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HomeMy WebLinkAbout032-2174-21-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 515271 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Erickson, William and An ela I Somerset, Town of 032 - 2174 -21 -000 CST BM Elev: Insp. BM Elev: / I BM Descrip ion: p Section/Town /Range /Map No: / - S 5 / - 0 /- S 8 1 27.31.19.1476 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic /20 Benchmark / D S 2 lat ..S� Dosing L 7 Alt. Aeration Bldg. e r - Sj� 7 G 3 , 2. a Holding St/Ht Inlet u TANK SETBACK INFORMATION St/Ht Otle TANK TO P/L WELL BLDG. Vent to Air Intake ROAD D I� Septic Dosing � Header /Ma v Aeration Dist. Pipe 2-11 - 7 Holding Pot. System "'A. 3.►� 36 1l02.l� � ,� �,. 'nal Grade I;r PUMP /SIPHON INFORMATION KIOC,'� Manufacturer -- /��^ , Demand Cover GPM S I'L` S g. 2- 1 �"], S Model Number TDH Ln Loss System ad TDH Ft at`" 3. tors 2 . Forcemain Len g h I I Dia. Z r Dist. to Well l� Z /j yer SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG JWE L LAKE /STREAM L CHING anufacturer: - < INFORMATION CHA OR Type Q( system: i ��/ N� 1 I nu�Q/t, ( NI Model Number: Yes t� No DISTRIBUTION SYSTEM _ (` �/2 — —] ifo Header n Distribution (( x Hole Size / x Hole Spacing Vent o Aid Intake Z ' (j Pipe(s) ' ' S pacing l / � r ll• (12 ?) 2.1 0 SG /, v . Len 9 th Dia Length � Dia _.l. -. acin S D C/ SOIL COVER x Pressure Systems Only xx Moun At - Grade Systems Only Depth Bed/Treench Center J Bed/Trench h o /] xx S ew /So d d Depth over nch Edges Topsoil xx MulchedV L4 � Yes 0 No ® COMMENTS: (Include code di persons present, etc.) Inspection #1:121 Inspection #2:_Yg Location: 589 200th Ave Somerset, WI 54025 (NE 1/4 NE 1/4 27 T31 N R1 9W) River Hawk Ridge Lot 21 Parcel No: 27.31.19.1476 1.) Alt BM Description =`rD� �7 d�� D C G�S_ s p� �Pi � 4A (/ 2.) Bldg sewer length - /�/ �— v "° ✓`'' `�/ `QRJV (� G9���� ���42Ck/3t - amount of cover Plan revision Required? Yes No l 2 ? Use other side for additional information. i _ SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. �I I XQ3 - 31 �'9 Pl� 1 commerce.wl.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 5 Y. i sco n s i n Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) 111 t Department of Commerce Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for second 89 L D 0 "H•t 0.0 tt purp oses in accordance with the Privacy Law, s. 15.04 1 m , Slats. I. Application Information — Please Print AMkfo Property Owner's Name t Parcel # / Property Owner's Mailing Address JUN 0 7 r� f110 Property Location /L_/�/ Z o z— �� �, S _D • IY r G lI 1 Govt. Lot _] �(O City, State Zip de /LJ�' y , 1 Z 7 INa 1� Z /�/ F / <, Section circle one) Yv T _ 3 r N; R E or W II. Type of Building (check all that apply) ZBloc wj!.�� 1 or 2 Family Dwelling - Number of Be rooms Subdivision Name filrit. �sEw K i l ❑ Public /Commercial - Describe Use ❑ City of �O✓,il ❑ State Owned - Describe U$e CSM Number El Village of 1 01 x �� Town of Odn / 1II. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. XNew System ❑ Replacement System g p y g y (explain) ❑ Treatment/Holding Tank Replacement Only Other Modification to Existing System B. ❑Permit Renewal El Permit Revision C1 Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner _ 6 IV. Type of POWTS System/Component/Device: Check all that a nound i El Non-Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Tre "ment Area Information: - - 14 1.1 Design Flow (gpd Design Soil Application Rate( Dispersal Area Require Dispersal Area Prop ( System Elevation CooO 1.O Q. (p (po U OLD (oo 0 /.0/. 8S✓ VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units p 2 c d New Tanks Existing Tanks 2 c 0 r ;; m as �� O 2 U in ti C-1 w C7 P. e t' r Holding Tank � L J d J S�q ..