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HomeMy WebLinkAbout042-1079-40-200 Wisconsin Department of Commerce Count � safety and Building Division � PRIVATE SEWAGE SYSTEM St. Croix INSPECTION REPORT Sanitary Permit No: ,, 463343 0 GENERAL INFORMATION (ATTACH TO PERMIT) ate Plan ID No: Personal informatiW?'you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. I 1 T #A Z b Permit Holder's Name: City Village X Township Parcel Tax No: Lon en, Cheryl I Warren, Town of 042 - 1079 -40 -200 CST BM Elev: / Insp. BM Elev: I BM Description: Section/Town /Range /Map No: M .O � (X) , p CST B-Ik ) 29.29.18.451A30 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURE CAPACITY STATION BS HI FS ELEV. Septic Benchmark l� t Ste_ f Zc� 5. Zo ny, 2a t Dosing I Alt. BM Aeration Bldg. Sewer (1 Holding St/Ht Inlet �L sv TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic f / + I Dt Bottom %U /, 3 � / J / "C O• Dosing 1, ,r S _ / Header /Man. Y�. — / J• l � r " 7 0 Aeration Dist. Pipe , D i �?- a I oj, 12- Holding Bot. System 4 Final Grade rr ` PUMP /SIPHON INFORMATION U , Cc+ cbtAj -- ad J Manufacturer / �'1 S j Demand St Cover O � Model Number 32 1 9� Lift Friction Loss System Head TDH Ft S'- . 9� 2.�p-{ 1 G15 1 1 9 , 1 0 Forcemain Length r Dia „ Dist. to Well I — SOIL ABSORPTION SYSTEM TttC11M Width / Length / No. Of Treaehes PIT DIMENSIONS No. Of Pit Inside Dia. Liquid Depth -01 MENSIONS I SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufact e . INFORMATION CHAMBER OR Type Of Syste � 21 + � /" UNIT o tuber: DISTRIBUTION SYSTEM em Header /Manifold f rr Distribution Spa f r ry r x Hole Size rf x Hole Spacing Vent to Air Intake�i r Pipe(s) [ p 2 . SO Length /'s� Dia Length_/ a ! / Spac 0 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of — Topsoil xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil Yes No Yes No n0 �y COMM NTS: (Include code is repencies, perso s prese t, tc.) Inspection # l;� `a-P/ ��P Inspe on #2: T - kW Lora i 774 103rd Street Roberts, WI 54023 (SE 1 T29N R18W) NA�L\ t + J � Parcel No: 29.29.18.451A30 1.) Alt BM Description= 2.) Bldg sewer length = 3 -amount of cover= Plan revision Required? Yes , p4 r - � Use other side for additional information. No 2c1e L — Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) f Safety and Buildings Division Copy an, . Washington Ave., P.O. Box St. Croix adison, WI 537 ,��0���� (� anitary Perm Number (to be filled in by Co.) ( �- ,... 33 3 Department of Commerce % Plan I. D. Number Sanitary Permit ica 'on E `0 }`3 1 12135 = S. ItS In accord with Comm 83.2 1, Wis. Aden Code, orm You wbviitb Pr 'ect Address (if different than mailfng address) may be used for secondary purposes Priv w, s15.0 1 xm) L Application Information - Please Print All Inform 74 103 Street Property Owner's Name arcel # Lot # Block # 042 - 1079 -40- 5 Na Cheryl Lon en - 2cm Property Owner's Mailing Address Property Location 639 93 Street Gov't lot SV /4, NW's., Section 29, City, State Zip Code Phone Number (circle one) Roberts, WI 54023 (715) 749 -3962 T 29 N; R 18 E or W II Type of Building (check all that apply) S J .11:1" _"U4�Q n Q,�,i S • suhmmm 143ine CSM N e t ❑ 1 or 2 Family Dwelling - Number of Bedrooms 4 •IL ' . S ❑ Public /Commercial - Describe use t , CSM Vol. 16 4355 ❑ State Owned - Describe Use ❑City nviijage ❑Township of Warren III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. X New System ❑Replacement System ❑ Treatment/Holding Tank Replacement Only Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New