HomeMy WebLinkAbout032-2181-05-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division Sanitary Permit No'
INSPECTION REPORT C 556321 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 a No
Erickson, Kell J. Somerset, Town of 032-2181-05-000
CST BM Elev: Insp. BM Elev: BM Description: Sectionrrown/Range/Map No:
6M / GS 01.31.19.1529
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
~,g S 3,1 /o . ( /ad
Septic cc ice- Z )boo Benchmark ,j 71-1
Dosing /aM `7~ 1v0~ AIBM~'AJ
As*aliam Bldg. Sewer /Qr7 ?J
'J c.aw ,n.s
Holding St/Ht Inlet 54 9 5
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic S~ /Vk 137-1 - Dt Bottom
9.5 y3. c~
A fn 132, i 7 166 / Header/Man. /,3 161,7'
Dosing / /Uld~
S~
Aeration Dist. Pipe ~/f ~Q/ S
Holding Bot. System T 7 7•2- /00 • q
Final Grade ~0 Z
PUMP/SIPHON INFORMATION
Manufacturer I GP Rand StCov~~~ J y~ ~`l3 /dZ-s a~
h) a e¢3[ur l
Model Number E H_
TDH Lift Friction Loss System Head TDH Ft C~ 7
%.2 11-7 31/3. g
Forcemain 1 Length Dia..-r Dist. to Well f^
5g L AW
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of jlench PIT DIMENSIONS No. Of Pits Inside Dia._ Liquid Depth
DIMENSIONS g 57 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of S stem: IL , f q UNIT Model Number:
OJT ~S
DISTRIBUTION SYSTEM o~
Header/Manifold I I Distribution J/ . x Hole Size x Hole Spacing Ve"to Air Intake
Pipe(s) /
Z Z, / T to
Z- ( v~
Length Dia 7i Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only d -•.i
Depth Over I Depth over xx Depth of xx Seeded/ odded xx Mul e`-' Y
Bed/Trench Center Bed/Trench Edges Topsoil ( ~ Yes No Yes ❑ I,
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 16 /1 (0 / Pi spection #2:
Location: 2317 76th Street S SET, WI 54025 (SW 1/4 S~a..1/4 1,-b T31 dN- R1 9W) Woodland Meadows Lot 5 Parcel No: 01.31.19.1529
GoJ U•. G
1.) Alt BM Description t!: L TMER
2.) Bldg sewer length = nQ f 5 L o e,~~ as`~ 1
- amount of cover = i 1 aw
o
L4
Yes No
Plan revision Required?
Use other side for additional information F/0]/7 ~Z - -
Date Insepc rs Sign re Cert. Ni
SBD-6710 (R.3/97) T
G1
Safety and Buildings Division County~Y • Grel•%w
} 201 W. Washington Ave., P.O. BOX 7162 Sanitary Permit Number (to be filled in by Co.)
5 ~p S Madison, WI 53707-7162
P'
7 55 3z
Sanitary Permit Application State Transaction Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit Z1 -4 ':T 43
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 , Stats. , 7(
1. Application Information - Please Print All Information
Property Owner's Name Parcel #
K. LL cl . Er: a z - 2,1S 1-
Property O is Mailing Address Property Location
2-3177 74e Govt. Lot `r
City, State 2 ~ Zip Code Phone Number '5W 1/4 -5 1/4, Section
A , ~ I/ (circle one)
rVtO T~~ T J N; RR_EorW
U. Type of Building (check all that apply) Lot #
Subdivision Name
❑ 1 or 2 Family Dwelling - N}Imber of Bedrooms
w Cleve A,,N~ t3'SQ. Block # L
❑ Public/Commercial - Describe Use a ❑ City of
CSM Number El Village of
El State Owne~-Describe Usg
X4own of fd A1C- L'5~4--
111. 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 (explain)
B. ❑ Permit Renewal Permit Revision El Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner
IV. Type of POWTS S stem/Com onent/Device: Check all that apply)
~r
❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade vlound > 24 in. of suitable soil ❑ Mound < 244i~in''.tof/!r~( is suitable soil
Pretreatment Device (explain) `7l
❑ Holding Tank ❑ Other Dispersal Component (explain) El . 1
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil Applic ion Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
-45 0 a . L5 11Z9
VL Tank Info Capacity in Total # of Manufacturer
a 0 y _
Gallons Gallons Units c
New Tanks Existing Tanks °
d A y
/A/ U V) h Cn V. 0 a.
Septic or Holding Tank
Dosing Chamber 1
VII. Responsibility Statement- I, the undersigned, assn a responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plum s Signature MP/MPRS Number Business Phone Number
4L . ZZJ405 66 21 4 G 4~W4
Plumber's Address (Street, City, State, Zip Code)
VIII. Coun /De artment Use Only
Approved Permit Fee Date Issued Issuing t Signature
$ S5 . oc /o / /Z
Given Reason for Denial
IX. Condi R0ffiVWNg*Reasons for Disapproval /Q t O~,S
eptia tank, eft ont finer and 3, (b V
G• ~,~.~r
;dispersal cell must all s e ! mafn -A •45
as.per management plan provided by plumboi. .
2. Afii6ack rey*'-W*nts must be,fr rwEld
as per 'cvsds 1 QrditarW e~
Attach to complete plans for the system and submit to the County only on paper not less than 8 1/1 x 11 inches in size
SBD-6398 (R. 11/11)
otiex,n Safety and Buildings
141 NW BARSTOW ST FL 4TH
P WAUKESHA WI 53188-3789
Contact Through Relay
www.dsps.wi.gov/sb/
www.wisconsin.gov
Oss~or~t+LS~~~' ~Gd Scott Walker, Governor
Dave Ross, Secretary
September 21, 2012
CUST ID No. 226900 ATTN.• POWTS Inspector
SHAUN R BIRD ZONING OFFICE
BIRD PLUMBING INC ST CROIX COUNTY SPIA
1432 120TH ST 1101 CARMICHAEL RD
NEW RICHMOND WI 54017 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 09/21/2014 Identification Numbers
Transaction ID No. 2149134
SITE: Site ID No. 782936
Kelly Erickson Please refer to both identification numbers,
2317 76TH St above, in all correspondence with the
Town of Somerset, 54017 agency.
St Croix County
SW1/4, SE1/4, S1, T31N, R19W
Lot: 5, Subdivision: Woodland Meadows
FOR:
Description: Mound, 3 bedroom
Object Type: POWTS Component Manual Regulated Object ID No.: 1387313
Revision; Maintenance required; 450 GPD Flow rate; 28 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 requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound
Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.01/O1) and the
"Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0"
SBD-10706-P (N.01/01).
The building sewer and distribution network piping shall be of material listed in X30-3 (nd
384.30-5, Wis. Adm. Code. .
Z)
In the event this soil absorption system or any of its component parts malfunctions so as to a health hazard,
the property owner must follow the contingency plan as described in the approved plans. In at tion, the owner
must comply with the operation, maintenance and monitoring duties as described in section VIII of the mound
component manual. A copy of this information must be given to the owner upon completion of the project.
