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HomeMy WebLinkAbout040-1240-00-000 1 Wisconsin gepartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix safety and Building Division INSPECTION REPORT Sanitary Permit No: 515195 0 GENERAL INFORMATION (ATTACH TO PERMIT) state Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Parcel Tax No: Connor, Mark A. I Troy, Town of 040- 1240 -00 -000 CST BM Elev: Insp. BM Elev: BM Description.. Section/Town /Range /Map No: 21.28.19.1218 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. A 7 /by, `7 �O Septic � s: Benchmark Dosing Alt. B i S Aeration , ,.�. r � l / t Bld . S wer¢ !`, tip:: � � ° �,,,.�,.....,• ,. Holding ��' +t"r � St/Ht In et � P a jo k. St/Ht Outlet ay TANK SETBACK INFORMATION / /•j /Z> > - TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet r✓ Dt Bottom Dum 7 �jQ kr t Z7 / �� Header /Man. `•J' 7 c7S 3.7Z o Aer tion Dist. Pipe 3.1 57. Holding Bot. System y• X7.5 Final Grade PUMP /SIPHON INFORMATION Z 5 g .9 Manufacturer Demand St Cover 3.35 �g �s woe 60.) I L T_A_ GPM F. L' CO Model Number n •� } � C � �•? • O""� ��` ` Y � _ � � 7 � -� TDH Lift11, a Friction Loss System Head TDH Ft I r to O 5 Forcemain Length Dia. , ► Dist. o well I 50 z SOIL ABSORPTION SYSTEM BED /TRENCH Width Length i No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS q / 15 pie SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE /STREAM CHAMBER OR Manufacturer: EZ ir /o eJ Type O System: UNIT Model Number: D J DISTRIBUTION SYSTEM Header /Manifold Distribution L x Hole Size / I x Hole Spacing � � V t to Air Intake \ Pipe(s) ZJ � , GS /i Z -6 I Jr g A, Length_ Dia ` Length Dia Spacing 2 ( SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only a Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center / qd Bed/Trench Edges \ Topsoil 1 Yes No Yes F_ No r D t COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: t � / / / y''j Inspection #2: / / Location: 581 Country Oaks Circle Ri er Falls, WI 54022 (SE 1/4 SE 1/4 21 T28N RI 9W) Country Oaks 1st Add Lott 117 Parcel No: 21.28.19.1218 1 1.) Alt BM Description = ' . �i �0� -� % `' 4 jr { � � i , (,- - � r 2.) Bldg sewer length = k ,° "Ls�- t "Jk /Z \ Ji - amount of cover Plan revision Required? Yes No I C� Use other side for additional information. )I _ ! � —_i __ _ —_ _ nsepctor's gnature Cert. No. SBD -6710 (R.3/97) k — --A commercemi.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 16 i s eo n s i n Madison, WI 53707- 2 nitary Permit Number (to be filled in by Co.) Department of Commerce -,,,,, 5/5i95 Sanitary Permit Application S tate Transaction Number In accordance with s. Comm. 83.21(2), Wis, Adm. Code, submission of this form to the appropriate governmental 7 re�rta unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for seconda �g J ur oses in accordance with the Privacy Law, s. 15.04 I m , Stats. I. Application Information - Please Print All Informatio Property Owner's Name Parcel # s r n A4 0 r k 4- Cc k e -o 9 0-,16 .,1 qo - oo ­ Ooa tJiCQ, Property Owner's Mailing Address /►� Property Location / 1 2-1 15 C t) ct 1 1r (/ S C ST. CROIX COUNTY C Govt. Lot City, State Zip Code t / <, / <, Section ✓ / S W ��� "! (� - l.zC�1�9 _2t d / (circle on T cX b N; R I. Type of Building (check all that apply) Lot # 1 or 2 Family Dwelling - Number of Bedroo s / 7 Subdivision Name 4GQ Block C ©1.t K4v OQ s El Public /Commercial - Describe Use FFF+++ N/A ❑ State Owned -Describe Vse / CSM Number l.