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HomeMy WebLinkAbout028-1018-90-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 556377 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Parcel Tax No: Yanish, Michael G. & Susan Rush River, Town of 028-1018-90-000 CST BM Elev: Insp. BM Elev: BM Description: Sectionlrown/Range/Map No: 0 1y\ 1- 12.28.17.96E TANK INFORMATION ELEVATION DATA 9< / 2- / LW, /Z 166 TYPE MANU ACTURER CAPACITY STATION BS HI FS ELEV. Z l c)~ 6I i ; - (07 9'9• 14:~ `C Septic 7-6 f zC Benchmark e7~ Dosing Alt. B Aeration Bldg. Sewer 13.Z Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO.., P/L WELL tBLDG. Vent to Air In a ROAD Dt Inlet - ALri.A. Jlne ~o G~ Septic 72 j 7 /oa / Dt Bottom / y Q, ~ ls~ 3 ~f0 . ~ Dosing Header/Man. -72 /62- jF Aeration Dist. Pipe 16 7 Holding Bot. System 71 /6 7 PUMP/SIPHON INFORMATION Final Grade 163. ~ S Manufacturer Demand St Cgyer 56 GPM 1~), / 1 ~.d a cep. -G ~5 Model Number TDH Lift Friction Loss System Head TDH F ley Forcemain Length Dia. I r Dist. to Well G ` Z910 SOIL ABSORPTION SYSTEM BED/TRENCH Width 9 Length No. XV es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS (.0 1 64D SETBACK SYSTEM TO P/L ' BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR o Type Of System: r D ioo A4 UNIT Model Number: ~IOo 7 DISTRIBUTION SYSTEM Header/Manifold 1 Distribution G / i Tole Size x Hole Spacin Veto Air Intake Pipe(s) c`C~ 3 1 3 Length Dia ILength / Dia Spacing t SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sledded Mulched Bed/Trench Center r Bed/Trench Edges Topsoil riI es Fw~ No es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: rL / ~ 1 /L Inspe tion / / Location: 412 Hwy 63 Baldwin, WI 54002 (SE 1/4 SE 1/4 12 T28N R1 7W) metes & bounds Lot j Plot dk Parcel No: 12.28.17.96E 1.) Alt BM Description ~orJ-c.s ~orr S 7c.~t~. j C~ ~-r 54 2.) Bldg sewer length 19.. - I •c,~ f - amount of cover = 1 v~ p Plan revision Required? ❑ Yes No Use other side for additional information. _ L Date Insepctor s Si ature o Cert. No. SBD-6710 (R.3/97) ~a ~ Nor • Scale: / 150 oil • So,% e~~/aa-bon ! P ♦ "s~ ~ d~ e lecr ~ ~ sXi r'zr u• ~ 1 31 ~ t 4`I ~ es o a w i cv , li t ~ 1 f e 5c,g6e~vy, Se/e. /2~ i Z6/1~ je, i74)( •Of" -'J,k t~(Jd7;~t,GOi~'~~ccJ/. 4 t t a~~ ,-le-1 00.28 - 1orb-90-4ZO 6CO-7 72s4 c ,es /s~ „rs t ct t t ~ /03.0 0-0 ~ t t 97.o' '990, (v"wood o st f p8 `rue/,~c 1 ~cnceP 3. ~ (ant 3B'--a• I, ,oodcd ~ `'T-po3~'.`Elee io .9d' $ra3ky 0r!` G " u3ooddn a/ict corner~0osts 1c/0 Assu.ned t Ilt✓. = l3~rn R✓.e Shed f£. g. ~ To o Uwe ~orrema:n proPost d uJ; ese~ C'anc,^c~e WLf~ ~ Ob M,C t!':P/e StPtr:c~,~/j0u,.npel~..~~cr: EX~3~.;, pf,c t Lo.('PC-s1S 61" 60 4-c e 2`r~..,~> S6 be abaa~t v~wde~ .,pct Y ff os pu eode~~ ,C.P Law id S~t.!!eol a t< okt/~L r•Vx. /a[c~ic~n ~{J'SGI~. ¢apd, e. %/1$ Q`~,t+f✓o{ fn,.rC: EXiJr~i»q efF/u~r~ /;Ae r'.o~bu,r; ed ~..P~s 1,7~e be -e,,74 ce d tc Ao ctse kY 4~:9sT.rt 3o3l,1.4r1. E.. ~ ~ t----------_ 1 a f 4 t t g k nd t t ~ PeBr t ~ E~D~~~1~ Sl6o!r,n. CeSflYeace- E.13. = IBo am of 5,'d:nq. Ele% : 9'~' EsE:.„e ed a !ev a--tmo b ofs3u:/~~%? SeyvV \,,311*17Well R /d,r'r C;p pY P zs~'= N S. Nay. Pay. ~~9 oae+at~y~ County Safety and Buildings Division St. Croix ,cc 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI 53707-7162 P= Iraq ion Number] Air ermit Application state In accordance with SPS4l2), 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 Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. Same 1. Application Information - Please Print All Information Property Owner's Name Parcel # Mike & Susan Yanish 028-1018-90-000 Property Owner's Mailing Address Property Location E l Govt. Lot l/ / 412 US H 63 City, State Zip Code Phone Number SE _SE Section 12 (circle one) Bald , WI 54002 (651) 497-8177 T 28 N; R 17 E or W II. ype of Building (check all that apply) Lot # 1 or 2 Family Dwelling -Number of Bedrooms 4ClSTIr(+~ Subdivision Name / Na Na M2zto~(~f~~1.