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034-1056-80-200
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ROME AMMINISAWMEN WA .� PrA �/ 9999999 9MMMMM9999�99 'IVA all ■.�99199� 008000000000009 ®� 9999919�!i�9999 0880080080000 ®089 ����� I�/�999999 - 0080080008800 ® ® ®9 ;, _ MEN ,��������� 000000000000080 ®9 NEW, 00000000800800 © ®9 99998889999998899 - 00000000000000999 '_ 0000800808080 © ®B� *9989989888998900 -- - 899989889899 ® ®B ® 8millio080880D890 . - 999999989999999®9 :: 988989899 ©00���0� 8999998999991I aA 8800880809 ®090�99' 0080000000098®98© - 88898998 ©� © ®��080 . _008080880 ®���0�0A _ 88888999 ® ®99 ®B99 ®� 999999999©80909©0 - - :_,889999 ®99 ©990000 -. 0000008089 © ©© ©099 8008890889 imams 9 logo 8999990B9B999 oil googol . 0800080889 ©® ©DIED 888000© ®98800080 ® 080008000 ® ® ®BBD 80080© one c— .. 8880 ®9 ©8900098099' .- �8080 ©0 ®008�8�8999�!! _ _ _ Wisconsin Department of Commerce ,PRIVATE SEWAGE SYSTEM County - Safety and Buildings Division St. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitafK Perm it No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 370362 Permit Holder's Name: ❑City ❑ Village -0 Tjqwrno State Plan ID No.: Lacy, Charles Springfield Townshi CST BM Elev.t Insp. BM Elev.: B Description: Parcel Tax Nn d o 'ro 4- 1056 -80 -200 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 5� , U�p Benchmark �(, /,,r' Dosing Alt. BM n Bldg. Sewer 0 r S Holding (9 / Ht Inlet A 7-3 TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. Ventto ROAD Air Intake Septic �� 32 ' NA Dt Bottom d 2 N.'Z 3 Dosing S�� S� NA Header / Man. NA Dist. Pipe H Ing Bot. System ' g �'` 1p0 .4I PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand �o 4 t � St cover 3 Model Number ( Z � GPM L o - 7 9S, / p TDH Lift �c Friction • ti S stem TDH 3• Ft I Z. /02, !a oss L Z� r� 6 Forcemain Length -+.135 Dia. � 2 /r Dist. To Well ��,Cb "ZO'� 3.35 (03 35' co.c7 r SOIL ABSORPTION SYSTEM BED/TRENCH Width • ,l len th r No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3•�b lD I I DI SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LE NG nu acturer: INFORMATION Type of ' br } } 1 O U T e Num er. System: DISTRIBUTION SYSTEM B •f Header / Manifold t I Distributi pg(s) 1 t w x Hole Size x Hole Spacing Vent To Air Intake Length ia. 2 Length? Dia. l (Z Spacing Z SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Y s [0 soil (]Yes C1 q;5 COMMENTS: (Include code discrepancies, persons present, etc.) QS ftu&I Inspection #1 Inspection #2: 4 / /( / o/ Location: 3292 72nd Avenue, Wilson, W1 54027 (NE 11 SE 1/4 25 T29N R15W) - 25291�397B -Lot 1 1.) Alt BM Description = 4,V CPa,�,,, S,� a/ (07,,`d l,� / (ow, i l r " 2.) Bldg sewer length = z' -a.*s Me'tk( d, - amount of c W e ' `I 1 m - , need sera ;ce CeK7 3.) contour = 3, 7 3 35 Y�, 1s J tt�d�. r i' r✓ a. lUlr�,{cr a 5 5 0 + 4 ;KSM lo r / /ham Plan revls qulred ? ' ❑ No Use other side for addition ' o SBD -6710 (R.3/97) p Q� 0 Date Inspector's Signature Cert. No. 3 29 1 z- +Z Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 I*Iscons; Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. I5.04(l)(m)] (Submit completed form to county if not state owned. Attach complete plans to the county copy only) for the system, on paper not less than 8 -1/2 x I I inches in size. County State a i P rrni Number ❑ Che�k if revision to previous application State Plan . D. Number 7�1s % C I. A plication Information - Please Print all Information Locatio Property Owner Name `1 , \ Property Location r �'' 1 \ X 1/4 $ /4, R�E�or Property Owner's Mailing Address / ."Z , // , ,. Lot Number Block Number _2 e7 (o S D ' 4" 4. f l I City, State Zip Code cy Pho"ber ` r J _. _ Subdivision Name or CSM Number LJ J L" C YO 2- csK-I' (4 4 II. Type of Building: (check one) r� \ 2O Cn� �OJ� ❑ Vi llage 1 or 2 Family Dwelling - No. of Bedrooms : Niy.G O AS `Y J GVTown of • Public /Commercial (describe use):_ • State -Owned i S �- (d r lc a tt ` . f . - �` Nearest Road 2 s, Parcel TaxNumber(s) 03 0,5( _go -3V � t D = (Z St> T ype of Permit: Check only one box on line A. Check box on line B if applicable) ZS. ?4 • l5. 