— Town of inroV III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. � New System 4 Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) B. El Permit Renewal El Permit Revision El Change of Plumber El 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) t, ❑ Non - Pressurized In - Ground ❑ Pressurized In - Ground ❑ At - Grade A Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) L V. Dis ersal/Tre ment Area Information: Design Flow (gpd Design Soil Application Rate(gpds Dispersal Area Requtr (st) Disoersal Area Prnr used System Elevation o a. , Y o , //a5 0 ! l- ` 5 50 7� 50 VI. Tank Info Capacity in Total # or Manufacturer Gallons Gallons Units � � U $ 2 New Tanks Existing Tanks ) o a• U i;z h rn w 3 a Septic or Holding Tank / 76 - D 6 I i r IiL i5 t"/ Dosing Chamber "O / + x VII. Responsibility Statement I , the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Pl Is Si nature MP /MPRS Number Business Phone Number �aa C. S tc Q C� - --- --- a2.,,25 y,: / 7/3 y Plumber's Address (Street, City, State, Zip Code) u3o 7 y ILI 1 5 l iter VIIICounty /De artment Use Onl "roved t o Di Permit Fee Date I sued I ur I El Ow en Reason Denial $ /l IX. Conditis"*Weasons for Disapproval r 1 1 Septic tank, effluent filter and 3> tio� ��� r ~ r w dispersal cell must all the services / maintain 4./ M l � ' as per management plan provided by plumber. 2 AN sekbiolck requirements muat;be maintained G l 4 N pit drdkNOM 4) Attach to complete plans for the system and submi the Coun only on paper not less than 8 t/2 x It inch in size SBD -6398 (R. 02/09) Valid thru 02/11 Plot Plan Page C/ of 9 Property Owner M�a:..�4.�- �.� —+—� �,6�� a�u 1 " _ 4Qft .legal Description Lcn- , - cou -wrm ohs (except wkere note Backh pit nr= TROV,, ST r^tam Ct3I., &MY E_�tlsc�n� 2.01 ,WE North d � 3 gEORoon� �' \ 1 J L& Fps foF44: CW000 R. vp Q. QQ,o q O NEw 7S r WK �X�5►1�►1v fv�tn"tiX� gwstF� hut, p5E P`v' O 8� Egy.s7 sue Location: h Ad C i� C' LM AR 90.0101, � 0 cbk urKV A DAIS AD 7�' I • � w plot flan. page O pr operty o wner MArw,A A o�, 1" _ 4oft .l eggal D escription U)rr t-, (except w&erre note '!I ZIT N. R w. ! o = BacMoe pat North OweLuu6 co qS !� J �ssu,K�o ivv -va' 'Ve w �� ItHF iz� � �`` • x �tn� � p..a�� =moo !tt rC� c�t�w''� 97. SQ R tAI f`T ut, t'Se g ..RF�B fir' pis-. � 4� � �WOppreD� .tro nR.N �r °tom N'� n8� _ � 3�4.0� Sam -rrt- pt �. 7� ,S`l'ue T.oCt�ttQl`t: -Ju WHG.L t � O MM ac ` Safety and Buildings ov PO Box 7162 commeme.wi. g MADISON WI 53707 -7162 Contact Through Relay isconsi �(.(I�j Y .S 60 Py www.commerce.wi.gov /sb/ Commerce www.wisconsin.gov Jim Doyle, Governor Richard J. I-einenkugel, Secretary I November 11, 2009 CUST ID No. 224832 ANN. POWTS Inspector MARY JO HUPPERT ZONING OFFICE HOLLISTERS SOIL TESTING & DESIGN ST CROIX COUNTY SPIA W9875 690TH AVE 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/11/2011 Identification Numbers Transaction ID No. 1734899 SITE• Site ID No. 752970 Mark a and Catherine Connor Please refer to both identification numbers, 581 Country Oaks Circle above, in all correspondence with the agency. Town of Troy, 54022 St Croix County SE1/4, SE1 /4, S21, T28N, R19W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1247479 Maintenance required; Replacement system; 450 GPD Flow rate; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.0 1 /01); Effluent Filter 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 manual(s) 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.145.06, stats. i The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the