Last Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS Sys . tem: Check all that a 1 ❑ Non - Pressurized In- Ground X Mound > 24 in. of �suitable soi ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Fiher ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating synthetic Media Fitter ❑ Leaching Chamber Q Drip Line ❑ Gravel-kss Pipe ❑ Other (explain) V. Dis ersat/Treatment Area Information: OD `T= rZ.OJ Design Flow (gpd) Design Soil Application Rate (gpdsf) Area Required (sf) Dispersal Area Proposed (d) System Elevation 1.0gpd/Sq.ft ASTM C -33 sand 99.78' @ 12" above 600 gpd 0.4 .ft native soil 600 sq. ft. 600 sq. ft. 98.78' contour VL 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 1,250 1,250 1 Wieser Concrete X Aerobic Treatment Unit Dosmg amber 750 750 1 Wieser Concrete X VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) I Plumber�Signatur MP/MPRS Number Business Phone Number William Schumaker Zdl MP #227990 715 386 -3121 Plumber's Address (Street, City, State, Zip Code) 1070 Scott Rd., Hudson, W1 54016 VIIL County/Department Use Onl Sanitary Permit F (includes Groundwater Date Issued Issuin Agent Signature o Stamps) Approved roved Surcharge Fee) ❑ ,C_ ven Re al J� IX. Conditions crApfiiroi#Measan& for- Disapps=wl SYSTEM OWNER, 1 Septic tank, efFluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintainec' as per applicable code /ordinances Attach complete plans (to the County only) for the system on paper not less than 812 t 11 inches In size I � Sei/ eft /cca�i on �o, E ��/ �On9Zrt � (,Jrwyrr¢ G�'bk7h �'qQ /oC S cs^i I (*/ Y3Ss; X C. �4 Pnr�� � bcdican, rcsid6nec p ; En j V "sc yo P.dc. � � 6 u: /d,•r�q sewer. 3 i OZ Proposed C,oresar con c re, {x r � � i � � /za.b��q - -ao e� /u�.►b oc;/44.- a& d1WOV6. fl h e 531 ! 1 PrapaS�'"� %estf Concrte 760 "►� R �ou.,► Cha..,bcr Proposed mound a6 .V 15',r JPac cd ai 2. �. ✓. e.P;�.. Assw.re,�t Z 4 Art 15-M. to &x Ytsa Pr Sy5rtlm Con3fruc f,a►�. '' CIO O V4 s V. ' /0,3 P .&�9 • 07 d . OS7 OYA- /C •7q• fvo• 00 tMcons6, Deparf►nent oI Cornmerce SOIL EVALUATION REPORT Page / 01 3 Hvision of Safely and Buildings r , In accordance will, Comm 85, Wis. Adm. Code Mlach cornrylelr, site plan on paper not less Than 8 112 x 11 Inches In size. flan m,rsl Counlys�• G/p 0�•x Include, but not Ihniled lo: vertical and horizontal reletence point (BM), direction and Percent slope, scale or dimensions, norih arrow, and location and distance to nearest road. Parcel I.D. rtease print all Into►rnaffon. A ed by ,1 Date infr r Pirsonal omalirm M0 Movldo may be vsed for Piton law, S. 15.04 ( 1 1(m))• ` ,R l o Properly Owner P operty Location .Dov Ativ� a,� ____ ovi. Lot SE ue A) 114 S 29 T 2 f N R /0 fl or) W Properly Owner's Malting Address �� J — 2 of fM Block N Subd. N me or CSMA 7 3 � /O 7 lf- : 5-7- - r --- Clt 1 ST. [I Y Sfate Zlp Code 1-7 Ft 0City Village ® Town Nearest Road Ro, T W/• y ( 7/ ) w�it'it°E /o3 /,7 5' [ New Construction Use: M Residenllal / Number of bedrooms Code derived design flow rate QpD [_] tteplacement [] Public or commercial - Describe: Parent maleriai _� % D ( '�i�_ PdIOM /;K&. Flood Plain elevation If applicable ry, General conrtnenls and recommendations: , 'Ve e ' . TE i So / j /� fQiQ �J- GQ.t� t7E,t�T7Otl,¢C� 1 4fo 0 U Boring M Ll Boring �� •� () �. R • (s 1J Zero`F �i'C�' Pit Ground surface elev. tt. Depth to Nmiling factor M. Soll Application Rat Horizon bepih Dondnanl Color nedox Description Texture Structure 7 Eonsistence Boundary Rools GPDMI . In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'E[1 #1 'E11102 l 0 AyR 3/ L 2 /MAR G� 3f . s • � . _ ) 5 YR S c [ /�•s hilC •wl ri' a • Z 3 - r r� u rr Boring �� { U Boring !f � S S.,$ • pit Ground surface Oev. fff• V fl. Depth to flmiling factor In. Noriz - -- �— Soll Application Rate oti 1 f)pnfh hn.,.i..anr r.J... n_.a_., n__�>_..