Loading...
HomeMy WebLinkAbout040-1267-20-000 Wisconsi; Department of Commerce County: PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 515023 0 GENERAL INFORMATION 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: Westerhaus, Thomas & Elizabeth I Troy, Town of 040 - 1267 -20 -000 CST BM Elev: Insp. BM Elev: Descriptio Section/Town /Range /Map No: Q0 • 00,0 BM Mrs 16.28.19.1454 TANK INFORMATION ELEVATION DATA - 7 D, r71 ,14D , �f TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. . $ � !b • $ lG�3 Septic `2 DD Benchmark Z 021 /��•� Dosing �QU Alt. BM Z Aeration f' / /] 2 5 Bldg. Se4fer 3 1 v �� U Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / Dt Bottom ! 40 p 7X 1AJ Z Dosing / Head 2 /Man. z Z d ,� /az.y5 Aeration Dist. Pipe - 2 , 10Z . y Holding Bot. System / Final Grade J �Z 0 PUMP /SIPHON INFORMATION h / 3. -Y5 Manufacturer Demand St Cover qp GPM / /- S 9�• �O Model Number kA�, TDH Lift ' Frict'on Lols Syst m Hr TQE1,, .. 11 � t0 l! Forcemain Leng�t G , t I Dia. r/ Dist. to Wel ! SOIL ABSORPTION SYSTEM BEDITRENCH Width / Length / No. Of Trench PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth /� DIMENSIONS t / SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM L N MBER Manufacturer: INFORMATION C Type Of System. r Z I ` � OA �/� , / ^ Model Number: DISTRIBUTION SYSTEM tilot^� /`/ ' Header /Manifold Distribution ! 2 x Hole Size 7 ` x Hole Spacing Vent to A In ke g 3.33 Dia Pipe(s) 6v �+ Spacing 3. i9. I LS Len th Len th Dia SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Sy,%tefRhOnIy Depth Over Depth Over xx Depth of x Seeded/ dded xx Mulched Bed /Trench Center I Bed/Trench Edges ` Topsoil, Yes No E] Yes ; ;o COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ! / / of I � pe do 2: / ZO ( / C) - Location: 323 Empire Builder Drive Hudson, WI 54016 (NW 1/4 SE 1/4 16 T28N R1 9W) Glover Station 5th /add Lot 93 / ardel a 16.28.19.1454 0� _ o Dn�e _ � el 2.) Bldg sewer length 1.) Alt BM Description -�P "'�'hll��1 1 � " ' .�Q 6 - �� = f7 t� cJ ' ` -~ r ' ° ",' A- 2 - amount of cover =� „ OX- Use other side foradd additional information. J �'C�� * revis Plan Re quired? ❑ [V] SBD -6710 (R.3/97) Date Insepctor's Sig t4 a Cert. No. Plot Plan, Page 9 of `S - --5oft Legal Description �,- qs G DO ,A — Sr- e- V jaksevN Sj �3. d 14AU.b UcRIV& : 4 t 71 n o F` 4 r t ee l0q > jo 'a 190,go � �� � aPPyC pIPL. A•S 944 4 ` bk or � n� o ' A N Ifte ChAA IL C merce.wl.gov Safety and Buildings Division 261 W. Washington Ave., P.O. Box 7162 i Q n s n Madison, WI 53707 -7162 Permit Number (to be filled in by Co.) rM of Commeros Z N Y Sanitary Permit Application Sta sactionNumber In accord�rbl�h s. Com .83.21(2), Wis. Adm. Code, submission of this form to the ppropriate ovet, S 10" egg G o taming a sanitary permit. Note: Application forms for tate - o dW k$ tdr`e P oject dress (if different than mailing address) e Department of Commerce. Personal information you pr ide ma be used for secondary uses in accordance with the Privacy Law, s. 15.04 I m , Stats. CO As � 1��^ y N � L Application Information - Please Print All Information OF &9r`� 1� /, (�ir0 p y Property Owner's Name Parcel # rL 4k "r -- Z - 00 Property Owner's Mailing Address Property Location l � G � r Govt. Lot e Ci ,State Zip Code Phone Number /U (� y., � y., Section (circle one T f - `" - _N; R /0 E. 11. Type of Building (check all that apply) OK Lot # t,, I or 2 Family Dwelling- Number of Bedrooms _ ..__. "V .. . _ .._.. _ ✓ _ ... Subjd y si n Name _._ ._/__... Pf _ ❑ Public/Commercial - Describe Use PW S t " Block # O� � A ,0 , -..