septic tank outlet filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD - 10691- P(N.01 /01). • The pressure network is to be constructed in accordance with publications SBD - 10706- P(NO1 /01) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems - Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) ". • The existing septic tank must be inspected for structural soundness, size and baffles and must be brought into conformance with the requirements of ch. Comm 83, Wis. Adm. Code. If it does not conform, a state - approved tank must be installed. MARY JO HUPPERT Page 2 11/11/2009 • This system is to be constructed and located in accordance with the approved plans and with the Uflow Mound Component Manual, (6/03) • Existing mound must be removed carefully with a high hoe tracked machine. Mound site must not be driven over or compacted. 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 provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Allen C Wendorf Wastewater Specialist, Integrated Services WiSMART code: 7633 (608)235 -0595, awendorf @commerce.state.wi.us cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Monday, 7:00 A.M. To 3:30 P.M. Hollisters Soil Testing & Design Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. "Construction business" means a trade that installs, alters or repairs any building element, component, material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the delivery of building supplies or materials, or the manufacture of a building product not on the building site. For further information, go to our website: www. commerce.wi.� =,ov /SB /SB- Buildin , ContractorProgram.htmi I EZFLOW MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: MARK A. & CATHERINE CONNOR Owner's Name: (same) Owner's Address: 581 Country Oaks Circle River Falls, WI 54022 Legal Description: SE 1/4 of the SE 1/4, S 21, T28N, R19W Township: Troy County: St. Croix � A v Subdivision Name: Country Oaks �� Lot Number: 17 Block Number: NA Parcel I.D. Number: 040 -1240 - 00 - 000 Plan Transaction No.: eo�an�utnen0un� „��e���� p•o W T.S ®�,�, ,/// Page 1 Index and title 11diti0rtal�y �� •,•...,, �•li= i Page 2 Data entry Co O N I Page 3 EZFIow mound drawings •• a�RY J ® °• • Page 4 Lateral and dose tankoF coMM� ' ;° • tiuPPER Page 5 Distribution media DIE?ARSMEpf i p;1 Bu ®188 t Page 6 System maintenance specificatiorgsVi R FALLS Page 7 Management and contingency plan °1 \� Page 8 Pump curve and specifications G pRRF `` Page 9 Plot plan SE E "Will; I ula V:;! % %� Designer: Mary Jo Huppert License Number: 1859-007 Date: 10/29/09 Phone Number: (715) 426 - 1775 Signature: ,L Designed Pursuant to the EZFlow Mound Component Manual (N. 06/03), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) EZFIow Mound Version 1.2 (R. 02/04) Page 1 of 9 EZFIow Mound and Pressure Distribution Component Design Site Information r Residential or Commercial Design Nose: Sena fiN (o) cam assume a 300.00 Estirnated Wastewater Flaw (gpd) Table 8344 -3 u soil tre~ for fecal 1.50 Peaking Factor (e.g. 1.5 =150%) txMonn of <= 36 kxtm. 450A0 Design Flow (gpd) 4.00 Site Slope ( %) 96.50 Installation Contour Line Elevation (ft) 140.00 Contour Length Available (ft) 24.00 Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpd/f?) Distribution Cell Information 4.00 Cell Width (ft) 115.00 = Dispersal Cell Length (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/fe) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? c Center or End Manifold 