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HomeMy WebLinkAbout004-1027-95-200Wi,~onsiif~,gepadment of Commerce PRIVATE SEWAGE SYSTEM S ~fety arA>, ';-,7din_: Division ;~ ~- INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) 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 Smith, David G. Cad ,Town of CST BM Elev: Insp. BM Elev: BM Description: ~~ ~' ~~ C5 TANK INFORMATION TYPE MANUFACTURER • ~~' CAPACITY Septic ~, 2 5~ ~ ~,~.. ~ ioc}c, Dosing ~ 3 ~ ,~.. ~O~ A'eYatlarr Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 7 5a~ ~3Ti! (o~ + II Dosing / ~5a ~ 13z / ~q b -- Aeration Holding PUMPISIPHON INFO~MA,710N ~~~ Manufacturer Demand GPM Model Number ~~~j,~~ ., ~~~ TDH Li~•~ Friction,;o~s ~ System ~H~ea~ ~ JJ -- TD~1• ~ Ft Forcemain Length ~ Dia. e i eII Dist. to w , 35~ Z- 3 z SOIL ABSORPTION SYSTEM County: St. Croix Sanitary Permit No: 499228 0 State Plan ID No: Parcel Tax No: 004-1027-95-200 Section/Town/Range/Map No: 12.28.15.188A2 ELEVATION DATA STATION BS . 9 HI rnti• 9 FS ELEV. ~ Benchmark ~• ~a7• ~~i Alt. BM 3.? .yy• .~•Z~ `T I, DZ Bldg. Sewer ' q;, 72. SUHt Inlet ~, 7. Z g~~aW SUHt Outlet ~ ~ \ Dt Inlet ~ ~ Dt Bottom ~ / b • ~ ~3 ~ y Header/Man. /' Z / ~(p•7 Dist. Pipe 3• ~, f X9.9 ~• Z„ (o . 7 Bot. System ~ •~ /~ Final Grade • L /~7. 7 St Cover c-0 ~ 3• zy 9r. az. i ,P x .~( tiy~ ~~• r 93•~ i, BED/TRENCH Width 1 Lengt ~ No. Of renc s PIT DIMENSIONS No. Of P't,~ Inside Dia, Liqui Depth DIMENSIONS / _ ~~ `_ _ SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: ,~ ~ Type O ystem: ~ ~ 8 ~ ~ ~ 7 ~ ~ ~ UNIT \ Model Number: O J / DISTRIBUTION SYSI"EM Ealic~ Header/Manifol~j ~ / 3 Distribution ~ ~ ~~ ' ~ ~ ~ L x Holo Size I ~ 3~~ x Hole S~p(acigng i/ ~ Vent tTO Air`In~ta~te~ y Length _ Di ength Dia Spacing ~ ~ (! • SOIL COVER x Pressure Svstems Onlv xx Mound Or At-Grade Svstems Onlv r Depth Over ~ Bed/Trench Center Depth Over Bed/Trench Edges \ xx Depth of Topsoil ~-• xx Seeded/Sodded u ched ~ • ~ ` . Yes ~f No Yes ~ No l /. ~ aK COMMENTS: (include code discrepencies, persons present, etc.) Inspection #1: 7 /~_/ ~ ~ d Inspection #2: ! / . I ~' Location: 3211 45th Ave~te Spring Vallt;y, WI 54767 (NW 1/4 SW 1/4 12 T28N R15W) NA Lot 2 / Parcel No: 12.28.15.188A2 1.) Alt BM Description = •YV ~ ~~ v~_ G ~ae. ~ l~ ~ ~O ~' ~"' 2.) Bldg sewer length = 'Sq ~~ o ~ ~~ -amount of cover = J ~ ~. ~^ ~ ~ ,~. ~ ~~ ~'K f'ta ~ Ck '~ ~ e.1LX• _ _ ~e ~b __ _ - _ - _ _ , Plan revision Required? ~] Yes No (~ i/ Use other side for additional informatio>~ ~ ~ ; _ _ _ __ _ _ _ "'_. __ i _1 Date Insepctor's S natur Cert. No. SBD-6710 (R.3/57) ~'~ ~ Ib~- lrb Safety and Buildings Division County St. CrO1X ~ 201 W. Washington Ave., P.O. Box 7162 . rscans~n Madison, WI 53707 - 7162 Sanitary Permit Numb (to be filled in by Co.) (608) 266-3151 Q ~ G•ZS Department of Commerce l Sanita Permit A lieation pp State Plan I.D. Number 1335867---1405079 revision In accord with Comm 83.21, Wis. Adm. Code, personal information you provi may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if different than mailing address) ~ 32 ~ ~ I. Application Information -Please Print All Infor tV ED RECE t. ~ ~5 5~ Property Owner's Name el # Block # Dave Smith JUL 0 e 2007 J 2 \ Property Owner's Mailing Address Property Location ST. CROIX COUNTY 1049 1100' Ave. NW '/., SW'/<, Section 12 City, State Zip C Roberts 54023 T 28 N; R 15 W ~ / $~~^ II. Type of Building (check all that apply) ' , /. / 6/`" ~ ~ b r`9'~'^ ~ ~'~"`' D ll f B X ~ n Nam CSM Number Subdivis io 1 or 2 Family we ing -Number o edrooms / 3 / ^ Public/Commercial -Describe Use ' /O' Z s/ ~ ~ ZZ ^ State Owned -Describe Use ~ ~ 7, ^City_^Village X ownship of Cady III. Type of Permit: (Check only one box on line A. Complete line B if applicable) - /b 2 -• A' X New S stem Y - ^ Re lacement S stem p y ^ Treatment/Holding Tank Replacement Only % Other Modification to Existing System ~ B• ^ Permit Renewal ~ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner Y9~ ~ 2 g /P~3©~~ liV. T e of POWTS S stem: Check all that a 1 ^ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil 'e ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculatin Sand Filter ^ ~ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ avel-less Pipe ^ Other (expla~ ) V. Dis ersaUTreatment Area Information: ,5 ~~j ' Q r Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Prop sed (sf) System Elevation 450 ~ 0.6 450 450 106. VL Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Tanks Existing Tanks n/O / / r" ~/ Qr['Nt.[d ,b PL{91, f i Septic or Holding Tank X 1000 1 Saw Pre-cast X Aerobic Treatment Unit Dosing chamber X 642 1 Straw Pre-cast X VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum er's 'gnatur MP/IvIPRS Number Business Phone Number Tom Gustum 227618 715-658-1344 Plumber's Address (Street, City, State, Zip Code) N13450 93701 Street, New Auburn, WI 54757 VIII. Couu /De artment Use Onl Approved Disapprove Sanitary Permit Fee (includes Groundwater Date Issued Issuin ent Sign (N ps Surcharge Fee) ~ ~ ~ ~ t3~ tven Reason for vial IX. Conditions of ApprovaUReasons for Disapproval nn ~ ~r b ~ 3) IG ' ~.e..v ~'e 5 ~'~- . e atf>l4 tEM QVYNE!!; ~ 1. fa7~,.efllueM taker and dispersal cell must all be services /maintained y Go ,~,t ~-~ tMS t\~ Sd'~.,~ ~I~O vr'~C. l^~ J • es per management plan provided by plumber. J nn(1 (~ ~ ~ Q~,~ ~ ,~, 2..AVF sePlacK txquirements must be maintained ~y_ ~ ,lam ~r~eC~ W I ~` ss per spp~gtile code! adinatu:es. z~ ~5 Attach complete plans (to the County only) for the system on paper not less than 81/2 z 11 inches in size 45th Ave. --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Plot Map Lot 2 part of 5.75 acres 83,E ~ ~ fi a i T ^ ^ Soil Borings V1Rh BeelQrae BMtm ELEV.100.0 -N~ end dbban in seat aide of 14' Baaswaod tree- also HRP BM2" 9.EY. 9&8' -Neil and ribbon in east aide of 24.O~t tree also HRP SCALE :1" = 40' 1600 Combo Tank unsuitable area from previous plan w ~- , 103.3' , /, BM S~ ' ~ ~ '' '~ ,' ~,~ , ,' ,' ;~ ; ,' Mound Area ~~ ,' / ; ®; , ~' ,' , ' / B2 ' ,' ' ~' 10 9' , BM 2 ~' /~ ' ~ sl ~~ ~ ooe s~ ' '~ ~ ;~ '~ ~' ~ ;' B1 , ~ , ' 1 .T ' ,~ ;~ ; a' ~, , ~ ; ^~' ~ ~ , ~c Q~ Insulate per Comm 82.30(11 xC) a' ~~ ~ ~ T ~~ ASTM D3034 or Sch40 4" PVC pipe ProP~ 3 Bdmt House Deve Smith (715) p 1046110th Ave y~ Roberta, V1A, 54023 Town of Cady NWS. of SWY. of Sec 12 T28NR15W Page 6 of 6 4stn s~v~e. --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ~ ~ ~~ T ~ Plot Map Lot 2 part of 5.75 acxes T h i i~ i i i / ~~ 103.3' ,~ BM1 '/ S/ ~s ~, lyn, 0 ~' Mound Area ' ,~ ~' ;~ 62 a 9' % ~' BM 2 ~ ~~ ~' 5~ ~~ B, i ' 1 .r ,, a' ~ ' ,~ ~ ' cP ^~ ~~ ~ ~ ` ~~ ~~ ~ ~, V LEGEND ^ =Soil Borings VYdh BacWwe BM1=ELEV. 106.0' -Na0 end dbbm m east side of 14' Bassxaod tree. also HRP BM2= ELEV. 96.5 •t~7 and r~bon in east side aF 24' Oak tree also HRP SCALE :1" = 40' 1800 Combo Tank unsuitable area from previous plan Insulate per Comm 82.30(11 xC) ASTM D3034 or Sch40 4" PVC pipe ~~ ProP~ 3 Bdmt House