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HomeMy WebLinkAbout040-1293-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453282 0 GENERAL INFORMATION (ATTACH TO PERMIT) , ate Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. = TQ , A*) *• Permit Holder's Name: City Village X Township Parcel Tax No: Sherman, Tami Troy Township 040 - 1293 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 1 1 1 3 �],, ) I --� 17.28.19.1680 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark I,,. 1✓ ( 162 2 ao/em ' Dosing Alt. BM Aeration Bldg. Sewers 0 S / 1 0 2-S - 0 Holding St/Ht Inlet (o , S O ( , oIf, St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic I r Dt Bottom , i 21 � 3S -" Io.[o 93 -S Dosing Header /Man. / t• �� tt �. �5 3•S� � 0�•�3 Aeration Dist. Pipe 3. 34a 3.bo Holding Bot. Syste [ `{- 30 30 1 03-30 ' Final Grade PUMP /SIPHON INFORMATION W ,; LI, 2 Manufacturer Y&ft GPM Dema St Cover 0.9b MQO Number , O(p IM � ` `f 0 2�' 1 ( TDH Lift Friction Loss System Head TDH Ft (,•53 o.z S' 6 .S - o . Z Z 3.30 0340 M - 3 0 Forcemain Leng�� ` Dia. 2 ff I Dist.toWell S IL ABSORPTION SYSTEM .rZGp Width Length No. Of TTenehes PIT DIMENSIONS No. Of Pits Inside Dia. ep ENSIONS SETBACK SYSTEM TO � I PiL I BL�D ^ GWELL LAKE/STREAM LEACH G lecturer: INFORMATION Type Of Syst CHAMBER R IMl UNIT Model Number: DISTRIBUTION SYSTEM "A4LOt" J ( � Header /Manifold if Distribution 1 „ x Hole Size I x Hole Spacing Vent to Air Intake I Z Pipe(s) 5 t(y 29`� I.O Dia Spacin .O� 11 q -- ----_— Length Dia I / Length & g 1 /� �.O / 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 Yes [] No Yes 2 No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: 6 1 ( 2 1 6 Inspection #2: ID / 17 �j J] Location 484 East Coe Rd. Hudson, WI 54016 (SE 1/4 NE 1/4 17 T28N R19W ) Piney Woods Lot 5 ,�, I ! Parcel No: 17.28.19.1680 dJ1 1.) Alt BM Descriptions 2.) Bldg sewer length = VlA -I�- q� 4 - amount of cover 3) iu�wa A - -fit Q --- - - -- -- - - -- - — Plan revision Required? Yes No Use other side for additional informa on. l _ --- L�� 714) SBD -6710 (R.3/97) Date 1, sepctor's Signature Cart. No. Safety and Buildings Division County C ZWK 201 W. Washington Ave., P.O. Box 7162 vi Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) (608) 266 -3151 Department of Commerce y State Plan LD. Number /OZ> Sanitary Permit Application YES r In accord with Comm 83.21, Wis. Adm. Code, personal information you provide pro ect Address (if different than mailing address) may be used for secondary purposes Privacy Law. -M J I. Application Information - Please Print All Information °' - t �� coaEr �� Pr y Parcel N Lot N Block 4 N Pr Owner's Na me J. Ji a 0 2 2004 L A] 010 - a - Owner's M ailing Address " ` i l Property Location /6CP6 51 Ct 4 ZONING OFFICE. y� '/a, A)E '/a,Section City, St at Zip Code /— Phone Number (circle one) / T N; R1 EorW II. Type of Building (check all that apply) Subdivision Name CSM Number I or. 2 Family Dwelling - Number of Bedrooms pmiey �cSoo� ❑ Public /Commercial - Describe Use G p� ❑ State Owned - Describe Use D) < C�ZL ! )G( b Z'7 ❑City_ ❑Village Q'lownship of V III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New 5ystem p y ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System ❑ Replacement System g p Y B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Q Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. TZpe of POWTS System: (Check all that apply) ❑ Non - Pressurized In- Ground 1K Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Dip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: 10 aA Design Flow (gpd) Design Soil Application te(gpdsf) Dispersal Area Requi ed (sf) Dispersal Area Prop sed (sO System Elevatio (od 31 d p5bO a VI. Tank Info Capacity in Total Number X Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement I, the u ndersigned, assume responsibility For installation of the POWTS shown on the attached plans. Plum 's Na me (Print) I Plumber' Si gnature MP /MSS' Number Business Phone Number - 2 716 `�.1 �7 71S X73 Plumber's Addre ss (Street, City, State, Zip Cod VIII, ount / De artment Use Onl Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing�tur ( Stamps) Surcharge Fee) - 3 o -o f ❑ Owner Given Reason for Denial t al /Reasot for Disapproval 3 eptic tank, effluent filter and yylkh dispe cell must all be serv3c /maintained p as per management plan provided by plumber.P 2. All setback requirements must be maintained as per applicable code /ordinances. 3. �f3 �� B3 2M 9&e_U'd Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) Lot S Lotto P M 2- Id0.0' ati �" t�o� P , lb g 1'Y! �= IDN.3' an sfJ�'k� 9 �'aG.�t c ,ro u ol .��Dowsr p� /c I WEl1 ' 4 s G� t � 'D z Av n 3 S, oic 4,— '`'-►, � pvG k a3 8' $ Joe& t Cim 2 �_ liir► �, C�ea fo�� /p 2 7 , 4 sf Safety and Buildings 4003 N KINNEY COULEE RD commerce.Wl.gov LACROSSE WI 54601 -1831 TDD #: (608) 264 -8777 I O s' www.commerce.state.wi.us/sb Department of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary May 27, 2004 CUST ID N0.226497 ATTN: POWTS Inspector ROGER D NELSON ZONING OFFICE NELSON PLUMBING ST CROIX COUNTY SPIA 122 E SUMMIT AVE 1101 CARMICHAEL RD ELLSWORTH WI 54011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/27/2006 Identification Numbers Transaction ID No. 1004118 SITE: Site ID No. 684121 — Jeff Warren Tammy Sherman Please refer to both identification numbers, East Cove Rd above, in all correspondence with the agency. Town of Troy St Croix County SE1 /4, NE 1/4, S17, T2 8N, R19W Lot: 5, Subdivision: Piney Woods FOR: Description: Proposed Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 960287 Maintenance required; 600 GPD Flow rate; 80 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.0 1 /01); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stars. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for POWTS - Version 2.0" SBD - 10691- P(N.01 /01). The pressure network is to be constructed in accordance with publications SBD - 10706- P(NOl /01) "Pressure Distribution Component Manual for POWTS - Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01 /81) ". • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. .OA I.T.S. Condition I4 A r%Rr► i ROGER D NELSON Page 2 5/27/04 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and e maintenance of the POWTS occurs m accordance with this chapter and the approved management plan under s. Comm 83.54(1). 0 Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Gerard M. Swim Balance Due $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm jswim @commerce.state.wi.us WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN o4� 0, Residential Application -A INDEX AND TITLE PAGE �V Project Name: 4 bedroom Mound system Owner's Name: Jeff Warren & Tammy Sherman Owner's Address: 519 4th Street Hudson, WI 54016 Job address: East Cove Road Legal Description: SE 1/4, NE 1/4, S 17, T 28, N R 19 W Township: Troy County: St. Croix Subdivision Name: Piney Woods Lot Number: 5 Block Number: Parcel I.D. Number: Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Designer: Roger Nelson License Number: MP 226497 Date: 05/20/04 Phone Number: 715 - 273 -4444 Signature: -A44 Designed Pursuant to the Mound Component Manual for 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 4.0 (R. 04/03) DEI'ARWENT Ot CON4 ,JERK' Pagel of 8 DIVISION OF SAFETY AND BUILW SEE '01Zj � NDENGE Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 83 -44 -3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of - 36 inches. 