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HomeMy WebLinkAbout038-1075-90-200 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 556333 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)I. Permit Holder's Name: City Village X Township Parcel Tax No: Jewell, Randall & Brid et Star Prairie, Town of 038-1075-90-200 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: g , li< _-_11 . ( 18.31.18.31 OE20 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS l o H 7 FS EL V. Septic Benchmark r~ LA1 i ~ I- p ,A 5 Mc., 7 Dosing PV AI BM -f" ✓ A-vb 11,70 7 'M . 'q Aeration 1 06 10(T- Bldg. Se er 7 Z Holding St/Ht Inlet OZ 97-7/ TANK SETBACK INFORMATION St/Ht Outlet 9 Z_ T 7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 4-1 Dt Bottom 15.35 53 • a3 Septic _750' ~g :77 15 ,7 `I 1, Header/Man. Dosing 7 5p ~ /dbp / 13 15 , Aeration Dist. Pipe ~La 547 /Q2. Holding A- Bot. System G.O lo-1-71- PUMP/SIPHON INFORMATION Final Grade /d3. (d Manufacturer Demand St ter O J` GPM G03Gd, g Z, T Model Number TDH Lift Friction Loss System Head TDH Ft 1/•s7 2.70 3.Z5 17.52 r,1 6m.) S, It /Z5 Forcemain Length r Dia. 1 ( Dist. to Well / flo Z SOIL ABSORPTION SYSTEM BED/TRENCH Width Length INo.OfTgenchds PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS IT /15 C SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: CHAMBER OR /5,61 UNIT Model Number: 57 1)32-' I rpoil 1 0 DISTRIBUTION SYSTEM t,JcS Header/Manifold Distribution 1 hF Ix Hole Size / Ix Hole Spacing Ve to Air Intake / 5 Pipe(s) t( Length 14 Dia Length 7~1)ia Z !J /f Spacing 2 •9 1 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded W Yom. xx Mulched Bed/Trench Center /f gC Bed/Trench Edges Topsoil l p f~ a Yes ~ No '_-Yes [E& No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection '~#°1: Inspection #2: / Location: 861 220th Av(~nue Somerset, WI 54025 (NW 1/4 NE 1/4 18 T31 N R1 8W) NA Lot 2 Cf1n Parcel No: 18.31.18.310E20 1.) Alt BM Description = 1"`~I C(~w` tis I- 1 ew~" 1 I d ;,J A r,J 6 2.) Bldg sewer length= 2 7 -amount of cover = Plan revision Required?❑ Yes No J-0 Use other side for additional information. T__ _t Date Insepctor' Signat Cert. No. SBD-6710 (R.3/97) 131- = 7" i/a 5 ~~t'~r j =lba ~j~' II ,tom 1 es'o~ro.~ County Safety and Buildings Division 57, 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) IFS Madison, WI 53707-7162 111 `~I iillt AppllCat1011 State Transaction Number In accordance with SPS 383.21 tai 2~ / / 0 .tdin. Code, submission of this form to the appropriate government unit W (O is required prior to obtainin A!ary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Depar tment of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04 l)(m), Stats. / / ~7 ^1Q I. Application Information - Please Print All Information (O r tIr (O( Property Owner's Name Parcel # 038-- 0?--9-o2 Property Owner's Mailing Address 1 Property Location 8~ D Govt. Lot City, State Zip Code Phone Number N LU ~1/ N Section / 716--760- 0 y circle one T 3 1 N; R / U E o<W II. Type of Building (check all that apply) Lot # 9-1 Subdivision Name or 2 Family wel ling -Number of Bedrooms l Bleelcd#" El Public/Commerce - D =,cribe J"l-r i~/ se ❑ City of ❑ State owned - Describe Use CSM Numb ' ❑ Village of U t_ l y 7 Town of `fltJ~- III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. 