__ �-- -•- - -- ... _ _ _ _ t I — - ■ \r . s 1 l�4w pas 0A) �� Properly Owner Parcel lb 0 pa of U Rorhrg M Poring �/ , . Pit Ground surface elev. r 11. Depth to limiting factor In• goll Application Rate I kttirnn Depth bominsrnl Color Rednx Description Texture F FC,,, sistence Boundary RWs GPD M' In. Munsell Ou. Sz. Cont. Color 'Efrof 'EMIR o • /o Y 9 3/3 — L f ie S ,3 . S . � z 3 �o YR �• eS 1 1G . s • 8' e 7•5 R zd� 1107.5 L /fSh 11"1 • �t — Z 3 , ti i y �L f � Boring it Ll Boring tLI —_— u pit Ground surface elev. it. Depth to limiting factor In. Soli Application Rale Ilorizon Uepth DOMlnanl Color Redox Description Texture Structure Consistence Boundary Roofs GPOlflr In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Effp1 'Etfi12 Boring !! t ❑1 Boring . IJ Ptl Ground surface elev, fl. Depth to limiting factor In. son nppncaiion Rate I Iorizon Depth Dominant Color Redox Ue'trOplion Texture Structure Consistence Boundary Roots GP011t' In. Munsen Ou. Sz. Coral. Color Gr. Sz. Sh. 'EMN1 '042 Emuenl #1 = BOU > 30 < 220 mgll and TSS >30 < 150 mgll. ' Emuenl #2 = BOO, < 30 mgll. and TSS < 30 Vigil. _ r '1 he Depatlment of Commerce is an equal opportunity service provider qnd employer. If you need assistance to access services or need.malerial in an alternate format, please contact (lie department at 608 -266 -3151 or ITY 608 -264 -8777. o -- w t, N � •� � -� � � ��� � off, �� � � � ''� � � '� �� -� �� � •• o � ,� � � D� Y �o °o �, J 00 V o� Q 1 N � � C - c- o � � � � � �� � �� �1 wa � c a� W � .W .0 3 �� 1 Y O C c W v� .� � � _ � � � G � "� Safety and Buildings commerce.wi. OV 4003 N KINNEY COULEE RD g LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 scons n vrww.commer isco govsb, Department of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary February 24, 2005 CUST ID No.227990 ATTN: POWTS Inspector WILLIAM C SCHUMAKER ZONING OFFICE SCHUMAKER PLUMBING ST CROIX COUNTY SPIA 1070 SCOTT RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 02/24/2007 Identification Numbers Transaction ID No. 1112135 SITE: Site ID No. 695046 Cheryl Longen Please refer to both identification numbers, 774 103rd Street above, in all cones ondence with the agency. Town of Warren St Croix County SW1/4 NW1/4 S29 T29N R18W Subdivision: CSM; Vol. 16, Pg. 4355 Lot 1 FOR: Description: Proposed Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1005412 Maintenance required; 600 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.01 101), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -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. ®. Yl S. 7 CajZditi ®nur�► n n... WILLIAM C SCHUMAKER Page 2 2/24/2005 • ' 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 inspectors. 