Loading...
HomeMy WebLinkAbout018-2015-00-006 . Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St Safety and Building Division INSPECTION REPORT Sanitary Permit No: 552367 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: 018-2015-00-006 Bu ni, Kelly I Hammond, Town of CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: /M m 35.29.17.1125 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION S HI FS ELEV. j . /9t3 Septic rr Benchmark 3 Z3 /a45 60 Dosing ~r 1 Alt. L t b 7 X '74` 11~6 ^ Bldg. Sewe /J - ic? Holding St/Ht Inlet q r~ 7T T TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 144 Dt Bottom Dosing Header/Man. 277 1-9-7110 Z T,'/ Aeration Dist. Pipe /.97 rOZ ' V Holding Bot. System ' Final Grade PUMP/SIPHON INFORMATION S7 Ian" /s Manufacturer Ui~ Demand St Cover -7 7 / '74,66 GPM j C./ 10 Model Number Z Y, 7Z TDH Lift Friction Loss System Head TDH P1,131 1 4.56 Z - Forcemain Length / Dia.. .t Dist. to Well 17 / SOIL ABSORPTION SYSTEM BEDITRENCH Width i Length / No. Of Tr ches PIT DIME SIB IONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS IT .7 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHLEACHING AMBER OR Manufacturer: __-1 INFORMATION Type ystem: L24 466 / I~ UNIT Model Number: 1 00 ~ DISTRIBUTION SYSTEM e~ HeaderlManif x Hole Size Hole Spacing Ve o Air Intake od Distribution 77, a 7 ad if ! Length Dia ZS Spacing___4_ x p Z S:s Length Dia Z Pipe , r SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only C.r Depth Over Depth Over xx Depth of xx Seeded/Sodded )o (Mulched ' Bed/Trench Center J , 0~ Bed/Trench Edges Topsoil ' ~ No ` ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ¢ (7 / I / /7► Inspection #2: / Location: 1915 66th Ave. mond, WI 54015 (SW 1/4 NW 1/4 35 T29N R17W) Croix Hills Lot 6 rcel 9: 35.29.17.1125 1.) Alt BM Description = ~ P/~~ 2.) Bldg sewer length = I ® c, ®110_ - amount of cover = A Plan revision Required? ❑ Yes 'No bZ 1N Use other side for additional information. Date Insepctor's Signat Cert. No. SBD-6710 (R.3/97) County E E Safety and Buildings Division 1 8 201 W. Washington Ave., P.O. X 72 Sanitary Permit Number (to be filled in by Co.) S Madison, WI 53707-7~ } NAY nmsaction Number nix t Application - In accordance with Wis. Adm_ Code, submission ofthis form to the appropriate gnvemmental unit is required prior to obtaining a sanitary permit Note: Application forms for state-owned POVirlS are submitted to - jest » (if d' than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondaryao 1757 46 in accordance with the Privacy Law, s_ 15. 1 in Stars. L A 'cation Information - Please Print Alt Information V IV r7 Property Owner's Name Parcel # V~ 14 till 1 © - 20) Zo Property s Mailing Ado- Property Location i S r Q Zip Code Phone Number w_ V j] tr. asection 3 -C' ~(crn le ones IAI Type of BaiMing (check all that apply) Lot Subdivision Name 1 or 2 Family DweHing- Number of Bedrooms B # 1 ❑ public/Commercial - Describe Use ❑ City of CSM Number ❑ Village of ❑ state owned -Describe use 5 Town of III. Type of P orally one boa on line A. Complete line B if applicable) A. New sy~em ❑ Replaccinertt System ❑ Treatment/Holding Tank Replacement Only ❑ other 1'4 dification to Existing System (explain) List Previous Permit Number and Date Lssued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer tONew Before Expiration Owner r/ IV. Type of POWTS S tem/Com nVDevice: Check all that ❑ Non-Pressurized Io-Ground ❑ Pressurized %n Ground ❑ AVGrade ❑ Mound > 24 in_ of suitable so Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pre reatment Device V. Dl tsaUTreatmeat Area Information: Design Flow (gpd) Design soil ication Dispersal Area Requi (st) Dispersal Area (sf) System Flevatim p p It Proposed 0 15D ISOI) o VI. Tank Info Capacity in otal # of Manufac S Gallons Gallons Units `gc' V S Now Tanks Existing Talcs U r/J H Vl W C7 rs. Septic or Holding Tads 1000 )9(10 l eSe 1 l 0,0 C DosingChomber DG VII. Res 'bility Statement- I, the aadetagmed, assns respomibilky for installation of the POW M shown an the attached Ph- Plumber's Name Mint) PI 's Si MP/MM Number Business Phone Number ally o OSS 4 524 Plumber's Address (Street, City, S~e, Zip Code) -vev - d -s s z- ortment Use Only ignat# isappro ved Perrmit Fee Date Issued ~ v wner Given Reason for Denial s &25-, .0 S IX. Conditions ofApprovaVReasoas for Disapprove! '~j C 011 r - 'G~ W _ SYSTEM OWNER: R~ b~ TY O 1 Septic tank, effluent filter and d d dispersal cell must all be serviced /maintained \ as per management plan provided by plumber. S7iUC.~ tin ' e and to the n 1 pernot Im dm in iehn in slope as per applicable cdb~ll ter th SBD-6398 (R- 11/11) I -Plot Plan = = Page 8 of 8 Property Owner ~;.uy fur I"=4©ft. Legal Description UT C rx t+Fus, 504 TwL (except where noted) N fuL/H s at-, T7-IA`, lK t7!rJ{ -r Z = Backhoe pit ou~A. Or ~{A/VlrlAr~i> S i. RDix L'0~th3 L _ 14 A ~ -8 AYE Af c. njT W_ A)S► North J E > d- Da 5 _ RIM f` C ~k T L?0Z Ob `Drctm ,~~1Dtr3 ~'ya t 'PF,O'~~D tbe~ i~ Or bm4W-.0WA % 3 Site Locadon: AMA. S ~,ri+AVS• ,4 COPY 9~tir~TFVo Safety and Buildings 3824 N CREEKSIDE LA '0/ r HOLMEN WI 54636 Contact Through Relay 0 www.dsps.wi.gov/sb/ P S w www.wisconsin.gov N ~O'ssroN Scott Walker, Governor Dave Ross, Secretary May 29, 2012 CUST ID No. 224832 ATTN: POWTS Inspector MARY JO HUPPERT ZONING OFFICE HOLLISTERS SOIL TESTING & DESIGN ST CROIX COUNTY SPIA W9875 690TH AVE 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/29/2014 SITE: Kelly Bugni Identification Numbers 66TH Avenue Transaction ED No. 2085946 Town of Hammond Site ID No. 779594 St Croix County Please refer to both identification numbers, SWI/4, NW1/4, S35, T29N, R17W above, in all correspondence with the agency. Lot: 6, Subdivision: Croix Hills FOR: Description: Four Bedroom Mound System / 5% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1372853 Maintenance required; 600 GPD Flow rate; 19 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD-10691-P (N.01/01), Pressure Distribution Component Manual - Version 2. 0, SBD-10706-P (N.01/01); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed 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 ITT SEWAGE requirements. • No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145. iondifto stats. A The following conditions shall be met during construction or installation and prior to occupancy or use: a~ Reminders D1v;cJOH OF SAFETY AN • 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. a.. . - • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • 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. MARY JO HUPPERT Page 2 5/29/2012 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. SPS 383.54(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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Of-~Olfffc-~ This Amount Will Be Invoiced. erarim When You Receive That Invoice, POWTS Plan Reviewer, Integrated Services Please Include a Copy With Your (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm Payment Submittal. jeny.swim@wisconsin.gov WiSMART code: 7633 Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety& Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE UJ o Project Name: KELLY BUGNI N v-~ co Owner's Name: (same) Owner's Address: 1810 Aspen Drive, #201 1AJ 1 Hudson, WI 54016 Legal Description: SW 114 of the NW 1/4, S 35, T29N, R17W Township: Hammond County: St. Croix Subdivision Name: Croix Hills Lot Number. 