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HomeMy WebLinkAbout032-1099-30-065 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 506266 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: Miller, Tyler I Somerset, Town of 032 - 1099 -30 -065 CST BM Elev: Insp. BM Elev: BM Description: SectionlTown /Range /Map No: 36.31.19.461A23 TANK INFORMATION r ELEVATION DATA TYPE MANUFACTURER ,`-` CAPACITY STATION BS HI FS ELEV. Septic �.._ Benchmark /6..l f�>✓ ) y Dosing I Alt. BM ;. ` c 7 fJ:ratiotl Bldg. Sewer f. Z3 1G( •7Z Holding v J 1 1 St/Ht Inlet $• Z` /� L r 7 m / �," •,�.. ,�,� r ..,r.,, -. 7 St/Ht Outlet TANK SETBACK INFORMATION TANK TO Pt WELL BLDG. Vent to Air Intake ROAD Dt Inlet F �`a Septic ' r i f Dt Bottom x 1 Dosing M._ �` a 1 Header /Man. Aeration Dist. Pipe 6"W1 t13-Al g Holdin Bot. System l.� 11z• s3 Final Grade . Z 59 PUMP /SIPHON INFORIVIATTON Manufacturer { Demand St Cover (oz GP Model Number ,e,- y �_ TDH LifjO 13 Frictio�Lo�— System H�ad TDI -2 Ft t �� . J cc77 ll��rr Forcemain Lg enth r , Dia. di Dist. to Well ' 1' SOIL ABSORPTION SYSTEM BED/TRENCH Width j Tjength No. Of rench PIT DIMENSIONS No. Of Pits Inside Dia Liquid Depth DIMENSIONS / SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type yyst m 5' I an, i - N - UNIT Model Number. DISTRIBUTION // �SIYSTEM �[J Header /Manifold Distribution a f / x Hole Sizei x Hole Spacing Vent to Air Intak / Pipe(s) 4 Length Dia Length 7 I Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or Al Systems Only Depth Over �es Depth Over ` xx ` Depth of (� xx Seeded /Sodded U N` xx Mulched V Bed/Trench Center ' _3 Bed/ Trench Edges \ Topsoil 1 1(�� ; es i.j No No ✓ COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: ` / '�' / Inspection Location: 779 190th Ave Somerset, WI 54025 (NE 1/4 NE 1/4 36 T31N R19W) NA Lot 6 ! `" k•' -i -• - Parcel No: 36.31 15 461 A 3 1.) Alt BM Description = 2.) Bldg sewer length = ' ;? � to L,.;% - - amount of cover = t Plan revision Required? 4 Yes No ' �� S Use other side for additional information. Date Insepctor' Signatur Cert. No. SBD -6710 (R.3/97) J r COfI'I1tIOM.W1.90V Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 St. Croix ��� �, Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) artnmtt of Commerce Dep M (p Z VIP IbA Sanitary Permit Application StateTransactioq►Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the riate g unit is required prior to obtaining a sanitary permit. Note: Application forms for state -o p0 are 1 t Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used seco in accordance with the Privacy Law s. 15.04 l m Slats. 79 19e Ave I, Application Inform 'on - Please Print All Information Property Owner's Name / RECEIVED Parcel # Tyler Miller 032- 1099 -30 -065 Property Owner's Mailing Address JUL 2 0 2007 Property Location Lot 601 Sommers Street No. #4 G° 'f10 1 t J mrrw City, State Zip Code PhonP umber NE %,, NE ' /., Section 36 (circle one) Hudson, WI 54016 7/ 5 .207 -_ T 31 N R 19 W H. Type of Building (check all that apply) a(, 0A ❑ # 1 or 2 Family Dwelling -Number of Bedrooms 4 � •c .n. 6 Subdivision Name 11 Public/Commercial - Describe Use Block # Na f t Na ❑ City of ❑ State Owned- Describe Use l /tom CSM Number ❑ Village of I li Vol. 20, Pg. 5066 ❑ Town of Somerset III. Type of Permit: (Check only one bog on line A. Complete line B if applicable) A. iKNew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner i IV. Type of POWTS S stem/Com nent/Device: Check all that appi ❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At-Grade found > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ other Dispersal Component (explain) 71 wetreatment Device (explain) V. Dis ersalfrreatment Area Information: a O, S Design Flow (gp) Design Soil Application Rate(gpdsf) Dispersal Area Requ sf) Dispersal Area Prop9sed (so System Elevation 600 gpd 1.0 ASTM C -33 sand 600 sq. ft. ' 600 sq. ft. 111.85' at 6" above O.