All holding/treatment tanks are to comply with SPS 384.25(7)(a).
SHAUN R BIRD Page 2 9/21/2012
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.
A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of See. 145.135 and 145.19, Wis. Stats.
Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
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.
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 $ 85.00
This Amount Will Be Invoiced.
When You Receive That Invoice,
Julia Lewis-Osborne Please Include a Copy With Your
POWTS Reviewer 2, Integrated Services Payment Submittal-
(262) 397-6005, Fax: (608) 283-7481 WiSMART code: 7633
julia.lewis@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.
t
Cover Page RECEIVED
SEP 14 2012
SAFETY S~+ iILDI~
Shaun Bird JGS
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 9/11/12
Owner:Kelly Erickson
Location:SW1/4 SE1/4 S1 T31 N,R19 W 2317 76thSt. Somerset
System type: Mound System
Manuals Used: Mound Component Manual Version 2.0 (01/31)
Pressure Distribution Manual Version 2.0 (01/31)
Page#
1. Cover Page
2. Mound Plot Plan
3. Mound Cross Section
4. Pipe Cross Section/Pipe Layout
5. Pump Chamber Cross Section
6. Pump Curve
7-8. Maintance and Contigency plan
9-12. Soil test
13. Filter Specification cross se 'tion
Shaun Bird r
Signature-
Fs~
License number 2 /900
i
PLOT PLAN
PROJECT Kelly Erickson ADDRESS 2317 76th St. New Richmond Wi 54017
SW 1/4 SE 1/4S 1 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX
SYSTEM ELEVATION 101.2' BEDROOM 3
CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK
MOUND XXX SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE 630
HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers none
BENCHMARK V.R.P. Top of power box ASSUME ELEVATION 100'
BOREHOLE O WELL IH.R.P. same as benchmark
76th St.
Scale = 1/4'1 = 101
3 acre Pa rce I
Wei I is to meet al I DNR setbacks Pro 3
Bedroom
House
Area 15' below Tank is to be properly
Grading is to be system is to bedded and provided
with lockdown covers
done to divert remain with approved
run-off undisturbed warning labels
away from
syste m B-3
100 2' Huffcutt Combo Tank
100'
99' ❑ B-1
B-2 ❑
B.M.* 3% Slope
Property Line
Mound System Cross Section and Plan View
- -
Dimension Feet
- A
r
B
5
j 7
r
D
r _
.J
J •F
r'r { .
y},
,
r r r. •
{ 7
F
} r
r. .
rJ
r 7 .r7r} }F r r}F r ~i r F { } . . '
.~r • { r"~} °t { ,.,{,~rL..} F ' F•. fr. r~' r}"'.r r F ~}5, { { { : -
S~ , i3 •r r r r .i
{i ~ r F
A r .•t . ,
S r t.'r
T
rr
Y r
r •r
7 r r• {
•i~ r7 Y
U
VV r
S
L
r
H v
r
I
T
s
r
K
r
1
L
S~
ZL
B_ _ I v
K T Slo e
L
r = Topsoil = ASTM C-33 Clean aggregate = 4 in, sch. 40 pvc
N' I Cap Material sand fill to 2 1/z in. dia. observation pipe
Geotextile G H
Fabric ~ I v i . 'L
r { { : F
D
E
Plowed Surface
(ro , ~ Ft Contour
Slope Direction
GENERAL INSTALL: LION: The mound area is staked out along the design contour. I"xisting
ve etation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or
g
chisel plow. Flowing may not proceed if the soil is wet enough at tCe plo u l Pt sand is pla e4d immediately
when a sample is rolled b,~tween the palms of the hands. AST M Q s or after lowing. Sand is pla„ed with a tracked machine keeping 12hm~or nyank o less than onekt
of
p
is placed overhead by a ~~ackhoe. Special care must be used placing laced, the entire mound
thickness to minimize cor, rpaetion of the plowed growth, limit ethe, rosion and cap is e t from freezing. The
is seeded and mulched ~io promote vegeta 6 inches and secured in place with rebar or a closet flange-
observation pipes are slotted in the lower
10/07 Igj Page of
Pressure Lateral .Layout
Two Laterals - End Manifold
4 - 'T'hreaded
f Cleanout
Lateral Turn-up Plug
Manifold -
M
L - - - Long
Force Main Sweep
r l 90
Bend
Distribution Netwvorh S ecifications Pressure System Construction
Lateral Diameter In,
Manifold Diameter 'Z- In, Laterals are constructed o!' Schedule 41) PVC
Orifice Diameter In. pipe. Orifices are drilled perpendicular to
X Orifice S aCin c lri_ the pipe with a sharp drill bit and race down.
L Lateral Length) Ft. Lateral turn-ups terminate with a threaded
M (Manifold Length)_ Ft. cleanout plug and are enclosed in a 6-8 inch
Force Main Diameter "Z In. diameter lawn sprinkler valve box accessible
Force Main Length from finished grade. -
• 6 • 9 • Grade =
6-8 Inch Lawn
Sprinkler'Valve
Box
U3/O5 lgj
i
- Tank Cross Section And Pump Performance Specifications
Septic-Dose
Purrs Manufac~ ~
Tank Manufacturer' PUMP Model Airxmber
Tank Model Number rdtunuufe1.`
Total Tank Capacit3' ! G +D Alarm
Alarm Model Number
Max Bury Depth
Switoh TyfW
Total Dyne !uc Head (TDH) Feet
Filter Manufacturer
Filter Model Number Elevation Head
Distal Pressure 10
Network. Loss
Minimum Pump ferfoynance R7u ired Force Main Loss -
V GP Ft TDH Total
outlet Manhole 4" Above Grade With 1a4anhole Min. 4" Above Grade
With Looking Device
Looking Der ica. Inlet Manhole Securely Mounted
< 6" Below CirWe Sea}}ed Watartight Weather-proof
-i Junction Box
Wn MW
S..
lzir~ished Grs'ade
Now
Vent Min. IT, Disconnect
Above Grade Means
` With Vent Cap
i;~ • ~l is aY,Y,Y,Y,Y,.,Y,lala i!'4!
t <•<oi. N.
Outlet Filter ` _
iY•
Ullet Baffle
Inlet
at ge~rve Eapacity Weep
Switch
GPI X1 Hole
f' Tank Volutnz = 13
'V'olume Ggl.