0.001 Lateral Spacing (ft) If N above, enter the elevation (ft) 21 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 025) 2.00 Orifice Spacing (ft) = $21 felorifice 2.00 Forcemain Diameter (in) 26.00 Forcemain Length (ft) Does the forcemain drain back? Y 85.00 Inside Pump Tank Elevation (ft) 6.50 System Head (ft) x 1.3 4.24 Forcemain Drainback (gal) 12.33 Vertical Litt (ft) 36.10 5x Void Volume (gal) 0.31 Friction Loss (ft) 40.34 Minimum Dose Volume (gal) 19.14 Total Dynamic Head (ft) 23.07 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. die. options I choice in. die. options I choice 0.75 125 1.00 1.50 1.25 x x 2.00 1.50 x 3.00 2.00 x 3.00 x Gallons/inch Calculator Treatment Tank Information Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser Manufacturer LJ galfin (enter result in cell B49) Dose Tank Information Effluent Filter Information 750.00 Dose Tank Capacity (gal) Polylok Filter Manufacturer 20.28 Dose Tank Volume (gaUn) 525 Filter Model Number Wieser Manufacturer Project: MARK A. & CATHERINE CONNOR Page 2 of 9 I Mound Plan View _. T 1/108 ... : :::........... .. : : :.. Observation Pipe �' .... .. . ............................... .......... K: 5 A W : :: a:::::: ::: :: :: : : : ::::: .:• :. :. :. : .: .: .: .:•:•:• :- :- :- : ::1::: — : : ... .................. B ::::::::............. ..... 3 :::..........I............. .......................... .. I ---------------- - - - - -- - --- ... . ..... ........... L Mound Component Dimensions A 4.00 ft E 13.92 in H 1.00 ft K 9.24 ft B 115.00 ft F 12.00 in 1 9.07 ft L 133.48 ft D 12.00 in G 0.50 ft J 6.70 ft W 19.76 ft 460.00 (ft Dispersal Cell Area 1502.84 (ft Basal Area Available 3.91 (gpd /ft) Linear Loading Rate 11.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 99.50 (ft) ----► F Dispersal Cell 98.00 (ft) Lateral 97.50 (ft)- -► — 6 Invert Elevation Di er I g sp sa Cell :.::�] :::::::::.::::: ......... .... � E D 3 Elevation .- .�.� ..:.:.:.:.:.:...:.:.:.. ' II . 96.50 (ft) Contour Elevation 4.0 % Site Slope Typical Dispersal Cell Shading Key See Page 5 1Q 0 Topsoil Cap c 2 0 ft Geotextile Fabric over © ���������� Subsoil Cap W f „„ ASTM C33 Sand a `� ® C� Tilled Layer 0.5 ft O F 0 0 EZFIow Media �* o +_ I- See details on page 4 for number, size, and spacing of laterals. Laterals are located in the 4" gravity distribution pipes as shown on page 5. Project: MARK A. & CATHERINE CONNOR Page 3 of 9 Center Connection Lateral Layout Diagram k---- P I I<- X IE xi2 W24I Laterals & force main d PVC Sch 40 Orifices point up except every (per COMM Table 84.30 -5) 5th one points Mown for drainage ♦ = Turn- up wtbalWve or cleanoutplug Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 125 in Orifice Spacing (X) 2.06 ft Lateral Length (P) 56.65 ft Orifices per Lateral 28 Lateral End (Z) NA ft Orifice Density 8.21 ft /orifice Lateral Spacing (S) 0.00 ft Manifold Length 0.00 ft Lateral Flow Rate 11.53 gpm Manifold Diameter NA in System Flow Rate 23.07 gpm Forcemain Velocity 2.36 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 4 in. min. Disconnect _ Tank component is properly vented ?: E Alternate outlet location Forcemain diameter Wieser Manufacturer �_ 2 in. Cap acity 750.00 Gallons Volume 20.28 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 24.99 506.86 C B 2.00 40.56 P um off elevation (ft) C 1.99 40.34 85.67 D 8.00; 162.24 D Total 36.98 750.00 IF E= � Dose tank elevation (ft) Min. 3" Bedding under tank. 85.00 Alarm Manufacturer k Level Alarm Model Number D Olt