�in situ soil 111.35' contour VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tanks ! po 16 t^, f L, Septic or Holding Tank 1,200 _ 1,200 1 VAescr Concrete X Dosing Chn 800 _ 800 1 1 Wieser Concrete X VII. Responsibility Statement- 1, the undersigned, assam responsibility for installation of the POWTS shown on the attached picas. Plumber's Name (Print) Plumber' gnawk MP/MPRS Number Business Phone Number Mark Stalinke 224757 1 (715) 760 -5067 Plumber's Address (Street, City, State, Zip Code) 338 County Road A, Hudson, Wl 54016 VI Coun /De artment Use On proved Permit Fee Date ued suing t Signature b $ OV ' °" - 7 Zo t tven for Denial IX. Cogdit9f lMteeasons for Disapproval 1. Septic tank,_eftluent fiker and dispersal cell must all be servlr es / maintained as per management plan provided by plumber. 2. AN edbwk requirements must be maintained code) ordirtattces. Attach to complete plans for the system and salrmit to the County only on paper not less flan 8 In z I I isches is sine SBD -6398 (R. 01107) Valid thru 01/09 4 r flA .i /90-,4�e. • Soy / .ems /ua6-o��o, � /o ca 6t�✓ ra�0. S —�' v:�tcfioY, oFs�'�acc 3/0,0 P roposed 0 Ac 6-6, cs„� �a�P so sow, � �b.cd*�•� � �t,� �-adc aE /�EYgrlr Scc. ,3� T. 3/r1 i �; , ,Pi.r,ilLnCC Propose.�bu,/d�ny � /9Gc� Tn.of+ -t-�, y °,su(. yo P.v. -' _ P� '� 032 :09� .3 -d6.s buy %d;n ZZ � y of � Ccr»m 82..30 / ' ./08 0 icysp• ' . 0 ro�ud - �•--A,1 efF /Cce. ,el;- /4ti•{p 6, inSEa / /cda� S.Tac / ki ,Z "scl,. tlo,od, e ,rrlex• S /o,OC tlrau�SyS�cm <ireq . ,' /o /� Proposed Plea nd Q1 zo.egX / /S.G/ w/G d:S/aysa 1 r r l �, 8aF9 /0 l- ,4 �e . �7 7177 � Soi / EI/Q�u4�br� / o, E � /o cci. 6c�„✓ ro�o. S ° /ter h1,' / /ZeW, cs ,r7 /W, I)e - * /7GT/'y S4 a. � it b.cc�,►�m �L,�i yradC a�E � i �� QcjidcnCC ��opose.c✓bu,�; �./9�; Tn.of'�r�c/S - c - �, . S,�G•/ %3.x.2' o`�. L'roi1� Co.,c.Jl. ! _ n �l 5 � {� 1!0-- ol y P��SC�( [�,xSLr (�.,c�t�C �Lf /, .'�CD� -, vte ec r,m b, Q - s. r. /RC. �b /y / ir sl e9k , e ,, ��; /Ec.fv bc :nS6a�//cda.t5T.oc�l M / P 0 . 0 n.j , � / J 2.O'e, n to uY i ,z sc1,. 63 r X G p2 �'a►'ce ryta %r► i l ,' i fY°POS�cI Alou d 46 /a ' J��o %rvGLS Sjo4Ceo(aL % v 4 d/ 3/s Bo' �.8a Safety and Buildings 4003 N KINNEY COULEE RD commerce.wi.gov LA CROSSE WI 54601 -1831 i ■ TDD #: (608) 264 -8777 O �' www.commerce.wi.gov/sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary July 09, 2007 CUST ID No. 224757 ATTN.• POWTS Inspector ZONING OFFICE MARK E STAHNKE ST CROIX COUNTY SPIA 715 6TH ST N 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 07/09/2009 Transaction ID No. 1413118 SITE: Site ID No. 727279 Tyler Miller Please refer to both identification numbers, 190th Avenue above, in all comes ondence with the a enc Town of Somerset St Croix County NE 1/4, NE 1/4, S36, T31N, R19W FOR: Description: Four Bedroom Mound System / New construction Object Type: POWTS Component Manual Regulated Object ID No.: 1139310 Maintenance required; 600 GPD Flow rate; 32 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01101), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.0 1 /0 1) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • Comm 83.22(7) - 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. P.O.W.T.S. Conditiona3v APPROVED" DEPARTMENT Of COMMERCE MARK E STAHNKE Page 2 7/9/2007 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of 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 Oerard M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART Code: 7633 jerry.swim@wisconsin.gov cc: James K Thompson, A.C.E. Soil and Site Evaluations (Plans Mailed To) Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. RFc J" 2 2 , 20 7 O/ S AF ,c r - Y MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN ��sL�INC;S Residential Application INDEX AND TITLE PAGE Project Name: Tyler Miller 4- bedroom residential mound Owner's Name: Tyler Miller Owner's Address: 601 Sommers Street No. #4 Hudson, WI 54016 Site Address: 779 190th Ave. Legal Description: