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HomeMy WebLinkAbout018-1040-90-000 o co o Co O 3-0 n d L1 c', 3 0 CD m 3 " \ 1 A~ Cl) $ -u ;u rn z O G) 9 H Z to G1 2 0 • 0 (JI U) CO 3 0, D1 C K N= N N C ~°N = D) 00 rn Q 3 a o y J y 3 3 m y N fO R (D -n C) zz N C O D O N p 0 N a D, a CO) a N a 10 a > > > Co O CD N N A O O O 7 O a O O M 3 > > N n~ N 0 ''7 O 0 l~ 51 c c O ° cn v D ~ a ur v y =r CL Co _ c c I ~ a0 0 0) 0) o I a0 00 ap\, ° ~ ' i rTVI Z -4 CL 0 0 N N p~ O N N A ° o= 0 r co z o o_ 3 1 m o N N N N N 3 M r C _ C N "a T -0 ca CL O O O Ln O O O °7 a 3 N y N= r 3 CO) y co? , -u o G CA a O 0 n m d v N ' m a y m - W N - A !r 2. FL I 3 d 3 d N al ~ ~l D D 0 C D D 0 A O m N m "*A• m N N N l~l N C N C CL fD CD (n N O y p z° CL A I U) -4 m m m m (D CL A c z D D ? Ca 01 ° o m CD m o ~n'iaD 3 o D 3 CD 0-0 y a (D ° mom D N° N a n F ° W-0 = 3 7 -1 O fD CD N a T v N r fD N y w C (ovo=mv z a :3 a» 3 N O F fl. Cal) °m ° x M N p. to ~ ai o m N N a a s~ m m ~ m CD cn °.o m a F vy,'o a m n e° C oa a, ~m Q as C -4 W o CX -0 010 F a aa a (D a N O~ O N N C D, fi < CD y QQ1° Ufa', y iv 3 CD M V 0 77 < ° j. N CL CD p CL o D J N I I o o a CD N v, O En O o0 F ° F o b CD (D CL CL k-j Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 552378 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan lp No: Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. as '71f Permit Holder's Name: City Village X Township Parcel Tax No: Gillis Farms Inc. Hammond, Town of [ 018-1040-90-000 CST BM Elev: Insp. BM Ele~v: BM Descro; s ~C Section/Town/Range/Map No: v V fZvCoJ~l 18.29.17.284 TANK INFORMATION ELEVATION DATA 01 ~a TYPE MANUFACTURER CA P6CITY STATION BS S ELEV. Se / 1,1 /0 n T Benchmark t7 •17 f N / to Dosi g / Alt. BM ~ y Aeration Bldg. Sewer ~D Ito 3.7Lj /03 2 Holding St/Ht In-let , ZZ ol. TANK SETBACK INFORMATION Ht Outlet 16 2~ TANK TO P/LII WELL BLDG. Vent to Air IntaAe ROAD Dt Inlet l ~7 [ fury 5 k J U 0 Z 7. 2 7 Septic > 1 1 'r L~ Dt Bottom `r 7 c' Dosin / v1ti t H der n. CIO Aeration Dist. Pipe Holding Bo .System PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover f. G-~ Gy J GPM / • 5 lo-5 Model Number lL yv,~,1( p,_ ~ a c" Z TDH Lift Friction Loss Syste eaj TDH Ft / iForcemain AL~ Ler~gth~ Dia. Dist. to Well V4' LI L' ~ SO L ABSORPTION SYSTEM BED/TRENCH Width 2 Len th No. Of Trenched G PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS I Y L~. r n - / SETBACK SYSTEM TO 1 7 P/ D WELL LA ST EAM EA ING Manufacturer: INFORMATION C ER OR Type f Syste , _ x~j Model Number: DISTRIBUTION SYSTEM -s✓ N" 4 ,ra /L S'CH 40 - pla s ~ar~ Header/Ma if d Distribution / t"P(I'L Ix Hole Size x x Hole Spacing Vent to Air Intake Length Dia Length 0 Dia Spacing f (~t SOIL OVER x Pressure Systems Only xx Mound At-Gra rSee_d.d/Sodcled tems Only t,CVh Depth Over Depth Over xx Depth of xx Mulched Bed/Trench Center Bed/Trench Edges// Topsoil Fa-1 Yes FE-] No ~ Yes FVAJ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ vIn/spectI92##~2/:~~C~/ Location: 1524 Hwy 12 Baldwin, WI 54002 (SE 1/4 SW 1/4 18 T29N R17W) 40 acres Lot F6 ~ Parceeel No: 18.29.17.284 1.) Alt BM Description of 1't'" ~t 111 4 A t Q'd (,h,~ d ~y ~D 2.) Bldg sewer length l d drV - amount of cover Plan revision Required? 7 Yes No Use other side for additional information. / l a ruluk~v~- Date Insepctor's Stnature Cert. No. SBD-6710 (R.3/97) , Safety and Buildings Division County Ivis W201 W. Washington Ave., P.O. Box 7162 nsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by C c0 Department of Commerce (608)266-3151 5) 37 l / Sanitary Pet Application State Plan I.D. Number In accord with Commi~ ode, personal information yo w~ ? 