600.00 Design Flow (gpd) 4.00 Site Slope ( %) 102.70 Contour Line Elevation (ft) 80.00 Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpd/ft) ` U { Distribution Cell Information 67.001 Dispersal Cell Length Along Contour (ft) = 8.96 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft) 1 I Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (c ore ) a Center or End Manifold 2.99 Lateral Spacing (ft) If N above, enter the elevation ft 3 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 4.00 Estimated Orifice Spacing ft = 11.77 ft /orifice P 9( ) 2.00 Forcemain Diameter (in) 25.00 Forcemain Length (ft) Does the forcemain drain back? Y 97.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 4.08 Forcemain Drainback (gal) 5.87 Vertical Lift (ft) 40.03 5x Void Volume (gal) 0.25 Friction Loss (ft) 44.11 Minimum Dose Volume (gal) 12.62 Total Dynamic Head (ft) 21.01 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 x x 1.50 x x 1.25 x 2.00 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) Weiser 800 - 325 -8456 1 Manufacturer gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.001 Dose Tank Capacity (gal) Zabel 1-800-221-574:fl Filter Manufacturer 20.601 Dose Tank Volume (gal /in) A100 Filter Model Number Weiser = Manufacturer Project: 4 bedroom Mound system Page 2 of 8 Mound Plan View FK 1/10 B . .•.•. .. -n- J Observation Pipe ; — L•L•L•L•L•L••.•L•'.•L•L•L•L•L• • L •L•L•L•L•L•L•L•L••.•L•L••.•L••. • •`.• L,L,., .,L,.,,.,,.,,L,L,.,• 5 :•L.L.L..,. L.L.•.. •..,,.•,..,.L.L. *-1 L,. A L•L•L• L•L••.•L•L•L••.•L•• L•L•L••.•L••.•L•L•L••.•L•L••.•L `• L••.•• I L Mound Component Dimensions Down slope toe extension made. A 8.96 ft E 10.30 in H 1.00 ft K Eaft ft B 67.00 ft F 9.00 in z 13.43 ft L ft D 6.00 in G 0.50 ft J 4.69 ft W 600.32 (ft) Dispersal Cell Area 1 1500.00 (ft) Basal Area Available 8.96 (gpd /ft) Linear Loading Rate 1 6.70 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 104.95 (ft) - ► .frrrrrr.r.. G H � rrrrrrrrr 2 rr�rrrr�,. .rrrrrir r rrrr rr rrrr rr�r� ,.._ F : = - Dispersal Cell 103.70 (ft) Lateral 103.20 (ft) - - - - - - - . . . . . . . Invert Dispersal Cell 3 p Elevation E ....... ..... .. a a 102.70 (ft) Contour Elevation 4.0 %Site Slope Geotextile Fabric Cover Shading Key, Dispersal Cell See lateral details on 1[] - Topsoil Cap c ° 1.5 ft Page 4 for number, size, c 5 :. L•L• ti :::: and s pacing of laterals. © r } }rr Subsoil Cap Z ''''' L L , p 9 R •' :�: • ••r• j "� ti fL;•.;L;L ; L :L,L.ti_:; ; Laterals are equally ASTM C33 Sand F Tilled La � d 0.5 ft r: }: Typical Lateral IM spaced from the :•• :•: •• : r•:•r•: distribution cell's L•L•L L•L�L �.;•.•ti ;L ;L ;L ;L•S 05 r•:•:•. Aggregate c f. :.:.... •..... •. •: centerline in the — A " —* distribution cell (AxB). Project: 4 bedroom Mound system Page 3 of 8 End Connection Lateral Layout Diagram Center the laterals over the R & B dimension •= Turn-up vW bo I I vo Iva or oleo n out plug P ' RII laterals are identical IF X I Holes drilled on the bottom of the lateral S equally spaced Laterals & force main of PVC Sch 40 3 (per COMM Table 84.30 -5) Force main connection via tee or cross to manifold at any point. Number of Laterals 3 Orifice Diameter 0.125 in Lateral Diameter 1.00 in Orifice Spacing (X) 4.09 ft Lateral Length (P) 65.44 ft Orifices per Lateral 17 Lateral Spacing (S) 2.99 ft Orifice Density 11.77 fe /orifice Lateral Flow Rate 7.00 gpm Manifold Length 5.97 ft System Flow Rate 21.01 gpm Manifold Diameter 1.50 in Total Dynamic Head 12.62 ft Forcemain Velocity 2.15 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and -► Comm 16.28 WAC Disconnect 4 in. min. Tank component is properly vented a Alternate outlet location Forcemain diameter Weiser 800 - 325 -8456 Manufacturer —r 2 in. Capacityl 800.00 Gallons Volume 20.60 