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020-1448-31-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 567279 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Johnson, Mark R. &Sarah Hudson, Town of 020-1448-31-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: 67 I3 V 1 1 G5-r-- 32.29.19.2864 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ,24 ` CAPACITY STATION BS HI FS ELEV. Septic ,^- 3/ Benchmark 5. /J JDs ,J�,� � /Lec)9 A l 14.. S i Dosing Alt. BM .'�1C p....-is S g 1.6 ,4 •/S k•�a l-) 1�s vz5 Bldg.Sewer /5.z7 9/• sY$ �. Holding St/Ht Inlet 1 f r 76. 77 St/Ht Outlet TANK SETBACK INFORMATION TANK P/L WELL BLDG. ent to •it Intake ROAD Dt Inlet — '1. dd/ Septic /A 26 / _ Dt Bottom /I(• 3S �,(. •72_ Dosing / J, / / Header/Man. SAi NId•-- Za 1 3,c, /01 , f5 Aeration Dist. Pipe 3 � T�6!, of S • Holding Bot.System Li.3(9 /4:5. 7.7 Final Grade PUMP/SIPHON INFORMATION Z-Cp /CZ •5 S Manufacturer 61;, Demand St Cover G 001 , GPM ir. I (�p�.t�1 7' 6 /Zee I S Model Number iC n 65 4/•�� `C Go o f-- s . rs /aa , TDH ILi?4,73 Friction L s. System Head TDs H.b• 01.- - Forcemain Le g Dia. Dist.to _ /� _ Z SOIL ABSORPTION SJSTEM BED/TRENCH Width Length No.Of Jjenches PIT DIMENSIONS No.Of Pits Inside Dia. 'Liquid Depth � DIMENSIONS / e �...._ SETBACK SYSTEM TO P/L / BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type OfM� 69 f� AJ� UNIT Model Number: DISTRIBUTION SYSTEM N Header/Manifoy if Distribution 2 // x Hole Size x Hole Spacing / Vent r Intake Length 3 Dia Length Dia •,z 3 Spacing 3 / 3• zoo SOIL COVER / x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of ^, xx Seeded/S•dd-• xx Mul ed Bed/Trench Center Bed/Trench Edges` Topsoil 143' " /� 7 ) Yes No Yes El No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: // / 22r/.3 Inspection#2: / / Ffc6f-- ) �~ ei Location: 643 Cobblestone Court,Hudson,X111 54016(NE 1/4 NW 1/4 32 T29N R19 Windsor gN 1st Add Lot 1 Parcel No: 32.29.19.2864 1.)Alt BM Description= �Q �r if/ tost: ....,* a 2.)Bldg sewer length= 24 -amount of cover= / 61f` i Plan revision Required? Yes No 15.4/_Ii7S ■Use other side for additional informa o ' 2 �� _ _ _-_I SBD-6710(R.3/97) Date Insepctor-` ignature / Cert.No. 1 5=5./eda%ua.‘'o,-,pi6 A Ex. & f!rust e%►l • ,Locu cd/o,-,:l.sepfe C, g,, N _sc.& c.u /oroP. C ' � 0 G Co66/e.-C .40.63/, /0/ae ofu ,-„ciso,-,fie 5‘..-W/2&"75/,Sec.32, 7:-Z-9/i., IQ,/9942, T. •/uo/$Q?3E•Cr ,r6,, 0/ 11/ 2 21/ / ' i 1 /. #0.26-/W8-3/-ceo / / --/-z) 0/4°5 'Arid C...cl-de-sac-, C.61, .SEcne Crt. AM.. d,if,'T,o of/off 56a4. Fief=9i..ge Propose..,” Mou..-td Q,E Eicsk//3.99' • 101,C0'L'a.e6ok.- w/to se/oo'd.'s.crse:/ Ce 1. Foa-r'60 ■ d i y o-r.i x.6 1 7 4-,At -a-1 5 4'&I%d•r y9.,2S'- W/%y°o+",'(-cei5 acedaZ.o%' r I� X'nvN6 a_(e.d-or/QVera./s c�be ia0.6q 6 /, p • r o PrdPo3C-d LAY-11 I • I /oca-6'un i ° <... ° 9- if �` /6FP 2a.a9e 1-. c -V ! d e. 3 ja/`ccniarn{F+ •, I 4^ ys-E� -., be a,YCa ua t d J' ///r"bt c,tie-e r t 9 99,67, t _ -n Proposed t gbcdra., \t , a t`t - 8Z kes,d�Ke . IS a . •9 t j t C � Vice' Prcpo"-c1 uirc.ser Caicre,Ee ttt El •�, `` .4 .6111.° 01° (-1.-)1.--P 4.240/850 . aP �,.,b.n. Y 5.27/P.6.. w/po/Lo,E1 p[-5,25 ► P/o ed 50E-g,r, .. CFf/uen66/�Qya ts.T.ouz`/a2`. _ OW' ue 3E'SSY' ` /4S � Sudci t1.L =/e4.e ' p a of 9 ■ fop urrArA. County _�` Safety and Buildings Division 3T 6/1-0-64-- s „l ,4' < 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) Madison,WI 53707-7162 r \o 7 27 q Sanitary Permit Applicati ..2 PAID State Transaction Number In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to •'Iv•.propriate governmental unit 2.03330<-(7 is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary / purposes in accordance with the Privacy Law,s.15.04(1)(m),Stats. °v Y.3 I. Application Information-Please Print All Information s ``' C r Property Owner's ame ',a 1✓ Parcel# ��k �® o - / Y� -3/-6640 Property Owner's Mailing Addre s T 2.614� Property Location ',,.c0,,�lr� Govt.Lot 0 2 i(lo,/-0 City,State ��,, �^ r Zip Code / / rPhone Numbctr p 5 t-Lt 1/4, ,m-)4/4, Section 3 GR M O-d1/2 e" t � t.t� c C/L r0 4/2 -5- ?p - b 6 3 / cle ne T (77/ N; R l E o o R.Type of Building(check all that apply) Lot# X1 or 2 Family Dwelling-Number of Bedrooms 3/ Subdivision Name . ,a/Yhit-44/ IVA Block# /7j;,/,/4- / 7 ❑Public/Commercial-Describe Use A.4. - "� G./ / ❑ City of CSM Number ❑ Village of ❑State Owned Describe Use ATown of /74 III.Type of Permit: (Check only one box on line A. Complete line B if applicable) A. )('New System ❑Replacement System ❑Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) List Previous Permit Number anoi Date Issued B. ❑Permit Renewal ❑ Permit Revision Change of Plumber '❑Permit Transfer to New 53t-74v0 5/ / 2d J/ Before Expiration Owner 5 IV.Type of POWTS System/Component/Device: (Check a 1 at ap ly) '��' 4747z 3/Z f 3 ❑Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade XMound>24 in.of suitable soil ❑Mound<24 in.of suitable soil ❑Holding Tank ❑Other Dispersal Component(explain) / n/�i❑Pretreatment Device(explain) 'IA V.Dispersal/Treatment Area Information: 6'/X A /O/V3 121 Ca - 601./ / /Oa. /D Design Flow(gpd) Design Soil Appli ation Rate(gpdsf) Dispersal Area Requir (sf) Dispersal Area Propos d(sf) System Elevation 0© ,GIl / o o-4 157440- ‘, © /0O ) ‘ 00/203 foe, . G a VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units w o '°'' . ° L o U y_ _w New Tanks Existing Tanks d / a U 'vs y y — 0. Septic or Holding Tank , /aoo / Dosing Chamber '©0 �. 8,o VIL Responsibility Statement- I,the undersigned,assume ponsibility Ilati 1. of the POR TS�6own on the attached plans. Plum (P nt) I / / Plumber' :`ii: - J'i — ����"DRS Number Business Phone Number . oC •0.35--? 