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HomeMy WebLinkAbout022-1009-77-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 552388 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: Bune, Beau & Sarah Kinnickinnic, Town of 022-1009-77-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 6-1 04.28.18.571330 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER t CAPACITY STATION BS HI FS ELEV. Septic Benchmark / v Z. 13 Dosing Alt. BM 112 - b5 Aermft~. _j n~ Bldg. Sewer * 9. 4( S o7 , /C T// fJ J Holding St/Ht Inlet 00 -7 1 ~~5 l /L St/Ht Outlet 7 7 !o TANK SETBACK INFORMATION TANK TO / P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic W j f, Dosing Dt Bottom ~Z d 3 ~J, ` ' X9'7' I Header/Man. / 1 Ob 117 117 S A6.71 Aeration Dist. Pipe S 1 71 r /I Holding Bot. System 116-01 (,2. (3 Final Grade / PUMP/SIPHON INFORMATION 4,31/8,71 Manufacturer Demand St Cove / J C GPM Lt.. fe Model Number 3.15 163-151 TDH Lift Friction Loss System Head TDH Ft 72- 2-qq, :3 ZS r 9 3 Length Dia.z, Dist. to Well Forcemain 1 5s'l I F _T SOIL ABSORPTION SYSTEM 1/.05 3-15 BEDITRENCH Width Length No. O Trenc s PIT DIMF~JSIONS No. Of Pits Inside Dja.` Liquid Depth DIMENSIONS Q C A _'_L SETBACK SYSTEM TO ✓ P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type f stem: 56 / / > 1r V CHA UNIT OR Model Number: O✓ DISTRIBUTION SYSTEM 1 Header/Manifol~ / Distribution 11 x Hole Size f Ix Hole Spacing / IVegr'DD Air Intake Pipe( ) Length Dia ,l 5 J_ Z,'5 3 Length~1 Dia 4 5 Spacing 5. Q'z SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of R__ xx Seeded Sodded xx Mulched Bed/Trench Center c 7 Bed/Trench Edges Topsoil I Sod Yes Fo No Yes ® No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #11-: / 3 ( I Z_ Inspection #2: / / Location: 534 Raymond Rd Roberts, WI 54023 (NE 1/4 SW 1/4 4 T28N R1 8W) NA t 7 40r Parcel No: 04.28.18.57830 1.) Alt BM Description = (Ca w~ ~je~~ C/ 2.) Bldg sewer length = - amount of cover = 130 /O~ ? C9 ~ Plan revision Required? Yes ;rNo S 3 Use other side for additional information. V v Date Insepctor's Signa re Cert. No. SBD-6710 (R.3/97) RECEIVE County Safety and Buildings Division J 7. D a 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) a S " I Madison, WI 53707-7162 P~ ST CRO.- 1?_ 55 23 9'9 ro"~~w ItdG , Sanitary Permit Application State Transaction Number 2/ D 3gZS In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1) m , S 1. Application Information - Pie se Print A n r a ion parcel # Property Owner's Name (`q, f c~ ~a - o~ r -7 duo Prope Owner's Mailing Address Property Location (578-30, Govt. Lot 7 City tate Zip Code Phone Number A-)A- 1/4, 57l.4-C Section 4- (~r l'_ -Z7 S- ~o a 3 z' / - a 7 ~ - ~ 13 T N; R ~ rc1E on eC"=J Type of Building ((check all that apply) Lot # Subdivision Name ,-1 or 2 Family Dwelling -Number of Bedrooms i O _ A Block # ❑ Public/Commercial - Describe Use Gl~ ❑ City of 0 ~o 1~ r.~r Q4 ~J~v&(W umber ❑ Village of f ❑ State Owned - Describe Use d^ a` ~d A Town of ~~t~n. n..) i ! • ni Z - Z 7 2 5- III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ANew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. El Permit Renewal El Permit Revision El Change of Plumber El Permit Transfer to New Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) NZX ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil )ks Mound < 24 in. of suitable soil ❑ Pretreatment Device (explain) ❑ Holding Tank ❑ Other Dispersal Component (explain) a 1.. 