Loading...
HomeMy WebLinkAbout036-2006-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420458 0 ATTACH TO PERMIT) GENERAL INFORMATION ( State Plan ID No: Q Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. �O 7� 9 Permit Holder's Name: City Village X Township Parcel Tax No: Johnson, Ray Stanton Township 036- 2006 -20 -000 CST BM Elev: Insp. BM Elev: BM Description: 1 0b. 0 I / O-D. U 1 /V a-c l /N► _- /Vo rte• -sZ, dcr a TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing / Alt. BM Aeration Bldg. Sewer Q On sD� 3 Holding St/Ht Inlet c � TANK SETBACK INFORMATION St/Ht Outlet _1 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet - S 9 7 - 0 A! xal 3 rr 5 Septic I ' _ Dt Botto LSD z3 $:� 9 .o Dosing , () Header /Man. 3. 24 Aeration Dist. Pipe Holding Bot. Sy I tN 5 ` x { / A p G PUMP /SIPHON INFORMATION Final Grad J /0 K � � S e s f. Manufacturer De nand St Cove oT �W f✓ 9V 1 577 Af - N Model Number �t'/ 3'V5 (J �f TDH Lift Friction Loss System Head TD 1 Ft 5 z � •2� Forcemain i Length , Dia. a Dist. to We t SOIL ABSORP ION SYSTEM ! BED/TRENCH Width Len 9 th No. Of Trench s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S ' / / c✓ L SETBACK SYSTEM TO P/ BLDG WEL LAKE /STREAM LE RING Manufacturer: INFORMATION BER OR Ty/ / / peip(,Systl � r AJ , NIT Model Number: DISTRIBUTION SYSTEM �'y�_W W HeaderlManifold Distribution � I x Hole Size x Hole Spacing Vent to Air Intake /I Pipe(s)� -7, Length �� Dia Length Dia ' Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only ` Depth Over y Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center '1 6V Bed/Trench Ed es To soil g p j Yes L ] No [ Yes C No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 10_J_ p6z —6 Inspection #2: /O Z/ � v� Location: 1840 147th Street New Richmond, WI 54017 (NE 114 SE 1/4 31 T31 N R1 7W) Oak idge Estates Lot i!12 Parcel No: 31.31.17.654 1.) Alt BM Description = �� ~ / e i a kR— C 9 -F p 2.) Bldg sewer length - amount of cover 3.) Contour =9 4 •Q /Sh I -b 3 7 Plan revision Required? �P." Yes [VIVO V nature Use other side for additional information. L � SBD -6710 (R.3197) Date Insepctor's Cert. No. M ZON ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC T This is to certify that I have inspected the septic tank pres ntly serving �W the residence located at: AIE , 1 Sec. JI T .3 1 N, R l � W, Town of sTANTOr`. I St. Croix County, Wisconsin. Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced SUNVq\CUZ 062- (:Eg" WI( EL F s£i2160,60 A603 17. tau" wH S s PUT 1 O Did flow back occur from absorption system? Yes No (if no, skip next line. Approximate volume r length of time: gallons minutes Capacity: 00 Construction: Prefab Concrete Steel Other Manufacturer ( if known) : _ Qg�� ee�-s Age of Tank (if known) : `3 '-1 ks _ -ZIEFFEk Fo Y X (Sig a (Name) Please Print /VLF 2Z ?- I Z- (Title) (License Number) (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or 4cansed disposer (1 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name . X Signat e " MP PR Z y I S Safety and Buildings Division County 1 \ 1 201 W. Washington Ave., P.O. Box 7162 "j C fi go a consin Madison, WI 53707 - 7162 Site Address Department of Commerce 0- 7_0Z__ 3ie00 l y /M IY7 TH 5T /0 Rto6i U. Sanitary Permit Application Sanitary Pe rmit f In accord with Comm 83.21, Wis. Adm. Code, personal information you provide � on El check if Revision may be used for secondary purposes Privacy Law, s15.04(l)(m) I. Application Information - Please Print All Information State Plan I.D. Number Property Owner's Name Parcel Number P ,N'j '70tH s6N 03(o- at o o(v- R - 000a Property Owner's Mailing Address e f )ir Y Location 5Y 1 64 0 I I T N S� me Pu&E IX COUN [ Y 9E '/a Z' /a; S 431 T 31 N, R l City, State Zip Code Phod - "N tvlt rOFFICE Lot Number Block Number Subdivision Name CSM Number New kieHvAbm1 W1 6g0J (71 5) 24 ( - yb12 OAK f jt6C 115s #%Tfs t D, I1. Type of Building (Check all that apply.) 