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HomeMy WebLinkAbout032-2100-90-000 Department of C mmerce County: �d Building g)ivisic �� PRIVATE SEWAGE SYSTEM St. Croix Sanitary ' INSPECTION REPORT ay Permit No: • 420729 0 FGENERAL,INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [ rivacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Nelson, James I Somerset Township 032 - 2100 -90 -000 CST BM Elev: Insp. BM Elev: BM D tion: �! Section/Town /Range /Map No: OU -0 / 0 b U C, (; C) M ( M S" eft=- 26.31.19.964 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. / � o Septic / Z Benchmark, Dosing Alt. B Aeration J Bldg. Sewer 12 ) • 9 86. o' Holding St/Ht Inlet 1Z .2-f 1 TANK SETBACK INFORMATION St/Ht Outlet X2. gS� TANK TO P/L WELL BLDG. FVenttoAiQ9jake ROAD Dt Inlet 1 Sept �� ? � O r ��� ��, Dt Bottom �� � • � � � • O 3 t Dosing 8 e7 Head an. L a ,�, 9g• 37 Aeration 7 Dist. Pi /• �`� c � 7 �a � 3 Holding Bot. S , �r 0!L 13 yt� 9r7 , (, 8� Final Grade 7 PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number , ' (! / j Vv r✓ CJ 2 7 - o TDH jLift_Friction Loss Syste Head TD t Forcemain Length Dia. Dist. to Well 12 �t Z•ZD +�2. , ®.� SOIL ABSORPTION SYSTEM d *,.e 4- LC C V . BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS Ro. Of Pits Inside Dia. Liquid Depth DIMENSIONS /Q � '•ld SETBACK SYSTEM TO P/ BLDG WELL LAKE /STREAM EACHIN Manufacturer: 4 INFORMATION CH OR Type f System: r� v, � Model Number: DIST N SYSTEM / t �I Head r /Manifold Distribution x Ho Size x Hole Spacin Vent to J— � Pipe(s) 1� I -3 6 / `��'J � Length /� Dia Length Dia (� Spacing dd SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded7Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil L; Yes [ No L Yes { No COMMENTS (Include code discrepencies, persons present, etc.) Inspection � #1: .. /f p� Inspection #2: ( / 9 Location: 1942 62nd St. Somerset, WI 54025 NW 1/4 SW 114 26 T31N R19W Pineckff�dt "19' Parcel No: 26.31.19.9� 1.) Alt BM Description = 646*19 .5�1 2.) Bldg sewer length = 7 r � =�'� -� l4N amount of cover = t Plan revision Required? re Yes UNo Use other side for additional information, SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. I RECEIVED NOV 1 4 2003 Safety and Buildings Division County t � 201 W. Washington Ave., P.O. Box 7082 S ®iU NTY Madison, WI 53707 — 7082 Sanitary Permit Number (to b filled in by Co) Dep artmei I t of Ci0NtW"FFICE (608) 261-6546 2� Sanitary Permit Application State Plan Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s 15.04(1 xm) Project Address (if different than mailing address) I. Application Information — Please Print All Information Pro Owner's m Parcel # Lot # / Block # ' C — ) ne Property Owrs Mailing Address Property Location 1 City, S Zip Code Phone Number kJ_ Section :�e_ � ,�( ircle E� fie) - II. a of Building (check all that apply) T N; R 1 or 2 Family Dwelling - Number of B ms Subdivision Name fiber ❑ Public/Commercial - Describe Use = 9 a . 20 ❑State Owned - Describe Use X (40 5 0 5D 6 ❑City ❑Villa a l Township of tv III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System ys ❑Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B. ❑ Permit R ene Permit Revision El Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner (/ ZcD 72-9 /Ulsu,.,/n /3 24;D3 IV. Type of POWTS System: Check all that appl ❑ Non - Pressurized In -Ground 0 Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Cham ❑ Drip Line ❑ Gravel -less Pipe ❑ e (explain) V. Dispersal/Treatment Area Information: — too Design Flow (gpd) Design So' Application Rate(gpds Dispersal Area Required (so Dispersal Area Pro sed (sf) System Elevation ZIA VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank ' Aerobic Treatment Unit Dosing Chamber L&�A , i VII. Respons ility Statement- I, the undersigned, assum esponsibility for installation of the POWTS shown on the attached plans. ;Plum 's ( 'nt) Plumber's 'gnu MPIMPRS Number Business Phone Number Plum 's Address (Street, City, S Zip Code) VIII. Coun /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuin gent Signature (No Stamps) � Surcharge Fee) , ❑ Owner Given Reason for Denial , IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent lifter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. OASLCL 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on Paper not Ins this $112 x 11 inches to size SBD -6398 (R. 08/02) I i — +•____ � � —. _ _�— '. -� -� — _j-- — I I - i I � � _. ��,. , i I rw i I � K it 1 I __V I 1 - I I y i Q I , I 1 , 1 i I , I G I r I _ qq i 1 i ref I L. 1. i (43 i 1 4 1 S arery ana bum ings • 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 erc Y �sconsin www.wisconsin.gov .wis c ons .wisonsin.gov Department of Commerce ` Jim Doyle, Governor Cory L. Nettles, Secretary November 07, 2003 CUST ID No.224263 ATTN.