4 V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Appl' ion Rate(gp Dispersal Area Required Dispersal Area Propose IY ' System Elevation 5-0 le 0 7s^o 5°r' 7-5-C v 7,.J VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units r f a U° 2, -6 New Tanks Existing Tanks 0 o 2 2 Y ~ a U .0 0. Septic or Holding Tank Dosing Chamber f VII. Responsibility Statement- I, the undersigned, ass a responsibility for installation of the POWTS hown on the attached plans. Plumber' Name (Print) Plumb Sign a /MFRS Number Business Phone Number Plumbe Address (Sleet, City, State, Zip Code) VII . Coun /De artment Use Only Permit Fee Date ued Issuing ent Sign Approved =7:hReason /j 7 for Denial $(o2-6- L Ix. Condi W easons for Disapproval G - ON' r rows 1. Septic tank, el f ubfit MW the dispersal cell must all be ~rvtrl!]6 t male L- W/ ,g as per fnanagetnertt plan pro Vuleii by'pkIrllW 2. AN satlack I'eVill, lent mua.be:mai A D U alk 0ai APP code / ofdit>an I J Lo f4 , l 16 Attach to complete plans for the system and submit to the County only oPer n Iess~9812 1 iinsi;ze SBD-6398 (R. 11/11) ' jt f 16 A 7"x'1° 4~. ~5,lzd 16 co e b - °3 f j- 4-a a~ 6a % k 5 it Arb Cnp~ R ~l~o~rnxr~rF~TO~ Safety and Buildings 10541N RANCH ROAD o I P HAYWARD WI 54843 3 j s a Contact Through Relay K P S www.dsps.wi.gov/sb/ www.wisconsin.gov A Fv SIONA~ bw Scott Walker, Governor Dave Ross, Secretary June 29, 2012 CUST ID No. 220357 ATTN.• POWTS Inspector BRADY J UTGARD ZONING OFFICE UTGARD PLUMBING & HEATING ST CROIX COUNTY SPIA PO BOX 413 1101 CARMICHAEL RD AMERY WI 54001 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/29/2014 Identification Numbers Transaction ID No. 2103925 SITE: Site ID No. 780997 Beau Bune Please refer to both identification numbers, CTH N above, in all correspondence with the agency. Town of Kinnickinnic St Croix County NEIA, SWIA, S4, T28N, R18W FOR: Description: Moun 5 edroom residence Object Type: POW omponent Manual Regulated Object IDNo.: 1379051 Maintenance required; 750 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.01101), SSWMP Pub. 9.6; Effluent Filter p,Q,W.T. Conditio 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 construct 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 p ~1.. OF k. HC requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s:145 SEE CORK _SPl stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Key Item(s) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • The gravelless system components must be installed in accordance with the manufacturer's printed instructions, the plan approval, and SPS 383 system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. • The float switch shall be a type that does not contain mercury. 2009 Wisconsin Act 44 prohibits the installation of float switches or relays that contain mercury. • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. BRADY J UTGARD Page 2 6/29/2012 ' Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 384.10. No fixture, appliance, appurtenance, material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system, unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • Maintain well and waterline set backs per SPS 383.43(8)(i). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of 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 Patrice Shando POWTS Plan Re iewe , Integrated Services WSMART code: 7633 (715) 634-7810, Fa . (715) 634-5150 , M - F 8:00 a.m. - 4:45 p.m. pat.shandorf@wisconsin.gov cc: Charles L Bratz, POWTS Reviewer II, (608) 789-7893, 7:45 am - 4:30 pm Monday - Friday 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 Project Name: BEAU BUNE Owner's Name: BEAU BUNE Owner's Address: PO BOX 89 ROBERTS Wl. 54023 Legal Description: NE / SW / S4 /T28 /R18W Township: KINNICKINNIC County: ST. CROIX Subdivision Name: NA Lot Number: 7 Block Number: N/A Parcel I.D. Number: 856769 Plan Transaction No.: Pagel Index and title `U~yGs rJ ~ Page 2 Data ent ry Page 3 Mound drawings , Page 4 Lateral and dose tank NC Page 5 System maintenance specifications Page 6 Management and contingency plan gage 7 Pump curve and specifications Page 8 PLOT PLAN 1 U 3 Page 