~t Gtr Block # ❑ Public/Commercial - Describe Use Na ❑ city of ❑ State Owned - Describe Use CSM Number ❑ Village of Na „(Town of Rush River 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. El Permit Renewal El Permit Revision El Change of Plumber El Permit Transfer to New List Previous Permit N her and Date Issued Before Expiration Owner IV. Type of POWTS S stem/Coro onent/Device: Check all that apply) ❑ 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) Q/4r? V. Dispersal/Treatment Area Information: ~azd Design Flow (gpd) Design Soil Application Rate(gpd, t) Dispersal Area Re 're d (sf) Dispersal Area Proposed (sf) levation ~ 54 1;02.00, 0' t 12" above 600 Gpd 1.00 Gpd/Sq. Ft. <(0 600.00 sq. ft. l oo 630.00 Sq. Ft l~/!ry contour VI. Tank Info Capacity in Total # of Manufacture Gallons Gallons Units 21 o New Tanks Existing Tanks t; a` U v~ 40 V. C7 Q, Septic or Holding Tank 1,200 0 1,200 1 Wieser Concrete X Dosing Chamber 800 0 800 1 Wieser Concrete X VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Dale Hudson 12/f., r~~1• MP 220853 (715) 684-3378 Plumber's Address (Street, City, State, Zip Code) 820 M Street, Baldwin, WI 54002 VI oun /De artment Use Only Approved ❑ Disapproved Permit Fee U Date Iswed Is ing A ent gn re ❑ Owner Given Reason for Denial $ ~ 2 d ! /d IX. A WS 'd PF6 ova~eason for Disapproval 3 (lyL. ~Y Gt Q 1. eptic tank, uent filter anc dispersal cell must be serviced/ maintained 5 IPS 3 5 3. 33 , as per management plan provided by plumber. V O"Att,,lry~,.-o` 1~.. (yt Gt~Ci~I 2. All setback requirements must be maintained v as per applicable code/ordinances. /1, M Attach to complete plans for the s em d submit to` the County only on paper not less than 8 1n z 11 'aches in size SBD-6398 (P, 11/11) Le7rtct 30 1 pk ~ gAt a Ii - - p,YARTn~N. . 02~ I, roc Safety and Buildings 141 NW BARSTOW ST FL 4TH WAUKESHA WI 53188-3789 :N ,r e Contact Through Relay ow www.dsps.wi.gov/sb/ '6Po Q4S www.wisconsin.gov ~SS[ON 5 Scott Walker, Governor Dave Ross, Secretary September 18, 2012 CUST ID No. 220853 DALE E HUDSON ATTN. POWTS Inspector BOLDTS PLUMBING & HEATING INC ZONING OFFICE 820 MAIN ST ST CROIX COUNTY SPIA PO BOX N 78 1101 CARMICHAEL RD BALDWIN WI 54002 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/18/2014 Identification Numbers Transaction ID No. 2147748 SITE: Site ID No. 783935 Mike & Susan Yanish Please refer to both identification numbers, 412 Us Hwy 63 above, in all correspondence with the Town of Rush River agency. St Croix County SE1/4, SE1/4, S12, T28N, R17W FOR: Description: Mound, 3 bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1391480 Maintenance required; Replacement system; 600 GPD Flow rate; 24 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.01/01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION ZQ SBD-10706-P (N.01101). The building sewer and distribution network piping shall be of material listed le X30-3, 384.30-5, Wis. Adm. Code. In the event this soil absorption system or any of its component parts malfunctions so as to c health hazard, the property owner must follow the contingency plan as described in the approved plans. In ad on, 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). DALE E HUDSON