3 ❑ City V 1 or 2 Family Dwelling - Number of Bedrooms ❑ Village ❑ Public /Commercial - De cribe UseIownshi ❑ State Owned Nearest Road �t K o.� � 0, �r rr s r 1`l7T N OAK 9_ 100C A L. III. Type of Permit: (Check only one box on line A. Numbering is for internal use.) (Complete line B, if applicable.) - [ A. 1 ❑ New 3 ❑ Replacement of 6 ❑ Addition to S stem 2 $ Replacement System Tank Onl Existin System For County use B ' []Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of POWT System: (Check all that apply. Numbering is for internal use.) 44 ❑ Non - Pressurized In- Ground 21 P (Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 0 Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑Aerobic Treatment Unit 49 ❑ Recirculating 30 13 Other V. Dispersal/Treat ent Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min. /Inch) Elevation 45o W0 �, y so p 4 91,75 /o% VI. Tank Info Capacity in Total Number Manufacturer Prefab - Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 1 66 0 1 00 6 / S X Dosing Chamber 80� ! x- S X VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's ignature MP/ ber Business Phone Number T E'F/= &X y ZZ321"Z `7/ 291- Sly 1 Plumber's Address (Street, City, State, Zip o �a x aR RE SS�.e )4// s�o VIII. Cou nty/Department Use Onl LJ ❑ Sanitary Permit Fee Disapproved Date Issued Issu' g Agent Signa a (No Stamps) includes Approved Owner Given Initial Adverse Surcharge Fee) c�j 3 es Groundwater Determination IX. Conditions of Approval/Reasons for Disapproval pe At( (� _ ,� i A tach comple a plans o e oun y y e system on r not ess x ches size �� C STS,, lua C2 _79Q(73 A_KS? C2 to ej- Vi s v, `J A.1 . 4 T �s a,1 u y Safety and Buildings 10541N RANCH ROAD HAYWARD WI 54843 0 isconsin TDD #: (608) 264 -8777 www.commerce.s i www.wiscon isconsin.gov n.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Secretary September 20, 2002 CUST ID No.223242 ATTN.- POWTS Inspector JEFFERY V FOX ZONING OFFICE CROSS COUNTRY EXCAVATING ST CROIX COUNTY SPIA PO BOX 295 1101 CARMICHAEL RD DRESSER WI 54009 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/20/2004 Identification Numbers Transaction ID No. 787885 SITE: Site ID No. 650451 Ray Johnson Please refer to both identification numbers, 1840 147TH St above, in all correspondence with the agency. Town of Stanton, 54017 St Croix County NW1 /4, SE1 /4, S31, T31N, R17W FOR: Replacement mound, 450 GPD Object Type: POWT System Regulated Object ID No.: 870503 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 p•� chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. co 11 The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: A l-� RT i� • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10691 -P ( N.01 /O1) and SSWMP Publication 9.6, "Design Of Pressurized Distribution Networks For Septic Tank- Soil - Absorption Systems." • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • 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 maintenance plan for this system must be given to the owner of the POWTS. Key Item(s) • The mound