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HomeMy WebLinkAbout040-1186-90-004 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 463364 0 GENERALsINFORMATION (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: Husb , Jeff Tro , Town of 040 - 1186 -90 -004 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /D Iftn C ST 36.28.19.792 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. - -5 -5 Septic '3 Benchmark t�; s�� , Idle D • to 14) • Dosing Alt. BM (— Aarnfinn /I Bldg. Sewer �5 1 13, 37 Holding 1 � St/Ht Inlet 12- . (U, � TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet ` Septic ► AIA ! > Dt Bottom �� T Dosing n 1 1 7 / Header /Man. z z5 97, ZZ- �1J w Aeration I Dist. Pipe Z 3 c 1 7, Z t> I V1 Bot. System 3.0 PUMP /SIPHON INFORMATION Final Grade Manufacturer / Demand St Cover •�, p� lipid PM J // Model Number -7 1 s. TDH Lif Friction Lo System Head TDH 5 �FFt Forcemain Length / Dia. 1 Dist. to Well /t SOIL ABSORPTION SYSTEM �•— BED /TRENCH Width i Length No. Of Tf�nch PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 1 �� K SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of System: ' CHAMBER OR Z A Model Number d . � 7 DISTRIBUTION SYSTEM 1 Header /Manifold Distribution Hole �� I x Hole Size x Hole Spacing Ve Air Intake 1-ength G Dia Z Length �"'�� Dia Spacing ` 3 ° 5 �" 6,4 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over IDepth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center , 1 7Z Bed/Trench Edges ` Topsoil 1 ('� _ s ;! No > es ? No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: (.G / Zd / d.5 L inspection #2: / / Location: 72 West Wood rid a Ddve River Falls, WI 54022 (NW 1/4 NW 1/4 36 T28N R1 9W) OaAag �� t 3 / Parcel No: 36.4. 19.792 1.) Alt BM Description = �V� G " 0 �5 2.) Bldg sewer length - amount of cover = Plan revision Required? ; tio Yes y +'1 loo Z Use other side for additional informan. _ Si Date L Insepct gna r Cert. No. SBD -6710 (R.3/97) ;� ..t . ,, ,. , , - � Saf Buildings Division County ` 201 W. *' mlgtgo Ave., P.O. Box 7162 St. Croix di tt, VVI' X 537 7 — 71 nitary Permit Num DOl�sin Department of Commerce ( IVED Sanitary Permit Appliea 'on S to Plan I.D. Number 3 8 In accord with Comm 83.21, Wis. Adm. Code, personal info ation y q� Wid� 9 2005 may be used for secondary purposes Privacy Law, sl 04(1)(tti P ject Address (if different than mailing address) I. Application Information — Please Prin 1n rmation 7 Z A " ) w�'` P C , ZONING OFFICE LR 10 A t/ Property Owner's Name `` Parcel t # S Block # -5 Property Owner's Mailing Address operty Location I 64 ,(/ �6 S� R Ile r, G NW /4, NW �/4, Section 36 - l City, State Zip C e Phone Number �j J River Falls, WI 54022 28 i I circle one) II. Type of Building (check all that apply) T N; R r 1 or 2 Family Dwelling —Number of Bedrooms 3 — Subdivision Name CSM Number Q,i „ � n 1/G _ Public /Commercial — Describe Use Oak Ridge Acres ❑ State Owned — Describe Use &jM /D o ity QVillage Brownship of Troy III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ® New System ❑ Replacement System ys ep ys ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: C ❑ Non — Pressurized In- Ground 0 Mound > 24 in. of suitable soil t ound < 24 in. of suitable soil 11 At -Grade 11 Single Pass Sand Filter Constructed Wetland ❑ Pressurized - -❑-Fle • eat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ® avel -less P' ❑ Other (explain) V. bis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area eqi ired (sf) Dispersal Area osed (sf) System Elevation i 450 Sr� O 45 q 450 �� 96.8' J VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 1000 1000 1 Weiser x Aerobic Treatment Unit Dosing chamber 650 1 650 1 1 Weiser x VII. Responsibility Statement- L the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb Signature MP/MPRS Number Business Phone Number Roger Nelson MP226497 715 - 273 -4444 Plumber's Address (Street, City, State, Zip Cod 122 East Summit Avenue Ellsworth, WI 54011 VIII oun / - e artment Use Onl Approved El Disapproved Sanitary Permit Fee ncludes Groundwater Date Issued Iss ' g Agent igna re to ps) Sure hazge Fee) / J El 36 , Owner Given Reason for Denial 7" I , } t a '�� , � y , � , + pp� pQ{ *,�roval/Reasons for Di approv I CIVI VVVNCFC. I,% eptic tan <, e t filter and dispersal cell must all be serviced / maintaine (,UT �l_ as per management plan provided by plumber. 