0,New System Replacement System) K❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. El Permit Renewal El Permit Revision El Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued q~ Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ound 124 in. of suitable soil Mound < 24 in. of suitable soil El Holding Tank El Other Dispersal Component (explain) Device (explain) / tv/r V. Dispersal/Treat ent Area Information: Desi Flow (gpd) Design pal Applicatio Rate(g dsf) Dispersal Area Requi d (st) Dispersal Area Prop sed (sf) System Elevation V00 /•o 11 ~OO /ZoD ~O~~z~y DD, VI. Tank Info /Capacity in Total # of Manufacture Gallons Gallons Units ~ i„ , o o I Jam' New Tanks Existing Tanks c & W 71 a U in v~ w C7 P~ Septic or Holding Tank 330 100 0 /330 ~ t _ Dosing Chamber 75P 75-0 VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS own on the attached plans. Plumber's Name (Print) Plumber' ignatur PRS Number Business Phone Number /59/t are ,0 do3S? ?rs-7Ga-o9YG Plumber's Address (S eet, City, State, Zip Code) /lb e VIII. ount epartment Use Only Approved ❑ Disapproved Permit Fee Date Issued Is mg Ag nt Sign re $ S ` El Owner Given Reason for Denial ' Z 7i C / IX. Conditions of Approval/Reasons for Disapproval j~ii fWYta w. ' a J~J✓ t SYSTEM OWNER: 1 Septic tank, effluent filter and t~hn dispersal cell must all be serviced /maintained ~ ~ /L2 N.a-¢~ . as per management plan provided by plumber.- Gzc- 2. All setback requirements must be maintained as per applicable Qr Pffi@&ns for the system and s. SBD-6398 (R. 11/11) O~pARSafety and Buildings ~ti~ DoT 10541 N RANCH ROAD o I 9 HAYWARD WI 54843 3 ' 0 S Contact Through Relay www.dsps.wi.gov/sb/ p S, w www.wisconsin.gov Scott Walker, Governor A~O~NSSION Dave Ross, Secretary September 11, 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 Identification Numbers PLAN APPROVAL EXPIRES: 09/11/2014 Transaction ID No. 2146670 SITE: Site ID No. 783777 Randall Jewell Please refer to both identification numbers, 861 220TH Ave above, in all corres ondence with the agency. Town of Star Prairie St Croix County NW1/4, NE1/4, S18, T31N, R18W FOR: Description: Mound, 4 bedroom residence p.Q.W Object Type: POWTS Component Manual Regulated Object ID No.: 1390927 ,~iti Maintenance required; 600 GPD Flow rate; 32 in Soil minimum depth to limiting factor from original grade; SysteQon Mound Component Manual - Version 2.0, SBD-10691-P (N.01101), SSWMP Pub. 9.6; Effluent Filter > A*V) P 1A The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes D IS0 OE SAFE 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 SEE CORFU 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: 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. • Care must be taken to preserve the bench mark during construction or establish a new bench mark with the elevation set to relate to the original bench mark. • The existing septic/ holding tank(s) must be inspected for structural soundness, size and baffles and must be brought into conformance with the requirements of SPS 383, Wis. Adm. Code. If it does not conform a state approved tank must be installed. • 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 BRADY J UTGARD Page 2 9/11/2012 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. 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. 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 Patricia L Shandorf POWTS Plan Revie C Integrated Services WiSMART code: 7633! (715) 634-7810, Fax: (715) 634-5150, M - F 8:00 a.m. - 4:45 p.m. pat.shandorf@wisconsin.gov cc: Charles L Bratz, POWTS Reviewer H, (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. j MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: RANDALL JEWELL Owner's Name: RANDALL JEWELL Owner's Address: 861 220 th. AVE. 861 220 th. AVE. SOMERSET WI. Legal Description: NW/NE/ S18/ T31/ R18W Township: STAR PRAIRIE County: ST. SROIX i Subdivision Name: VOLA PG197 Lot