• POWTS Inspector KIM A O CONNELL ZONING OFFICE K.O. CONSTRUCTION ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/07/2005 Identification Numbers Transaction ID No. 931247 SITE: Site ID No. 656302 Jim Nelson &Lisa Ramsay Please refer to both identification numbers, 62ND St above, in all correspondence with the agency. Town of Somerset St Croix County NW1 /4, SW1/4, S26, T31N, R19W FOR: Revision to previously approved plans, New mound, 600 GPD , Object Type: POWT System Regulated Object ID No.: 893662 p•� ' z (1ll The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes 1 and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: �, t i General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the ' "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10691 -P ( N.01 /O1) and SSWMP Publication 9.6, "Design Of Pressurized Distribution Networks For Septic Tank- Soil Absorption Systems." • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. Key Item(s) • A copy of this approval letter and index sheet shall be attached to plans that correspond with the copy on file with the Department. Changes to the approved plan must be submitted for review and approval. Failure to properly attach the approval and index page to plans that match the copy on file with the Department may result in enforcement action under s. 145. 10, Stats. • This approval is for a revision to previously approved Transaction number 843598 The approved changes are: the location and the entire design of the mound have changed and a new soil test has been provided (see plans). • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to KIM A O CONNELL Page 2 11/7/03 the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(1). Consult the Department of Natural Resources for well setbacks and exceptions to the setbacks. • Bed tank(s) per COMM 83.45(5). • Insulate building sewer per COMM 82.30(l 1)(c). • Provide frost protection per COMM 83.43(8)(c), 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 a seu provide a copy of this letter to the owner and any others who are responsible for the installation, eration or ma' tenance of the POWTS. Sincere Fee Required $ 60.00 Fee Received $ 60.00 Balance Due $ 0.00 Gam. - Pa la" Shando POWTS Plan Revie , Integrated Services WiSMART' code: 7633' (715) 634 -7810, Fax: (715) 634-5150, M -f 7:45 am - 4:30 pm pshandorf@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 i l e M MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: JIM NELSON Owner's Name: JIM NELSON LISA RAMSAY Owner's Address: 4426 WOODDUCK WAY RACINE WI 53403 Legal Description: NW- SW- SEC26 -T31 N -R1 9W Township: SOMERSET County: ST. CROIX 9 -� $ Subdivision Name: PINECLIFF $ 0 }1 Lot Number: 19 Block Number: Parcel I.D. Number: 032 - 2100 -90 -000 Plan Transaction No.: 1. .Index and titl Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 PLOT PLAN' Designer: KIM A 00014NELL License Number: 224263 Date: '10/01/03 `.Phone Number: 715 - 755 -3145 Signature: Designed Pursuant to the Mound Component Manual for POWTS V %sign 2.0 SDB- 10691 -P (N. 01101), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 3.0 (03/01/01) Page 1 of 8 i Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 83 -44 -3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of - 36 inches. 600.00 Design Flow (gpd) 3.00 Site Slope ( %) 98.20 Contour Line Elevation (ft) 32.00 Depth to Limiting Factor (in) 0.50 In -situ Soil Application Rate (gpd/ft Distribution Cell Information 60.001 Dispersal Cell Length Along Contour (ft) = 10.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest int in the distribution Y Pressure Disribution Information network? Enter Y or N (c or e) E Center or End Manifold 3.33 Lateral Spacing (ft) If N above, enter the elevation ft 3 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 3.00 Estimated Orifice Spacing (ft) = 10.00 ft%rifice 2.00 Forcemain Diameter (in) 235.00 Forcemain Length (ft) Does the forcemain drain back? Y 86.40 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 38.33 Forcemain Drainback (gal) 12.13 Vertical Lift (ft) 80.54 5x Void Volume (gal) 3.18 Friction Loss (ft) 118.87 Minimum Dose Volume (gal) 21.82 Total Dynamic Head (ft) 24.72 System Demand (gpm) Lateral Diameter Sele Manifold Di amete r Selection in. dia, options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x X 1.25 x 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information 800.00 Total Tank Capacity (gal) IS160.001 Septic Tank Capacity (gal) 36.00 Total Working Liquid Depth (in) WEEKS IManufacturer 22.22 gal /in (enter result in cell 849) Dose Tank Information Effluen Filter In formation 800.001 Dose Tank Capacity (gal) JZabel IFilter Manufacturer 21.761 Dose Tank Volume (gal /in) A100 Filter Model Number WEEKS iManufacturer Project: JIM NELSON Page 2 of 8 i Mound Plan View T 1/10 B :,:. J Observation Pipe K T—T . — A 1. + B I 3 :: . L Mound Component Dimensions Down slop toe extension made. Al 10.00 ft E [ AO. in H 1.00 ft K 7.33 ft B 60.00 ft F in I 10.00 ft L 74.65 ft D 6.00 in G ft J 4.93 ft W 24.93 ft 600.00 (ft) Dispersal Cell Area 1 1200.00 (ft Basal Area Available 10.00 (gpd/ft) Linear Loading Rate 1 6.