HomeMy WebLinkAbout014-1034-20-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 556351 0
GENERAL INFORMATION State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)).
Permit Holder's Name: City Village X Township Parcel Tax No:
Anderson, Donald A. Forest, Town of 014-1 Q34-20-000
CST BM Elev: Insp. BM Elev: BM Des tion: Section/Town/Range/Map No:
00 (v/ CvU`~~ 16.31.15.242
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
C O 2 y d7-- ' ~ 00, k2I
Dosing Alt. BM
lAeration- LJ Bldg. Sewer 7--b < CAXT
e110& A-Ct- A a Z c~
Holding SVHt Inlet 1-:r
TANK SETBACK INFORMATION St/Ht Outlet TANK TO L-! i WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic t Botto g y yam/
Dosing Hea Man. 77
or 07'3 e2.0 6 .r r"'6.
Aeration \ Dist. Pipe
Holding Bot System 1DK-
t O
Final rade
PUMP/SIPHON INFORMATION Z, Lz _ j / 7s
Manufacturer Demand S over - i
GPM - h r y -
E
W- ~7
Model Number - /.J
TDH Lift Friction Lo
ts System-Head TDH Ft ~e
G -6
Forcemain Le g Dia. y Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS /
7
SETBACK SYSTEM TO J P/L BLDG-- WELL LAKE/STREAM HING Manufacturer:
INFORMATION Ty V System: Coil AMBER OR
~j
(cI > IM + UNIT Model Number:
~{'r 0 + D~
/ 4/
t> -
DISTRIBU ION SYSTEM o,01 a44 r - cv, 04
^
Head anifold ' ;lDistributio /1 ► x Hole Size x Hole Spacing Vent or Intake
Length Dia LePipe(s) -I -
ngth 9 t,Dia i , `Spacing /iv I~
SOIL COVER x Pressure Systems Only xx,Mound 0r At-Grade Systems Only
Depth Over / Depth Over p( Depth of b , " xx Seeded/Sodded xx Mulched
1~
Bed/Trench Center Bed/Trench Edge S Topsoil
J klt 0 Yes No Yes N ]No
COMMENTS: (Include cof discre en ies, persons present, etc.) Inspection om#1:~/ / r "C Inspection #2:
i n: tt~ t''~"~" Parcel No: 6.31.15.42
Locat o 2867 CTY RD Q irr(NW 1/4 NE 1/4 16 T31 N R15W) 40 acres Lot 1.) Alt BM Description u f G
2.) Bldg sewer length = 7 51) lslrc Wlnl ~ ~►'t ~ ~ f l~ l'1 Y~ v)Vqf
- amount of cover = r „ o
by
Plan revision Required? 0 Yes No
Use other side for additional information. D Q _i
SBD-6710 (R.3/97) Date Inse Signature Cert. No.
County
S~-
RECEIVE - Safety and Buildings Division
+ p $ 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
Madison, WI 53707-7162
OCT 0 2 2012 , 55X3 51,
State Transaction Number
t'Application ! 5
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04 1 (m , Stats.
ation
1. Application Information -Please Print All Inform ~ ~7 j
Prope Owner's Name Parcel # t&
14
Property Owner's Mailing Address Property Location
Govt. Lot (.2~j~/ /
City, S e Zip Code Phone Number/ C~ ~'/,,''/4, Section ((ci
C Ll` OJ 715- 76& - C /y trcle one). /~C!
T N; REo~ V
II. Type of Building (check all that apply) Lot #
Subdivision Name
XI or 2 Family Dwelling -Number of Bedrooms
Block #
❑ Public/Commercial - Describe Use ❑ City of
CSM Number El Village of
El State Owned -Describe Use
X-Town of
/X 5
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. List Previous Permit Number and Date Issued
El Permit Renewal El Permit Revision ❑ Change of Plumber El Permit Transfer to New
Before Expiration Owner
IV. Type of POWTS System/Component/Device: Check all that apply) O N O
❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
i
V. Dispersal/Treat ent Area Information:
Design Flow (gpd) Design Soil Application Rate dsf) Dispersal Area Required (s Dispersal Area Proposed System Elevation