Dimension
(reserve) A o , Elevation
'a'• 2 . Ft Bottom
Yew
C f , Q • s- Elevation
{dose) D '
r3 ~
(dead) Ft
v
j
' < l•a i 1< i ~ ..iii f s i s I Y Y f Y T• a i l i i a a a':
Total
. + . 1 a .iii i i a,i,<,i awa, iyt. Yl : : w.'a': i•i•i'i t faw{w, {•a a + i 1 a a i i { a < ~ 1 i .
wi
i _ w
+jY;•; f ~•i+44w .Y' Y1411-4-11
G ith the
and 'ba~., filled in accordance a ON: The ci`dosemutam tlk depth bedded
ed. by ft
ENERAL INSTALIi..~►'S th of bury. t►- adlook}
manufacturer's product manufacturer may not
al speoificactions• . e locking fittings, (p
sppr~l ttings, and
be exceeded without pjric',r dl?Pr`°' and o"~•utlet is of Manhole covers approved exposed to grade have. to an. the twnk 0WOU 'with watarti8ht
rill, ~,onneatod 44 PVC to bridge the tank
.
installed. Piping at the ynlSagging., The force main-is Sleeved gties wi vui thth N 4" 1at; S30oh(I and Comm 16.29,
laid on stable soil to p Debt st Ming or WYWO comp
excavation and the .sle~i'ue. is seated wa +earti8t• Ete
page of
02105 LJ
W LaaerJet 3100; ~ 115 bbd dowt sway-D-uo c.a.Pvi Mp , oits-
t 40
a~
9 EH SERIES SUMP/EFFLUENT FWUMP
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sr~~ i111w~t 19lIIIIIIttMlril~ sI111R IRst~q
mm w. Mu NP wa Ili
K a 81M.1d AMitMti 8 it IF IK 9.11 ~ 1161 x f l4
$1 f5 41 32 32 8d11~33 59$28 ~ ag w v
0 w1MSa 41;0 N5 314 13D low 10 ldl
$.41 y SS0tu1
8e{~yy1 599219 Lwm 4'0 !20 314 6.5 1090 19 $1 5S $,ti 41 rMI t tR
9B1tl1~31F6 588869 WMBW 400 115 3a i3A 1o3$ A 61 55 1t 32 12$ 2p 21
RM 4"8 __!8p 3N 66 1099 10 &1 41 V 131 ZP 2T ~tt>s1l~sil!
aua4{3g OL-
C~M,w$BWPAt l--"LiMbfilOdWat W aar canWlnwutd9NatlalOs~1 11artIMIwI1Yn1NYw1111Mft N►UBSaP1 •
Fl.gW- L tnmtka
-~oateti Cast Iron
Motor Hoes _ inB E~ax~► w
0 1409 2004 3000 Poly Carlwo3lsGe
3 [mpcller material _
..gym alter c Closed Vane.
ABS .
a0 Volute
Power Cord s~Tw'.r~
W 's Nitrite With carbon and
Mechmniual Shall Soul
20 - cera6nir fac6sa
S1*111esls Steel
A town
Staialet4tt,$teet
x la zs ` Shaft t„lpper MOW" and tower
Heu[intts Hall sessions
0
0 20 40 60 F3a
FLOW- GALLONSPOWTE Little t"iiwnt Trump CO.
PUMP PERF'URMANCE CURVE kl2anx uatr•t4mwwsst-bbOK738sa
_ L15 6002 VWWO *a.y47,a1S!] • Fps: 405.22LIM
X rtw . rKS-
IrA FOM 9"935 - 07103
www.UttlleG1antrumP-cOm
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page -~_of-
FILE INFORMATION _ SYSTEM SPECIFICATIONS Fd OwnerSeptic Tank Capacity ❑ NA
Septic Tank Manufactui at- ❑ NA
DESIGN PARAMETERS _ Effluent Filter Manufacturer- - - U NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units T _ ' - NA Pump Tank Capacity - - al El NA
Estimated flow (average) a1/day Pump Tank Manufactur~ar NA
Design Now (peak), (Estimated x 1 5)) al/day Pump Manufacturer NA
- - - - - _ S 21_'x__
Soil Application Rate x Pump Model Ll NA
Standard Influent/Effluent Quality - - Monthly average* Pretreatment Unit `~XNA
Fats, Oil & Grease (FOG) <30 mg/L Cl Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODr,) x220 mg/L A ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) <150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) 0 NA
Biochemical Oxygen Demand (BODS) <30 mg/L. I-] In-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) <30 mg/L ❑ At-Grade ;;4ound
Fecal Coliform (geometric: mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size 36 in dia. T ❑ NA Other: ---T_----❑ NA
Other. ❑ NA Oilier: Cl NA
r and septic tank effluent. Other: 0 NA
'Values typical fordomesticwastewale
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) ~ At least once every: e7 El ear s~ month(s) (Maximum 3 Years) El NA
Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA
Inspect dispersal cell(s) - At least once every: ❑ month! s) (Maximum 3 years) El NA
Clean effluent filter At least once every: month! Cl NA
- ❑ onthi s) ❑ NA
Inspect pump, pump controls & alarm At least once every: ear(s',
Flush laterals and pressure test At least once every: - - 0 month(s) p NA
other; - - At least once every: ❑ monthl s} 11 NA
❑ year(s)
_
Other: D Nd
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master
Plumber; Master Plumber Restricted Sewer; POWTS lnspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must
include a visual inspection of the lank(s) to identify any missing or broken hardware, Identify any cricks or leaks, measure the volume of
combined sludge and scum and to check for any back up or ponding of effluent on the ground si irface. The dispersal cell(s) shall be
visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface.
The ponding of effluent on the !!round surface may indicate a failing condition and requires the immediate notification of the local
regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents or
the tank shall be removed by i Septage Servicing Operator and disposed of in accordanc5 with chapter NR 113, Wisconsin
Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
and any servicing at intervals of s'12 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS' check treatment tank(s) for the presence of painting products or other chemicals that
may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the
tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent.
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the
effluent pump or contact a Plunitser or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels
within the pump tank.
Do riot drive or park vehicles oval tanks and dispersal calls. Do not drive or park over, or otherwise disturb or compact, the area within
15 feet down slope of any mound +)r at-grade soil absorption area.
Reduction or elimination of the tollowing from the wastewater stream may improve the performance and prolong the life of the POWTS:
antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain
(sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scrape; medications-, oil; painting products;
pesticides; sanitary napkins; tarripons; and water softener brine.
ABANDONMENT
When the POWTS sails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly
and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
* All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks; and pits shall be excavated and removed or their covers removed and the void space filled with soil,
gravel or another inert solid material.
CONTINGENCY PLAN
if the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
d A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system.
The replacement area should be protected from disturbance and compaction and should not be infringed upon by required
setbacks from existing ai id proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in
effect at that time.
A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a
holding tank may be installed as a last resort to replace the failed POWTS.
The site has not been Evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation
Ilnust be performed to locate a suitable replacement area If no replacement area is available a holding tank may be installed as
a last resort to replace ti-te failed POWTS.
Mound and at-grade soil absorption systems may be reconstructed in place following romoval of the biomat at the infiltrative
s rface. Reconstruction a of such systems must comply with the rules in effect at that time.
<<WARN ING>>
SEPTIC, PUMP AND OTHER ThEATMENT TANKS MAY CONTAIN LETHAL GASSES AND/Oft INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR O'C'HER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DP-ATH MAY RESULT- RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWf S MAINTAINER
Name /t/__-z4 'j e Name ---~?1 i
----Phone J j J - -Phone ~J °c4 to G/ r. fa
SEPTAGE SERVICING OPERATOR- (PUMPER) LOCAL REGULATORY AUTHORITY _
Name - - - - Name S~ ✓U! ` -
Phone Phone ''j /d' d
2 8 Wisconsin Administrative Code.