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 pm WiSMART code: 7633 jswim@commerce.state.wi.us cc: James K Thompson, A.C.E. Soil and Site Evaluations (Plans Mailed To) Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 it o MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Cheryl Longen & Wayne Browne 4 bedroom residential mound Owner's Name: Cheryl Longen Owner's Address: 639 93rd Street Roberts, WI 54023 Parcel Address: 774 103rd Street Legal Description: SW1 /4 NW1 /4, Sec. 29, T.29N., R. 18 W. Township: Warren County: St.Croix Subdivision Name: CSM Vol 16, Pg. 4355 Lot Number: 5 Block Number: Parcel I.D. Number: 042 - 1079 -40 -200 Plan Transaction No.: Page 1 Index and title Page 2 Data entry s Mound drawings Page 3 g RECEIVED Page 4 Lateral and dose tank Page 5 System maintenance specifications FEB 1 8 2005 Page 6 Management and contingency plan Page 7 Pump curve and specifications SAFETY & BUILDINGS Page 8 Site Plan Page 9 Soil Evaluation Report Designer: Bill Schumaker License Number: 227990 Date: 02/11/05 Phone Number: (715) 386 -3121 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) a B rXV V1r. Page 1 of 9 Version 4.01 (R. 09/04) DEPARTMENT OF COMMERCE g IVIStON Of AND BUILDINGS t SEE COR ESP DENCE Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) j R Residential or Commercial Design Note: Sand fill (D) calculations assume a f^ 400.00 Estimated Wastewater Flow ( Table 83 -44-3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of <- 36 inches. 600.00 Design Flow (gpd) 7.00 Site Slope ( %) 98.78 Contour Line Elevation (ft) 24.00 Depth to Limiting Factor (in) 040 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 100.00 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point - in the distribution L Y Pressure Disribution Information network? Enter Y or N (c or e) Center Center or End Manifold 1.50 Lateral Spacing (ft) If N above, enter the elevation (ft) 4 Number of Laterals of the highest point. _ 0 .125 Orifice Diameter (in) (e.g. 0.25) 2.50 Estimated Orifice Spacing (ft) = 7.50 ft /0 rifice 2.00 Forcemain Diameter (in) v 40.00 Forcemain Length (ft) Does the forcemain drain back? [� Y f 92.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 6.52 Forcemain Drainback (gal) 7.45 Vertical Lift (ft) 64.36 5x Void Volume (gal) 0.92 Friction Loss (ft) 70.89 Minimum Dose Volume (gal) 14.87 Total Dynamic Head (ft) 32.95 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. op tions I choic in. dia. options choic 0.75 -- - - - - j 1.25 x � -- x -- 1.00 x 1 - - - -1 1.50 x 1.25 x x + 2.00 1.50 x _ 3.00 _ 2.00 x 3.00 x ------ - - - - -1 -- - - -- Gallons /Inch Calculator (optional) Treatment Tank Information 7 Total Tank Capacity (gal) 1 0002 0 Septic Ta nk Capacity (gal) 37.00 Total Working Liquid Depth (in) Wieser Concrete ] Manufacturer 20.28 gal /in (enter result in cell B49) D ose Ta nk Information E ffluent Filt Info 750.361 Dose Tank Capacity (gal) Zabe J !Filter Manufacturer _ 20.28 D ose T ank Volume al /in ) A 100 Alter Model Number Wieser Concrete ] Manufacturer Project: Cheryl Longen & Wayne Browne 4 bedroom residential mound Page 2 of 9 Mound Plan View T :o: J 1 / 10 B Observation Pipe 3 _ I .5. A W t� . . . . . . — B — • I .... . .. ... ... L ..... - Mound Component Dimensions A 6.00 ft E 17. 04 in H 1.00 ft K [ Aft ft B 100.00 ft F 9.25 in z 10.22 ft L ft D 12.00 in G 0.50 ft J 5.63 ft W 600.00 (ft Dispersal Cell Area 1 1621.84 (ft Basal Area Available 6.00 (gpd /ft) Linear Loading Rate 1 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.55 (ft) - -► G * H 2 ,,,,,,i j F ; : ; : ; : Dispersal Cell 100.28 (ft) Lateral 99.78 (ft)--► — Invert Dispersal Cell : ' Elevation E D ::::: :: :: • . ____. _ a - -. •. =. . _%.. 98.78 ( ft) C ontour Elevation 7.0 % Site Slope Geotextile Fabric Cover Shading Key a. Dispersal Cell See lateral details on 1❑ ® Topsoil Cap c ° 1.5 ft ••.••.••.••.••.••.••.••.••.