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HomeMy WebLinkAbout042-1056-95-200 0 o i � T � $ . � z e E ( _ ° 2 -4 J @ % %/$2 G) CC) 0\E § [ k® ° ^` E E R a§ 7 CA o ' ° (D / k f ¢ § c \ \ 2 3 o S ° C:, ( 10 a B - ` K $ 3 / 2 § E n r ■ { CL FO 0 0 0 §- Q 2 § 3§ o < w z ` n c (A co (A U % > - ) \ ° S ` � � § I ) m J - O � ~ ° z CL / § § c . g § � \ { M � \ � ® 3 � \ 0 w � / § § 2 z 0 q 2 7 z 2 « CA) k � @(± i k§0 \Ej r {// % �E{ // }g C) ƒ CD CD\ ow I %\ /� / �± 3 0 � , , 7 § 7/ // 8 = 4 Wisoonsin Department of Commerce PRIVATE SEWAGE SYSTEM ounty: Safety and Wiclings Division St. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you txovice may be used for secondary purposes (Privacy Law. s.15.04 (1)(m)]. 384279 Permit Holder's Name: ❑ C Villag;( Q Town o : State Plan ID No.: N [son, Gary Warren Townshi b Z�Tro,.ts. CST BM Elev.; Insp. BM E ev.: C scri pt' / Parcel Tax No.: 1 ,9' . ) 1 / oo it TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Q�LS uOD Benchmark Dosing .., J � It. BM 7,-4-3 9°Y•Sd�/ Bldg. Sewer 2 CI T. g9 Holdin ®/ Ht Inlet q(" NK SETBACK INFORMATION St/ Ht Outlet I l Z TANKTO P/L WELL BLDG. Air Intake ROAD Dt Inlet .$ 9 39 Septic > Sb' Z 1 NA Dt Bottom /b. y D. It Z Dosing " << _ 32 / NA Header /Man. NA Dist. Pipe S' 3 Z 1 I Holdin Bot. System S 11S7 PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand Si Cover _ Model Number o 3I(L Z'k�GPM L�- � �. L 013 TDH Lift .�{3 Frictio tssttem Zy TDH % SFt 1 3 I`f. Forcemain Length &S Oia. Dirt. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width I ten h r No. Of Tfe�lties T No. Of Pits Inside Dia. Liquid Depth D IMENSIONS ( o S Z �r S DI acturer. SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM L N - INFORMATION Type O r CH Et Numb System: D F 3 ''OR UNIT DISTRIBUTION SYSTEM tits Header gy 3- ` r Distribut ion Pipe(s) , I 11 I x Hole Size x Hole 5pa� ing Vent To�Air take 3. Dia. �_ Length': 1 Dia. I 'Z- Spacing 3 • D 1 3! Ib I � Ot it 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 ❑ No COMMENTS: (Include code discrepancies, persons present, lftdection #1: /d / l � Inspection #2: / Location: 842 110th Street, Roberts, WI 54023 (NE 1/4 SE 1/4 20 T29N R18W) - 202918317A20 -Lot 7 1.) Alt BM Description = ` &I— s - (w• if s 2.) Bldg sewer length= 4b' U I - amount, of cover= 1r.S.A,,),tk 1 IL'o ``b _ P 3.) contour = �. 30 - s u ��j�,� a. �- � Plan revision required? ❑ Yes IONo ?: E M 2 other side i information. 1 Z OI e!l ( aC► ct ��' Date Inspector's Signature Cert No S80-671 ( .3/97) • i I O i n a ` ` Xk 2S g�f 2 0 q4, S+. Sanitary Permit Application Safety & Buildings Division r In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 N*sconsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned.) Attach complete plans (to the county p r stem, on paper not less than 8 -1/2 x 11 inches in size. County State Sani Pe tN,!? er ❑ sion to previous application State Plan I. D. N 6 'f Z L Application Information - Please Print #11 Informaj4jErjtU X Location: Property Owner Name Property Location 9 �a 1/4, N, WA (o Property Ow Ws Mailing Address IT 5FRUX Lot Number Block Number / �IJNY'V e City, tate Zip Code Pbft ber Subdivision Name or C e r t C:I ✓ ) 11. Type of Building: (check one) a S g,. 1. ❑ City I or 2 Family Dwelling -No. of Bedrooms: �„� ❑ Village ❑ Public /Commercial (describe use):_ fif Town of ❑ State -Owned a 4�v� OJ 91 . } ( 1c $ Nearest Road Parcel Tax Nu ber(s) III. Type of Permit: (Check only one box on line A. Ch eck box on line B if applicable) !/ - 6 ~ q - 1 - 2 Q O A) 1. J9 New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only q 1 g , . 