9 soil test Designer: BRADY UTGARD License Number: 220357 Date: 06/1)412 Phone Number: 715-268-6995 Signature: Designed Pursuant to the Mound Component Man for POWTS Version 2.0 SDB-10691-P (N. 01/01), and SSWMP Publication 9.6 D ign of Pressure Distribution Networks for ST-SAS (01/81) Version 3.11 (R. 06/01) Page 1 of 9 Mound and Pressure Distribution Component Design Site Information R Residential or Commercial Design Note: Sand fill (D) calculations assume a 500.00 Estimated Wastewater Flow (gpd) Table 83-44-3 in-situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150%) coliform of - 36 inches. 750.00 Design Flow (gpd) 10.00 Site Slope 106.00 Contour Line Elevation (ft) 18.00 Depth to Limiting Factor (in) In-situ Soil Application Rate (gpd/ft) i Distribution Cell Information 95.00 Dispersal Cell Length Along Contour (ft) = 7.90 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? C Center or End Manifold 3.95 Lateral Spacing (ft) If N above, enter the elevation (ft) 4 Number of Laterals of the highest point. 0.188 Orifice Diameter (in) (e.g. 0.25) 2.50 Orifice Spacing (ft) = 9.88 fe/orifice 2.00 Forcemain Diameter (in) 65.00 Forcemain Length (ft) Does the forcemain drain back? Y 99.00 Pump Tank Elevation (ft) 3.25 System Head (ft) x 1.3 10.60 Forcemain Drainback (gal) 8.25 Vertical Lift (ft) 85.89 5x Void Volume (gal) 3.22 Friction Loss (ft) 96.49 Minimum Dose Volume (gal) 14.72 Total Dynamic Head (ft) 49.81 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options _ choice in. dia. o tions choice 0.75 1.25 1.00 1.50 x x 1.25 2.00 x 1.50 x x 3.00 2.00 x 3.00 x Gallonslinch Calculator Treatment Tank Information 950.00 Total Tank Capacity (gal) 1585.00 Septic Tank Capacity (gal) 38.00 Total Working Liquid Depth (in) WIESER Manufacturer 25.00 gal/in (enter result in cell B49) Dose Tank Information Effluent Fitter Information 950.00 Dose Tank Capacity (gal) POLYLOK Filter Manufacturer 25.00 Dose Tank Volume (gal/in) PL-525 Filter Model Number WIESER Manufacturer Project: BEAU BUNE Page 2 of 9 Mound Plan View _ t . . . . . . . . s 1/108 J Observation Pipe ' ❑ - FK O D A W B I L Mound Component Dimensions A 7.90 ft E 27.48 in H 1.00 ft K 11.06 ft B 95.00 ft F 9.50 in z 15.35 ft L 117.12 ft D 18.00 in G 0.50 ft J 6.44 ft W 29.69 ft 750.50( ft2) Dispersal Cell Area 2208.75 (fe) Basal Area Available 7.89 (gpd/ft) Linear Loading Rate 9.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 109.29 (ft) G H r{{rr}r}{} 2 {{{{{ri\ I F = Dispersal cell 108.00 (ft) Lateral 107.50 (ft)-lo. - Invert Dispersal Cell = t Elevation E . D . . . 4 4 106.00 (ft) Contour Elevation 10.0 % Site Slope Geotextile Fabric Cover Shading Key m c. T Dispersal Cell See lateral details on 1❑ 0 Topsoil Cap c 1.5 ft Page 4 for number, size, Subsoil Cap C Q and spacing of laterals. T © ASTM C33 Sand ~ Z H+ / F Laterals are equally Tilled Layer 0.5 ft Typical Lateral spaced from the ❑ Aggregate c I distribution cell's 05 0 centerline in the A distribution cell (AxB). Project: BEAU RUNE Page 3 of 9 Center Connection Lateral Layout Daigram Force main connection via tee or cross to marrfold at any point. Laterals are identical IE P S Turn up v„"bal I salve or x-}IExl2 f xl2 Laterals & force main of PVC Sch 40 cleansitplug per CMW Table 84.30-5 Hales drilled an the bottom of the lateral Number of Laterals 4 Orifice Diameter 0.188 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 46.81 It Orifices per Lateral 19 Lateral Spacing (S) 3.95 ft Orifice Density 9.88 ft2/orifice Lateral Flow Rate 12.45 gpm Manifold Length 3.95 ft System Flow Rate 49.81 gpm Manifold Diameter 1.50 in Total Dynamic Head 14.72 ft Forcemain Velocity 5.09 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and - Comm 16.28 WAC 4 in. min. Disconnect Tank component is property vented y