5� 2. All setback requirements must be maintained 3 as per applicable code /ordinances. t , c omplete plan he C�ty ly ) ffo�or the system on paper not less than 81/2 ches IIn SBD -6398 (R. 01/03) ,� � A- �� (Be) , 6M2 7.2 - 5'cale Lod 3 9 L.p f 3 3;7 s �� f 4 132, °• \ y a 1 � lG p /640 1 s 1 1 1 In Jc t4`' s 6 o A/A) Ncl yv. 5 34 rzr.V 74)9 C33 "A ( f I � s 3 �ous� f f 1 3� i � fir,' ✓ .way � . 40 s uJ� cG Safety and Buildings commerce.wi. OV 4003 N KINNEY COULEE RD g LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 �' i sco n s i n www.commer isco sin.go t Department of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary March 11, 2005 CUST ID No.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: 03/11/2007 Identification Numbers Transaction ID No. 1113787 SITE: Site ID No. 695349 Jeff Husby Please refer to both identification numbers, CTH MM above, in all correspondence with the agency. Town of Troy St Croix County NW1 /4, NW1 /4, S36, T28N, R19W FOR: Description: Proposed Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1006540 Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /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, stats. 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 Private Onsite Wastewater Systems Version 2.0" SBD - 10691- P(N.O1 /O1). • The pressure network is to be constructed in accordance with publications SBD- 10706- P(NO1 /O1) "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)". • 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. P.O.W.T.S. Conditionall APPROV DEPARTMENT OF rnmur. r ROGER D NELSON Page 2 3/11/2005 • 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 ins ecp tors. 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 maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • 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 Balance Due $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pin WiSMART code: 7633 jswim@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 I F FB 2 C FO MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN �U Residential Application Q INDEX AND TITLE PAGE � /*Oo Project Name: 3 bedroom Mound Owner's Name: Jeff Husby Owner's Address: 1650 Valley Quail Drive River Falls, WI 54022 Job address: Cty MM Legal Description: NW 1/4, NW 1/4, S 36, T 28 N R 19 W Township: Troy County: St. Croix Subdivision Name: Oak Ridge Acres Lot Number: 38 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: 02/23/05 Phone Number: 715 - 2731444 Signature: 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) iVIS t FETY A D I3UI jIN S Page 1 of 8 '-LL- CURRESP &&DENCE Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) r Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 83 -44 -3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of - 36 inches. 450.00 Design Flow (gpd) 4.00 Site Slope ( %) 95.80 Contour Line Elevation (ft) 24.00 Depth to Limiting Factor (in) 0.50 In -situ Soil Application Rate (gpd 1ft Distribution Cell Information 50.001 Dispersal Cell Length Along Contour (ft) = 9.00 Cell Width (ft) 1.001 Dispersal Cell Design Loading Rate (gpd /ft 1 I Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution I Y Pressure Disribution Information network? Enter Y or N (c or e) a Center or End Manifold 3.00 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) 3.00 Estimated Orifice Spacing (ft) = 8.82 ft /orifice 2.00 Forcemain Diameter (in) 85.00 Forcemain Length (ft) Does the forcemain drain back? [ Y 83.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 13.86 Forcemain Drainback (gal) 13.47 Vertical Lift (ft) 29.65 5x Void Volume (gal) 0.85 Friction Loss (ft) 43.52 Minimum Dose Volume (gal) 20.82 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) 1000.001 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 650.001 Dose Tank Capacity (gal) JZabel 1- 800 - 221 -5742 Filter Manufacturer 17.001 Dose Tank Volume (gal /in) A100 Filter Model Number Weiser =Manufacturer Project: 3 bedroom Mound Page 2 of 8 Mound Plan View F J Observation Pipe om' ' T'.'