3 I may be use%E~C6rtdary purposes Privacy Law, s15.04(1 X Project Ad~djre~sss (if different than mailing dress) mac T /7 / ~^AQ -~3 -~-Iu 1. Application Information - Pie NVMriformation L y _ Property Owner's Name 51 Gu Zp1,UN Parcel # Lot # Block # G Q f?b P N, '26,35 Property Owner's Mailing ddress Property Location / 2dlf / J~Qy,, Section Z C City, State Zip Code Phone Number f J^ d Z N; R c E orircle oad T ~ It ype o Building (check all that apply) V14 or 2 Family Dwelling- Number of Bedrooms Subdivision Name CSM Number ❑ Public/Commercial - Describe Use - ` `S ❑ State Owned- Describe Use ❑Ciry ❑villageV?rownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System eplacement System ❑ Treatment/Holding Tank Replacement Only Other Modification to Existin System B. ❑ Permit Renewal 44-it Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date lssue d Before Expiration Plumber Owner IV. Type of POWTS System: Check all that apply) ❑ Non -Pressurized In-Ground ❑ Mound > 24 in, of suitable soil ❑ Mound < 24 in. of suitable soi t-Grade ❑ Single Pass Sand Filter ❑ Constructed Welland ❑ Pressurized In-Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatm Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ gravel-less Pipe ❑ Other (explain) V. Dis rsalffreatment Area Information: O ' Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Aria- ~uired (st) Dispersal Area Proposed (sf) System evation QJ . (/p 0 9/71 ° VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tacks Tacks optic Holding Tank bic Treatment Unit O 1 /Dk 52-Dosing Chamber ,,e 5 VIL Responsibility Statement- 1, the undersigned, ascame responsibility for ins 'Pago-n~~f the POWTS shown on the attached plans Pl hex's Name (Prim) Plum s ignat MI&W RS umber Business Phone Number e- i /4 Plumber's Address (Street, City, State, ip od 2fu . Coun rtment Use Only Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Dat Isstied suing A t Signature tamps) Surcharge Fee) DD ~7 j3 I ❑ Owner Givers Reason for Denial / IX. Conditions of Approval/Ressons for Disapproval Plt- 4111~ Al~~ Attack complete plans (to the County only) for the system on paper not less than SM x 11 inches in sine SBD-6398 (R. 01/03) Safety and Buildings Division county s 201 W. Washington Ave., P.O. Box 7162 nsin Madison, Wl 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) ~ W (608) 266-3151 5GJ Z Department of Commerce State Plan LD. Number Sanitary Permit Apphcatt~B` fF N In accord with Comm 83.21, Wis_ Adm. Code, mformation you 64,4 ! may be used for secondary purposes Pn~w, s15.04(l)(m) Project Address (if different than mailing address) f Ro b.e.., JA w 4. 1. Application Information - Please Print All I tidn Property Owner's Name Parcel #p Lot # Block # Q 1 f S Lzi Property Owner's Mailing Address yropeny Location (,2--64) , City, State Zip Code Phone Number circle one l Z ~AI S+rs~ T N; R If. Irype of Building (check all that apply) 1 or 2 Family Dwelling -Number of Bedrooms Subdivision Name CSM Number ❑ Public/Commercial - Describe Use r ~S ❑ State Owned -Describe Use ❑city ❑Village Wownship ofA qI III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System ❑ Replacement System Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of PORTS System: Check all that apply) ❑ Non -Pressurized In-Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At-Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In-Ground ❑ Hording Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip lane ❑ Gravel-less Pipe ❑ Other (explain) V. Dis rsaUTreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. ank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units ^ Concrete Constructed Glass New Existing Tanks Tanks v /~J Septic or Holding Tank v~d ~OD liU ( •t2 Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' MP/MPRS Number Business Phone Number t T/7 Q C 10 0? - Plumber's Address (street, city, S , Zip e) A 4-Z s Gu VIII. Con /De rtmeat Use Onl 17 Sanitary Permit Fee (includes Groundwater D Issued Surcharge Issuing t Si o S ❑~ea Fee) Z L 11 vcn Reason Denial ~J(~ 7 DL Conditions of Approv"easons for Disapproval t Cam. -5 a VIL e 17 e&4 SYSTEM OWNER;. 