7/5- '- 760- 09 Plumb 's Address(Str City,State,Zip Code) .County/Department Use Only Approved ❑Disapproved Permit Fee r<"e77 Date Issue ring Age t Signatur ❑ Owner Given Reason for Denial gs 11/ 'It 3 . IX.Conditions of Approval/Reasons for Disapproval n saw l a-4t,� <<,,l( 14: s -- -2s'i Vh es Gwufi n... 6 � wla�•.4 k 10 Acute 042A- 44m4.0-1- V S xi er vii, Q i 2 y A o cmpl las o a sy V /ans mC nly only on per not less 8 4 12 z 11 in es in size SBD-6398(R. 11/11) `/_a,? -/J' DIVISION OF INDUSTRY SERVICES `(../y3 OE 10541 N RANCH ROAD { p.RTA,fpN, � � HAYWARD WI 54843 d S '� �� �D �� Contact Through Relay p www.dsps.wi.gov/sb/ 9 A ',' ` it 3© F www.wisconsin.gov 4,0 ssrer P�' Scott Walker,Governor Dave Ross,Secretary November 20,2013 CUST ID No. 220357 ATTN::POWTS Inspector BRADY J UTGARD ZONING OFFICE UTGARD PLUMBING&BEATING ST CROIX COUNTY SPIA PO BOX 413 1101 CARMICHAEL RD AMERY WI 54001 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/20/2015 Identification Numbers Transaction ID No.2333047 • SITE: Site ID No. 797770 Mark Johnson Please refer to both identification numbers, 643 Cobblestone Ct above,in all correspondence with the agency. Town of Hudson St Croix County SW1/4,NE1/4, S32,T29N,R19W FOR: CONDI Description:Mound,4 bedroom residence Object Type:POWTS Component Manual Regulated Object ID No.: 1459262 APP Maintenance required; 600 GPD Flow rate; 50 in Soil minimum depth to limiting factor from original grade; Syst (Ls�T OF Mound Component Manual-Ver.2.0,SBD-10691-P(N.O1/01,R. 10/12),Pressure Distribution Component Mao FESSIO Ver.2.0, SBD-10706-P(N.01/01,R. 10/12),SSWMP Pub.9.6; Effluent Filter DIVISI• . fai.i The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructs d and located in accordance with the enclosed approved plans and with any component manual(s)referenced above. The owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code �' SEE COR• 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: Key Item(s) • 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. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(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 per Mound Component Manual. • Materials shall conform to the requirements of SPS 384.10.No fixture,appliance,appurtenance,material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system,unless it BRADY J UTGARD Page 2 11/20/2013 is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • Maintain well and waterline set backs per SPS 383.43(8)(i).Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. 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 Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building,structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 Fee Received$ 250.00 Balance Due $ 0.00 Patricia L Shando .................._...................._................................................... POWTS Plan viewer Integrated Services WiSMART code:7633 (715)634-780, Fax 715)634-5150,M-F 8:00 a.m.-4:45 p.m. pat.shandorfa i .nsin.gov cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services(formerly Safety&Buildings)will be modified. Code references with prefixes starting with"Comm"have been replaced with "SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety&Professional Services.Additionally,all IS(formerly S&B)codes have been renumbered and addressed in a"300"series. For future reference,the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. i MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: MARK JOHNSON Owner's Name: MARK JOHNSON Owner's Address: 1301 COULEE RD.HUDSON WI. 54016 SITE ADDRESS 643 COBBLESTONE CRT. HUDSON WI. 54106 Legal Description: SW/NE/SEC. 32/T 29!R 19W Township: HUDSON County: ST.CROIX Subdivision Name: WINDSOR HEIGHTS 1ST.ADDITION Lot Number: 31 Block Number. N/A TIONALLY Parcel I.D. Number: 020-1448-31-000 ROVED • SAFETY AND Plan Transaction No.: NAL SERVICES Page 1 Index and title )USTRY SERVICES Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank -� Page 5 System maintenance specifications ESPON CE Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 PLOT PLAN _ Page 9 soil test 2, j �7 C_ (-i7 Designer. BRADY UTGARD License Number: 220357 Date: 11/121 ,.�„�_ �./ Phone Number. 715-268-6995 Signature: ,, AWA& Designed Pursuant to the Mound Component anal 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 3.11 (R. 06/01) Page 1 of 9 Mound and Pressure Distribution Component Design Site Information R Residential or Commercial Design Note: Sand fill(D)calculations assume a 400.00 Estimated Wastewater Flow(gpd) Table 83-44-3 in-situ soil treatment for fecal 36 1.50 Peaking Factor(e.g. 1.5= 150%) `oliform of<= inches. 600.00 Design Flow(gpd) 2.00 Site Slope(%) 100.10 Contour Line Elevation(ft) 50.00 Depth to Limiting Factor(in) 0.80 In-situ Soil Application Rate(gpd/ft2) Distribution Cell Information 100.00 Dispersal Cell Length Along Contour(ft) = 6.00 Cell Width(ft) 1.00 Dispersal Cell Design Loading Rate(gpd/ft2) 1 Influent Wastewater Quality(1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? C Center or End Manifold 1 3.001 Lateral Spacing(ft) If N above,enter the elevation(ft) 4 Number of Laterals of the highest point. 0.188 Orifice Diameter(in)(e.g. 0.25) 3.00 Orifice Spacing(ft)= 9.38 ft2/orifice 2.00 Forcemain Diameter(in) 90.00 Forcemain Length(ft) Does the forcemain drain back? Y 93.00 Pump Tank Elevation (ft) 3.25 System Head(ft)x 1.3 14.68 Forcemain Drainback(gal) 7.35 Vertical Lift(ft) 62.81 5x Void Volume(gal) 3.24 Friction Loss(ft) 77.49 Minimum Dose Volume(gal) 13.84 Total Dynamic Head(ft) 41.94 System Demand (gpm) Lateral D_ iameter Selection I Manifold Diameter Selection I in. dia. options 1 choice in. dia. options 1 choice 0.75 1.25 1.00 1.50 x 1.25 x 2.00 x 1.50 x 3.00 2.00 x 3.00 x Gallons/Inch Calculator Treatment Tank Information 800.64 Total Tank Capacity(gal) 1200.00 Septic Tank Capacity(gal) 36.00 Total Working Liquid Depth(in) WIESER Manufacturer 1 22.241 gal/in(enter result in cell B49) Dose Tank Information Effluent Filter Information 800.64 Dose Tank Capacity(gal) POLYLOC Filter Manufacturer 22.24 Dose Tank Volume(gal/in) PL-525 Filter Model Number WIESER Manufacturer Project: MARK JOHNSON Page 2 of 9 Mound Plan View • ____,, J ". . . . . . . . . . . . . . . . . . . . . . . . . — K . . . ....... _ . . . . . . . • " A • • . 0 B - - - - . . . . . . . . . . • • " • • • w • " 1... . . . ............ - 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...-...................-.........-.........-.-.-.-.....-.-.-.-.-.-.-.-. - • • • • . • • • - . • • - • • • • - - • • - • - • • • • • • • - - • - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • ......•.•...•.•.........-.•.•.•.•.•.-.•.•.•.-.•.•...•.•.•.•.•.•.-.-.•.•.•.•.• •-F- -t----I • L • Mound Component Dimensions A 6,00 ft E 7.44 in H 1.00 ft K 6.99 ft B 100.00 ft F 9.25 in 1 6.03 ft L 113.99 ft D 6.00 in G 0.50 ft J 5.01 ft W 17.05 ft 600.00 (ft2) Dispersal Cell Area 1203.46 (ft2) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate . 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.37 (ft) --÷ .e Me..... ,z.„ El,„„-/i,"""/"Pe ->) , G I H F :::.:-:.: .•: :•::::::: Dispersal Cell : ::::::::::: 101.10 (ft) Lateral 100.60 (ft)–* — ..:.•::: :::::::: - ::::::::::::: - : Invert . . .. -..:-:::: :: :-:::::-:-:.:.:. - •:-:•:.:.:-:- -:.. Dispersal Cell 0 Elevation ::;::':;:iii:::: iii::::.:. :::::.;:.:::: : :" D :•.•.::;::ilal :::::::: ::.. .-.........•.•....: :-: :•:•:1: ::::::::::::::::1: :::::::::::.: ::::::::::::::. ..::::::;;;:-.:::::.:::::: ::::.::::- -: :::::-:-:.:-:-:- . -----------• ---. — - • — ' 411 100.10 (ft)Contour Elevation 2.0 % Site Slope Geotextile Fabric Cover Shading Key .0 0 O .a. –lr-- Dispersal Cell See lateral details on El I 1 Topsoil Cap z . o 1.5 ft -7- Page 4 for number,size, [2] Mia Subsoil Cap To 0 El and spacing of laterals. li 1 a ralha E] Min ASTM C33 Sand ,.43 E , -+-0.5 ft F Laterals are equally I Tilled Layer Typical Lateral spaced from the 11 Aggregate 5. 2 -AL— El ...i... distribution cell's centerline in the * o 0---A--II distribution cell(AxB). Project: MARK JOHNSON Page 3 of 9 Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at an point. Laterals are identical or is 1< P I s • • j-C=Turn-up vdball valve or x-41/n xi241 Laterals&force main of PVC Sch 40 S cleanout plug per COMM Table 84.30-5 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.188 in Lateral Diameter 1.25 in Orifice Spacing(X) 3.18 ft Lateral Length (P) 49.29 ft Orifices per Lateral 16 Lateral Spacing(S) 3.00 ft Orifice Density 9.38 ft2/orifice Lateral Flow Rate 10.49 gpm Manifold Length 3.00 ft System Flow Rate 41.94 gpm Manifold Diameter 2.00 in Total Dynamic Head 13.84 ft Forcemain Velocity 4.28 ft/sec Dose Tank Information Locking cover with warning label and locking device and l-----_ sealed watertight Electrical as per NEC 300 and --► i Comm 16.28 WAC 4 in.min. J Disconnect Tank component is properly vented �. ❑ g <-- Alternate outlet P location I r Forcemain diameter WIESER Manufacturer ■11:: • Q 2 in. Capacity 800.64 Gallons —ip- Volume 22.24 gal/inch A Weep hole or anti- Dimension Inches Gallons B U siphon device A 21.52 478.51 i B 2.00 44.4$ d Pump off elevation(ft) 1 C 3.48 77.49 - �— I 93.75 D 9.00 200.16 D 1 Total ( 36.001 800.64 ,,Dose tank elevation(ft) ,..) 3" Bedding un er tank. "- ( 93.001 Alarm Manuafacturer LEVEL Alarm Model Number DLV Pump Manufacturer GOULDS Pump Model Number EPO5 Pump Must Deliver I 41.94Igpm at ( 13.84Jft TDH Project: MARK JOHNSON Page 4 of 9 • Mound System Maintenance and Operation Specifications Service Provider's Name UTGARD PLUMBING Phone 715-760-0946 POWTS Regulator's Name ST. CROIX Phone 715-386-4680 System Flow and Load Parameters Design Flow-Peak 600 gpd Maximum Influent Particle Size' 1/8 in Estimated Flow-Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 ml Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test monthly 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 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: MARK JOHNSON 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 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s.281.48,Stats. The contents of the septic tank shall be disposed of in accordance with NR 113,Wis.Adm.Code. The operating condition of the septic tank and outlet fitter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment,maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However,if such products are used they shall be approved for septic tank use by the Department of Commerce. Puma 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 Pu P( �) be 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 mounds 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 BOD5,150 mg/I.TSS,and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5,30 mg/L TSS,10 mg/L FOG,and 104 du/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 pending. Pending levels shall be reported to the owner,and any levels above 6 inches considered as an impending hydraulic failure requiring additional,more frequent monitoring. Cortinaenty Ptan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank,pump,pump controls,alarm or related wiring becomes defective the defective component(s)shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface,it will be repaired or replaced in its'present location by increasing basal area if toe leakage occurs or by removing biologically dogged absorption and dispersal media,and related piping,and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project MARK JOHNSON Page 6 oflk ��4x -r Gt�ULDS PUMPS` ' Submersible . . Effluent Pump VW 4 MODEL 3`7I EPO4 & Ep05 .... • Series ......................._.........._.......__................................................................._........__..........._........._............_......... APPLICATIONS •Fully submerged in high ■EPOS Impeller:Thermoplas- ■Bearings:Upper and lower • Specifically designed for the gr turbine oil for tic endosed design for heavy duty ball bearing following uses; lubrication and efficient improved performance. heat transfer. construction • Effluent systems ■Casing and Base:Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms st! riot strerf • Heavy duty sump �.Auto- 9 and corrosion Standards&ssorirt,on P math models include resistance. • Water transfer Mechanical Float Switch SP r it tx3asa9 • Dewatennq assembled and preset at the for Motor heat sfer,iron Registered Goulds Pumps es ISO 9001 SPECIFICATIONS factory. strength,and durability. ■Motor Cover:Thermoplastic •Solids handling capability: FEATURES cover with integral handle and °/$°maximum. EPO4 Impeller float switch attachment points. •Capacities:up to 60 GPM. tic semi-open • n with s' ra Power Cable:water Severe duty •Total heads:up to 31 feet. rated oil and wafer resistant. •Discharge size: 1'h"NPT. pump out vanes for r►dedtanical seal protection,•Mechanical seal:carbon- rotary/ceramic-stationary, Q BUNA-N elastomers. •temperature: 104'F(40"C)continuous 40 --(60'c)intermittent. METERS FEET fasteners: 300 series 10- ; r stain!€ss steel. t 1 •Capable of running 9` �o — 1 I --1- ;fry without damage to - , 1 ;nmponents H 25 " i _ L. t--.