must be on the 99.25' contour to be sited as shown. Elevation adjustments are shown on page 3. The pump is adequate in spite of the changes in elevations. • The actual liquid level of the sp ecified pump tank is 37" and the gallons per inch is 21.76 per product approval. q P The proposed pump settings have been adjusted provide a dose volume that is greater than 5 times the void volume and less than 20% of the design wastewater flow plus drain back. i ' JEFFERY V FOX Page 2 9/20102 Note • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to 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. • The existing septic tank must be inspected for structural soundness, size and baffles and must be brought into conformance with the requirements of COMM 83, Wis. Adm. Code. If it does not conform a state approved tank must be installed. • The bottom of the distribution cell shall be level per the Mound Component Manual. • The maximum finished slope of the mound surface shall be equal to or less than 3:1 per the Mound Component Manual. Reminder • This mound is designed to be installed on a level site. • Limit activities in the area 10' beyond the edges of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Abandon failing system per COMM 83.33. • Provide frost protection per COMM 83.43(8)(c). A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall rovide a copy of this letter to the owner and any others who are responsible for the installation, operation o intena ce of the POWTS. Sincerely —, Fee Required $ 175.00 /7 Fee Received $ 175.00 Balance Due $ 0.00 Patricia L Shandor POWTS Plan Reviewer, Inte�rat d Services WiSMART code: 7633 (715) 634 -7810, Fax: (715) 634-5150, M -F 7:45 am - 4:30 pm pshandorf@commerce.state.wi.us cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544 . w MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Ray Johnson Owner's Name: same Owner's Address: 1840 147th St. / Oak Ridge Trail I New Richmond WI 54017 Alyt f SE L Legal Description: ► F-V4( SE'Y4t S 31 T31 N R17 W Township: Stanton County: St. Croix Subdivision Name: Oak Ridge Estates 1st Addition Lot Number: 32 Block Number: Parcel I.D. Number: 036 - 2006 -20 -0000 Plan Transaction No.: ),W,T.S. Page 1 Index and title l tl0 Page 2 Data entry VE Page 3 Mound drawings cE Page 4 Lateral and dose tank WENT OF ILDINGS Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications ;)RRF-SPONDEN Page 8 Plot Plan Page 9 Soil Test Designer: Jeff Fox License Number: MPRS 223242 Date: 08/29/02 Phone Number. 715 - 2943141 Signature: Designed Pursuant to the Mound Component Manuaffor POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 3.0 (03/01/01) Page 1 of 9 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 300.00 Estimated Wastewater Flow (gpd) Table 8344 -3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of - 36 inches. 450.00 Design Flow (gpd) 0.00 Site Slope ( %) 1 S -9M Contour Line Elevation (ft) 41.00 Depth to Limiting Factor (in) 0.50 In -situ Soil Application Rate (gpd /ft) Distribution Cell Information 60.00 Dispersal Cell Length Along Contour (ft) = 7.50 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/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 (c or e) c Center or End Manifold 3.75 Lateral Spacing (ft) If N above, enter the elevation (ft) 4 Number of Laterals of the highest point. 