This document was dratted in comptian~:e with chapter SPS 383.22(2)(b)(i)(d)&(f) and 383.54(1), O (3),
Wisconsin Department of Commena SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code C-'--
County
Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must
include, but not limited to; vertical and horizontal reference point (SM), direction and Parcel I.D.
percent slope. scale or dimensions. north arrow, and location and distance to nearest road.
Please print all information. Reviewed by Date
Personal information you provide may Le used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner r Property Location
Ka"11-41 _3 / Govt. Lot 5~W 114 114 S T N R E( W
Property Owners Mailing ress Lot # Block # Subd. Name or CSM#
city tats p Code Phone Number ❑ City [I Village own Nearest ad
if~ewConstrucfion Use4ZResidential / Numberof bedrooms Code derived design flow rate GPD
Replacement ublic or commercial - Describe:
Parent material Flood Plain elevation it applicable h.
General comments
end rltaannterldatiorls;
&7
System Type- _.L - System Elevation /_~l'.-.'~..
C] Boring
pit Grootld surface elev. 11 -j- ft. Depth to limiting factor J - in,
Soil Application Rate
-
Horizon Depth Dominant Colon Redox Description Texture Structure Consistence Boundary Roots GPD/W
in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2
s u. 1
Z. - 0 10
s'
707,
Bo" # apit Sormg
Grot end surface elev. h' Depth to limiting factor !~f in. Soli Application Rate
Horizon Depth Dominant Color Retiox Description Texture Structure Consistence Boundary Roots •E GPD/fPE2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. SK
31 C,
Sly' Ot - +n9n and TSS < 30 mglL
Effluent #1 = SOD l) < 220 mgn- and TSS S30 150 mg/L ' Effluent fit = B
CST Number
CST Name (Please Print) _ 226900
Bird Plumbing, Inc. Sflci'an Bird Telephone Number
Date Evaluation Conducted
Address ;hmond 715-246-4516
1008 192nd Ave, New Ri , WI 54017 l G✓
Property Owner - J -/Parcel ID 4 Page of
Boring # Boring I UV J
U Pit Ground surface elev. } ft. Depth to limiting factor Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDI(t`
in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
-30
,s
Bonny # O Boring
❑ Pit Ground surface elev. it. Depth to limiting factor in. Solt Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'Eff#GPDIf'Etf#2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
PTA El
Boring # Boring Grourio surface elev. ft. Depth to limiting factor in.
El Pit Soil Application Rate
Horizon ')epth Dominant Color Redox pesglption- Texture Structure consistence. Boundary Roots 'Eff#1 PDlit=Eff#2
in. MunseN Qu 5z. Cord. Color Gr. Sz. 5h.
I
i
TSS >30:< 150 mgA_ ' Effluent #2 = BOD,,<_ 30 mg& and TSS: 30 mg►L oyer.
' Effluent #1 = BO05 > 30.-: 220 mgll_ and
you
assistari The Department of Commerce is an equal Opportunity aprovider
department at 608-266 31 S leo TTY b08 26i1'8?77. services or
need material in an alternate format, please contact
5E68330 (RAM)
Soil Test Plot Plan
12roject Name Kelly Erickson Shau} ~rd
Address 2317 76th St.
New Richmond Wi 54017 C #226900
Lot 5 Subdivision Woodland Meadows Date 9/11/12
S W 1/4 SE 1/4S 1 T 31 N/R19 W Township Somerset
F] Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume elevation 1 oo ft. Top of power box
ystem Elevation 101.2' *HRPSame as Benchmark
76th St. Scale is 1" =40'
Scale = 1/4" = 10' unless otherwise
noted
3 acre Parcel
Pro 3
Bedroom
House
76th St
B-3
16-o, o
B-1
B
gM,* -2L]
3% Slope
Property Line
,0j~
. )F TER CARTRIDGE INSTRUCTIONS
fro+, 1~'~ i
r
.s
Hsu
Ylnstallatlan
';*rTP I MY RC the filter case ants the and of the outlet pipe to ensure it is
centered under the access oponisig. If not, then either Insert wore pipe into the
tank through the outlet or solvent weld (glue) additional pipe onto the outlet
pipe.
ST Ep 2 White the case is still Sty fitted an the outlet pipe, measure the length
of -S4-inch pipe needed to bract, the filter to the tank and wall if utiltting the
optional supplemental side suppurt. If side support method is not utilized,
proceed to st p four.
.^.r ~'k•F" i1 For installations utiCAL11i the optional supplemental side support_
solvent weld the %-inch pipe onto the filter case. If side support method is not
`Ca
utilized, proceed to step foul.
Solvent weld the fitter ruse onto the outlet pipe. Insert the titter
cartridge into the case, pressin l dowry until the filter locks into the bottom of
1114_ rase.
If a VitS switch is utili::fud- insert into the filter and luck by turning iclockwise 9D°•
Maintenance
1. The effluent filter should be !:leaned every time the septic tank Is
serviced.
z. open the outlet access opening to inspect the tank and fitter
3. Pump the septic tank consph.ltely, making sure to remove the sludge
layer on the bottom of the t ulk and not just the scrum and effluent.
4. once the effluent level has klaen lowed below the invert of the
outlet pipe, firmly pull up url the titter handle to dislodge the
cartridge from the case.
S, Slide the cartridge up and at it of the case for cleaning.
b. If a Vlts switch connected tr: an alarm is present, the switrle a
should be removed by turnir•g counterdockwise 90° and cleaned •.:FI
with water only.
'•'i ,
Y. While holding the cartridge to Its side (large flat surface father!
down) over the access opening, rinse off the cartridge with wetee
only, making sure an septaga. material Is rinsed back into the tank- ; .
s. if Vk5 switch is utilized, reph4re by Inserting into filter and ar v -
turning clockwise 90*-
a..
9• Insert the filter cartridge bank into the case, pressing down until ,
the filter locks into the bottruun of the case.
to. Replace and secure the accei;s opening on the tank.
':i~:••..IV;..t"=""dl:.. ...;C.: RI7 .A'JdLtT. .'Iti'F:,. .'1 ft.7:tr4C ~.{~'V:1F!f•1 - -
wwwbearroinsfte.col«n 877-MVILTERS (653-4583)
1 Y.?-
r4
Wisconsin Department of Commerce SOIL EVAL TION F RT Page of
Division of Safety and Buildings t P
in rdance with Comm 85, Wis. Adm.
1~ County 3f-,(,,
4 A, ►
Attach complete site plan va not less than 8 1/2 x 11 inches in ke'. IPI"st
.
include, but not limited to: vertical and horizontal reference point (BM), direction ddi4VurC i. Parcel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road'.''- 2/01/ D 5~C
Please print all information. Re 'ewes Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
Govt. Lot 3W 1 /4j~1 /4 S, T N R (9pf W
Property Owner's Mailing dress Lot # Block # Subd. Name or CSM#
City late p Code Phone Number ❑ City ❑ Village own Nearest ad
W vl (
AA,-J " OJ) I
01-19-ew Construction Us Residential / Number of bedrooms Code derived design flow rate J~ GPD
❑ Replacement ❑ ublic or commercial - Describe:
Parent material /1 - Flood Plain elevation if applicable A-1
General comments
and recommendations:
System Type System Elevation
t Boring # Boring a v
Pit Ground surface elev. 71 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 •Eff#2
Z -D s u~
3 s S •-y,~ -
Boring # Boring
Pit Ground surface elev. 1 ft. Depth to limiting factor ~v in.