.'.'.'.'.'.'.'.'.'.'.'.'. . J ff 4 . . . I L Mound Component Dimensions Down slop toe extension made. A 9.00 ft E 16.32 in H 1.00 ft K Aft ft B 50.00 ft F 9.00 in z 9.00 ft L ft D 12.00 in G 0.50 ft J 6.03 ft W 450.00 (ft) Dispersal Cell Area 1 900.00 (ft Basal Area Available 9.00 (gpd /ft) Linear Loading Rate 1 5.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 98.55 (ft) ► ho Z F 97.30 (ft) Lateral 96.80 (ft) — ; . _ ; . Invert Dispersal Cell Dispersal Cell : 3 Elevation E ' D . .............. ... .. .... .. .. . . . . . . 4 4 95.80 (ft) Contour Elevation 4.0 % Site Slope Geotextile Fabric Cover Shading Key 'a _c. T Dispersal Cell See lateral details on 10 _ Topsoil Cap 0 °' 1.5 ft :•: Page 4 for number, size, Subsoil Cap w o 5 �::• s of laterals. © ® �;:�''• • and spacing 9 © ASTM C33 Sand 1° ••'�• F ® Tilled La c 0 Laterals are eq uall y � 0.5 ft Typical Lateral spaced from the Layer 0 }c: • distribution cell's 5 A ggr e ga te c ..;.;:;::.; ;.,.;;•;;,....� ;5 centerline in the A distribution cell (AxB). Project: 3 bedroom Mound Page 3 of 8 • End Connection Lateral Layout Diagram Center the laterals over the A & B dimension •- Turn -up wfbalI valve or clonnout plug e P _l All laterals are identical I<- X I Holes drilled on the bottom of the lateral S equally spaced Laterals & force main of PVC Sch 40 S (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) 3.03 ft Lateral Length (P) 48.48 ft Orifices per Lateral 17 Lateral Spacing (S) 3.00 ft Orifice Density 8.82 ft /orifice Lateral Flow Rate 7.00 gpm Manifold Length 6.00 ft System Flow Rate 21.01 gpm Manifold Diameter 1.50 in Total Dynamic Head 20.82 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 4 in. min. Disconnect Tank component is properly vented - E— Alternate outlet location Forcemain diameter Weiser 800 - 325 -8456 Manufacturer 2 in. Capacityl 650.00 Gallons Volume 17.00 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 23.68 402.48 B 2.00 34.00 C Pu off elevation (ft) C 2.56 43.52 83.83 D 10.00 170.00 D r � Total 1 38.241 650.00 Dose tank elevation (ft) 3" Bedding un er tank. 83.00 Alarm Manuafacturer IS. J. Electro Systems Alarm Model Number 1101 HW Pump Manufacturer Myers Pump Model Number I ME 40 Pump Must Deliver 21.01 gpm at 20.82 ft TDH Project: 3 bedroom Mound Page 4 of 8 I 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 Zoning Phone 715 - 386 -4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1000 gal Maximum TSS 150 mg /L Soil Absorption Component Size 450 ft Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 m 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 Moundl Ins e 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 •.........••.• ............... Grade 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: 3 bedroom Mound Page 5 of 8 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 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 fitter 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 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. I Project: 3 bedroom Mound Page 6 of 8 4 v 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 Ln W 30 W U- w e � 4 25 Z Tip 20 6 ��. 15 Q O 4 ~O 10 ~ 2 5 0 t O 0 10 20 30 40 50 60 70 80 90 100 CAPACITY GALLONS PER MINUTE �n- �p1"1 1101 Myers Parkway, Ashland, Ohio 44805-1923 419/289 -1144 FAX 419/289 -6658 Telex 98-7443 pu 7 o-YO 8 K3326 7/81 Printed in U.S.A. S -QIe Zp L a i' 7 s '� Q� /✓o 7' L7 `� -Af °10 1 � z n Je N s d 11�l�JY,r. A J % S3G r. rA' G ri G1 ti d C i � yaus� ?7 i i 11r,' ✓� way _ 40 1 _ Pa 53'o -P�' plewS q „ t Lan e 05/30/2000 14:20 71524 01 'r TOM NELSON �__` L... J PAGE 02/04 WR , Oro Depa',anent Commerce ;SOIL AND SITE EVALUATION DM" of Safety and Buildings In accord with Page 1 of 3 Gomm 83.05, Wis. Adm. Code Attach complete she plan on paper not I�sa than 8'rG x 11 inettea in size. Plan must Fnvar AwC*tat aY b`a's" Include, but not limited to: verUcai and horizontal rderance point (BM), direction and County percent slope, scale or dimemstom, north arrow; and location and distance to nearest road. � I.a.