3 - 7"7 A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System B) Permit Number Date Issued ❑ A Sanitary Per mit was previously issued IV. Type of POWT System: (Check all that apply) 16 • Non - pressurized In- ground and ❑ Sand Filter ❑ Constructed Wetland • Pressurized In- and , r ❑ Holding Tank ❑ Single Pass ❑ Drip Line • At-grade Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (GalsJday /sq. ft.) (Minlinch) Elevation VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks -43� ❑ ❑ ❑ ❑ jam- ❑ ❑ ❑ ❑ CT G Ct, VIII. Responsibility Statement I, the undersigned, assume res on ibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plumber's Signature (no stamps): AWRS No. Business Phone Number Plumber's Address (Street, City, State, Zip Code) cU S 7` R j Yc l4— e IX. County /Department Use Only ❑ Disapproved I Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) ®. Approved ❑ Owner Given Initial Adverse harge Fee) Determination 325. CD t o -26- X. Conditions of Approval /Reasons for Disapproval: 4fttPu44 C-) c S P DX, S wu J ri CP rnn t I Safety and Buildings 10541N RANCH ROAD HAYWARD WI `54843 TDD #: (608) 264 -8777 Visconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary September 06, 2000 CUST ID No.225150 ATTN: POWTS INSPECTOR ZONING OFFICE MICHAEL E WILSON ST CROIX COUNTY SPIA 400 STATE ROAD 46 1101 CARMICHAEL RD AMERY WI 54001 -4019 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/06/2002 Identification Numbers Transaction ID No. 431327 Site ID No. 198073 SITE: Please refer to both identification numbers, Site ID: 198073, CHARLES LACY above, in all correspondence with the agenc ST CROIX County, Town of SPRINGFIELD; 72ND AVE NE1/4, SETA, S25, T29N, R15W FOR: NEW MOUND, 450 GPD Object Type: POWT System Regulated Object ID No.: 759260 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. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. This plan action is subject to designer comments on the plan. 2. The maintenance plan for this system must be given to the owner of the POWTS. j 3. The orientation of the mound system must be such that the mound's longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. P.01 4. Holes must be drilled with sharp bit and all burrs and foreign matter removed before installation. Con 0 x!; 5. The management plan / users manual must contain the telephone numbers of persons to contact Be sure R" to amend your plan and provide this information to the owner. 6. The changes made to this plan on 9/6/00 by this reviewer were acknowledge and approved by the system RTML,' designer. t N Of s 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 SEE CORF construction /installation /operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 08/18/2000 FEE REQUIRED $ 175.00 Rt' "? FEE RECEIVED $ 180.00 PATRICIA L S DOF , POWTS AN REVIEWER REFUND AMT $ 5.00 Integrated Services (715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM Refunds of $25 or less will be PSHANDORF @COMMERCE.STATE.WI.US made only on written request. WiSMART code: 7633' cc: CHARLES LACY y MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Lacy Mound Owner's Name: Charles W. Lacy Owner's Address: 2965 60th Av. Wilson, WI. 54027 Legal Description: NE1 /4; SE1 /4; SEC.25; T29N; R15W Township: Springfield County: St. Croix Subdivision Name: N/A V.T.S. Lot Number: 1 Block Number: Parcel I.D. Number: Plan Transaction No.: of co OtNG>< Page 1 Index and title `�' Page 2 Data entry E NDENCE Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 Pump specifications l > J Page 6 Management plan Page 7 System and maintenance specifications Page 8 Site Plan Page 9 Tank Cross Section Page 10 Filtration Spec. Designer: Michael E. Wilson License Number: 225150 Date: August 16, 2000 Phone