Number: .4 Cg Block Number: TS Parcel I.D. Number: 038-10759-0200 Unally Plan Transaction No.: 3 ~ ND ILDINGS Page 1 Index and title ~Y A Page 2 Data entry Page 3 Mound drawings SPONDEN Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 PLOT PLAN / - Page 9 SOIL EVALUATION Designer: BRADY UTGARD License Number: 220357 Date: 09/04/12 Phone Number: 715-760-0946 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) Version 3.11 (R. 06/01) Pagel of 9 Mound and Pressure Distribution Component Design Site Information R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 83-44-3 in-situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150%) coliform of - 36 inches. 600.00 Design Flow (gpd) 7.00 Site Slope 100.71 Contour Line Elevation (ft) 32.00 Depth to Limiting Factor (in) 0.50 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) = 8.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 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 4.00 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) 2.90 Orifice Spacing (ft) = 11.54 ft2/orifice 2.00 Forcemain Diameter (in) 85.00 Forcemain Length (ft) Does the forcemain drain back? Y 92.00 Pump Tank Elevation (ft) 3.25 System Head (ft) x 1.3 13.86 Forcemain Drainback (gal) 9.21 Vertical Lift (ft) 46.83 5x Void Volume (gal) 2.09 Friction Loss (ft) 60.70 Minimum Dose Volume (gal) 14.55 Total Dynamic Head (ft) 34.08 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 1.00 1.50 x 1.25 x x 2.00 x 1.50 x 3.00 2.00 x 3.00 x Gallons/inch Calculator Treatment Tank Information 750.00 Total Tank Capacity (gal) 1300.00 Septic Tank Capacity (gal) 38.00 Total Working Liquid Depth (in) weiser Manufacturer 19.74 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 750.00 Dose Tank Capacity (gal) Zabel Filter Manufacturer 19.74 Dose Tank Volume (gal/in) A100 Filter Model Number weiser Manufacturer Project: RANDALL JEWELL Page 2 of 9 Mound Plan View T 1/1 0 B : I~t J Observation Pipe :l?Q : . . . - K.. O s❑ A W :~:::::::::::::::8 - . . . 3 .0.'.•.•.'.•.'.'.'...'.'.'.'.....'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.' - . . . . L Mound Component Dimensions ft A 8.00 ft E 12.72 in H 1.00 ft K Aft B 75.00 ft F 9.25 in z 8.85 ft L ft D 6.00 in G 0.50 ft J 4.39 ft W 600.00 (ft2) Dispersal Cell Area 1263.84 (fe) Basal Area Available 8.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.98 (ft) ► ~ . f{r{{{{{{{ 2 {r{r{rr{\ {{}}}}}}}{{}}}rte F = Dispersal Cell 101.71 (ft) Lateral 101.21 (ft)-10- Invert Dispersal Cell : . . . : ' . ' Elevation E p 3 .1:::::::::1 F41 100.71 (ft) Contour Elevation 7.0 % Site Slope Geotextile Fabric Cover Shading Key d a Dispersal Cell See lateral details on 10 0 Topsoil Cap c ° 1.5 ft Page 4 for number, size, Subsoil Cap h o and spacing of laterals. © ASTM C33 Sand 0 F Laterals are equally Tilled Layer 0.5 ft Typical Lateral spaced from the H , I ❑5 W distribution cell's ❑5 0 Aggregate v c centerline in the in the * A * distribution cell (AxB). Project: RANDALL JEWELL Page 3 of 9 Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at any point. Laterals are identical ~E 1P S Turn-up wrbsll valve or (F X-- ~Ext2 x12- 1 Laterals & force main of PVC Sch 40 clesnoutplug per COMM Table 84.30-5 Holes drilled on the bottom of the lateral Number of Laterals 4 Orifice Diameter 0.188 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.94 ft Lateral Length (P) 36.75 ft Orifices per Lateral 13 Lateral Spacing (S) 4.00 ft Orifice Density 11.54 ft2/orifice Lateral Flow Rate 8.52 gpm Manifold Length 4.00 ft System Flow Rate 34.08 gpm Manifold Diameter 2.00 in Total Dynamic Head 14.55 ft