✓ ��/ Dosing C ber I 7sd VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS show the attached plans. q a ber's Name (Prin Plumber's Signature MP R Number Business Phone Number � L4 C U -/'SJr -S Z 7L- V;7Z -Z ( /Z 1 PI ber's Address (Street, City, State, Zip Code) Z u S CI �So �'' r x IAJ VIIL Coun /De artment Use Onl pproved ❑ Perm it Fee Date Iss ed Issuin gent Signature ❑ f al $ to �� IX. Conditions of Approval/Reasons for Disapproval STEM Q, ER: Septic t , effluent fiRor and dispersal cell must all tze sar bo /M aintained as per management plan pmvkW by 0~ I l At ba,:mainhMW as �" � olid� /of�lrinrbrM, (( Attach to complete plans for the system steem and submit to the County only on paper (( not ��less than 81/2 X 11 inches in size_ ^ 3) Z0,j; l 1 P_ 6 4 . 1�( L*Q. ►`G SBD -6398 (R. 02/09) Valid thru 02/11 ;J j �� J a .�•+ roc. S�"�� . ; Seax S /VE - �y j( SEC, a� w t ro 1/1e,+1, o�C S sfe+�n � -t -r-o A- 3'� Lo J /01, 9J� JA e 757c0.1 rz- w �. /� •/ -- T"►�o a� of �.� do�,�re.. s P� L�c� ='z /03. S tiq I. a P° s ® D1 �„ A IVV t Safety and Buildings 10541 N RANCH ROAD commerce HAYWARD WI 54843 Contact Through Relay i sco n s i n ,vw�n,•commer www.wisconsin.gov Department of Commerce www.wisconsin.gov Jim Doyle, Governor Aaron Olver, Secretary June 04, 2010 CUST ID No. 222872 ATTN.• POWTS Inspector JACQUE M HAWKINS ZONING OFFICE HAWKINS SOIL TESTING & SEPTIC SYSTEMS ST CROIX COUNTY SPIA 2659 150TH ST 1101 CARMICHAEL RD LUCK WI 54853 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/04/2012 Identification Numbers Transaction ID No. 1800337 SITE• Site ID No. 756796 Bill Erickson Please refer to both identification numbers, 57TH St above, in all correspondence with the agency. Town of Somerset St Croix County P.O.W. NE 1/4, NE 1/4, S27, T3 IN, R1 9W } r (;012dt tl r, it FOR: Description: Mound, 4 br res Object Type: POWTS Component Manual Regulated Object ID No.: 1266774 ARTMENT OF CO' Maintenance required; 600 GPD Flow rate ;' 30 in Soil minimum depth to limiting factor from original grade; ETY Ate Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 101), SSWMP Pub. 9.6; Effluent Filter' The submittal described above has been reviewed for conformance with applicable Wisconsin Administr ` e EE COR i C and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constru cted 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: Key Item(s) • 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. • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. JACQUE M HAWKINS Page 2 6/4/2010 ' • 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 other regulations and exceptions. 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 i' Fee Received $ 250.00 Balance Due $ 0.00 / Patricia L Shand rf POWTS Plan Review , Inte ated Services WSMART code: 7633 (715) 634 -7810, Fax (715).634 -5150 , M -th 8:00 - 4:45 pat.shandorf @wiscons3g'ov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Monday, 7:00 A.M. To 3:30 P.M. 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. eov/ SB/ SB- BuildinaContractorPro.,ram.html JACQUE M HAWKINS Page 2 6/4/2010 ' • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(i). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. 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 f for the installation, operation or maintenance of the POWTS. Sincerer Fee Required $ 250.00 i' Fee Received $ 250.00 Balance Due $ 0.00 / Patricia L Sl azrd POWTS Plan Review , Integrated Services WiSMART code: 7633: (715) 634 -7810, Fax 715) 834 -5150 , M -th 8:00 - 4:45 pat, shandorf @wisconsirrg'ov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Monday, 7:00 A.M. To 3:30 P.M. 