6 Block Number NA SYSTEM Parcel I.D. Number. 018 -2015 - 00 - 006 illy Plan Transaction No.: Page 1 Index and title if E L) ~t4stl6!•",'~°.:s~ql~~ Page 2 Data entry ) BUILDINGS e ± f~6v Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan ~DENCE fi( (ET I's I Page 7 Pump curve and specifications ~p PP T11 a Page 8 Plot Plan :g ~ ~ ~n tlr, ti. lap Designer. Mary Jo Huppert License Number. 1859-007 Date: 05/09112 Phone Number (715) 426-1775 Signature: ALCM d Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01101), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SOD-10706-P (N. 01/01) Version 5.1 (R. 06/06) Page 1 of 8 i Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 83-44-3 in-situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of - 36 inches. 600.00 Design Flow (gpd) 5.00 Site Slope 100.50 Contour Line Elevation (ft) 19.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/fr) Distribution Cell Information 1 75.00 Dispersal Cell Length Along Contour (ft) = 8.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/fe) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? ~ y ^r of E Center or End Manifold 4.00 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 Orifice Spacing (ft) = 10.00 Wforfice 2.00 Forcemain Diameter (in) 86.00 Forcemain Length (ft) Does the forcemain drain back? Y 89.00 Pump Tank Elevation (ft) 6.50 System Head (ft) x 1.3 14.03 Forcemain Drainback (gal) 12.75 Vertical Lift (ft) 46.75 5x Void Volume (gal) 1.16 Friction Loss (ft) 60.78 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 24.72 System Demand (gpm) 20.41 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x x 1.00 1.50 x 1.25 x x 2.00 1.50 x 3.00 2.00 x 3.00 x Gallonsiinch Calculator Treatment Tank Information Total Tank Capacity (gal) 1200.00 Se tic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser Manufacturer galtin (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.00 Dose Tank Capacity (gal) Pol lok I Filter Manufacturer 22.24 Dose Tank Volume (gal/in) 525 Filter Model Number Wieser Manufacturer Project: KELLY $k~Nt Page 2 of 8 Mound Plan and Cross Section Views 1/108 J Observation Pipe _ O Q A W :::::':::::':::'::'•'.'•:•i B ,C: L Mound Component Dimensions A 8.00 ft E 21.80 in H 1.00 ft K 10.16 ft B 75.00 ft F 9.25 in z 12.00 ft L 95.33 ft D 17.00 in G 0.50 ft J 7.01 ft W 27.01 ft 600.00 (fe) Dispersal Cell Area 1500.00 (ft2) Basal Area Available 8.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 103.69 (ft) H G 102.42 (ft) Lateral F Dispersal Call 101.92 (ft)-0 - Invert Dispersal Cell [ Elevation D ® a 100.50 (ft) Contour Elevation 5.0 % Site Slope Geotextile Fabric Cover Shading Key -T Dispersal Cell See lateral details on 1[] [ Topsoil Cap 2 c 1.5 ft Page 4 for number, size, .w...rw Subsoil Cap WO © and spacing of laterals. ASTM C33 Sand / F Laterals are equally ®Q Tilled Layer 0. ft Typical Lateral spaced from the © v ® distribution cell's Aggregate centerline in the A distribution cell (AxB). Project: KELLY NLW* Page 3 of 8 f3U~Nl End Connection Lateral Layout Diagram P• • fu t•. uyttf.._ ..a'....i :h•s•:.,ui.luV l r ? st.