cell (Z): 12.5 ft System Elevation of Mound: 101.27 ft �- Final Grade of Mound: 103.06 ft Mound Plan View Observation Pipes Z--I� WI Distribution Cell A T B k–K I Tilled ArealFill Material L ' Mound Cross Section Final Grade Observation Pipe Synthetic Fabric H G Distribution Cell System Elevation a F 0–A RJ y 3 Cover Material L�eral Fill Material Invert Tilled Area Slope �Forcemain System Contour Notes: Fill material to consist of ASTM C33 Sand Distribution cell aggregate to comply with Comm 84.30(6)(1) Synthetic Fabric covering on cell per Comm 84.30(6)(g) Distribution Cell to have minimum 6" aggregate below lateral and 2" above. Mound System Pape 3 of 6 Pressure Distribution Calculations Project Name: Warner -Mound Lateral Layout Lateral /Manifold Design Lateral elevation: 101.8 ft Lateral diameter: 1'h In. Rows of Laterals: 2 Lateral spacing (S): ft Manifold type: center . Lateral to cell edge: 1.5 ft Orifice diameter: o.i25 • In. Lateral discharge rate: 9.89 gpm # of Laterals: 4 System discharge rate: 39.54 gpm Distal Pressure: 5 ft Manifold diameter: 2 .r In. Lateral Length: 37 ft Manifold length: 3 ft Orifice Spacing /Distribution Forcemain Friction Loss Orifice spacing (X): 18.89 Inches Forcemain length: 80 ft Orifices per lateral: 24 Forcemain diameter: 2 w In. Avg. a /Orifice: 4.69 fe Friction loss in forcemain: 2.585 ft Lateral Side View Manifold M Lateral M Lateral x x x x x x q x q x x x Lateral Length Lateral Length Lateral Plan View Lateral Length ` I Turn - up w /ball valve or cleanout plug 0 0 S 0 0 �- Orifices on bottom of lateral equally spaced PVC laterals and forcemain to comply with specifications per Comm 84.30(2Xe) Forcemain connection via tee or cross to manifold at any point Clean Out Detail Observation Pipes Gean -out plug Final Grade or ball valve Water tight cap or plug Lawn Sprinkler Box lot Note C1oW Kolar ti" MinimuT- n W bQ umd in Long Sweep 90 I place of 3/8' bar or two 45's L 3/8` Bar Lateral Mound System Page 4of6 Septic, Pump and Dose Tank Project: Wamer -Mound Tank Information Dosage Volume Pump tank manufacturer: Wieser Concrete Forcemain drains back to tank? OQ Yes Onto Pump tank sizelmodel: W1000 /650 -MR Lateral void volume: 15.6 gal Pump tank gal /inch: 17 Dosage to absorbtion Cell: 78.2 gal Actual Pump Tank Volume: 646 gal Forcemain volume: 13.9 gal Tank bottom elevation (inside): 91 .5 ft Total dosage: 92.2 gal Septic tank size /model: W1000 /650 -MR - -� Pump and Filter Total Dynamic Head Pump Manufacturer: Goulds Are laterals highest point? y Pump Model: PE51 P1 if not, enter highest elevation: p ft Effluent Filter: Pol lock 525 System head (distal x 1.3) 6.50 ft Vertical Lift ( "D" to lateral) 9.60 ft Note: Access opening of sufficient size to be provided to allow Friction loss in force 2.59 ft removal of filter. Opening to terminate at or above grade. Pressure loss from filter. 1ft Total dynamic head (TDH): 18.69 ft Pump Tank Diagram Dose Tank Levels Watertight Locking Cover In. Gal 4 Inch With Warning Label ,nished A Reserve 22.6 383.8 Minimum Grade B Pump off to Alarm 2.0 34.0 Alternate C Total Dosage 5.4 92.2 Outlet Location Ele per Comm D Effluent depth for pump 8.0 136.0 t 6.28 and Total Capacity: 38.0 646.0 1 Forcemain NEC 300 Weep Hole A orAnti- Siphon f3 Device C —rk; Pump must be capable of. 39.5 GPM and head pressure of 18.7 Feet t GOULDS PUMPS Submersible • Effluent Pump PE D VLVEM PIMP SPECIFICATIONS MOTOR FEATURES Pump — General: General: ■Corrosion resistant • Discharge: 1'h" NPT • Single phase construction. • Temperature: 104 °F (40 °C) • 60 Hertz ■ Cast iron body. maximum, continuous when • 115 and 230 volts ■ Thermoplastic impeller and fully submerged. • Built -in thermal overload pro- cover. • Solids handling: '/2" tection with automatic reset. ■ Upper sleeve and lower maximum sphere. • Class B insulation. heavy duty ball bearing • Automatic models include a • Oil -filled design. construction. APPLICATIONS float switch. • High strength carbon steel ■ Motor is permanently Specially designed for the • Manual models available. shaft. lubricated for extended following uses: • Pumping range: see PE31 Motor: service life. •Mound Systems performance chart or curve. • .33 HP, 3000 RPM ■ Powered