-_72:0,T :• C1 7 ! • Motor: (- _ i 1 •EP04 Single phase:0.4 HP, u 6" 20' , 11 S or 230 V,60 Hz, 1550 RPM, built in overload with r automatic reset. 15; •EPOS Single phase:0.5 HP, e- L" v ;; ,115 V or 23OV fO Hz. 1550 " :3' t u . ,HPM, built in overload with , EPOa automatic reset. _ •Power cord. 10 foot i 5 standard length, 16/3 I _ SJTW with three prong grounding plug. Optional 20 0- ° to 20 3t1 o GPM foot length, 16/3 55.11-W W with ' r as three prong grounding plug L-_ --_,c.--- (standard on EPOS) > 2 a 6 a in it mVh CAPACITY /r G1 p n ./\ y Goulds Pum (;err , k tr6,.r;a0 rriy. ,0"01 4rt1 ITT Industries .:4?'''' ■ So,/ea/uac.o„p, A EX/Z7&li 47rezde e%►t • .Lca { �. o ti. 56216 ' 4 ,cad_ . Lj .,, 4,K#X80 , ii O6 Co66/cs6o4e G1-• Lc-63/ /4/4e o(e .77-4/s9-f ( Sc..)r /IE/`S/StC.32, T.29/t, I IQ./964)., T.o!',[k,alSori 56-C-rb:‘ai c..)f. fJc.l. #o20-/WS-3/-42 . / f i I 97 1 c_„.,_de-.5A.c.. Cobh .56,,,eert. Ate.. d.ril.:Too ofe/off SEa4. E/ee=9d B ' / 0 ' t � iC 64 ■ ' u toropos,d ! 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Washington Ave., P.O. Sox 7162 Sanitary Permit Number (to be filled in by Co.) P $ Madison, WI 53707-7162 A` r as Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the applopriate governmental unit 1932394 l/ is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used rs-r 6ond7 purpos es in accordance with the Priv Law, s. 15.04 1)(m , Stats. 643 Cobblestone Crt. L Application Information - Please Print All Information Property Owner's Name V < 9~ Parcel # Mark & Sarah Johnson 020-1448-31-000 Property Owner's Mailing Address "W" 'k Location 43 Stone Harbor Place Govt. Lot City, State Zip Code Phone Number SW NE _'/e, section 32 ( Hudson, WI 54016 381-128 circle o (715) T 29 N; R 19 E or r W II. T pe of Building (check all that apply) Lot # or 2 Family Dw^ellwing/ - Number of Bqd ms T 4 31 Subdivision Name ~!{'YI,Q. G~ ~-rse Block # Windsor Heights 1" Addition D Public/Commercial - Describe Na ❑ City of D State Owned - Describe Use CSM Number U Village of Na VTown of Hudson III. Type of P rmit: (Check only one box on line A. Complete line B if applicable) A" ew System D Replacement System D Treatment/Holding Tank Replacement Only D Other Modification to Existing System (exPlain ) B• Permit Renewal D Permit Revision D Change of Plumber M YCmlit Transfer to New List Pree~vious Permit Number and Date Issued Before Expiration Owner s 3 0 74 6+ 55 k e-o/ 5 IV. Type of POWTS System/ComponentlDevice: (Check all that apply) D Non-Pressurized In-Ground D Pressurized In-Ground D At-Grade ound > 24 in. of suitable soil D Mound < 24 in. of suitable soil D Holding Tank D Other Dispersal Component (explain) D Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Pol Lok PL-525 effluent filter Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 600.00 Gpd 1.0 Gpd/Sq, Ft. ASTM-C33 600.00 sq. ft. 600.00 Sq. Ft. 100.60 @ 6" above sand fill - 0.6G d native soil 100.10' contour VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units / New Tanks Existing Tanks Y ` V on ~ vi w C7 is. Septic or Holding Tank 1,200 Na 1,200 1 Wieser Concrete X Dosing Chamber 800 Mt, 800 Combination ST/PC VII. Responsibility Statement- I, the and reigned, ass responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' Signature MP/MPRS Number Business Phone Number James K. Thompson 3'--- MPRS 30021 715 248-7767 Plumber's Address (Street, City, State, Zip C 340 Paulson Lake Lane, Osceola, WI 54020 VIIL un epartment Use Only pproved D Disapproved Permit Feed Date Issued Issuing ene ❑ Owner Given Reason for Denial 3 13 IX Conditions of Approval/Reasons for Disapproval ,a r , `I r SYSTEM OWNER: C h /V G'l~ - / 1. Septic tank, effluent filter and /J Iv e fist, dispersal cell must bra .;zety.L~c~l maintained J~C,II as per management plan provided by plumber.S 2. All setback requirements must be maintained bs for the system and submit to the County only on paper not less than 81/2 x 11 inches in size SBD-6398 (R- 11/11) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mark & Sarah Johnson Mailing Address 43 Stone Harbor Place, Hudson WI., 54016 Property Address 643 Cobblestone Crt., Hudson, WI. 54016 (Verification required from Planning & Zoning Department for new construction.) City/State Hudson, WI., 54016 Parcel Identification Number 020-1448-31-000 LEGAL DESCRIPTION Property Location SW 1/4 , NE 1/4 , Sec. 32,T 29 N R 19 W, Town of Hudson Subdivision Plat: Windsor Heights 1 st Additon , Lot # 31 Certified Survey Map # NA , Volume NA , Page # NA Warranty Deed # qj ) qrt (before 2007)Volume , Page # Spec house ClyesEho Lot lines identifiable Elyesono SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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 §SPS. 383.52(l) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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 Safety And Professional Services 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 Planning & Zoning Department within 30 days of the three year expiration date. 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. Number of bedrooms 4 SI ATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) State Bar of Wisconsin Form 6-2003 $ T1 2 9 5 0 x:4 04414 7 SPECIAL WARRANTY DEED 972489 Document Number Document Name BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED, made between First Bank of Baldwin 02/01/2013 12:36 PM EXEMPT#: NA REC FEE: 30.00 ("Grantor," whether one or more), and Mark R. Johnson and Sarah L. Johnson, TRANS FEE: 180.00 PAGES: 1 husband and wife as survivorship marital property ("Grantee," whether one or more). Grantor for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in Recording Area St. Croix County, State of Wisconsin ('Property") (if more space is Name and Return Address needed, please attach addendum): ~O yN~g LOT THIRTY ONE (31), WINDSOR HEIGHTS 1ST ADDITION, TOWN OF HUDSON. V-3 3583 020-1448-31-000 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 arising by, through, or under Grantor, except: easements, restrictions, and rights of way of record, if any. Dated ,Q First Bank of Baldwin SEAL SEAL * * By: Steven H. Perry, President (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF ) ss. authenticated on , e4 .U Y COUNTY) stag ofj cb/irRS0# Personally