3) -tG.: 1 1'. C tank, effluent fixer end f~ r lacQ 5 sd-e N., ; ~N dispersal cell must all be serOm / maintained ~ as pw * no - 0:1 ruWment plats provided by plumimr. tG C k'f'et^ G- ra`~d-L 2. 14411111MMItIVOMI-im"W ~.b*~ ,Ise, 6e- , PP as hK C061 «0 01,1 . Attach complete plans (to the County only) for the system on paper not Ins than 81/2 x ll inches in size SBD-6398 (R. 01/03) wptw~o Safety and Buildings o~ 3824 N CREEKSIDE LA HOLMEN WI 54636 D 3 Contact Through Relay R www.dsps.wi.gov/sb/ yt~ S www.wisconsin.gov ~ssior~+ Scott Walker, Governor Dave Ross, Secretary July 25, 2012 CUST ID No. 648443 ATTN: POWTS Inspector ZONING OFFICE KEITH E KNUDTSON ST CROIX COUNTY SPIA 927 150TH ST 1101 CARMICHAEL RD ROBERTS WI 54023 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/25/2014 Identification Numbers Transaction ID No. 2103918 SITE: Site ID No. 780995 Tom Gillis Please refer to both identification numbers, 1524 Hwy 12 above, in all 'correspondence with the agency. Town of Hammond St Croix County SETA, SWI/4, S18, T29N, R17W FOR: Description: At-Grade / Three Bedroom / Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1379048 Maintenance required; Replacement system; 450 GPD Flow rate; 44 in Soil minimum depth to limiting factor from original grade; System: At-grade Component Manual, Version 2.0, SBD-10854 (N.03/07), 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. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Cold Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and APPI dispersal are prohibited. • The existing POWTS must be properly abandoned per SPS 383.33 Wisc.Adm. Code. ~ • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption t7~_ area. chs. NR 811 & 812c SEE COR1 • 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. KEITH E KNUDTSON Page 2 7/25/2012 t 1 • 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. Stat • SPS 383.22(7) A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • SPS 383.52 Responsibilities. 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). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation/operation. 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 Fee Received $ 250.00 Balance Due $ 0.00 Charles L Bratz J POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday charles.bratz@wisconsin.gov 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. f r kv r, RESIDENTIAL AT-GRADE DESIGN Pressurized - Sloping Site INDEX AND TITLE SHEET Project Tom Gillis At-Grade Owner Tom Gillis Address 1486 County Rd. TT Roberts WI 54023 612-751-3516 Legal Description SE1/4-SW1/4 Sec. 18 T29N-R17W Township Hammond County St. Croix Subdivision Name Lot No. Parcel ID Number 018-1040-90-000 Plan Transaction Number Index sheet Page 1 Calculations Page 2 At-grade drawings Page 3 Laterals and dose tank Page 4 Specifications Page 5 Management & contingency plan Page 6 Pump Curve Page 7 Plot Plan Page 8 Designer Keith Knudtson License Number MPRS#648443 Signature Phone Number (651) 470-1737 Date 06/07/12 A4-C,We- Yer a,Oj 581 -1~8~~--D3/off, Designed pursuant to: At-grade Component Manual for POWTS and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01/81) itl~nalx- Version 3.11 (05/01) Page 1 of 8 f f NGS F iESp CF, PRESSURIZED AT-GRADE DESIGN At-grade Design Worksheet - Sloping Site Flows and Site Data Entry. (r or c) r Residential or commercial? 