-- ❑ City of ❑State Owned - Describe Use a CSM Number ❑ Village of Town of J Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. J(New System y ❑Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System (explain) B. 11 Permit Renewal ❑Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) 0a � ❑ Non - Pressurized In -Ground ❑ Pressurized In- Ground ❑ At -Grade 9 Mound > 24 in. of suitable soil ❑ Mound < 24 in of sui le oil s1 ❑ Holding ank ❑ Other Dispersal Component (explain) Z g p po ( p ) Pretreatment Device (explain) / V. Dispersal/Treatment Area Information: DesigprFlo�;pd) Design Soil Application R Dispersal Area Required , (so Dispersal Area Proposed System Elevation ( b , � n VV VV VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units d o, u New Tanks Existing Tanks `` d c y E5 a. Septic or Holding Tank Dosing Chamber V C 1 F 1::::±:::j1 VII. Responsibility Statement- 1, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. Plum er's Name (Print) A , , / Plumber's Signature MP /Ief ft"umber Business Phone Number `v lV /�Oa G �6 G Z/ Plumber' ddress (Street, City, State. Zip Code) 64 J VIII. Count /De artment Use Onl pproved ❑ isapp Permit Fee Date Is d Issuing t Signatur z//,�—� ❑ rven Reason enial $ w O � IX. Conditi�$t2(casons for Disapproval 3 Go r{Y�d�1'S i S G t. Septic tank, effluent filter and a M / dispersal cell must all be services maintained W` P" ^_ as per management plan provided by plumber. 2 AN setback requirements must be Mintained Attach to complete plans for the system and submit to the County only on paper not less than a 1/2 x 11 inches in size SBD -6398 (R. 01/07) Valid thru 01/09 I i y . 136 W0 M BTZYZ ;'1 .:'i:F +Gli'f :':: 31ct� . °•i.j .v IIA .; .soomm:, to 19W , �Nn as ' A as Plot Plan Page 9 of 'S Legal Description c-avftI sIM i cs G4k A la . 4 Of - Ne SW/4 S 11. TZ1W 'Rt`t+..3 MWI S3:_CLf )C Eat. i W�Sc' gi;� 'd = NAB F�cRi �.1M'P1RE '6eat�ET� 'pF,1vF r 4 h 1� IDO,yo oL • �" P PvGP�PE. AT ¢d p i ,, - yb suRRnM !00.00 " a 44.5 ,4sswN.�n 0 ° o a N /o N We Lmadon: .sea. O w Q ULM* �I Safety and Buildings 3824 N CREEKSIDE LA commerce.wi.gov HOLMEN WI 54636 ■ Contact Through Relay i sco n s i n www.commerce.wi.gov /sb/ ' Department of Commerce www.wisconsin.gov Jim Doyle, Governor Richard J. Leinenkugel, Secretary RECEIVED October 17, 2008 CUST ID No. 224832 NOV 0 5 2008 TTN: POWTS Inspector ST. CROIX COUNTY MARY JO HOLLISTER ZONING OFFICE ONING OFFICE HOLLISTERS SOIL TESTING & DESIGN ST CROIX COUNTY SPIA 530 CTY HWY M 1101 CARMICHAEL RD RIVER FALLS WI 54022 -4011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/17/2010 Identification Numbers Transaction ID No. 1598824 SITE: Site ID No. 743535 Thomas & Elizabeth Westerhaus Please refer to both identification numbers, 323 Empire Builder Drive above, in all correspondence with the agenc Town of Troy St Croix County NWl /4, SE1 /4, S16, T28N, R19W Lot: 93, Subdivision: Glover Station 5th Addition FOR: Description: Four bedroom Mound System / New construction / 3% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1205060 Maintenance required; 600 GPD Flow rate; 25 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual- Version 2.0, SBD- 10691 -P (N.01 101), Pressure Distribution Component Manual- Version 2.0, SBD - 10706 -P (N.01 101) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manuals) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 14506, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • 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 ofSee. 