••. • Page 4 for number, size, n� Subsoil Cap �' 4 4 k ;f'• and spacing of laterals. ASTM C33 Sand 14 :' Laterals are equally Z 0.5 ft ....." Typical Lateral •. F spaced from the Tilled Layer c d '� distribution cell's 5Q Aggregate o ' _• ' ' "_'* centerline l the A distribution cell (AxB). Project: Cheryl Longen & Wayne Browne 4 bedroom residential mound Page 3 of 9 Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at any point. Laterals are identical Will P 5 ,L •= Turn -up vWball valve or 4)j<-x12 Laterals & force main of PVC Soh 40 clean out pl u g per COMM Table 84.30 -5 Holes drilled on the bottom of the lateral Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.50 ft Lateral Length (P) 48.75 ft Orifices per Lateral 20 Lateral Spacing (S) 1.56 ft Orifice Density 7.50 ft /orifice Lateral Flow Rate 8.24 gpm Manifold Length 1.56 ft System Flow Rate 32.95 gpm Manifold Diameter 1.25 in Total Dynamic Head 14.87 ft Forcemain Velocity 3.37 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and —� 4 in. min. Comm 16.28 WAC Disconnect _ Tank component is properly vented E— Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Ca:p acityl 750.36 Gallons Volume 20.28 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 21.61 438.35 C B 2.00 40.56 P ump off e levation (ft) 92.83 C 3.39 68.65 D 10.00 202.80 D Total 37.00 750.36 Dose tank elevation (ft) 3" Bedding un l tank. 92.00 Alarm Manuafacturer ' LevelArm Alarm Model Number 1,DLV Pump Manufacturer Goulds Pump Model Number! 3887 EP05 Pump Must Deliver I 32.95 gpm at r 14.87 ft TDH Project: Cheryl Longen & Wayne Browne 4 bedroom residential mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Bill Schumaker Phone 715-386-3121 POWTS Regulator's Name St. Croix County Zoning Phone 715 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1200 gal Maximum TSS 150 mg /L Soil Absorption Component Size 600 ft2 Maximum FOG 30 mg /L Type of Wastewaterl Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 ears Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 years_ 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 Tum -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: Cheryl Longen & Wayne Browne 4 bedroom residential mound Page 5 of 9 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 &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 fitter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter 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 fitter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent 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. Project: Cheryl Longen & Wayne Browne 4 bedroom residential mound Page 6 of 9 • GOULDS PUMPS Submersible Effluent Pump 3871 EPO4 EP05 APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lovvt�: grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the E lubrication and efficient improved performance. construction. • Effluent uses: heat transfer. ■ Casing and Base: Rugged t systems • homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms superior strength and corrosion manual operation. Auto- SP resistance. Canadian Standards Assouauon • heavy duty sump matic models include • "vatei transfer Mechanical Float Switch ■ Motor Housing: Cast iron • De�:vaterin for efficient heat transfer, Goulds Pumps is ISO 9001 Registerer g assembled and preset at the factory, strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic FEATURES cover with integral handle and • Soiicis handling capability: float switch attachment points. maximum ■ EPO4 Impeller: Thermoplas- 0 Power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant. • Total heads: up to 31 feet, pump out vanes for mechanical • D�scharge size: I h' NPT. seal protection - • mechanical seal: carbon - rotaryiceramic- stationary, 3;-;NA N elastomers. • Temperature. 