4,1
VI. Tank Info Capacity in Total of Manufacturer
Gallons Gallons Units U, y =
New Tanks Existing Tanks 0 o
J b a U in in w c~ i~
Septic or Holding Tank
Dosing Chamber
VII. Responsibility Statement- 1, the undersigned, assume responsib' ' stallation of the POWTS wn on the attached plans.
Plumbes ame rint) _ Plumb Signa P RS Number Business Phone Number
3-5- 7
Plum is Address (Street, City, State, Zip C de)
beK :5
V I. oun epartment Use Only
Permit Fee Date Is ued Issuin ent Signature
pproved lsapprove $ &,75. Z /
even Reason for nial
IX. CondiWpgttW&"E(Reasons for Disapproval 3\ t•~0~5 ~~t~1_' J
1. $eptic tank, effluent filter and f r ~yC~CU~
dispersal cell must aQ be sen&-e-t! maintair~ r A, as per management plan provided by plumber.
2. AA se$aack requOments must.be iintal * Q i
as opp , DI~Q 311
Attach to complete plans for the system and ubmit to the Coun ly on paper not less than 8 1/2 x 11 inches in size
SBD-6398 (R. 11/11)
lIq 1q1 E 5
AJ 4o
774 ru -
cA ?
- - - C-7-171 -
131' - l !a a /3 o -tea , 7 -3~1 ~
160, ~1 13a'" 1
T 5 `
q \ \ \ ~ t3-1
13 9 )3- t"
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C~ ~
Safety and Buildings
s 4 ARTr NT 10541 N RANCH ROAD
er F
~ HAYWARD WI 54843
- Contact Through Relay
3 ' p K www.dsps.wi.gov/sb/
ti www.wisconsin.gov
s
Scott Walker, Governor
S10:3A~ Sw
Dave Ross, Secretary
September 10, 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: 09/10/2014 Transaction ID No. 2144635
Site ID No. 783547
SITE: Please refer to both identification numbers,
Glennis Ahles above, in all correspondence with the agency.
2867 Cty Hwy Q
Town of Forest
St Croix County
NW1/4, NEIA, S16, T3 IN, R15W
FOR:
Description: Mound, 3 bedroom residence P,Q W.T
Object Type: POWTS Component Manual Regulated Object ID No.: 1389971
Maintenance required; Replacement system; 450 GPD Flow rate; 19 in Soil minimum depth to limiting factor rAnditio
original grade; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.01101), SSWMP Pub. O APPR
Effluent Filter
VISIO Ty
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Code
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructe
and located in accordance with the enclosed approved plans and with any component manual(s) referenced abov SEE CORRESP'
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:
• In the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the
owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the
mound component manual are complied with. A copy of this information must be given to the owner upon
completion of the project.
• The float switch shall be a type that does not contain mercury. 2009 Wisconsin Act 44 prohibits the installation
of float switches or relays that contain mercury.
• The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle
size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner
of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to
service the filter shall terminate at or above finished grade with a watertight cover.
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.
BRADY J UTGARD Page 2 9/10/2012
• 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.
• The existing POWTS must be properly abandoned per s. SPS 383.33 Wis. Adm. Code.
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 fo tallation, operation or maintenance of the POWTS.
Sincerely, ~
- Fee Required $ 250.00
- - Fee Received $ 250.00
f' Balance Due $ 0.00
Patricia L S an o
POWTS Plan Reviewer, Inter d 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 Il, (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.
BRADY J UTGARD Page 2 9/10/2012
• 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.
• The existing POWTS must be properly abandoned per s. SPS 383.33 Wis. Adm. Code.
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 fo tallation, operation or maintenance of the POWTS.
Sincerely, i Fee Required $ 250.00
Fee Received $ 250.00
Balance Due $ 0.00
Patricia L S an o
POWTS Plan Reviewer, IntgEr d 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 11, (608) 789-7893 , 7:45 am - 4:30 pm Monday - Friday
Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety & Buildings will be
modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the
relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety &
Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future
reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366.
MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN
INDEX AND TITLE PAGE
Project Name: GLENNIS AHLES
Owner's Name: GLENNIS AHLES
Owner's Address: 2867 CTH. Q
2867 CTH. Q
CLEAR LAKE WI. 54005
Legal Description: NW/ NE/ S16/ T31/ R15W
Township: FOREST
County: ST. CROIX
Subdivision Name:
Lot Number: Block Number: tally oft
Parcel I.D. Number: 014-1034-20-0000 E
~p ~ GS
Plan Transaction No.:
Page 1 Index and title DNDE` NC E
Page 2 Data entry
Page 3 Mound drawings
Page 4 Lateral and dose tank
2 S
Page 5 System maintenance specifications Z'
Page 6 Management and contingency plan `~t J
Page 7 Pump curve and specifications
Page 8 PLOT PLAN
Page 9 SOIL EVALUATION
Designer: BRADY UTGARD License Number: 220357
Date: 08/26/12 Phone Number: 715-760-0346
Signature:
rnual esigned Pursuant to the
Mound Component 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) Page 1 of 9
Mound and Pressure Distribution Component Design
Site Information
R Residential or Commercial Design Note: Sand fill (D) calculations assume a
300.00 Estimated Wastewater Flow (gpd) Table 8344-3 in-situ soil treatment for fecal
1.50 Peaking Factor (e.g. 1.5 = 150%) coliform of 36 inches.
450.00 Design Flow (gpd)
5.40 Site Slope
94.21 Contour Line Elevation (ft)
19.00 Depth to Limiting Factor (in)
0.50 In-situ Soil Application Rate (gpd/ftz)
Distribution Cell Information
75.00 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft)
1.00 Dispersal Cell Design Loading Rate (gpd/ft)
1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point
in the distribution Y
Pressure Disribution Information network?
C Center or End Manifold
3.00 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)
3.00 Orifice Spacing (ft) = 9.38 ftz/orifice
2.00 Forcemain Diameter (in)
80.00 Forcemain Length (ft) Does the forcemain drain back? Y
84.00 Pump Tank Elevation (ft)
3.25 System Head (ft) x 1.3 13.05 Forcemain Drainback (gal)
11.63 Vertical Lift (ft) 46.90 5x Void Volume (gal)
1.69 Friction Loss (ft) 59.95 Minimum Dose Volume (gal)
16.57 Total Dynamic Head (ft) 31.46 System Demand (gpm)
Lateral Diameter Selection Manifold Diameter Selection
in. dia. options choice in. dia. options choice
0.75 1.25 x x
1.00 1.50 x
1.25 x x 2.00
1.50 x 3.00
2.00 x
3.00 x
Gallons/inch Calculator
Treatment Tank Information 600.00 Total Tank Capacity (gal)
1000.00 Septic Tank Capacity (gal) 38.00 Total Working Liquid Depth (in)
weiser Manufacturer 15.79 gal/in (enter result in cell B49)
Dose Tank Information Effluent Filter Information
600.00 Dose Tank Capacity (gal) Zabel Filter Manufacturer
15.79 Dose Tank Volume (gal/in) A10_0 Filter Model Number
weiser Manufacturer
Project: GLENNIS AHLES Page 2 of 9
Mound Plan View
T
J
1/10 B Observation Pipe 3
F.K J
O A
V, -
B
: I
L
Mound Component Dimensions
.05 ft
A 6.00 ft E 20.89 in H A6.94 ft K 10
B 75.00 ft F 9.25 in z ft L 95.10 ft
D 17.00 in G 0.50 ft J ft W 23.72 2 ft
450.00 (ft) Dispersal Cell Area 1258.58 (ft) Basal Area Available
6.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement
Mound Cross Section View
Aggregate Dispersal Area
Finished Grade 97.40 (ft)
H
.fffff}fri 2 frrfrfr~,:_ G
F
Dispersal Cell 96.13 (ft) Lateral
95.63 (ft)-► Invert
Dispersal Cell
Elevation = D
❑ a
a
94.21 (ft) Contour Elevation
5.4 % Site Slope
Geotextile Fabric Cover
Shading Key T Dispersal Cell See lateral details on
1❑ Topsoil Cap c c 1.5 ft Page 4 for number, size,
Subsoil Cap 0 o o /and spacing of laterals.