Soil 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
-W L
mz-
Z s- e w
4Z
.3 , s l ,2
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA. ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) CST Number
Bird Plumbing, Inc. Shaun Bird ;V`U~ - 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 715-246-4516
Property Owner _ Parcel ID # Page of
Boring
F-] Boring #
3 Pit Ground surface elev. /b' ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/if
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#/1 •Eff#2
'2- _30 Id il
a Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
❑ Boring
Boring # Ground surface elev. ft. Depth to limiting factor in.
F-1 ❑ Pit Soil Application Rate
Horizon 7epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDAf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
• Effluent #1 = BODS > 30 1220 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 (8.6100) ~
Soil Test Plot Plan
Project Name Kelly Erickson Sha rd
Address 2317 76th St. _
New Richmond Wi 54017 #226900
Lot 5 Subdivision Woodland Meadows Date /11 /12
S W 1/4 SE 1/4S 1 T 31 N/R19 W Township Somerset
❑ Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of power box
ystem Elevation 101.2' *HRpSame as Benchmark
76th St. Scale is 1" = 40'
Scale = 1/4" = 10' unless otherwise
noted
3 acre Parcel
Pro 3
Bedroom
House
76th St
B-3
I rb. o
❑ B-1
B-20
B.M.* 3% Slope
14 No-
Property Line
commerce.wi.gav Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162
n c' Madison, WI 53707-7162 (w bo fill-9 in by Co.)
-
peparfmmerrt of Commerce
Sanitari~ Permit Application State frartsacti{on N(eumber 3 5
In accordance with s. Comm. 83.21(2), Wis Adm. Code, submission of this form to the ap`ncgpriate governiis tai _ I
unit is required prior to obtaining a sanitary permit. Note: Application forms for state-6* firtl YOWTS;e Project Address (if different thtut mailing address)
submitted to the Department of Commerce. Personal information you provide may be used for: secondary
purposes in accordance with the Privacy L- a,;, s. 15.04(1)(m), Slats. I -
1. Application Information Please Print All Information
Property Owner's Name- Parcel #
Property Owner's Mailing Address iy dir. Property Location
C~ C. (
Govt. Lot
City, State Zip Code Phone Bier Cam y,/., Section /
CAJI :S 01 ~ (circle e
.11 r
11. Type of Building (check all that apply) Lot # t
Subdivision
2 F'amilDwe/ll' Number of Be oo Name
❑ Public/Commerciuil-Desert be ❑ City ol'.________,__
CSM Number U Cage of
❑ State Owned - Describe Use -
ttof_JD~---
1Q. Type o Permit: (Check only one box on line A. Complete line B if applicable)
A. ew System 11 ReQlacemumt System ❑ TreatmentlHolding "Tank Replacement Only L1 Other Modification to Existing System (explain)
rmit Number and Date Issued
List Previous Permit
❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New
Before Expiration Owner
IV. Type of POWTS 5 stemlCom onent/Device: Check all that a i
❑ Non-Pressurized In-Ground ❑ Pressui ized in-Ground ❑ At-Grade nd > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ T Iolding Tank ❑ Other Dispersal Component (explain) _ Preireatmcnt Device (explain)-_- -
V. Dis ersaUTreatment Area Information: L -
Design Flow (gpd) Design S '1 Appli^ o~ Ra of tdsi) Dispersal Area Requi d ( Dispersal Are Pr used (sf) rem L= titer v~
Vl. Tank Info ' Caaacity in Total # of Manufactu r
_v
Gallons Gallons Units v
A
New Tanks Existing Tanks L e/VyJj7 t J~C o u; Y e~
w U in N va C7 A.
Septic or Holding Tank
Dosing Chamber ZIJ _
VII. Responsibility Statement- I, the undersigned, assu gponsibility for installation of the POWTS shown on the attached plans.
Plumb Name (Print) Plumber' gnature MP/MPRS Number Business Phone N Lin ber
Plumber's ddress (Street, City, State, Zip C o
=mss
Permit Fee jv Date Issued I' ing Agent ignatur
rApproved unt /De artment Use Onl
D Disapproved $
❑ Owner Given Reason for Denial
A all/Reasons for Disapproval tM .5 lira
. ditieus-nt;.`
SYSTEM OWN ,
lc ank, effluent filter and
dispersal cell must all be serviced / mld as er mana errtent plan providedby plumber.
2. All setback requirdtr*W" m and submit to the County only on paper not less than 8 to > t r inches in size
a$ per applicable code/ordinances.
SBD-6398 (R. 02109)
q1 PAPLA Safety and Buildings
141 NW BARSTOW ST Ft. 4TH
°z WAUKESHA WI 53188-3789
K Contact Through Relay
~ www.dsps.wi.gov/sb/
" www.wisconsin.gov
OFE39IONScott Walker, Governor
Dave Ross, Secretary
August 20, 2012
CUST ID No. 226900 ATTN.• POWTS Inspector
SHAUN R BIRD ZONING OFFICE
BIRD PLUMBING INC ST CROIX COUNTY SPIA
1432 120TH ST 1101 CARMICHAEL RD
NEW RICHMOND WI 54017 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 08/2012014 Identification Numbers
Transaction ID No. 2136354
SITE: Site ID No. 782936
Kelly Erickson Please refer to both identification numbers,
2317 76TH St above. in all correspondence with the
Town of Somerset, 54017 agency.
St Croix County
SW1/4, SE1/4, S1, T31N, R19W
FOR:
Description: Mound, 3 bedroom
Object Type: POWTS Component Manual Regulated Object ID No.: 1387313
Maintenance required; 450 GPD Flow rate; 27 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 bated in accordance with the enclosed approved plans and with any component manual(s)
referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance
with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound
Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.01/01) aA"e n
"Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Syste (a,
SBD-10706-P (N.01/01).
The building sewer and distribution network piping shall be of material listed in Table - and
384.30-5, Wis. Adm. Code. .
In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,
the properly owner must follow the contingency plan as described in the approved plans. In addition, the owner
must comply with the operation, maintenance and monitoring duties as described in section VIII of the mound
component manual. A copy of this information must be given to the owner upon completion of the project.
All holding/treatment tanks are to comply with SPS 38425(7)(a).
SHAUN R BIRD Page 2 8/20/2012
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.
A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
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.
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/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.
Sin rely, Fee Required $ 250.00
This Amount Will Be Invoiced.
When You Receive That Invoice,
Julia Lewis-Osborne Please Include a Copy With Your
POWTS Reviewer 2, Integrated Services Payment Submittal.
(262) 397-6005, Fax: (608) 283-7481 WiSMART code: 7633
julia.lewis@wi sconsin. 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.