E Alternate outlet location Forcemain diameter WIESER Manufacturer - 2 in. Capacityl 950.00 Gallons Volume 25.00 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A i~ 23.14 578.51 C B 2.00 50.00 _t P4 ump off elevation (ft) C 3.86 96.49 99.75 D 9.00 225.00 D Total 38.00 950.001 1 Dose tank elevation (R) 3" Bedding un er tank. 99.00 Alarm Manuafacturer LEVEL Alarm Model Number DLV Pump Manufacturer GOULDS Pump Model Number EP05 Pump Must Deliver 49.81 gpm at 14.72 ft T D H Project: BEAU BUNE Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name UTGARD PLUMBING Phone 715-760-0946 POWTS Regulator's Name ST. CROIX Phone 715-485-4680 System Flow and Load Parameters Design Flow - Peak 750 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 500 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1585 gal Maximum TSS 150 mg/L Soil Absorption Component Size 750.5 fe Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Tum-up Detail Finished *00000000000090 Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: BEAU BUNE Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01) and SSWMP Publication 9.6 (01/81)) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as, an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically 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. I Project: BEAU BUNE Page 6 of 9 EP04' & EP05 Series A APPLICAY1004S • Fully sutarraerged M high a EP05 impeller: Thermop►as• 8 964aingS. Lipper and lower grade turbine of for tic enclosed design for heavy duty bail bearing Specifically designed for the Egon and ettdw improved performance, rMtruction. tollowing uses teataransfer. ■ Casing and past: Rugged • Effluent systems thertttOP40K design provideS AGENCY tGT1N6 • Homes Available for atil mnk and superior strength and coavsaon c81010011k U&MW s wmKiMm • farms MaNal operation. Auto- resistance. G. F4 re tQ3550 • Heavy duty sump M* W10dek include et Motor Housing: Cast iron • water transler mecbanital Fioatiwitcrt CMM Pwr+~+sno"0t kvww ability. • Qewate ring assembled and preset at the stctngth a for a strength, and heat dulabipty. factory SPf CIFICATIONS M fluor Cover: ThermOplaStK - FEATURES cover with integral bandit and • Solids handling capability: float switch attachaemt poinu_ S a maximum- A EW fttepeW. tltct rn *S- g Power Cable- Severe duty • Capacities: up to 60 GPM- tic "n*opendt* with rated oil and water resistant, • Total heads: up to 31 W. ptr" tut whet ter mechwCal • Discharge size Vh NPT. seal pmk tw, • Mechanical seat- carbon- f rotaryJ,eram~c-stationary, ~ OUNA-N elastomers. • 1 0411f (4011} continuous mot" FEET `1401F MOO intermittent. t0 • Gasteneri: 300 series ;(b n!eSS 4teeV. 9 . , -►~r S 1 Capable of running dry without damage to a fill, a.ompOnentS Q ? 25• i;~ V et r Motor x •c Apo dingle phase 0 4 HP. Y 6 115 0,' 430 V. 60 Hz, 1550 RPM, bu+h in overload with o 5 t S` /tj/ , 7.R automatic reset ~ a r [~•os • EP05 Single phase, 0 5 HP. o 715 v or 230V. 60 Hz. 1550 a to; d RPM bu.ii in o"doad with .tw° automatic tset. z • anwPr ;ordtt~ foot S, - Standard length. 16/3 ` j SiT'WI with three prong gmund'tng plug. Optional 20 ° °o to 20 30 40 ' GPM io,). Sh 168 SJTW with ?hree prang grounding plug a 6 a o ~ 4?a 1 cs'f~ on V051 CAPACITY Govilds #'uT71PS C 2003 "o ids?vmos /C ' Lnk' ~7 1 T IF dustrie,S fie•...,,r +uiy 2? 