0.188 Orifice Diameter (in) (e.g. 0.25) 2.00 Estimated Orifice Spacing (ft) = 7.50 ft /orifice 2.00 Forcemain Diameter (in) ,40 35.Forcemain Length (ft) Does the forcemain drain back? Y 91.00 Pump Tank Elevation (ft) Enter Y or N 3.25 System Head (ft) x 1.3 5.71 Forcemain Drainback (gal) 7.42 Vertical Lift (ft) 53.75 5x Void Volume (gal) 1.12 Friction Loss (ft) 59.46 Minimum Dose Volume (gal) 11.79 Total Dynamic Head (ft) 39.32 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options J choice in. dia. options choice 0.75 1.25 1.00 1.50 x 1.25 x 2.00 x x 1.50 x 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Powers Manufacturer J gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.00 Dose Tank Capacity (gal) Zabel Filter Manufacturer 41.74 29-W Dose Tank Volume (gal /in) A100 Filter Model Number Weeks Manufacturer Project: Ray Johnson Page 2 of 9 Mound Plan View t 1/10 B : K :O: J Observatwn Pipe p A w B� :f. ............... .............................. ................................... I �: . ------------------------------------ L Mound Component Dimensions Down slope toe extension made. A A6.00 ft E 6.00 in H 1.00 ft K gift ft B ft F 9.50 in z 5.38 ft L ft D in G 0.50 ft J 5.38 ft W 450.00 (ft) Dispersal Cell Area 1 1095.00 (ft) Basal Area Available 7.50 (gpdtft) Linear Loading Rate 1 6.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area /0/. , 5q Finished Grade 44*.ft (ft) —� H � tf!!! }!t!!!!! /}t!!!!}1,,. `� • 75 F ::: Dispersal cell 99-25- (ft) Lateral �J8-�5-(ft) —► — Invert Dispersal Cell Elevation E D ' . . * � 5 , z . 8-2&-(ft) Contour Elevation 0.0 % Site Slope c -} 5! Geotextile Fabric Cover Shading Key 9- T Dispersal Cell See lateral details on 1Q Topsoil Cap c C 1.5 ft Page 4 for number, Subsoil Cap Q size, and spacing of ]: ASTM C33 Sand d 0 5 ft Typal Lateral F laterals. Laterals are ® Tilled Layer �, equally spaced from OS Aggregate c F the distribution cell's }— - A ---* centerline in the distribution cell (AxB). Project: Ray Johnson Page 3 of 9 Center Connection Lateral Layout Daigram Face main connection via tee or cross to manifold at any point. Laterals are identical i P s �= Turn- up vdballvshreor �E x- -)�I+at rt2 +1 Laterals& Force main of PVC Sch40 clesnoutplu0 per COMM Table 84.30 -5 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.188 in Lateral Diameter 1.50 in Orifice Spacing QQ 2.02 ft Lateral Length (P) 29.2 Orifices per Lateral 15 Lateral Spacing (S) .75 ft Orifice Density 7.50 ft /orifice Lateral Flow Rate 9. gpm Manifold Length 3.75 ft System Flow Rate 32 m Manifold Diameter 2.00 in Total Dynamic Head 11. 9 ft Forcemain Velocity 4.02 ft/sec ose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and — 0 Comm 16.28 WAC 4 in. min. Disconnect --1- Tank component is properly vented = E Alternate outlet location Forcemain diameter Powers Manufacturer 2 in. Capacit 800.00 Gallons Volume I gal /inch A .';? l - -7 ce Weep hole or anti- Dimension Inches Gallons B siphon device A 46&.% 4 7 B 2.00 40.00 - y 3.5 4 Pump off e levation (ft) C 99-4 4 67 91.83 D 10.00 2-1 '1 D Total ,3 D ose tank elevation (ft) 3" Bedding un er tank. 91.00 Alarm Manuafacturer Tank Alert Alarm Model Number 101 V Pump Manufacturer Goulds Pump Model Number EPO 5 Pump Must Deliver 39.32 gpm at 11.79 ft TDH Project: Ray Johnson Page 4 of 9 • 1 • 1 n I; METERS FEET 10 MODEL: 3871 s Singlephase, 115V uQa 5 20 Materials of Construction _ 5 Brass /thermoplastic 4 15 EP05 .Features and Benefits o •Top suction eliminates impeller clogging. s 2 EPOa • Corrosion resistant 5 construction: I _ 0 10 p � 30 40 • Float actuated switch. ° p z a s e