145.20(2)(d), Wis. Stats. I • 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. • Maintenance information must be given to the owner of the tank explaining that periodic cleaning of theeffluent filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval P.t+,wr. conditions. Conditionc Y • A copy of the approved plans, specifications and this letter shall be on -site during construction and qpea4o C r_ , inspection by authorized representatives of the Department which may include local inspectors t` DEPARTMENT OF COf`rSi�Et�CF DIViSIUN OF SAFETY AND BU1L►%' S MARY JO HOLLISTER Page 2 10/17/2008 Owner Responsibilities: • The current owner, and each subsequent owner, sl ll 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. • 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). • 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 bolding, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the actress 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 �e— /1 � Fee Received $ 175.00 Balance Due $ 0.00 Gerard 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: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application 0 ,J INDEX AND TITLE PAGE �l Project Name: THOMAS & ELIZABETH WESTERHAUS Owner's Name: (same) Owner's Address: 1790 Summit Street River Falls WI 54022 Legal Description: NW 1/4 of the SE 1/4, S 16, T28N, R19W Township: Troy County: St. Croix Subdivision Name: Glover Station 5th Addn. Lot Number: 93 Block Number. NA Parcel I.D. Number: 040- 1267 -20 -000 Plan Transaction No.: w • ' �i •••�G0NS��Y ��., Page 1 Index and title • ••.�•., Page 2 Data entry •1` O • ', Page 3 Mound drawings MA��S -tea Page 4 Lateral and dose tank Page 5 System maintenance specifications Page Page 7 specifications contingency p lan Pump curve and • "•" : ' #Q��•• Page 8 Plot Plan '•� *'••,� bES1G Designer: Mary Jo Hollister License Number: 1859 -007 Date: 10/14/08 _ Phone Number: (715) 426 -1775 Signature: '` . `wl Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706 -P (N. 01 /01) Version 5.1 (R. 06/06) Page 1 of 8 c,u E�PUNC7CNCE 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 1.50 Peaking Factor (e.g. 1.5 = 150 %) fecal coliform of - 36 inches. 600.00 Design Flow (gpd) 3.00 Site Slope ( %) 100.40 Contour Line Elevation (ft) 24.00 Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpd /fe) Distribution Cell Information 60.001 Dispersal Cell Length Along Contour (ft) = 10.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/fl 1 I Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure isribution Information network? Enter Y or N (C or E) E Center or End Manifold 3.33 Lateral Spacing (ft) If N above, enter the elevation ft 3 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) 2.25 Estimated Orifice Spacing (ft) = 7.41 ft /orifice 2.00 Forcemain Diameter (in) 172.00 Forcemain Length (ft) Does the forcemain drain back? Y 88.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 28.06 Forcemain Drainback (gal) 13.23 Vertical Lift (ft) 55.91 5x Void Volume (gal) 4.06 Friction Loss (ft) 83.97 Minimum Dose Volume (gal) � 0.50 In -line Filter Loss (ft) 33.37 System Demand (gpm) 24.29 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x x 1.00 1.50 x 1.25 x x 2.00 x 1.50 x 3.00 2.00 x 3.00 x Gallons /inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1200.001 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser Manufacturer gal /in (enter ressdf °^ - Dose Tank Information Effluent Filter Information 800.001 Dose Tank Capacity (gal) Best Filter 22-241 Dose Tank Volume (gal /in) BTGF10 -8 _ Filter I Wieser I Manufacturer Project: THOMAS & ELIZABETH WESTERHAUS Page 2 Mound Plan and Cross Section Views .................................................... T t Observation Pipe K W a I: :•:•:-:-:•:•:-:•:•:•:•:•:-:-:•:•:•:•:•:-:•:•:-:•:•:•:•:•:•:•: • :•:•:•:•:- :•:•:•:•:•:• :•:•:•:: I L Mound Component Dimensions Down slope toe extension made. A 10.00 ft E 15.60 in H 1.00 ft K Eaft ft B 60.00 ft F 9.25 in 1 15.00 ft L ft D 12.00 in G 0.50 ft J 6.25 ft W I 600.00 (ft) Dispersal Cell Area 1500.00 (ft) Basal Area Available 10.00 (gpd /ft) Linear Loading Rate 6.