came before me on n * ~OSiq the above-named Steven H. Perry, President TITLE: MEMBER STATE BAR OF WISCO.NSIN- (Ifnot, t°'"`' y. to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 70C, instrume tt nwledged the ame. THIS INSTRUMENT DRAFTED Maxfield E. Neuhaus - Attorne at 'w Notary Public, State of VVI: River Falls, WI 54022-0138 = r My commission (e p muauc 4(expires: a , z ) (Sign ores nay be'authPnlicated:or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDA FORM.: t1.pi,Y MODIF} TION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. SPECIAL WARRANTY DEED y a 02003 S, X, AR OF WISCONSIN FORM NO. 6-2003 *Type name below signatures. . + INFO-PRO- www.infoproforms.com Abbli. commerce.Wi.gov Safety and FA~Winjhvivision County 201 W. Washin Bo7 62 St. Croix i sco ns i n Madison, WI 370 - 2 Sanitary Permit Number (to be filled in by Co.) Department of Commerce 538,2400 late Sanitary Permit Applicat on RECEIVE[ 1932394aolionNnmber In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this fo to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application fo s for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you pro de maAPJ?us0ir~s~gcpdary 643 Cobblestone Crt purposes in accordance with the Privacy Law, s. 15.04 1 m , Slats. L UU ~I 1. Application Information - Please Print All Information ST. C Property Owner' e PLANNING & ZONING OFFICE Parcel # 020-1448-31-000 Scott Wan Property Owner's ailing Address Property Location 55 Robin Lane Govt. Lot City, State Zip Code Phone Number NE'/a,SW'/<, Section 32 Hudson, WI 54016 715-781-2501 (circle one) IL Type of Building (check all that apply) 61-1 Lot # T 29 N; R 19 W ®1 or 2 Family Dwelling -Number of Bedroo s 4 Subdivision Name 31 Windsor Heights 0 Addition P1a~ ock# ❑ Public/Commercial -Describe Use Na City of ❑ State Owned - Describe Use / /4,4 J CSM Number ❑ Village of & X G&. Na ® Town of Hudson III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ® New System ❑ Replacement ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) ` System B. ❑ Permit ❑ Permit Revision ❑ Change of ❑ Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner Expiration / - / I - W. Type of POWTS System/Component/Device: Check all that apply) O v~ oa 7' /UU - ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade N Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment evice (explain) V. Dispersal/Treat ent Area Information: G Design Flow (gp Design Soil Ap ation Rate(gpdsf) Dispersal Area Require sf) Dispersal Area Propose System Elevation 600 1.00 600.00 sq. ft. 600.00 sq. ft. 100.60'@ 6" above (0 120' 100.10' contour VI. Tank Info Capacity in Total # of Manufacturer w Gallons Gallons Units F o w U New Tanks Existing Tanks Q~ Uo F w a 1'n/ /'dl ~ofz S25 Z ¢ a Septic or Holding Tank 0 1 1200 1 Wieser Concrete ® ❑ ❑ ❑ ❑ Dosing chamber 0 00 800 1 Wieser Concrete N ❑ ❑ ❑ ❑ VII. Responsibility Statement- I, the and igned, assiup~ respo ibility for !2a . n of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' Sign MP/MPRS Number Business Phone Number ~7 I James K. Thompson 30021 (715) 248-7767 Plumber's Address (Street, City, State, Zip Code 340 Paulson Lake Lane, Osceola, WI 54020 VII Coun /De artment Use Only Permit Fee ,XApproved -rDisapproved Date sued Issuing A Signature _ ne eason for Denial $ / 7 J~ GU Z IX. Condit &W (Reasons for Disapproval 3, Go ; or~5 ``n Sv'a e a.r', 1. Septic tank, eMubnt filter and dispersal cell must all be services / maintained - 4115 2.: AN sdr management lan provided by plumber. / 1.C2 ~4 !M t 7 c5 / (1 ci 1 1 C✓1 G~ requirements, must be maintained a: ps.ppio" code / cfdinances. a a.ti 12 , Attach to complete plans for the system and submit to 7,0147falS Cty only paper not less than 81/z x 11 inches 'n size oto pe_ /I d ~ ,~-~.Q. rya . SBD-6398 (R. 01/07) Valid thlu 01/09 Safety and Buildings 3824 N CREEKSIDE IA commercem.gov HOLMEN WI 54636 Contact Through Relay isconsin www.commerce.wi.gov/sb/ www.wisconsin.gov Department of Commerce Scott Walker, Governor Paul F. Jadin, Secretary April 25, 2011 CUST ID No. 30021 ATTN: POWTS Inspector JAMES K THOMPSON ZONING OFFICE A.C.E. SOIL AND SITE EVALUATIONS ST CROIX COUNTY SPIA 340 PAULSON LAKE LN 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/25/2013 SITE: Identification Numbers Scott Wang Transaction ID No. 1932394 643 Cobblestone Court Site ID No. 766330 Town of Hudson Please refer to both identification numbers, St Croix County above,' in all correspondence with the agency. SWIA, NEIA, S32, T29N, R19W Lot: 31, Subdivision: Windsor Heights 1 ST Addition FOR: Description: Four Bedroom Mound System / 2% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1310971 - ` Maintenance required; 600 GPD Flow rate; 50 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD-10691-P (N.01/01), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01/O1); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed ROM and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code CU7Zdt'h requirements. A 9.2 F'h P No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, DEPARTMENT 01 stats. DIVISION OF SAFETY The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders SEE CORE-,' SF • 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. • 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. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. The section of force main located within this area shall be installed in a trench no wider than 12". • 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. RECEIVED MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN APR 18 2011 Residential Application INDEX AND TITLE PAGE SAFETY & BUILDINGS Project Name: Scott Wang 4 bedroom residential mound Owner's Name: Scott Wang Owner's Address: 55 Robin Lane Hudson, WI 564016 Site Address: 643 Cobblestone Crt., Hudson, WI 54106 Legal Description: SW1/4 NE1/4, Sec.32, T.29N., R.19W. Township: Hudson County: St. Croix Subdivision Name: Windsor Heights 1st Addition Lot Number: 31 Block Number: Na •T.S. ~nally Parcel I.D. Number: 020-1448-31-000 )VED Plan Transaction No.: COMMERCE AND 8t/1LDIN(iS Page 1 Index and title Page 2 Data entry Page 3 Mound drawings DPage 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Attached soil evaluation report Designer: Thompson License Number: 30021 Date: 04/12/1 Phone Number: (715) 248-7767 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) Version 5.1 (R. 06/06) Pagel of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) 10~ Residential or Commercial Design Note: Sand fill (D) calculations assume a 4Estimated Wastewater Flow (gpd) Table 83-44-3 in-situ soil treatment for fecal coliform of - 36 inches. Peaking Factor (e.g. 1.5 = 150%) 600.00 Design Flow (gpd) 2.00 Site Slope 100.10 Contour Line Elevation (ft) 50.00 Depth to Limiting Factor (in) 0.60 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 Y Pressure Disribution Information network? Enter Y or N (C or E) c I Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) 2.00 Estimated Orifice Spacing (ft) = 6.00 ftz/orifice 2.00 Forcemain Diameter (in) 90.00 Forcemain Length (ft) Does the forcemain drain back? L ' 93.