fi Dave Smith (715) ptppp~ed 10491101h Ave Well • Rot>~ls, VN, 54023 Town of Cady NVVY. of SWY, of Sec 12 T28NR15W Page 6 of 6 ~~ :~sconsia Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in accordance with Comm 85, Wis. Adm. Code #53 Page 1 of 3 Fredericks Perc Testing Attach com late site lan on a er not less than 8'/z x 11 inches in size. Plan must P P P P t not limit d to: verti l nd h l d b i t l i i f t BM di ti d County St. Croix nc u e ca a or zon rec u e, a re erence po n ( ), on an percent slope, scale or dimensions, north arcow, and location and distance to nearest road. Parcel I.D. Please print all information. Revie d By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). S L 2 a 7 Property Owner roperty Location KEMP, JEFF vt. Lot NW1/4 SW1/4, S12, T28N, R15W Property Owner's Mailing Address MAY 2 Y Z00 7 of # Block # Subd. Name or CSM# 219 - 75th ST Proposed Lot 2 City State Zi GodsT ~~~ ~ City [~ Vllage ~ Town Nearest Road Clear Lake WI 005 715-263-3427 Cady 45TH Ave New Construction Use: ~ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ^ Replacement ^ Public or commercial -Describe: Parent material Glacial drift & loess Flood plain elevation, if applicable na R General comments Recommend a mound, having a centerline located on or near the 104.5' contour and recommendations:Q - -~. II / I ~„ ' „ ~ I/el / ~-- ^ Boring Boring # ~ ~ ~ , Pit Ground surface elev. 104.7 ft. De th to limiti factor 38 in. ~~ P n9 Soil Applica ' Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP Dlfts in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 •Eff#2 1 0-8 7.5YR 3/2 ----- sil 2mgr mfr gw 2f .6 .8 2 8-16 7.SYR 5/4 ----- I 2fabk mfr dw 2m .6 .8 3 16-29 7.SYR 4/4 ----- sl 2mabk mfr gw im .6 1.0 4 29-38 10YR 5/6 ----- Is Osg m! gw if .7 1.6 5 38-44 7.5YR 4/4 fid 7.5YR 5/8 & f2d 7.5YR 5/3 sl Om mfi aw ---- .2 .6 6 44-58 10YR 4/4 cid l0yr 5/8 & c2d 1 r 5 3 fsi Om mfr ---- ---- .2 .5 ~d 2 ^ Boring Boring # ® Pit Ground surface elev. 105.9 ft. Depth to limiting factor 18 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP DIft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 *Eff#2 1 0-8 7.SYR 3/2 ----- sil 2mgr mfr gw 2f .6 .8 2 8-18 7.5YR 5/4 ----- I 2fabk mfr dw 1m .6 .8 3 18-28 7.5YR 4/4 cld 5YR 5/8 & c2d 7.5YR 5/3 ~ 2mabk mfr dw 1f .6 1.0 4 28-55 7.5YR 5/2 mip 7.5YR 5/8 & m2p lOYR 6/1 c 3fabk mft ---- ---- .2 .3 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS <_30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: ,.> ~ CST Number Chris Fredericks ,e,,, j , 71618 Address Fredericks Perc Testing Date Evaluation Conducted Telephone Number 2017 B# Street Cumberland, WI 54829 ~ ~ _ ~~/26~~~~E' 715-419-0127 SBD-8330 (R.07/001 i P [~ Boring Parcel iD # Page 2 of 3 I ~ I °"""y " ~ Pit Ground surface elev. 103.3 ft. Depth to limiting factor ig in. Soli 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 'Erf#2 1 0-9 7.5YR 3/2 ----- sil 2mgr mfr gw 2f .6 .8 2 9-19 7.5YR 5/4 ----- f 2fabk mfr dw im .6 .8 3 19-31 7.5YR 4/4 cid SYR 5/8 & c2d 7.5YR 3 sl 2mabk mfr gw if .6 1.0 4 31-65 7.SYR 4/4 mip 7.5YR 5/8 & m2p 10YR 6/1 ~~ Om mfi ---- ---- 0.0 0.0 ~~ ~b erty,G)wner IGEMP, JEFF Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS <30 mgJt 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.07l00) FfEd2fiCk5 P2fC T25ting . ~ f ~~- ~{-/ ~- Yet-~ '7~ y,2o~± ~1~~~~~ o ~ ~ ~ „=`~~ Exc~Pt WYIERE SHa~~ o. fn ~~' id \ov . \o~ wo~~~~ ~ ~ ~3 i'R~w~a~~~ ~.~ ~c~v~ = -oo,a` Na;i ~ r.b ;~. Er~sf ~~ ~. \o~ r° SEConI ~~i~i'i ~,Wt , Na~~ i ~ r/r, ~~o,~ ~~~ ~a_e + ~ D~ .~,~~ o~ ~~ ~ \4 ~' ~~ W ~? ~ l s s~ ,o~ ~Z ~~ .s~` I~ ® : ~?~ ~ ~~ ° Z ~o ~ Pro~o s~Q toT Z ~ Pert N y Nw-Sri?-f ~- 3~~t ~ G~koY -fa+~1~- ~rl~ P To s~~~r~~ r~~ ur-E ~ s ~~ S! /8~~ commerce.wi.gov ^ ^ ~sconsin Department of Commerce June 28, 2007 CUST ID No. 227618 THOMAS GUSTUM GUSTUM SEPTIC SERVICE N13450 937TH ST NEW AUBURN WI 54757 Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.wi.govlsb! www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/28/2009 SITE: Dave Smith 45th Avenue Town of Cady St Croix County NW1/4, SW1/4, S12, T28N, R15W RECEIVED JUL 0 5 2007 Identification. Numbers Transaction ID No. 1405079 Site ID No. 719702 Please refer to both identification numbers, above, in all comes ondence with the a enc . FOR: Description: Three Bedroom Mound System /New construction /Revision Object Type: POWTS Component Manual Regulated Object ID No.: 1103575 Maintenance required; 450 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.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/OI) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The approved chan eg swill become an addendum to the plans that were previously on 10/24/06 under Transaction ID No. 1335867. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the 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. • 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. • Comm 83.22('7) - A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. P.O.W.T.S. Conditionally ~4PPROVED THOMAS GUSTUM Owner Responsibilities: Page 2 6/28/2007 • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) -The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4} shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence maybe 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 o the owner and any. others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ~~ Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mori -Fri, 7:1 S am - 4:00 pm j erry.swim@wisconsin.gov Fee Required $ 75.00 Fee Received $ 75.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. Mound System .~~~,~ ,~ ~ i_'ao~~ Py ~ of s Cover Page Project Name: Dave Smith 450 GPD Mound Owner's Name Dave Smith Owners Address 1049 110th Ave. New Auburn, WI. 54757 715-237-2180 Legal Description -~ ~ '/., sw ~ '/4 Sec 12 T 28 N, R 15 w ~ Township Cady County ~efwn S[; Git~t ~ Subdivision Vol 21/ 5188 Lot# 2 ParcellD# pending OF ~~ Tab{e of Contents -'"~`'`"'~S'~ pg '~.,~Q ~a 1 Cover page !'2'1 2 Mound Sizing Calculations N' ~ ~~ 3 Pressure Distribution Layout and Dynamics 4 Dose Tank /Pump Curve 5 Management and Contingency Plan ~~~~~~ 6 Plot Map total # of pages: 6 pIVISION aF SAFETY AND gk11LDINGS 4 SEE CORR- PONDENCE Designer Name: Tom Gustum License #: D1201 Date: 6/23/2007 Ph. #: 715-658-1344 ~~ ~ Signature: T Mound System Design Methods Used per "Nbund Component Manual For Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10691-P (N.01/01) per "Pressure Distribution Component manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10706-P (N 01!01) { Spreadsheet provided by: 3bAdvisemenl N724t36 220th St, Boyceville, WI 54725 Ph: 715-643068 email: 3ba~3badvisement.com I ,. Slope: # of Bedrooms: Depth to limiting factor: Absorbtion rate of fill material Absorbtion rate of in-situ soil: Effluent quality Max BOD effluent value: Max TSS effluent value: Mound System Mound Sizing Calculations Project Name: Dave Smith 450 GPD Mound Site Conditions Project Type: 1 or 2 Family Dwelling 5 1 3 18 in. 1 gaVft2Jday 0.6 gallft2Jday Eff#1 ~ 220 mg/I 150 mg/1 Design of Entire Fill Cell depth at upstope edge (D): Cell depth at downslope edge (E): Distribution cell depth (F): Cover thickness over edge (G): Cover thickness over center (H): End slope width (!