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HomeMy WebLinkAbout004-1017-90-200 •Wisconsin ,Aepartm-Ait of commerce PRIVATE SEWAGE SYSTEM county: St. Croi Safety and Building Division Sanitary Permit No: INSPECTION REPORT 515042 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: Cullen, Michael & Trac I I Cady, Town of 004- 1017 -90 -200 CST BM Elev: / �� ' Insp. BM Elev: BM Description: Section/Town /Range /Map No: / / DO d jT l�h ! - -e - �� 1 P 08.28.15.121 C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER , *" CAPACITY STATION BS HI FS ELEV. 1° �' /Lr�- Septic 93 /DD , °:� '•. L� Benchmark 0 _9 b y y Dosin Alt. BM Aer Bldg. Sewer Holding , t/ t Inlet (o Z 98 TANK SETBACK INFORMATION St/ t OuUet TANK TO P/L WELL BL Vent t o Air Intake ROAD Dt Inlet Septic �j 11 1 / Dt Bottom Dosing i! _, Header/ an. 7 Z�� 4_5 7 a Dist. Pipe S • �� / u 1 , Holding Bot. System .�-- Final Grade PUMP /SIPHON INFORMATION ! • � ' 45 Manufacturer t GPM nd S Cover �_— 3s /D Z. S� L Model Number e TDH J Li Friction Los System Head TDH Ft ( 7 �j / 1 Forcemain Length. i Dia. ' / Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width ; Length No. Of Trenctl'es PIT DIMENSIONS No. Of Pits, Inside Dia, Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEA Manufacturer: INFORMATION BE R OR Types Of System: t UNIT Model Number: f f `I.� / 4.. w� DISTRIBUTION SYSTEM i S Header /Manifol Distribution , - x Hole Size x Hole Spacing g Ve t Air Intake Pipes) ° '' _ < v Length Dia Length �� Dia f ' 6 Spacing -� 3 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center ' , BedlTrench Edges ` Topsoil J F I Yes [E No Yes Q No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:�/ /0 Inspection #2: Location: 427CTY RD NN Wilson, WI 54027 (NW 1/4 SW 1/4 8 T28N R15W) NA Lot 1 Parcel No: 08.28.15,121C An �� 1.) Alt BM Description - " 2.) Bldg sewer length =��� /Z/ „0`,�) c o amount of cover = f. kno Do3l�p�,, �t�rtdl ak a•� ^.A_ Der - w b2 1 aJ -fiv►kk T !ef ,� - G�2? 0 9 Plan revision Required? [ Yes No Use other side for additional information. L Date Ins ctor's S' atur Cart. No. SBD -6710 (R.3/97) Safety and Buildings Division County 20 Washington Ave., P.O. Box 7162 St. Croix 1 *61consi s Uiadison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commer (608) 266 -3151 / O Sanitary P m lt Application State Plan I.D. Number .In accord with Comm 83.21, Wis. Adm. Code, personal information you provide Project Address (if different than mailing address) may be used for secondary purposes Privacy Law, sl5.04(1)(m) I. Application Information — Please Print All Information RECEIVED 427 Co. Hwy. NN Property Owner's Name t Parcel # LaLa Block # MAR 0 6 2009 004- 1017 - 90-200 Michael & Tracy Cullen Property Owner's Mailing Address 5T CROIX COUNTY Property Location PLANNING & ZONING OFFICE G, 595 Tindalls Nest Gov't lot NWI& SW� /.. Section8 6 City, State Zip Code Phone Number (circle one) Twin Lakes, WI 53181 T 28 N; R 15 E or W II. Type of Building (check all that apply) b (, ^ _ � ❑ I or 2 Family Dwelling — Number of Bedroo s: 4 IL ' N Subdivision Name CSM Number NA 860272, Vol. 22, ❑ X Public /Commercial — Describe Use: �OJ', G� w � Pg. 5454 ❑ State Owned - Describe Use: ❑City ❑Village Township of Cady III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. X❑ New System ❑ Replacement System g p y g y ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing S B. 11 Permit Renewal 11 Permit Revision 11 Change of 11 Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl ❑ Non — Pressurized In- Ground Mound > 24 im of suitable soil X Mound < 24 in. of suitable soi ❑ At -Grade ❑ Single Pass Sand Filter 11 Constructed Wetland El Pressurized In- Ground 11 Holding Tank El Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate (gpdsf) Dispersal Area Required (s Dispersal Area Proposed (sf) System Elevation #r 1.0 gpdsf ASTM C -33 sand / �0 q� 101.14' at 18" ative 600 d ✓ 600 s ft. 600 s ft -/ gP 0.6 dsf native soil 9• � q• � 99.64' contour VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fibetr Plastic Gallons Gallons of Units 5Z C Concrete Constructed Glasr:' New Existing Tanks Tanks r" Septic or Holding Tank 1,200 1,200 1 Wie er Concrete X Aerobic Treatment Unit Dosing Chamber 800 800 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) ber's Signature MP/IviPRS Number Business Phone Number Dale Hudson �' MP #220853 (715) 684 -3378 Plumber's Address (Street, City, State, Zip Code) �( �ke,ti 820 Main Street, Baldwin, WI 54002 VI oun /De artment Use Onl Approved Disapprov Sanitary Permit Fee (includes Groundwater Dat Issue Issuin ent Sign r o S Surcharge Fee) �} ( Z S oo ?�1 D Q iven Reaso r_Denial w .7 r IX. Conditions of Approval/Reasons for Disapproval 3 ) SYSTEM OWNER: 1. Septic tank, effluent filter and dispersal cell must all be services./ maintained as per management plan provided by plumber. 2. AN setback requkements must be maintained as per applic" Code / ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 z 11 inches in size SBD -6398 (R. 01/03) 2/e : °5/O ��QE��T/atGy �u / /cnPrv/° //ot sy s� hw%su/%y 0 S T.o{C dy "S1•GO,jcG, being acf � 3 � • . y.!' ar ;lf-'A f P�o(�o5cd i,.�, cSe-r' Cw�crt�c SL.Sc.(. ✓O.ad.C. cJL/� /11X1�8La � Wi S ` y . CoK P4ssrcFPAU 16 bui /al,�ysuucr $ .4, U H L G /td`,yys�� �Qo• A / 9 "o ■ � � /���' .4SSU mid Pao pos4.d nto � � � z sS /9,r Flo. 6s cJ/l ox�G� 'alFfocrS4. /ce / /,o %ce.dor, `mil. b day 99. 6X ' TWO(z)d,'str.'/xt�c+7 g r.99 7 '�a / %B "or,;4yes o 3 S, o,t 2•S3� Leco p P�. 8 oFs 1 • E"Xi.'s �7 y � �.de e /ems • Lo ca-4 C - �z��. ma r� / / n, �� � cs�, d�z sy O St c. B, .00r caoy f.Cro jcG. cJ /, 6. cb �O�cf /0 /7 90 -2W being S,cw a cK S � 3 � • /oc 7V' � o- dr ; �'� � P ropaScc� �: cSer' Csr,cr�G - a7[.N /1s0 -8ca fr; / .,� %tl. 5�sc.(, s/O.a ✓.C, „ �0 P<S'.�cFFV44 U b $ did. C�,.►�_ = T,00� � �, , Yi'Sbce / joy. ��" • � � ., Pao poszd nto ury, � � � z � /9,r /10. Wye-. 4rcotala;,n, It w //v'X /GYJ' o�iS�OcrS� /Ce / % %ce dor, V b 'X r`9, 67 'r..- "or,;4zeS o ,$Pu cZ- .53 S P� . 