F Laterals are equally
® ASTM C33 Sand ;o Z /I
Tilled Layer = 0 0.5 ft Typical Lateral spaced from the
Q C~ Aggregate tr c 0 distribution cell's
centerline in the
- A * distribution cell (AxB).
Project: GLENNIS AHLES Page 3 of 9
Center Connection Lateral Layout Daigram
Force main connection via tee or cross to manifold at any point. Laterals are identical
P S
•=Turn-upydballrralvoor X-402' 02+1 Laterals&Force main ofPVCSch40
aleanoutplug per COMM Table 84.30.5
Holes drilled an the bottom of the lateral.
Number of Laterals 4 Orifice Diameter 0.188 in
Lateral Diameter 1.25 in Orifice Spacing (X) 3.20 ft
Lateral Length (P) 36.80 ft Orifices per Lateral 12
Lateral Spacing (S) 3.00 ft Orifice Density 9.38 ftz/orifice
Lateral Flow Rate 7.86 gpm Manifold Length 3.00 ft
System Flow Rate 31.46 gpm Manifold Diameter 1.25 in
Total Dynamic Head 16.57 ft Forcemain Velocity 3.21 ft/sec
Dose Tank Information Locking cover with warning
label and locking device and
sealed watertight
Electrical as per NEC 300 and -10
Comm 18.28 WAC 4 in. min.
Disconnect _
Tank component is properly vented E- Altemate outlet
location
_ Foncemain diameter
Xl:
weiser Manufacturer
2 in.
Capacityl 600.00 Gallons
Volume 15.79 gal/inch A
_ Weep hole or anti-
Dimension Inches Gallons B siphon device
A 26.20 413.73 C
B 2.00 31.58 Pump off elevation (ft)
C 3.80 59.95 84750
D 6.00 94.74 D
Total 38.00 600.00
Dose tank elevation (ft)
3" Bedding un er tank. 84.00
Alarm Manuafacturer LEVEL
Alarm Model Number DLV
Pump Manufacturer GOULDS
Pump Model Number EP05
Pump Must Deliver 31.46 gpm at 16.57 ft TDH
Project: GLENNIS AHLES Page 4 of 9
Mound System Maintenance and O eration S ecifications
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 450 gpd Maximum Influent Particle Size 1/8 in
Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L
Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L
Soil Absorption Component Size 450 fe Maximum FOG 30 mg/L
Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL
Service Frequency
Septic and Pump Tank Inspect and/or service once eve 3 ears
Effluent Filter Should inspect and clean at least once eve 3 ears
Pump and Controls Test once eve 3 ears
Alarm Should test monthly
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 Turn-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: GLENNIS AHLES Page 5 of 9
Mound System Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
General
This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its'
component manuals [SBD-10691-P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system
maintenance and maintenance reporting.
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death.
Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as
POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access
openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound,
defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an
effective locking device to prevent accidental or unauthorized entry into a tank or component.
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic
tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be
assessed at least once every 3 years by inspection.
The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions
are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm,
the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending
continuous alarm.
The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the
tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of
when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank.
The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such
products are used they shall be approved for septic tank use by the Department of Commerce.
Pump Tank
The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper
operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary.
Mound and Pressure Distribution System
No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be
seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for
vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the
mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the
mound be heavily mulched as protection from freezing.
Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30
mg/L 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.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in
proper operating condition.
If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately
repaired or replaced with a component of the same or equal performance.
If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, lt 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.
I
Project: GLENNIS AHLES Page 6 of 9
MGOULDS PULPS Submersible
Effluent Pump
EP04 Series
APPLICATIONS • Full submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower
Specifically designed for the grade 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 Canadian Standards Association
• Heavy du sum operation. Auto resistance. (/$A•
duty p matic models include tpo File # LR38549
* Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron
• Dewatering assembled and preset at the for efficient heat transfer, Goulds Pumps is ►so Soot Req;stered,
factory, strength, and durability.