Number: 715 - 268 -6626 Signature: /2t, C e-4 Version 2.2 (8/4/00) Pagel of 10 Mound and Pressure Distribution Component Design Maximum Design Flow 900 gpd Site Information R Residential or Commercial Design (R or C) Orifice 300.00 Estimated Wastewater Flow (gpd) Diameters 1.50 Peaking Factor (e.g. 1.5 = 150 %) 1/8 = 0.125 450.00 Design Flow (gpd) 5132 = 0.156 3/16 = 0.188 6.00 Site Slope ( %) 7/32 = 0.219 99.30 Contour Line Elevation (ft) 1/4 = 0.250 24.00 Depth to Limiting Factor (in) 9/32 = 0.281 0.50 In -situ Soil Application Rate (gpd/fl?) 5/16 = 0.313 Distribution Cell Information 1.00 Dispersal Cell Design Loading Rate (gpole) 120.00 Dispersal Cell Length Along Contour (ft) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N e Center or End Manifold (C or E) 2.00 Lateral Spacing (ft) if N above, enter the elevation (ft) 2 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 3.17 Estimated Orifice Spacing (ft) 5.92 fe /orifice Orifice Density - 7_,V ,.- 3:6@ rcemain Diameter (in) 150.00 Forcemain Length (ft) Does the forcemain drain back? Y 88.00 Pump Tank Elevation (ft) Enter Y or N 6.50 Operational Head (ft) 55.05 Forcemain Drainback (gal) 12.30 Vertical Lift (ft) � 108.64 5x Void Volume (gal) Friction Loss (ft) 1 R( � 163.69 Minimum Dose Volume (gal) Li .7 Total Dynamic Head (ft) 31.31 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia, I op tions I choice in. dia. options choice 1.00 1.00 1.25 1.25 1.50 x x 1.50 x 2.00 x 2.00, x x 3.00 x 3.00 x Treatment Tank Information Gallons /inch Calculator (optional) 1000.00 ST /ATU Capacity (gal) 600.00 Total Tank Capacity (gal) wieser's Manufacturer 36.00 Total Working Liquid Depth (in) 16.667 gal /in (enter result in cell B48) Dose Tank Information 600.00 Dose Tank Capacity (gal) /Effluent Filter Information 16.76' Dose Tank Volume (gal /in) ✓ zabel Filter Manufacturer wieser's Manufacturer A -100 Filter Model Number Project: Lacy Mound Page 2 of 10 Mound Plan View ...................................... L J ....... . . . . . . . . . . . . . . . . . ...... Observation Pipe . . . . . . . . . . . . . . . . K 0 C� A ......................... W ........................................ B ................... ................. ................ * ' ........................................... .......................................... ........................................... .......................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . T . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . + L Mound Component Dimensions Al 315 ft E 14.70 in H .00 ft K 8.71 ft I M.00 ft F 9.50 in 1 .21 ft L 137.43 ft 0.50 5.83 18.76 �D in G E i1ft J ffilft W Efift I 450.001(fe) Dispersal Cell Area 1 1554.881 (ft) Basal Area I 3.751(gpd/ft) Linear Loading Rate 1 20.001 (ft) 1/6B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.09 (ft) H G . r rrrrrrrrrrrrrrrrrrrrrrrr�rrrrrr .. F Dispe rsal Cell 100.80 (ft) Lateral . . . . . . . . . . . . . . ... Invert .......... ............. .................. Dispersal Cell EL . ............ .......... E .............. . ....... ...... ........ ...... (ft) Contour Elevation 6.0 % Site Slope Shading Key m Dispersal Cell Topsoil Cap See lateral details rrrrr r Subsoil Cap o — bo 0 // page 4 for number of ASTM C33 Sand :5 F laterals, size, and Tilled Layer 0 0.5 ft 6) Typical Lateral spacing, Laterals are Aggregate M 0 centered in the AxB A 40' Distribution cell. Project: Lacy Mound Page 3 of 10 Lateral Layout Diagram Laterals centered over the A & B dimension Turn -up wt ball valve or clean P .l All laterals are identical k- X rl Holes drilled on the bottom of the lateral S equally spaced Force main Connection via tee or Cross to manifold at .arty point. Laterals & force main of PVC Soh 40 (per COMM Table 84.30 -5) Number of Laterals 2 Orifice Diameter Lateral Diameter'1. 