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. eov/ SB/ SB- BuildingContractorPropram.html a MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Bill and Angie Erickson Mound Site Owner's Name: Bill and Angie Erickson Owner's Address: 202 Sunrise Drive Somerset WI 54025 Legal Description: NE1 14 -NE1 /4 Sec. 27 T31 N -R1 9W Township: Somerset County: St. Croix Subdivision Name: River Hawk Ridge ,111Y Lot Number. 21 Block Number: NA J D Parcel I.D. Number: Plan Transaction No.: NDEN Page 1 Index and title Page 2 Data entry Page 3 Mound drawings p 37 Page 4 Lateral and dose tank 0 Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Designer: Jacque Hawkins License Number MPRS3 222872 Date: 05/09/10 Phone Number: 715 -472 -2421 Signature: A, Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706 -P (N. 01/01) Version 5.1 (R. 06/06) 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 83-443 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of - 36 inches. 600.00 Design Flow (gpd) 1.00 Site Slope ( %) 101.35 Contour Line Elevation (ft) 30.00 Depth to Limiting Factor (in) 0.60 In -situ Soil Application Rate (gpd /fe) Distribution Cell Information 75.001 Dispersal Cell Length Along Contour (ft) = 8.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft) 1 I Influent Wastewater Quality (1 or 2) Are the laterals the highest oint in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) C Center or End Manifold 4.00 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) 2.00 Estimated Orifice Spacing (ft) = 8.33 ft /orifice 2.00 Forcemain Diameter (in) 160.00 Forcemain Length (ft) Does the forcemain drain back? Y 80.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 26.10 Forcemain Drainback (gal) 15.143 11.35 Vertical Lift (ft) 67.44 5x Void Volume (gal) 3.04 Friction Loss (ft) 93754 Minimum Dose Volume (gal) 0.00 In -line Filter Loss (ft) 29.66 System Demand (gpm) 20.89 Total Dynamic Head (ft) Lateral Diameter Selection Manif Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 x 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 Total Tank Capacity (gal) 1250.001 eptic Tank Capacity (gal) Total Working Liquid Depth (in) Skaw Precast Coma Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 754.35 Dose Tank Capacity (gal) Best Filter Manufacturer 16.05 Dose Tank Volume (gal/in) G -10 Filter Model Number Skaw Precast Co. I Manufacturer Project: Bill and Angie Erickson Mound Site Page 2 of 8 Mound Plan and Cross Section Views 1/10 B : :�:. J on : Observati Pipe _ K :'-' -' :5 W • A :is : I.. .................... I Mound Component Dimensions ✓ A 8.00 ft E 6.96 in H Aft ft K Aft ft B 75.00 ft F 9.50 in z ft L ft D 6.00 in G 0.50 ft J W 600.00 (ft) Dispersal Cell Area 1 1034.15 (if) Basal Area Available 8.00 (gpd/ft) Linear Loading Rate 1 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 103.64 (ft) —► I H I F ::: ...rs eii 102.35 (ft) Latera �ispen�i c 101.85 (ft)—► — Invert Dispersal Cell :D t Elevation E •- i i S�7 i i ]�i i�i __J ~ J - J : i] - i 4 .J. - J, i " J • �J ' ,J ~a { +~ a`i. { - { i. -i, 3 i �, r, J i { w :J. _ i •�_�._.], �, ; i ; 7� ],. ?... fi. ~i ~ �i '•]_ .?, { �, J • l.~ i� { •�� J =i• `i .- -. _ ~ 101.35 (ft) Contour Elevation 1.0 % Site Slope Geotextile Fabric Cover Shading Key a Dispersal Cell See lateral details on [] _ Topsoil Cap o Q• 1.5 ft ;.: ; Page 4 for number, size, Subsoil Cap 'a c 5 and spacing of laterals. ASTM C33 Sand .