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 24.69 508.69 B 2.00 41.20 C Pump off elevation (ft) C 2.14 44.11 um 97.83 D 10.00 206.00 D Total 1 38.831 800.00 il D ose tank elevation (ft) 3" Bedding un er tank. 97.00 Alarm Manuafacturer IS. J. Electro Systems Alarm Model Number 1101 HW Pump Manufacturer JMyers Pump Model Number I ME40 Pump Must Deliver 1 21.01 gpm at r 12.62 ft TDH Project: 4 bedroom Mound system Page 4 of 8 r Mound System Maintenance and Operation Specifications Service Provider's Name Installed by Nelson Plumbing Phone 715- 273 -4444 POWTS Regulator's Name St. Croix County Zonin 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 600.32 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 Mounidl Ins ect for ponding and seepage once every 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished • XMGrade 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral g Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: 4 bedroom Mound system Page 5 of 8 `7 o r 7 M E40 Series 4/10 HP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE O 50 100 150 200 250 300 350 40 12 35 10 W 30 w li F- Z 25 6 Z 20 6 0 J 15 /2. 2 4 10 l.. 2 13 0 0 10 20 30 40 50 60 70 80 90 100 I r CAPACITY GALLONS PER MINUTE 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289-1144 FAX 419/289-6658 Telex 98-7443 1C3328 7/91 Printed in U.S.A. LOJ� K LDt-5 �,, SGT It / L4 J Z£S Eat / -;� B M V /00•0 on / p p ' o e- Let Govrnrr ern 2�loy. On S 7 " dag,'c a ".J..poNtr p lc Wei) V n n h 4' Put 0 t33 � t � S loop& A �13 1 as °a/ 4A*consin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code _ County Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must �x i include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. �C�1VO I hJ G percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information wed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Rev' N �QD J ROD H{ (_ 6e+ Lot S E 1/4 NE i/4 S `-) T Z g N R l q E (o W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# S CtrlNNvQ)r Lft" S City State Zip Code Phone Number ❑ City []Village ® Town Nearest Road Czw CUL FPw I k.,1 S q o vL lS ) 1 4 2S- LN Z 1�-� 1EE- Z� ® New Construction Use: ® Residential / Number of bedrooms 3 Code derived design flow rate S Q �•. PD ❑ Replacement ❑ Public or commercial -- Describe: Parent material 1l l Flood Plain elevation if applicable ` ` ` General comments and recommendations: Prr— G VZU C S 1 -t9` W I4 l PS t,_pp L e-Q-I C, GUhJ�'L1V�ZL'1 , �OZ.7 ` :S1" 0flt;C1il. ❑ Boring Boring# ❑ E' "i .�,,` ` .ZaO Pit Ground surface elev. ft to limiting factor 6 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz 1 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I 'Eff#2 lcmlLZLI - stl z.isb 0-� _ -S .5 •b 2 l0 -31 la`�2316 � Gr sl � Z'�sb12 Y,�,'ft- cLV .S -a •� 3 3l --S 31y _ St- -sl LCSb�X SI -SS S 313 — L ow, vvf 0S . 3 . S S 56 10Ltr2yla — S o 4 ml ,Z �.. Z a Boring # ❑ Boring [� pit Ground surface elev. ft. Depth to limiting factor ? �� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Erf#1 I •Eff#2 1 0 -a lob tzZCZ - s i 1 Z`� ►�-f� , s e . I� s I - Z b1-t W)'Fl- CS — - S �D �SY 23 1 Y �- is l0-s b n1v'Fl- — t- Z . 38-s - S7 P--yIy L \esbk m s •s -V/ — i 1 > Sb M. o S9 Y4 1 Z Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 _< 150 mg/L • EffluMit #2 = B s � ° m an < To-mg/L CST Name (Please Print) � Si a e CST Number Arthur L. Wegerer i[. 1 -3 ' S 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Hain St. River Falls, WI 54022 \Z—%4)k 715 -425 -0165 I Property Owner pPt H L Parcel ID # - 'N�j 11 1 G Page Z of F �] Boring # Boring pit Ground surface elev. 1 I. C) ft. Depth to limiting factor 8 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff #1 •Eff#2 0-7 1(- Z L z — L, Yvt I M. I- z ��3 lo�2t231y — S/ M.