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 103.17 (ft) -- 0 * G H 1 I F 101.90 (ft) Lateral Dispersal Cell 101.40 (ft) --� -- _ Invert Dispersal Cell Elevation _ D 10 .40 ft Contour Elevation 3.0 % Site Slope Geotextile Fabric Cover Shading Key o, Dispersal Cell See lateral details on 1Q _ Topsoil Cap 0 c 1.5 ft Page 4 for number, size, 02 rrrrrr. Subsoil Cap W o and spacing of laterals. ASTM C33 Sand o ':, : F Laterals are equally Tilled La yer 05ft Typical Lateral spaced from the Aggregate a distribution cell's centerline in the 0 — A IF distribution cell (AxB). Project: THOMAS & ELIZABETH WESTERHAUS Page 3 of 8 i End Connection Lateral Layout Diagram C~" •. Turn- upwtbaltvalvworadssnoutplug P - - �j All laterals are identical tE X I Noles drAed on tNe boaeom of [Ke Fatet al equaMq spaced S Laterals & Fwce main of PVC Sch 40 [DK COMM Table 84.30.6] S Fwce main ccmn*ectton wa tee at cross to manifold at "port[. Number of Laterals 3 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.25 ft Lateral Length (P) 58.50 ft Orifices per Lateral 27 Lateral Spacing (S) 3.33 ft Orifice Density 7.41 ft /orifice Lateral Flow Rate 11.12 gpm Manifold Length 6.67 ft System Flow Rate 33.37 gpm Manifold Diameter 1.25 in Total Dynamic Head 24.29 ft Forcemain Velocity 3.41 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and - -1 � Comm 16.28 WAC Disconnect 4 in. min. co Tank component is properly vented F — Altomatp nutiPt 'location Forcemain diameter Wieser Manufacturer 2 in. Cap acityl 800.00 Gallons _r Volume 22.24 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 22.20 493.63 B 2.00 44.48 C Pump off elevation (ft) C 3.78 83.97 88.67 D 8.00 177.92 D Total 1 35.971 800.00 Dose tank elevation (ft) 3" Bedding under tank. ~— 88.00 Alarm Manuafacturer I Tank Alert Alarm Model Number I HW101 Pump Manufacturer JGould Pump Model Number PE51 Pump Must Deliver 33.37 gpm at F ft TDH Project: THOMAS & ELIZABETH WESTERHAUS Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name Tri-County Sanitation I Phone 715 386 -2130 POWTS Regulator's Name St. Croix County Zoning Phone 715 386 -4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1200 gal Maximum TSS 150 mg /L Soil Absorption Component Size 600 ft Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. J. All gravity and pressure piping materials conform to the requirements in Comm S4, Ms. 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 ,1 6 -8" Diameter Lawn / Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: THOMAS & ELIZABETH WESTERHAUS Page 5 of 8 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 (01181), 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 84nches 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 fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the fitter is equipped with an alarm, the fitter 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. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent fitter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October - February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg /L BOD 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg /L BOD 30 mg/L TSS, 10 mg/L FOG, and 10 cfu /100 ML for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. 