300.0 Estimated wastewater flow (gpd) 450.0 Design wastewater flow (gpd) 4.00 % Site slope 98.50 Contour elev. below lateral (ft) 44.00 Depth to limiting factor (in) 0.6011n-situ soil application rate (gpd/ft^2) Distribution Cell Information (1 or 2) 1 Influent wastewater quality 8.00 Linear loading rate gpd/ft 8.00 Effective absorption width (ft) 10.00 Max. effective width permitted (ft) 94.00 Aggregate length (ft) Pressure Distribution Data Entry (c or e) c Center or end lateral connection 2 Number of laterals 0.188 Orifice diameter (in) e.g. 0.188 Not a final calculation 1.92 Estimated orifice spacing (ft) 1.50 Forcemain diameter (in) 5.74 Forcemain flow velocity (ft/sec) 18.00 Forcemain length (ft) y or n Does forcemain drain back? 93.00 Pump tank elevation (ft) y or n Are laterals at highest point? NA 3.25 System head (ft) x 1.3 1.7 Forcemain drainback (gal) 5.00 Vertical lift (ft) 42.0 5x Lateral void volume (gal) 1.56 Friction loss (ft) 43.7 Minimum dose volume (gal) 9.81 Total dynamic head (ft) 31.6 System demand (gpm) Lateral Diameter Selection Gallons/Inch Calculator (optional) Pipe diameter Design options Design choice Total Tank Capacity (gal) Designer 1 in Total Working Liquid Depth (in) must select 1.25 in Gal/in (enter result in cell G46) one lateral 1.5 in x x diameter 2 in x Treatment Tank Information 3 in x 1000 Septic tank capacity (gal) Wieser Concrete Manufacturer Effluent Filter Information Dose Tank Information Pol -Lok Filter manufacturer 750.4 Dose tank capacity (gal) PL-525 Filter model number 20.3 Dose tank volume (gal/in) Wieser Concrete Manufacturer Project: Tom Gillis At-Grade Transaction Number: Page 2 of 8 AT-GRADE PLAN VIEW D 1/6 B Observation pipes (2 typical) B A 8.00 ft t;:: r T 94.00 ft t---1 1/6 B 15.67 ft C 10.00 ft WC D 5.00 ft E 2.00 ft D T L 104.00 ft B W 20.00 ft A x B 750.00 ft^2 L T E-- Cap Typical obs. pipe. = Total aggregate cell A x B Slotted in the lower l~.J se and anchored = Plowed area L x W securely. IM 6° AT-GRADE CROSS SECTION Svnthetic fabric cover 100.29 ft Finished grade Lateral elevation invert elev. 99.00 ft Observation pipe at aggregate toe E 4 % Slope Surface contour gg,50 ft C A and system elevation D = 12 in. topsoil and subsoil ® over aggregate and tapered to toes. Plowed layer below L x W = 6 in. aggregate below pipe(s), and 2 in. above pipe. Project: Tom Gillis At-Grade Transaction Number: Page 3 of 8 PRESSURE DISTRIBUTION AND DOSE TANK Lateral Diagram - Center Connection I P I IE X IE xl2 I x124) Laterals & force main of PVC Sch 40 Last hole drilled next to end cap (per COMM Table 84.30.5) Holes drilled on the bottom of the lateral, • ■ Turn-up wtballvshre orclesnoutplug equsug spaced Lateral Specifications 0.188 Orifice diameter (in) Center Lateral connection point X 1.95 Orifice spacing (ft) 2 Number laterals 24 Orifices/lateral P 45.83 Lateral length (ft) 15.8 Lat. discharge rate (gpm) 1.50 Lateral diameter (in) 1.50 Forcemain diameter (in) 31.6 Sys. discharge rate (gpm) 18.00 Forcemain Length (ft) 9.81 TDH (ft) Typical Pump Chamber Layout Approved manhole cover with Weather-proof warning label and locking device junction box Final grade 4° disconnect Tank component is Alternate properly vented f--- outlet location 18" min. Electrical as per NEC 300 and Ir^ Approved outlet joint Comm 16.28 WAC Tank full Inches Gallons A Provide 1/4" 'hc~ies CT-a A 20.8 422.5 weep hole or Alarm on antisiphon I 3$5.3 B 2.0 40.6 B device. E C 2.2 43.7 Pump on 02 . S(o o D 12.0 243.6 94.00 ft C G Totals 37.0 750.4 Pump off p ~a 42 3.36 D ~fa~ 3 °7 7~v, 36 3" Bedding under tank 93.00 ft Goulds Pump manufacturer S.J.Electro Alarm manufacturer EPO-4 Pump model number Tank Alert Alarm model number Project: Tom Gillis At-Grade ' Transaction Number: Page 4 of 8 '~a.ll~ gals. uk~ )os'e r- X G( USA ` G 76J Is. At-grade System Maintenance and Operation Specifications Service Provider's Name Powers Sanitation Phone 715-246-5738 POWTS Regulator's Name St. Croix CountyZoning Office Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 750.0 f:2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Ins ect for ondin and seepage once eve 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the at-grade 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 at-grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. 