1K1 Orifice Spacing (X) Lateral Length (P) Orifices per Lateral $ Lateral Spacing (S) Orifice Density 5.92 fe /orifice Lateral Flow Rate 15.65 gpm Manifold Length 2.00 ft System Flow Rate opm Manifold Diameter Total Dynamic Head 2/; I ft 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 -1E Alternate outlet location Forcemain diameter wieser's Manufacturer _ Z' Capacity 600.001 Gallons Volume 16.760 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 18.03 302.23 B 2.00 33.52 C Pump off elevation (ft) C 9.77 163.69 � 88.50 D 6.00 100.56 D Total 1 35.801 600.00 iF Dose tank elevation (ft) 88.00 Alarm Manuafacturer S.J. ELE. Alarm Model Number 101 H.W. Pump Manufacturer Zoeller Pump Model Number 437-- I ( Pump Must Deliver 31.31 gpm at 21 "7 ft TDH Project: Lacy Mound Page 4 of 10 N {�— 61 F w It TOTAL LL HEAD CAPACITY CURVE ETERSYNAMICHEADFEET/ o. MODEL137 -139 CAPACITY GALLONS /LITERS o 0 4r 30' CAPACITY _ _ 1- HEAD UNITS /MIN 0 p o 1 yr11'h g FEET METERS GAL LTRS_ NPT 25' - 5 1.52 104 - - - 394 5' W 10 3.05 79 300 0 = 15 4,57 64 242 0 2p 20 6.10 36 136 25 7.62 8 30 0 26 7.92 0 0 15' O r 4 10' 2 5' I 121; 0 U.S. 10 20 30 40 50 60 70 80 90 100 110 GALLONS 4 LITERSI 60 160 240 320 400 I 0 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Three phase pumps are available in 200/208V or 230V. a Mercury float switches are available for controlling single • Electrical alternators, for duplex systems, are available and and three phase systems. supplied with an alarm. a Double piggyback mercury float switches are available for • Mechanical alternators, for duplex systems, are available variable level long cycle controls. with or without alarm switches. a Long cords are available in lengths of 15- 25 -35 -50 feet. • Combination starters are available. a Over 130 °F. (54 °C.) special quotation required. Standard All Models - Weight 47 lbs. 1 /2 H.P. SELECTION GUIDE SELECTION GUIDE 1. Integral float operated 2 pole mechanical switch, no external control required. 137 /139 Series Control Selection 2, Single piggyback mercury float switch or double piggyback mercury float Model Volts -Ph Mode Amps Simplex Duplex switch. Refer t0 FM0447. M137/139 115 1 Auto 10.4 1 or 1 & 8 _ 3. Mechanical alternator "M -Pak" 10 -0072 or 10 -0075. N137/139 115 1 Non 10.4 2 or 2 & 7 3 or 5 & 6 4, Combination Starter. Refer to FM0514. D137/139 230 1 Auto 5.2 1 or 1 & 8 5. See FM0712 for correct model of Electrical Alternator "E- Pak ". E137/139 230 1 Non 5.2 2 or 2 & 7 3 or 5 & 6 6. Mercury sensor float switch 10 -0225 used as a control activator, specify •H137/139 200-208 1 Auto 8.2 1 & 8 — duplex (3) or (4) float system. '1137/139 200 -208 1 Non 8.2 2&7 3 or 5 & 6 7. Four. (4) hole "J- Pak ", junction box, for water tight connection or wired -in J137/139 200 -208 3 Non 22 2&4 3 & 4 or 5 & 6 simplex or 2 pump operation, 10 -0002. •F137/139 230 3 Non 3.0 2&4 3 & 4 or 5 & 6 8 Two (2) hole "J- Pak ", for Watertight connection or splice, 10 -0003. 'G1371139 460 3 Non 1.5 2 &4 3 &4or5 &6 No molded plug Three phase units require a control switch to operate an external magnetic or combination CAUTION starter. All Installation of controls, protection dsHcsa and whiny should M done by a qualified For information on additional Zoeller products refer to catalog on Combination starter, licensed electrician. All electrical and safety codes should be followed including the FM0514; Piggyback Mercury Float Switches, FM0477; Electrical Alternator, FM0486; most recent National Electric Code (NEC) and the occupational Safety and Health Act Mechanical Alternator, FM0495; Alarm Package, FM0513; and Sump /Sewage Basins, (OSHA). FM0487. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. ) 3280 Old Mll/eis Lane nufacturers of .. , Z MAZZLff O. Loulsv(Ne, Kentucky 40216 pp p (502) 778 -2731 1�7,V �hWIRS Ylhff lff7 0 ._ /o Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code 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 shal be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet fitter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The finer 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 finer shall be serviced if the alarm is activated continuously. Intermittent fitter 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, Safety and Buildings Division. 