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: We:: q"eKhAuse o M s Page 6 of 8 gqj QOULOS PUMPS Submersible Effluent Pump PE MOTOR Pte► Getl�: r COasion msMn • l asaufta. 'Teter 10ff l ' 60 Heft ■ Cast ha► body. . G�rxrott3 when • � 1 S � 230 vdt5 ■ Thermoptastk anpeMet ark tt�y sttfxrtetged. • 8ta'h -in t#tenttal overload pro covet: • 5t�ds hzmri�g:'�4" tectiort t�lh a1A0nt�ic tt;slx ■ Upper sleeve and tower ntaxhnMm sphere. ' Class B irk. heavy dray 6aN beating APPLKA?WW ` Aft is models tnchtde a • Milled design. canmucti . float switch. =sftenq* SP y � for the • Ma" models avaaabie. • carbar stt'd a p enaane fa a follavving mss: ` RWOV ranger see PE31 Motor: wMata rife. E �� Pei ce diarc or oteve. o ; 5 v �� � ■ Fb�ed for aonthuoas = ae Law Presw e Pip ms Syst ' Maualaen wary: 53 GPM • Shaded Pole design ■ willin dw • ftsement Dmb tg • MatdW= head. 25' TDH PE41 Motor tNOrki of the mote► • CHime�ra Duty SumW PE41 Pday.- .40 HP, 3404 RPM Qukk Paaer Maxim= GPaciry. 61 GPM a 115 and 230 voles tend, 20' swxlard k lgft • Makknum beat 29' TDH • PSG design heavy duIy 1 W S1IW with PE51 Pax PES1 Mahar: 115 a( 230 voRtTot Kj" Mtn► cq)adty. .. 70 GPM • 30 HP, 3400 RPM ■ urea is he" duty. • Ma dMum head: 37' TDH • 115 are! 230 vats P d compam nn�as FEET ' � �" ■ Medunkil seat is Cuba% ceramic, BUNG and stemless "Doss: re,. NWr, res+! steel_ 35 t� �. �0. m te Suss steel Uetler5. Ili = _ , 2 GPM USTOW u t �C i i" • trS 20 Testid to UL.778 w! GA 2U 108 %mdar& 15 l�rcanst "` treeids/un�slsIS096t11 i0e 0 ° o t0 = 40 SO z-t r• Vv63tirRt�ttLS �t11/V1�t� 20 30 60 70 GPM BO of 0 5 M 10 15 MA/h ' M• Wisco Hu Rel bons In dustry, Labor and Hu SOIL AND SITE EVALUATION REPORT Page I of 3 Labor 'A ;on of Safety & Buildings in accord with ILHR 83.05, OUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in si . Ptvfi'must not limited to vertical and horizontal reference point (BM), drection and 6y slope, s l ur' } , LtR EL I.D. # ppo�+pq� dimensioned, north arrow, and location and distance to nearest road APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION f `'` D DATE a. (,f ST PROPERTY OWNER: PRO ON e �ZS e � �UW `s S c"U C7 z seu e� W •.. 4,S I' -6T � .N,R l g E (or w - PROPERTY OWNER :S MAILING ADDRESS. LOT #. BLOCK # SUB .. NAME OR CSM # z S 2 LU�2S t DE �2l vE X13 , ---_ --6 v S`molu 5 1'; t t) . CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®TOWN ' NEAREST ROAD 1Z QkEz tCLS -S wl 5g 01:z- 5) q Z-5 8161 New Construction Use [XJ Residential / Number of bedrooms [ J Additi n to existing building [ J Replacement [ J Public or commercial describe Q, g Code derived daily flow b pt) gpd Recommended design loading rate bed, gpd/ft - trench, gpd/ft Absorption area required SW3 bed, ft SM trench, ft Ma)dmum design loading rate • `� bed, gpd/ff - S trench, gpd/ft Recommended infiltration surface elevation(s) V�i 1. It (as referred to site plan benchmark) Additional design / site considerations ►`'lDW -p W/ 8 >L 6 LZ ` oF Sft;..O R LL Parent material LDS (3yEz• Rood plain elevation, if applicable N fl It S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for s stem O S ,®U ®S EI U 0 S EI U I O S ®U O S 51U I O S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color I Mottles I I Structure I GPD /ft in. Munsell Ou. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bourrlary Roots Bed ra>dl to�t231Z Sil Z`Fsb S •� 34s6l, es - V s Ground 3 18 3% L( -) i, t,�.Sbh >��r• - Z . 3 elev. _ C I tL SL Ui c ez'r N 12 L D i v j < So o Izo C - Depth to limiting factor —y Remarks: 1 Boring # 0 -9 Z Fz 9 -L3. l0`1fL 31b S1) 2m S b h w ag -S -� 3 2S S Ground 3 �t tZ c11 �v — -V -5 elev. Z S 3� S �t 2y/ L� _ ° I.