io 12 GPM CAPACITY METERS FEET 25 MODEL DV Pump Specifications Features and Benefits 0 6- ° /1° and 1 12 HP • EPO4 impeller- semi -open design = 5 Up to 60 GPM with pump out vanes to protect 15 Maximum head to 32' mechanical seal. 4- Discharge size 1 NPT • EP05 impeller - enclosed design 0 3-10 roved performance. Solids: 1 /4" maximum Z 2 - 5 • Rugged glass - filled thermoplastic 1 AI motors feature ball casing and base design provides ° ° bearing construction. superior strength and corrosion 0 5 10 15 20 25 30 35 40 U.S.GPM Single phase: resistance. 0 2 CAPACITY 6 8 1 M3hy Materials of Construction ' Cast iron motor housing for Cast iron efficient heat transfer, strength, Thermoplastic and durability. Stainless steel • Corrosion resistant threaded stainless steel shaft. *Available for automatic and manual operation. • CSA listed models available. All Models are designed for continuous operation and feature stainless steel hardware. Mound Svstem Maintenance and Operation Specifications Service Provider's Name Jeff Fox Phone 715 294 3141 POWTS Regulator's Name St. Croix County Zoning Phone 715- 386 -4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ft' Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL i Service. Freguency 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 Mound 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 Tum-up Detail Finished •............•. ................ Grade 6 -8" Diameter Lawn .. Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Ray Johnson Page 5 of 9 Mound System Management Plan Pursuant to Comm $3.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abardonmerd 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. EVosed 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 finer 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 ser4ce needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank 4 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 sal 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 S , 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/1oo mL for highly treated effluent. Influent flaw may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing pant 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 cull. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding Fels 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 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Ray Johnson Page 6 of 9 J r7 1 � ni IA - � LA r 1 t 1 1 ON D rr - I _ a - . DA K P -14 i kAl t_ _ 77C� Z - 88/18/2002 19: 21 7152483586 SUPERIOR. AUTOMOTIVE PAGE 04 vvbwrlsrt Depwlm.rd at c nvnwm SOIL EVALUATION REPORT I -f D IMM o( Set* end butici tps in a000r"ncs Mill C-mm alk W&S, Adrn_ Code - Att00h Oomptete 00 p1m on Pow not assn Man 8112 x i 1 odwe in sin. Plot nxm inducts, but not inni Aed to: vertical anal t*ftntai rdfaranca pawn (aq, &*Cbon and Prroat I.D. peroeM aka, 00" Or &TWIslats. north or—. and location amt distance to mwe m row. o 3 L 00 L " o - o Pf"** print all lreformadw, Rwiew0d DY Daft wa-nsi Mwnwuon you w A 4w noy b vw w seoona wy p mpmm (Prlvaey t.sw, s. 16.01(1 (on)). Pnapoty Otwwr prop" S & TO k • Q Oavt tat pjf 1/4,& IM 3 T 31 N R f 7 E (a PmwtY Mnbv Adddrm Lot w mol* or csw t q 7 5 f k. fi 3 R,d ,e- E s +.c AD ©CRY 0 Vwwe baTawr. Neo06t Raw as R"* w T4 0017 r 7 f Y. y rN I O. K. #d 7 L. CI New coneaumon l l w. [3 Ftasit wWW f Nunoer 0f DWM&M _,._,, , code derived da0ayfl slow n qe O aPd to Rapt O"A" D Pubw or wmmwcw - cmeatea: Parent mrWW A- c. i 0. t O Rood P'Wm bi0ratim It app{o" a Go wwamwwa . mwmff ndrdor,e: T S v sj f- s G 7S s 1�,� �v flit D J M d� 5c�' .w + la 8 ,7S EZI �, ❑ Pat Ground a -- 9 ft, Dap& a knbtp _ Im scat Nvapffism pa" W-bm Depth Dprinellt Coior Rsdox DOto o* n TO)MU s Slruehya Caxaswnoe Boundary Ro6t8 A�teleea Qa- Sz- C M. C4i4r Or. 8z. 9h. 