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 14.68 Forcemain Drainback (gal) 7.22 Vertical Lift (ft) 62.76 5x Void Volume (gal) 3.14 Friction Loss (ft) 77.44 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 41.19 System Demand (gpm) 16.86 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x x 1.00 1.50 x 1.25 x x 2.00 x 1.50 x 3.00 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information 800.64 Total Tank Capacity (gal) 1200.00 Septic Tank Capacity (gal) 36.00 Total Working Liquid Depth (in) Wieser Concrete Manufacturer 22.24 gal/in (enter result in cell 1349) Dose Tank Information Effluent Filter Information 80_0.64 Dose Tank Capacity (gal) Pol Lok Filter Manufacturer T22.24 Dose Tank Volume (gal/in) PL-525 Filter Model Number Wieser Concrete Manufacturer Project: Scott Wang 4 bedroom residential mound Page 2 of 9 Mound Plan and Cross Section Views T 1/10 B ::::::::::.:.:.:.:•:•:•:•:•:•:•:•:......................J ♦ Observation Pipe K ffs•:f:f:::r::.;f.:::.;.f.s:r.f.r.;;.x:.f: ,L ;L•• L L L••. ;ti•L.L L L;L.L L L L•L•L• :i}r:: rj: : : r r r r } r f•f.f •r?r,•'r:r: A ;fy•. ~~.f:( tip. ~L:y;..1.11 5 L;ti ;t ti:1.. ::...ti.ti ;'..ti:ti.ti•ti.5~.ti.1.`..ti L• L• L•L•~•L.L L.•. L.L ..L: S.. L.L.L.L.L.L•L.L: L.L.L. r.r.r.r.:.r.r.i.: .:.r.r.r..•.r.: .:•r•:.: .::r: '..L•L•5••.••.•S•S•L•L•L•L.L•L•ti:1•L•L•L•L•L•L•L•L•L•L•L•L•L•L•L•L•L L•L•y.•L _ W .l. l . B I . i L Mound Component Dimensions A 6.00 ft E [Aft in H ft K A17.05 ft B 100.00 ft F in z ft L ft D 6.00 in G J 5.01 ft W ft 1 600.00 (ft2) Dispersal Cell Area 1203.46 (ft) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.37 (ft) ♦ H G 1 I 101.10 (ft) Lateral F Dispersal Cell 100.60 (ft)---O- - Invert Dispersal Cell Elevation : D Q 4~' AI 41L ~1~ 100.10 (ft) Contour Elevation 2.0 % Site Slope Geotextile Fabric Cover -0 4) Shading Key Q Dispersal Cell See lateral details on 10 ® Topsoil cap ii 1.5 ft Page 4 for number, size, r.r•:•:•r :•r•r•:•r r r r O ~ •ti.1•L.L.L.L.{.L.L•L.L.L.'..'ti.4 •f.:.:.r.:•:.:.:•r.:•:•:.:.:. Q "Subsoil Cap N "c 1 M. f;1f L ; ~f1rtiti and spacing of laterals. n T? r f f ? f r r`f r Laterals are equally y(J ASTM C33 Sand `4 i° ftifti • L.•..•.••. L.•..L.•..L.L.L; .ti v C 0. ft T spaced from the Tilled Layer d f~.' yf~f~r F {~s:: pical Lateral of}r}}} H y.1•ti,X •ti•yy1•ti•yy•.•ti• L distribution cells yr{{y;y{; : r•{•r r•r•:•:•: • © lti,r;y,l;•,:r..; , Aggregate L L L.L.L••.•L.L.L ti er c ~titif};L ;LfLf}~L;L.tif:f:'.r.f•. centerline in the A distribution cell (AxB). Project: Scott Wang 4 bedroom residential mound Page 3 of 9 Center Connection Lateral Layout Diagram Force main connection via tee or cross to mar&oW at any point. Laterals are identioal P S Turn-upvdbsllvslveor IEX-+sl2 I x12 Laterals6Force main ofPVCSob40 cles noutpluq per COMM T" $4.30-5 Holes drWed on the bottom of the lateral Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.01 ft Lateral Length (P) 49.25 ft Orifices per Lateral 25 Lateral Spacing (S) 3.00 ft Orifice Density 6.00 ft2/orifice ' Lateral Flow Rate 10.30 gpm Manifold Length 3.00 ft System Flow Rate 41.19 gpm Manifold Diameter 1.25 in Total Dynamic Head 16.86 ft Forcemain Velocity 4.21 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and L Comm 1 6.28 WAC 4 in. min. Disconnect y Tank component is properly vented F- Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Capacityl 800.64 Gallons Volume 22.24 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 20.02 445.20 B 2.00 44.48 C P= ump off elevation (ft) C 3.48 77.44 93.88 D 10.50 233.52 D Total 36.00 800.64 IF Do♦ se tank elevation (ft) 3" Bedding un er tank. 93.00 Alarm Manuafacturer LevelArm Alarm Model Number DLV Pump Manufacturer Zoeller Pump Model Number BNJ52 Pump Must Deliver 41.19 gpm at 16.86 ftTDH Project: Scott Wang 4 bedroom residential mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name James K. Thompson Phone 715 248-7767 POWTS Regulator's Name St. Croix Co. Zoning Dep't. Phone 715 386-4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ft2 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 eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Ins ect for ondin and seepage once eve 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 Z75 Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral y. Project: Scott Wang 4 bedroom residential mound Page 5 of 9 Mound System Management Plan Pursuant to Comm...83.54, Wis. Adm. Code GenTeral 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), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the J 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 BOD6, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 104 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 ''?esAls above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continaencv 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 by 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, R 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. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. i Project: Page 6 of 9 PUMP PERFORMANCE CURVE MODEL 15111521153 TOTAL DYNAMIC HEAD/FLOW 5° PER MINUTE 14 45 153 EFFLUENT AND DEWATERING 12 40- MODEL 151 152 153 3s 10 152 , Feet Meten Gal. Ulan &f.