~: Fill length (L): Upslope width (J): Downslope width (Toe) (I): Fill Width (1N): Page 2 of 6 18.0 in. 21.6 in. 9.5 in. 6 in. 12 in. 10.4 ft. 95.8 ft. 7.3 ft. 11.0 ft. 24.3 ft. Design of the Distribution Celt Basal Area System Design Flow: 450.0 gal/day Basal area required: 750 ft2 Distribution cell width (A): 6.00 ft Basal area available: 1275 ft2 Distribution cell length (B): 75.0 ft Area of Distribution Cell: 450.0 ft2 Qbservation Pipes Contour Elevation of Mound: 104.50 ft Location from end of cell (Z): 12.5 ft System Elevation of Mound: 106.00 ft Final Grade of Mound: 107.79 ft Mound Plan View /Observation Pipes z~ i W K ,~ "'~ ~ t~istrfk~ut+4ri Genf ~~~ A g K- Tilled ArealFill Material L - Mound Cross Section Final Grade- ~~~ Observation Pipe Synthetic Fabric }~I G Distribution Cell System Elevation ~~ ,~' ~~~ ~ ~~.n, F sd Cover Materia{ ~ 1 ~..atGrau Fill Material Invert Tilled Area Slope ~`~-Forcemain System Contour Notes: Fill material to consist of ASTM C33 Sand Distribution cell aggregate to comply with Comm 84.30(6)(1) Synthetic Fabric covering on cell per Comm 84.30(6)(8) Distribution Cell to have minimum ti' aggregate below lateral and 2" above. x ~ Mound System Page 3 of 6 Pressure Distribution Calculations Project Name: Dave Smith 450 GPD Mound Latera! Layout LateraUManifofd Design Lateral elevation: 106.5 ft Lateral diameter: 1'~ ~ In. Rows of Laterals: 2 ~ Lateral spacing (S): ~~ft Manifold type: end • Lateral to cell edge: 1.5 ft Orifice diameter: o.a.ss ~- In. Lateral discharge rate: 12.52 gpm # of Laterals: 2 System discharge rate: 25.04 gpm Distal Pressure: 2.5 ft Manifold diameter: trh . In. Lateral Length: 74 ft Manifold length: 3 ft Orifice Spacing/Distribution Orifice spacing (X}: 49,33 Inches Orifices per lateral: 1 g Avg. ft2lOrifice: 11.84 ft2 Lateral Side View Manifold ~La~teral x ~7~ ~ x Lateral Length Lateral Plan View Orficesonbotlomof ~eralegl~liys~c~ PUC ~era~ and forcemain ~ comply w~h spec~c~altis per Comm 84.30(2 Forcemaincanriec~ri~a ~eorcross~ manr<oldatany poilt Clean Out Detail Glean-out plug Grade ,-vr ball valve Water tight cap ar plug Lawn Sprinkler Box Long Sweep 90 or iwa 45's--~,. Forcemain Friction Loss Forcemain length: 290 ft 3 Forcemain diameter: 2 ~ In. Friction loss in forcemain: 4.023 ft Observation Pipes 6" Minimu~ .Slot Nole: Cbsef Collar may be used in place of 31$" bar `~-318" Bar ~` ~~. i ~-- ZZ ~ ~ -' 1~eral le~th Mound System ~ a a s Septic, Pump and Dose Tank Project: Dave Smith 450 GPD Mound Tank Information Pump tank manufiacturer: Skaw Precast Pump tank size/model: 642 Pump tank gallinch: 16.47 Tank bottom elevation (inside): 80 ft Septic tank manufacturer: Skaw Precast Septic tank sizelmodel: 1000 Pump and Filter Pump Manufacturer: Zoelle Pump Model: Zoeller 140 Effluent Filter: 8" bio-tube Note: Access opening of sufficient size to be provided to allow removal of filfer. Opening to terminate at or above grade. Pump Tank Diagram Dosage Volume Does forcemain drain back to tank? lateral void volume: 15.6 gal Dosage to absorbtion Cell: 78.2 gat Foccemain volume: 50.5 gal Total dosage: 128.7 gat Total Dynamic Head Are laterals highest point? if not, enter highest elevation: 0 ft System head (distal x 1.3) 3.25 ft Vertical Lift ("D" to lateral) 26.00 ft Friction loss in forcemain: 4.02 ft Pressure loss from fitter: L__._"~ft Total dynamic head (TDH): 33.27 ft ~t~~ Dose Tank Levels 41°x" wen v~r,s ~ao~ c~ In. Gal M~;~ A Reserve 23.2 381.5 ,,~ B Pump off to Alarm 2.0 32.9 i C Total Dosage 7.8 128.7 °~ ~`~"' D Effluent depth for pump 6.0 98.8 16.28 and '" "~~-300 Total Capacity: 39.0 642.0 otA~- s.~ oe~~ Pump must be capable of: and head pressure of: - 80.5 25.0 GRk~I 33.3 eet 7~ Pump Curve: Zoeller 140 :AD CAPACnY CURVE MODELS "i40/4140" '~'"~ tm+nu'c HEAD/cMacm' PER MMNTE EFFWlNI AND DIIVATERING Ft. Meters Gad. Urc ~ Iy] 91 !N m snq fl4 , aln . 1s 4s] 76 2m 4140 140 Y0 9.fo s9 n] , 2S 1.92 59 723 •.p .N! 9.15 49 1~ ~~ 49 1},18 21 A --_ ] t9 ], 2 3 ~ ~ `~ ~ ~ ~ 6 u s ~ a 0 M Mound System Management Plan pursuarrt to comet 83.54 W. A. C. page 5 of 6 Owner's Responsibility: The component owner is responsible for the operation and maintenance of the component. The county, department or POWTS service contractor may make periodic inspections of the components, checking for surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary maintenance reports to the appropriate jurisdiction and/or the department. Septic lank: Septic tank(s) are to be inspected routinely and maintained by department approved individuals when necessary in accordance with their approvals. The use of chemical/biological "treatments" is not required or recommended. If such additives are used, make sure they are approved by Department of Commerce, Safety and Buildings Div.. Effluent filters are to be removed 8~ cleaned as necessary, with provisions to keep solids from passing the septic during removal. No more than 1/3 of the usable tank volume may be occupied by sludge/scum. 3 year inspection: if tank has greater than 1!3 volume sludge, tank contents must be emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified of when pumping should be done as to not exceed 1/3 sludge volume. Septic tank should be routinely inspected to be watertight and of good repair. Pump/Dose Tank If an effluent filter has been installed in the pump/dose tank, it must be removed ~ cleaned as necessary, with provisions to keep solids from passing to the mound component during removal. The pump, float switches and alarms must be inspected at least every three years for proper operation. Pump/dose tank should be routinely inspected to be watertight and of good repair. Mound and Lateral System The mound system component must remain free of ponded surface water prior to pump operation. If 4 inches or more water level is detected in the observation pipes, the owner must be notified of possible problems/failure. The designed daily flow capabilities of the component should never be exceeded. Trees and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the component. Activities OTHER than mowinglmaintenance (i. e. excessive walking, pets, vehicles, etc...) could compress the component and reduce it's absorbtion capabilities and/or possibly cause it to freeze in winter conditions. Lateral distribution pipes should be flushed outltested every 18 months using the cleanout points at each end of the component to remove scum that may clog orifices. Performance Monitoring: Performance monitoring must be done at least once every three years following the installation or at the time of a problem, complaint, or failure. Contingency Plan: if the septic tank, pump