# St. Croix APPLICANT INFORMATION - Please prinf all information. Peraonet informetbn you provide may us taw a 96.04 M (MA BY' f p �peKY owner 4 Property Location ' IT Hartenstein, Wade GOVL Lot NW 1/4 NW 1/4 S 36 T 28 N R 9 vV property Owner's Mailing Address b l of Block # Subd, Name or C8M# 74 VV Woodridge Ax � Cfty 38 Oak Ridge Acres ��� 7; c `► ❑ City Vlfte ZTown Nearest Road Y CTHMM New Construction ' Use: Residential / Number of bedrooms 3 []Addition to existing building n Replacement ❑ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate 1.2 bed, gpdM rl Z trench, gpolft= Abso ion area required 375 bed, IF Bch, W Maximum design loading rate 1.2 bed, gpd!(N 1.2 tr ench, gpdw Recommended infiltration surface elevation(a) 97 ft (as referred to site plan benchmar Additional d esign I site conatderatlons Patient material Loess over 4100lal outWash Flood Plainglevation. ifs ucable l\1A ft S: Suitab Conventional Mound In- Ground Pressure AT -Grade System In Fill Holding T+tnk U= Unsui ci S® U ® S o U p 3 ®U r7 S U p 8® U p s U SOIL DESCRIPTION REP WT Boling# Horizon Depth Dominant Color Mottles Texture Structure 9isten Boundar Roots GPI)1W oun in. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. tied Trench 1 1 0-17 10yr3/2 - sia 2nusbt� ew 2 f .5 .6 2 17 -35 10yr4/3 - c1 2msbk mfr ew if .4 .5 Ground 3 35 -45 10 /6 - _ elev 9i'4 la 2msbk mvfr ow .4 98.t)7 ft 4 45.52 10yr4/4 f1f7- 5yr6/8 scl Imsbk rizfr „2 Depth to kmNing factor 45 L.1 - Remarks: " w/ bands of set 10 r4 V 0 -24 10yr3/2 - Zmsb mfr cw 2f .5 2 elev 9-48 10yr4 /4 4 -39 10yr4/4 f1f7.5yr6 /8 ail Imsbk mfi ew if .2 Grou 3 t:1f7,5yr&8 acl. Imsbk mfi - .2 3 84.4 ft Depth to limiting factor 24 Remarks: n� CST Name (Please print) Signatum: Telephone No. ' Thomaii C. Nelson Addrses Fnvitomext%i By pe9agn 715- 246 -2454 1432120i1t Street, New Richmond, WI Sd CST Number Ref # 05/06/2000 227337 257 05/30/2000 14:20 71524:x.301.; TOM NELSON PAGE 03/04 PRnPERTY OWM Hartmsleln, wade SOIL OIESCRIPTION REPORT zsr Page 2 of 3 PARCEL P.D dII FA t vironwe�a all Bv Ace' Horizon Depth Dominant Color Mottles Structure GPD/ft� in. Munseli Qu. Sz. Cont. Color Texture Gr. S7. Sh. onsistence Boundary Roots BedITrench 3 1 0-22 10yr3/2 - sit 2msbk mfr Cw 2f .5 .6 2 22 -32 10yr4/4 - ail 2xwbk Haft ow 1 f .5 .6 Ground elev f1�1.5yr6 /8 .3 94.8fi R Depth to Ilmitlnn factor 32 Remarks; Ground elev Depth io Ilmiti�y facWr Remarks: 4rourtid eiav ` Day D gmding fe�ctor Remarks: Ground ele De pm to limiting facmr Remarks: 05/30/2000 14:20 71524.._x01 TOM NELSON PAGE 04/04 � Iy l� U6 R3 b �I `. 4, 7 6� gy•ci a CST �A73$7 O ST. CROIX COUNTY WISCONSIN PLANNING & ZONING DEPARTMENT f t M tf N u ■ 11 w mean ST. CROI . 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CROIX COUNTY l SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer - � � ! C Eu 6p m S Mailing Address M :50 t C t �/ Q (AA, c 122 I V Property Address 7 Z A 1 UJ 6 -+# wco p 2 -q& p R - t yE (Verification required from Planning Department for new construction.) City /State 4AA.� `t`l� Parcel Identification Number 0 Vo - LEGAL DESCRIPTION Property Location %4 , % a , Sec. T _?j_N R_W, Town of _41?o f Subdivision O w K P la-k , Lot # 38 Certified Survey Map # , Volume , Page # Warranty Deed # -7 �� Z , Volume Z 76 Page #, c�) SZ Spec house yse no Lot lines identifiable yes 4w 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. 