-t i I.. 14.-t.' .1 •-L~i.•, •Ldl.• S .at.' l,.- •r...tr. ,t ti:.• t rr•-t t' ?,qua ;aF'a:sd l' Xk:i- -f ilrt i J1iLe-11iar- Vl 1 l i- ul £ '4~ S 'il ITi 5 °ltfult i( _if ; P0;.. L i'»f e::5 u f C ' rt a G! :--VC "-,J, 0 Pei Ta: 284 :r)-$i Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 73.37 ft Orifices per Lateral 30 Lateral Spacing (S) 4.00 ft Orifice Density 10.00 ft /orifice Lateral Flow Rate 12.36 gpm Manifold Length 4.00 ft System Flow Rate 24.72 gpm Manifold Diameter 1.25 in Total Dynamic Head 20.41 ft Forcemain Velocity 2.52 ftfsec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and -`-10 Comm 16.28 WAC 4 in. min. Disconnect Tank component is property vented : E'---- Alternate outlet location Forcemain diameter Wieser Manufacturer --I?- - Capacityl 800.00 Gallons Volume in. Volume 22.24 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 23.24 516.82 B 2.00 44.48 C Pump ofd elevation ft C 2.73 60.78 89.67 D 8.00 177.92 D Total 35.97 800.00 ~ Dose tank elevation ft 3" Bedding under tank. - 89.00 Alarm Manuafacturer Tank Alert Alarm Model Number -10, Pump Manufacturer 'Gould Pump Model Number Pump Must Deliver 24.72 gpm at 20.41 ft TDH Project: KELLY BUC-W I Page 4 of 8 Mound. System Maintenance and Operation Specifications Service Provider's Name Ron's Septic Service Inc. Phone[ 4715 749-0153 POWTS Regulator's Name E__St Croix County Zoning i Phone F(715) 386-4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 400 Igpd Maximum BODS 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frenuency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Inspect f~ndin and seep a~c a once every 3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Tum-up Detail Finished 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: KELLY BUGNI Page 5 of 8 LUC COMA6 F : ~ ~YIi r~' ~g kL~1 Et 0 .b~Ba dtr.5t.~. 7f lrrm P MWn ° a k g - } a y u f A . "dvrr~r3rvrs at:3ufpllt Tw_ r ri ert.- J,e rn~n a CA fS,.,.n.. - ,-~..:~.k..~,. zi,,•.~`^.v7.~ r r- .t ~ y ma L.vSi iP,71I IR't t~,}. 4.i0. ` Y s t: ae Ria- iapi S vc I ilpEi~E. aw f - e G to „i t :c "k... 3 . « •evi, ssEvi i yys"i- U i sie _ rt k . ~Tn' tifEr and IGw€r ^ wn e-sfv .r>, .eii. sw a y Uury 6bal, j, +q~nf 1 AFPLWAUIW~ ~ ~ i 'yiic+.3 iiii ibl~ F ` - - - .:sc• itiua`iCai$il Fifr rt:DEC."tfti£t7 ;VVv . l fv d(CB : Service We. Mound' YVS-Lefr" i r ~i k[~.lw Su V~ 33; rice 3ils.~tc ISr✓, ~f Poweled, illr Continuous c,eiueitvu0Sliit} Systems =5~a i ~sllytlt; i i Vohs li3u=aseitt l3. us6N FIR-44 CA ripe Systerm illidaittli. m capaum 33-1 EaFm S7litue Ot design Ail i<a lltvs are within tiie Bas*r ent )raining " lesR mum > att: 25 # u- w PE41 M= 'Wolking limits of the 01010f r Heavy Outv Sumpt PE41 Pte: -4014P, 3400 i f 4uW(cusconnaa power Dewatenn9 " Maximum tapac►:. 61 GPM " 115 and 230 volts cord, 20, swndard length, " Maximum head: 29` Mli PSC design heavy duty 1613 5!fW wfth PE51 Pump; PEST mur 115 or230 v*growt&9 mmmum capacity: 70 GPM .50 HP, 3400 RPM A C~ ~ te~2 unit heavy n tmd:37' TQH 115 and 230 v~ duty, Y ter..,,'.. • .i-. y.. •~..,-.1...4 _ Wmv ,1 and Apinks MOOR& Pm. M41, PM I am. 35 A SO ~ t/ Stai1116SS Steel e~*,, 10, 2 GPM i 30 t FT AGSKIrLISTOM v 25~ ~c t1S H TeNW 1>a tp. n aad CSA n2 109 ftmbrds is 4CMdbmAxKbWSAU9dWm 10~~-cr+r.