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 100.49 (ft) --► rrrr ,rrrr,,. H r rrr .:rrrrr G I .� rrrrrrrrrrrrrrd 6 4rrrrrrrrr,.rrrr... F Dispersal Cell 99.20 (ft) Lateral 98.70 (ft) --► — Invert Dispersal Cell ....[] ...:........... ....•.,........ � Elevation 4'.t 77�� 98.20 (ft) Contour Elevation 3.0 % Site Slope Geotextile Fabric Cover Shading Key -0 Dispersal Cell See lateral details on Q Topsoil Cap BE 1.5 ft Page 4 for number, Subsoil Cap size, and spacing of rrrrrrnr ASTM C33 Sand F laterals. Laterals are Typical Lateral Tilled Layer c 0.5 ft equally spaced from 05 Aggregate o the distribution cell's }--- A centerline in the distribution cell (AxB). Project: JIM NELSON Page 3 of 8 End Connection Lateral Layout Diagram Center the laterals over the A & 9 dimension or, 4111 Turn-up rriball valve oroleanoutplug `I P All laterals are Identical IF x--il Hol es drilled on the bottom of the lateral $ equally spaced Laterals h force main of PVC Soh 40 S (per COMM Table 84.30 -6] Force main cemneotion via tee or oross to manifold at any point. Number of Laterals 3 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 3.08 ft Lateral Length (P) 58.52 ft Orifices per Lateral 20 Lateral Spacing (S) 3.33 ft Orifice Density 10.00 ft /orifice Lateral Flow Rate 8.24 gpm Manifold Length 6.67 ft System Flow Rate 24.72 gpm Manifold Diameter 1.50 in Total Dynamic Head 21.82 ft Forcemain Velocity 2.52 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and --► Comm 16.28 WAC 4 in. min. Disconnect Tank component is property vented IE Alternate outlet location Forcemain diameter. WEEKS Manufacturer 2 in. Capacityl 800.00 Gallons Volume 21.76 gal /inch A _ Weep hole or anti - Dimension Inches Gallons B siphon device A 20.90 454.73 13 2.00 43.52 C Pump off elevation (ft) C 5.87 127.67 87.07 D 8.00 174.08 D Total 36.761 800.00 ir Dose tank elevation (ft) 3" Bedding under tank. 1 86.40 Alarm Manuafacturer SJ E LECTRO Alarm Model Number HW 100- _J Pump Manufacturer [ GOU LDS Pump Model Number 311 L Pump MusfDeliver 24.72 gpm at 21.82 ft TDH Project: JIM NELSON Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name KIM A OCONNELL Phone 715 - 755 -3145 POWTS Regulator's Name ST. CROIX COUNTY ZONING Phone 715-386 -4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity WOO gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ft Maximum FOG 30 mg/L Type of Wastewaterl Domestic Maximum Fecal Coliforml >10E4 1 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 ears Mound Inspect for ondin and seepage once eve 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished �...... • •. *,�,,•�. ............... Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: JIM NELSON Page 5 of 8 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code G eneral This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01 101) and SSWMP Publication 9.6 (01181)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet finer shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 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 may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD 30 mg/L TSS, 10 mg/L FOG, and 10 cfu/100 ml- for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating cond'iti'on. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: JIM NELSON Page 6 of 8 i. A .. .. NNE MENNEN of MENIMMINNIMME ME MOMMEMIUM w . ''ter ■■ "� MMOOM■OM■M■M■ ■ .. �►lA� ®err._ ■ ■►� ■ ■r■ ■ ■ ■ ■■ ►!�aE■rre�a r . � ■�� ■ ■ ■ ■ ■■r�r ■M�r ' WOMEN! ' ►. ~ iii �iMs ■ NONE �rriM■�M��i. •.