� ft b S k 2 S JF5 SIC-1 S 8 l�`�2b 13 - L5alz - 1uP ►J? Depth to — limiting factor Z S'' Remarks: CST Name: Please Print Phone: Arthur L. We erer 715- 425 -0165 ' legerer Soil Testing & Design Service -P.O. Box 74 River.Falls,WI. 54022 ' Si Date: CST Number. . d�lo3 -43 S -g�OU 220254 PROPERTY OWNER E J SCN4U -TZ SOIL DESCRIPTION REPORT Page Z of 3 PARCEL I.0. # P1v1b) ) j G l Depth Dominant Color Mottles Boring # Horizon Texture Structure Consistence GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Y Roots Bed Mir d _ = "3 0 -lb IO 1fL — s zlzblT . 11 Z�'�bY� lv S Ground (-J Zrn sbh m�,- es — • �! .S elev. lbL).- y yrz stiR s`b Depth to 5 y� 10`22 b�3 — ZSBR - limiting !J? factor ------------- z6 Remarks: Boring # Ground elev. ft. Depth to — limiting factor Remarks: Boring # Ground elev. fl. Depth to limiting factor Remarks: 3oring # K 'ti around ?lev. 0. )eplh to imiting actor Remarks: _ RGOULDS PUMPS Submersible Effluent Pump MODEL 3885 x WE Series --- - PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPLICATIONS ■ Shaft: Corrosion -resist ---- - Sift9f phase (60 Hz): can be operated continuously stainless steel. Threaded • Capacitor start motors for without damage when fully Specifically designed for the design. Locknut on all models maximum starting torque. submerged. following uses: to guard against component • Built -in overload with ■ Bearings: Upper and • Homes damage on accidental reverse automatic reset. lower heavy duty ball bearing • Farms rotation. • SJTOW or STOW severe duty construction. • Trailer covets oil and water resistant power • Motels ■Fasteners: series p ■ Power Cable: Severe duty stainless steel. cords. • Schools • Hospitals ■ Capable of running dry • Y3 and t ee Epoxy seal on motor end models have rated, oil and water resistant. • Industry without damage to NEMA three prong grounding plugs. provides secondary moisture • Effluent systems components. • HP to 3 and larger units have barrier in case of outer jacket d to damage an prevent oil Designed for continuous bare lead cord ends. Standard cord is l SPECIFICATIONS operation when fully Three phase (60 Hz): wicking. submerged. Optional lengths are available. Pump •Class 10 overload protection � 0 - ring: Assures positive • Solids handling capabilities: MOTORS must be provided in sealing against contaminants 3 /d' maximum. separately ordered starter and oil leaks e -- • Discharge size: 2" NPT. ■ Fully submerged in high- unit. g ' • Capacities: up to 140 GPM. grade turbine oil for lubrication • STOW power cords all have AGENCY LISTINGS • Total heads: u to 128 feet and efficient heat transfer. bare lead cord ends. p Tested to UL 778 and TDH. ■ Class B insulation on ■ Designed for Continuous ® CSA22.2108Standards •Temperature: '/3 - 1 ' /2 HP models. Operation: Pump ratings are By Canadian Standards 104 °F (4p°C) continuous ■ Class F insulation on 2 HP within the motor manufacturer's CM us File �8sa9 140 °F (60°C) intermittent. models. recommended working limits, Goulds Pumps is ISO 9001•Registered. • See order numbers on reverse side for specific HP METERS FEET voltage, phase and RPM's 40 130 L – F SERIES: WE available. 120 - - f 1 14 SIZE: 3 /4 SOLIDS 1 I I I I RPM: 3500 & 35 110 – - – t— -- t 1 1750 FEATURES 30 100 -► SGPM - - -- - - - } s Fr - ■ Impeller: Cast iron, semi- 90 - open, non -clog with pump -out W zs 80 - - - - _+ - vanes for mechanical seal - - - - - - - protection. Balanced for 2 20 70 _ smooth operation. Silicon } bronze impeller available as Q 1 s so _ r an option. 40 ■ Casing: Cast iron volute type 10 for maximum efficiency. 