6. Areas within 15 feet of the downslope toe will be protected from compaction. 7. All other construction details are as per the at-grade component manual SBD-10570-P (R. 6/99). Lateral Turn-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: Tom Gillis At-Grade Transaction Number: Page 5 of 8 At-grade System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10570-P (R. 06/99) and SSWMP Pub. 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet fitter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The fitter 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 fitter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent fitter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. At-sarade and Pressure Distribution System No trees or shrubs should be planted on the at-grade. Plantings may be made around the at-grade's perimeter, and the at-grade 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 at-grade is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the at- grade be heavily mulched as protection from freezing. Influent quality into the at-grade 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 BOD5 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the at-grade component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by renovating the biologically clogged absorption and dispersal media, installing new piping, and replacing other components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Tom Gillis At-Grade Transaction Number: Page 6 of 8 Page 7 of 8 MGOULDS PUMPS Submersible Effluent Pump EP04 3871 EP05 APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses: heat transfer. ■ Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion • Farms manual operation. Auto- resistance. Canadian standards Aswaaf f 1 • Heavy duty sump matic models include • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "C" or "I"'.) factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic Wft P1mps is ISO 9001 Wqsi>red. FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. '/4" maximum. ■ EP04 Impeller: Thermoplas- 0 Power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi-open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: 1'12" NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104~f (40cC) continuous METERS FEET 1401F (60cC) intermittent. • Fasteners: 300 series 10 stainless steel. 9 30 s GFM • Capable of running dry without damage to a zs r> cofnponents. 25 a 7 Motor: • ER04 Single phase: 0.4 HP, 6 20 115 or 230 V, 60 Hz, 1550 s RPM, built in overload with Q t s automatic reset. a 4 EPOS • EP05 Single phase: 0.5 HP, o 115 V or 230V, 60 Hz, 1550 3 10 RPM, built in overload with EP04 automatic reset. 2 • Power cord: 10 foot s standard length, 16/3 1 S1TOW with three prong grounding plug. Optional 20 ° °0 10 20 30 40 so GPM foot length, 16/3 SJTW with three prong grounding plug o 2 a s s 10 12 m3/n (standard on EP05). CAPACITY Goulds Pumps ® 2001 Goulds Pumps ITT Industries Effective May, 2001 83871 Sanitary Site Plan Page 8 of 8 + For: Tom Gillis SE1/4- SW1/4 Sec. 18 T29N-R17W Town of Hammond - St. Croix County 0 25 50 ~ML;-.