SPECIFICATIONS i Motor Cover. Thermoplastic
• Solids handling capability: FEATURES cover with integral handle and 314' maximum. ■ Ep04 Impeller: Thermoplas- float switch attachment points.
• Capacities: up to 60 GPM. tic semi-open design with ■ Power Cable: Severe duty
• Total heads: up to 31 feet. pump out vanes for mechanical rated oil and water resistant.
• Discharge size: 1 Vz° NPT. seat protection.
• Mechanical seal: carbon-
rotary/ceramic-stationary,
BUNA-N elastomers.
• Temperature:
1044 (40"C) continuous
1401(60"C) Intermittent. METERS FEET j _ T
• Fasteners: 300 series 10AT
stainless steel
• Capable of running sa - a. s GP rn -
dry without damage to
$ i ~2.5rT
components.
7 {
4
d
Motor: W
• EP04 Single phase: 0.4 HP, y zo}
115 or 230 V, 60 Hz, 1550
RPM, built in overload with o 5 t5
automatic reset. - _
• EP05 Single phase: 0.5 HP, o 4
IE
P05
115 b or 230V, 60 Hz, 1550 `
3 10~ i.._
RPM, built in aver!oad with
automatic reset. I ` z EP04
• Power cord: 10 foot 5~
standard length, 16/3 i
f i
S1TW with three prong
grounding plug. Optional 20 0 0 _
a 10 20 30 ao 54 GPM
foot length, 16/3 S1TW with
three prong grounding plug
(standard on EP05). 0 2 a 6 8 10 12 m'/h
CAPACITY
Goulds Pumps
c'• 2003 Goulds Pumps
Effective July, 2003 ITT Industries
83871
Iq 1q1 ZTs
4o Z/-O
to
47 9/k
l~ ~ - a = shy ~
160, &1
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address ,
Property Address
(Verification required from Planning & Zoning Department for new construction.)
City/State 7 Parcel Identification Number
Gc. it
LEGAL DESCRIPTION ,
1/4 1
Property Location ~ /4 Sec. T~3 LN R l W, Town of
Subdivision Plat: , Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # (before 2007)Volume , Page #
Spec house ❑ yesyno Lot lines identifiableXes ❑ no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
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
nty deed recorded in Register of Deeds Office.
property described above, by virtue of a 76
Numb of bedroo s /2/ice
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)
IIIlilllllllill1II III
l i l l i i l l
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 2 B 0Tx:4065322 7
WARRANTY DEED 963333-
BETH PABST
THIS DEED, made between Francis A. Knollmeyer and Glennis L. REGISTER OF DEEDS
Knollmeyer f/k/a Glennis L. Foley f/k/a Glennis L. Ahles, husband and wife ST. CROIX CO., WI
("Grantor" whether one, or more) conveys and warrants Donald A. Anderson 09/12/2012 11:13 AM
and Michael D. Flandrick L (rj ti in ftImM EXEMPT#: NA
("Grantee", whether one or more), the following described real estate in ST REC FEE: 30.00
CROIX County, State of Wisconsin:
TRANS FEE: 1380.00
The N%2 of the NE'/., the SW'/< of the NE'/. and the N%: of the SE'/• of the NE'/., PAGES: 1
all in Section 16, Township 31 North, Range 15 West, Town of Forest, St.
Croix County, Wisconsin.
RETURN TO
St. Croix County Abstract & Title Co. Inc.
219 S. Knowles Avenue
New Richmond, WI 54017
Tax Parcel No: 014-1034-10-000:014-1034-20-000: !
014-1034-30-000;014-1034-40-000
This S is not homestead property
Exception to warranties: Municipal and zoning ordinances and agreements entered under them, recorded easements for the
distribution of utility and municipal services, recorded building and use restrictions and covenants, and further except 2012
real estate taxes.