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 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. d to the S . Croix County Zon Certification stating hat our septic stem has been maintained must be completed and returned t g Y P Y P h' 8 Department within 30 days of1he three year expiration date. Ul * ,, , , , ) - %* 3 / i'? / 0 � I I ATURE OF APPLICANT DATE OWNER CERTIFICATION 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 prop scribe abov by ' e of a warranty deed recorded in Register of Deeds Office IG ATURE 1JF 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. Parcel #: 040 - 1186 -90 -004 03/3012005 09:04 AM PAGE 1 OF 1 Alt. Parcel #: 36.28.19.792 040 - TOWN OF TROY Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner JEFFREY R & MICHELLE S IVERSON IVERSON, JEFFREY R & MICHELLE S 72 W WOODRIDGE DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 72 W WOODRIDGE DR SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.000 Plat: 2237 -OAK RIDGE ACRES SEC 36 T28N R19W LOT 38 OAK RIDGE ACRES Block/Condo Bldg: LOT 38 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 36- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 11/08/2004 779379 2691/Q23 WD 11/08/2001 661456 1757/356 WD 1010412000 631105 1548/178 LC 10/04/2000 631104 1548/177 WD 2004 SUMMARY Bill M Fair Market Value: Assessed with: 27585 34,900 Valuations: Last Changed: 07121/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.000 35,000 0 35,000 NO Totals for 2004: General Property 0.000 35,000 0 35,000 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 17,600 0 17,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 040 - 1186 -90 -003 03/30/2005 09:06 AM PAGE 1 OF 1 Alt:. Parcel M 36.28.19.791 040 - TOWN OF TROY Current X i ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * PATRICK G & DEBRA J ABAIR ABAIR, PATRICK G & DEBRA J 72 W WOODRIDGE DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 72 W WOODRIDGE OR SC 4893 SCH D OF RIVER FALLS 7 SP 0100 CHIP VALLEY VOTECH 1. Legal Description: Acres: 0.459 Plat: 2237 -OAK RIDGE ACRES SEC 36 T28N RI 9W LOT 39 OAK RIDGE ACRES Block/Condo Bldg: LOT 39 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 36- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 10/13/2003 743390 2433/626 WD 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 27584 34,900 Valuations: Last Changed: 07121/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.459 35,000 0 35,000 NO Totals for 2004: General Property 0.459 35,000 0 35,000 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 17,600 0 17,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 U 2769P 052 -7 19 ¢'x4S2 State Bar of Wisconsin Form 1 - 2003 KATHLEEN H. WALSH + WARRANTY DEED SISTER OF DEEDS CROIX CO.. MI Document Number Document Name THIS DEED made between Jeffrey R. Iverson and Michelle RECEIVED FOR RECORD S. Iverson, husband and wife 1 03/22/2005 10 :40AN ( "Grantor," whether one or more), WARRANTY DEED and C 6 J Builders, Inc. DEAPT * ( "Grantee," whether one or more). REC FEE: 11.00 TRANS FEE: 149.70 COPY FEE: Grantor, for a valuable consideration, conveys to Grantee the following CC FEE: described real estate, together with the rents, profits, fixtures and other PAGES: I appurtenant interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is needed, please attach addendum): Lot 38 Oak Ridge Acres, Town of Troy Recording Area Name and Retum Address 'WESTCONSIN CREDIT UNION PO BOX 308 RIVER FALLS WI 54022 040 - 1186 -90 -004 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Roadways, Easements, and Restrictions of Record Dated March 21 200 / w As SEAL) (SEAL) effr R. Iverson * Michelle S. Iverson (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. authenticated on St. Croix COUNTY) Personally came before me on March, 21, 2005 the above -named Jeffrey R. Iverson and * Michelle S. Iverson TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the (If not, foregoing instrument and acknowledged the same. authorized by Wis. Stat. § 706.06) p, FE G J THIS INSTRUMENT DRAFTED B n Y: 2` Aa Imo � * b`ennif � A. Fe son Michael H. Foreeki Attorne NOTARY Z Notary Public, State of Wisconsin Eau Clai Wisconsin — * My Commission (is permanent) (expires: 03/23/2008 ) (Signatu s b knowledged. Both are not necessary.) NOTE: THIS IS A STANDARD Y MO NS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED �OF F WISCONSIN FORM No. I -2003 *Type name below signatures. Auomey Michael H Forecki 3452 Oakwood Hills Pkwy Ste I, Eau Claire WI 54701 -7928 Phone. (715) 835 -3029 Fax (715) 835 -4112 T5308163.ZFX Title One Premier Group Produced with ZipFonn by RE FormsNet, LLC 18025 Fifteen Mile Road, Clinton Township, Michigan 4W35.(800) 383 -9605 www.zVorm.com