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 Dlstrlbutlon 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 conpaction may hinder aeration of the infiltrative surface within the mound and sno% compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/LTSS, and 30 mg/1- FOG. 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 peformed 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 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [SBD- 10572 -P (R. 6/99)] and local or state rules pertaining to system maintence 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 prever accidental or unauthorized entry into a tank or component. CoWnoencv 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 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. Questions on the operation or maintence of this system should be directed to your designer, county zoning or health inspector. Page 6 of 1 +C Mound System Specifications Owner's Namel Charles W. Lac Designer's Name I Michael E. Wilson Sanitary Permit Number Design Flow - Peak (gpd) 450 Estimated Flow - Average (gpd) 300 Septic Tank Capacity (gal) 1000 Soil Absorption Component Size (f: 450 Type of Wastewater Domestic Inffluent Limits Septic Tank Pump Tank Dispersal Design Flow - Peak (gpd) 1000 450 450 Maximum Influent Particle Size (in) NA NA 1/8 Maximum BOD5 (mg /L) NA NA 220 Maximum TSS (mg /L) NA NA 150 Maximum FOG (mg /L) NA i NA 30 Service Frequenc Septic Tank Inspect and /or service once every 3 years Outlet Filter Should inspect once a year and clean once every 3 years Pump and Controls Test once every 3 years Alarm Should test month{ Pressure Systeml Laterals flushed and pressure tested once every 1.5 years Mound Ins eet once every 3 years Other Lateral Turn-up Detail "'+ 6" Diameter Lawn Finished Grade Sprinkler Valve Box .......... : ... Z Threaded Cleanout Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Bends Same Diameter as Lateral Project: Lacy Mound Page 7 of 10 I i , 1 1, I 1 . I { I I I I_ , ' 1 ! I , i I ; I 1 I 1 1 I I I \ NZI Ir _�7 S T r i I I I I I •; , it 26) � I Novi I � I 1 t/ 1 - I 1, I �I I I I I I �I i I 3f I o 0 1 I , 56" t 39" 0 84" c 0 m Dr N �•• � D O i u i. Its f 3.• 4 8" I 5" It mm W s Z x 42" m m z U) 0 D - mi m o m O (O �m0 =D =� = = �0 ! N _Q N D �zO m o o A O -�, =�O•• K: V n C � C r —m.. G7 (n m m Z mm ° 0 CA e D O u �! � N >�� l D n �� �r -�OOOA w�w� C p v� rn.i omm v' ° vi y m �C rn w O m V D ��'~° ono n O(n� (n � Z 00 rR m 0 V -U o m �—�-•� D \\ S r00 CJ N 0 -0 CM C) O � UvU L ZZ D m \/ O = j � �� D �. �O 00 \v m a) N a b ' r� CM �T On o �Z�7 Q of N r' n I Q rA C') D r •" _" �Oa v m� Z Q7 ONE n r D- C zrn � xs c o �D ��� r o Fri CO 0 c � rn ro m O v o C: -0 M + I ` •' V + MAOE R! USA 1 i F11ttradon 1/16 • ri o riginal Zabel Filter for waste flows from 3,000 d to 4,500gpd. The o g 9p • Disc dam design is proven to reduce TSS and BOD in residential and commercial waste flows. • All A100 -12 filters come ready to accept the Zabel SmartFilter On • ny Alarm. I i n herotonti�tr • Easy to install either in the tank or outside the tank in a Zabel $Soo enla U 3 Basin Assembly. • Extension handle included with every filter. t is � e Commercial Filter Package A100- 12x16 -FP A100 -ADA Reducers are included with all A100 -12x16 A100- 1200's they are optional �� a9s on A100 -1206 Filters Handle Parts Included A =1/2" Tee (SLIPxSLIPxSLIP) B =1/2" Female Adapter (MIPTx SLIP) r Certified to C =1/2" Schedule 40 pipe ! , 'g' C 0 ANSI /NSF _ A100 -12x30 Standard 46 WASTEWATER FILTERS & ACCESSORIES 1-800-221 PART • • • f Al 00Cartridge 707 ridge 169.95 133.00 108.00 102.00 98.00 7100 -12x30 12" x 30" Case and Cartrid a 208.95 174.00 