30 _ 2" NPT discharge. 5 20 -, - ■ Mechanical Seal: SILICON 10 CARBIDE VS. SILICON o 0 t CARBIDE sealing faces. 0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 GPM Stainless steel metal parts, 0 5 10 15 20 25 30 35 m3 /hr BUNA -N elastomers. CAPACITY Goulds Pumps © 2003 Goulds Pumps Effective July, 2003 wwv.goulds.com ITT Industries A B3885 'PROPERTY OWNER SCIIU-T t SOIL DESCRIPTION REPORT Page Z of 3 PARCEL I.D. N Et hJ Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Texture Consistence Boundary Roots Bed Tech R 31 z s I 1 Z`�sbk T>- � - S 1�F • s ,6 Z lb -h 1U`t 3 /r - s2') Z� s�h ha'fi CS S .� Ground 3 Y/V - S1 LJ Zrn Air )V-O- (i-s — . q .S elev. Abu.- y 2L -cn Sy2V' /6 .stiR. S1?) Depth to S y 101.2 �(3 — LSBR - limiting _ tiP lip factor Remarks: Boring # Ground elev. ft. Depth to — limiting factor Remarks: Boring # Ground elev. It. Depth to limiting factor Remarks: 3oring # "v around —, ,lev. ft. )epth to imiting actor Remarks: _ `rl n•r •rnrr .'.r ..... Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page I of Labor and Human Relations g _ .lriv lion of Safety 8 BuikSngs in accord with ILHR 83.05, Wis. Adm. Code COUNTY 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 reference point (Blv% direction and % of slope, scale or PARCEL I.D. dimensioned, north arrow, and location and distance to nearest road. ' APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R DATE PROPERTY OWNER: PROPERTY LOCATION C�IQr<Z`� S e Pk&) E 3C1iUC Z &e9AT NLQ 1/4 1 /4,S NOT ,N. Efor W PROPERTY OWNER' - .S MAILING ADDRESS. LOBLOCK # SUBD. NAME OR CSM # Z S8 l� lV ?S IDE - D2LUE c 1 lN — G L V ST"O)U S F . CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE ®TOWN ' NEAREST ROAD IZIU EZ P C - S wl 5L,o'2;L S) q Z-S'- $bbl �ZO� -( P11Z$ balL.m DR. New Construction Use [>q_ Residential / Number of bedrooms [ J AdditiQn to existing building [ J Replacement [ J Public or commercial describe Code derived daily flow b (Y) gpd Recommended design loading rate ^ q bed, gpd/ft — trench, gpd/ft Absorption area required Soo bed, ft Sib, _ trench, ft ' Ma)dmum design loading rate • `4 bed, gpd/ft • trench, gpd/ft Recommended infiltration surface elevation(s) 1.O1 \4 ft (as referred to site plan benchmark) Additional design/ site considerations _MDUNA� W/ 8 '>L b 3' S � , M L /U . LZ ' 01= Srti, -o FL LL Parent material l.nt S ovFz- Lilt Yom E Flood plain elevation, if applicable M;� ft S = Suitable for system COWEN71ONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HO ❑ S ®U ❑ S �U LDPlG TANK U = Unsuitable fors stem ❑ S ,® I ® S I—] U ❑ S U I I ❑ S ® U SOIL DESCRIPTION REPORT Borin # Horizon Depth Dominant Color Mottles Structure GPD /ft g in. Munsell I Ou. Sz. Cont Color (Texture I Gr. Sz. Sh. Consistence lBarldary I Roots Bed rerrh I o- g t � � 2 31 Z � Si I Z�s6 Y�t.'Fs- �S 1� • S . � .V S Ground 3 18 3% Lb' elev. fL St t_ Utz 6's R.m b U" - < So p Cz p Depth to limiting factor Remarks: Boring # 13 S Z q - L3. 10 Sl1 - 2- 31i z )id Ground elev. , CIO L 2.S- S L sy 1 sLC d z 2 S 8 - !0`72613 LSIZ Depth to - Gmiting factor ZS° Remarks: CST Name.