�.rr�! ►`r■r■iri■r�r■rr� Now MEMO: 0 ■ ■ � MODEL 3885 MINES SIZE 3 /4" Solids ��• NONE MEMO INNER owl SEMIN MMMMMMMMMMMM No MOM ■EM MEMO M■ME■■M■ M■ NOMINEES *4 13. �■■■ ■■■i■r■■■■E WOMEN ONE MENOMONIE NONE IN MEMNON MEMNON ummummom ■�■■ EEEOriO ■�■iE■ I 1 I r _ r I I _ i I I f i I i I I I 1 , I i I i I Nt y I t I , I - r t , 4 - y I _ - - �_ - i� __1 � -___i Wisconsin Department of Com erce�Q� S IL EVALUATION REPORT Page g of Division of Safety pnd Building Nov in accordance with C m 85, Wis. Adm. Code rrTb CRO COUN I Y County Attach complete site plan on p per tf ORYSF 11 ' es in size. Plan must include, but not limited to: vert erence point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Rev' wed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). NOV 1 3 Property Own Property Location - �- — Govt. Lot f& 114 1 1/4 S T N R �(or Property Owner's Mailing Address Lot # loc Subd. Name or GSW City Stat Zip—Code Phone Number ❑ City ❑ Village X Town Nearest Road New Construction Use, Residential i Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable ft. General comments p and recommendations: Boring # ❑ Boring ❑ J Pit Ground surface elev. ��_ ft. Depth to limiting factor 94 P' Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 -/ S Boring # ❑ Boring pit Ground surface elev. - 6 AP,6 ft. Depth to limiting factor S? in. I Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 S i * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 _< 150 mg /L * Effluent t? .= BOD < 30 mg /L and TSS < 30 mg /L CST Nam lea e irl�--) Signature , CST Number A dr ss a Evaluation Conducted Telephone Number 7 SBD -8330 (R07/00) i . Property Owner Parcel ID # Page of Boring # ❑ Boring ® Pit Ground surface elev. U.6- ft. Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * 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. SBD -8330 (R.07 /00) Iv o o` z � J r Safety and Buildings Division County FN * Zsconstn 201 W. Washington Ave., P.O. Box 7082 WI 53707 - 7082 Sanitary Permit Number (to be filled in by Co.) — Department of Commerce RQ �o 7a Sanitary Permit A plieation Sate Plan l D. Number In accord with Comm 83 21, Wit. Adm. Code, io} yc8 p / U dray be used for secondary putpotet Pri Y Uw, sl (1 xm) � Project Address (if diffarew than mailing addrou) I: Application Information - Please Print All Informa ion ZONING OFFICE /. Z ropers Owner' Na a Parcel # Lot # / P' Block # Property Owner's Mailing Address Property Location �� �) yes JZ Lion _ City, :'tsto Zip Code Phone Number / II. Type of Building (check all that apply) '��' ° C� 1 or:' Family Dwelling - Number of Bedrooms Subdivisio 0 CS`4AX ❑ Public/Commercial - Describe Use ^ ❑ State Owned - Describe Use k/ X o t . Vilkge ®7 owaship r w _ III. Type of Permit: IVJW k only out box on line A. Complete lne B If applicable) 00 V A ' New S em Yes t System ❑ Treatment/Holding Teak Replacement Only ❑ Other Modification to Existing: System B• ❑ Permit Renewal ❑ e it Revts ❑ Change of ❑ Permit Transfer t List Previous Permit Number Date Issu Before Expiration Plumber Owner IV. T of POWTS S stem: Check all that appl ❑ Non -Pressurized In -Ground Mound > 24 in. o f suitabl Soil Mound < 24 in. table ❑ At tttgk P r ❑ Constructed Wedand ❑ Pr*Uudzed In- Ground ❑ Holding Tank ilter Aerobic Treatment n ❑ Recirculating Fi ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber 1:1 D) Line el - less Pi ❑ Other (ex ai tift V. Dispersal/Treatment Area Information: Design Flow (go) Deli Soil Appli 'on Rate( 1) Dispersal Area flWui ( Dis 1 ro ( Elevation J ZA '7 VI. Tank Info Capacity is Total Num �M_asnufa/c/turge� Prefab S Fiber l Gallons Gallons of Units New I Existing �! ✓ Septic Tanks Tanks or Holding Tank _ Aerobic Treatment Unit Dosing Chamber Ze VII. Responsibility Statement- I, the undersigned, assliff. responsibility for Installation of the POWTS shown on the attaohsd Pl. ns. lumber' carte Print) Plumber's MP/MPRS Number Business Phone Ntamba 2 Plumber's Addres -- (( - S Ve t, City, S te, Zip C6je VIII. oun /De artment Use Onl pproved ❑ Disapproved Surc Feet Fee (includes Groundwater Date Issued ing Ag nt Si Sm") ❑ Owner Given Reason for iai 2 S• `� /� 3 Q 3 (l- I Conditions of Approval/Reasons f Disapproval 7 DN �' • Attache k S the Clr.tyy only) tar the system Paper not lest 3112 s It IocYa An In d SBD -6398 (R. 08/02) °'� ��t� fl-v C'°'nA" Safety and Buildings - 10541 N RANCH ROAD J HAYWARD Wl 54843 TD #: (608) 264 -8777 Viscon i www.commerc . o ns ov www.wiscnsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary March 06, 2003 CUST ID No.224263 ATTIC° POWTS Inspector KIM A O'CONNELL ZONING OFFICE K.O. CONSTRUCTION ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL � Identification ° hers A a PLAN AP ROYAL EXPIRES: 03 /06/2005 Transaction ID No. 8 98 SITE: Site ED No. 656302 m Nen & a Ramsay Please refer to b identification numbers,' Ji lso Ji ND l above, in all co spondence with the agency. Town of Somerset St Croix County 4r NW1/4, SW1 /4, S26, T31 19W FOR: New mound, 600 GPD Object Type: POWT System fated Object ID No.: 893662 The submittal