04 (40 C) continuous 40 F 160�C) intermittent. METERS FEET • Fasteners 300 series 1 , -� stainless steel. 9' 30 ��• 5GPM • Capable of running dry without damage to 8 —zs 1'7 ,omponents. - - 25 Q � Motor: _ • EPO4 Single phase. 0.4 HP, `— e� 20 15 or 230 V, 60 Hz, 1550 a RPM built in overload with /�/ ' S automatic reset. TP. 4 EPOS • EP05 Single phase: 0.5 HP, o 5 V or 230V, 60 Hz, 1550 3 10 RPM, built in overload with EPO4 automatic reset 2 • Povver cord 10 foot l 5 standard length, 16/3 1 S1TOW with three prong grounding plug. optional 20 0 0 0 10 20 30 40 so GPM foot Length, 16/3 S1TW with three prong grounding plug 0 2 4 6 s 10 12 m n standard on EP05). e /' cc ad u Goulds Pumps Io.ids Pumps ITT Industries �_ xp'mper 2002 PS 7 1 / 9 vt - re 74 N buy/ L� ya.� � c,�k►yr,� �a� �� lad S cs•n «� y3 5:s 3e c. x9 Til, ro xG, Pe+poud /'csldwrct• re of ji ",o r c. o ,�...�p�ofvsod /O 'd I � b u: /di i�g sewer I � , I 2 proposed cc);cs•r Con cre.1�-- wtP, 60-me SLp6Y. &LOvK 00 o v l G l i c I "A•S.r.,n. 3034 e4clu -.4 /lne. w 9 N o 93 �� � ! I Proposto� �;es�Cor,cr�e I � i I we.p Aso -•►, a ,ou.,. Chae,nbsr: t I 11 a I Pr'opos�.d mou..+d c+� .Z�.PS'x //X o , �. ✓, e.P;,oc. f�ssu..ncpl Z .o CI /�r,' S st em conStrut fare `3 .2 P gar ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner Mailing Address (0 3 y 93 r Property Address 7 7 /03 Z�� . (Verification required from Planning Department for new construction.) City /State Parcel Identification Number O �,Z - /o 79- 5/ -2 -d 2 (.45 - 3 0 ) LEGAL DESCRIPTION Property Location S eJ %4 , /'l GJ % 4 , Sec. 29' , T _,L9 N R /8 W, Town of r e Subdivision Certified Survey Map # 7 Y�L 7 _, Volume 16 , Page # sue . Warranty Deed # (p 3 (G-9 , Volume , Page #• Spec house w c6 Lot lines identifiable 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning ent within 30 days of the three year expiration date. X 3 11 o /o 9 16NATUAE OF APPLICANT DATE OWNER CERTIFICATION Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the Y pr de 'bed above, by virtue of a warranty deed recorded in Register of Deeds Off ce /1 3 " MNATURE 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 V 2005;' `195 DOCUMENT NUMBER XATHLE£N H. MALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO.. MI RECEIVED FOR RECORD Donald D. Anderson and Edie R. Anderson, husband and wife, Grantor, 10 -2002 3 :10 PM conveys and warrants to Cheryl M. Longen a single person, Grantee, the following described real eH Ze in —Croix County, State of -- Wisconsin: A parcel of land located in the SW4 of the NW+% and the SE'-c of the NWic REG FEE: 11.00 of on 29, a 7 h ip 29 North, Range 18 West, more fully described TRANS FEE: 19;', 0e as Lot of Cert Survey Map Recorded August 19, 2002 in Vol. 1 6, C=OPY FEE: Pa g55, as Document No. 687457. CERT COPY FEE: PAGES 1 The Grantee, its successors and assigns hereby agree to share in the maintenance of the joint drivewa, easement as shown on said Certified Survey Map on a 50/50 pro -rata basis with adjoining property owner. NAME AND RETURNCA.g '.CUP, INC 'i:3 1971{ 3 FIUD: Oi4. WI 54016 042- 1079 -40 -000; 042 - 1079 -50 -000 Parcel Identification Number This is not homestead property. Exception to warranties: All easements, restrictions and rights -of -way of