3 / A - oZ C) Existing System $) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) k - l . ❑ Non - pressurized In- ground ,� Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch Elevation VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks 0 ❑ ❑ ❑ ❑ -m ❑ ❑ ❑ ❑ T '— III. Responsibility Statement I, the u dersigned, assume responsibility for install 'on of the POWTS shown on the attached plans. P ame nt) Plumber's Sign r no s MP/MPRS No. Business Phone Number lumber's Address (Street, City, State, ip Code) IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued ssu' g Agent Signa re (No stamps) Approved ❑ Owner Given Initial Adverse Surcharge Fee) do Determination 3�z s. S 26U i X. Conditions of Approval /Reasons for Disapproval: �e�w.�.sw -1 t5 .Nl.2�oy►s � �,e, .� �a�=�t �- S- T�-� -�. .�- �� =�`�. SBD -6398 (R 07/00) v `M - \- 1 3 f\ v 4 " -3 1 � I ` � 4 M ,� if T I Iz J �J Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 www.TDD #: (608) 264 -8777 erce *isconsin www.commw s i n.g o v wisconin.gov Department of Commerce Scott McCallum, Governor Brenda J. Blanchard, Secretary June 16, 2001 CUST ID No.224263 ATTN: POWTS Inspector ZONING OFFICE KIM A O'CONNELL ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON Wl 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/16/2003 Identification Numbers Transaction ID No. 649742 SITE• Site ID No. 630812 GARY NELSON Please refer to both identification numbers, 110TH ST above, in all correspondence with the agenc TOWN OF WARREN ST CROIX COUNTY NE 1/4, SE1A, S20, T20N, RI 8W LOT: 7, FOR: NEW MOUND, 450 GPD OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 795594 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. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10691 -P (N.01 /01) and SSWMP Publication 9.6, "Design Of Pressurized Distribution Networks For Septic Tank- Soil Absorption Systems." • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The maintenance plan for this system must be given to the owner of the POWTS. Site Specific Conditions: • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area. I _ KIM A O'CONNELL Page 2 6/16/01 • The actual gallons per inch for the specified pump tank is 19.64 per product approval. The proposed pump settings provide a dose volume that is greater than 5 times the void volume and less than 20% of the design wastewater flow plus drain back • Maintain well and waterline set backs per COMM 83.43(8)(i). • The designer proposes to install a state approve outlet filter to achieve the requirement of wastewater particle size. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the septic tank outlet filter will be required. The outlet filter shall be installed per product approval stipulations. 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. Sincerely, FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 PATRICIA L SHANDORF POWTS PLAN REVIEWE , INTEGRATED SERVICES WiSMART code: 7 (715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM PSHANDORF @COMMERCE. STATE. WI.US cc: GARY NELSON r Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 isconsin www.wisconsin.gov .wis c ons i n.gov .wisonsin.gov Department of Commerce Scott McCallum, Governor Brenda J. Blanchard, Secretary June 16, 2001 CUST ID No.224263 ATTN: POWTS Inspector ZONING OFFICE KIM A O'CONNELL ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 06/16/2003 Transaction ID No. 649742 SITE: Site ID No. 630812 GARY NELSON Please refer to both identification numbers, 110TH ST above, in