00 Safety and Buildings commerce.wi. ov 3824 N CREEKSIDE LA g 'HOLMEN WI 54636 Contact Through Relay i c o n s i n www.commerce.wi.gov /sb/ Department of Commerce www.vrisconsin.gov Jim Doyle, Governor Richard J. Leinen kugel, Secretary March 02, 2009 CUST ID No. 220853 ATTIC- POWTS Inspector DALE E HUDSON BOLDT'S PLUMBING & HEATING, INC. ZONING OFFICE 820 MAIN ST ST CROIX COUNTY SPIA PO BOX 78 1101 CARMICHAEL RD BALDWIN WI 54002 HUDSON WI 54016 CONDITIONAL APPROVAL IdenhfieatianNutnbers , PLAN APPROVAL EXPIRES: 03/02/2011 Transaction ID No. 1642142 SITE: Site ID No. 746046 Michael &Tracy Cullen Please refer to botli identificatio n numbers, 427 CTHNN abo;vo " Jri;all corres oridencewith,theegency, Town of Cady St Croix County NVV1 /4, SW1 /4, S8, T28N, R15W FOR: Description: Four Bedroom Mound System / 5% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1217863 Maintenance required; 600 GPD Flow rate; 18 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.01 101) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • 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 down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the effluent filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. P'.Q.W.T.$. • A cony of the approved plans, specifications and this letter shall be on -site during construction a Ott . clonally ins ection by authorized representatives of the Department, which may include local ins ector Av DEPARTMENT OF COMMERCE DIVISION OF SOFFTV ONn Bull 110Nrc DALE E HUDSON Page 2 3/2/2009 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. • 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). • 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 $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm Wis1V1 code: 7633' jerry.swim@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. MOUND AND PRESSURE DISTRIBUTION COMPONENT D940 r Residential Application,, INDEX AND TITLE PAGE ` Project Name: Michael & Tracey Cullen 4- bedroom residential mound Owner's Name: Michael J. & Tracey E. Cullen Owner's Address: 595 Tindalls Nest Twin Lakes, WI 53181 Site Address: 427 Co. Hwy NN Legal Description: NW1 /4 SW /4, Sec.8, T.28N., R.15W. Township: Cady County: St. Croix Subdivision Name: CSM Vol. 22, Pg. 5454 Lot Number: " 1 Block Number: Na Parcel I.D. Number: 004 - 1017 -90 -200 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Attached Soil Evaluation Report Designer: Dale Hudson License Number: 220853 Date: 02/24/09 Phone Number: (715) 684 -3378 Signatur 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) a 1_of 9 SEE CORkt-SPONDENCE Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a i 400.00 Estimated Wastewater Flow (gpd) Table 83 -44 -3 in -situ soil treatment for I 1.50 Peaking Factor (e.g. 1.5 = 150 %) fecal co liform of <= 36 inches. 600.00 Design Flow (gpd) 5.00 Site Slope ( %) 99.64 Contour Line Elevation (ft) 18.001 Depth to Limiting Factor (in) 0.60 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 100.00 I Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure D_ isribution Information network? Enter Y or N (C or E) El Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation ft _ 2 Number of Laterals of the highest point. _ 0.125 Orifice Diameter (in) 2.50 Estimated Orifice Spacing (ft) = 7.50 ft /orifice _2. 