Pump Manufacturer Zoeller Pump Model Number 152 Pump Must Deliver 23.07 gpm at 1 — 91 -- 41 ft TD Project: MARK A. & CATHERINE CONNOR Page 4 of 9 EZFIow Distribution Cell Media Layout 4.00 Cell Width (ft) 2.00 Sidewall to Lateral (ft) Distribution Cell Cross - section Arrangements 4 ft Wide Component Legend ® 6" EZFIow Bundle - EZ0601A, 5 or 10 Foot Lengths 12" EZFIow Bundle - EZ1203H, 5 or 10 Foot Lengths 12" EZFIow Bundle - FZ1203HP, 5 or 10 Ft Lengths 0 4" Distribution Pipe With Pressure Lateral Inside 0 Tumup Enclosure — — — — Lateral Distribution Cell Plan View Layout - Typical 4.00 Cell Width - A (ft) 1 1 Cell Length - B (ft) t! Force Main 4 ft Wide ------- - - - - -- - -- -- — Center Connection f R re-cT A/VeK A. � CAT" ER IMF- Co �o� P � S of `1 Mound System Maintenance and Operation Specifications Service Provider's Name _ Darrell's Septic Phone' 715 425 - 1025 POWTS Regulator's Name St. Croix County Z _ i 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 fe 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 _I nspect for ponding and seepage once 3 years O ther 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 EZFIow mound component manual. 2. Dispersal cell media conforms to EZFIow products approved for use with the EZFIow Mound Component Manual approved 6/3/03. EZFIow media is covered with an approved geotextile fabric. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished • ............. .............�� Grade .............. ...................... .. . ........ 6-8" Diameter Lawn ........ . Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Lateral Ends at Last Orifice Where Variable Length Cleanout Begins Long Sweep 90 or Two 45 Degree Bends Same EZFIow Media Diameter as Lateral 1.25 Feet �-- Distribution Lateral Lateral Cleanout Project: MARK A. & CATHERINE CONNOR Page 6 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code rai This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [EZF1ow Mound Component manual 6 /3103 and SSWMP Publication 9.6 (01181)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. if an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure 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 13013 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 dogging 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 dogged 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: MARK A. & CATHERINE CONNOR Page 7 of 9 iy KW P8W0WANCEVJM TOTAL, DYWX MEADOLOW Mays, iair.Lmi3 PER LYSW E u EFRUENTAND DEWATER#NG In 17 ~ MODEL, 151 152; 159 0 , ro ,ws of tmn eIL c. u m '� s +ks • a to r 1111 n IN 1St ap .45 m M 771 70 7a5 16 Ld 711 "1 a got 6t 231 70 tt -0 110 44 52 in )q, fy`§ ra. 7.3 td a as. 49 a � a to » ds a a. 1L9 - - - tt •t 7 - awrattwa 7oe4 vat • 3ssL t at WE 310 36 AD 3k 3h 5 _ et•tees 4 _ 90 a d t,�tt iMMA del 151 Md" 1521153 Cfl1VSUL'F FACTORY FOR F SPECIAL APPLICATIONS 3 7/n 3 � • 5A • Tmmd do** pwab a517�bb. 7 7�e , ;rr3t • E aftffi t m for rjsmm, we WNW* to sa1p�(ed ttuitl fn �ttn. "�" • Vat * Lei komrst OWN am wdit br ooaOt 3 7/8 3 273. • Doubb OWN* vwi" W M IM Mildw em strdaft t for tie* IVA Wog MW dW OV& I'll nbob. • SeW 004 kx mmMW for wWokr kWAMM Ste l FM142D. 1 i • Over lWF. L5 If I 1 � 11 11 /ts tY lj6 pan 151l1S?Ji59 S 1 _r Elba t an 12 t zeta " er:ut a10 t tors I t st i i1 7 t Yar, ; 8t11� 115 f A* U MR9ida6 Ya3 E1St t3o 1 Non 43 1 Sort �t� 1 fi10 43 brbMd tars Nt9 1{5 � 1 t 20r ' 8N 116 1 1 Aaft 4L SELECTION GME E1St 700 t I Nan 5] t Zara BEUS 900 t IMb 5a Miamdad Sara veal�le 1ere1 OorYt atlticit or dililb t> ° Goat low FAft 10 FA104R. L On for=0000W a MuVW M"W 64WL AN atw5111100 d'eoareu. 