Dated this 10th day of September, 2012.
~ i~
Francis A. Kn Knollm
Glennis L. Knollmeyer
AUTHENTICATION ACKNOWLEDGMENT
Signatures authenticated this day of STATE OF WISCONSIN
20 V nrg
o`` r~
QALECOUNTY OF ST CROIX'
TITLE: MEMBER STATE BAR WIS
_ Personally came before me this 10th day of September, 2012, the
(If not, = = above amed Francis A. Knollmeyer and Glennis L. Knollmeyer
authorized by § 706.06, Wis.%tats.) UB% ~ f/k/a tennis L. Foley f/k/a Glennis L. Ahles to me known to be
the p on s) who executed the foregoing instrument and
'N, OF VVtwledg a e.
'~~~•auuuaH''``
THIS INSTRUMENT WAS DRAFTED BY AA
Robert L. Loberg / Loberg Law Office * u~
Notary Public County, Wis.
1211413 / alp 1 D12)7113
Mfq&~kNTY DEED Form No. 1-2003
A Wisconsin Department of Commerce
* Division of Safety and Buildings U 10. f Q~~ ~v~ ~F~T Page ofa
in accorAraW';nrith Comm 85, Wis. Adm. a
ti ff Unty / . /'J K
Attach complete site plan on paq(ttf®i3}~ss than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: VAGi and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.
Please print all information, Reviews y at
r 0
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.0 (1) (m)). ~
.'7
Q Property Location C
Properta~ne
G I Govt. Lot t-J 1
/4 N (7-2/4 S T N
Propert ailing Addrs 3 E (or W
Lnt # Block # Subd. Name or S
2-~29
City State Zip Code Phone Number !Yd
C LQ L4 1~- t ~ S yD0 S ❑ City ❑ Village K Town Nearest Road
(7 S) a 63- X53 ore FEONewmat Construction UserResidential Number of bedrooms
Code derived design flow rate J~' GPD
acement Public or commercial - Describe:
erialn y comments Flood Plain elevation if applicable
and recommendations:
Fwn~ 7 ~ ~ 9 ky, 0 h O v r^
Boring # ❑ Boring q
M Pit Ground surface elev. /°117 f,, Depth to limiting factor_ in.
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounda Roots Soil A lication Rate
in. Munsell Qu. Sz. Cont. Color ry GPDff('
Gr. Sz. Sh. *Eff#7 *Eff#2
d`f y 12 fs r Q.a a m , b
DL
3 7.5 y ~ a Feb k rn ~r C,,,~
S`i Qy F F'7.s Y R b S L. a s s ►,c f
s, S y FS k ~ C w ~
F 7.5 -f L 0-M
Boring # Boring
Pit Ground surface elev. Y Dep,i, ~ C)
to limiting factor__ in. _
Horizon Depth Dominant Color Redox Description Texture Soil Aplication Rate
in. Munselt Structure Consistence Boundary Roots GPD/fF
Qu. Sz. Cont. Color Gr. Sz. Sh.
1 y *E11V1 *Eff#2
bw Q W a m
-1 S
/ $ YR S btC r c 1-x.7 Wi
SL sbk Cw ~F V
R y r Y2 6/ S L I Ind Fr 1,0
y iR y/ s b/ L
* Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30.< 150 mg/l- Effluent #2 = BODS E 30 mg/L and TSS < 30 mg/L
CST Name (Please Print Signature
CST Number
dress
-7 LJ
Date Evaluation Conducted Telephone Number
7-31 - b1 a 6, g-
3
Property Owner L 5 Parcel ID# Page C.? of
❑ Boring # ❑ Boring
W 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
loYQ 5' s IG F r t? "..7 .2 Al
❑ Boring ❑ Boring
L ❑ 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.
❑ Pit
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
Effluent #1 = BOD, = 30 < 220 mg/L and TSS =30 < 150 mg/L Effluent #2_ = BOD,, < 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 f6miat, please contact the department at 604-266-3151 or TTY 604-264-3777,
SAD-F330 (R.07/00)
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