for continuous • Effluent/Dosing Systems PE31 Pump: • 115 volts operation. • low Pressure Pipe Systems Maximum capacity: 53 GPM a Shaded pole design work ng limits of within h motor. • Basement Draining • Maximum head: 25; TDH PE41 Motor: ■ Quick disconnect power • Heavy Duty Sump/ PE41 Pump: • .40 HP, 3400 RPM cord, 20' standard length, Dewatering • Maximum capacity: 61 GPM • 115 and 230 volts heavy duty 16/3 S1TW with • Maximum head: 29' TDH • PSC design 115 or 230 volt grounding PE51 Pump: PE51 Motor: plug. • Maximum capacity: 70 GPM • .50 HP, 3400 RPM ■ Complete unit is heavy duty, • Maximum head: 37' TDH • 115 and 230 volts portable and compact. • PSC design ■ Mechanical seal is carbon, METERS FEET ceramic, BUNA and stainless 40 - -- - • MODELS: PE31, PE41, PE51 steel. -PESf- :- `__.,._ HP: .33, .40, .50 ■ Stainless steel fasteners. 35 - 10 - + - - _ -► 2GPM AGENCY LISTINGS 30 1 FT o ' W 25 _ - - - _ 7 - _ ci US a 20 Tested to UL 778 and Z __ CSA 22.2108 Standards } By Canadian Standards Association 15 - _, _. - -- File #LR38549 O — - _ -- j Goulds Pumps is ISO 9001 Registered. 10 5 OL 0 0 10 20 - 30 ~ 40 - 50 60 70 GPM 80 0 5 10 1 m3m Gou lds Pumps CAPACITY © 2004 ITT Water Technology, Inc. Effective June, 2004 ITT Industries BPE31/41 f Mound System Management Plan pursuant to comm 83.54 W. A. C. page 5 of 6 Owners Responsibility: The component owner is responsible for the operation and maintenance of the component. The county, department or POWTS service contractor may make periodic inspections of the components, checking for surface discharge, treated effluent levels, etc. The owner or owners agent is required to submit necessary maintenance reports to the appropriate jurisdiction and /or the department. Septic Tank: Septic tank(s) are to be inspected routinely and maintained by department approved individuals when necessary in accordance with their approvals. The use of chemical/biological "treatments" is not required or recommended. If such additives are used, make sure they are approved by Department of Commence, Safety and Buildings Div.. Effluent filters are to be removed & cleaned as necessary, with provisions to keep solids from passing the septic during removal. No more than 1/3 of the usable tank volume may be occupied by sludge /scum. 3 year inspection: If tank has greater than 1/3 volume sludge, tank contents must be emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified of when pumping should be done as to not exceed 1/3 sludge volume. Septic tank should be routinely inspected to be watertight and of good repair. Pump /Dose Tank If an effluent filter has been installed in the pump /dose tank, it must be removed & cleaned as necessary, with provisions to keep solids from passing to the mound component during removal. The pump, float switches and alarms must be inspected at least every three years for proper operation. Pump /dose tank should be routinely inspected to be watertight and of good repair. Mound and Lateral System The mound system component must remain free of ponded surface water prior to pump operation. If 4 inches or more water level is detected in the observation pipes, the owner must be notified of possible problems/failure. The designed daily flow capabilities of the component should never be exceeded. Trees and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the component. Activities OTHER than mowing /maintenance (i.e. excessive walking, pets, vehicles, etc...) could compress the component and reduce it's absorbtion capabilities and /or possibly cause it to freeze in winter conditions. Lateral distribution pipes should be flushed outhested every 18 months using the cleanout points at each end of the component to remove scum that may clog orifices. Performance Monitoring: Performance monitoring must be done at least once every three years following the installation or at the time of a problem, complaint, or failure. Contingency Plan: If the septic tank, pump tank or any of their components therein (including floats, alarms, pumps, etc) become defective, the defective tank or component must be replaced immediately to ensure that the system can operate as designed. If the mound component cannot accept