described above has been r . wed for conformance with a is a Wiscons a Codes and Wisconsin Statutes. The submittal has b CONDITIONALLY A ED. The o er, as defied in chapter 101.01(10), Wisconsin Statutes, is resp ible for compliance th al S. The following conditions shall be met during cons on or insta on and prior to occ use: ' General Approval Conditions: L t • This system is to be constructed and located in accord with the enclosed approved s "Mound Component Manual for Septic Tank Effluent r ate Onsite Wastewater Syst - 91 -P (N.01 101) and SSWMP Publication 9.6, "Design O essu ' Distribution Networks For ri ank- Soil Absorption Systems." • In the event this soil absorption system or any o s component parts nctions so as to create a health hazard, the property owner must follow the c gency plan as describe the approved plans. In addition, the owner must insure that the operation, enance and monitoring duties escribed in section VIII of the mound component manual are complie ith. A copy of this information m e given to the own upo completion of the project. Key Item(s) • A copy of this approval letter and ' x sheet shall be attached to plans that correspond with cop on file with the Department. Changes to approved plan must be submitted for review and approval. i e to properly attach the approval and dex page to plans that match the copy on file with the Departme ay result in enforcement action under s. 5.10, Stats. • The proposed pump is near its limit with the proposed total dynamic head. If upon installation, the total dynamic head increases, the proposed pump must be reevaluated and may be inadequate. Note The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to I • T KIM A O'CONNELL Page 2 3/6/03 the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above fmished grade with a watertight cover. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Maintain well and waterline set backs per COMM 83.43(8)(1). Consult the Department of Natural Resources for well setbacks and exceptions to the setbacks. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 4P — atricia L Shandorf POWTS Plan Reviewer, Integrated Services WiSMART Code 7,533] (715) 634 -7810, Fax: (715) 634-5150, M -F 7:45 am - 4:30 pm pshandorf @commerce.state.wi.us cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544 I r MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: JIM NELSON - -- -LISA RAMSAY Owner's Name: JIM NELSON -- -LISA RAMSAY Owner's Address: 4426 WOODDUCK WAY RACINE WI 53403 Legal Description: NW-- SW-- SEC26 - -T31 N--R1 9W Township: SOMERSET County: ST. CROIX Subdivision Name: PINECLIFF Lot Number: 19 Block Number: Parcel I.D. Number: 032 - 2100 -90 -000 , Plan Transaction No.: Page 1 Index and title Page 2 Data entry c� cs Page 3 Mound drawings ur� Page 4 Lateral and dose tank Page 5 System maintenance specifications NCE Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 PLOT PLAN $ 'J Designer: KIM A OCON License Number: 224263 Date: 02/28/03 Phone Number: 715 - 755 -3145 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01181) Version 3.0 (03/01/01) Page 1 of 8 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: Sand fill (D) calculations assume.a 400.00 Estimated Wastewater Flow (gpd) Table 83 -44 -3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of « 36 inches. 600.00 Design Flow (gpd) 3.00 Site Slope ( %) c 100.40 Contour Line Elevation (ft) 32.00 Depth to Limiting Factor (in) 0.50 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) 7 ­ 8 ­ 0 _ 01 Cell Width (ft) 1.00 Dispersal Celt Design Loading Rate (gpd/ft 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest oint in the distribution I Y Pressure Disribution Information network? Enter Y or N (c or e) E Center or End Manifold 4.00 VVteral Spacing (ft) If N above, enter the elevation ft 2 N ber of Laterals of the highest point. 0.125 Ori iameter (in) (e.g. 0.25) 3.00 Estima rifice Spacing (ft) = 12.00 ft /orifice 2.00 Forcemain eter (in) 376.00 Forcemain Len ft) Does the forcemain dr ' ack? y 88.40 Pump Tank Eleva ft) Enter Y or N 6.50 System Head (ft) x 1.3 61.33 Fo main Drainback (gal) 12.33 Vertical Lift (ft) 67.38 oid Volume (gal) 3.63 Friction Loss (ft) 128.7 inimum Dose Volume (gal) 22.47 Total Dynamic Head (ft) 2 System Demand (gpm) Lateral Diameter Selection ant Diameter Selection in. dia. options choice A in. dia. options choice 0.75 1.25 x 1.00 1.50 X 1.25 x 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons /Inch Calculator (opti Treatment Tank Informati 800.00 Total Tank Capacity 1260.001 Septic Tank acity (gal) 36.00 Total Working Liquid D (in) WEEKS I ufacturer 22.22 gal /in (enter result in cell B Dose Tank Information Effluent Filter Information 800.00 Dose Tank Capacity (gal) lZabel Filter Manufacturer 21.76 Dose Tank Volume (gal/in) JAI 00 Filter Model Number WEEKS IManufacturer Project: JIM NELSON -LISA RAMSAY Page 2 of 8 t Mound Plan View T 1/10 B .. . .. J .. Observation Pipe:: ;: K Q LI A W I ; :I:;:;:;:;::: B I • 3 . I L � Mound Component Dimensions Down slop toe extension made. A Oft E 8.88 in H 1.00 ft K 7.24 ft B 75, F 9.50 in 1 8.00 ft L 89.47 D 6.00 i G 0.50 ft J 4.93 ft W 20. 