10060 WM eed spa b5 dace by i *mgkd 3 V*Wa WMCoWawftl04W MdiIlaiwaW rBio >sr A(S) dwtwd t�dridret. Awdaadal Clad astray attaratd�M1 a tollaMad inrildnp ew moa or � �> rttrelR ti1MbAM 6�ideltaM p�1 end Yloaoa�petlen71�M4nnd11a5 RESERVE POWERED DESIGN Far unto cures a MWA ssf* bdw is wined ba the dmW d eve► Zoelw pung. Lwbft IMN.10: RQ. aWC t101i' NY 4MW ot. . swTo j . 3umm "flow a► offs (AAr-K 0 am zodw cc. All rlpllla 3aeer++�d PKo c Ca^'" R, <4 , PA - ID Wisconsin Department of commerce SOIL EVALUATION REPORT P 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Vft. Adm. Code County ST. CROIX 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 (BM), direction and Parcel I.D. 040 - 1240 - 00 - 000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all informafion. Re ewes Date Personal information you provide may be used for secondary PFWOE 15.04( 1) (m)). 1 Property Owner Property Location • MARK A. & CATHERINE CONNO ]OCT 3 O ZOO Govt• Lot - - - -- SE 1/4 SE 1/4 S 21 T 28 N R 19 E (or) )W W Property Owner's Mailing Address Lot # Block # Subd. Name CSM# 581 Country Oaks Circle PLANNING &ZONING FFJUE I -- I Country Oaks City State Zip Code Phone Number ity []MIlage • Town Nearest Road River Falls, WI 1 50422 ( 715 426-0635 Country Oaks Circle New Construction UseE] Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD . Replacement Public or commercial - Describe: Parcn material sandy outwash Flood Plain elevation if applicable General comments Mound System -- 1.00 ft. sand fill -- 0.4 loading rate -- system contour 96.50 ft. and recommendations: f f Bourg # E] Boring o pit Ground surface elev. 97.87 ft. Depth to limiting factor 30 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Cola Gr. Sz. Sh. *Eff#1 I *Eff#2 1 0 -3 7.5YR2.5/1 - 1 3fgr mvfr cw 3vf -co 0.6 0.8 2 3 -10 10YR2 /2 - 1 3f -msbk mvfr cs 2vf-co 0.6 0.8 3 10 -18 10YR4 /3 - sicl 2fsbk mfr cs 2vf-co 0 0.6 4 18_24 10YR4 /4 -' cl 2fsbk mft cs lvf-m 0.4 0.6 5 24 -30 10YR3 /6 sl Ifsbk mfr cb lvf-f 0.4 0.7 6 30 -36 7.5YR4/6 f2f 7.5YR4/4 s l Om dh __ __ 0 0.6 Horizons 5& 6 have some gr; few cobs. Horizon 5 is a heavy sl. 2 Boring # [] Boring 96.87 30 Q Pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roo D P ry is GP /fft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *042 1 0 -4 7.5YR2.5/1 - 1 3fgr mvfr cw 3vf -co 0.6 0.8 2 4 -9 10YR2 /2 - 1 2fa &sbk mvfr cs 2vf-co 0.6 0.8 3 9 -19 10YR4 /3 - sicl 2fa &sbk mfr cw 0.4 0.6 2vf-co 4 19-24 lOYR4 /4 - cl 2fabk mfr cs lvf-m 0.4 0.6 5 24 -30 10YR3/6 - sl 2fabk m fr cb lvf -m 0.6 1.0 6 30 -36 7.5YR4/6 f2f 7.5YR4/4 sl Om dh __ __ 0,2 0.6 Horizons 5 &6 have some gr; few cobs; Horizon 5 is a heavy sl. * Effluent #1 = BOD > 30 220 rrg/L and TSS >30 1 SO mg& * Effluent #2 = BOD < 30 mg/L and TSS < 30 ng/L CST Name (Please Print) Si re CST Number - Mary Jo Hu ert Hollister's Soil Testing & Design) 224832 Address Date Evaluation Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 10-18-09 (715) 426 - 1775 Property Owner CONNOR, Mark A. & Catherine Parcel ID # 040 - 1240 - 00 - 000 Page 2 of 3 F3 Boring Bones # E] Pit Ground surface elev. 94.57 ft. Depth to limiting factor 24 in. Soft 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 I 'Eff#2 1 04 10YR2 /2 -- l 3f -mabk mvfr cw 3vf-co 0.6 0.8 2 4-9 1 I OYR2 /2 -- 1 2f -msbk mvfr cs 2vf-co 0.6 0.8 3 9 -16 10YR4 /3 -- sicl 2f -msbk mfr cs 2vf-co 0.4 0.6 4 16 -24 lOYR4 /4 -- cl 2fsbk mfr cs 2vf-m 0.4 0.6 5 24 -30 7.5YR4/6 f2f 7.5YR4/4 scl Off) deh -- lvf-f 0.0 0.0 orizon 5 has some gr. F-1 Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Sod 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 'Eft#2 F Boring # Boring S Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >3() 150 mg/L ' Effluent #2 = BOD < 30 mg& 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- 8330Teg (&07100) Plot Plant for Site and Soil Evaluation Page 3 of 3 Property Owner M -AgK A.