wastewater or ponds wastewater to the surface, the component must be repaired or replaced in it's current location by either: extending basal toe to provide added absorbtion area; or by removing the clogged bacterial mat,aggregate cell, and distribution piping within the mound and replacing said components in order to return system to proper working order as required. v . � I s � I I 7 v 'Ni N II -J 1 N I A q 'I ' C 0 eL co u x c o ay o ` N G° a WiisconsinDepartment ofcommerce ATION REPORT Page I of 3 Division of Safety and Buildings in atxo e County St.Croix Attach complete site plan on paper not less than 8 /2 x 1 In 1 must include, but not limited to: vertical and horizontal r erence point (BM), direction and Parcel I.D. } Pending„ percent slope, scale or dimensions, north arrow, a d loca 1 a d tiis nceto nearestoad. �. dU "� Re ' wed b Date please print all in rmation. ;' av Personal information you provide may be used for seco ary ptttp�A a'F0 "W 6 j ` s�15.04 (1 (m)). Property Owner Broperty ovation AHRH Properties LLC Govt. Lot SW 114 SE 1/4 S 1 T 31 N R 19 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 404 Screen Avenue .10 - Woodland Meadows City State Zip Code Phone Number ity f Village ■ Town Nearest Road New Richmond I WI 54017 1 ( 715 222 - 0169 CTH E] New Construction User Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD 0 Replacement 13 Public or commercial - Describe: Parent material Loess over glacial till Flood Plain elevation if applicable X — tt General comments Site suitable for a mound system `t alv and recommendations: F71 Boring # 0 Boring o 28 36 ■ : Ground surface elev. 1 • ft. Depth to limiting factor - in. Pit Soil Appfication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -2 10yr3 /2 sil 2msbk mfr as 2f .6 .8 2 2 -28 10 4/4 sil 2msbk mfr cw if .6 .8 3 28 -36 10yr4/4 flf5yr5 /8 sicl lmsbk mfr cw - .2 .3 4 36-40 7.5yr4/4 fsl Om dvh _ - .2 .5 2� Boring # Boring 22 -24 pit Ground surface elev. 1 DZ • S 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 1 0 -9 10yr3/2 sil 2msbk mfr as 2f .6 .8 2 9 -22 1 4/4 sll 2m 0k 1311` cw If •6 $ 3 22 -24 10yr4/4 flf�yr5 /f3 sicl _ __ lmsb --, mfr cw 1f 2 3 4 24-40 7.5yr4/4 fsl Om dsh - - .2 .5 * Effluent #1 = BOD > 30< 220 mg/L and TSS >30:s 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Thomas C. Nelson 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, WI 11/17/04 715- 246 -2454 1 Woodland Meadow Scale 1 "= 30' 8M, Top of conduit,00.00� Lot 20 8M2 Top of conduit 103.13 81100.10 82102.86' 83100.76' N OO f , e YAK ��I fit^ �� �� a�' � . .w^' •� Thomas Nelson -1227387 r ST CROIX COUNTY • SEPTIC TANK MAINTENANCE AGREEMENT + AND OWNERSHIP CERTIFICATION FORM Owner/Buyer , Mailing Address _ 33 , YS _ ��- Property Address Z > 2 -0 7 (Verification required from Planning Department for new construction) City/State (/y Parcel Identification Number 0 LEGAL DESCRIPTION 5c� SC— '/. / 'I 3/ N -R1�w, Town of 5d' P16 -� • Property Location /., Sec. °�G �aw3' , Lot # �d Subdivision li�/� �� Certified Survey Map # , Volume Page # Warranty Deed # , Volume Page # Spec house ❑ yes l no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE .. Improper use and maintenanceofyour septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What You put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The P ro PertY owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and b em master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage stem with the standards disposal system e De artment Department of Natural Resources, State of Wisco of Commerce and the nsin. Ccmfication set forth, herein, as et by the p P Office within 30 stating that your sep s stem has been maintained must be completed and returned to the St. Croix County Zoning Y e e expiration date. GNA OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owncr(s) of the perry described bove, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNA OF APPLICANT X DATE e artznent. • " ...... Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning D p •• Include with this application: a stamped warranty dedd from the Register of Deeds office a copy of the certified duvey map if reference is made in the warranty deed L I ,a , / � • 9,� S'1s� � O 1 ' 0h/ o \s a °v�asO�y o M N O 9 � s' 8 o a0 -B �sZ \ h N O O Co V V w p h h p 'd I .