Cover Page
Shaun Bird RECEIVED
Bird Plumbing Inc. AUG - 9 2012
1008 192nd Ave SAFETY & BUILDINGS
New Richmond Wi 54017
715-246-4516
Date: 8/ 7/12
Owner:Kelly Erickson
Location:SW1/4 SE1/4 S1 T31 N,R19 W 2317 74th St. Somerset
System type: Mound System
Manuals Used: Mound Component Manual Version 2.0 (01/31)
Pressure Distribution Manual Version 2.0 (01/31)
Page#
1. Cover Page
2. Mound Plot Plan
3. Mound Cross Section
4. Pipe Cross Section/Pipe Layout
5. Pump Chamber Cross Section
6. Pump Curve
7-8. Maintance and Contigency plan
9-12. Soil test
13. Filter Specifications and cross Clio
Shaun Bird `
Signature
License number 226900
4
S
PLOT PLAN
PROJECT Kelly Erickson ADDRESS 2317 76th St. New Richmond Wi 54017
SW 1/4 SE 1/4S 1 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX
SYSTEM ELEVATION 99.5' BEDROOM 3
CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK
MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630
HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers none
BENCHMARK V.R.P. Top of conduit ASSUME ELEVATION 100' Filter BEST GF10-8
❑ BOREHOLE WELL * H. R. P. Same as Benchmark
NB • M • * Property Line (not to scale) No-
99.5 B -1
3 Acre Parcel
98. Grading is to be done to divert
run-off away from system
97.5' Huffcutt Combo Tank
B-3 ° B-2 Scale = 1/4" = 10'
6% Slope
Area 15' below system is to
remain undisturbed Pro 3
Bedroom
Tank is to be properly bedded and House
provided with lockdown covers with
approved warning labels
j~h St.
2
Mound System Cross Section and Plan View
i - ' Dimension Feet
A
L
I
B
I
F
D
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'r"~ 112,P.6 s nl'
r - = Topsoil = ASTM C-33 : R"B,4 = Clean aggregate = 4 in. sch. 40 pvc
•}1yr{r
f Cap Material sand fill :4V1fLr1 '/2 to 2 `/2 in. dia. observation pipe
- II
Geotextile G H
Fabric -
- : S'Lt{f {rLJ1JLr1 L~{:' r Jar.{ .rLJ JLr1r{r{r{r
}r Lr•r•J•r•J.r.r F
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l r Ft Contour
Slope Direction -__...y
GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing
vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or
chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth. to form a'/4 inch soil wire
when a sample is rolled between the palms of the hands. ASTM C-33 quality .and is placed immediately
after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or
is placed overhead by a backhoe. Special care must be used when placing ,;and of less than one foot
thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound
is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The
observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange.
10/07lgj Page of
I
Pressure Lateral Layout
Two Laterals - End Manifold
4 - Threaded
R Cleanout
Lateral Turn-up - Plug
Manifold
M
X
L Long
Force Main Sweep
90
Bend
Distribution Network Specifications Pressure System Construction
Lateral Diameter 2- In.
Manifold Diameter Z In. Laterals are constructed of Schedule 41) PVC
Orifice Diameter 3 In. pipe. Orifices are dril+ed perpendicular to
X Orifice Spacing) In. the pipe with a sharp dri ll bit and face down.
L Lateral Length) Ft. Lateral turn-ups terminate with a threaded
M Manifold Length) Ft. cleanout plug and are enclosed in a 6-8 inch
Force Main Diameter _ In. diameter lawn sprinkler valve box accessible
Force Main Length Ft. from finished grade.
Grade :C
6-8 Inch Lawn
Sprinkler Valve
BOX
Page of
03/05 lgj
i
Septic-Dose Tank. Cross Section And Pump Performance Specifications
Tank Manufacturer Pump Manufacturer Tank Model. Dumber Z~' 0 (1 ME
Pum Model Number
Total Tank Capacity S d Alarm Manufacturer
Max. Bury Depth Alarm Model Number t/
Switch Type Ali r
r Dynatruc He -
Filter Manufacturer' Total ad (TDH) Feet
Filter Model Number Elevation Head L
Distal Pressure
Network Loss
Minimum Pump erfOrManCO Req7Ft ed Force Main Loss
p GPM au S- . TDH Total
outlet Manhole Vl in. 4" Above Grade With Manhole Min. 4" Above Oracle
Looking De~ioe. inlet Manhole Securely Mounted With Looking Device
< 6" Below Gnride Sealed Watertight Weather-proof
Junction Box -
WM 00 no W=
~Y n1nY
_ - Finished Cxrade
Vent Min. 12" Disconnect
Above Gracie Means
With Vent Cap
. Yr r,,,> r ;r . ;Y r , r Y `,;a>,;; Y,~,'<;r~i 1•r ;,;a;<:•<;.,D;a::;a :;a:,/
Outlet Filter _ _
Xnlet Baffle
Inlet ~ ;
Switch Setts,and Reserve Eapacity Weep
Tank Vohrme = GPI Hole
Dimension: lnottes 'V'olume Gal. Y
s 367
(reserve) A
{ B ; 2 CJ 0 Elevation C
alarm Ft
Bottom
c ; S i :Y
{dose)
Elevation
• : (dead) D to a;
19L~= Ft
Total I V '~•Y ar: :.aaY..Y; ar.a: '..,I
a< a, t l t a a t{ t< a< e a t < a t t 1< t< I i 1 a 444. t< a t a,
a.a a'a { Y ♦'a r Y a Y a> a a la>'a l a~ a, Y> a Y r, Y l Y~ as r r r r r a ;Y,'Yal rY:r , 'a Y
Y3>aa{ 1 r a 1 i{ V V V 414
a a s a< a<< V a a{< a< a V i< V,< a i♦ a{{ a/ 1 V{ a i{ i{ i{ a/{< a•a: a t a a< a ii t a i< I a 1 i a< i<
r~ , a>. r a r>,> r a r Y°. r Y r 9:~ra! Y it<t r r r>
NERAL INSTALLA'T'ION: The septic/dose tank is bedded and back filled in accordance with the
GE . Maximum depth of bury as. specified by the Manufacturer maY not
manufacturerys product. approval specifications
' have an affective locking device (padlock)
be exceeded without pirior approval. Manhole covers expond to grade with watertight fittings, and
installed. Piping at the iYtlet and outlet is of approved material, connected to the ferric
40 pVC to bridge the tank
with 4" Sob.
stable soil to prevent settling or sagging.. The form main sleeved.
laid Electrical gpv. complies ith NIEC 300 and Comm 16.211.
excavation and the-sleeve is sealed wstertO.