� C-A I" =40fx Legal Description Lcrr , -,, - �-,�..� o� (tvcept where noted) �' /y s z�, -r2�-- �9 w,_ to = Backhoe pit ST. C RDlX C.Otxt1 m kA)t 5 OQ W ►J , 2 0/9 -Wrs North d� G�� G I 3 BEDRObn^ �E�� ToP OF 5rrp avoK J /�SS�nM.xEl� IGO.CD � p�►,K 50� ����0Z q CJg K vi r O q�. 47 �t.gw.5 Site Location: 0 d c 4N b Oh►3 AC. 7�' r 7 - •x t� ; x F RSA A f l_ - TO" GO TRY OAKS, �aosa _ LOC4 rfV {N Ttt£ SOVTN£kST 114 Of THE SOUTHEAST 114 Amp ra S �91Y Oft{"t wa t14 OF'rN£ souryasr U4 f1F S£CftON 2t, fpWNStitR' r#4Rltl, RANS££ST, tOM Uf TR4Yf ST CROt> COI1N7 an WISCONSIN f C R•1 0 't; sai .' H f A7 r �v F f F t A F 591, t G h li ! i : ♦/ °r Ptl. ld Y Iv't x :•nfq r FMx (• f f7 ern vn see. a r JFrYC. rl F sal Fr E 2 rL M J ClFxfr eF A 3 +t F F d 4F i i4F tL7Nfi rum Ii e idF' 0 S t IE ,. f 1 dJ t LQI 4 _4 ! it L� y f�i f {Irr'.fr S vF xf 1Nktaf#N✓r.e_ l F f ri [f _ . tnvh sc'r itJr roe _ r,F ,e.ir +'r• 8 r. A d tf N N rsFX T" daa if' er. ;3,,f tb 4 i rEY } I 1 Y `^ # v r# FN M' J V a..f Y. ^.�d ': d : ♦ J eF -t r a ri rot f!'t -:S h7 rt.lht! a 4 } .iFrs' ,xeNnFS fWlSq+.4u . LR „ y t IA 12 ;<4fn'j r k�'wr Y k 1, t V r F�J< ILMrf F Jtv Wt Y 3 } � _ vda e . .0r, ti t 5.` t 4 ® N '4 F 3 r � 4' • E YiY S f 71' y, 9 1e' y= '` C e r 4 Et: O $ it e y 6� , N E 1 R fl �41 G rpry aN 4 � l � �. �� � ":i • 6 ,5 /✓( / {�¢/l[I1ARetNr�T�( �� �'� In c f rra rL)Ja rc✓1. $r t 4t .� ft J sN ♦IrtliltftffAI 4.Y�Y..MM 4 r ,.rt Lf'cas r u'.n3 NUI. t� i Sd T. Nrr, 1 16 z 4 , t I , rl y if °i yi y ,,r` + : sl rtn5 -ar {6 �>y I ' 9E LOT 4� CS �t T �vt :rs i It i' a & FAB£ - 23t2 ti SW _ p qp x1 j tfFy li J s 1 F`f 44` oil su•tF dr'r Lrr#tf'dF #I ^. K1 e - u rp Ffc J;.lJla, aifN, ' J n aw src J r +4 4'11L - err.rrn .N6 t rdurrct' '.dOdl(TtQk �RErCl1 r L €kL Errx cI r a # +ra, rErr Fd4 +a. ' : rfliaer !t _rrE -01ANljS rrv,F,ror +4�Jra.ae�c D' Y- 1EIN6S A r'I tKJNS .. Stt 1{f�$ :" rNls nrsret�Wt>Mrca�Fre s. iE F? l ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer tnC1yt_ a� Mailing Address � C-0 < Property Address ^ ii (Verification require from Planning Department for new construction.) '' ii City /State ktVR_t_ 1 : � Parcel Identification Number OHO - i LIZ -. 00 - 000 LEGAL DESCRIPTION Property Location S E - _ ' /4 , SE '/4 , Sec. , T 2-9 N R 1 C l W, Town of Subdivision 06 , Lot # 1 Certified Survey Map # , Volume , Page # r Warranty Deed # , Volume , Page # �_• Spec house ! yes no Lot lines identifiable es no SYSTEM MAINTENANCE ;oac.tr-TI 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 County 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 Department ithin 30ds of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I /we certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(s) of the property d ribed above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * * * * ** Any information that is misrepresented 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 and a copy of the certified survey map if reference is made in the warranty deed. 49 VOL VOL 99 PACE5 5430133 5TATE- BAR OF WISCONSIN FORM 2 – 1982 4 DOCUMENT N WARRANTY DEED ter„ REGISTER'S OFFICE ST. CROIX CO,, WI Recw to RacOrd Ray Galep, Robert L. Mackey Laurence $E P 1996 `— Mu_rphY anal Norwood F..ck lundd. — as -^_ -_ part_nersh� io property. -- at 3:00 Yf cunvc y> auu �.