- -11FOM Gal uws Oo \ 5 1.5 5o 189 69 261 77 291 o a 151 10 3.0 45 170 231 70 285 25- 15 4.6 38 144 53 201 of 231 7 20 6.1 29 110 44 187 52 197 t, 6 B 20 25 7.5 15 81 129 42 159 le 7-h. 30 9.1 23 87 33 125 /1'• ~ Ti7 36 10.7 zz 5s 40 121 11 42 2 Shu4o8 Head: 301E 9.1m 38 R (11.8111 44 R 3.4m) - NN Ota50eB 0 I I go -T i0 20 30 83.80 0 9 160 cainNS Y LITERS 0 b 80 1 0 1 3jo 311D FL PIER MINIM Model 151 Models 152 / 153 CONSULT FACTORY FOR If SPECIAL APPLICATIONS 67132 6,N 374 asra 37/I32 4!A Tinned dosing panels available. Electrical altemato s, for duplex systems, are available and supplied with an alarm. ~ 4374 32~Tru Variable level control switches are available for controlling s7n 327a2 single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Owik-Box available for outdoor installations. See FM1420. Over 130'F. (54'C.) special quotation required. 151/152/153 Series 1111/16 12tA 1511162J153 YODELS Control 8elecbon Yodel Volts Ph Yode Am Sfm lax Duplex l s 1/e N151 115 1 Nan 6.0 1 2 or3 aJA BN151 115 1 Auto 6.0 Included 2 or 3 E151 230 1 Non 3.2 1 2 or 3 BE151 230 1 &to 3.2 Included 2 or 3 sK2444 SK2054 N152 115 1 Non 8.5 1 2 or 3 BN152 115 1 Auto 8.5 Included 2 or 3 E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 to 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN153 115 1 Auto 10.5 Included 2 or 3 El 53 230 1 Nan 5.3 1 2 or 3 SELECTION GUIDE BE153 30 1 Auto 5.3 Included 2 a 3 1. Single piggyback variable level float switch or double piggyback variable level float 0 CAUTION witch. Refer to FM0477. An nc:auation of controls, protection devices and wiring should be done by a qualified 2. See FMO712 for owed model of Electrical Alternator E-Pak. .tensed etectnctan. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). 3. variable level oontrol sMch 10.0225 used as a control activator, specify duplex (3) or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO. P.O. BOX 18347 ~ O F:<' ' : I j• t, o Loukillillf, KY ca n@ Run 7 Manulachavrs of. SHIP TO: TO: 3649 619 Cana Run Road Loulsvrrla, KY 40211.1901 ® 1(502) 778.2731.1(800) 928-PUMP L79' Pia 51hC /Ygf hUpJAvww.zoeller.com PUMP CO FAX(602) 774.3624 ® Copyright 2004 Zoeller Co. All rights reserved. Pc), 7 o~ 9 a,(o., • ,Loca{~d~%]..5~ , 1QP~ X80 0 Gf~ C'o66/tst~i~ Sw`Il~~y ScC. 3.2 T. Z,pi(.~ rJC-/. #020-/W.9-3/-~ Cam!- de -S.c. ~ ~6/C ~On2 C~I't . -6. of/off SEa.~• ~lev_WBs!' proposes( MOLL.Id2~- {7.05X //3.99'"', /oG.m~Co•+1 w/to'x/ao'd.3,oc/sa! Ce.!/. Po, rCyr oCi3 fr~'6cc briv~ /a ~ra.Cscz'& IN X , r W/ ~Y 4or,"~YBJ 5,oacedaL2. o/' r ~ndKE a (ed oE` /Q FeraJs 60 5e rao.6o . P~oposc,d ~x!l r /o ca..6'v v o ~ L n /ooP i v o1 ~ be ¢sYCQ(ls~ ~ t ` 9967, n % % Pro p~ 5td 1 Qesdcrce. ~ ` a j kee S. ~ ~p, e, loo yL•o~ ~L- 5.25 ► Prop~'ed S~r3~~m `R eo 7- occtl-& PIN 36+5. Sf~' 9&~" 9~ O ZZ&2 lee ,4ssu.,,ed l~tW = /~.ca 9 R. 8 qe, t hA.I~ 2180 Wisconsin Department of Commerce SOIL EVALUATION REPOR Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 020-1448-31-000 Please print all information. Reviewed Datef/ Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). l~ x k ~ Property Owner RECENED Property Location Scott G. Wang Govt. Lot SW 1/4 NE 1/4 S 32 T 29 N R 19 W Property Owner's Mailing Address SEP 0 3 2009 Lot # Block # Subd. Name or CSM# 55 Robin Lane S EP 31 Windsor Heights 1 St Addition City State Zip Code,41 E City J Village e Town Nearest Road Hudson WI by &Z(715) 386-5801 Hudson 643 Cobblestone Crt. 1011 New Construction Use: &#I Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD I Replacement -J Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable Na General comments and recommendations: Site suitable for conventional POWTS wit 0.4 gpd/sq.ft. ' ading rate. System elev. = 96.00'. Replacement site requires mound with 6' san aced on 100.00 contour. Boring # J Boring Pit Ground Surface elev. 99.44 ft. Depth to limiting factor 84" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 1Oyr3/2 none sil 2fgr mvfr cs 2fm,1c 0.6 0.8 2 10-25 1Oyr4/4 none sil 2fsbk mvfr c%` 2f,lmc 0.6 0.8 3 25-34 1Oyr4/6 none grsl 2fsbk ds cw 2f,1mc 0.6 1.0 4 34-42 1Oyr4/6 none Is Osg dl gw 1vf,fm 0.7 1.6 5 42-64 7.5yr5/6 none s Osg dl ci 1vf,fm 0.7 1.6 6 64-84 1Oyr5/6 none sAfs/sl Osg/2msbk dl/dsh - 1vf 0.5 1.0 Horizon #6 consists of an unsorted mixture of soils dominated by 10yr5/6 0 sg s, also including 10yr4/6 0 sg Ifs & 10yr4/4 2msbk sl. Om 10yr4/6 Ivfs & limstone fragments observed at 84 - 92". Boring # J Boring 16 Pit Ground Surface elev. 100.20 ft. Depth to limiting factor >87" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 1Oyr3/2 none sil 2fgr mvfr cs 2fmc 0.6 0.8 2 12-28 1Oyr5/4 none sil 2fsbk mvfr cw 2fm,1c 0.6 0.8 3 28-37 7.5yr4/6 none ifs 1 msbk ds gw 2fm,1 c 0.5 1.0 4 37-60 1Oyr4/6 none s/Ifs 0 sg/1msbk dl/ds gi 11fm 0.5 1.0 5 60-87 1 Oyr4/4 none sl/Ifs 1 csbk/l msbk mfi - 1 fm 0.4 0.7 Horizon #4 consists of a mixture of s s dominated by Oyr5/6 0 sg s &10yr4/4 0 sg Ifs. Horizon #5 consists of a mixture of soils dominated by 1 r4/4 1csbk sl &1Oyr4/4 1msbk Ifs. * Effluent #1 = BODS> 30 < 220 mg/ and TSS >30 < 1 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg1L CST Name (Please Print) Signat . CST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 8/31/2009 715-248-7767 Property Owner Scott G. Wang Parcel ID # 020-1448-31-000 Page 2 of 3 73Boring # J Boring Pit Ground Surface elev. 98.79 ft. Depth to limiting factor 79" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-15 1Oyr3/2 none sit 2fgr mvfr cs 2fm,1c 0.6 0.8 2 15-27 1Oyr5/4 none sil 2fsbk mvfr Cw 2f,1mc 0.6 0.8 3 27-37 1 Oyr4/6 none gr sl 2fsbk ds cw 2f,1 me 0.6 1.0 4 37-50 1Oyr4/6 none Ifs Osg dl gw 1vf,fm 0.5 1.0 5 50-68 1Oyr5/6 none s Osg dl ci 1vfJrn 0.7 1.6 6 68-79 1Oyr4/6 none s/Ifs/sl Osg/2msbk dl/dsh - 1vf 0.5 1.0 Horizon #6 consists of an unsorted mixture of soils do Inc u in &sg &I Dyr4/4 2msbk sl. No Redox. concentrations foun OM 10yr4/6 Ivfs & limstone fragments observed at 79". jj~j Boring# J Boring Pit Ground Surface elev. 99.79 ft. Depth to limiting factor 50" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-15 1Oyr3/2 none sil 2fgr mvfr cs 2fmc 0.6 0.8 2 15-33 1 Oyr5/4 none sil 2fsbk mvfr cw 2fm,1 c 0.6 0.8 3 33-41 1Oyr4/6 none Ifs 1msbk ds gw 1fmc 0.5 1.0 4 41-50 10yr4/6 none s Osg/1msbk dl gi 1fm 0.5 1.0 5 50-63 1Oyr4/6 none slAfs Om/1msbk, dh - 1fm 0.2 0.6 Horizon #4 consists of a mixture of soils dominated by 10yr4/6 Om sl &10yr4/6 lmsbk Ifs. Mound system recommended for site to overcome Om sl. F-1 Boring # I Boring ~ Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 -S_30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) A.C.E. Sal & Site Evaluations f U ~ Scoff C. u~a.