Forcemain Velocity 3.48 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 properly vented E--- Altemate outlet location Forcemain diameter weiser Manufacturer 2 in. Capacityl 750.00 Gallons Volume 19.74 gal/inch A _ Weep hole or anti- Dimension Inches Gallons B siphon device A 26.92 531.38 C B 2.00 39.48 -t P~ ump off elevation (ft) C 3.07 60.70 92.50 D 6.00 118.44 D Total 37.99 750.00 D♦ ose tank elevation (ft) Bedding un er tank- 92.00 Alarm Manuafacturer LEVEL Aiamn Model Number DLV Pump Manufacturer GOULDS Pump Model Number EP05 Pump Must Deliver 34.08 gpm at 14.55 ft TDH Project: RANDALL JEWELL Page 4 of 9 I Mound System Maintenance and Operation Specifications Service Provider's Name UTGARD Phone 715-760-0946 POWTS Regulator's Name ST.CROIX Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1300 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ft2 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 INSPECT FILTER ONCE A YEAR Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Tum-up Detail Finished • Grade 6-8" Diameter Lawn . . . . Threaded Cleanout Sprinkler Valve Box • . • Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: RANDALL JEWELL 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 fitter 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 fitter 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 BOD5, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 ml- for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continuency 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 clogged 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. Project: RANDALL JEWELL Page 6 of 9 GOULDS PUMPS Submersible Effluent Pump EP04 & EP05 Series APPLICATIONS • Full submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower Specifically designed for the 9me turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication and efficient improved performance. construction. Effluent systems heat transfer. ■ Casing and Base: Rugged • • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms superior strength and corrosion mama! operation. Auto- III* Canadian Standards Association Heavy duty sump matic models include resistance. V.PY ~ ode # uz38549 • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron • Dewatering assembled and preset at the for efficient heat transfer, Goulds Pumps is ISO Soot Registered. factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic Solids handling capability: FEATURES cover with integral handle and • g ca ty: float switch attachment points. '/4" maximum. ■ EP04 Impeller: Thermoplas- 0 Power Cable: Severe duty • Capacities: up to 60 GPM. tic semi-open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: 11/2" NPT, seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104eF (40°C) continuous MErezs FEET ___1400T (600C) intermittent. • Fasteners: 300 series 70 - i stainless steel. 97 30 ~ I # f-SGPM - - } • Capable of running dry without damage to $ _ Zs Fr components I _ 25 - Motor: _ } I t k • EP04 Single phase: 0.4 HP, U 20 115 or 230 V, 60 Hz, 1550 RPM, built in overload with s i~ automatic reset. Q 4 15 • EP05 Single phase: 0.5 HP, o epos 115 V or 230V, 60 Hz, 1550 3- 10 RPM, built in overload with t 1 automatic reset. 2 EPOa • Power cord: 10 foot 5L - - - ; a--- _ standard length, 16/3 S1TW with three prong plug. Optional 20 o grounding th, , 196/3 S1TW with o 10 20 30 40 50 GPM foot length, three prong grounding plug , (standard on EP05). 