—Please Print Phone: Arthur L. We erer 715- 425 -0165 egerer Soil Testing & Design Service —P.O. Box 74 River Yalls,WI.54022"' . Sgnattue: Date CST Number.. oc- tn3 - Q3 S -g..pV 220254 s PLOT P LAN I Pa 3 of 3 �7 pia. PVC �tp� w�3•�'�F16N 30 PVC Mt q^R1zl?R Plug Lcu co � 1 2S � • �o Mk) 'r eOr pn-cr GR X11611 J'l,C' M"jr o2 Pi P a�srvoZa arts WK(A. v I I # 15:) 'ON auoydalal pau6iS alep ainleuBIS 1ST SZC)2 S9t0 - S 2.h IEJb Oleo ST. CROIX COUNTY l SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer l ► l 6 m(- S UQ Q-g fiCf�C'L 5 4 4 Mailing Address 2 7 �e -►?1� � c0e r Property Address 3 A3 '` � r e rR u 4 w., '�) r ,N tJQ AkaS Q ►7 (Verification required fro Planning & Zoning Department for new construc ion.) City /State Parcel Identification Number Z Z / ! U / Z - 7 Zd D LEGAL DESCRIPTION Property Location' /4 , 51:� 1 /4 ,Sec. Z I 4et , T �N R�W, Town of 0 f V Subdivision 0(boe-1- -k{% o ^ F1� Cl l + o Y , Lot # 93 . Certified Survey Map # ?? , Volume , Page # Warranty Deed # 7� Z� , Volume , Page # Spec house yes Lot lines identifiable _'fie no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (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. 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 Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Nu RMNATURE of bedrooms �/ J 0 OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) r 11111111111111111111111111111111 lIINIIIilllllllll State Bar of Wisconsin Form 1 -2003 * 8 8 3 Q 5 22 0 1 WARRANTY DEED 883520 KATHLEEN H. WALSH Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD THIS DEED, made between Jimmie H. Caldwell and Gloria S. Caldwell, husband 10/30/2008 10:30AN and wile WARRANTY DEED EXEMPT s REC FEE: 11.00 ( "Grantor," whether one or more), and Thomas M. Westerhaus and Elizabeth A. TRANS FEE: 348.00 Westerhaus, husband and wife as survivorship marital property PAGES: 1 ( "Grantee," whether one or more). Grantor for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in Name and Return Add St. Croix County, State of Wisconsin ( "Property") (if more space is ?h i #14ts 4 (T /,'z (/kd "tt needed, please attach addendum): �79� LOT NINETY THREE (93), GLOVER STATION FIFTH ADDITION, TOWN OF TROY. r(r Vc r ) /A; W_r 15 :.. 0 40 -1269- 20-000 Parcel Identification Number (PIN) This is not homestead property. fit) (is not) Grantor warrants that the title to the Property is good, indefeasible, in fee simple and free and clear of encumbrances except: easements restrictions, and rights of way of record, if any. Dated 1 bB (SE ) (SEAL) (SEA (SEAL) Gloria S. Caldwell • AiTi`>jTICATION ACKNOWLEDGMENT Signat►rre(s `' ' ` STATE OF WISCONSIN ) CHARIFNE A I AR SON ) ss. authent ow oil r � Notary Public PIERCE COUNTY) V r'1 m ar''' ,:. Personally came before me on /d g * the above -named Jimmie H. Caldwell and Gloria S. Caldwell TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) mstrum ) a //e nd aclrnowl ged same. THIS INSTRUMENT DRAFTED BY: s —° Joseph D. Boles - Attorney at Law Notary Public, State of River Falls, WI 54022 -0138 My commission (is-per"w=t) (expires: l (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 02003 STATE BAR OF WISCONSIN FORM NO. 1-2003 *Type name below signatures. INFO -PRO' Legal F«ms • (800)655 -2021 • ;ntoworom,s com 1 of 1 t � ON \ 61 8 8\ \ \� x / s �o i p`L \2.502 ACRES ; 108,979 S.F. � Q . p V p�� 8 �� \ x', 2.506 ACRES n A 109,182 S.F. 18.12' co \ 1 00 370 50' 220- 29 01 E 53 I ov 150.00' N 055 —1 �. 93 �I 05, 150' 2.510 ACRES I 109,341 S.F. N I 33' 33' ° a 1 NORTH LINE OF THE a� _ SW 1/4 OF THE SE 1/4 .n N 88 W 524.15'+ I • 150.00' 224 ._15' NI L�.I 1 10 CV I I 94 � 0 40' � . a 1 2.515 ACRES CO34 - 109,547 S.F. 0 0 I 4.370 to C4.0 1 �: o N 26 °03' 44" E 50.45 1.94' I ^ 200.00'' 149 172.30' I° N 88 0' 36" W 52 .15' _ o N { ' � N 88° 10' 36 " W 50 1.50' t to — N 88° 10' 36" W 470.07 `�I 3 i W I 249.49'0 220.58. ry N ' NI Off N f O — — to M 0' 88 . .� aj o 20' WIDE °' 94.0'r I I I DRAINAGE — _ u. ° O I i 50' EASEMENT 283 0 .» I Z 1 501 N 88 1 I I M rn Lo i W - I o I0) 96 W 5 0' L RES M . r 2.840 ACRES 2.511 W N i 98 123,732 S.F. �I m 1 ' i N It 109,395 S.F. N 50'0l i 1 9.5A1 etrcc