tank or any of their components therein (including floats, alarms, pumps, etc) become defective, the defective tank or component must be replaced immediately to ensure that the system can operate as designed. If the mound component cannot accept wastewater or ponds wastewater to the surface, the component must be repaired or replaced in it's current location by either: extending basal toe to provide added absorbtion area; or by removing the clogged bacterial mat,aggregate cell, and distribution piping within the mound and replacing said components in order to return system to proper working order as required. St. Croix County Planning and Zoning Wednesday, May 28, 2008 at 3:20: SI PM Detail Sanitary Information Page 1 of t~ Computer #: 004-1027-95-200 Sub/Plat: NA Section: 12 Parcel #: 12.28.15.188A2 Lot: 2 TN/RNG: T28N R15W Municipality: Cady, Town of CSM: Vol. 21 Pg. 5188 1/4 1/4: NW 1/4 SW 1/4 Owner: Smith, David G. & Kathy Jo 3211 45th Avenue Spring Valley, WI 54767 State Permit: 499228 Issued: 10/30/2006 POWTS Dispersal: Mound less than 24" suitable s Permit: New County Permit: 0 Installed: 07/06/2007 POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Ryan Yarrington NA Ryan Yarrington Signed Off: Yes Maintenance Scheduled Pump Date Pumped 7/6/2010 Plumber Other Requirements Gustum, Tom permit in blue sanitary folder until final inspection -Gustum will need a new state plan and revision no tanks installed at inspection in 2006 Additional Notes Monev Owed At plowing inspection with Mark Iverson, soil $0.00 conditions were verified at A+3. Informed homeowner and soil tester(Mike Hasset) that a State Onsite would be required. 11/21/06 Leroy onsite system is A+O, Soil tester and Leroy found an alternate site which will be a mound. Gustum will need a new state plan and revision. 7/5/07 New mound plan submitted Wisconsin D4partment of Commerce PRIVATE SEWAGE SYSTEM ' r Sdtety an iBuilding Division ' INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Smith, Dave Cad ,Town of CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION 1 _ ~ 1 ~~ Manufacturer De G Model Number `~ TDH Lift Friction Loss em e H Ft Forcemain Length Dia. ~ Dist. to well S(~II ARS(1RPTInN SYSTEM county: St. Croix Sanitary Permit No: 499228 0 State Plan ID No Parcel Tax No: oc - l o - 4 - Section/Town/Range/Map No 12.28.15. ~$ ELEVATION DATA ~i STATION BS HI FS ELEV. Benchmark 3 r-t ti. `•F• cj Alt. BM Bldg. Sewer SUHt Inlet `t.5 a Ou t T. r'` 25 Dt Inl D ottom ~ .'~ `~ eader/Man. t. Pipe ot. System Final Grade St Cover <-.J - ~ -~ v at- C ~\ ~~~ ~, BED/TRENCH Width Length No. Of T nches PIT DIMENSIONS No. its Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer CHAMBER OR INFORMATION Type Of System: UNIT Model NwT~ber IIICTRIRI ITI(1N CYRTFM ,7 Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length is Spacing Sw711_ COVER v Prna~nrc Cvctemc only YY Mn~~nd Or At-Grade Systems OnIV Depth Over Dept ver xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed! tench Edges Topsoil Yes No ! Yes I No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection#1;~~_/ /~~J6 Inspection #2: / Location: 3211 45th Avenue Unknown (NW 1/4 SW 1/4 12 T28N R15W) NA Lot 2 -°(~~/J~,,(~/~~/~a~~~,~,~_/ Parcel No: 12.28.15. -- ~ ~ ~-cv~+'r+v' 1GLp w i - 1.)Alt BM Description = 2.) Bldg sewer length = -amount of cover = Plan revision Required? 'Yes " No ~ Use other side for additional information. _ -~- ~-------- Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) ~ ~~ C0111r1'1@I'c@:Wi.gOV SAFETY AND BUILDINGS DIVISION Integrated Services Bureau 13 East Spruce Street INSPECTION REPORT Chippewa Falls, wl Sa7zs •, C~nSI n www. commerce. wi. gov/sb 715 X2 Department of Commerce ) 6-2544 ( bate of Inspection: November 21, 2006 Plumber Name and Address: Project Name: Smith E~ Thomas Gustum, MP 227618 Use: Residential RECEN N13450 937th St. Legal Description: NW, SW, 12, 28, 15W New Auburn, WI 54757 Site Number: 719702 1 1 2006 DEC " Subdivision: Lot 2 CSM Ce fled Soil Tester Name and Address: Municipality: Town of Cady tt, CST 224974 cROlx CouNTY - 1 r. County: St. Croix s 5 03 Fairway St Eau Claire, WI 54701 Plan Transaction Number: 1335867 Sanitary Permit Number: Owner Name and Address: Dave & Sarb Smith Wastewater Flow: 450 gpd 1049 110th Ave. persons Present: M. Hassett Roberts, WI 54023 This onsite. investigation was completed at the request of the certified soil tester (CST) to assist in verifying soil conditions for a new onsite system. The original approval was for an at-grade type of dispersal cell. Such cells require a 36 inch vertical separation for treatment over a limitation such as seasonal soil saturation or bedrock. It was determined by a county inspector, at the time the treatment tanks were installed, that there was insufficient vertical separation to allow the installation of an at-grade type of dispersal cell to be installed. A two compartment septic/dose tank had been installed at the time of the inspection and is still in place. Upon reevaluation by the CST, he determined that the site was not suitable for the proposed at-grade system. My review of soil conditions at the proposed at-grade site confirmed the unsuitable conditions. The soils in the proposed area are of a forest thus having a thin A horizon (topsoil). It is my opinion that redoximorphic features are visible immediately below a 3 inch thick A Horizon. Such a condition does not qualify for use as a treatment and dispersal area as per Comm 83.44 (3) (b), Wis. Adm. Code, and that the estimated highest level of soil saturation must be reported as zero inched as per Comm 85.30 (20 (b), Wis. Adm. Code. The only option available to prove the above area's suitability would be soil saturation monitoring pursuant to Comm 85.60 (3), Wis. Adm. Code, during a normal spring season. This process could take several years to complete and may still yield unacceptable results. Fortunately, more land area is available at higher elevations to locate the dispersal cell. Two soil borings were evaluated in this new area and found to be acceptable for a mound system. The soil profile in this area can be described as follows: 00-03" 7.5YR 3/2 L, 2m-cgr, mfr, cw. 03-14" 7.5YR 4/3 L, 1 m-csbk, mfr, cw. 14-19" 7.5YR 4/3 SL, 1csbk, mfr, w/fad 10YR 516 & 6/3 rmfs, cw. 19-36" 7.5YR 4/6 SL, 1csbk, mfi, w/f3f 7.5YR 5!6 rmfs Leroy G. ansky, stewate pecialist Ljansky@commerce.state.wi.us E-mail 715/726-2544 Voice 715/726-2549 Fax cc: County ~ Plumber CST ^ Owner ^ Other St. Croix County Planning and Zoning Tuesday, December 12, 2006 at 9:17:18 AM A Detail Sanitary Information Page 1 of l Computer #: Sub/Plat: NA Section: 12 Parcel #: 12.28.15. Lot: 2 TN/RNG: T28N R15W Municipality: Cady, Town of CSM: Vol. 21 Pg. 5188 1/4 1/4: NW 1/4 SW 1/4 Owner: Smith, Dave 3211 45th Avenue Unknown State Permit: 499228 Issued: 10/30/2006 POWTS Dispersal: At-grade Permit: New County Permit: 0 Installed: POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inscector As Built Plumber Other Requirements Additional Notes Monev Owed Ryan Yarrington NA Gustum, Tom At plowing inspection, soil conditions were verified. $0.00 Not determined Signed Off: No Soils were A+3. Informed homeowner and soil tester{Mike Hasset) that a State Onsite would be required. 