0 2 4 6 8 10 12 m11h CAPACITY Goulds Pumps E 2003 Goulds Pumps ITT Industries Effective July, 2003 93871 L/ T- 86 f 1- i1a¢ /Ilk - r~~3i~~1 =Ia© ~f~ 131- a V3r /oo,7Nom'" 330, ® b o~ CC> 1 Wisconsin Department of Comm SOIL EVALUATION REPORT Page ~ of r 13 Division of Safety and Buildings Qi Q ry . SC [ i a ordance( with Comm 85, Wis. Adm. Code County Attach complete site plan on papern less x 11 inches in si P n must 54 -C include, but not limited to: vertical . ital reference point (BMi2n~ Parcel I.D. percent slope, scale or dimenSi0h north arrow, and location and di a e t r~ p _ 0 Please print all information. rviewed Dt Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 R*). /Z Property Owner Property Location -t R C. Govt. Lot 1 /4 I V FJ/4 S T.21 N R 1~e E (o Property net's Mailing Address Lot # Block # Subd. Name or CS $61 aao C-. 44 vo/. / 17 City State Zip Code Phone Number ❑ City ❑ Village $ Town Nearest Road ISO Ivher wt (715) 78/- DD27 _;of I ❑ New Construction Use: Residential/ Number of bedrooms _ Code derived design flow rate ~n 1) GPD Replacement ❑ Public or commercial - Describe: Parent material D C. S r. ny ICY"' Flood Plain elevation if applicable General comments / S L rn 0%) and recommendations: C--s C.", 1, 81) r ,~a rr11 _t.., Cbq,SdG~ D N I 0 D,.7/ •~orrr u~r, Boring # Boring 5/1 ® Pit Ground surface elev. 17 ,71 ft. Depth to limiting factor _a2._ 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 O- 0 1 R3/ 5. a 5 F . 49 a 1 `fRy 5L FS vL rj<L Gtv F y 3 -3 SYk L S K 51~ v,--. F , ~1 F ,S`~RV o-m h 3~- - ° tti _ Boring # Boring 1-~J Pit Ground surface elev. OD~7J 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 _ 1-f3 .,L FSbW a~ . a s Y y~ L FS b le- %A.,7 3 to-%3 s P.y/ s i t 9 , 7 3Y-tb Sy yh T7.5` A,V 0 AIM iq AV Y * Effluent #1 = BOD5 > 30:E 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number dres ate Evaluation Conducted Telephone Number ;k 7 to \Chi -3b Lox --6 rJ Off„ Parcel ID # Page C>? of Property Owner, F-31 E] Boring Boring # Pit Ground surface elev. ft. Depth to limiting factor-.32_ in. Soil Application Rate `fF Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#GPDEff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. s S,L. aFs K aw aF • b i C) o yR / '7.5'~ RY S S b VL G w 3 l6- SyO S L I F56 rL1, GV-1 _ 5yRy1t4 If151~ ~ s L o-Vq h f r - / El El 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 Eff#GPD/ft2EfF#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz, Sh. F] Boring ❑ Boring # Ground surface elev. ft. Depth to limiting factor in. 0 Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfif in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 *Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) L. Rahn 411 t,Q~ ~-~'f e,,>4& t ~r~L ~Q e. 3 X+ 06 Sc a t.; 1 ' 4~~7 ` t : n~ ~ ,5 ''i' 1-7 Y ,mac Ta grv► l p Nc- • L- :r• -ro p e 2 L : t PRa ~a5~ u,ol~ QID TQhK a Sof -.P 7 Al - h Jim y 1•e~ _ __r.___! ~o _ t q91131 <<Fe~ccrc.~ S ESQ ~3 a I -DO.-71 a ~ S ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address L) Property Address (o Rao (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number 103S-10?5?-&&4oo LEGAL DESCRIPTION Property Location / 1/4 , Sec. , T v ( N R/ 2W, Town of 5 ~ Subdivision Plat: , Lot # D~ Certified Survey Map # 73 , Volume age # ~°7~6 Warranty Deed # 3d f (before 2007)Volume Page # Spec house 0 yes no Lot lines identifiable es 0 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. 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. Nu r of bedrooms l SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 09/07) U. 2 8 6 3 P 41. 