NE1 /4 NE1 /4, Sec. 36, T.31N., R. 19W. Township: Somerset County: St. Croix Subdivision Name: CSM Vol. 20, Pg. 5066 Lot Number: 6 Block Number: na Parcel I.D. Number: 032 - 1099 -30 -065 Plan Transaction No.: Page 1 Index and title 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 Site Plan Page 9 Attached soil evaluaton report Designer: Mark Stahnke License Number: 224757 Date: 06/19/07 Phone Number: (71 5) 760 -5067 Signature: 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) DIVIS+un Of SNtEI Y kou buiLuiNGS Version 5.1 (R. 06/06) Page 1 of 9 SEE CORRES NDENCE �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) 11.00 Site Slope ( %) 111.35 Contour Line Elevation (ft) 32 .00 Depth to Limiting Factor (in) 0.50 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 100.00 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) _ 1.00 Dispersal Cell Design Loading Rate (gpd/ft) L 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest po in the distribution [ Y _ Pressure Disribution Information network? Enter Y or N (C or E) `� cl Center or End Manifold 3.00 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) = 6.00 ft /orifice 2.00 Forcemain Diameter (in) 110.00 Forcemain Length (ft) Does the forcemain drain back? Y 102.50 Pump Tank Elevation (ft) Enter Y or N .5 ystem Head (ft) x 1.3 17.94 Forcemain Drainback (gal) .93 Vertical Lift (ft) 62.76 5x Void Volume (gal) 3.83 Friction Loss (ft) 80.70 Minimum Dose Volume (gal) 0.00 In line Filter Loss (ft) 41.19 System Demand (gpm) { 19.27 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. o to ions I choice in. dia. options choice 0.75 I 1.25 x 1.00 1.50 x 1.25 x x 2.00 x x 1.50 x 3.00 2.00 x 7 3.00 X Ga llons/in ch Calculator (optional) Tr Tank Information 8 00.64 Total Tank Capacity (gal) 1200.00 Septic Tank Capacity (gal) 36.00 Total Working Liquid Depth (in) W ieser Concrete_ - ] Manufacturer 22.24 gal /in (enter result in cell 1349) Dose Tank Information Effluent Fi lter I nformation 80 0.64 Dose Tank Capacity (gal) PolyLok `. _ _!Filter Manufacturer 22.24, Dose T ank Volume (gal /in) ,PL -525 Filter Model Number Weser Concrete - Manufacturer Project: Tyler Miller 4- bedroom residential mound Page 2 of 9 Mound Plan and Cross Section Views T 1/108. s J Observation Pipe W 7 __ B . I ....... ............................... I 0--- J L Mound Component Dimensions A 6.00 ft E 13.9 H 1.00 ft K 7.80 ft B 100.00 ft F 9.25 in z E13.99 0.88 ft L 115.61 ft D 8: 00 i G 0.50 ft J ft W 20.88 ft 600.00 (ft Dispersal Cell Area 1 1688.43 (ft) Basal Area Available 6.00 (gpd /ft) Linear Loading Rate 1 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 113.62 (ft) --► rrr.+ H 2 /riiiii . G F '� '• Cell 112.35 (ft) Lateral rrrr r r / /rrrr . Dispersal 111.85 (ft)--► — Invert Dispersal Cell ' 3[�, t Elevation E D :' �.. .4 + • J J J ,• J 1 }• 1 i i J J J` " J " J V '"`• J 4'u 111.35 (ft) Contour Elevation 11.0 %Site Slope Geotextile Fabric Cover Shading Key $. Dispersal Cell See lateral details on Topsoil Cap 3 •C 1.5 ft • . Page 4 for number, size, Q 'rrrr Subsoil Cap 0 o 5 f�: and spacing of laterals. •:::•::� ti :;::•: ASTM C33 Sand ' ; r : :•, ; • • :.;_?: • : • � F Laterals are equally 13 > ; Tilled Layer .w d 0.5 ft :' Typical Lateral spaced from the Y ••1• •• •• ••.,•• 05 M Aggregate v o " �''.• U. distribution cell's A'_''T centerline in the IF distribution cell (AxB). Project: Tyler Miller 4- bedroom residential mound Page 3 of 9 Center Connection Lateral Layout Diagram Force main connection via tee or cross to manifold at ang point. Laterals are Identio al P 5 •= Turn -up Wball valve or IE X-- �IExflx1241 Laterals & force main of PVC Sch 40 of as n out pl u y pet COMM Table 84.30.5 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.01 ft Lateral Length (P) 49.25 ft Orifices per Lateral 25 Lateral Spacing (S) 3.00 ft Orifice Density 6.00 ft /orifice Lateral Flow Rate 10.30 gpm Manifold Length 3.00 ft System Flow