3 e387' ~J 7--f X /3/x - aeJ'' lip- op, 03 f lei y~l Wisconsin Department of Commerce SOIL EV J~IJOA~-PORT Page of 3 Division of Safety and Buildings C~ in accordance h CorPIptS~ ^lid ode County Attach complete site plan on paper not less than 8 1/2 x 1 inches in size. Plan mu t . '-13, Ik include, but not limited to: vertical and horizontal referen point [~~fd dir 9cl A 11 , Panel I.D. 0 6 ~c3 ~ percent slope, scale or dimensions,. north arrow, and Iota or an lstance to nearest road. - I 7~ V $1. CROIX C- IJP.lT' Revi ed by Please print all informat n. Date Personal information you provide may be used for secondary pu as (Pri vacy Law, s. / 7Y e Properly Owner Property Location Govt. Lot rU r 1 /4 4~-J /4 S T N R E (or) W s, Lot # Block # Subd. Name M# Property Owner's Mailing AddresJ 1 ,-G Gty State Zip Code Phone Number ❑ City ❑ Villager Town Nearest Road New Construction Use: esidential / Number of bedrooms ZY/ Code derived design flow rate J c f GPD ❑ Replacement Public or commercial - Describe: - - Parent material ze- 2h°4 Flood Plain elevation if applicable fs/% ft. General comments and recommendations: CSwtI /,t ~'~t-- IGacoCd C, e~~ 16Sr lz9 7, ❑ Boring ^ Boring # M Apit Ground surface elev. Depth to limiting factor in. Soil loation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ffr in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 •Eff#2 Boring # ❑ Boring j C/p~ ✓ ~--f Pit Ground surface elew , ~2-ft. Depth to limiting factor - in. Soil Application 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 `EEfff#2 0'~ I-A • Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 150 ` Effluent #2 = BOD 130 mg/L and TSS < 30 nVL CST Narne (Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 540 - 715-246-4516 Property Owner _ Parcel ID # Page of Boring # ❑ Boring 0 . Pit Ground surface elev. /1 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/T in. / Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Ejfff#2 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. S91 -Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'- in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ❑ Boring # Pit Boring ❑ Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 -Eff#2 Effluent #1 = BOD6 > 30 < 220 mg/L and TSS >30 1150 mg& ' Effluent #2 = BODs 130 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 608-2648777. SBD-8330 (R.6(00) + 5 r Soil Test Plot Plan Project Name Gloria Vorwald Trust Shau Jr!6 Address 1108 Cty Rd N Roberts Wi 54023 CS #2900 Lot 7 Subdivision Date 1 /28/05 NE 1/4 S W 1/4S 4 T 28 N/R18 W Township Kinnickinnic [-I Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 107.1 *HRpSame as Benchmark Alternate Benchmark Top of Steel Fence Post c 103.0' 870' AtI.B.M. Property 594' Property Line B.M. 103' B-3 45' 106' 10% Slope 10' 66' B-2 0' 90' BB -110' Scale is F = 40' unless otherwise noted 2601' Property Line RECEIVED 1 111111 CEP 5207 If11111 11111 Illif lilli Ifit Ilflil !11! III! 856769 KATHLEEN H. WALSH $T.(t0{X COUNTY REGISTER OF DEEDS ST. CROrx Co.. RECEIVED FOR RECORD ~fF1ED SURVEY MAP LOCATED IN PART OF THE NE 1 /4 OF THE SW 1 /4 OF 08/02/2007 09:30AM SECTION 4, T28N, R18W, TOWN OF KINNICKINNIC, ST. CERTIFIED SURVEY MAP CROIX COUNTY, WISCONSIN. NORTH 1 VOL: 22 PAGE: 5429 CORNER SECTION REC FEE: 13.00 4 • COPY FEE--3.00 REPARED FOR: j OYVVMR:2 rFBEERTS, NE WILLIAMS MCI~.e 3 PG. (3~8 C.T.H. 'N' GLORIA F. VORWALD WI 54023 ; EAST-WEST 1/4 LINE . iJ REVOCABLE LIVING TRUST 3 N89'4237 W 660.08 i1 I P 6il _ --297. C.T.H. ,,"N'° 363.04 _ ° FOUND SMVW3rW E21 % ~ p dA SET V 297.00 r 3f.... o$.. r ....U-.......... W'm SMAO * o _ or 11 sm id.-P B"AIM 1 LOT s LOT 6 A ► pig. A 3 g C This Certified Survey 3 A LA M4 was prepared pursuant to a s~ w _ s partition order issued I r o j N ~T by the St. Croix g 0 ;Q a► i E7..~ = O County Circuit Court April 30 44Y I to I - IF .d w Alm s Cr 30 5p•!V rn > 9 49 '_W~ A Z J \ cn m i '6, EA EN3 W 166, N i z r 9.21t6 ~k i S? ~^'4, i~° cr 7 3 36 zi-U Ln -p= S89.42 7'E 660.07' j m S ao O N y i BUILDER SHALL BE RESPONSIBLE FOR j 1 c ✓ ✓ 66 fr' DE 1 MINING PROPER n c#n j STRUCTURE ELEVATION AND APPROPRIATE SITE i o LOT 7 GRADING. i~b A g' I ~ i VV v LEGEND c I FOUND 1-1/4- OUTSIDE 0 DIAMETER IRON PIPE ~O S89'16'01'E 660.02' I 1 DIAMETER IRON PPE S89'16'01"E 660.02' 13 SET 1' OUTSIDE ~.a O DIAMETER BY 18' LONG o m M nMPLGl°.