- •� '• F Laterals are equally Tilled Layer m 0.5 ft Typical Lateral ' ?.: spaced from the []5 0 Aggregate v distri bution cell's ° centerline in the — A * distribution cell (AxB). Project Bill and Angie Erickson Mound Site Page 3 of 8 Center Connection Lateral Layout Diagram Force main connection via tee or cross to mar"d at ang point. Laterals are klentic al i P s f= Turn -up wtball valve or f <-X--�iE212 I xt2� Laterals & force main of PVC Sch 40 clean out pl u 9 per COMM Table 84.30 -5 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.10 ft Lateral Length (P) 36.75 ft Orifices per Lateral 18 Lateral Spacing (S) 4.00 ft Orifice Density 8.33 fe /orifice Lateral Flow Rate 7.41 gpm Manifold Length 4.00 ft System Flow Rate 29.66 gpm Manifold Diameter 1.50 in Total Dynamic Head 20.89 ft Forcemain Velocity 3.03 ftfsec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and --► Comm 16.28 WAC Disconnect —1 4 in. min. Tank component is properly vented = Alternate outlet location Forcemain diameter Skaw Precast Co. Manufacturer �_ 2 in. Ca aci 754.35 Gallons Volume 16.05 gal/inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 27.17 436.11 C B 2.00 32.10 Pum off elevation (ft) C 5.83 93.54 91.00 D 12.00 192.60 D Total 1 47.001 754.35 iF ' Dose tank elevation (ft) 3" Bedding uncTer tank. 1 90.00 Alarm Manuafacturer JSJ. Electro Alarm Model Number I Tank Alert Pump Manufacturer JGoulds Pump Model Number EP05 Pump Must Deliver 29.66 gpm at 20.89 ft TDH Project: Bill and Angie Erickson Mound Site Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name Raska Sewer Service Phone 715- 755 -4888 POWTS Regulator's Name St. Croix County Zonin Office 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 1250 gal Maximum TSS 150 mg /L Soil Absorption Component Size 600 ft Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Moundl Inspect for ponding 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 •........... 00000000**06999 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: Bill and Angie Erickson Mound Site Page 5 of 8 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code 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), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD 10706 -P (N. 01/01)) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection, The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent fitter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution 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. Contlnflency 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 dogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatrrrent Un#s The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 8 Page 7 of 8 GOULDS PUMPS Submersible Effluent Pump l 3871 EPO4 EP05 APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses: heat transfer. ■ Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion • Farms manual operation. Auto- resistance. 1 0 Ca odw StandardsAssoaanon • Heavy duty sump matic models include • Water transfer Mechanical Float Switch ■Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "C" or "F ".) factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic GmklsKsnpsis ISO 9001 k4sWed. FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. ' /4 " maximum. ■ EPO4 Impeller: Thermoplas- ■ Power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: 1'12' NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA -N elastomers. • Temperature: 104"F (40`C) continuous METERS FEET 140"F (60`C) intermittent, 10 • Fasteners: 300 series stainless steel. 9- 30 s GPM • Capable of running dry without damage to s 25U - cornponents. 0 7 a Motor: _ • EPO4 Single phase: 0.4 HP, v_ 6 20 115 or 230 V, 60 Hz, 1550 RPM, built in overload with o 5 15 automatic reset. Q 4- EPOS • EP05 Single phase: 0.5 HP, o 115 V or 230V, 60 Hz, 1550 3 10 RPM, built in overload with EPO4 automatic reset. 