-.j cram Boats (Foot) 1 Inch = 80 tt. 40 Acre Parcel 1320 ft. P2 P/L Pole Barn 97.00' Proposed 8'x 94'At-Grade Mound Cell w/a System Elev. of 98.50' 1320 ft B 98.00' I B #2 #1 Corn Field BM Proposed 1112 Sch. 40 F.M. 1 - M 4% #2 I I 99.00' I Proposed Wieser oncrete 750 Gallon Dose Tank Failing BM#2 = Top of spike at base of huge cottonwood tree Elev. = 99.86' Sewer # Proposed 4"Astor D-3034 10000' Conveyance Pipe Three Bedroom Home Proposed Wieser Concrete 1000 gal. Septic Tank w/a • WELL Poly-LokPL-525 Filter FN# 1524 HWY 12 Existing Bldg. Sewer 4" Sch. 40 to be used crossing old tank and out of outlet onto solid ground. Note: House is > 100 ft North ofHWY 12 A BM = Bottom of Pole Barn Siding S.E. Corner * HRP = Same 1320 ft ASSUMED ELEV. = 100.00' Jun 03 12 09:47p Dave Fogerty Plbg. 17154687013 p.1 or - WicwminDoparimaatofCommew SOIL EVALUATION REPORT Page / of 3 DMston of Safety snd Buildings m acmrdw cewah Comm 85, Wis. Adm. Code _ Courtly . Attach ooatplete site plan on paper not less than 8112 x 11 inches in size. Plan must Include, but not rme'teci to: vertical and horbmntal r serene pond (BU). d nm6on and Pawal I.D. percant a om. wale or dtmer akxw. north srrm, and location and dlstanee to newest road. f G d - dOm Please print all inklTltallOn. Reviewed by Date P--W InIM-6m Ya P-do --Y bo uwd loroarnnd-Y pmpoaos lPnvxy Law. a 15.04 (t) (cap. PropertyOwner Property Location 0 /r 1 Govt Lot s,~F 114„ iZ~/ v4 S T Z 9; N R / E (or PropertYGwrwrs MalkVAd*= Lot# Block # Subd Narne or CMW - - v Al. 7r City State Zip Cade Phone Number ❑ City O Village UTown Newest Road v t 1 A 0 New Construction Use: QWResidenftai ! Ncrs9wof betpoorns .3 Cade derived design flow rate $ cy GPD Q• Replacement ❑ Pubic or commercial - esrnbe: Parerd metedal t - rr 77 ♦ / Ptain elevation iFappkable It. and oonunendata~ ~fp `11 r= 1 / t l ornsr ek4le/ !o n Aw - Ve, 5- # F-/1Swing ©Pit Ground surfaoa elev. IL Depth to W *Q factor yj in. Sop Rate Horton Depth Dominant Radon Desailrtion Texhae StuchNe Consistence Boundary Roots - GPDM in. Munsap Q L Sz. Cori. color Gr. SZ SK a •af#1 -Eft#2 -s L s AR 9& G co 7 Z 13 -2 . S- Y r S C o O ,Clo z lr~ rrv re ` Elm" Boft 2 pit C*=w surface elev. 9~ . 7 ft. Depth to lutjWQ factor 3 y in, Sol Role Hormn Depth Dominant Redox Descdplion Twdwc Structure Consistence Boundary Roots GPDM Ns MraisaA Qu. Sz Cant. Color Gr. Sz_ sh. 'EflfM •Eff#2 -/Y r .s s .2mW~t F z S 3 z 3 7s s L , EfNuertt #t = BOp 30_ 224 ntj & and TSS >30 5150 mglL • 6Auent 02 = DOD K 30 rrrgtand Tt3s c 3D mg+L CST blame f %we- Pni) = Nuffa er ,o aai/mod Address sic/ Ewift a6an Go Aclad Tele Mf* Nu ffkw ~ 7 ~0 GC..~f/ ~I~~.r> R_D ~,r>►!~' s 1P 2. ~1L 7>s = yl6-vo00 Jun 03 12 09:47p Dave Fogerty Pibg. 17154687013 p.2 ~rvP~► : - ' Panoe~m /oYo - y~ - am P" or 0 Mika 0 Pit 4 ariaoa ei~.. ~ f) ~ _R Dew to tg fsdnr~~ IFL Avokswaftu F moA O"A Oca*mt g;mm a ccedpom Tom= sb[r2err: canico os aammimy . PAlaft e 6,. Hansom Gn. sk Cat Clot Qr- sz SIL 'B®ci ' 2 sL s o Zy 3 - P i' 1 - 7 L der /lr as ~ y , e br d DWI El 1 4. Q soft* ©~e II Pit c s oq mop i Appkagm soy Rob' Haim Oepmr .00mb"t RedaKDrMawM' B Tea Sire km Cmddeme Bouday nooks GPWR in ikaeset CkL S;. float. C d" GL SL Sh. 'EU1 'm e°'inS SO" # [L~~JJ ❑ s~It c~muaeaaieaoeelsv R Deptnbi~~ryfae~or ire Soi i?eba Fbria OWh' Dadnsrrt CoW Redarci]es*k n. T"Um a mum cmimme Smsmy ftm MOM kt ltUMA OL ISr- CM & cow Or. SL 8h 'f ~1 'i'.liO2 ' ~Alrs>nt~1 ~ Bpi ~ 90_?~ ate- irrd'19S ~^'[50 mplL ' Emsyax ~ ~ ~i 30 rnpll. grid T58 t 90 mgR TA DOW== Gf CO Q 14 An 09W OWNWICy SUTJw pt'O VWW smd If you need Ito socesa servicas or =W mmxtset in an sift Me faema Nurse ooa= We dgwunca at 608-26fr3jsj w TfY 6D8-26 .Vn_ . . Jun 04 12 08:25a Dave Fogerty Plbg. 17154687013 p.2 t Z r IX a W 1M r1 t f ki O V 0 O O • O z b 0 a ? z v x : ti ~9 It ~ ~ it Iti 1 ~ ~ U a rt i y w 4 b •o U 2 4 7 4 P 2 7 5 -7 -e+ 9 1 a! t:-; A KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 2 - 1998 REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between Bernard M. Lewis and Bernice H. Lewis, 12/15/2003 10:00A1f husband and