Page of
02/05 Lx
W LeserJet 3100; 1 775 !)be atler may -vo c.:av+ e,t ,
rw~mrrww~.w~.r~rrr•~i r~r. -
9EH SERIES SUMP/EFFLUENT PUMP
11.85
8.95 Q
o •
SplucifiQa#ions
11110. 96aFi m OWNS sinlrtttlrtt WORD! a~ m to m am mmmo 1
Ma it MR 6r "Us 011.1%1 Anew r It IF u 9u w0. W OXO N *
6114-0 568x80 Wo Ole 115 314 116 1006 70 V 55 41 32 13,8 26 24 9.11111.64R1IN
9DWm 569346 WJW 4116 230 3N 6,5 1000 70 64 55 41 32 13:8 26 21 8.11 1 11MICAN
W"AF8 F9tM OtICSA 400 115 3W 13.0 1000 70 64 55 41 32 138 20 27 8.11 1 11f0 t tN
sJWMW F3>= 6Ia 41"0 290 3N fib 1000jj! 64 55 41 82 139 ZB. 27 &11 t1lNW-4
CaRintmt DulyRMai-'tit0e Gi1BFYVa4Pwapalte r+le0wn6nua1tdulYat IonYaslMyanennwMhialhrNdAtlatdnaa10S1erMsepatflea."
FLOW- LFTER$/HOUR Cmetruaden
0 looo 2006 3000 Motor Housing Epoxy Coated Cast Iron
[nipeller Material Poly Cqbonstc
to 1 e11orT Closed Vane -
Volute AB8
o Power Cord SJTW- A
7s
4 zo Mechanical Shalt Seal Nitrite with canton and
cenv ni4: faces
Fasteners StainlessSteel
= 0.o Shaft Stainlem Steel _
Bewings Upper Sleeve and Lower
Ball Bearings
0 20 40 60 96
rLOV- GALLF3NSPAIMTE
PUMP PERFORMANCE CURVE Little Giant Pump Co.
u5V 60HZ PO Bea 131198.04mbom Cittr, 40K 73157
PRooee 449_"7.0H • Fax: 469.23a.UM
E.rdl: arsunlan~rvlat~laWdwt,eaeo
WWW.Littlecilant-Pump.com C3 Form 496235-07103
Ii"OWTS OWN R'S MANUAL $ MANAGEMENT PLAN Page -7 of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity 0 NA
Permit #
"5-~, Septic Tank Manufactul er ❑ NA
67 /7Z/1 26'_-C442n~
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units _NA 'Pump Tank Capacity al ❑ NA
Estimated flow (average) gal/day Pump Tank Manufacturer C, ❑ NA
_DesignJkw-(peak),-(F_stimated-x-~1.5_ ~~!J a - -Pump-Manufacturer - -
Soil Application Rate _ `C7 al/da / t2 Pump Model ❑ NA
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ~ NA
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODs) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg]L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand {BODs) 530 mg/L El In-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L NA ❑ At-Grade >Oound
Fecal Coliform (geometric. mean) <104 cfu/1OOml ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size 1k in dia. ❑ NA Other: NA
Other: NA Other: - tA
A
*Values typical for domestic wastewater and septic tank effluent. Other. MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
81year(s).
1
Pump out contents of tank(s) When combined sludge and scum equals one-third (f~) of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ❑month! s)
year{s;(Maximum 3 years) ❑ NA
Clean effluent filter At least once every: l 11 months s) ❑ NA
;Kyear(s,,
Inspect pump, pump controls & alai 'm At least once every: D month(s) ❑ NA
- .4$ year(s)
Flush laterals and pressure test At least once every: ❑ month(s)
DNA
>K ear(s) _
Other: At least once every: ❑ monthis) ❑ NA
❑ year(s)
Other:
❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master
Plumber; Master Plumber Restricted Sewer; POWTS Inspector: POW rS Maintainer, Septage Servioing Operator, Tank inspections must
include a visual inspection of the hank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of
combined sludge and scum and tc check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be
visually inspected to check the effiilent levels in the observation pipes and to check for any ponding of effluent on the ground surface.
The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local
regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third (16) or more of tl le tank volume, the entire contents of
the tank shall be removed by a Septage Servicing Operator and disposed of in accordance: with chapter NR 113, Wisconsin
Administrative Code.
All other services, including but no's limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
and any servicing at intervals of 51:: months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided tr the local regulatory authority within 10 days of completion of any, service event.
START UP AND OPERATION Paget of 13
For new construction, prior to ust: of the POWTS' check treatment tank(s) for the presence of painting products or other chemicals that
may impede the treatment process and/or damage the dispersal 'cell(s). If high concentrations are detected have the contents of the
tank(s) removed by a septage sei vicing operator prior to use.
System start up shall not occur wrien soil conditions are frozen at the infiltrative surface.
During power outages pump tar KS may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cells; in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent.
To avoid this situation have the ;:ontents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the
effluent pump or contact a Plummer or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels
within the pump tank.
Do not drive or park veNcies ove,, tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within
15 feet down slope of any mound or at-grade soil absorption area.
Reduction-or-efi mtia» u"h-L-tcltowhVrtsrr~ tft~ as e-water stream may improve the pe ormance an pro ong the lie of the POWTS:
antibiotics; baby wipes; cigarettF butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain
(sump pump) water; fruit and ,egetable peelings; gasoline; grease; herbicides; meat scrapa; medications; oil; painting products;
pesticides; sanitary napkins; taml:,ons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is ;;ermanently taken out of service the following steps shall be taken to insure that the systern is properly
and safely abandoned in complial ice with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and piss shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septagr-i Servicing Operator.
After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil,
gravel or another inert said material,
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system.
The replacement area s could be protected from disturbance and compaction and shoi.4d not be infringed upon by required
setbacks from existing ar,d proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in
effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances In POWTS technology a
holding tank may be instOled as a last resort to replace the failed POWTS.
The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation
must be performed to loc ite a suitable replacement area. If no replacement area is available a holding tank may be installed as
a last resort to replace thLs failed POWTS.
Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative
surface. Reconstructions of such systems must comply with the rules in effect at that time.
<<WARN ING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTTER TREATMENT TANK UNDER ANY CIRCUMSTANCES. OE'ATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name Sit cr~~ Name
Phone 6._ ,J -
Phone 7f J
/
L=~j
SEPTAGE SERVICINGGOOPEERATOF: PUMPER LOCAL REGULATORY AUTHORITY
CJ r~ 1??, ( Name Name '
Phone [
Phone
This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wiscoi isin Administrative Gode.
H
FILTER
CARTRIDGE INSTRUCTIONS
Installation
STEP I Dry fit the filter Case onto the end of the outlet pipe to ensure it is
centered under the access, opening. If not, then either insert more pipe into the
tank through the outlet or solvent weld (glue
pipe. ) additional pipe onto
the outlet
yea tW While the case is still dry fitted on the outlet pipe, measure the length
of VNI-inch pipe needed to brace the filter to the tank end wall if utilizing the
optional supplemental side support, If side support method is not utilized,
proceed to step four.
rr P For installations utilizing the optional supplemental side support:
solvent weld the y._inch pipe onto the filter case. If side support method is not
utilized, proceed to step four:
Yf;
=cry
Solvent weld the finer case onto the outlet pipe. Insert the filter
cartridge into the case, pressing down until the filter locks into the bottom of
the case.
If a VRS switch is utilized: insert into the filter and lock by turning j~. •;1 . ti
clockwise 900.
Maintenance
2. The effluent filter should be cleaned every time the septic tank is
serviced.