Rate 41.19 gpm Manifold Diameter 2.00 in Total Dynamic Head 19.27 ft Forcemain Velocity 4.21 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as L652 C 300 and - -� Comm AC — 4 in. min. Disconnect _ Tank component is properly vented E Alternate outlet location Yf Forcemain diameter Wieser Concrete Manufacturer 2 in. Capacityl 800.64 Gallons Volume 22.24 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 19.37 430.82 B 2.00 44.48 C P�off elevation (ft) C 3.63 80.70 103.42 D 11.00 244.64 D Total 36.001 800.64 iF Dose tank elevation (ft 3" Bedding uncTer tank. J 1 102.50 Alarm Manuafacturer Zoeller Alarm Model Number A -Pak 10 -1494 Pump Manufacturer Goulds Pump Model Number 3871 EP05 Pump Must Deliver 1 41.19 gpm at 19.27 ft TDH Project: Tyler Miller 4- bedroom residential mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Mark Stahnke Phone (715) 760 -5067 POWTS Regulator's Name St. Croix County Zoning Dep't. 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 1200 gal Maximum TSS 150 mg /L Soil Absorption Component Size 600 ft Maximum FOG 30 mg /L Type of Wastewaterl Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency e a v 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 every 3 years 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 10 Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Tyler Miller 4- bedroom residential mound Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code Ge neral 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. Panto 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 condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project. Page 6 of 9 .`� GOULDS PUMPS Submersible Effluent Pump <' EPO4 3 871 EP05 a APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lo,.er Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing following uses lubrication and efficient improved performance. construction. heat transfer. ■ Casing and Base: Rugged •Effluent systems g gg • Homes Available for automatic and thermoplastic design provides AGENCY LISTING manual operation. Auto- • Farms superior strength and corrosion • Heavy duty sump matic models include resistance. SP Canadian Standards Association • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron Goulds Pumps is ISO 9001 Registered • Dewatering assembled and preset at the for efficient heat transfer, factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. maximum. ■ EPO4 Impeller: Thermoplas- 0 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'/2" NPT. seal protection. • Mechanical seal: carbon - rotary/ceramic- stationary, BUNA -N elastomers. • Temperature: 104 =F (40 - C) continuous 140'F (60`C) intermittent. METERS FEET • Fasteners: 300 series 10 stainless steel _ ► • Capable of running 9 30 GPM dry without damage to 8 z F"r components, 25 a 7 Motor: • EPO4 Single phase: 0.4 HP, 6 z 115 or 230 V, 60 Hz, 1550 a RPM, built in overload with > 5 automatic reset. 0 15 • EP05 Single phase: 0.5 HP, 0 4 EPOS 115 V or 230V, 60 Hz, 1550 3 10 RPM, built in overload with automatic reset. z EPO4 • Power cord: 10 foot 5 standard length, 16/3 1 S1TOW with three prong grounding plug. Optional 20 ° ° 0 10 20 30 4o so GPM foot length, 16/3 S1TW with -//./9 �orr1. iYhn.'murn ol�Sclai�t ru �e ro! three prong grounding plug o z 4� a 10 'u m��n ;standard on EP05). CAPACITY Goulds Pumps 2002 Go�ios Pumps ITT Industries = 3 ixuve Saptember, 2002 0� 33871 I RECEIVED Wisconsin Department of Commerce OIL EVALUATION EPORT Division of Safety and Buildings Page of in 5W4€� Cod Attach complete site plan on paper not less t County include, but not limited to: vertical and horizd percent slope, scale or dimensions, north ar Parcel I.D. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, a. 15.o4 (1) (m)). Property Owner Property Location Govt. 1/4 114 S T N R 9 �(or) W Property Owners ailing Address Lot # 810 # Subd. Name or CdY State Zip Code Phone Number ❑ C I] Vllage Town Nearest Road U) New Construction Use: �4 Residential / Number of bedrooms Code derived design flow rate GPD Q Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable ft. General comments p and recommendations: Boring # r ❑1 Boring tai Pit Ground surface elev. ft. Depth to limiting factor in. Soil A lication Rate Horizon Depth kDomman r Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Efi#2 �2 -3 'w _ — Gs' Tc ^—� I Boring # Boring L ® Pit Ground surface elev. , 1& ft. Depth to limiting facto in. Soil Application Rate Hcnzon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 i r s 7 * Effl ent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg/L ent #2 = BO < 30 mg/L and TSS < 30 mg/L CST Nam ease t) Signat� CST Number Address 3 a Eva Elation Conducted Telephone Number Property Owner I Parcel ID # Page C:�,Z of 51 Boring #❑7I Boring 0 pit Ground surface elev, ft. Depth to limiting factor -. �� in. Soil Application Rate MHodzonDepth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev, ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 *Eff#2 Boring Boring # ❑ ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Etr#1 *Efr#2 * Effluent #1 = BOD > 30 < 220 mg1L 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 (R07 /00) Z I/ -- A0 psi II I .0 I � \ 9.3 (A 6 °77 / Ah' f RECEIVED Wisconsin Department of Commerce O OIL EVALUATION EPORT Page -' Z Division of Safety and Buildings �� � in acco n 5MF5.s J Cod County Attach complete site plan on paper not less than 81 x 11 include, but not limited to: vertical and horizontal refs nce p d Parnat LD. h^ j - tjLG✓ �!'�1 percent slope, scale or dimensions, north arrow, and I MR I Please print all information. a Date Personal Information you provide may be used for secondary purposes (Privacy Law, a. 15.04 (1) (m)). , S Q Property Owner Property Location Govt. Lot 1/4 1/4 S T N R �(or) W Property Owner's ailing Address Lott # 1 # Subd. Nam or CSM# CO 2 City State Zip Code Phone Number ❑ City ❑ VII ge aTown Nearest Road S" ( ) Z 26 �gJ New Construction Use: Residential/ Number of bedrooms - :: Z Code derived design flow rat GPD ❑ Replacement ❑ Public or commercial - Describe: Parent materials Flood Plain elevation if applicable 44114t ft. General comments �! / and recommendations: S s7"iiry &5 o,v u� we� )„e - �� /3S — 7 dNih -d Boring # �F�1ry Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Etf#2 3 v2 -3 e 3 r , Boring # E] Boring ® pit Ground surface elev. ft. Depth to limiting factor 3_ in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 led * Effl t #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ent #2 = BO : 5 _ 30 mg/L and TSS < 30 mg/L CST Na ease ) Signature CST Number Address Da a Eva uation Conducted Telephone Number a Property Owner Paroel ID # Page of 3 F-51 Boring # ❑ Boring 10 pit Ground surface elev. 11�8,D_S' ft Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 "Eff#2 F Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Efr#2 ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mgA- * Effluent #2 = BOD :5 30 mgA- and TSS 5 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. Sa n- 8330 OL07/00> Property Owner / Parcel ID # Page L:,z of 3 551 Boring # ❑ Boring pit Ground surface elev. /P– ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 glid F —I Boring # El El ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil — Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F—I Boring # ❑ Boring ❑ Pit Ground surface elev. $. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA- ` Effluent #2 = BOD 5 30 mg/L and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. sao -ego (�mroo> 6 _ — - BOO ,Bsl I 1� � O Z h 1 P A 101 CcpJ�su�C' /:Jc / ,el � /� � ✓ef �iJ�s b s E306363 VOL 20 PAGE 5066 REGISTER OF DEEDS ST. CROIK CO. MI RECEIVED FOR ECORD 09/14/2005 06:10AN 0 0 0 CERTIFIED SURVEY NAP REC FEE: 13.00 COPY FEE: 3.00 PAGES: 2 SNlnO °� �zz C) z vol*2 C z THE EAST UNE OF THE NE1 /4 OF a ` SECTION 36 BEARS SOOT 4'42'E AS it 22 c r- ! a 4 1 . 