all correspondence with the agency. TOWN OF WARREN ST CROIX COUNTY NEIA, SETA, S20, T20N, R18W LOT: 7, FOR: NEW MOUND, 450 GPD OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 795594 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes VI and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The. owner, as defined in ' t chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. Co ` d -t The following conditions shall be met during construction or installation and prior to occupancy or use: t ' General Approval Conditions: Nor • This system is to be constructed and located in accordance with the enclosed approved plans and with the UI SA,F "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems SBD- 10691 -P (N.01/01) and SSWM:P Publication 9.6, "Design Of Pressurized Distribution Networks For Septic Tank- So* SE.E cu; ,ZF Absorption Systems." • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The maintenance plan for this system must be given to the owner of the POWTS. Site Specific Conditions: • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area. KIM A O'CONNELL Page 2 6/16/01 • The actual gallons per inch for the specified pump tank is 19.64 per product approval. The proposed pump settings provide a dose volume that is greater than 5 times the void volume and less than 20% of the design wastewater flow plus drain back • Maintain well and waterline set backs per COMM 83.43(8)(i). • The designer proposes to install a state approve outlet filter to achieve the requirement of wastewater particle size. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the septic tank outlet filter will be required. The outlet filter shall be installed per product approval stipulations. 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 co pondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 � ,. BALANCE DUE $ 0.00 PATRICIA L SHANDORF t POWTS PLAN REVIEWER, INTEGRATED SERVICES WiSMART code: 7633 (715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM PSHANDORF @COMMERCE.STATE. WI.US cc: GARY NELSON MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: GARY NELSON Owner's Name: GARY NELSON Owner's Address: 830 110TH ST. ROBERTS WI 54023 Legal Description: NE- SE- SEC20- T20N -R18W Township: WARREN County: ST. CROIX Subdivision Name: CSM Lot Number: 7 Block Number: Parcel I.D. Number: '.T.S. Plan Transaction No.: "Orally W, r!kL Page 1 Index and title Page 2 Data entry OF CONAERC AN tNG Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications E NDEN Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 PLOT PLAN (Q y��'7 -/ I Desigr►er: KIM A OCONNEL License Number: 224263 Date: 05/24/01 Phone Number: 715 - 755 -3145 Signatur Dosicgneci 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 3.0 (03/01/01) Page 1 of 8 I Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: Sand fill (0) 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 a= 36 inches. 450.00 Design Flow (gpd) 4.00 Site Slope (%) 99.70 Contour Line Elevation (ft) 26,00 Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpd/W) Distribution Cell Information 75.001 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpdtft 1 I Influent Wastewater Quality (1 or 2) Are the laterals the highest p0l in the distribution 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 2 Number of Laterals of the highest point. 