`1r EDp LANDS IRON PIPE. WEIGHING 1.13 a ~ LBS. PER LINEAR FOOT cw+' A SOIL BORING g SOUTH 1/4 LOWEST BUILDING OPENING CORNER LBO - THE LOWEST WINDOW OR SECTION 4 DOOR ELEVATION N LOT AREA TABLE LOT f DESC. SO:.FT. ACRES EASEMENT FENCE T g LOT 5 INC RW 217,602 5.000 LINE TABLE =!22 LOT 5 EXC RW 200.765 4.609 A# SCARING D/ST. or HEARING D/ST. j :48 LOT 6 INC RW 266.202 6.111 E1 N01'0933E 55.01' E12 S6717607"W 132.43' , - LOT 6 EXC RW 243,865 5.598 E2 N01179 33 E 234.52' E13 567176 07 W 186.85' 10 m m LOT 7 315.319 7.239 E3 N0117933 £ 81.67' £14 S4017506'W 201.14' N RW = C.T.H. 'N' £4 S36:35 30 E 100.28' E15 N01179 33 E 154.56' RZOR > r, Z E5 S0871 05 E 197.63' E16 N67176 07 E 51.34' r~+ t~ Qo° 52 E6 N67VS 07 E 222.25' E17 N0871 05'W 198.03' c SCALE IN FEET 1" 200' E7 N67176 07 E 325.25' E18 N36;55:30 W 23.13' o E8 S01179 :53'W 311.17' E19 N0117933 E 73.58' S 200 0 200 E9 50117933 NW 139.59' C20 N01V933 E 109.51' E10 N3917339 W 180.50' E21 N885908'W 115.12' X108 NINSTRUMENT 14-02 DATE 06/27/2007 KBE Eft N247958 lY 138.29 SHEET 1 OF 2 Vol 2a- -m 5123 CERTIFIED SURVEY MAP LOCATED IN PART OF THE NE 1/4 OF THE SW 1/4 AND IN PART OF THE SE 1/4 OF THE SW 1/4 OF SECTION 4, T28N, R1 8W. TOWN OF KiNNiCKINNIC, ST. CROIX COUNTY, WISCONSIN. SURVEYOR'S CERTIFICATE: I, Douglas J. Zahler, Registered Wisconsin Land Surveyor, hereby certify that by the direction of Jeanne Williams, Trustee of Gloria F. Vorwold Revocable Living Trust, I have surveyed, divided and j mapped port of the NE 1/4 of the SW 1/4 of Section 4, T28N, R18W, Town of Kinnickinnic, St. Croix County, Wisconsin, described as follows: Commencing at the South Quarter comer of said Section 4; thence along the North-South Quarter line of said Section 4 N01'09'33"E a distance of 1451.36 feet to the point of beginning; thence continuing along said North-South Quarter line N01'09'33"E a distance of 1213.65 feet to the northeast corner of said NE 1/4 of the SW 1/4; thence along the East-West Quarter line of said Section 4 N89'42'37"W a distance of 660.08 feet to the northeast comer of a Certified Survey Map j recorded in Volume 19, Page 4982; thence along the east line of said Certified Survey Map 501'09'33"W a distance of 1208.54 feet; thence S89'16'01'E a distance of 660.02 feet to the point of beginning. Containing 18.350 Acres (799,323 Sq. Ft.). Subject to right-of-way of C.T.H. "N" along the northerly side of the above described parcel, and subject to all easements, restrictions and covenants of record. I also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described; that 1 have fully complied with the provisions of Chapter 236.34 of the Wisconsin Statutes in surveying and mapping the some. a'7 Douglas . Zahler RLS #2145 Date of W~G'oy S & N Land Surveying y DpLUMA ~Z s 2920 Enloe St. 7gWlM Hudson, WI 54016 82145 HLMOK v~oQ~ ! {A Q85R R $'r.CROIX COUNTY .S MAINTENANCE-' AGREEMENT AND OWMUtSMP CERTIFICATION FORM Mailing Address ~-d d ~ To~ t l ~ss Property Addr,,ss X31__ ( Verification regtured frcxn Planning & I3eparttnextt for Sew construction) (-+s W Parcel Identi cation Number City/State R()kp LEGAL D "_RUTION r(~) Property Local ion E t/. , ~ 'A , Sec. L, T ~N R~p W, Town of _ h' ~(1 i Gk%,Nn;L Subdwiston Plat: , Lot t# J- ~yA-1-. Certified Surrey Map # DD Volume page # Warranty Deed # A '7z// 3 (before 2007)Volume Pale # spec house rt yes)(no Lor lines ideat"Ablet1 no SYSTEM MAjNTZNAN!Q E AND OWNER CERTqiCATIQN improper use and mainvenanc a of your septic system could result wits premature failure to handle wastes Proper maintenance consists of pumping out the septic tank every ifiree years or sooner, if needed, by a traatati`d puorpm. W hat you put into the systettt can affect the function of the septic tank as a bviatment stage in the waste disposal system. Owner tuaintenance itsp€rr-sibilitics we specified in §Comm. 93.