'EwIN`t `ow !r a .3 f Y . r bK 4 3 3a y.SYRYI Y to- Li F Pit Ground stufaea aisv. �.'f '2 -,. IL D"Al to Nnutirty tw* � ro at. StiV Aopkmftn Reto t�artzDrl Dam Roftx Description Toxin Structure Cormallo ce s mdary Fbm ral'OJIP M. Mwtastl Qu. Sz. Cone Caw Car, ex. 8h. •ewrrf 'EwN2 t . J ± , ,�3 ft � y� it Etpt/ent it i ° WD > 30 S 220 ffv& And TSS a8p a 130 awl. ' Eft" art z� BW ; 30 nv L am TSS !j 30 mWL. CST (F"kletse Eiprtehre ! r p _ y ' tom" hYumdw .a "t h S`t Dm* EW*Lm i m C , TOb0wo Ntol i er 08/18/2002 19 :21 7152483568 SUPERIOR ;4JTOMOTIVE ' PAGE 06 rmpwvownar G� t� 71,10,11 t T viqMspw+ P,.w00 al e pwo �$ Pit GMWW sisr. 25 It. Door+ in w„hn Yl-_ h Sal Applokm Rob Nwimn NO Dw tw t C elor RWM Dearripmt Tedus &Axi a C,onalsitnot Bowdery MOLE in. Muntw ou. Sr- Card. Color or. 8t. Sh. 'EIf1t1 'ErM2 CIS ap+ - s . 9 f r w 1 , S t� in ED pit around atNt eatev. it to ltrYtl v U,*t 3Q h. soir tiorl2Cn Dw1h Darr ino t Redm Dem"m TadA t Stuck" Cuntittenes Sandwy Mots OPDV in. tdunterr OLL SL out Cobr or, $, 8h. '@tTM4 'E1182 iFLs 2f b le Mfr AS am e 5 9 1 2- Lb 5 Y f - FS FSbk- M �] Pit C:i+o�rrd surface Dieu, _ h Pit Depth t: NOV Isaw DeW wortron sad OwurteeK Color rwaxe 9bnrGt+re CSor>aistrnoa 9wetdery Roma in. Mutaar (u. tic. Cont. Color E1Muert #►1 = Bt]p� > 3p < 22Q mAfL end 788 > _ 158 myll. ' Ef4Mar+t iM2 = lidp = 90 nw& and r$8 = 30 The Deparanent of Commerce is an equal opportunity service provider and empfoyer, if you need assistance to access services or noad rntetial is an altereata format, phase cmm" Ste depat#"mt at 609-2W3151 or TrY 608. 264 -8777. saanwnutno� 08i18f2002 19:21 715246358E SUPERIOR AUTOMOTIVE PAGE 05 Zz tv Y r y 3 - 3 _ " lot- ..ac in ) i " IN ` p 4C ILA na - �, 4 . 3 1 Gc-- i Wisconsin Department of Commerce SOIL EVALUATION REPORT page I of L / Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Ste, C R o i X Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal jalocat& ice�pp dif8cio`TiYf ' Parcel I.D. percent slope, scale or dimensions, north arrow, �rd4lWa , rx a tonearestFroad. Please print all ination. Reviewed by Date Personal information you provide maybe used for seco urpflfltt'rtcapt( Property Owner Property vocation NW 5� (,� Q ? Govt. Lot N 6 1/4 & Le 1/4 S 3 T 3/ N R r 7 E (04 Property er's Mailing ? dress j z Lot # -:" Block # Subd. Name or CSW f s 4 V7 5't oa. k R.4 E s +aics H 0, City State Zip Code Phone Number [:1 City E] Village Town Nearest Road r.W R'"i%o►+ w SYOI*7 (��� �� ' • f" !� Srl- V - % Dak r2� �G - r L ❑ New Construction Use:3 Residential / Number of bedrooms _ Code derived design flow rate SO GPD a Replacement ❑ Public or commercial - Describe: Parent material G 1 0' C' i C..( n v "t w A- 5 i Flood Plain elevation if applicable D ft. Genera ec a lions: � Su SS� 5 �' A. (e r }L 75 r srta ((aw ►� D -� �^ � 5 fo D .7S r F-/] Boring # ��1 Boring �( Pit Ground surface elev. 9 q'; C ft. Depth to liming factor I in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I 0 - I v -f 3 / - LS a f(, le ,7r.1- q5 >� I. S 9 F 5b X i'3 ,/(`. -- 4 w ryl . 5 3A- - 7.511ZY/Y F5 A F5 t4 ✓ - W e...'!