11/21/06 Leroy onsite At-grade system is A+O, Soil tester and Leroy found an alternate site which will be a mound. Gustum will need a new state plan and revision. Safety and Buildings Division County St. CTO1X 201 W. Washington Ave., P.O. Box 7162 'isconsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266-315 ~c~c/ ZZ~ O Sanitary Permi A plication 1.D. Number p 1335867 In accord with Comm 83.21, Wis. Adm. e, personal information you prove may be used for secondary purpos s Privacy Law, s 15.04(1) `' `® oject Address (if different than mailing address) V G 3z~ ~ L Application Information -Please Print All In rmat n ` 45~' St. ~S t~. hut= Property Owner's Name Dave Smith ~'~ 0 P cel # LoJ~I-~ Block # 2 j~ Property Owner's Mailing Address g1 ~ Property Locatio 1049110'~Ave. NW '/<, SW'/a, Section 12 City, State Zi Code Phone Number T 28 N; R 15 W Roberts 5 23 II. Type of Building (check all that apply) ~ ( ~ 6r c ~ 5~ owr X 1 or 2 Family Dwelling -Number of Bedrooms 3 Subdivision Name CSM Number ^ PubliclCommercial -Describe Use i f "~ 2 I L ^ State Owned -Describe Use 1 Z 'r 7J .~ 7 ~ ~c.~ ^City ^ Village X Township of Ca y III. Type of Permit: (Check only one box on line .Complete line B if applicable) ``~' X New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T e of POWTS S stem: Check all that a ^ Non -Pressurized In-Ground ^ Mound > 24 in. of s itable soil ^ Mound < 24 in. of suitable soil X At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ H lding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Cham er ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpds Dispersal Area Required (sf) Dispersal Proposed (sf) System Elevation 450 ,/ 0.6 ,~ 750 / 750 9 ~ I00. VI. Tank Info Capacity in Total umber Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons f Units Concrete Constructed Glass New Tanks Existing Tanks ~ CC.ti.c.~ ~ t C1~ ` ~ ` septic or xolaing Tank X 1000 S w Pre-cast X Aerobic Treatment Unit Dosing Chamber X 642 Skaw Pre-cast X VII. Responsibility Statement- I, the undersigned, a some responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's MP/MPIZS Number Business Phone Number Tom Gustum 227618 715-658-1344 Plumber's Address (Street, City, State, Zip Code) N13450 93T~ Street, New Auburn, WI 54757 VIII. oun /De artment Use Onl Approved lsappro anitary Permit Fee (includes Groundwater Date Issued Issuin gent Signature Stam urchazge Fee) ~5~ ~ /D jj~ D( rGivenReaso r-Denial . , p IX. Conditions of ApprovallReasons for Disappro al , ~ `~'~~~ ~'~ 3, G re~. SL Pl 5'~ r~ SYSTEM OWNER: o ' ~` .. 1. Septic tank, effluent filter and dispersal cell must all se es t',~ e,~~- wr t~,,`S ~„~,~,, V' • as per management plan provided by 2 All setback requirements must be as par app~Cable code / a~dintfloes. Attach complete plans (to he County only) for the system on paper not less than 81/2 x 11 inches in size P/L ---- ~ ~rzs~,a cd > > CcGG ll 3~ ~ ~~~ ~, 1 O ~ ~ ~ `~ CD ~~~ ~ g ,~ ,:. -~ ~~ ~ ~ _ ~, w ~ - ~. , o~ o _ ---- -- ----~_ __ o - a ~ A~ ~~% ~ p J~ S' ~ ~Q % ?~ a W -, ~ _ V © _. _ - _l\.. _ _ _ _ ; . ,. ~ L ,yam ~. 3. 7L'~ ~S'7 r"~` ~...,. ~ J ~6 ~ ~ n t- ~ ~ r \ `~~~ oo ~{~~ (-~ ~-K z'r,a2~~/yL~,.~ _ ,..,rte y p c - ~\ dy Z ~~ ~',7 ~ C~. /_ ~ \ / ~ =?L.t T~7.L t~~P 11 -9 ., c~, ~u. ~-[ I~JV A:J \ \ _- ~1 ~ ~ ( .-~_"`'~ ~_ ~'1~~ % ~/"`"n`.~r7.~ 1 1) rJ .?.~.. "~A ~.14~~c, ~C`f'i` N ~ O - N ^ U ~~ _ r \ ~ A Z l J I'"' IT7 OJ m ~~ o ~ api D ~ r o ~~ ~ ~o~~m r C ~~ m ~~~~W ~ ~~, ~ ~, ... j ~~ c~ ~ m /n ~_ ~ ~ ~ ~~_ N ~ N w ~, "+ ~ SU Z o A ~ ~ O _,_____ ~ ~o ~ v ~ O ~ cQ fD ~ ~" ~ C ~' ~ 1 -o D N i ~ -- --- - -- _ o - - ~ 0 ~ ~ n C gyp? (D ~ ti A W N 11.'. a -- 1---, $ 7 6 - ~ ---4 3 ---- 2 1 -- - . 45th Street ~e a~ ~ ~ _ , --- ~ .»,~ --------------------------------------------------------------------------- ----------~P„ox---- ---- ---`--- ~ '. Piot Map Lot 2 ~\ \ r ~ ~ D ~' o~° 0 ~~ B~ ~oA° i M2 ';~ _ B~ , ,. 7~~ J Q~ 'a of~_ 83 Skaw o ~'"Foy 9g , 1600 Combo Tank ~~dn , e~ `~ 1p3 5, ~ ~oG^ 8M~ '°o, ~~ ~~,°~ ASTM D3034 or ~'oy ^ Sch40 4" PVC pipe ~oG ^ ~/'~~ proposed, proposed 3 bedroom --' walkout house t 8 7 I 8 5 4 C `~% ~~G ^ B ~,~~ /~~ ~°~/ 3 LEGEND ^ =Soil Borings With Badchoe BM1=ELEV. 100.0' -nail in large map ~ tree- Iso HRP BM2=ELEV. 100.0' -ground EL at " t " st- a HRP SCALE : 1" = 40' :iUStUPTI ~ Dave and Barb Smith Plot Plan ~ /4 jP,ptlC 1045110th Ave. Z~j ~~ Roberts, VH 54023 Town of Cady NW/. SW1/. Sec 12 T28N R15W 2 ~. ~ L ~ ~ Wisconsin Department of Commerce ~, L EVALUATION REPORT Page _L of _„~ n ivicinn of Safoty and t3uildinaS - _ Ina +Omm 135, WIS. Ham. 11006 ,,..~ -- County ~ ~ i2°~ Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must but not limited to: vertical and horizontal reference point {BM), direction and include Parcel LD. , scale or dimensions, north arrow, and location and distance to nearest road. ercent slope , p Please print all information. Review by Date Personal information you provide may be used for secondary pur ose 15.04 (1) (m)), //,~// ~ z~i u1 jJ Owner roperty Location Property / l~iP.tQ ~ ds' J ~' vt. Lot ,,r/.c/ 114 Jal 1/4 S /,? T o78 N R /S"' ~ (o , Property Owner's Mailing Address S E P L t # Block # Subd. Name or CSM# ~ ~ /~~ ~6 y9 a ~ u~; City State Zip Code PhoiBi!iN ' y ~.~.4uage ®Town Nearest Road o.~er rr !/.1'' yo 3 rr~ID y1' ~~.Oda' GPD t r i fl 3 ' ow a e gn Code derived des New Construclion Use: ~ Residential ! Number of bedrooms . J~ ^ Replacement ^ Public or commercial -Describe: Parent material Flood Plain elevation if applicable mdA ft. General comments ~ ~„ ~, ,,~,~p~ ,duo rJ f SY ~ ~~ p//qtr t ~ e,~ pi„/L RA r~ ,rJ a o PLO s.rr ~ rs~Ef's and recommendations: Yo Q! ~tdiro/xo~ /2tGoiYNi./D sY.f. ~. -/oo.d ~~foLtatJ to„jraut Boring ii , Boring # ® Pit Ground surface elev. 03 S ft. Depth to limiting factor ~~_ in. Soil A lication Rate th D t Col D i tion Redox Descri Texture Structure Consistence Boundary Roots GPD/flz Horizon ep in. nan or om Munsell p Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 D-3 /o ~C .~/ -- ~ v ~ qs ~ u . C .d 3 - •?~ /a y2 /3 ~ .Z ~ 6k ~ c s . ~ . 0 -3 7.~' .C ~ s/ .2 ~.r~ ~~ ar G D .37 ~' ~t.v~ r .a rve'.~io . S ~ r Ev `~~v~L ~ .t Tar ^ °? Boring # ^ Boring ~~ ~ pit Ground surface elev. /QO.O ! ft. Depth to Limiting factor ~_~n. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 D -G o Y.t 3/z s / .Z r u ~ ,?d . D C-/y a .3/6 - /s r~ ~ s .? ~ 7 !. 6 .~ - 4~ a Y .s'/ '' S v /' G .S .7~ G -3 o rc 7 "' rod ~~' Q ~ .S~ ! d d "~ ~.vs ~Arvd-~ro ss. d. ' Effluent #1 = BOD > 30 < 220 mg/L and TSS~d mg/L ' Effluent #2 = BOD < 3o mg/L ana t 55 < su rngll_ CS,T Name (Please Print} r CST Number t ss rr ,7.?y97y Address Date Evaluation Conducted Telephone Number .Sa3 ~ ,C~1' .fir; ~a ~.0 •Cl~Y` ~ 8-/7-c /S 3y 8~~0 ...,.. ~,,,, m,,..,,,,,, " 1~ ..,y ~ °'s ~ 7 Y f ~, ,~~_~. e Property Owner ~,IU!" ~'~,IdQ .