00 _ Forcemain Diameter (in) _ 110.00, Forcemain Length (ft) Does the forcemain drain back? Y 92.501 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 17.94 Forcemain Drainback (gal) 8.22 Vertical Lift (ft) 90.53 5x Void Volume (gal) 2.54 Friction Loss (ft) 108.48 Minimum Dose Volume (gal) 0.00, In -line Filter Loss (ft) 32.95 System Demand (gpm) 17.26 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choic 0.75 1.25 x 1.00 1.50 x I x 1.25 2.00 I� 1.50 x x 3.00 2.00 x 3.00 x Gallonslinch Calculator (optional) Treatment Tank Information i 800.64 Total Tank Capacity (gal) __J2_06._Odi Septic Tank Capacity (gal) F _ 36.00 Total Working Liquid Depth (in) Wieser Concrete 1 Manufacturer 22.24 gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 800 64� Dose Tank Capacity (gal) �P I - Lok Filter Manufacturer Tank Volume (gal /in) [PL 525_ Filter Model Number 22.24, Dose Tan Wieser Concrete -; Manufacturer Project: Michael & Tracey Cullen 4- bedroom residential mound Page 2 of 9 Mound Plan and Cross Section Views 1 ' ' 1/10 B Observation Pipe ; ' '•': ;:::•..... J .. j J j ©: — I K • 5 A W B —� .... .. ........ :. .... :. ....... :.................................... I L Mound Component Dimensions A 6.00 ft E 21 .60 in H 1.00 ft K Aft ft B 100.00 ft F 9.50 in z 10.91 ft L ft D 18.00 in G 0.50 ft J 7.28 ft W 600.00 1 (ft Dispersal Cell Area 1691.18 (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 102.93 (ft) - -i ♦ H ,,,..,,.,.. G 1 ....... ° °' 101.64 (ft) Lateral Dispersal F Cell 101.14 (ft) —► — Invert Dispersal Cell :•: Elevation . D F :< �... ` .\ 4 4 � 9 .64 (ft) Contour Elevation 5.0 %Site Slope Geotextile Fabric Cover Shading Key o, T Dispersal Cell See lateral details on 10 _ Topsoil Cap c °• 1.5 ft - Page 4 for number, size, 20 Subsoil Cap y c and spacing of laterals. ASTM C33 Sand ` '�';'' '; Laterals are equally v ' ` F spaced from the Tilled Layer �+ 0.5 ft 'Typical Lateral y distribution cell's © Aggregate centerline in the A distribution cell (AxB). Project: Michael & Tracey Cullen 4- bedroom residential mound Page 3 of 9 End Connection Lateral Layout Diagram Later *#Mer ov" the A.& 134wntnsion • v Turn -up vdball vslvoor *14"noutplug J rFoic*ma P nticA IE. X -� I Holes drilled on the bott of the lateral S nacuon via top of Dross to manifold at 4n nt. y Late+als &force main ofPVC Sch40 (per COMM Table 84.305) Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 98.67 ft Orifices per Lateral 40 Lateral Spacing (S) 3.00 ft Orifice Density 7.50 ft'/orifice Lateral Flow Rate 16.48 gpm Manifold Length 3.00 ft System Flow Rate 32.95 gpm Manifold Diameter 1.50 in Total Dynamic Head 17.26 ft Forcemain Velocity 3.37 f/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and Comm 16.28 WAC 4 in. min. Disconnect Tank component is properly vented 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 18.12 403.04 B 2.00 44.48 C Pump off elevation (ft) C 4.88 108.48 1 93.42 D 11.001 244.64 D Total 800.64 Dose tank elevation (ft) 3" Bedding un er tank. ♦ _ 92 - 5 - - 250 Alarm Manuafacturer SJE Rhombus Alarm Model Number Tank Alert SJE1011421 Pump Manufacturer Goulds Pump Model Number EP05 Pump Must Deliver 32.95 gpm at 7 T - 61 ft TDH Project: Michael & Tracey Cullen 4- bedroom residential mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Dale Hudson Phone! 