•:u ruru ur — ' �—i.� Connor, husba and wife as ,,si_yayQhj p-- �eg is c e rotDeer�g -- -- marita l property, property, THIS SPACE RES ERVED FOR RE CORDING DATA _ NAME AND RETUP ADD sS ttic followhig described real estm - e in — t . C o i X County, C7 l l aeN. Y i State of Wisconsin: P. o e -,� - PARCEL IDENTIFICATION NUMBER I Lot 17, First Addition to Country Oaks in the Town of Troy. T � oa- §�:�;: !I This is no homestead propcuy. XX'KXX (Is net) Exception towarrandcs: Eas ements, restrictions zinc 1_ '7 11.S -of -way of record, if any. Datcd this _— � day of _ A i 1 11S t A.D.. 19 y u _. — (SEAL) L ure nce Murphy Norwood Ecklund — (SEAL) (SEAL) I AUTHENTICATION ACKNOWLEDGMENT Laurence btu r h State of Wisconsin, Stgnature(s) p —�� ss. Norwood Ecklund County authenticated this 3O� 1 'day of All t 19 9 6 Personally came before me this day of - -- 19 —_• the above named Kr i.stina Oaland TITLE: ME: BER SPATE PAR Or- WISCONSIN - - - - -- ° - - -- - --- - -- _' (If not. _ -- -- authorized by §700.06" Wis- st:us.) to me knowil to he the person __ •rho executed the frncgoing 1` instrument and acknowledge the same. TI 11S INSUMMENT WAS OnAr tro ety I orn-y Kri Ogl.an —_ _ _ -- - -- - - -- 51 id S o n WI 54016 Not irq Pribh( County. Wig II (SiEnautres may he authenticated or arl(riowicclird Roth are tra 1\f) (.Hnilll551ri1 m permmlent. (if riot. stare expirationclnlc' II r i.rrc�cary) _ 1 l Q r I �' t L,mr: rf Ix... •n, mgninF in .rny —r-ilp slrould hr iylxd nr 1111 —d hel—I II r "p,`-urc: _.. STAT1'R, \R (it �l'ICC(1NGiN pr.rrn- .nrr.garOz -.— — I ' W%i:RANIN trl'n i-:+rrn No 2 inR2 Q c C) e ° o 0 ' a c a y o a Qz _0 cz mm @ E -• C T a U y' T - O) Z c - 0 l y N Y C t > c 3 � c •3 O •- �0��.No m� `O T N fp L c O o c Z 'F 'o �i c E m Ucz T d O 3-o c� " E c Q) o O N 7 c 0 N Q G O ON c Cl) v � rn w O z N w a D N f- V) p c O O O z v ' N E p L) Z N f0 CK 0 E N O ffi O O • �V N CT) f0 "'" - O O a N N 0 0¢ Q O No o N d 'a � Z Z Z v N G z CN E o N N C N r O .. E CD o =_ > U') 7 C f6 � Y as c U o o a a E U r L1. H � V a cn •► �aaa a ) o o V ) J U Y rn Z @ 0 W N � O O 0 C O O .-. C 0 N 0 O O Q 00 CO 7 m C d N O U ' 0 cn c �? � N LO C O Q o a E Qfn+ 0 0 O N C C L3 Q 0 0 0 ° N N N 3 0 06 N i i C CV N 0 0 u N O N � U rrrVYil O N H U N O z Z -- Cf1 O CQ y I RECEIVED ST. CROIX COUNTY ZONING OFFICE JAN 0 4 2010 CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC T I� B� c ZON NG O FFI CE This is to certify that I have inspected the existing septic and /or dose tank presently serving the following residence: (Street address ,?/ /VYLI Q_ oks C41, located at: v '/4, >C— 1 /4, Section 5� 1 , Town -�8' N, Range j W Town of - Fro C4 St. Croix County Wisconsin. Upon inspection, Ccertify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service f L10 � Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 166 0 / 7,vo Construction: Prefab Concrete n Steel Other Manufacturer (if known): _U),e c r Age of Tank (if known): r ej ber (if wn) .--- (Licensed PI ber Signature) (Print Name) re5 ids h (Title) (License Number) MP /MPRS !1 -lam �q (Date) Form to be completed by licensed plumber (Dept of Commerce Chapter 5 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 9/2008