0.188 Orifice Diameter (in) (e.g. 0.25) 4.00 Estimate Orifice Spacing (ft) = 11.84 ft /orifice 2.00 Forcemain Diameter (in) 40,00 Forcemain Length (ft) Does the forcemain drain back? Y 92.00 Pump Tank Elevation (ft) Enter Y or N 3.25 System Head (ft) x 1.3 6.52 Forcemain Drainback (gal) 8.37 Vertical Lift (ft) 67.38 5x Void Volume (gal) 0.55 Friction Loss (ft) 73.91 Minimum Dose Volume (gal) 12.17 Total Dynamic Head (ft) 24.90 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selecti in. dia. options choice in. dia. options choi 0.75 1.25 x 1.00 1.50 x 1.25 2.00 x 1.50 x x 3.00 2.00 x 3.00 x Gallonsnnch Calculator (optional) Treatment Tank Information 1000.00 Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) 52.00 Total Working Liquid Depth (in) we �� Manufacturer 19.23 gallin (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.001 Dose Tank Capacity (gal) Zabel Filter Manufacturer 19.041 Dose Tank Volume (gallin) JA100 Filter Model Number weeks Manufacturer Project: GARY NELSON Page 2 of 8 Mound Plan View 1/ Observation Pipe 3: 4 K -T Q A W �— L Mound Component Dimensions Down slope toe extension made. A 6.00 ft E 12.88 in H 1.00 ft K .24 ft B 75.00 ft F 9.50 in z 9.00 ft L 9 .47 ft D 10.00 in G 0.50 ft J 5.69 ft W 2 .69 ft 450.00 (ft Dispersal Cell Area 1125.00 (ft) Basal Area A ailable 6.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. P pe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 103.33 (ft) ! 2 ` G HI >� F Dis�ersa4 ceA 10103 (ft) lateral 100.53 (ft) Invert Dispersal Cell ' V Elevation E 70 (ft) Con Elevation 4,0 Site Slope Geotextile abric Cover Shading Key �, p rsal Celt See later I details on 0 Topsoil Cap 1.5 ft Page 4 f r number, ® Subsoil Cap size, and pacing of ASTM C33 Sand laterals. terals are Tilled Layer 0.5 ft Typical Lateral F equally s ced from © Aggregate a 0 : the distri tion cell's A centerli a in the distributi0 cell (AxB). Project GARY NELSON Page 3 f 8 i I I I End Connection Lateral Layout Diagram i Latwals een over the mans m • = Turn -up vdbaII valy ®or clean tplug P All latwals are wle"cal IE X ---.>I Holes drO d on the bottom of the lateral equally spaced S FOMQ main Connection Vi too or cross to m an*old at any point. laterals & fo" m ain of PVIC 4h 40 (per COMM Table 84.30-5) Number of Laterals 2 Orifice Diameter 0. 88 in Lateral Diameter 1.50 in Orifice Spacing (X) .08 ft Lateral Length (P) 73.44 ft Orifices per Lateral , 19 Lateral Spacing (S) 3.00 ft Orifice Density 11.84 ft /orifice Lateral Flow Rate 12.45 gpm Manifold Length .00 ft System Flow Rate 24.90 gpm Manifold Diameter .00 in Total Dynamic Head 12.17 ft Forcemain Velocity .54 ft/sec Dose Tank Information Locking cove with warning label and Ioc 'ng device and sealed watert ght Electrical as per NEC 300 and —� — Comm 16.28 vv, Disconnect X 4 in. Tank component is properly vented < — After�nate outlet loc0on ForcemairP diameter weeks Manufacturer 2 in. Capacityl 800.00 Gallons _r Volume 19.04 gallnch A Weep hol� or anti - Dimension Inches Gallons B siphon deice A 27.22 518.30 C 1 1 B 2.00 38.08 ump o elevation (ft) C 4.80 91.30 92.67 D 8.001 152.32 D Total 1 42.0 800.00 tan elevation (ft) 3" Bedding under tank. 92.00 Alarm Manuafacturer I S.J. ELE SYSTE Alarm Model Number HW 101 Pump Manufacturer I GOULDS Pump Model Number I WE031 J- Pump Must Deliver F 2,4.90 gpm at 12.17 ft TDH Project: GARY NELSON Page 4 Of 8 II Mound System Maintenance and Operation Saecificatigns Service Provider's Name KIM A OCONNELL Phone 715 - 55 -3145 POWTS Regulator's Name ST CROIX COUNTY ZONING �} Phone 71 6 -4680 System Flow and Load Parameters Design Flow- Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow- Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ft Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform �10E4 -cfu/100 mL 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 yR Pump and Controls Test once every 3 years Alarm Should test monthly Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspeot for ponding and seepage once every 3 Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have awatertight 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- requir-etnents 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 Clealnout Sprinkler Valve Box Plug or Ball Vallve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project; PARY NELSON Page 5 of 8 i Mound System Management Plan Pursuant to Comm 83.64, 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 i81)] 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 finer 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 fitter 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- perforrnanee 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 Distributio 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 DOD,, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BUD 30 mg/L TSS, 10 mg /L FUG, and 10" cfu /1 W 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 orfte clearing 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 IQcebon by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replaoln9z components as deemed necessary to bring the system into proper operating condition. See Page 6 of thispian forte, Ratite and toephone number of your local POWTS regulator and service provider. Project: GARY NF; Page 6 of 8 Performance I f L'i'luent, Curves U III pl V METERS FEET _. 90 — -- - -,-- - - — -- -- - -- —.,�__ MODEL 3885 t -- 25 80 SIZE 3 14" Solids WE15H t Q �! a 70 z 20 WE10H ---- - — -- 00 WE07H a b0 50 — 15'r , WE05H 10 � 30 WE03M ! 20 ; WE03L Ww- 10 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM 0 10 20 30 m' /h 2�.°1fl CAPACITY l �G©ULDS PUMPS, INC. 5B*CA FALLS PEW YCM 0146 METERS FEET 120 - +-- —�- �- MODEL 3885 35 SIZE 3 /4" Solids 110 WE15HH — i 100 30 90 25 I. } �I 20� I — — - J t 60 0 15 50 WYE05HH 0 1 30 t 20 i I o o 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM -- - -- -- - - -- l 0 10 20 30 m CAPACITY 1985 Goulds Pumps tnr Effective July, 1985 C388` rA fA r ; 71j .. /3V YER : G'AA NEG so.v ' �'Wlscon t ; - artment of Industry SOIL AND SITE EVALUATION / 3 Labor and Human Relations Page of Division of Safety and Buildings in accordance-with-s 83.09, Wis. - County Attach complete site plan on paper not less than 8 1/2 x t 1 InchoA In size. Plan,tnust Jr G R O l x Include, but not limited to: vertical and horizontal reference pojnt (9M), dirpFtio 8nft percent slope, scale or dimensions, north arrow, and locatioryand, distance taneitcesl road. Parcel I.D. # APPLICANT INFORMATION - Please p rint all information. ' 'j P _ ewad by Date Personal information T - you provide may be used for secondary purposesl,(Privacy Law, s (m))• a Property Owner -� • Location' - D ARYL .I U' 1J e .S Govt.. Lot 1/4 SLC 1 /4,S �• T Z ,N,R E (or) Property Owner's Mailing Address _ Lot # lock# Subd. Name or CSM# aUj Of' 17tt 3 ST OAT i Pi ►�E BA> - ' /� PI'4)6- CSM City State Zip Code Phone Number Nearest Road [ mot/ /• 5 � ? 