600.00( ) Disper II Area 1200.00 (ft Basal Are vailable 8.00 (gpd/ft) Linear L Rate 7.50 (ft)1/10 B Pipe Placement Mound Cros ection View Aggregate Disp I Area Finished Grade 102.69 (ft) — 0 ,,,, ♦ H ',,,,,;,,,, G 1 F Dispersal cell _ 101.40 (ft) Lateral 100.90 (ft) -► Invert Dispersal Cell 1 E D • 3 Elevation vati n � � J L A :l i LI• •I q•� A .:. - ` A v 1 .t .<,Z .. 1 J ! . ... Jk ) 7 '1 4 T J A.. i.�� 1.. A 100.40 (ft) Con to t levation 3.0% Slope Geotextile Fabric er Shading Key — r Dispersal Cell See lateral details on 1� ® Topsoil Cap s 1.5 Page 4 for number, Subsoil Cap size, and spacing of ASTM C33 Sand . F laterals. Laterals are ( Tilled Layer c ft Typical Lateral equally spaced from 15 Aggregate o 5; the distribution cell's �— A centerline in the distribution cell (AxB).. Project: JIM NELSON - -- -LISA RAMSAY Page 3 of 8 End Connection Lateral Layout Diagram Laterals otntertd over the A & 9 dimension = Turn -up vWball valve or olvanoutplug , I P ---� All laterals are identical IF X --4 I Hol es drilled on the bottom of the lateral S equN{y spaced Force main connection via top or cross to manifold at Jny point. Laterals ek roroe main of PVC Soh 40 (per COMM Table 84.30 -5) Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1,50 in Orifice Spacing (X) 3.06 ft Lateral Length (P) 73.44 ft Orifices per Lateral 25 Lateral Spacing (S) 4.00 ft Orifice Density 12.00 ft /orifice Lateral Flow Rate 10.30 gpm Manifold Length 4.00 ft System Flow Rate 20.60 gpm Manifold Diameter 1,50 in Total Dynamic Head 22.47 ft Forcemain Velocity 2.10 c Dose Tank Information Locking toy warning label and ng device and sealed rtigM Ele al as per NEC 300 and ----IP ` m 16.28 WAC 4 In. min. Disconnect Tank component is property ( Aftemate outlet location Forcemain diameter WEEKS Manufacturer 2 in. Cap acityl 800.00 Gallons Volume 21.76 gal /inch A _ Weep hole or anti- Dimension Inches Gallons siphon device A 20.69 450.13 B 2.00 43.52 Pump off elevation (ft C 6.08 132.27 89.07 D 8.001 174.08 D Total 1 36,761 800.00 D ose to vation ft 3" BedIng uncTer tank. 88.40 AF Alarm Manuafacturer Si ELE RO Alarm Model Number HW 10 Pump Manufacturer GOU S Pump Model Number WEO 1 L Pump Must Deliver I 20.60 gpm a 22.47 ft TDH Project: JIM NELSON - -- -LISA RAMSAY Page 4 of 8 Mound System Maintenance and Oneration Specifications Sep vice Provider's Name KIM A OCONNELL Phone 715 - 755 -3145 PO`,NTS Regulator's Name ST. CROIX COU ZONING Phone 715- 386-4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 7g/L Septic Tank Capacity 1260 gal Maximum TSS 150 Soil Absorption Component Size 600 ft Maximum FOG 30 Type of Wastawaterl Domestic Maximum Fecal Coliforml >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 ears Effluent Filter Should inspect and clean at least once eve ears Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure teelm every 1.5 ears Mound Inspect for ponding and seepage on very 3 years Other Mis eous C nstruction an a rial tan ards F 1. Observation pipes are slotted and ma s conform to Table m 84.30 -1, have a watertight cap, and are secured in as shown in the moun onent manu 2. Dispersal cell aggregate conforms to Comm 8 6)(i), Wi Adm. Code. 3, All gravity and pressure piping materials conform t r irements in Comm 84, Wis. Adm. Code., 4. Tillage of the basal area is accomplished with a mold d or chisel plow. 5. The mound structure and other disturbed areas will be, d and mulched to prevent soil erosion and help reduce frost penetration. Lateral -up Detail Finished ....... 