55S2 12 REFERENCED TO THE ST. CROIX 2 m c 2� COUNTY COORDINATE SYSTEM y � Le Z l �� g Q� ca l c O z G'j n I i v e N� LOT_ 5 C IN_ VOL. - I 4_810 I - - NOO 14'42 "W 446.35' �A70r 33.00' 33' I Q�y i I 'i'i'�•�, I 33' nrn C Fn� > v �o m C a i I 'm %nom 'N tNAN �y D oo.. p NZQ9 y y..z " a y o 2 i I- w n or C CA w as 414.42' • �' v Z j a o% NOO'14 42 W 447A2 - 3 3.00' FIRM o 2n _j I v ' WO CA 8w* s V CA A '� �' r I� M CIE i ;v (n ? .................. ............................... I 1 y 'T1 6 6. p S — m e — fQ E2 • � S001 4'42 448.61 °f- �s m ♦ 80th Street EAST UNE OF THE NE1 /4 E9 -------------- r y SOO'14'42'E 2655.84' UNPLATTED LANDS SHEET 1 OF 2 SHEETS Vol 20 Page 5066 * 8 5 4 5 5 6 1 State Bar of Wisconsin Form 2 -2003 854556 WARRANTY DEED KATHLEEN H. WALSH DocumentNumber Document Name REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 06/27/2007 03:30PM THIS DEED, made between Jan Pvzik and Linda Pvzik husband and wife WARRANTY DEED EXEMPT I ( "Grantor," whether one or more), REC FEE: 11.00 and Tyler S Miller TRANS FEE: 231.00 PAGES: 1 ( "Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following Retur Address 1 described real estate, together with the rents, profits, fixtures and other appurtenant David J. Name and R R ^ interests, in St. Croix County, State of Wisconsin ( "Property") (if, Da t urn A more space is Da Locust Street needed, please attach addendum): 30 4 That part of NE1 /4NE1 /4 Sec. 36- T31N -R19W described as follows: Lot 6 of Hudson, WI 54016 Certified Survey Map recorded in Vol. 20 of Certified Survey Maps, page 5066 as VU Doc. No. 806363. St. Croix County, Wisconsin. 032- 1099 -30 -065 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated blo A /0 -T � ��fSEAL) (SEAL) ?v. * * n �ik (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) Jan Pvzik and Linda Pvzik, husband and wife I I STATE OF ) authenticated on d ) ss. A f COUNTY ) * Kristina 0 land l/--- Personally came before me on TITLE: MEMBER STATE BAR OF WISCONSIN the above -named (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: * Attorney Kristina Oeland Notary Public, State of Hudson WI 54016 My Commission (is permanent) (expires: (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 © 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 * Type name below signatures. INFO -PRO Legal Forms 800 - 655 -2021 www.infoproforms.com • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer y hll- 1 1tel✓ Mailing Address C jo1 S� . �V• 6� ��t s ova ; �r/��, S )`�l/ Property Address 7 7 7 1 7v r� A ve - , (Verification required from Planning Department for new construction) City/State � dfM e� Se. I,,� Z Parcel Identification Number n 3 a - 1619 " 36 - 64 LEGAL DESCRIPTION Property Location !V 1:�: % )JE" %a, Sec. _ 3 6 T R Town of Somme ae l - Subdivision , Lot # Certified Survey Map # , Volume , Page # D Warranty Deed # ?S V FS , Volume , Page # Spec house ❑ yes Ino Lot lines identifiable L7 yes ❑ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restricted.plumber or a licensedpumperverifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic�iank is less than 1/3 full of sludge. Uwe, 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 Zoning Office within 30 days of the thre ye expiration date. 7 SIONATURE dF 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 the property described bove, by virtue of a warranty deed recorded in Register of Deeds Office. 7 11Z / SIG ATURE O APPLICANT DATE * * * * ** Any information that is mis- represented 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 of the certified survey map if reference is made in the warranty deed t ,n � ---, HIM I I r p 11 11 �3 c 3 1 11 �, 1��1 '' �y f 11� i� pp A ll i ►�1 �,1! � � j �li I fV u I i �' i j C9 fl�39r I , _ • i' • I I e. P u� yy � a 1 ski n I r -- i < i � W ` 3 I. SIC" I I f l g o sib a-mi.7 � I - Al i t j i i • � i I, I - 7. sf - -- - aim 41W