15 , 3 �t • fl d oU ❑ City ❑ Villa ,—,/ Town //0 ff4, 06 - New Construction Use: Dagssidential / Number of bedrooms Addition to existing building ❑ Replacement Y J ❑ Public or commercial - Describe: 7 b � Code derived dally flow _ gpd Recommended design loading rate bed, gpde trench, gpd /f1 Absorption area required _5m bed,11 2 9 renr h, ft 2 �� Maximum design loading rate bed, gpd /ft` • ✓ trench, gpd/ft Recommended Infiltration surface elevation(s) some— p s_ • 3 ft (as referred to site plan benchmark) Additional design /site considerations MevND S ' ' 7L—M R6 Q V i IR D • Parent material - w/f Flood plain elevation, if applicable ft S = Suitable for system Conventional Moog In- GroundPrressure AT -Grade system , iin , Fil Holding Tan U = Unsuitable for system El u U U 5 ❑ U ❑ S E U ❑ S U ❑ S L" U ❑ S Er U SOIL DESCRIPTION REPORT �ew I -9 � • #1 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench / 0�3 /0 2-/2 -- — 5Z- /,7' hK jW w — , y ; .5 �t y 3 -a /d Yk 31 3 5/L Z f Shy f/2 Grp — S ; • C. s GeV nd 3 �•�• /o YA / S QL a hk .oi V c s - • s ; . . s - /pp ft. /•P /0Y/f % 16p Mi'X of S Dr S �f!,C ate. • ? YX 7- S/L / f /�� vi • Lt it'' _ 2- 3 Depth to limiting fvt oT ; factor Remarks: Boring # / 0'/ IPYX 2-/2 fs ,(, _5 .�. 2 z - lk • /D YAP 3 /3 /1— Z f shk �Yi2 S • 5 : . s L '6 M He 1 -1, Ground S/ /O I//e S/ C 2 A M o T S C S � r S Gt ,e l( if_' 7;• 8 elev. ft t7 3� S v - tA /0 y io R j�l2- 511 ifs �»+ i - _ . Z • 3 Depth to ?• S Y)e limiting I I &V Ow dCTf �d sl - s/�rV� factor n. Remarks.: COS Name (Please Print) Signature Telephone No. R6)t3E1RT V L13R � C WF 7t 5. 394 0185 Address Date CST Number M41P,(I& !/- oq MT Z 2_ 4 315 Ulb Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54018 ORIGmAL r SOIL DESCRIPTION REPORT Z PROPERTY OWNER \ Page of PARCEL 1.D.# _ I b s CI S oaU (3 19.5 1 Boring # Horizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 10 2 1 - TL 17S - y ; . .� y 3.27 /o I /? .1 SiL 2,m f he ,mot Ground 3 7. 3 Ts J l L f ,fh& 444 CS . elev. ��t � n. �o rfi� l2•— , Depth to 7.s lO /P X/6 G .Ld- Xt OTS S/L li * vu -6e 6 Z S z • 3 limiting c 9 Y V4 factor J �• /O YA 5� Remarks: i� y r� �lZ c zA Ho T s S /L / 7�S.6i� Awls /' Q S — Z 3 Boring # / o• /l /oYR z /�– Sz- /fs,bi� •pie w — .�(: , s .`� � - // 2S lo ye 313 S /L 2. S - F)t- 3 /o V 3/ c z X oTS S/ L / f f & 1' mac s L :. 3 Ground /0 y �Z ele - 5i, /o y $L 1 , lq S /do •/a oz rto Depth to limiting ' /� �� y/� s — C. S . . f . 7 factor In. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. Depth to limiting factor — in. Remarks: Boring # Ground elev. ft. Depth to limiting factor In ' Remarks: SBDW -8330 (R. 08/95) i O (� Q o � y � y � a c b lLn rj VS, � o � � b w ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 01 �S O Mailing Address Property Address :1 4 /� (Verification required from Planning Department artment for new construction) City /State Parcel Identification Number d .Lz=E - 9S S LE GAL DESCRIPTION Property Location kZ _ Y a, -�E Sea��, ,L N -R W, Town of Subdivision , Lot # Certified Survey Map At __ la,27/,�� , Volume Y y j , Page # Warranty Deed # w x4 l Volume d ,Page # Spec house j yes O no Lot lines identifiable yes 0 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 wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the hree year expiration date. SIGNA O 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 described above, by virtue of a warranty deed recorded in Register of Deeds Office. 6/ lot' SIGNAM V APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. « « « * *« ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed I 4 VOi. 1645P 596 l STATE BAR OF WISCONSIN FORM 2 - 1999 1646.403 WARRANTY DEED KATHLEEN H. WALSH Document Number REGISTER OF DEEDS I L ST. CROIX CO., WI This Deed, made between L. Newel Jones a Dorothy Y. Jones, RECEIVED FOR RECORD husband an wife, by tlity kaa?s, Chair attCney -- ir- fact,- -- - 05-24 -2001 9:39 AM WARRANTY DEED Grantor, and Gary A Nelson and Jillie J. Nelson, hus band and EXEMPT 0 - - -- CERT COPY FEE: wife, -- _- -- COPY FEE: TRANSFER FEE: 120.00 - - - - - RECORDING FEE: 10.