~iJI Tai' Parcel ID # Page _~ of ..~ Boring # ^ Boring ~ ~~ f ® pit Ground surface elev. 98.0 ft. Depth to limiting factor .31i in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dlft? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh, *Eff#1 *Eff#2 / O-3 o Z - s ~ v~i' a v C /.e a 3 - art y - .Z s6k ,-, ~ ~~ s a -.i•~ 7 y s/ 1~ ~ ~ s /.y S/ 8 .>z~ y r~,v~ r r~vE~~ .r s. B. ~ ^ Boring # ^ Boring ' ^ Pit Ground surface elev. ft. Depth to limiting factor in. 5oi1 A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dlff° in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODg < 30 mg/L and TSS < 30 mglL • ~ k The Department of Commerce is an equal opportunity service pravide~~, e~np~oyer. If you need assistance to access services or need material in an alternate format, please contact the ~d~a~~t at 608-266-3151 or TTY 608-264-8777. ~ t •~ san-ssso tR.o~roo) '`~,°j !., ' 1 Property Owner ~/,OIJ! ~'~,I~tQ ..S~iyi T~ Parcel ID # w.A ' S ~> ~~.a~. 3 ~ ~ f ,~ Page _~ of .~ a Boring # ^ Boring ~ ~~ / ® Pit Ground surface elev. 98, 0 ft. Depth to IimiGng factor .31o in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz; $h~ ' - `Eff#1 `Eff#2 ~ 3 - ar.~ y - a s6k .av ~~ c s 3 ? -Jy oY,t s - s/ k ~~ c s ~~ y .~ -ai ~ y - s/ ~~ k ~~ s /.~ y 8 .>r` '' reap r raE,~~o .r s. B ~ a Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor 'n• Soil A liptioh Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f1? in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. `Eff#1 `Eff#2 Boring Boring # ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L `Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provided •e~nployer. If you need assistance to access services or • need material in an alternate format, please contact the ~le'trt at 608-266-3151 or TTY 608-264-8777. ~~ ~ °- ' ''~ SBD-8330 (R.07/00) ~ ~ A.4~ -;H e i°~ ,~ ~- i ' ~" ~ ~ ~ . . _ ~ ~ ~ o w ~ o ~ ~~ ~ ~ ~~ ~ o ~ ..~ ~ `t ~ A O 'A 'a • " ~ ..~ N ~ ~ ~ a . ;. ~ ._._ ._ .. ~ ,_, .....r / . 1~ .. ~. a ++ Ra a . r ~ ~~ 'R .W ~ ~ ° :b • ~ O ,p ?a ` ` o ~. a. ~ ~ . .~~~d~ ~ µ ~ n ,. ~ ~ n y". ~ •fi 4 ~ ~ ,~ ~ ~ o ~~ ~ ~, +~ e °. o °.; ~, ~ u ~~ ~ ~"' ` ti ~ t~ 19a. ~® ~.. K ~ ~ I ~ a .. ~~~ s ~ ,~ ~ ~ ,M ~ :~ ~G. V 4 ~ . ~ Q O ~ ~ c A ~- .~ b Z- 5 N f7 ^0 'V a,c i ~~o 0 c., u ~ ~ ~ H ~~i •:.~ vi O ~ cri n ~-,. ~ ~ y .. /'1 its ~1 .. ,~ L ~ `" L ~ a ~" ~ ~ o ,~ o +C! a H r x ~~ ~ 1A~ • ~ (,~ 4 ~~ > ~' t ' 82'2335 VOL 27 PAGE 57 $$ CERTIFIED SURVEY MAP VOLUME 2} PAGE 5785 . THE NORTH HALF OF THE NORTHWEST QUARTER OF THE SOUTHWEST QUARTER, SECTION 12, TOWNSHIP 28 NORTH, RANGE 15 WEST, TOWN OF CADY, ST.CROIX COUNTY,WISCONSIN OWNER/PREPARED FOR: Jeffery Kemp 219 75th Street Clear Lake, WI 54005 West 1/4 Section 12-28-15 Fd Aluminum Cap P'~'B• N89'4C ~ N89_ centerline 1 0 0 I50 C ~ a 1 Q I2 , Y iid i ~ S U O N N IA ~ N N ~ ~ ,~ 1 N ~ ~ O W I Im ~ L tV ~ N ~ V ~ O 4 ~ ' a' ~ I~ D a ~ v li3.Q0~ 342.00' ~~ m 375.00'_ Nl i Set ~3/4° tron rebar ~~ i ~7' south of fence ~rti I ~ z I ol, o m N 00 ~ 1 N Ni OAi rn L ~j ~ Southwest corner Section 12-28-15 Fd Aluminum Cap 1291.09' Z , a ~'~ , ~, J , ~, .-° . s~ '~'N° O ~. Z -~ 8 ~ ~ N N •^/, m N - I ~ Z OI ~ 0 O P J ti f A a ? l N p N O r+l Set 3/4° Iron rebar 11' south of fence centerline NW /SW 17" 657.~5r- -_4_01_1._01' J1 ' ° " ~ POO"E _641,_60' _ 1 N89 40 7 E ti 39.44' Set 3/4" Iron rebar -~ --- ~~- --- - - ~ 18' west of fence corner building setback line } V1 LOT 3 ' ° i ~ I[ z 378,429 sq.ft. ' o o i° 8.69 acres incl. r-o-w N ~ ; ~ 1~ I Do i ~ I d 353,844 sq. ft. I ~ I 8.12 acres ~ ^'. Iz not incl. r-o-w ~ i~ ~" 398.58' 550.30' 589'48'19"W Set 3/4" Iron rebar 1323.88' '3' south of fence UNPLATTED LANDS L O1. , 247,958 sq.ft. PREPARED BY: 5.69 acres Joel A. Brandt incl. r-o-w JB SURVEYING LLC 966 Rustic Road 3 214,525 sq. tt. Glenwood City WI 4.92 acres , not incl. r-o-w Set 3/4" Iron rebar 14' south and 13' west or fence corner LOT 2 250,545 sq.ft. 5.75 acres incl. r-o-w 239,886 sq. ft. 5.51 acres not incl. r-o-w Note: Each parcel on this map is subject to State and County laws, rules and regulations (i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing n /~ /'~ any parcel, contact the St. Croix County Zoning Office and Town Board for advice. f,' ~..... - G o..........5 ~q 1. ~b -.. s Norfh is referenced to hhe west line of the Southwest Quarter of Section 12-28-15, which is bears N00°24'22"E fSt. Croix County Grid System) 1 of 2 N89'40'17"E KA'fRLEBA H. Rfi62STER ~ DEEDS ST. CROIX CO. MI RECEIVED FOR ~tECORD i4/®7/2A0G 68s15Al1 CfiRTIFIED SURVEY MAP REC FEfi: 13. N COPY FEE : 3. ®B PACES: 2 ------- --- Eost 1/4 5335.18' Section 12-28-15 Fd Aluminum Cap UNPLATTED LANDS 1324.17' NE corner 45th Ave_ 34.82'v LEGEND ~~~+~ti overnment Corner las noted) .qc~w. et 3/4" x 18" Iron rebar weighing f aaoo rt 502 lbs./lineal ft. o~¢nwooocfrv, oil tests ~y~ L S SCALE: 1" .250' ~~ ~ v1o 2~~ 3' 0' 250' 500' Page 1 of 2 Vol 27 Page 57$8 3 • commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601-1831 TDD #: (608} 264-8777 www. commerce.wi. govisbl www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary October 24, 2006 CUST ID No. 227618 THOMAS GUSTUM GUSTUM SEPTIC SERVICE N13450 937TH ST NEW AUBURN WI 54757 ATTN: POWTS Inspector ZONING OFFICE BARRON COUNTY SPIA 330 E LA SALLE AVE RM 2104 BARRON WI 54812 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/24/2008 Identification Numbers Transaction ID No. 1335867 SITE: Site ID No. 719702 Dave Smith Please refer to both identification numbers, 45TH Ave above, in all corres ondence with the a~ene Town of Cumberland Barron County NW1/4, SW1l4, 512, T28N, R15W FOR: Description: Three Bedroom At-grade System !New construction Object Type: POWTS Component Manual Regulated Object ID No.: 1103575 Maintenance required; 450 GPD Flow rate; 37 in Soil minimum depth to limiting factor from original grade; System(s): At-grade Component Manual, SBD-10570-P (R.6/99), Pressure Distribution Component Manual -Version 2.0, SBD- The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system. is to be located and constructed 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 POWTS 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 I S feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the tank/filter for maintenance purposes must be provided per Comm 84.25(7), Wis. Adm. Code. • Comm 83.22(7) - A copy of the approved glans specifications and this letter shall be on-site durine construction and open to inspection by authorized representatives of the Department which may include local inspectors. ~.'a, ¢, ~~~~~ ~. ~ ~ i d ~" ~~' ~~` ~~. ~, ~. -," r` J ~ THOMAS GUSTUM Page 2 10124!2006 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual, and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) -The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety& Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence maybe 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, ~~~~ erard M Swim POWTS Plan Reviewer, Integrated Services (608}789-7892, Mon -Fri, 7:15 am - 4:00 pm ferry. swim@wisconsin, gov cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 r ~ ~i r +" At Grade Cover Page pg 1 of 8 Project Name: Dave Smith 3 Bedroom At Grade Owner's Name Dave Smith Owners Address 1049 #4e- ~/p'+~ ,cJ~~ Roberts, WI 54023 Legal Description fvw ~ +/, sw ~ +/ Sec 12 T 28 N, R 15 w ~ Township Cady County Saint Croix Subdivision Lot# 2 Parcel ID# Table of Contents ~~ '°~~ ° ~ ~1- a CDYP.r ~E ~= ~ ~ ~ ~~~~ 2 At-Grade Sizing Calculations ~ ~USTtjfi~ o~ 3 Pressure Distribution Layout and Dynamics 1~1 ~ r'~ 4 Dose Tank Calculations/Pump Curve ,~.4 ,~~~`~ 5 Management and Contingency Plan ~~s, ~ ~~~ e Plat fatal # of ,Ck3~P.S~ s ~ivi~' :i :~+{tt Gi~f hi;:411 iYUif_liifvv~ Designer Name: Tom Gustum --~ -~- License #: D1201 ~_` ~,~~-~,~,~::~ Uf~lv~~+C`= y~~ r QB.t@~. tQ(13(2QQ6 Ph. #: 715-658-1344 Signature: ~1~~a Af-Gxas1P DP.Si~tn 1lifP.lhads llseti per "At-Grade Component AManual For Private Onsite Wastewater Treatment Systems° (Version 1.0) SBD-70570-P (R.6/99) per "Pressure Distribution Component manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10573-P(R.6/99) y ! ~~ "~ ' At-Grade Sizing Calculations Project Name: Dave Smith 3 Bedroom At Grade Site Conditions Private Dwelling or Commercial: p (P or C) Design of the Distribution Cell System Design Flow: 450.0 gal/day Distribution cell credit width (A): 10.00 ft Distribution cell length (B): 75.0 ft Area of Distribution Cell: 750.0 ftz Slope: 12 # of Bedrooms 3 t~~`h i`fT rrrtrri`~i~t~' factor: ~6 ri~t. Absorbtion rate of in-situ soil: 0.6 gallft2/day Effluent quality Eff#1 • Max BOD effluent value: 220 mg/I Max. TSS effluent vatue~ 15Q ~t Contour Elevation: 100.00 ft Page 2 of 6 Design ofi ~tntire Component Upslope Width added to A (E): 2.0 ft Total Width of Distribution Cell(C): 12.0 ft. Perimeter Beyond Aggregate (D): 5.0 ft acr~ra~+P b4tir,~t~r of C 22.d Ft. Overall Length of Component(L): 85.0 ft. Elevation of Lateral in Cell: 100.50 in. Height of Component Over Lateral: 15.5 in. Height Over Rest of Cell_ t3.5 in~ Final Grade of Component: 101.79 ft Observation Pipes Location from end of cell: 12.5 ft t~1 GTa~,~e titian 1fii~vu ~~f i~ ~i~ TAG ~ I l IL- B~ Pipes ~~- B~ W ~ ~o~ 1 I_ ~ a ~ I ~ I ~ ~L IV L A.t-~~~,° ~.rn.Gs Serta~ Final Grade Lateral Invert Synthetic Fabric Corer Material-.~ Distribution Cell S~~tem ~~rl~our ~,~ ~ 4bP ~bserv~.7on pipe ,ptia~ti ati Tilled Area ~ i ~ ° ~ q°° d6 '.e68° ,ae a E ~~. q C '~ p~ ~`-~~ Slope Notes: Distribution cell aggregate to comply with Comm 84.30(6)(1) Synthetic Fabric covering on ceH per Comm 84.30(6)(8) Distribution Cell to have minimum 6" aggregate below lateral and 2" above. Y ~ • I L r At-Grade Page 3 or 6 Pressure Distribution Calculations Project Name: Dave Smith 3 Bedroom At Grade Lateral Layout Lateral/Manifold Design Lateral elevation: 100.5 ft Lateral diameter: 1'~ ~ In. Rows of Laterals: 1 Lateral to upper cell edge: 2 ft Manifold type: center • Lateral discharge rate: 15.15 gpm ~t~1f~ ~lu~~ettsr:' ~ t,. t~ ~ rrr. sys~~a ~+rs~ehk~rg~e ra+te.~ 3a.3 P gprrr # of Laterals: 2 Distal Pressure: 2.5 ft Lateral Length: 37 ft Orifice Spacing/Distribution Forcemain Friction Loss Orifice spacing (~: 19.73 Inches Forcemain length: 45 ft Orifices per lateral: 23 Forcemain diameter: 2 ~ In. p,~,g,. ~?~Or.'~ar..e: }~.~ fi!2 Friction loss in forcemain: p,~g~q ~ Avg. Lin ft/Orifice: 1.63 Lateral Side View Forcemain ~~ Lateral Lateral ~ ~ x x Xx ~ 2 2 Lateral Length Lateral Length Lateral Plan View Lateral ~ _ ~ Turn-up vJball valve a cl~nout plug o Orifices On I>dtom d PVC Manifold lateral equally s c PVC laterals and facern3in to carply wdh speaf~catbrrs peg Conm84.30(2) Clean Out Detail Observation Pipes Glean-out plug final Grade or bal{ valve Vdater tight cap or plug Lawn Sprinkler Box lot Note: Closet Collar ~° frAlnlrl'IUITI may be used in ~o^ ~ ~¢~~ ate, ~I place of 3J8" bar orhvo 45's ~ 3j8" Bar Lateral l ~ t At-Grade Page 4 of 6 Septic, Pump and Dose Tank Project: Dave Smith 3 Bedroom At Grade Tank Inform Pump tank manufacturer: Pump tank size/model: Pump tank gal/inch: Tank bottom elevation (inside) Septic tank manufacturer: Septic tank sizelmodel: ~tion Skaw Precast 642 aS. 4a 92 Skaw Precast 1000 Dosage Volume Does forcemain drain back to tank? L- Y4 Lateral void volume: a,$ ~ 't ~ Dosage to absorbtion Cell: 39.1 gal Forcemain volume: 7.8 gal Total dosage: 47.0 gal Pump and Filter Total Dynamic Head Pump Manufacturer: Little Giant Are laterals highest point? y Pump Model: 9EH if not, enter highest elevation: 0 ft r=fftueni t=ilYer: orenco t~iatut~e $' S~s~tem field ~drsta~x P.3~ 3.25 fif Vertical Lift ("D" to lateral) 8.00 ft Note; Access opening of sufficient size to be provided to agow removal of filter. Opening to temfinate at orabove grade. FrICtIOn IOSS in forcemain: 0,8g ft Total dynamic head (TDH): 12.14 ft _..- 4 inch Minimum,' Alternate Outlet Location Pump Tank Diagram Watertight Locking Cover ~Whth Warning Label inishr Grade Elect. per Comm 16.28 and NEC 300 Waep Hole A or Anti- B Sphon Device ~ 1 ~ t Dose Tank Levels In. A Reserve 28.1 B Pump off to Alarm 2.0 C Total Dosage 2.9 D Effluent depth for pump 6.0 Total Capacity: 39.0 Pump Curve: Little Giant 9EH '~ FL(1V- L[TERS/F1DUR Gal 463.3 32.9 47.0 98.8 642.0 10 t- 0 a Pump must be capable of: and head pressure of: 30.3 GPM 12.2 ft S N 7.5 y W f 5 ' A W 2.s 0 Little Giant FLOW- GALLONS/MINUTE 9EH PUMP PERFORMANCE CURVE 115 V 6UHZ ,~ ~t • -- At Grade Management Plan pursuant to comet 83,54 w. A. C. pages of 6 Owner's Responsibility: The component owner is responsible for the operation and maintenance of the component. The county, C~Qfj3aS~:!KLL'S~~ C1S Qr3MlT~ ~.1C'1.~~4CR CA4~!2!.~45 SKy3~j Sz+,abR ~ ~.L~s^rR!.~:l3RLS ^.~ t~Fd ~.f35~?,~.JS~RJS~rtis, ~.h~rJF.~r3 f.~ surtace discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary maintenance reports to the appropriate jurisdiction and/or the department. Septic Tank: ~e~+,is +~~ak{s; ,a-~ t~ .hP .4rts~nec:-~+ .rLL.l+4~tE~)~ ~4c+ ,71~i7.+a'~4~L+ ~j~ t1e,:na'~~:me^.+ ~GI~L~~~G+ .t%+.~~ .iL~.1~.