158.00 152.00 148.00 - �1 ' 01 - !Mrtrii dg es A101 -12x16 12" x 16" Replacement Cartridge 97.95 81.00 54.00 A101 -12x30 12" x 30" Replacement Cartridge 137.95 115.00 104.00 Packa Commercial Filter A100 1206 - FP 7 A100 - 1206 and 26" Basin Assembly 293.95 19, ACCESS A100 /300- RHEK-SF SmartFilter Retrofit Handle Extension Kit 1 7.45 4.75 4.50 4.40 4.30 A100 /300 -RHEK Retrofit Handle Extension Kit 7.45 4.75 4.50 4.40 4.30 A100 /300ADA Extension Apapter 29.95 19.00 18.00 17.00 16.00 FC100 Flow Control /Maintenance Plate 9.95 9.00 8.00 7.00 6.00 SmartFilter Alarm All Zabel Filters are SmartFilter ready. Add $7570 to the price of any filter or filter package to add the SmartFilter Alarm. 10 hu' A Low tMou�v.� p, ! o o v Wisconsin Department of commerce SOIL EVE- 6�rT1O, REPORT Page _ I of '3 Division of Safety and Buildings 1 in accordance with C 8g 'Ws. - Kd tt: Code ' >• County Attach complete site plan on paper not less than 8 1/2 x 11 rn si e. P t ' include, but not limited to: vertical and horizontal referen p�`•ht (BM), Peel 1. D. percent slope, scale or dimensions, north arrow, and lo ca �hd dlstatl fo nearest road. Please print all informa op.i �,. iewed by Date n Personal information you provide may be used for secondary pur osesy(Priv Privacy La f. `-�✓�'�' °�-� lAU V Property Owner patio ; i u�t. 1 govt. Lot `1/4 1/4 S T N R (or Property wners Mailing Add res Lr. 4jot i Subd. Name or CS&V Clty 7e Zip Code Phone Number ❑ City ❑ Village Town Nearest Road �l7 New Construction Use: Residential / Number of bedrooms !.3 Code derived design flow rate S"D GPD ❑ Replacement Public or commercial - Describe: Parent material Flood Plain elevation if applicable A1 ft. General comments // {r 9 9 3 ' and recommendations: yWp )o_ sy /D F-/1 Boring # Boring r ❑ rd�11 Irk 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/If in. Munsell Qu. Sz. Copt. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring # ❑ Boring ® Pit Ground surface elev. 98"a ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 7 3 — * Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg/L * Efoent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Prin / ) Signature CST Number T le hone Number Address D e a Eva tion Conducted P f Property Owner " ' Parcel / ID # _ Page —'—.r2 of _ Boring # ❑ Boring �(] pit Ground surface elev. ��Fir�s_ 7 ft. Depth to limiting factor Soil lication 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 r agi 7 r F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication 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 Boring F] ❑ Pit Boring # Ground surface elev. ft. Depth to limiting factor in. Soil lication 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:S 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD < 30 mg/L 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. SBD -8330 (R.6 /00) 33 - - _. �� i S f CROIX COUNTY SEPTIC T ;%NK MAINTENANCE AGREEMENT A AND OWNEitSHIP CERTIFICATION FORM /Buyer e' Lo N (,,- _r i -- Mailing Address sY_ 6 LY so,- Property Address 3 a 202 — (Verification required from Planning Department im new construction) _ City /State Parcel Identific;i, ion Number LEGAL DESCRIPTION Property Location &L ' /,, C ' /,, Sec. s ; T N -R_ / — W, Town of Subdivision _ , Lot # Certified Survey Map # G -7 �S 7 Volumc / , Page # Warranty Deed # �a&a a- 6 , \Volume 3 , Page # � • Spec house Cl yes ❑ no Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Prope; maintenance consists of pumping out the septic tank every three years or sooner, il' needed by a licensed pumper. What you put ut o 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 t ner and by a master plumber, journeyman plumber, restricted pluinher or a licensed pumper verifying that (1) the on -site wastewaterdi:.posal system is in proper opernting condition and/or (2) after inspe,: Lion and pumping (if necessary), the septic tank is less than 1/3 full of sludge. i I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards j set forth, herein, as set by the Department of Comma. e 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 three year expiration date. GNATURE OF APPLICANT U 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) rite owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. 