� •s -b ,cam 3 3y -cab -- 2SL1231y — s1 ld-Sbk hi k3 4 LJb-80 - - -7 L1fZ31 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color . Redox Description Texture Structure Consistence Boundary hoots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Ef##2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 -264 -8777. SUD•8330 (8.6/00) �. PLOT PLAN Page 3 of 3 ' 'Scale 1' =S0 ' 1-o T LpT S L O T- b 0 N bIST. P LP LJz m (n r(! got 3--7' v tv oT - c0)%jIP er tot 8 wt �t-I t 3 x.43 r P r � L �. �Z___� -0 715- 425 -0165 220 _ Z 1 254 CST Signature Date Telephone No. CST No. Job NO. ' Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County S .. - C M Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must IYI i Include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner I Property Location S) N ICtJt� CE RODi }E( L Gent; -Lot SE 1/4 NE 1/4 L� T 2 -es N R . )� E (o W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# r1, IV Zf 22 Cl.'I-1 NNQ Or– City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road R SL ELLS I IJ) I S q o ZZ I ( - ) 1S) 1 4 ZS- LN Z 'TIZ 1 1 L sT c o� R1� ® New Construction Use: ® Residential / Number of bedrooms 3 Code derived design flow rate _ LA SO GPD ❑ Replacement ❑ Public or commercial- Describe: Parent material Flood Plain elevation if applicable ft General comments - and recommendations: w I -Q 4 I p I LLS Lo x1 G e o'tz� blS�BvhoN �� ltl�l�� _ Lit. l.0 3 -Z' © Boring # ❑ Boring pg Ground surface elev. 1 \))i. 'fL Depth to limiting factor `� 6 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 I 'Eff#2 �S 3 31 - 7,S�h31y _ GrS( leS I n. �z mU`F>^ eS .L1 ,6 S) -Sa StiIZ 313 — L ovv\ mi -. (:�S S s8 6 loLt2�la Fil Boring # ❑ Boring ® pit Ground surface elev. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. l 0-5 toy tzz CZ - s i 1 Z`Fs rn aw Z $ -1.7 )Dy23A 3 1 - 2 -3 8 - IS` a31y 'S 1 --s bk m U'Ft- I Z 3$-S S lP--Tly L 0S b1t wei- 16 s S3--�3 7•s K2Y/ � st 1 L�Sb>z yn.� �.,�, — . 2 - 3 - 13-89 7S`12 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) SI a e CST Number Arthur L. Wegerer . 1' -31$ - S 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Hain St. River Falls, W I 54022 715 -425 -0165 Property wner ��-b L Y _ p1 !'I Parcel ID # �lVp ► )V G Z of F�il Boring # [j Boring ® Pit Ground surface elev. l 3- ft. Depth to limiting factor 80 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftt In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff #1 •Eff#2 0 - toK2 - LtZ — L. 1m q.s - .L-) . 6 Z fZ 31 3 0`2 y .:s �b 3 M -yb -2 SV231y — S� I (-S bk y L) 6 -8C) . S' 1231 9 F-1 Boring # ❑ Boring ❑ Pit Ground surface eiev. ft. Depth to limiting factor in. Solt Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 El I Boring F ❑ 9 Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color . Redox Description Texture Structure Consistence Boundary Roots GPD /ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and T < SS 30 — 5 _ 9 _ 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 (X6/00) PLOT PLAN Page 3 of 3 r, Scale 1' =5o ' 13g. 23' Lo �- LDT S LOT b CP D � C�1nTrUv2 �Z LO Z. � vl m rl ni 1v3. 2 col 3�' 8.3 5 V1 Itj II Bolo 1>0 Ivp7 Comp -e 1 'I is pnZ�A I _ �� — : z LL �>^� �►-i t 3 of 43 ' - _ T � �. lZ 715-425-0165 220254 CST Signature Date Telephone Rio. CST No. Job NO. Mound System Management Plan • Pursuant to Comm 83.54, 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 abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet fitter shall be assessed at least once every 3 years by inspection. The outlet fitter 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 fitter is equipped with an alarm, the fitter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent fitter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg /L BOD 150 mg/L TSS, and 30 mg /L FOG for septic tank effluent or 30 mg /L BOD 30 mg/L TSS, 10 mg /L FOG, and 10 cfu /100 mL for highly treated effluent. Influent flow may not exceed maximum design flows specified in the permit for this installation. Peu pe 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. Continency 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. Project: 4 bedroom Mound system Page 6 of 8 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM ' 4 CU.v v� rVl h Owner/Buyer ' I Mailin g Address s C 1 �=� Y�Sy✓� �✓ ; S `�o �° Property Address CU `�- c` Soh (Verification required from Planning Department for new construction) j co � b Z City /State Parcel Identification Number O g 3 LEGAL DESCRIPTION so Property Location SC 1 /s, OE V4, Sec. 1 T 2_�5 N -R I �—W, Town of I I Vr0 �:j Subdivision j i yx e` j c . Lot # Certified. Survey Map # . Volume . .Page # Warranty Deed # Volume 2 Page # _ C . Spec house ti yes )� no Lot lines identifiable 0q yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wast ewater disposal syst em 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 of the three year expiration date. DATE SIGNATURE OF APPLICANT OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of th property described above, by virtue of a warranty deed recorded in Register of Deeds Office. s �/ 04 SIGNATURE OF APPLICANT DATE ****** Any ani pe rmit be' revoked by the Zoning Department. * * "" information that is aris- represented may result in the s pe mg 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 l 11 • U 2559 P 433 7610 963 STATE BAR OF WISCONSIN FORM 2 - 2000 KATHLEEN H. WALSH Document Number WARRANTY DEED S T T. . ICROIXOCO. , W I RECEIVED FOR RECORD This Deed, made between Donald O. Rodahl and Joyce J. Rodahl husband and wife Grantor, and Tami A. Sherman Grantee. 04/29/2004 08:000 Grantor, for a valuable consideration, conveys and warrants to Grantee WARRANTY DEED the following described real estate in St. Croix County, State of Wisconsin (if EXEMPT # more space is needed, please attach addendum): LOT FIVE (5), PINEY WOODS SUBDMSION IN THE TOWN OF TRANS FEE: 11.00 TRA FEE: 239.70 TROY. COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Address fq. ' ;5l�E,e/�/�/t/ 040 - 1293 - 50-000 Parcel Identification Number (PIN) This jLp2j homestead property. (is) (is not) Exceptions to warranties: easements, restrictions and rights of way of record, if any. Dated this day of Aprih 2004 * * Donald O. Rodahl * *� Jo — Ice J. odahl AUTHENTICATION ACKNOWLEDGMENT Sianature(s) STATE OF WISCONSIN ) ) ss. PIERCE County. ) authenticated this day of Personally came before me this c�7 day of April , 2004 the above named Donald O. Rodahl and Joyce J. Rodahl * TITLE: MEMBER STATE BAR OF WISCONSIN jr I (If not, SL ' �own to be the persons) who executed the foregoing authorized by 5706.06, Wis. Stats.) ��` O , ' ' 'in and acknowledged, the e. �� THIS INSTRUMENT WAS DRAFTED BY ?; �OZ Joseph D. Boles - Attorney at Law s River Falls WI 54022 = - �p * MrV&gl9ic, State of I C raS( fl • , V B y a ssion is verman . (If not, state exi irati date: (Signatures may be authenticated or acknowledged. Both are not neces�0i�� a O ) * Names of persons signing in any capacity must be typed or printed below the > t h► INFO (800 )655.2021 wwwJnfaproforms.c= STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2 - 2000 Neo I ` I I j FiNF- �CD i i l i r 0 f/! p 3 0 O m F C O m � m -a A� • .. m t CD Ff 3 Z 0 ° c a � q �• O to O W !R < N ° ICI CL n 0 - 3 •OD j N (D O N 0 W Q O cn � O CD N �' O ° p7 7 dl y� O d C A v,zD — c. w w D '�' c. m W CL _ ° N O -- m \\ o m 1 1 Z N n O p C ! a 3 "m• fu O O O r! 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