record, if any. Dated this '/ Co XA daa�/ of September, 2002. �7 (SEAL) td �d. L {SEAL) D. Anderson e (SEAL) (SEAL) AUTHENTICATION Kay V. Pairs ACKNOWLED2CKNT Signature(s) _ N otarY Public STATE OF WISCONSIN ) state nt W i Si- C ICJ1 COUNTY S5. _ «� authenticated this __ day of 2002 Personally came before me thi day of September, 20 D2 the above named Donald D. Anderson and Edie R. Anderson (s... to me known to be the persons (s) who executed the foregoing instrument a acknowled a the same. � .an.e v, incea oc Tvnedi TITLE: MEMBER STATE BAR OF WISCO:JdIN f �! isia..�c� =ei (If not, ✓ +/ n authorized by 9706.06, Wis. Stats.) IC C.V 1". /'LL � F /.'! (Name rsilcla oc rvoedi TH15 INSTRUMENT WAS DRAFTED BY: Notary Public �7 County, Wis. Stuart J. Krueger My commission is permanent. (If not, expiration date:) Rodl-_, ox Beskar, Boles & Krueger; F C. /Z P -- s 138 iv_ Falls, WI 54022 90 59S Y6 A) e0444Z� 8 - 7 ti• s ' VOL 6 PAGE 4355 4079 _ 5r"o - 0 75 11 ,9 -as' 1 KATHLEEN H. WALSH o ��•?- GD Z Q - �D o lf4 3,0 1-4-7 ' ST. CROIXOCO. , V I RECEIVED FOR RECORD 14 9 /d � Ol� yS" /.4 �.5"1� zo-� ? 08-19 -2002 10:30 A THIS INSTRUMENT DRAFTED BY: JOSEPH W. GRANBERG CERTIFIED SURVEY MAP REC FEE: 13.00 COY UNPLATTED LANDS PAGES: 2.00 SOO 'p 1 ". SOO 44 '01 "E 305.13" 647.73' S00 'E 1692.94' WEST LINE OF THE NWI /4 ^z � A CZ x H33 Zo — i zz z _ Z._ i m DO F G9 m nZm um ��N m ova mo - n �� O � °� 0 xN ~ `� �, �O�m `� Z z0 D A H � O In ON N o..� p �C�D mcn r 3-ncn .. " z• "M " m o c I N 1 m z m m N I O m �� O 3`91 C - ) - n o' X77 m ® O r D ��o ��� O �+ Q ZZ NO Ly,(A� Fq m • a , i;, �i;, ; 0 O m 4�jj � cn D .- .. - ..-.cn m 0 FpfN p \ITI Om0 O �xHDn // D D p 1O 0< -1 � mwr �Z �14 ' 6V <D�D AOm m X m(n NgZ O X-r 33 : pC N - A Z Zm m m, cn �• m M v IV1� � O rn HZ m Z/5 m ' ,' o v 33 c oD �M �� o m N a z m rn ; :.'.: a-+ o No ° om 71m M _ v u) m o �� m O I� O O m y \�� 0� v CN1 ® m SOO�d'01 "E 239.12' S00 °44 01 E 304.03' xA N r 32.45' 271.58' o ••• o0 C M A 271.57' a c :<m N O rn Hm cn�, rn m o \� 4 _-4 m rn z m r rn _c r m 1st z m CD w (Oil (NO --4 N 66 M Lp { O p 0oo °cam °c ><cnzcn En rCt'C D CDCn C9 f A O N m °m��i °m° ' ZmZ �' c M c czi �° : G) ® rn o m m c�T► ' . 33 °- m o) �m "m 9 g ��0 fu ° m G) -1 G") O m 2 2^ c v m Z •. w I A - pAOJa R HRL 1-4 ( ✓', ,• r9 •�.� L o ' b , v - n La �1UI N ZI1�1� O -I O V I m N ' � ° l0 <-t'5 N { r Z c4 i �t]Cn Z F�f0 > OH �ru C : iG"N -<D-<D v nom F. o _ n n c� cn M m o ED • 4 R m m E— c cn (n f�11 O D .�► � ul N S o v x 100' BUILDING SETBACK LINE O N / _ -m. _. -.. _ . . _. _. . - . _. . .. _ .. _. 33 z z a w - SW1 4 -NWI 4 °w - Z o ° a ° > w — IVOOo 20'47 "E • , 609.44 ' m rn o m -:4 't1 66.04 3 w p 33 33' o o S E oP' 1 c m a N y - 33' — —N 271_70' — ro — — 27170' — W L -- xx v w w 5 4 C.0 - 66.04 ' 271.70 ' w_ 271.70 ' STR EET m w D mi - w o C NOO 20'47 "E 609.44' w - -- o m z — — — — — — — — — - m i ' n - ® — -------- - -W�mm 0610T 3 1 1 511 LOT 2 LOT 1 CA Z N CERTIFIED SURVEY MAP VOLUME 1 , PAGE 3263. J c Aq ti �.. 1. /'L •_ /i... .v L.C. { ^J� � r Mscnnsln bepnitn,enl of Cnrnmerce SOIL EVALUATION REPORT l of 3 <ivlgirnt of Safely and Flulidings rage • In accordance with Comm 85, Wls. Adm. Code _ nllnrh cnnq�tetn Alle plan on pnpr not tags Ilmn 0 i/7 x 11 Inches In size. Plan mull Counly�l.,t O /•� Inrlurfr+., but not Ilnrlled lo: verlicnl and Florizrnrint referenrr, point (f)M), direction and / / a 4 x - ii - I t - y• - d percent slope, Arnie or dhnnnslons, north nrrnw, and Iocnlion and distance to nearest road. Parcel I.D. & � � ` . o c0 rtense print alt tnformallon. Revlewed by Date r'M1,Mmil Inrnrni:,llon yprr prnvlrle may ba tilted Im arcondmy pwPoselt (Privacy law, a. 15.o4 (1) (m)), 1 'r1111erly Qwner Properly Locallon .DON .VDE/P..f a im Go vt. Lot 1 1 4 t'rnlre,ly Owner's Mailing address - - -- - -- - — �� 1 / 1 S Z9 T .Z.