` - Se en W ► eN / �. Boring # goring ® pit Ground surface eiev. ( t ;-s ft. Depth to limiting factor in. I Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 o -►a j v,4ja 3/ 5 L-- r m F. a .2 M S I 32 7.S'� Rll 5 L-- i 5b�- w►�r� C� Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 rng/L and TSS < 30 mgfL CST Name (Please fZ Signature CST Number S- �Gl..` . S�� +d � O - T Date Evaluation Conducted Telephone Number Address O .S'�' . �\, wr 51r�at� -13 - 715- �yg -3s $g I.nT nwwn /�nglnn V Property Owner C , 914—I M D r A :T 0 � h 5 v `'% Parcel ID # Page C� of / Boring # ❑Boring 1 ,3 1 pit Ground surface elev. . a ft. Depth to limiting factor in. Sal 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 L If G e1S L.. 9 F Sb k f r c w 11''? . .9 3 aa-a� 7.57AY ( -- --- FS a F3 6 K- 5 Boring # ❑ Boring O r pit Ground surface elev. 2 • 31t. Depth to limiting factor �_ in. I Awlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EflM 'Etf#2 �.s1R -- FL5 a F 6 M r ekS la- D 7,5Y -Y) FSbm- no F Boring # ❑ Bourg ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil APDhcabon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Etf#2 ' Effluent #1 = BOD > 30 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 = BOD _< 30 nWL 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 � f IC'fi�l o h r N ct • ` I a ►o a T ,P r I f �� m - p � T m h ..t + 7 m 2 ( �./� ,oc; 1 � a ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer _ .JU IBS 0 Mailing Address _ 1AqQ 1 `17 ) 6VIK &065 �'/Zdt 1 , Ale/N �1 �'lflYlOGl714 G✓f Property Address 17 (Verification required from Planning Department for new construction) City /State A JA) kiL''JS//MA10 Parcel Identification Number CA- aD 0 6 -zo - 0600 LEGAL DESCRIPTION Property Location JIBE %,, :gE %; Sec., T_31 N -R _aW, Town of �7 AI�TOIJ Subdivision Q Ak QIOGC eS 7t►TES sT 7IDPI K1 Lot # 3 � Certified Survey Map # . Volume , Page # Warranty Deed # �3� (0�6 , Volume t9 . Page # a2( Spec house ❑ yes K no Lot lines identifiable ❑ yes ❑ no SYSTEM NLAE'41TNANCE 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) 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 1/3 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 Zoning Office within 30 da s of the, three ye xp tion date. 1 0 0�— IGNA APPLICANT DATE OWNER CERTIFICATION I (we) certif that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pror7�71 ' b v e, by virtue of a warranty deed recorded in Register of Deeds Office. j siGNATLft OF 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 DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1 -1942 THIS SPACE RESERVED FOR RECOROINO DATA WARRANTY DEED 4 39GSG nox 81 t PA,I ? , -- _- - REO1STER S OFFICE This D"d ,madebetween William W. Winchester and `T. : CO., Dolores E. Winchester, hus an an w e, as _ lad for Recce Joint tenants A L 21 Grants, IM and C r 1 Ra mon Jo nson an Ro Qrta ue pf 11:15 A iM Johnson, as marital property w th r g is o ��AA survivorship $ 1 4 Z O S c�C - Grantee, r of Deeds Witnesseth, That the said Grantor, for a valuable consideratio RETURN TO conveys to Grantee the following described real estate in St Croix County, State of Wisconsin: Tax Parcel No •113 ( 0 mod C0QO Lot Thirty-two 32) O Rid Estate y � Ridge Est s t _ First Addition to the Township of Stanton, being located in the Northwest guar 1<r c the Southeast quarter (NW} of SEJ) of A Section Thirty -one (31), Township Thirty -one 3 _A ;.550 (31) North, Range Seventeen (17) West. FEE Thi is homestead property. list (is not) Together with all and singular the hereditaments