~eao9~1 peed, '~1 ~ • •'s s s •-2~~ 0 1 i f'~3E r ~t~.y. NI 20 3o ao so er 50 70 GM "9 0 0 10 t5 m3ih Pursuant to Comm 83.54, Wis. Adm. Code is 1 2 S X3$2- rGe feral This system sh opperated in accordance with comm Wis. Adm. Code, and shall maintained in accordance with its' component manuals (SSD-10691-P (N.01/01), SSWMP Publication 9.6 (01181), and Pressure Dilution Component Manual Ver. 2.0 SSD-10706-P (N. 01/01)] and local w 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 t 3 Gerem 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. -;4 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 shag be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Sao-ft Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shag 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 shag 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 shag be serviced if the alarm is activated continuously. Intermittent fitter alarms may indicate surge flews or an impending continuous alarm. The septic tank shall have its contents reproved 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 shag 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 shag be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shag be inspected at least once every 3 years. AN switches, alarms, and pumps shag be tested to verify proper operation. If an effluent fitter is installed within the tank it shag be inspected and serviced as necessary. 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 pound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter wig promote frost penetration. Cold weather Installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODj, 30 mg/L TSS,10 mg/L FOG, and 104 cful100 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 dogging has occurred and N orifice cleaning is required to maintain equal distribution within the dispersal cell Observation pipes within the dispersal cell shag be chocked 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. If the septic tank or any of its components become defective Contionency Plan per operating condition . Pocent shag be repaired or replaced to keep the system in If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the detective component(s) shag be immediately repaired or replaced with a component of the same or equal performance. If the mound component fags to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in Its' present location by increasing basal area if toe leakage occurs or by removing biologically dogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretr anerrt t1Mts 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. gip. :XF►j-y 17 = ~ Cr T • Plot Plan Page 8 of 8 Property Owner BuEn►z I"=4©ft Legal Description rxT C, , MIX 544 0r (except where noted) N ~1'l4~ s rZgr~, R i7WJ ToW Or AAAAMQ4 ST J~ = Backhoe pit ~Rotx Cor .MD4r . W!~Cb W; L:~ = HAS $vrr~~a~ North 41 ~i~~ ~ ~ }oo. oo' ` n A 5 q9 $ Z C~'t~' ~lD a 49 00 • Q~J,DFl3,~ Sd 'PRaP~D tbe~ 1AA1 R Z ,aS ass A ~ (Aa'T WAK9} r Sf 3 Site Location: At. A -S a Ab=- Oct-19-2010 01:59 PM St. Crcix County Plan/Zon ng 715-386-4626 1,`1 ST. CROIX COUNTY SEPTIC TANK MAlNTI3NANCE AGRE3CM>,NT AND OWNERSHIP CERTIFICATION FORM owner/Buyer _ I -41 Mailing Address &I Z Property Address 5-7,101 / q 6- ~ bA (Vcrlrw,tion require from Pl1111nins & Zp ins Departntcnt for new construction.) City/State dvr li✓ Parcel Identification Number ( ~ ~d l 'rj -©Q -0o6 L L DESCRIPTION ~ //2S) Property Location '/R .WJ&-I_ yq . Sec. 3,5, T _!2tN R_aW, Town of o Subdivision Plat: 1k f , Lot # Certified Survey Map # , Volume, Page # Warranty Deed # ~SJ ~-31i,01 (bcj ore 2007)Volunte , Page # Spec house -yes Ro Lot lines identiliablo es 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 fttnction of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities arc specified in §Conmi. $3.