2 • Power cord: 10 foot 5 standard length, 16/3 1 S1TOW with three prong grounding plug. Optional 20 0 0 0 10 20 30 40 50 GPM foot length, 16/3 S1TW with three prong grounding plug 0 2 4 6 a 10 12 m3/h (standard on EP05). CAPACITY Goulds Pumps C 2001 Goulds Pumps ITT Industries Effective May, 2001 83871 R ECE I VE Wi&ra - nstn Department of Commer SOIL "EVALUATION REPORT Pa e I of Division of Safety and Buildings DE C 1 8 20 g in accordance Q Comm 85, Wis. Adm. Code ST. CROIX County Attach complete site plan on p t )art YI�fx Ff`1 inch¢s in size. Plan must J include, but not limited to: vertical and hon ce point (BM), direction and Parce l I.D. percent slope, scale or dimensions, north arrow, and IocaUOYt °and distance to nearest road. 03 -- 2 i Please print all information. rRe)4 b Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner nn Property Location Q - � — (7 t lJ E/ /t' Govt. Lot N E 1/4 NC cc 1/4 S 2 7 T N R / / f (or)oN Property Owner's Mailing Address Lot # Block # Su d. Name or �/ C �/ SM# City State Zip Code Phone Number ❑ City ❑ Village aTown Nearest Road 117 3 Z S ,SOS +P�se 5- r4sf New Construction Use: Residential / Number of bedrooms Code derived design flow rate 66 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable General comments and recommendations: Sya ��`�� -�"� �'tsx'C' ark C "o.���c�.c• A1,e Via( l{ /S 4 ❑ I Boring # E] Boring 0 pit Ground surface elev. Depth to limiting factor < 3b in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Z /D `fie y �2 G ,P� yyi ✓fi G i� O • S r 3 20.26 7s�iP Nrf /*��� 6- 34 j 6YQ 4 0.7 /. Q, F9-1 Boring # ❑ Boring ® pit Ground surface elev. �0� S ft. Depth to limiting factor 3� 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 ©- /6 101 �S G 21W-(k 14 C w /-7 D, S O 2 &-2t/ IDYL G L ;�Wik rn ✓g, c :,C' o. s 0, 9 3 2y 36 7s�p s, 2 /77ShA � � � � s la- o,s 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 CST Name (Please P ' t) Si nature CST Number t) S* ( 0 4� 2313 i Y Address Date Evaluation Conducted Telephone Number � 90 C f6,2- L-/J rd- 6-L )Z -13 —63 /s- 2� 320 SBD -8330 (R07 /00) Property Owner /Came) &1 1 e Parcel ID # Page c;� of 3 Boring Boring'# ❑ ® pit } Ground surface elev. /0/,o Sft. Depth to limiting factor 38 in. Sal 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 0.5- 0 2 l �/� d �- d � �� � w 0.57 0 , 38- Y 6 2, sre 0,V 0 6 S V6 -LYS 75-Re 1 Z- 10, l,a 8 9y sr� cep ,2.s rr� % SiL ('Vi -► F� — 0,0 D, a 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 /11 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F1 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 i 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) i Property Owner o &e l,if / Parcel ID # Page o of 3 F3 -1 Boring # Boring pit Ground surface elev. /Q ft. Depth to limiting factor 1 3 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 oo5 l 3 21-39 7, s-4 5 a ^ oc, as v 6.1 l 3 Y6 2, sye n, 0 , V 016 S IW -YS 7s7k , 7 /,A $11 YY SYw 0 Ce .2,sXf s � S%L (o 0,0 0,2 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 F1 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 ' 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) s y Ow'NL�' J�� N � In-i�: I Ge� AddreSs 313) �e s e t� �l Ssro , Date ! _ 15--03 Benchmark I C 0,14 e.- .� Be11C:1!1.ai_� !