and appurtenances thereunto beiongSn;i, And William W. Winchester and Dolores E. Winchester warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except None and will warrant and defend the wme. Dated this day of July (SEAL) UA-2 e- UJ i" CA 12,&- (SEAL) • William W. Winchester Dolores E. Winchester (SEAL) (SEAL) ALITHENTICATIOh ACKNOWLEDGMENT Signature(s) of William W. Winchester STATE OF WISCONSIN and Dolores E. Winc ter SS. _County. i au notated this ay of J 19 8 8 Personally came before me this day of ' 19 the above named John R. Haasch ITLE: MEMH£R$ikT �AROF MFiJeClNSfirr (If not Notary Public, St. Croix to me known to be the person who excuted the authorized by § 706.06, Wis. Slats.) County foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY J.R. Haasch, Broker 144 W. 2nd St. New Richmond, Wi 54017 Notary Public County, Wis. (Signatures may be authenticated or acknowledged. Both My Commission is permanent. (It not, state expiration are not necessary.) date: 19 ) 'Names of persons signing in any capacity should be typed or printed below their sig„atures. NF ?473 WARRANTY DEED STATE BAR OF WISCONSIN Nelco Forms, P.O. Box 10208, Green Bay, WI 54307 -02M FORM No. 1 -1982 M „b1,8So09 N OZ,OE .N „b0,£1 rJ 1 ,LS b91 I Sb 1£I ££ ONIt1V3B 3- 19NV, 01 NbVd L `JN18VAH H19NT) HID N3 - i M „bS,LZo£ N OZ,Bb S£ 3 91 9Z 'I N -- 1 _...: -' - - '- - - - H101 ON N - - I 1N30NV1 - IV a1N30 OHOH.) 0801 S[lluvd 101 1. , , an S31h1S3 319V1 VIVO 3n�jnD - M!!4 Nf4 f 4. Nn11"?3S 3' L?lVc! .N.. 1410 t � .oz! ' J 3'IVGS ££'6b / / - - - M I 3S- 3S 3 -MS / 9 9 �7 � 5Z X1170 I I � 1Li0032! / N SV / 161L '96Z 3,Ibo98N , pb'Sb 6z �L c� 2';� Eo \ / � ° g W Ow V �O�'� . �;; 3G -3N 3S-MN p`�M`; - 3N� o O� b �` j / R' �• �2 O 1 1 `l £6'69 1 � S32i0d �I off$ V� \ 3N -35 3N -MS MN -3S 9£' 9 4 1�1i v4o 2 9 , V \\ Q� o a•�"° 0 0 t .6 6 ' /62 w b �/ > - - -- -- - - -- X 1 1f10 ° ss g b � HD13�S N011'VDCI - 1 < '9 aed „b£,6£ °£9 £,BIoS61 W o 1/jb� O�X ° - m A � � � ' 1S � 9 , n 9 L 6 "13 N 31'✓M 6 `9 M0 03.1vW1153 l3 ?131t/.M I{OIH 3NIl an01N00 Z S � s D = O� 0 a 00Z C „xl 0 fXJI 00Z —I m 0) a 13 - -- -- rn 0) S3aDV90'Z Nll /'S8 - l/ 0 1 56 ° 71 v N 89'1 ONIH013M O 9� 31V�5 31IS N� Z A 3 3d Id NO& 0£X ,I .w/ /' / SNOUVA83S80 >iVIOS WOH3 3fl✓:II. 3HV S`JNIMV38 "ITV O W--{.z 40 Z� �i` - 'NMOHS 3n'1Vn 3.1. ��L (laind00 ONV 0 M "9 ° b w .'G �; 1 W c p) D o0 WIl1V0 - S0 - Sn 1L £,' , SONO�3S A1N3M1 1 31111 7N 3141 Ol 30'w - ti � � : . , 5£ / � N338 3�VH S1N3W3✓•J !1 �3W tiV 3f19NV T” O 00 G' ' 16 - 73 - 13 ,Z S• ' 4�.°9 /ti / �.Q 1004 V JO H1Q3NONOH 3rd 1. DHV]N 3141 1 6 X08 y /O > _6L '� - 30VW N338 3AVH S1N3W32lnSV3W ifV3Nil �- 0 a3NHOJSNViH-L / �I , mo 30 dOJ W 8 S36DVO l �tii L� 4 310N o d70 N3S114838 HlIM 311 1 I o & s2 O % � (u NO✓31 „9F X,.,. 'lr•J3W(1NOW a3NLi00 N011035 A1. Nn; v> ( lez g 1004 1V3N10 /'SBl 89'I ONIH013M ' 3dld Nny 1 1 \ �O O ,17Z X,. H11M 03NV-LS S83N800 10� 83H10 N 61 ! g9o O A '0310N SS3 rJn „I '1N3v4nNOVI 3dld NOW 9NI1SIX3 L so2 S n N 0310N SS33Nn S3a0V 9Z l Q) W \b � 0 V 0 1004 - 1 V3N1 / SBl S9'£ ONIH013M ' 3dld NOaI „OE > Z J 0N3031 ° O g4 C;.4 Na 3 c ' C n / M B 711 0 B N w H U b I f -- ? -zn 4 - 7f I> 0 99 (.oOeM "bl, 8 °0 o z N Z m N c ° to 07 75md A ' m t � !] D O V o • A N S380tlz£I A O cc) c N o w ;D �J - MN N r O � Di A n 8� _ a- I�Cn m S383V c,c: l n m CD 6 �- - L w N gg N goo (I -�- = A p'L AS ° p 1g co g 0` o Z7 A o LO 3• a G g Ib 81Z O M rri 4o0LN „ M„ 9 b , 10 ° 68 S °p6 „OS a � wg1,3 „gd9 , ti C 1 0 9S °G ti 1, ° vM