9.9 9 6 . Grade \ �/ Diameter Lawn Threads snout Sprinkler Valve Box Plug or Ball e Distribution Lateral � Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: JIM NELSON - -- -LISA RAMSAY Page 5 of 8 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and coven: should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s, 281.48, Slats. The co nts of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and fUter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be oved unless provisions are made to retain solids In the tank that may slough off the filter when removed from its enclosure. If the filter is a ped with an alarm, the filter shall be serviced if the rm is activated continuously. Intermittent fitter alarms may indicate surge flows or mpending contlouous alarm. The septic tank she a its contents removed when the volume of sludge and scum in the tank exce 1/3 the liquid volume of the tank. If the contents of the tank ar t removed at the time of a triennial assessment, maintenance personnel all advise the owner of when the next service needs to be performed aintain less than maximum scum and sludge accumulation in the The addition of biological or ch I additives to enhance septic tank performance is generally required. However, if such products are used they shah be approved for septic use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at once every 3 years. All switches, ajar and pumps shall be tested to verify proper operation. If an effluent filter is installed within the to . ' shall be inspected and serviced ecessary. un d ssure istri utio to No trees or shrubs should be planted on the mound. Pla maybe made ar d the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to de some pr n from frost penetration. Traffic (other than for vegetative maintenance) on the mound Is not recommended since soil oompa may hi r aeration of the Infiltrative surface within the mound and snow compaction In the winter will promote frost penetration. Cold weather II ( 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 BOD5 0 mg /L TSS, and 30 mg/L FOG for septio tank effluent or 30 mg/L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 10 cfu/100 mL for hig tr ed effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point a e end of lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pr a test Is perfo d it should be compared to the initial test when the system was Installed to determine If orifice dogging has occurred If orifice cleaning squired to maintain equal distribution wttitkt the dispersal cell. Observation pipes within the dispersal cell shall be checked f ffluent ponding. Ponding els shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure r iring additional, more frequen nitoring. Contingency Plan If the septic tank or any of its components become def ' e the tank or component shall be repaire eplaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or rel d wiring becomes defective the defective compone shall be immediately repaired or replaced with a component of the same or ual performance. If the mound component fails to accept wastewat or begins to discharge wastewater to the ground surface, it repaired or replaced in its' present location by increasing basal area if toe I age occurs or by removing biologically clogged absorption and I media, and related piping, and replacing said components as med necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and tele ne number of your local POWTS regulator and service provider. Project: JIM NELSON -- -LISA RAMSAY Page 6 of 8 �� �iiir�iii��i■ rl■`� ■■■ ■ ■■' " ■ ;, _ _ ���i��r�r ■rr��.lir� ®rCC� �ii r " 011111%AIMr■e■■i■M Elm niffiraft"Ir ��ell■ r■r �■ N■ rr A�1 ■■IIAMII�■ � ►�e■rrerreerrr �. WA EM�� MODEL W5 YAMMER s F A MM mmm�� g000m No • �r.� eNr r ■rre�� ■ ■r■■■ mo i ■r■Ir�■■rrrle■r■■rr■■s ■■ � I■eee��■r■i■i■■■irei■rr■r■r�. • . M� ■�:rr ■ ■ ■ ■ ■r■� ■ ■ ■■ r i�e ®i■MENNEN mom ■■ r■i■►■■ =�■rl■r■Ir ■ ■■■■I■1■ • ■ �.Ci■ ■ a■ r iCCCimom �� � ® ®�ii ����ii lil�i �■® I�i I�iili i��ili r ■tee■ ■eri■eeerrrr�e. ■i■eier�ee■�rr e■re■■ leer rec�►eiee�■rie► e ie■re■Ir■rr■ir►� irr■e �e.r.r.�..ei... . . rCee l■■ e�r■■elir■� ■■r■■�■I■reeieeirerr Oo e k 00 � \ `Z `�. � � � � ,- �,,i'� `�.-- �� ,, Y 11 �� � / _ f�' _.. � ...,. ,.. _ _._ h _� i _�- - '" 1 _ ___-r -_ �' Q }\� / / � �� �'" � j ` _ s'. � � a ' _ � _. N � � Z ,r� � . � �__� _ , _ -._ ` ,� \ �ti �� � � � ��� 1 � � ;,- . ti _ �� _ `� o . _ __ .� .� � � � z� w ,3 � .' �, .� � � � . � `� - , __ '� �: �� .� __ _ . _. � � _ �,. / 3� �$ J . � � , ' ' ' ' � . ` . � , . � � � � �. %� � _ . f ~� *� . � � ;� � $ � �* �^ ` \ �k :�. \ ��v¥ °� � % ¥ . . ¥ . �© � , 4 . � �. . . . ��° � \ \; . ». ;« � �� r ,: y � � . » .. Wisconsin Department of Industry SOIL AND SITE EVALUATION Lal. zr and "Human Relations I Page of .3 Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County 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. # 3 / APPLICANT INFORMATION - Please print all information. eviewed" Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). M ope , Owner Property Location j al , �' Govt. Lot 1/4 T 5 ,N 4 V or& Property Owner's Mailing Address Lot # I Block# Subd. Nam' el M# �� ! - , +Gk l t Y City Sta a Zip Code Phone Number .j rest