7_15 68 4 -33_78 POWTS Regulator's Name St. Croix County 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 ft Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for pond ing 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. 7 All 'L.. .J ♦......1.. G....... ♦- 4.6- 4.+ ' tl--- OA %A /;- AA— r`.+.1.. J. llll graYily QIIV NrcJJUrc pl�llly ll 101Gl 1010 VVI IIWI III lv UIG IV4Uircl l IVl lW If vv1I It II vT, If vIQ. r'lvl 11. vvv0. 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 ••...••....... Itoe ......... Grade 6 -8” Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Michael & Tracey Cullen 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), 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 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. 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. Project: Page 6 of 9 XGOULDS PUMPS Submersible Effluent Pump 3871 EPO4 EP05 APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses: heat transfer. ■ Casing and Base: Rugged • Effluent systems •Homes Available for automatic and thermoplastic design provides AGENCY LISTING - superior strength and corrosion • Farms manual operation. Auto Canadian Standards Association • Heavy duty sump matic models include resistance. SP • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron • Dewatering assembled and preset at the for efficient heat transfer Goulds Pumps is ISO 9001 Registered. factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. V4'' 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 • Discharge size: 1' /z" NPT. seal protection. • Mechanical seal: carbon - rotary/ceramic- stationary, BONA -N elastomers. • Temperature: 104 - F (40 °C) continuous 140-F (60"C) Intermittent. METERS FEET + -- • Fasteners: 300 series 10 , stainless steel. 9 30 ��. —s GPM • Capable of running dry without damage to 8 2,5 FT components. 25 Q 7 Motor: _ • EPO4 Single phase: 0.4 HP, ti 6 20 115 or 230 V, 60 Hz, 1550 - / - Z. // 5 RPM, built in overload with o 15 automatic reset. 4 • EP05 Single phase: 0.5 HP, o EPOS 115 V or 230V, 60 Hz, 1550 3 10 - RPM, built in overload with EPO4 automatic reset. 2 • Power cord: 10 foot 5 standard length, 16/3 1 S1TOW with three prong grounding plug. Optional 20 0 0 0 10 20 30 40 50 GPM foot length, 16/3 S1TW with 3.Z• 9S o gyo.�. m•�:e►u. yam. ei d three prong grounding plug ` (standard on EP05). 0 2 4 6 8 10 12 m3 /h CAPACITY Goulds Pumps 2002 Goulds Pumps ITT Industries Effecuvc September, 2002 93871 9. 7 01` 02/20/09 FRI 13:50 FAX 715 386 4686 Q001 1Mtconekr DgmwW wa of Ca+anerce SOIL EVALUATION REPORT page / of ` DMehm oTSebty mid Buitdinge In accordance wish Comae M Wft. Adm. Code County S T C' 0e O X Attach complete sits Plea an Paper net Isle Own 6 *2 x 11 Inches in eke plan moat � but jZ= kA aK doel and hodnwfti n4wenoe point (Mott. direction, and ParoM 'LO. /O! f0 �ErC� / /C rroeah arrow, and locallon and dbdmnce to nearest roan print am hTfor AeawL by Dana a.w6eYSdtar+soeweay . aer+waa ' taw.i +so+r)a ;'/z 7 0 fl.rrtar fJ SCO Lt.ayC� SAij Q/V RECEIV Lot IM 5A-2 114 S T ft w t 3Cf IV� JUL 2 3 2 iyl: �(r- ` tip` o' i` ©'`''f S� J K /NC! AW/ r'I74 &fbO '0 $� NTY D 00 W Town Na@leat �� Nsw Carralra+�ilaer U.0 Raddan*M1 / NwnberW bedro wns Cods dadrrad design tiow nd, yid ''�( d b OPD ❑ Replacenre a ❑ Public or cormrwdel - Daso6e Pow rt rrsato O � /NE vc�si W /S "* " Flood Plate elatimtfart YappYrxible ft, Gonatsl ttigarrants and Area Spot Tested suitable f a Mound (P.O" .T.S,) system using It BO1`'Q * J4 � Ground atsfaae elev 98�Sa 1t Doplh b [imillm factor• / � In. ,SSA Ed MEMO now Ftofttioer DepSt Dorrr6naet Oak, R dox Damon Teadtso SetaCbNa Consistence Boundary Roots OHM in. Mime" Qu: &L Cont. Caw or. Ss. Sh. "EtNI+ 'EflIR2 / O - /d 3/ -- S/ L Z,,,,s S Cs 3 f S O -S L s hK - ---- -- S! z z o f Mo r 5G L.. .2 f5 ble rKf' 7• S � 5 2 ' s Yk A v s C L 0 n jLf I' v . c? * 0 Borlrw p L o P S.rS a [a Pit onoratd statw= elev. � `� a. 04MM to re IS a bcbm / ,9 iR . papftNion tior�on Depth Dominant Colow Red= D"c* lion Todum S/ntctwe C"uAwtenos Ba+tdary toots OPWR f MAMMA CkL SL Cont. Color Or. Sz. Sh. •arlll 2- S SQL - f S h4- d < GS G /D f•ff .n&f -s cL. 2 A"fi aW 7 s Y2 23 S YR z. Ato is CL O, 4't. n+�.r:-f�• 0 0 /O y2 • t'JlMtarR aM - 6e > 90 � 2ZD 010c and l88 Z.-M 3150 j' • � ra stt ft2 - s �0 mgll -and 758 90 trrgll_ CW Nam. f4ease P** O r 'u 1 b fz 1 •c a� ` �` t r� Ada�s.a Ulbricht & Associates °��` �� 7/5 �� it? 2812 10th Ave. Spring Valley, Wl 54767 RJIGINAId 1 - .. •.: �� ®� rig 02/0/09 FRI 13:51 FAX 715 386 4686 [M 003 .�;� � 24 uo s t r ' �lo �$ j4 ` .60 ' Ito �d �3 .Ko a _ 7 M. ca a lop o1� o / 6 X8.50 j-RA." ftAt Ulbricht & Associates Private Sewage Consultants 2812 10th Ave. goring Valley, Wt 54767 f3 0y5 tiii )tC re) //67v Z6a • 70 S sp Z 3 ' wren Depntrnerk of catanerce SOIL EVALUATION REPORT Wsiun of Sawy mud BuiidkW in accordance wan Conan 85. Vft. Adm code C0 y S T o? ° / Attach Complete site plan on paper not less 8uat 8112 x 11 i ise in size. Plan must but )o and horfaortaf reler post (ems. n and s , D. p Q Y, 0 / l s sca di ions, rarlh arrow, and IocsUon and distance to neatest road. Please print all lnforMabl . by Date beasedrore•Conderirpwv —/a' myt•sma. t�04(t)�)• 7 Z 7 l� 5 o f , �Ai,) RECEIV L.0t 4V4) 114 s TZ� N RCS ( w i�opettyanners MaDV Address fat # Block # Subd Name or CSMfR 3 C f . ff� 4141 JUL 2 3 2 (�M 1 P-- -- AfP 1 A) 6- - PYOr of $,' t� S� 1 C W ,5P X / A/ 6— slate 2V Code a I*xrdw 0 0Y 0~ 0 NegrestRoad 1 V y7O VI ) &fAw66Dj C 4,P ..IViV New OonstructlM t1swo Resideraal / fwmber`oi bedroorns Code dertaed design low rate ys O GPD ❑ Repla nmt ❑ Pubic or conwerdal - Descd* Parent mat r d A ES$ /N�' A�wscC / Flood Plain aWwation 8 appicabie R Caenerel Consruerks and x Area Spot Tested suitab for a mound (P 0.W.T.S,) system using _Z& L A j /N /%`t V l © Bafn� J4 sit Ground surraoe elev R D to hdor / O � SSS � sal APPIcadon Rase Horiaon Daplb DCntir ­ me t Color Radon Oesaipfion Texture Struckwe Consklenm Boundary Rods GPM ln. Munsea MI. Sz. Cont Color air. Sz Sh. *M I 'Fir#2 / 0-& /0 N j — SQL z.r 5 & dS Cs 37 G � z - ? sip & shx T57 CS 3f . 