2. Open the outlet access op,ming to inspect the tank and filter,
3. Pump the septic tank completely, making sure to remove the sludge a a
layer on the bottom of the tank and not just the SCUM and effluent.
4. Once the effluent level has been lowered below the invert of the "
outlet pipe, firmly pull up cm the filter handle to dislodge the _
cartridge from the case.
5. Slide the cartridge up and slut of the case for leaning. Y
6. If a VAS switch connected to an alarm is present, the switch`
should be removed by turning counterclockwise goo and deaned
with water only.
While holding the cartridge on its side (large flat surface facing
down) over the access opening, rinse off the cartridge with water
only, making sure all septage material Is rinsed back into the tank.
8. If VRS switch is utilized, replace by inserting
turning clockwise 901, into filter and
9. Insert the filter cartridge back into the case,
the filter locks into the bottom pressing down until
of the case.
10. Replace and secure the access opening on the tank.
VA. - W.
www.beamnsite.com 877-MUILTLRS (653-4S83)
12-
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer r
617-
Mailing Address ? ? 6 • !1 t
1/ _ _ (.v 1 5 C~ G
Property Address 2 31
(Verification required from Planning & Zoning Department for new construction-)
City/State VV Parcel Identification Number PJ,oC ' ~1 ~S
LEGAL DESCRIPTION
Property Location5t-) A/4 , .56 V4, Sec.
- , _.gN R / W, Town o.f__
Subdivision -14
- Lot #
Certified Survey Map #
Volume , Page # _
Warranty Deed #j Z
Volume Page #
Spec house ye no Lot lines identifiable
yes no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a li,ensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal systt m. 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 (l.) 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.
1/we, the undersigned have read the above requirements and agree to maintain the private ;sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office,
:t7
SIGNATURE OF APPLICANT(S) - ~ 6~/1 Z
DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the PI;4xming & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings
in accordance wf ria Cc+de
County St.Croix
Attach complete site plan on paper not less than 81 x 1i i I~ iMlust
include, but not limited to: verti I a ontal re ence I r rand Parcel I.D. If 3 ndingd (~/U
percent slope, sc r di sis, rrow, an locati and distanpe to nearest read.
all Info atioW) V '2 f 2 0 Q 4 Revivog&d b Date
Personal informa you provide may be used for seconds purposes (Privacy Law x.15.04 (1) (r)). -7
Property Owner ZONING 0~ I~~pertyLo ation
AHRH Properties LLC d'v°T. M--j SW 1/4 SE 1/4 S 1 T 31 N R 19
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
404 SCrreen Avenue 5 - Woodland Meadows
City State Zip Code Phone Number ity []village ■ Town Nearest Road
New Richmond WI 54017 ( 715-222-0169 CTH -Somerset
-71 S7".
New Construction Use[] Residential /Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement Public or commercial - Describe:
Parent material Loess over glacial till Flood Plain elevation if applicable N-A ff.
General comments
and recommendations:
-aZ
Boring
❑ Boring # 0
El - Pit Ground surface elev. 99.86 ft. Depth to limiting factor 41-66 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f?
in. Munseli Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-6 10yr3/2 sil 2msbk mfr as 2f .6 .8
2 6-18 10 4/4 sil 2msbk mfr cw if .6 .8
3 18-24 10yr4/4 sicl 1 mfr .3
cw if .2
4 24- 7.5yr4/4 fsl Om dvh cw - .2 .5
5 41-66 7.5yr4/4 f2f5yr5/8 fsl Om dvh - - 2 5
2 ] Boring # ® Boring 97.50 27-29
F
Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-6 10yr3/2 sil 2msbk mfr as 2f .6 .8
2 6-27 1 4/4 sil lmsbk mfr cw if .4 .6
3 27-29 IOyr4/4 f2f5yr5/13 sicl 1 k mfr cw 3
4 29-44 7.5yr4/4 fsl Om dvh cw - 2 .5
5 44-60 7.5yr4/4 sc Om dvh - - .0 .0
* Effluent #1 = BOD > 30 < 220 mg/_ and TSS >30:5 150 mg/L ` Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/_
CST Name (Please Print) Signature _ - CST Number
Thomas C. Nelson 227387
Address Date Evaluation Conducted Telephone Number
1432 120th Street, New Richmond, W1 11/17/04 715-246-2454
Property Owner AHRH Properties LLC Parcel ID # Pending Page 2 of 3
❑ Boring Boring
# ® Pit Ground surface elev. 86.60 ft. Depth to limiting factor ~0 in.
Soli Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/If
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0-9 10yr3/2 - sil 2msbk mfr as 2f .6 .8
2 9-25 10 4/4 - sil lmsbk mfr cw if .4 .6
3 540 7.5yr4/4 - sl Om dvh - - 2 .5
❑ Boring # Boring
spit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
❑ Boring # H Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Molication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 `Eff#2
` Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mglL and TSS < 30 mglL
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.
SM-6330Teg (R.07/00)
l
41
Woodland Meadows
Scale 1":30'
BM1 Top,of conduit pipe 100.00' Lot 5
BM2 Top of conduit pipe 97.40
61 98.86
8297.501
8396.601
Nort
1V
\ lore ~
~,y ado t
r ~
~ 98
Thomas Nelson
n?387
8068749
State Bar of Wisconsin Form 2-2003 Tx:4050425
WARRANTY DEED 960322
BETH PABST
Document Number Document Name REGISTER OF DEEDS
ST. CROIX CO., WI
THIS DEED, made between The Burnside Registered Limited Liability Partnership, 07/23/2012 12:08 PM
a Wisconsin Limited Liability Partnership EXEMPT#: BA
("Grantor," whether one or more), REC FEE: 30.00
and Kelly J. Erickson TRANS FEE: 59.70
PAGES: 1
("Grantee," whether one or more).
Grantor, for a valuable consideration, conveys and warrants to Grantee the following
described real estate, together with the rents, profits, fixtures and other appurtenant
interests, in St. Croix County, State of Wisconsin ("Property") (if more Recording Area
space is needed, please attach addendum): Name and Return Address
Lot Five (5), Woodland Meadows, Town of Somerset, St. Croix County, Wisconsin. Polk County Abstract
I Suite 1, 825 US Highway 8
St Croix Falls, WI 54024
032-2181-05-000
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Exceptions to warranties: All easements, conditions, covenants, and restrictions of record.
Dated July 17, 2012
The r . t~~~bility Partnership
(SEA(SEAL)
Kenuncan, General Partner
(SEAL) (SEAL)
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Kenneth M. Duncan, General Partner
STATE OF WISCONSIN )
a nticated on July 17, 201 ) ss.
COUNTY )
/0
* Susan D. Lee Personally came before me on
TITLE: MEMBER STATE BAR OF WISCONSIN the above-named
(If not,
authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the foregoing
instrument and acknowledged the same.
THIS INSTRUMENT DRAFTED BY:
Susan D. Lee
Lee Law Office, LLC Notary Public, State of Wisconsin
My Commission (is permanent) (expires: )
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
A¢f AN' DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003
* ype name below signatures.