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area That part of NE 1/4 SE 1/4 Sec. 20- T29N -R 18W described as follow Lot 7 Name and Return Address of C ertified Survey Map recorded in 14 of Certified Survey Maps, page 3862 as Doc. No. 6 7'M, St. Croix County Wisconsin. DAVID J. ESTREEN 304 LOCUST ST. S M HUDSON, W r , 54016 042- 1056 -95 -000 q `(G - " / 0 s - (o Q - Parcel Identification Numbe be (PIN) This is not homestead property. CK) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this c� day of April 2001 L. a ell Jones IIJ + Dor rtes Ffa11y Jat es, Y>Pr at i[> -fact AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE, OF WISCONSIN ) - & d 1 X County ) authenticated this day of, ,a +` Personally came before me this 1 1 day of A pril, 2001 the above named L. New Jones and Dorothy Y . Jones, husband an wife, ,:....._. k Ha l ]y Jntes, tD -at - - - - -- t otTt�'y'- itrfact TITLE: MEMBER STATE BAR OF WISCON&iy - - - -- - - -- (lf not, to me known to be the person(s) who executed the foregoing — instru ent an acknoXledg he me. authorized by § 706.06, Wis. Slats.) �� s - -- - THIS INSTRUMENT WAS DRAFTED BY «: r1lC�( (£ .nom - _- K ristina Ogjand. Attorney ---- ..- _____.._ Notary Public, State of Wisconsin H„dann WT SGOt ,ji.___ .____.._ My Commis ion i permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) -- � ( ` � oC) ) ' Names of persons signing in any capacity must be typed or printed below their signature. lr rmaron Prores wais company. Fond du Lao. vm STATE BAR OF W ISCONSIN 1100455 -2021 WARRANTY DEED FORM No. 2. l"9 / s FILED ' 6141 2 6 2000 b 8 KATHLEEN H. K'M—% L SLCWc� j Gzana Certified Survey Map Daryl Jones, eta], Part of the Northeast 1/4 of the Southeast 1/4 of Section 20, Township 29 North, Rang w o 18 West, Town of Warren, Si, Croix County, Wisconsin. Q N 89'10vd't? UNPLATTED LANDS OWNER'S ADDRESS: N 89 10'06' 430,01' ►� ? 17113 Stone Pine 13ay o 0 397,60' Hudson, Wl 54016 1790 .36' Eiw1/4L�IE ; 33.01' U i a o � ! t y Z This instrument drafted by a z I �I G Laurence W. Murphy 1 r • w LOT mil "I Dated: February 17, 2000 c 3.240ACRE 141,121 SQ. Fr h I w w N 2."7,/QW5. 130,090 SQ. F7. "Revised this 22nd day Ci DIC.ROAORO.W. C QI of May, 2000." y o 97 I I �I d� M Q2 w � r K 89 14' 40' E ,.?0.00' 'q "e W q APPROVED 3 g W 3412 33 33 W q� ST. CROLX COUNTY I L 071 i 1 0. Pt uving lonrcq and Parka ComrrOee t , P S C 8 h W k w I.J20AdPES, 101,041 SQ. Fy, ~ H $ h .7 MAY 2 6 200✓) $ 2.1JJACRL+s, 92,929 w I a b RoYv o, W. I $ o 00 2 11 not recd %Ahin 30 days of a I x approval num date a � al•ofl be I 9. 1•f' 46 qq ' E 430,0 W I f ' w 396.x8' ' " 34 LEGEND: g LOT 8 c ;o ol$ I Z W 2,J2oACRes, 10r,041 SQ, rr. 1 N h o 14 • f' X 24' IRON PIPE WEIGHING i 12PACRFS,' 02,742 Pt'' 1. 13 LBS.AIN. FT. SET EXC, ROAD A0. W. I s U , i 1' IRON PIPEFOUNO 1 t 35.72 $ 2 C $OILAORING 394,28 I y C S 89 ' W S 4 ors/oNArro 071"' UNPLATTED LA!VP 430.00 to g WAY LOCH Y/O,v 69' 14' 4 ' 430.00 $ h $ a 394.06 � $ $ tz { ROAD WaACX LINE . / 3.5.94 I g w �I 3 a.__L,O�'_9 W ti µuNdr4 f I = O �k••�, 41 ?.J20ACRES, 10!,041 SQ.'PT. ' g 2. 124 ACRES, 9$602 SQ. Pr. I 1 00' era ROM R.O.W. Z $ Q ~ ��,,......... 1 ( W `` II J $ 41.00' 393.26' r ae a ti frLAUREt�CE 38.74' �o ! p ; a : 352.26' y m i W M HY 4 S 89. 14'46' W 430.00' _ O9 S 1713 s ` ? FALLS, 4 4 E N ' � . Wisc. J ,J LOT y ` VOL 10, P AGE 2872 ' U _ LAND {s �� v o • _ "i y o ao ooS,CALo 20 • aoo 400 SHEET 1 OF 2 Vol.14 Page 3862