4 8>m3~,14 STATE BAR OF WISCONSIN FORM 1 KATHLEEN H. WALSH - 1998 REGISTER OF DEEDS WARRANTY DEED ST. CROIK CO.. WI RECEIVED FOR RECORD Document Number 08/10/2005 L1:50Ati This Deed, made between Keith C. Vogel, single , Grantor, and Grantee. Randall Jewell and Bridgett-Jewell, husband and wife WARRANTY DEED EXEl~~' # Grantor, for a valuable consideration conveys to Grantee the following REC FEE 13.00 described real estate in St. Croix County State of TRANS FEE: 828. 00 Wisconsin (the "Property"): COPY FEE: CC FEE: PAGES: 2 Recordin Area Name and Return Address Four Seasons Tale r f; ~ ° 206 2nd Street Hudson. WI 54016 his - QS'G9-7s- Parcel identification Number (PIN) This is homestead property. SEE ATTACHED (is) (is not) Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this 28th day of July, 2005. (SEAL) (SEAL) rian , AIF f ei C. V el (SEAL) (SEAL) W R AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, WENDY SWATZINA } ss. authenticat N O TA yY F U B L I C St. Croix County e TAT= WI Personally came before me this 28th day of July, 2005 the above named Brian Vocel, as IF I Keith C Vo el sin le to me known to be the person who executed the foregoing TITLE: MEMBER STATE BAR OF WISCONSIN in trumen nd acknowledge a same. (if not, authorized by §706.06, Wis. Stats) cx-D THIS INSTRUMENT WAS DRAFTED BY Nota Public, Stat of Wisconsin Coldweli Banker Burnet/Robert Nicholson 1301 Coulee Road My commission is pe anent. (If not, state expiration date: Hudson, WI 54016 5-40978 4, ) (Signatures may be authenticated or acknowledged. Both are not necessary.) ` Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. WARRANTY DEED FORM No. 1 -1998 Milwaukee, Wis. U 2863P X115 FOUR SEASONS TITLE, INC. Policy Issuing Agent For COMMONWEALTH LAND TITLE INSURANCE COMPANY COMMITMENT FOR TITLE INSURANCE EXHIBIT A Legal Description Commitment No.: WIS-050975 The land referred to in this Commitment is described as follows: Lot 2 of Certified Survey Map recorded in Volume 18 of Certified Survey Maps on Page 4746, as Document No. 762286, located in part of Lots 2, 3, and 4 of Certified Survey Map recorded in Volume 1 of Certified Survey Maps on Page 197 as Document No. 330373, located in part of the Northwest Quarter of the Northeast Quarter (NW% of NE%), Section Eighteen (18), Township Thirty-one (31) North, Range Eighteen (18) West, Star Prairie Township, St Croix County, Wisconsin. For Reference Only: Property Address: 861 220th Avenue, Somerset, WI 54025 Parcel ID Number. 038-1075-90-200 ALTA Commitment Exhibit A 9'A• n'-Y II'Oy" e'ik• -1..--- r z g~ a f LL%I x A 2W V n. ` . o ~ ~ d s ayIi _atIE~.. ~ s 1 d 00 ~ s a - 3 S 5'-3K" o Q !p' 'a g p 4 ~ m"W 31- d y -4 a ' IA A - ~l b g j - s ;G S 5 I 1 n _ O t m S .6'-Y _ B'-3" II'-1' a'-Y l'iK• ~ _B'-II' 'Yik" 30'O" 3a'p• sc~ i D ag Q Do iog~ y p o 4 e O 's SE9 ? m 77. Q FIRST FLOOR PLAN/ New Horizon Homes, Inc. sue: va ^ rp• Bcr ro Ago JPA~ tree lls. RIcMOM bWl•coroln DRAM DT. J. stun, '4 REVIB®: i( Jewell Femlly aemw.rar ` PMONE:I.lE.3a6.9PD1 GElI: OYtE: 3], bR I -P'yy„®~ i~ Et~iAti: Augrt p m F m m Sg (1 O j 8~t~a 8 x , 8 c ~~o Fo i ~ o E F w A r3'-u' p'-3K• - soaK- _ ea a~al ~ t. 3 D t s ~=e ~ ~P~ r Q • -x e D P ~ r ~SfB. e - Z : { O ' rZZm `O D 00 g IS'-Y 6 3i z X (1 l} Y 6 56'4' 3 T B ~ S s ~ a z ~ 0 T ~ Z E ll a, D p (P FE -m ~ o S Z g`~~-> 7rC e~ $ 19 a ~qd g€ g $t gg~ 6~ Rg D 1 b'S df ae laa e D 8: $s s€ d§ g § !a 3F$3'fa?i a e m _ m f ~ c : A 1\ 11 I(J~ s g m m e4 s a ~z y g ~ a g'x l 4-0' FOUNDATION PLAN New Horizon Homes, Inc. Rlctin,d DRAYM BY: A 6MItN FiE1'I6m: ~ ~ Jewell Family , \ A+aff,I.iB.sDOI c=~a»I~ DALE:,y,g,.i n, tiJD I PiaMBBx pNAl. 7 6 2 2 8 6 ' APR ^ VOL 18 PAGE 4746 WALSH ' REGISTER H. DEEDS ST. CROIX CO. IiI RECEIVED FOR kEfi D CERTIFfE'D-` UA-VIEY_ MAP 05/12/200 09:25AN LOCATED IN PART OF THE NW1/4 OF THE NE1/4 OF SECTIO'l1°"1'8;431 N, R1 8W. CERTIFIED SURVEY 1lAP TOWN OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN, INCLUDING LOT 4, LOT REC FEE: 13.00 A CERTIFIED SURVEY MAP RECORDED IN VOLUME 1, COPY FEE: 3.00 3, AND PART OF LOT 2 OF PAGE 197, AT THE ST. CROIX COUNTY REGISTER OF DEEDS OFFICE. PAGES. 