8 5 1Z 2f'51je d5A CS Z F ii io f f f ri or s 5GL Z f sh /VK ' ,tu — 7.5`2 s k G �. ots CL V,/1,,,t Y k eodrrB # O P SSS Z i� Pit Grounds xfnedev 9�5 ft. Deollobnov fauior , Rde Hodson Dsplh Don*=*Cdm RedoxDesc*don Texture suuckre Con roe Boundary Rods GPDW K Mu.usea am sz. cork. color Gr. sz. Sh. 'EW •rte 0-9 a t//? 3 s it- Znf f sh d-5 C S 13 f . ce 2, S• 5f L f ,5 hey CS . C D S SIL 2 f - Sh C f G • a9 AO kL, ft -ft Ots 5cL zf 7• S YX a3 • S 2 n�f z ko is ez O, � n�.2 Fl, o O /o Y / T1 • Ellfuent #1= BOD > M M n%X and TSS 3- < 150 nW& • Mont 82 - BOD : 30 "A. and 75S _< W MO. csr Name (Please Print) 0 13 I b 1 c (1 �� � Aadm Ulbricht &Associates Ode Evaluallon Co ndocled �� �wm - 79r9l 2812 10th Ave. Spring Valley, WI 54767 O RIGINAL e c��� ©mom ,...� ��m� .�.•• WIN �; OO e terra / mom, mumms r ' W mm M� Mmmm mm M■ Mmm mm =��Mm m • CG� cT !�`wy Nov 1 2.6 , r S U1QUe /0/2 Sr //} / Rio S • = 1 -e 13M # z Sci /Ot'l -s T p of 6 " , co.kj ,) 0 qq � s Y N y 2-3% T c 3M 4 . of s /ate SE - Q 9d.tio fFPP . /oo - /4 ( n p Ulbricht & Associates Private Sewage Consultants a WL.P1.200 800 —MR triple TANK SPECIFICATIONS A Ic o ti a 61" 36' 67' DIMENSIONS: cs WALL: 3' 80TTQM: 3' r COVER: 6" MANHOLE: 24' LID. PRECAST CONCRETE RISER HEIGHT- 53' 0.0. cc �R• LENGTH: 164' 0.0. 4� BELOW NLET.41' 0.0. r� LIQUID LEVEL: 36" LTI eo _ _ WEIGHT: BOTTOM 12.000 LSS. c v a I_ 1 COVER 8,170 LGS. ° g / INLET AND OUTLET: m' N co i i' CA5T -A -SEAL BOOT OR EOUAL TER GASKET, CAST -A -SEAL BOOT OR EQUAL UE INLET AND OUTLET BAFFLE AND FILTER: o o b- WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) W LIQUID CAPACITY: 3146 GAL/IN (SEPTIC} ~ 22.24 GAL/]N (PUMP) TOP VIEW LOADING DESIGN: 8' 0" UNSATURATED SOIL C v W Ln JAN TANKS � N WILL HAVE ONE VENT OVER OUTLET d H 0 AND WILL HAVE TWO VENTS IN COYER OVER INLET � m s m TANK CAN BE USED AS. � SEPTIC/ HOLDING/ P UMP OR SIPHON _ OR S €PflC/SIPHON 2 9 i . eo m Au jj 4" INLET -_ — — — — m C - - - - - — — _ 1 4' OUTLET Q _ 0 O o w 40 � Q , Q U r- r. g w w a SIDE VIEW 1> CUSTOMIZED TANKS: SHEET No. m TANKS CAN BE CUSTOMIZED CONTACT WESER CONCRETE a / TANKS ARE MANUFACTURED TD MEET OR EXCEED ASTM C -1227 REQUIREMENTS O N •' ¢) w ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer <'l Q r le Ira CC V Mailing Address `��� Gt /S' s / r ev Property Address 7 co, A0 y (Verification required from Planning & Zoning Department for new construction.) City /State ��� G11"' � , Parcel Identification Number 00D� ' 41 90 - zar LEGAL DESCRIPTION -1 Property Location /V� '/4 , _.5W '/4 , Sec. T Z 9 N R /5 W, Town of �✓6F Subdivision Plat: C' -51 Z -- 5 00-1 , Lot # �. Certified Survey Map # _ ,?4 1 1 10 2 7 e , Volume Z Z , Page # Warranty Deed # (before 2007)Volume , Page # Spec house i' yes )(no Lot lines identifiably yes L no 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. Number of bedrooms _ _ All 3 / fl / a9 SIGNATURE OF LICANT(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. 