� N R /0 Q (or) W S / -• Lot Block N Subd. 141 r CSMM City § aiT — T(;oT iTi�r;e u 'r 1JC(ty U Village fo Town Nearest Road RO,S eRTS I 4 :, ' /. — - c 7/5 7y% •.�.3SZ G�/��t'�t°E•cJ /03 �� S . r,, . New ConAlrtrcllon U!;": Resldenllal 1 Number of bedronms Code derived design Pow rata I Rnptacernenl U Publlc or commercial . Descrlbe: opt) r'nrrtnl nnierinl - �I��D -R0/D 4j/-C- Flood Plain elevation it epplicalrlo l;mrrtral rnrnn,nnls — n. :,n recomrnendaltonA: /fo0,vp 5f/S7 U Floring>1 U Boring fg•79 . pit Ground surince elev. _ f1 . Depth to limiting factor in. Solt Application Role i Iorizrnt I)epih Donlhlanl Color Redox Description Texlure Structure Consistence Boundary Roots GPDMI , In. Murlsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Effp1 "EM i 0-9 �o yR 31 2fsbk . �,�,� Cw 3f . 5 . Z y e5 zf s 30 s ) s yQ 56 / hip' �+++i -�— IPA, �� ofd s�' r oo �.�r, i� ti r U .I . L { 9o,ing o U F3oring y'O '�LJ s. S. -- II g hit C3round surrace elev. 11. Depth to Ilmlling factor In, s I Iorizon Uepllt Dnl Color Redox Oesr rlptlon Texlure Structure Consistence Bounds Roots Soil /1 plication Rate in. Qu. Sz. Cont. Color Boundary aFD /fir /o 3 G /Gr.�� R C . Eft ' � Z h 4M 7W s %R ----- 5 q / S 3G 7•S YR ( G z , k NoTS C / sh k 3 Ettluerll N1 - 900 > 30 < 220 rrrg/L end TSS >JO < 150 mg/L • Effluent A2 a 900 r < 30 mgrL and TS3 < 30 mp/L CST Name (Please Print) Signalure RG►�2T' uL�2i��� CST Number ndriress 2 2. G 3 7 S Dale Evaivatlon Conducted Telephone Number tb11�> l. Aa,cc]ale �'�uvt,� � ' 100 Z 7/S •.�8� • $ / $ S Private Sewage Consultants 655 O'Nell nd. Hudson, Wis. 64016 B local zonin can be REQUIRES ATE EVEL PLAN APPROVAL. Plans will need to be submitted by a qualified designer per Comm. 83.22(2)(C)1. D� lnperly Owtrer -- rarcel IV N I rage of 1 hrnhrg N U tlo ►ir,g q SS pit (3imind smtLtcw elev. ` / fl. beplh to limiting factor �� In,l Soil Icallon Rate I Inrimn Dhp1h Dominant Color herinx Deecripllon Texlure Structure Consistence Boundary 116619 GPD /(1' In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. TIM TIM o io �R 3/3 — L- z ,5hk 4- fie S' 3 . S - 3 /o !�R y` /L �FSh _ - )�j -7. yg y S� L 7- A+4 d,e ,w,ICi ' c — • s • 8 7-5y C-2-.P- hors L /� �,�I�i' a — 1 hnr►ng $ U flo►h�g I U pit Gromnd stnL+ce P.Iev, _ fl, Depth to Ihniling factor In. Soil Np Ifcallon Role TI rhnn Urpih Unmlmenl Color nedox Oesc0pllon Texture Slruclure Consistence Boundary Roots Grom M. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff1f1 'Ef1N2 1 I 1 noring A U Poring • hit Ground wince elev. fl. Depth to limiting factor In. Soil Application Rate I Irnlzon Ueplh Onminnnl Color nedox Uescriplinn Texlure Slruclure Consistence Boundary Roots GPU /It' In. Munsell Ou. Sr. Cont. Color Gr. Sz. Sh. i TONI - F-M2 I I I I ' Eflhrenl N1 - BOO > 30 < 220 mg/l and TSS >30 < 150 mg/l ' Effluent Art = BOD < 30 mg/L end TSS < 30 nVIL r I he 1)epnthnenl of ('nnmrerce is nn equnI opporlun1(y service provider and employer. iryou need assislnnce to access services or need .mnlerial in on ititernate format, please contact the department al 608 - 266 -3151 or TTY 608 -264 -8777. f it ftmm O cz- •. o � J 00 . v 64 o �, • 00 C a C� ;o o v � 0 � o r aM I W � 1. .