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance The protterty owner agrees to submit to St. Croix County Planning & Zoning D"arimwt a certification form, signed by [he owner and by a traster plumber, journeymen phini er, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater dispo al system is in prupcr operating candition and/or (Z) after ;nspechon and ptimping of ilecessHry the Septic tAnk is - less 0iAn 10 tull i)fsludge i/we. the undersigned have read the shove rt quirements and agco to maintain the private sewage distwsat System with the standards set fordi- herzin. as set by the DepartimAt of Commerce and the Department of Natural Resources, hate of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. t TO,x County Planning dr. Zoning Depariment withal 30 days of the three year expiration date. I/we certify that all statements on this form are tnu to the best of my/our laiowledge. i/we amtare the ownet(s) of the 9fopeity described above, by virtue of a warranty.kart iecorded in Register- of Deeds Oftacc. Number of bedrooms , 6 SIGN" LIRE 01= APPLICANT(S) "Any. mfg irnatoon that is misrepresented may result in the sanitary permii bcwg revoked by the Plaaniag & Zoning Dep,utment. include with this %pplieation a recorded weuranty i ecd from the Rt:gistcr of V4=t.6 Office and a copy of the crnifiud survey ,nap it mferenee is made iii die war,anry deed. (RFV 08/05) 941325 BETH PABST STATE BAR OF WISCONSIN FORM 2 - 2000 REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD THIS DEED, made between Donald Vorwald, a married 09/12/2011 11:06 AM person, Grantor, and Beau M. Bune and Sarah E. Bune, EXEMPT # NA husband and wife, as Survivorship Marital Property, Grantee. REC FEE: 30.00 Grantor for a valuable consideration, conveys and warrants to TRANS FEE: 249.00 Grantee the following described real estate in St. Croix County, PAGES: 3 Wisconsin: **The above recording information verifies that this document has SEE EXHIBIT "A" ATTACHED HERETO AND MADE A PART been electronically recorded HEREOF & returned to the submitter Recording Area Name and Return Address: Edina Realty Title, Inc. 400 South Second Street, Suite 115 Hudson, WI 54016 865555 Exceptions to warranties: 022-1009-77-000 Easements, restrictions and rights-of-way of record, if any. Parcel Identification Number (PIN) This is not homestead property. Dated this September 2, 2011 b7w~ Donald Vorwald WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2-2000 1 of 3 AUTHENTICATION ''AfCKNOWLEDGMENT Signature(s) STATE OF O oS (O 51 h COUNTY OF U F6 l C~ authenticated this September 2, 2011 Personally came before me this ' the above Donald Vorwald, a married person to me TITLE: MEMBER STATE BAR OF WISCONSIN known to be the person or persons who executed the (If not, foregoing instrument and acknowledged the same. authorized by §706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Martin D. Henschel CHERI BROWN 6800 France Avenue South, Suite 410 Notary Public, State of Wisconsin Edina, MN 55435 My commission is permanent. (If not, state the (Signatures may be authenticated or acknowledged. expiration date: 03/01/2015) Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2-2000 2 of 3 EXHIBIT "N' Parcel l: Part of the NE % of the SW % of Section 4, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin described as follows: Lot 7 of Certified Survey Map recorded August 2, 2007 in Volume 22, Page 5429, as Document No. 856769. AND Parcel 2: Together with and subject to a 66 foot wide road easement as shown on Certified Survey Map in Vol. 22, Page 5429, Document No. 856769. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2.2000 3 of 3