/`' (✓ 3•� IV4 9G>11"F�/ 1—J 5011 Lorin` f I_ J SLMaoie Af'- - Li ` �\ F= 40' sc de ' I I - -S _-- -- -- -- -- - -- i i IT i •. i 1 I II1 !II i i I I I I! it I 1 1 4 ' 6A "In S• � N.B.A./C.B.A. S Q \ 120,97 SQ. FT. X 2.78 ACRES, / /m . ` D / LOT 21 / N.B.A. /C. B. A. / / 0 m / / -,130, 768 sq. ft. ` 126,888 SQQ./FT. N O r / X3.00 Ocres N 2.91 ACREtS - 1 m / \ 0 -:2 1 m m LOT 20 0 -, 131, 053 sq. ft. N O 3.01 acres N m - -\ \ \ X30' \ 03 OS \77 \22), "� 1 X33 ,- � / / � o� POSSIBLE TOWN 00 ,111 - I r-- FT 124,646 SQ. \\ 2.86 ACRES \ \ 11 't6g, z � 136, 298 sq. LOT 15 ft. 3.13 acres D� N.B.A. /C.B.A. ro 1 M823 SQ. FT. \ 2.68 ORES L07'16 — — i- �—+ — 862, \ . W v�i_•� O \ \ \ 132, 096 sq. ft. rn I -7, r \, \ 3.03 acres \ 0 i - o ` �O Z -1-�. sin \ \� \ \\ \ ��/ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer Mailing Address 2d Z �k ,-- t Property Address 595 2-00 A Lt-e-, (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number 6 3 Z ' 2-1 Zl ' G D d LEGAL DESCRIPTION Property Location '/4 , ' /4 , Sec. 2 -7 , T N R 9 W, Town of �50 /71- Subdivision Plat: a w Lot # �. Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house yeskno Lot lines identifiable yes C] no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (I) the on -site wastewater disposal system is in proper operating condition and /or (2) after inspection and pumping (if necessary), the septic tank is less than l./3 full of sludge. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. 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 the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms r Rill 4 / SIGNA RE OF APPLICANTS) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is rnade in the warranty deed. (REV. 08/05) State Bar of Wisconsin Form 2 -2003 * 9 0 6 0 9 9 1 WARRANTY DEED 906099 BETH PABST Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD THIS DEED, made between Grand Properties, 03:15PM rties, LP WARRANTY DEED EXEMPT r ("Grantor," whether one or more), REC FEE: 11.00 and William Erickson and Angela Erickson, husband and wife TRANS FEE: 60.00 ( "Grantee," whether one or more). PAGES: 1 Recording Area r Grantor, for a valuable consideration, conveys and warrants to Grantee the following 4 described real estate, together with the rents, profits, fixtures and other appurtenant Name and >t Estreen interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is 3 Street needed, please attach addendum): Lot 21, River Hawk Ridge, St. Croix County, Wisconsin Hudson, W154016 lvI -18 &009 032 - 217421 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions t warranties: Easements, restrictions and rights -of -way of record, if any. Dated Grand Pro rties, LP P (SEAL) (SEAL) * *MN[G l Managerneit, LLC, by Michael J. Germain, its Chief Manager (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) Grand Properties, LP by MMG Mana¢ement, LLC, by Michael J. Germain, its Chief STATE OF ) Mans er ) ss. authenticate oy Z COUNTY } / %.-- Personally came before me on * Kristina Oelana I the above -named TITLE: MEMBER TATS BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledged the same. authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: Notary Public, State of Kristina Oeland, Estreen & Oeland My Commission (is permanent) (expires: 1 304 Locust Street, Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 0 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 • Type name below signatures. INFO -PRO' Legal Forms 800 - 855 -2021 www.imWrofomu.com 1 of 1 v / S 77 °20,53,, E 41 9,14' I o � 00 o 00 oo �- 0 w I o c N •�' •� LOT22 LOT 24 / 1,30, 892 sq. ft. 132, 591 sq. ft. �� 1 / :3.00 acres 3.04 acres 1 4 8 . E ti o / S -73, �. 16, �A)��� ON / OU TL C hJ , / IN h,I OT 25 32 sq. ft. '1 acres / pp / m O '� b D �N / 0 LOT 21 Z 130, 768 sq. ft. N o \ / 3.00 acres U o M m LOT 20 W \ 131, 053 sq. ft. l o J. 01 o acres \ \ 6 01) 3 m h O P 3 6 0° •1 . \ 9 0 9 N O, N, J � � — S 87 0 50'00" W 08 110.85' S 7cres W.M. ho b C11 0 .~~ LOT 15 6 6' 3.13E acres TO O.H. W.M. h o 0 LOT 16 �ao 3.03E acres M n 14 W" � o