S OIL El Gtypy. YIU a Town 10 New Construction Use: ® Residential / Number of bedrooms �� Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow (0 gpd Recommended design loading rate __, bed, gpd _�jtr h, gpd/ft Absorption area required COO bed, ft2 Zoo trench, 11: Maximum design loading rate _ bed, gpd/ h, gpd /ft Recommended infiltration surface elevation(s) �D y It (as referred to site plan bench Additional design /site considerations Parent material _ - Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = unsuitable for system ❑ S ®u Co s El ❑ s W u ❑ S 1 U [Is ®u [Is [0 u SOIL D fi,961 TION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD 1ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 1 1,3 / 0 -// - A, 4"1 2, At Ground , 7s-9 _ elev. A� 4e Depth to limiting factor ? in. Remarks: Boring # / Ll ©� 7 _ � a Ground elev. Depth to limiting factor in. Remarks: CST Name (Please Print) Signature Telephone No. , �61 Address, Date CST Number L ti SOIL DESCRIPTION REPORT PROPERTY OWNER �® � 9, • Page of i PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench :4 ; Ground el v. ft. Depth to limiting , factor 29 in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # L Ground elev. ft. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) I y � e� 5z ,f), : : : - ST CROIX COUNTY SEPTIC 'TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwneriBuyer - Mail in Address Property Address � S (Verification required from Planning Department for new construction) City /State 11��,'l� Parcel Identification Number -zln-�_ LE GAL DESCRIPTION Property Location /,, /�, Sec. TZ� N -R9W, Town of Z Subdivision %�✓.�(�, =�--_ ,Lot # � Certified Survey Map # , Volume , Page # Warranty Deed Volume �,�, Page # _ �l Spec house Q yes no Lot lines identifiable 11� yes O no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenas._c consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposaI systrrn is in proper operating; condition and/or (2) al'Icr inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludE; •. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the stands. is set forth, herein, as set by the Department of Commerce and the Department f Natural R t p o to Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date, S 'ATURE 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 owner(s) of tile Property Property descr ed above by virtue of a warranty deed recorded in Register of Deeds Office, GNATURE OF APPLICANT DATE I Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department.' *'* •' ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy ol' the certified survey map if reference is made in the warranty deed r — — v�, .15&. PAG: ,302 68$03 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED R E G IS T ER O — _ This Deed, made between Pinecliff P artn ers hi p consisti of RECEIVED FOR RECORD Michael J. Hartman and Wendell V. V — — _ - -, —__ W -05 -2001 10:00 AN — — — -- WARRANTY DEED -- - -- EXENPT N Grantor, and James B. Nelson and Lisa C Ram say, husband and CERT COPY FEE: COPY FEE: wife. - -- --- -.. - -- . - - -- — TRPNSFER FEE: 265.00 -- - -- —_ ___— — — - - - - -- RECORDING FEE: 10.00 — - - - - - -- - - -- — — — -- -- PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. C _ — — — __ County, State of Wisconsin (if more space is needed, please attach addendum). Reco+ding Area Lot 19, ne Cliff in the Town of Somerset, St. Croix County, Wisconsin' Name ko ft"Ifi ft OGLAND 7_i1z BStreen & Ogland P,O, ROx 359 Hudson, W1 54016 032 - 2100 - 9 Tpropert]y Parcel Identification Number (PIN) This is homeste & (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. 2001 Dated this ���_ day of _ Janua — Pinecliff Partnership — - - - - -- — — — — + Michael J. Hartman AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) P insctiff Partne rship, consisting of Michasl J- _ ) ss. etmae•, —.� - -- County ) � � • 2001 — -- - - -- �aDtheri catcid +s d y of Jsnuar Personally came before me this —_ - -- day of _— - -. -- — - -- the above named �fCrfst nhbglantl �{$ pit2hT�£R STATE BAR OF WISCONSIN - -- — J — to me known to be the person(s) who executed th foregoing instrument and acknowledged the same authorized by 3 706.06. W is. Stats.) __ ---- THIS INSTRUMENT WAS DRAFTED BY ' ___. ___— —. —_ ----- - - - - -- — — Attorney Kri Ogtan —` _— —_— .— Notary Public, State of Wisconsin Hu WI N4016 — - - - - -- My Commission is pennanen[, (If not, state expiration dat (Signatures may be authenticated or acknowledged. Both are not necessary.)- - - - - -- - - - - -` ' Wormaaion Protacsionals company. fond du Lac. 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