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department it certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifyfng that (1) the on-site wastewater disposal system is in proper operating condition rind/or (2) atler inspection and pumping (if necessary). the septic Innk is less than P3 1-till ofsludge. 1/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards sot 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 he completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. 1/we certify that all statements on this form are true to the best of my/our knowledge. 11we am/are the owner(s) of the property described above, by virtue ora warranty deed recorded in Register of Deeds Office. Numbe • f bedrooms ~ / Gib b ~ NAT I'LICANT(S) DATE **s`Any information that is mi presented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Resister of Deeds Office and a copy of the certified survey map if referenwe is made in the warranty deed. (REV. ONS) s t EC Wisconsin Departmento mmeroe OIL EVALUATION REPORT page 1 of 2 Division of Safety and B ings k A,` , in'a"nce Comm 85, Wrs. Adm. Code county Attach complete site n on SjMj Fill AiligW /2 x 1 inches in size. Plan must ST. CROIX include, but not ' ' point (BM), direction and Parcel I.D. Ol - 2015 - 00 - 006 percent slope, scale n and distance to nearest road. Please print a!l infnrmaftion. Re ' by Data 61 Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1) (m)). ~16 1 Property Owner Property Location 0 El KELLY BUNGI Govt. Lot SW 1/4 NW 114 35 T 29 N R 17 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSW 6 Croix Hills city State Zip Code Plane Number Village ■ own Nearest Road #uD UJJ WI 5401k ( ) 66th Avenue New Construction UseE]Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ❑ Public or commercial - Describe: Parent material loess over till Flood Plain elevation if applicable NA ft. General comments Mound System --1.42 & sand fill 0.40 loading rate and recommendations: Boring conducted to move system area due to contour lines and elevations from previous report dated 12-6-05. Soil on-site W'th Ryan Yarringtoon, St. Croix C ty Zoning Specialist. K ✓.'r A Boring ,111 0 Boring Pit Ground surface elev. 100.90 ft. Depth to limiting factor 19 in. Soil Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Mur"" Qu. Sz. Cord. Color Gr. Sz. Sh. 'EfW1 'Eft#2 1 0-12 10YR3/2 - sii 2fsbk mfr 0.6 0.8 2 12-19 10YR4/4 - cl 2fsbk mfr 0.4 0.6 3 19-24 10YR4/4 c2d 7.5M/6 scl 0m 0.0 0.0 F-1 Boring # ❑ Boring' ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'EfW2 ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent # = BOD 30 mq& and TSS < 30 mg/l. CST Name (Please Print) S CST Number Mary Jo Huppert ollister's Soil Testing & Deli 224832 Address Date Evalua Condtxed Telephone Number W9875 690th Avenue, River Falls, WI 54022 05 - 08 - 12 (715) 426 - 1775 fT\T MMI~TIV'I.NI~\ r s' Plot Plan for Site and Soil Evaluation Page 3 of 3 Property Owner BuN~s P I"=40ft. Legal Description LOT 6 e-& I y. tt s us, sw 1& o F , ,L (except where noted) N► L&F S u5, T29'3i1, ~z [7WF~Or A, AAAAAiwA sT a = Backhoe pit g-Rot x CO U-64 . LU sc, Alsr„a LL - Nit ND ~r aar North ~44A, 'k - p al~,,~05 fi•~ti Ro o ! oo. oo ~~o~ n ^C1 0 ~~d►~ ~Y~ ~j ogre Rip°z Vo6 !9 ~ 'PRot~D u,~ roN 'R 05 (NbT WA V, ED) w of A iE-T Site Locadon: V . #1807 11 Page 1 of 3 consin ~s Y Department of Commerce n