2 SIGNATURE OF APPLICANT DA '1 u ••• * ** 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 G,nn the Register of Deeds office a copy ofihe certified survey map if reference is made in the warranty deed i Iy vl 1553PAG 47 X226? 6 KATHLEEN H. WALSH — Document Number REGISTER OF DEEDS .J WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD Gerald Johnson a /k/a Gerald D. Johnson, a married person, 10 - -2000 11:15 AM conveys and warrants to Cha _ hcy, the following WARRANTY DEED described real estate in t� — Croix County, State of EXEMPT # Wisconsin: CERT COPY FEE: COPY FEE: TRANSFER FEE: 16.80 RECORDING FEE: 10.00 PAGES: 1 Recording Area Name and Return Address Thomas A. McCormack 102010'" Avenue P.O. Box 2120 Baldwin, WI 54002 034-1056-80,-90 (Parcel Identification Number) Part of the Northeast Quarter of the Southeast Quarter (NE '/ of SE '/<) of Section Twenty -five (25), Township Twenty -nine (29) North, Range Fifteen (15) West, Town of Springfield, St. Croix County, Wisconsin, more particularly described as Lot One (1) of Certified Survey Map filed September 26, 2000, in Volume 14,of Certified Maps, page 3954, as Document No. 630576, office of the Register of Deeds for St. Croix ounty, Isconsin. Exception to warranties: all easements and restrictions of record. This is not homestead property. Dated thisL ;v day of ' ",C , 2000. °Gera d D. f6hnson C_ ° AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ST. CROIX COUNTY Personally came before me this day of authenticated this day of tJ �� ''� 2000 the ab named Ger @ld Johnson a /k/a Gerald D. Johnson mewn toe the,;. person(s) who executed the regoing trum�n and •' signature acknowledge the sam r �Q U type or print name signature TITLE: MEMBER STATE BAR OF WISCONSIN type or print named �� Q J .••'� (If not,. S 1 A T E o authorized by §706.06, Wis. Stats.) Notary Public St, Croix County, Wi sconsin My commission is permanent. (If not, state expiration date: THIS INSTRUMENT WAS DRAFTED BY •) Thomas A. McCormack *Names of persons signing in any capacity should be typed or Baldwin, WI 54002 printed below their signatures. Information Professionals Company Fond du Lac, Wisconsin 800 -655 -2021 (o YI)1.1553PAGE 47 62267 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD Gerald Johnson a /k/a Gerald D. Johnson, a married person, 10 -23 -2000 11:15 AM conveys and warrants to Charles Lacy, the following WARRANTY DEED described real estate in St. Croix . County, State of EXEMPT a Wisconsin: CERT COPY FEE: COPY FEE: TRANSFER FEE: 16.80 RECORDING FEE: 10.00 PAGES: 1 Recording Area IVY, � I Name and Return Address � p el Thomas A. McCormack �� 1020 10' Avenue P.O. Box 2120 Baldwin, WI 54002 034-1056-80,-90 (Parcel Identification Number) Part of the Northeast Quarter of the Southeast Quarter (NE Y4 of SE Y4) of Section Twenty -five (25), Township Twenty -nine (29) North, Range Fifteen (15) West, Town of Springfield, St. Croix County, Wisconsin, more particularly described as Lot One (1) of Certified Survey Map filed September 26, 2000, in Volume 14 of Certified Survey Maps, page 3954, as Document No. 630576, office of the Register of Deeds for St. Croix County, Wisconsin. Exception to warranties: all easements and restrictions of record. This is not homestead property. Dated thisL oo day of iK :,Q , 2000. •Ge�VD.�hns�on AUTH ENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ST. CROIX COUNTY v✓ Personally came before me this 2- day of authenticated this day of t3.IIJ 2000 the ab named Gerald Johnson a/k/a Gerald D. Johnson me vrn tope the.;. person(s) who executed the regoing : {rurg and.' signature acknowledge the sam ; �Q► M type or print name signature ,,// J ' TITLE: MEMBER STATE BAR OF WISCONSIN type or print name /f Nd ( 4, (If not, Notary Public St. Croix County, Wisconsin. 