~ is ~ t 2.. ~-~'~2 ac~" lz~~ • - O Co66/est~ P /C' ` LAI C-u ..5. ~ Tv~✓ o~/off SEQ. E/ev' = 9B. 8Y.' / Gtl. 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W O W W W O CYI N 0 0 0 i O 111111411111 IIIII IIIII Illll IIIII 1111 111111 IIII IIII * 8 6 3 88 5 0 1 State Bar of Wisconsin Form 1-2003 863850 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number Document Name ST. CROIX CO., WI RECEIVED FOR RECORD 11/09/2007 10:00AH THIS DEED, made between James R. Dardine and Lisa J. Dardine, husband and WARRANTY DEED wife EXEMPT I ("Grantor," whether one or more), REC FEE: 11.00 and Scott G Wang TRANS FEE: 434.70 PAGES: 1 ("Grantee," whether one or more). - Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is Name and Return Address needed, please attach addendum): River Valley Abstract & Title, Inc. Lot 31, Plat of Windsor Heights 1 n Addition in the Town of Hudson, St. Croix 1200 Hosford Street, Suite 201 County, Wisconsin. Hudson, W154016 File #2696433 020-1448-31-000 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: Easements, restrictions, rights of way of record, if any. West Lake Builders, Inc. shall have the exclusive right to construct the home and any other out buildings on the property. These rights are transferable to any new buyer in the event the lot is resold. Dated November '2007 (SEAL) Q, (SEAL) * * J e Dardine (SEAL (SEAL) * * Lisa J. Dar e AUTHENTICATION ACKNOWLEDGMENT Signature(s STATE OF WISCONSIN ) ) authent ated on NOTARY PUBLIC Ss. St. Croix COUNTY ) STATE OF WISCONSIN , * Personally re me on November / '2007 TITLE: MEMBER STATE BAR OF WISCONSIN the a -named ames ardine and Lisa J. Dardine (If not, authorized by Wis. Stat. § 706.06) me know to be th er (s) who executed the foregoing instrume and ac wl ged the same THIS INSTRUMENT DRAFTED BY: * r4 L Attorney Doug B5 tart' Public, State of Wisconsin / 1200 Hosford Street, Suite 201 Hudson, WI 54016 y Commission (is permanent) (expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 ' Type name below signatures. ``'"FRO SETBACKS: NW D ~5 FRONT = 50' (UNLESS OTHERWISE NOTED) a~` SIDE = 12' _ ~aoy REAR = 25' D ZA S W m S E PROJECT LOCATION I ~ I 13 / 14 WINDSOR HEIGHTS 15 / N 88°46'25 E 650.30 X 242.03' 342.27' 66.0( ~ 28 ~ Oo 29 o o / 44631 S.F. \ 48699 S.F. / o Ul 1.02 Ac. 4 x.12 Ac. , m w . N 83.1846» \ 66, 236.76' COBBLESTONE 30 z COURT s0 i o 45801 S. F. 4 , - - 1 w 1.05 Ac. 32 64880 S. F. 31 co I00 1.49 Ac. ro o / ,yo 45708 S.F. 'o E: co n o / 1.05 Ac. r1 V 421.68' 385.54' S 88°58'0, I JNP1 ATTED LANDS R.A.=S 89'4c ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owners 5 Mailing Address Property Address (v zl3 C6166/es&iQ C.r~_-_ ~ s6117 CO SYC)A (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number ro ~O l.~.S<8- 3 LEGAL DESCRIPTI N Property Location 5 LJ '/a , Y1 6-1/4 , Sec. -3 - , T ;L~0 N R / 7 W; Town.of 3 . Subdivision Plat: ~i dso'>" Lot # Certified Survey Map # , Volume, Page # k Warranty Deed # 450 8 S~ (before 2007)Volume , Page # Spec house>3ets19:& Lot lines identifiable es C SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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 Planning & 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 Planning & Zoning Department within 30 days of the three year expiration date. 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. N e o s e/ Mer T J~1Z7/11_ V""tIVNATURE O PPLICANT(S) DATE ***Any information that is misr resented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 09/07) ~ l Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County t Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 0,1-6 ` c- 3~ - percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. R ew Date Personal information you provide may be used forsecondary purposes (Privacy Law, s. 15.04 (1) (m)). t 3 Property Owner P rty Location Q ' Goti t. Lot 11)E 1S 1j 1/4 s32 T 2q N R E (or) Property Owner s Mailing Address Lot # Block # IS ubd. Name or CSKW `103'1 uJrr~cl~or I~el h s~ Ali I on Pin. &X uty State Zip Code Phone Number ; City ❑ Village E3-Town Nearest Road W 1 t.... a p r Q New Construction Use: ® Residential / Number of bedrooms 3 y Code derived design flow rate q`K 40 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material 4 II FI lain elevation if applicable wZ~4 ft. General nerts stern (fdm to)) ' qy . 10 ("*v-- 18 ~ 0~ and recommendations: ' ~ ~ d S '420" t~ M'q Z?v ' 0.2 4 - Q a4-ad "yfrd>~~ ~3 s 1. id-&~eL42- 1-14 a'n fI L y'ti M1 Boring # ❑ Boring Pit Ground surface elev. • 30 ft. Depth to limiting factor -"54 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft: in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 I yf-31 - - Si I Zms1=k r eS lv g 2 12- r y y si 6 2msb r 'c Cs `vf (o 3 -5~} I SL( sbk r `n ~r C'5 -FT= Yr bra - - lvP ~vp Boring # ry~~ Boring ( F2-1 pit Ground surface elev. Depth to limiting factor l_ U in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 -7 r -~J 3J 2- :5, Zm5 r C 5 v SL msb r cs 75 1 any - AJP GVP Effluent #1 - BOD > 30:5 220 mg/L and TSS >30:5 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS 130 mg/L CST Name (Please Print) lgnature CST Number u 253 U Address Date Evaluation Conducted Telephone Number 11 80p se'-4.~~1 (~Z~ --77-US-' (7(5)7/,0 -0Z~9 Property Owner ll. rC Parcel ID # Page 2 of F771 Boring # E] Boring 'Q pit Ground surface elev. -;,Oft. Depth to limiting factor 5q in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 2. 14 -2 5 trY ~5b m c 5 t v~ • `f t6 - SL ~3r~5 "4-'r LS q y -1~ l C3 5 V-rct \ e S o h - PJ NP ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 •Eff#2 I Boring # ❑ Boring F-1 ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 •Eff#2 Effluent #1 = BOD6 > 30 1220 mg& and TSS >30 < 150 mgA- • Effluent #2 = BODS < 30 mg/L and TSS < 30 mg& The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. S13"30 (RAW) s PAGE 3OF~ NAME: eS~I~a LOT# [ LEGAL DESCRIPTION,~ I U*1/4,S_~?-T&,N,R, E(or SCALE: I"= z, ELEVATION: (coo - O BM 1 DESCRIPTION: I1 a i )Z ~~®~C~L`~ ►'e 2 BM 2 ELEVATION:. z O eC . 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