a rd* Cod Z Steel's soil service, Inc. Division of Safety and Buildings St. Croix Attach complete site plan on paper not less than 8%2 x 11 in n size include, but not limited to: vertical and horizontal reference point BM), direction and percent slope, scale or dimensions, north arrow, and location an distanle NM"* .N I I.D. c Uj W ) ; Please print all information. wed B Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location French Homes, Inc. Govt. Lot na SW1 WNW1 5, T29N, R1 Property Owner's Mailing Address Lot # Block # Subd. NaP.O. Box 350 na Croix Hills Icc~ l.ov lz City State Zip Code Phone Number . ❑ City ❑ Village N Town Nearest Road Roberts WI 54023 715-718-2929 Hammond 190Th St D New Construction Use: ❑ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe: na Flood plain elevation, if applicable na ft. Parent material Silty sediment and underlying reddish sandy loam till General comments Mound Design, system elevation 99.1,,1ft based on contour line elevation 97.70ft. No deviation from site and recommendations: area w`ouARrst contacting soil tester d e t poor soil conditions SqJ 7 ok (`l o F-11 Boring # ® Ground surface elev. 97.70 ft. Depth to limiting factor 19 -/in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-12 10yr3/2 none A 2msbk mfr cs 1vf .6 .8 2 12-19 10yr4/4 none scl 2msbk mfr gw na .4 .6 3 19-48 10yr4/4 c2d 7.5yr5/6 scl om mfr na na .0 .0 F2113oring # ® Ground surface elev. 97.70 ft. Depth to limiting factor 26 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'EM 1 0-9 10yr3/2 none A 2msbk mfr CS 1vf .6 r.8 2 9-26 10yr4/4 none sicl 2msbk mfr gw na .4 3 26-40 10yr4/4 f1d 7.5yr5/6 sicl om mfr cs na .0 4 40-60 5yr4/4 c2d 7.5yr5/6 girls Osg mvfr na na .7 1.6 Effluent #1 = BOD? 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) i ature: CST Number 248956 David J. Steel kddress Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 11/22/2005 715-760-0347 SBD-8330 (8.07/00) Property Owner French Homes, Inc. Parcel ID # Pending Page 2 of 3 ❑ Boring # ❑ Ground surface elev. 95.00 ft. Depth to limiting factor 20 in ® Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10yr3/2 none A 2msbk mfr cs 1vf .6 .8 2 9-20 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 20-48 10yr4/4 c2d 7.5yr5/6 cl om mfr na na .0 -0 -1 Boring # ❑ Ground surface elev. ft. Depth to limiting factor in. ❑ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # ❑ Ground surface elev. ft. Depth to limiting factor in. ❑ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft' 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 = BODS < 30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07100) Steers Soil Savice. Inc. STEEL'S SOIL SERVICE INC. 3 of 3 David J. Steel French Homes Inc. 994 200' St. CST-POWTSM SWl/4,NWl/4,S32,T29N,R17W Baldwin, WI 54002 Lic. #248956 Town of Hammond, St roix Co. Direct 715-760-0347 Croix Hills Lot, )z Fax 715-684-3449 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this test may or may not be as shown, as permanent lot lines were not established at the time the soil test was conducted. Legend N 1" = 40' ♦ = Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe • = Alt Benchmark Ele. 100.00 ft ❑ Top of 3/4" pvc pipe - onngs uA Boring Elevations 1= 97.00 ft )j-b ~~n•~a~"r C, 7,6b B2 = 97.00 ft h l B3 = 95.00 ft B4 = 0.00 ft j a8r ~D SI m C0 3. 3 36 ~ ~ tl1 f ~ rn x 9sc o a a o o Q C ~Qr r r' --I r G 9z r ;MR I IN[ of 7w fN 114 - NV IA I Ong, . I , is-Is I ( I I Q§K I " , I If vN E $ I I I r'1 eerrai w Mfr E- 1 5 Rs I I I I I 9 I II ► r~ 1 1 , I III I - ~ 1 ti \ ~ ~_.