~F 3PSFrEin necessary in accordance with their approvals. The use of chemical/biological "treatments" is not required or recommended. If such additives are used, make sure they are approved by Department of Commerce, Safety and Buildings Div.. Effluent filters are to be removed 8~ cleaned as necessary, with provisions to keep solids from passing the septic during removal. No more than 1l3 of the usable tank volume may be occupied by sludge/scum. 3 year inspection: If tank has greater than 113 volume sludge, tank contents must be emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified of when pumping should be done as to not exceed 113 sludge volume. Septic tank should be routinely inspected to be watertight and of good repair. Pump~lJose Tank If an effluent filter has been installed in the pump/dose tank, it must be removed & cleaned as necessary, with provisions to keep solids from passing to the mound component during removal. The pump, float switches and alarms must be inspected at least every three years for proper operation. Pump/dose tank should be routinely inspected to be watertight and of good reQa~.s. At-grade and Lateral System The at-grade system component must remain free of ponded surtace water prior to pump operation. If 4 inches or more water level is detected in the observation pipes, the owner must be notified of possible ,ox~-e,-.nslfai~.~e :~hE deS~nPd daily f~Y,~ r~hilii~s ttf the rc~m~~nt c-uu.t~ .eevP~ tie exree~ed. 7xP.es and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the component. Activities OTHER than mowing/maintenance {i. e. excessive walking, pets, vehicles, etc...} could compress the component and reduce it's absorbtion capabilities and/or possibly cause it to freeze in winter conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the cleanout points at the end of the distribution laterals to remove scum that may clog orifices. Performance Monitoring: Performance monitoring must be done at least once every three years following the installation or at the time of a problem, complaint, or failure. Contingency Plan: If the septic tank, pump tank or any of their components therein {including floats, alarms, pumps, etc} become defective, the defective tank or component must be replaced immediately to ensure that the system can operate as designed. If the at-grade component cannot accept wastewater or ponds wastewater to the surface, the component must be repaired or replaced in it's current location by either: extending basal toe to provide added absorbtion area; ar by removing the clogged bacterial mat,aggregate cell, and distribution piping within the cell and replacing said components in order to return system to proper working order as required. i. w ~, , ,t State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Number {{ Document Name THIS DEED, made between Jeff Kemp, a married person ("Grantor," whether one or more), and David Smith and Barbara Smith husband and wife ("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 St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): That part of N 112 NW 1/4 SW 1/4, Sec. 12-T28N-RISW described as follows: Lot 2 of Certified Survey Map recorded in Vol. 21 of Certified Survey Maps, page 5188 as Doc. No. 822335, St. Croix County, Wisconsin Covenants to run with the land: 1. Home must be built on basement foundation. 2. Home must have a minimum 5-12 roof pitch. 3. No single wide trailers are allowed as a residence. 82354 IIATHLEE1i H. MALSN REGISTER QF DEEDS ST. CROIX Ci).. MI RECEIVED FOR RECORD 04!24!2006 03:30PM MARRAIITY DEED EXENPT # REC FE£: 11.00 TRAKS FEE: 1z4.50 COPY FEfr: CC FEE: PAGES: 1 Recording Area Name and Return Address t,(} +- ~~ ~ l David J. Estneen 304 locust Street Hudson, WI 5401 B Part of004-1027-95-000 Parcel Identification Number (PIi~ 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 and reservations, if any, of record. Dated ~ ~ ~ ~~~ li ~ ) i ., ~Y *Jeff (SEAL} (SEAL) * * AUTHENTICATION Signature(s) Jeff Kem a marri d erson authenticated on G ~~ *Kristina and TITLE: MEMBER STA BAR OF WISCONSIN (If not, authorized by Wis. Star. § 70b.Ob) THIS INSTRUMENT DRAFTED 13Y: ristina QglandLEstreen & Oglapd 304 Locust Street. Hudson. WI 5~QI6 ACKNOWLEDGMENT STATE OF ) ss. COUNTY ) Personally came before me on , the above-named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. * Notary Public, State of My Commission (is permanent) (expires: l (Signatures may be authenticated or ackpowledged. Both are aot 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. I-2003 '~ Type name below signatures. INfO-PROTM Legal Forms 804-855-2021 www,infoprofomu.com 1of1 . ST. CROIX COUNTY ^ , ~ r ' ~ ~ SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIl' CERTIFICATION FORM Owner/Buyer ~ ~ ~ yJ~Gc, rGL <~_yYYj -~h Mailing Address Property Address 3 a 1 ~ 5~ -e. c,~ 1 ~ t.,~.~~ (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number (')~ " ~~ZyT ~ ~s ~~~ LEGAL DESCRIPTION Property Location ~ ~ '/a , ~ VJ t/4 ,Sec. ~ c7~ , T Z-a N R ~ ~ W, Town of Subdivision Lot # Certified Survey Map # ~ Z Z 3 3.5 ,Volume ~ ~ ,Page # S l Q~~j Warranty Deed # ~S Z 3 s ~/b ,Volume ,Page # Spec house yes no Lot lines identifiable yes 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 ll3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. 1lwe 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 -~ SIGNATURE OF APPLICANTS} 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. (xEV. osios> ' ~ ~ r ` ~ • V CERTIFIED SLJRVE~ MAP VOLUME 27 PAGE 5788. THE NORTH HALF OF THE NORTHWEST QUARTER OF THE SOUTHWEST QUARTER, SECTION 12, TOWNSHIP 28 NORTH, RANGE 15 WEST, TOWN OF LADY, ST_CROIX COUNTY,WISCONSIN SURVEYOR'S CERTIFICATE t, Joel A. Brandt, Wisconsin Registered Land Surveyor, hereby certify that I have surveyed, divided, and mapped the north half of the Northwest Quarter of the Southwest Quarter of Section 12, Township 28 North, Range 15 West, Town of Cady, St. Croix County, Wisconsin, more particularly described as follows Commencing at the West Quarter corner of said Section 12, as the point of beginning of the parcel herein described Thence N89°40'17"E, along the north line of said Southwest Quarter, a distance of 1324.17 feet, to the northeast corner of the northwest quarter of said Southwest Quarter, and east line thereof; Thence 500°25'40"W, along said east tine, a distance of 663.92 feet; Thence 589°48'19"W , a distance of 1323.88 feet, to the west tine of said Southwest Quarter; Thence N00°24'22"E, along said west line, a distance of 660.82 feet, to the point of beginning. The described parcel contains 876,932 square feet (20.13 acresl. Said parcel is subject to the right-of-way of 320th Street to the west and 45th Avenue to the north and to the easements of record and as shown. That 1 have made such survey, land division, and map at the direction of Jeffery Kemp, Owner, 219 75th Street, Clear Lake, 54005. That such map is a correct representation of the exterior boundaries of the land surveyed, and the subdivision thereof made. That I fully complied with the provisions of Chapter 236.34 of the Wistonsin State Statutes and the subdivision regulations of St. Croix County in surveying, dividing and mapping the same. /~~ 1 A ,~y\SCGY1/~' 1 Dated this 2.3 day of / "1 ~L-~ \ , 2006. .~~. • sw~wor r:ew o~.cwuvooo atr~ ~ -vn Joel A. andt, R.L.S. #2603. ~~ SURv F~ Approved this~~ day of ~ , 2006. APPROVED J / ~crleooc~caouirrr ~J~ ,~l Gc~fIJN~''v~ ~ 5t. Croix County Zoning Representative APR 0 7 2006 It not reoordsd within 30 days of sQpovd data sPP~ s1aM be nuM au~d Vold Vol 2 7 Page 57 88 Page 2 of 2 2 of 2