2 SURVEYOR: PREPARED FOR: DOUGLAS J. ZAHLER BRIAN VOGEL S a N LAND SURVEYING, INC. S88°39'08"E 2633.53' 1705 VICTORIA RD. SO. 2920 ENLOE STREET MENDOTA HEIGHTS. MN 55118 HUDSON, WI 54016 220th AV. NORTH LINE OF THE NE1/4 N1/4 C. 18 (EAST) S88°39V8"E 857.83' NEC O SEC. 18 0 331.47 33.E i~ 460.38' S88°39'08"E 858. T f"z °2 1775.7a II//i~v 331 4T 33.Oa 1 -33.oa 361.5 _ 99.02'1 V IRON PIPE FOUND PROPOSE 6a S13°02'58"W 3.35' DRIVEWA pt $ _ _ , t FROM SET 1" IRON PIPE ®s` EXISTING DRIVEWAY I L.r' w' :S OWNER: EXISTING Q HOUSE 861 KEITH 2200TVOGEL H TH AV E, 1 ' it 86, WELL SOMERSET, WI 54025 5.038 ACRES co ' ro d toc (219,456 SO. FT.) Qa SEPTIC w °i INC. R/W : cn VENT_ y EXISTING 4.787 ACRES 21 • ~2. 12 i2 LOT x R" (208,518 SO. FT.) 02 • ; 2 GARAGE g~ z EXC. R/W 6.978 ACRES I N m y O j Cn (303,946 SO. FT.) y C Q INC. R/W I `l° 6.629 ACRES I O m I O A w (288,750 SO. FT.) 0 -n ci N 5~ : EXC. R/W V I w m mm ~~7{ N ~ tJt 11J A Zm S89°17'32"E 331.45' : 114.95' 350.06' N N I p m m v Z 66.00' I I y66.00' S89°17'32"E 465.01' I C, n m m 02 SOO°42'28"W Noo°42'28"E y Qv ,Q O 33.00''- r-33.00' co O I N i I o O 66.00' I Im z m S89°7732"E A I LOT 4 6.006 ACRES W~`SCO (261,606 SO. FT.) INC. R/W DOUGLAS J. 2 5.980 ACRES LOT 3 09 ZAHLER (260,51 517 SO. FT.) EXC. R/W 8.109 ACRES 5-2145 (353,242 SO. FT-) H S ® g INC. R/W 75' 8.084 ACRES ® ® SETBACK (352,153 SO. FT.) NAVIGABLE a • \ EXC. R/W WETLAND 11.7': 364.47 ~ 502.79 N88°42'42"W : 867.26' SOUTH LINE THE NW7/4 OF THE NEt/4 ~ _MGV]GPd_La_C_D_C~Lp_MD~ LEGEND FOUND ALUMINUM COUNTY SECTION APPROVED ~ CORNER MONUMENT 3T. CR00C COUNTY FOUND V OUTSIDE DIAMETER IRON PIPE Planning Zoning and Poe Cemmitr.e O SET 1' OUTSIDE DIAMETER BY 18" LONG IRON MAY 1 2 2004 PIPE, WEIGHING 1.13 LBS. PER LINEAR FOOT BUILDING SETBACK LINE (AS SHOWN) If not recorded wUfiin 30 days Ot RECORDED BEARING AND/OR DISTANCE fal date ahaN be SCALE W 919 E hY~ 66' WIDE JOINT DRIVEWAY EASEMENT mod FOR LOTS 3 AND 4 200 0 200 EXISTING FENCE THIS INSTRUMENT DRAFTED BY: WILLIAM KANE ® SOIL BORING - JOB NO. 6351-01 DATE: 10128/2003 REVISED: 05111/04 SHEET 1 OF 2 SHEETS Vol 18 Page 4746 Parcel 038-1075-90-200 08/24/2012 04:26 PM PAGE 1OF1 Alt. Parcel M 18.31.18.310E-20 038 - TOWN OF STAR PRAIRIE Current ❑ ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 05/12/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner RANDALL & BRIDGETT JEWELL O - JEWELL, RANDALL & BRIDGETT 861 220TH AVE SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 861 220TH AVE SC 3962 SCH DIST NEW RICHMOND SP 1700 WITC Legal Description: Acres: 6.978 Plat: 4746-CSM 18-4746 036-2004 SEC 18 T31 N R18W 8.74A Block/Condo Bldg: LOT 02~ C VOL I PAGE 197 N LOT 2 CSM 18-4746 (6. Tract(s): (Sec-Twn-Rng 40 1/4 60 114 WI Gam) 18-31N-18W NW NE Notes: Parcel History: Date Doc # Vol/Page Type 08/10/2005 803014 2863/414 WD 05/12/2004 762286 18/4746 CSM 07/23/1997 891/243 07/23/1997 833/394 more... 2012 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/05/2012 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 6.978 39,900 149,500 189,400 NO 08 Totals for 2012: General Property 6.978 39,900 149,500 189,400 Woodland 0.000 0 0 Totals for 2011: General Property 6.978 39,900 168,200 208,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00