�Njm fpO 11 Oh N � y V c rt� • ^ - W . v b, N p II ap O O 0 00 V) Q� \ G M • v>Go s � Z . l • ' ' s ue° p p y ; 1 • ------- C4- - - - - -- - i C3 l Ark ,/ , ro 5 P Sl 23 228 M � 8� 96. X38 50, 43'2 •S3 ,. N1g �6, 2 ��', \\.2 21 BZ 27F 3 I• I .1. r h V to O L p V io C N to co '^� II 77 ;. O p � co� O O 25.13' -L'" Z Cl) N m C ^ o co w.:P y �F , 47 O 1� Oro "ado •ti 327.54 200.00' h -p ?��6 :n •'� � . � 1 0 N00'18'10 "E 527.54' h h� ,�h�ry N c O " - A SGNV� a311d]dNn ,f 8 Ogf S 3„01,81.00N— � � ,82•9tv9Z 11.0 UR WON `Z ,89'lfZ ,6f 6S Z6 Z91 ;L6 >J / _ ,90'6ZL s y o V� cn o a 3 Of ; ZS JOS �A� 06 ' 3 a • � / c � O !'� m � if '99 � `S2 • \ / �Cb �- I w / ? \* 96 Z9 � • ? I L goo �"'� ���' � S 9 �ioM f fllffl 11111 Nlfl If1f1 (111111111 I1f1111111 11111111 • STATE BAR OF WISCONSIN FORM 2 - 2000 * 9 1 4 9 2 5 1 Document Number WARRANTY DEED 914925 BETH PABST This Deed, trade between The Burnside Registered Limited REGISTER OF DEEDS Liability Partnership, a Wisconsin Limited Liability Partnership, ST. CROIX CO., WI RECEIVED FOR RECORD 04/21/2010 11:05AM Grantor, and Lawrence J. Warner and Susan J. Warner, husband and WARRANTY DEED wife, as joint tenants, EXEMPT t REC FEE: 11.00 TRANS FEE: 66.00 Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum:) Recording Araa 11� Lot 20, Woodland Meadows, Town of Somerset, St. Croix County, Name and Return Address Wisconsin. Northwest land Title, Inc. PO Box 520 The undersigned, Kenneth M. Duncan, hereby states that he is the Milltown. WI 54858 authorized general partner to execute this Warranty Deed on behalf of The Burnside Registered Limited Liability Partnership, a Wisconsin Limited Liability Partnership. 032 - 2181 - 20-000 Parcel Identification Number (PIN) This is not homestead property. 6W (is not) Exceptions to warranties: easements, roadways, rights of way and zoning restrictions. Dated this /s/ day of April 2010 - THE BURNSIDE REGISTII2ED LIMITED LIABILITY PARTNERSHIP, A WISCONSIN LIMITED • . TY PARTNERSHIP BY: s r t KENN . DUNCAN, GENERAL PARTNER AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. County ) authenticated this day of , Personally came before me this day of April 2010 the above named • Kenneth M. Duncan M . TITLE: M EMBER STATE BAR OF WISCONSIN i to me known to be the person(s) w3lo eji c�u�e f g authorized by § 706.06, Wis. Stats.) in nt and acknowledge h 's Awe r THIS INSTRUMENT WAS DRAFTED BY Bruce P. Anderson, ANDERSON LAW OFFICE Notary Public, State of N$ h► r Balsam Lake, WI 54810 My Commission is ermanent. (If no l kp ate: (Si — ll lllll� 111 \ \ ) gnatures may 6e authenticated or acknowledged. Both are not necessary.) • Names of persons signing in any capacity must be typed or printed below their signature. RRANTY DEED STATE BAR OF WISCONSIN v FORM No. 2 - 2000 INFO -PRO (a00)668 -2021 www.infoproforms.com Parcel #: 032- 2181 -20 -000 05/14/2010 02:59 PM PAGE 1 OF 1 s Alt. Parcel M 01.31.19.1544 032 - TOWN OF SOMERSET Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 01/13/2005 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co -Owner 0- BURNSIDE REGISTERED LIMITED LIABILITY PARTNERSF BURNSIDE REGISTERED LIMITED LIABILITY PARTNERSHIP 7698 SOUTH BAY DR BLOOMINGTON MN 55438 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description 2320 76TH ST SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 3.250 Plat: 10- 046- WOODLAND MEADOWS LOTS 1/24 032 -05 SEC 1 T31 N RI 9W PT SW SE WOODLAND Block/Condo Bldg: LOT 020 MEADOWS LOT 20 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 01- 31N -19W SW SE Notes: Parcel History: Date Doc # Vol /Page Type 10/02/2009 904725 WD 04/08/2009 892748 SD 01/13/2005 784949 10/046 PLAT 2010 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/03/2008 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.250 49,200 0 49,200 NO Totals for 2010: General Property 3.250 49,200 0 49,200 Woodland 0.000 0 0 Totals for 2009: General Property 3.250 49,200 0 49,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 11°J-,LZ 11 --- --------------- - ----- r-------- -- • - - - -- ------------- . 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