-.19187' 9H a , ~,r +.,~t 1~ pg \ I I \ \ 1 ~x I ~4ye I ~3vpN' - _ ~ _ _ - _ N G'!J4 N 1}OR,6C• ` L - W j/. Wp Me 'I 0 , WIN ■ Y tl . Z0 :mad S9Q-IS GNb Jti13WS BEE69OLS89 eZ :Ii 9083/Z7f60 8 0 5 5 8 4 4 Tx:404INV WARRANTY DEED 955620 BETH PABST REGISTER OF DEEDS Document Number Document Name ST. CROIX CO., WI 05/03/2012 12:44 PM THIS DEED, made between Central Bank, a Minnesota banking corporation, EXEMPT*: NA sucessor-in-inte st to The RiverBank ("Grantor," whether one or more), and Kelly REC FEE: 30.00 Bugni,d S~gGi'SOYI ("Grantee," whether one or more). TRANS FEE: 60.60 Grantor, for a valuable consideration, conveys to Grantee the following described PAGES: 1 real estate, together with the rents, profits, fixtures and other appurtenant interests, in St Croix County, State of Wisconsin ("Property"): Lot 6, Croix Hills, Town of Hammond, St Croix County,. WI Name and Return Address St. Croix County Abstract & Title 219 S. Knowles Ave New Richmond, WX 54017 018-2015-00-006 Parcel Identification Number (PIN) This is not homestead property. Exception to warranties: Municipal and zoning ordinances and agreements entered under them, recorded easements for the distribution of utility and municipal services, recorded building and use restrictions and covenants, general taxes levied in the year of closing and .Dated this 27th day of April, 2012. Central Bank, a Minnesota banking corporation, sucessor-in-interest to The RiverBank By: Zach McBroom, Attorney in Fact AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF MINNESOTA ) ) ss. authenticated on W&S1, rlJy }o r, COUNTY ) Personally came before me on this 27th day of April, 2012, the TITLE: MEMBER STATE BAR OF WISCONSIN above-named Central Bank, a Minnesota banking corporation, (If not, sucessor-in-interest to The RiverBank, by Zach McBroom, authorized by Wis. Stat. § 706.06) Attorney in Fact to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: • Robert L. Lober Notary Public, State of Minnesota _3 " o?> o r) 5 ) Loberg Law Office aln My Cotrunission (is permanent) (expires: (Signatures may be authenticated or aclmowledged. Both are not necessary.) -Type name below signatw'es MARIA L. RODLUND Votary Public Minnesota 11(9"C,oTfnGsonExpresianLay3l.2M5 I I WARRANTY DEED FORM N40.1-2003 1 of 1 i 09/12/2006 11:28 6087859330 SAFETY AND BLDGS PAGE 02 xxUHYN 9w C ~ ~t- ~ I I vu $ r"Ci m P1 A g ~i i . a 8H a Fits 11 g C !0; ty r '~~'eg-net 3 ~ ~f1 N`IE~ ~rt~ a , ~ Eye ~4 it i l a P ~ ~J1q r~n ?c° i saNvfd3ila~aNn t/1 ,m HC INn i53M (H1UON) 'V'm OTLSZ M Z/ G P Y^n 09'90Ct sl ,pe.K.a7 n ,n_hOfl - V.l'•' ~Ytg'A!r- -_-.rY9F1-.- l l 09 _ _ _ _ _ _ _ _ - V e SF-7 I Nr -It ' I Pu +JO xln 7ul r I _3 I Iii 186 ~u W w I I `R;,~ ~ 7 y u ~ n H >a ~ u -I ~ pNVO y 1 1 N ~ I ' 1 [ ~ ~'••~+1 C.3 .a ''i IV I„" r \ 0111 \ w6~ I ,-a r I w~ ' RITS I I RISK \ \ \ 17 a r r i n r•• n a O rY ~ II m a zI. Ici I~v 4' ..,mcrc- - - x1-wL 5• 1 \ \ • y -3 V 1% 41- al, I I 1 x I ~ I ail ~I Sl ~ `I ~1 I ; w _y~i9i11L N--9a`Lti I s I ~•----I~i ~ ~ ~ a. I 1 a YYY - ~ 3 S a y ( ' N a x w m I L' y I H m -9 I (x^ G1 __±Z'bIC M ,to,r.l.oa nJ I cn I Yf~Ry Lq 'R b r r-r wn ~a ~ I ~ I A; I ~ d S I! I I I +I/ b~ s i - ,.L I`~'-- I•,>O VL'J N ,tlC,tC.W X•• I~ I V'ilr/tl9 Al LS.aO+--,~ tl a - ,a0'cyE .war FLI- AO'9rl MJ xa ,CO.LY - xY \ Ic ,£G'QO£l 3 .GO,LI.OO r ~I L/1 MN - 4/t M5 3H1 !O 3NI 115tl3 aF ,P~y tC- ICI IQI_LY'rNll lp~g r~ 1-0'3 ~IEIVED ~ . rn I ! 6 ~ boos . ~ S