08/05) iffifi ififl Illii iflli fllif 11111 ills flllli lifi ilfl State Bar of Wisconsin Form 2 -2003 * 8 8 7 5 2 8 1 WARRANTY DEED 887528 BETH PABST Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD THIS DEED, made between Scott M. Jones and Erin L. Jones, husband and wife 01/29/2009 11 : 10AM WARRANTY DEED EXEMPT t 17 ( "Grantor," whether one or more), and Michael J. Cullen and Tracy E. Cullen, REC FEE: 11.00 PAGES: 1 husband and wife ( "Grantee," whether one or more). Grantor for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant [recording Area interests, in St. Croix County, State of Wisconsin ('Property") (if more Name and Return Address / space is needed, please attach addendum): Thomas A. McCormack G Part of the Northwest Quarter of the Southwest Quarter (NW 114 of SW 114) of Section S. 1020 10th Avenue Township 28 North, Range 15 West, Town of Cady, St. Croix County, Wisconsin, more PO Box 2120 particularly described as follows: Baldwin, WI 54002 Lot 1 of Certified Survey Maps filed September 12, 2007 in Volume 22 of Certified Survey Maps, Page 5454, as Document No. 860272, office of the Register of Deeds for St. Croix 00 1017 -90 -200 County, Wisconsin. Parcel Identification Number (PIN) This deed is given in full satisfaction of that certain Land Contract between parties dated This is not homestead property. November 2, 2007 and recorded December 14, 2007 as Doc. No. 865667, office of the (is) (is not) Register of Deeds, St. Croix County, Wisconsin. Exceptions to warranties: Easements and restrictions of record, and except any liens and encumbrances created or suffered to be created by the acts and defaults of the grantees, their heirs, successors and assigns. Dated A2 _ (SEAL) f' (SEAL) * * S6tt M. Jones (SEAL) C (SEAL) * * Erin L. Jones AUTHENTICATION ACKNOWLEDGMENT Signature(s) _ STATE OF Wisconsin } ) ss. authenticated on St. Croix COUNTY) Personally came before me on L * the above -named Scott M. Jones atdE ' . 04nes TITLE: MEMBER STATE BAR OF WISCONSIN kc (If not, to me known to be the per� sy" te the foregoing authorized by Wis. Stat. § 706.06) instrument and ackno edged tli R �, •, r. :� sr THIS INSTRUMENT DRAFTED BY: * Thomas A. McCormack ^'• Thomas A. McCormack _ Notary Public, State of WiseOgsn Z. r' Baldwin, WI 54002 My commission (is permanent) jlaix Xxxxxxxxxxx xx ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 02003 STATE BAR OF WISCONSIN FORM NO. 2-2003 *Type name below signatures. INFO-PRO' Legal Forms • (800)655 2021 • k4oprotorms.com 1 of 1 111111 IIII' !IIII VIII Illi IIII 1111111111 IN 860272 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 09/12/2007 09:40AM CERTIFIED SURVEY MAP VOL: 22 PAGE: 5454 REC FEE: 13.00 CERTIFIED SURVEY MAP COPY FEE: PAGES: 2 2 Scott M. and Erin L. Jones Located in the Northwest '/a of the Southwest ' /4 of Section 8, T 28 N, R 15 W, Town of Cady, St. Croix County, Wisconsin This property is subject to a farmland preservation agreement LANKA TTED LANDS --- NORTH 2632.72' - - p A a-a WEST LINE SW 114 NORTH 3oo.43' 361 C T H "�ll �l o p 1015.93 CO O O p S K Z A ZE tit I1 1-- 000 ► �` B O Is: %p i„ $ N oo IZ 5 I I� N r.� 0 o �0 Q n o C E 3 � � w i Cn c SOUTH 300«43' v rn 0 UNNA TTED LANDS This Instrument Drafted by Mark W. Peavey SHEET l OF 2 1 of 2 Vol. 22 Page 5454