wife, Grantor, and Gillis Farm, Inc., Grantee. Grantor, for a valuable considerati-o`n -Cbnveys and warrants to Grantee WARRANTY DEED the following, described real estate in St. Croix County, State of Wisconsin (The EXEP(PT # "Property"): REC FEE: 11.00 TRANS FEE: 1080.00 The Southwest Quarter (SW 1/4), EXCEPT the South 268 feet of the West COPY FEE: 238 feet of the Northwest Quarter of the Southwest Quarter (NW 1/4 of SW CC FEE: PAGES: 1 1/4), Section Eighteen (18), Township Twenty-nine (29) North, Range Seventeen (17) West. The East Half of the Southeast Quarter (E 1/2 of SE 1/4), EXCEPT the West 231 feet of the South 1320 feet thereof, Section Thirteen (13), Township Twenty-nine (29) North, Range Eighteen (18) West. The West Half of the Northwest Quarter (W 'h of NW 1/4), EXCEPT a Recording Area parcel of land located in the Northwest Quarter of the Northwest Quarter Name and Return Address (NW 1/4 of NW 114) described as follows: Lot One (1) of Certified Survey Hendrik W. Van Dyk Map filed January 6, 1983, in Volume "5" of Certified Survey Maps, page VAN DYK, O'BOYLE & SILER, S.C. 1243, as Document No. 382030, Section Twenty-four (24), Township Twenty- Post Office Box 118 nine (29) North, Range Eighteen (18) West. New Richmond, WI 54017 SUBJECT to easements and highway conveyances of record. 018-1040-50-000 018-1040-60-000 022 IU34-70-0UU 042-1035-30-000 042-1066-70-000 & 042-1066-90-000 Parcel Identification Number (PIN) This is not homestead property. This conveyance is given in Satisfaction of that certain Land Contract between Bernard M. Lewis and Bernice H. Lewis, as vendors, and William A. Gillis, Gregory J. Gillis, Patrick W. Gillis and Robert E. Gillis, as Purchasers, dated December 3, 1984 and recorded December 4, 1984 in Vol. 701, page 442 as Doc. No. 398267. Said Purchasers interest was assigned to Gillis Farm, Inc. by Assignment of Land Contract dated June 26, 1990 and recorded April 5, 1991 in Vol. 897, page 404, as Doc. No. 467956. Said Land Contract was amended by Amendment to Land Contract dated January 6, 1995 and recorded January 10, 1995 in Vol. 1108, page 258 as Doc. No. 525020. Exceptions to warranties: Subject to all easements, restrictions' and covenants of record, and any lien created by act or omission of Grantee. Dated this 10th day of December , 2003. t ysr 6~ *Bernard M. Lewis *Bernice H. Lewis AUTHENTICATION ACKNOWLEDGMENT Signature(s) Bernard M. Lewis and STATE OF WISCONSIN ) Bernice H. Lewis ) ss. County ) authen 'c ed th' 10 hda of D b r , 2003. Personally came before me this day of 2003 the above named * Hendrik W. Van Dyk to me known to be the person(s) who TITLE: MEMBER STATE BAR OF WISCONSIN executed the foregoing instrument and acknowledge the same. (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Hendrik W. Van Dyk Notary Public, State of Wisconsin Post Office Box 118, New Richmond, WI 54017 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 1995 INFORMATION PROFESSIONALS COMPANY FOND DU LAC, Wi 800-655-2021 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer o~ Mailing Address 1 Property Address _y Lo / 2_ (Verification required from Manning & Zoning Department for new construction.) City/State of Parcel Identification Number 516 Z)00 LEGAL DESCRI P iT.IO' N Property Locat , A J ion~w ' V" ' Sec. 'N R~W Town of /4 , //4,9f erne ~ Subdivision Plat: Lot # Certified Survey Map # , Volume , Page # Warranty Deed # 2/ (before 2007)Volume Z Page # s Spec house D yes drh~'o Lot lines identifiable 9 /yes D no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance- The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe 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. Nu edr s SIGNATURE OF APPLICANT(S) DATA ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 09/07)