3 T E authorized by §706.06, Wis. Stats.) My commission is permanent. (if not, state expiration date: THIS INSTRUMENT WAS DRAFTED BY 1 ) Thomas A. McCormack 'Names of persons signing in any capacity should be typed or Baldwin, WI 54002 printed below their signatures. Information Professionals company Fond du Lac, Wisconsin 800.855 -2021 f i G3 057G c— _ -0 Z THIS INSTRUMENT DRAFTED BY MICHAEL ERICKSON OcbO o U 1 W N O O 17 N) Z 1 O D C { BEARINGS ARE REFERENCED TO THE rn < I EAST LINE OF THE SE1 /4 OF SECTION - 25, ASSUMED TO BEAR S1 *29 C) z I I ST. CROIX COUNTY Q Planning Zonino 0 1 O l 2 6 000 f � F1LE. � SEP 2 la f_,: 2 6 2000 d -' 1 ,5�, ,o IF If not recorded witnirl 30 aays of L WITHLEEtJ H. WALSH I� I lO approval dale approval shall be Reel; ;Crof Deco null and void SLCtoixCo,W1 1 � 1 Ic, fn rim• I o W O I Z CC £E � m - -n s'� -- -- -- G) + U LJ(�d LN ° Q 1 v 0 — ,96`LLE A& SZ,90o LON 0 c0 m z I@ I Cs ' I N O '0 1t7 I9 1 I + 22 � I 1 `l7 Z D N N Z o f f� I� S 2 zM O I� I� I w rrl y D co n r. w 100 I� + � d 0 m m N G� 0 0 .. w p fn p� M I o lUp S-n i m 0 m N 0 Ul i i I-11 I 1Z W I� I I �� 3 s 1 �' ® m I Cl1 I I 00 ; I� 1m -- ,96'4LE 3183.900 LOS – ------ - - - - -- o .� o I �]�7LLn( &@ @EHA - -� o I ----- - -- - - -- m I r m 0 I , �N 9 Cf> ' . : m M co 0 . 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Box 232 Amery, WI 54001 Phone: (715) 268 -6626 January 9, 2001 St. Croix County Zoning Office 1101 Carmichael Rd Hudson, WI 54016 To Whom It May Concern: Please find enclosed a Holding Tank Servicing Contract for Charles Lacy. They will be using a holding tank until this spring when a mound system will be installed. The holding tank was installed in December and was inspected by your office at that time, but they did not have the service contract signed because it originally was going to be a mound system. If you have any questions regarding this matter please give me a call. Sincerely, t Deanne R. Gould Office Assistant 'ONING OV-FICL i i HOLDING TANK SERVICING CONTRACT Contract Date This contract is made between the Holding Tank Owners) Name(s) and Pumper's Name C_ 4 6?h ( C l 6 Cu rs � We acknowledge the installation of (a) 'holding tank(s) on the following property: (Provide legal descripti /,rte ,�5 'i S C- 'Iti s Z — T� �v �? l s" � ✓ 1. The owner agrees to file a copy of this contract with the local governmental unit that has signed the pumping agreement required In COMM 83.53(1) (b), W(s. Adm. Code with the County of 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purposes of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges Incurred In servicing the holding tank(s) as mutually agreed upon by the owner and pumper, 3. The pumper agrees to submit to the local governmental unit which has signed the pumping agreement required by COMM 83.55(2), Wis. Adm. Code, and to the County, a report for the servicing of the holding tank(s) within 10 business days. The pumper further agrees to include the following In the report; a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing: g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain In effect until the owner or pumper terminates this contract. In the event of a change of this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local governmental unit and the County named above within ten (10) business days from the date of change to this service contract. Owner(s) Names) (Print) Owner's Signature(s) Subscribed and sworn to me on this date: gC � - -z as Today's Date Pumpees Name nnt) Pumpers SigniWFe of ub _ 9 t nature umper's Registration Number Commission Expir atbn SS Drafted by the Land and Water Resources Department Personal information you provide may be used for secondary purpose [Privacy Law, s1 5.04(1)(m))