Page 2 9/18/2012 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/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. Sin ly, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Julia Lewis-Osborne POWTS Reviewer 2, Integrated Services WiSMART code: 7633 (262) 397-6005, Fax: (608) 283-7481 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 Safe & Professional Services. A ty ddltionall all S &B &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 Residential Application INDEX AND TITLE PAGE RECEIVED Project Name: Yanish 4-bedroom residential mound SEP 10 2012 Owner's Name: Mike & Susan Yanish SAFETY & BUILDI N(I'S Owner's Address: 412 Hwy 63 Baldwin, WI 54002 Site Address: Same Legal Description: SE1/4 SE/4, Sec.12, T.28N., R.17W. Township: Rush River County: St. Croix Subdivision Name: Na Lot Number: Na Block Number: Na Parcel I.D. Number: 028-1018-90-000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings 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 Site Plan Page 9 Attached Soil Evaluation Report Designer: Dale Hudson License Number: 220853 Date: 09/05/12 Phone Number: (715) 684-3378- Signature: d` Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-.P (N. 01/01), and both ti: SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) ar- GG~. y Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) U <~\C-1$1 Version 5.1 (R. 06/06) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) 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 r 1.50 Peaking Factor (e.g. 1.5 = 150°/x) fecal coliform of - 36 inches. 600.00 Design Flow (gpd) 16.00 Site Slope 101.00 Contour Line Elevation (ft) 24.00 Depth to Limiting Factor (in) i 0.60 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 100.00 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highestpoint in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) 1'_7C Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation 4 Number of Laterals of the highest point. 0 125 Orifice Diameter (in) 2.00 Estimated Orifice Spacing (ft) = 6.00 ft2/orifice 2.00; Forcemain Diameter (in) 250.0 Forcemain Length (ft) Does the forcemain drain back? ' Y 81.00, Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 40.78 Forcemain Drainback (gal) 20.58 Vertical Lift (ft) 62.76 5x Void Volume (gal) 8.71 Friction Loss (ft) 103753 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 41.19 System Demand (gpm) 3579 Total Dynamic Head (ft) 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 x 1.50 x 3.00 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information 800 64l Total Tank Capacity (gal) 1200.00eptic Tank Capacity (gal) 36.00! Total Working Liquid Depth (in) Wieser Concrete Manufacturer 22.24 gal/in (enter result in cell 649) Dose Tank Information Effluent Filter Information 800.64 Dose Tank Capacity (gal) PolyLok j Filter Manufacturer 22.24yDose Tank Volume (gal/in) `PI-525 Filter Model Number Wieser Concrete Manufacturer Project: Yanish 4-bedroom residential mound Page 2 of 9 Mound Plan and Cross Section Views T 1/10 B J Observation Pipe L:SJ... :a [7, A W .l. I B z ::.:Q L Mound Component Dimensions ft A A12.00 ft E 23.52 in H [Aft ft K Aft B ft F 9.25 in 1 ft L ft D in G 0.50 ft J W 600.00 (ft2) Dispersal Cell Area 2463.94 (ft2) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 103.77 (ft) ► ♦ H G j 102.50 (ft) Lateral F Dispersal Cell 102.00 (ft)--1 I - Invert Dispersal Cell . Elevation D 101.00 (ft) Contour Elevation 16.0 % Site Slope Geotextile Fabric Cover Shading Key Dispersal Cell See lateral details on 1 Topsoil Page 4 for number, size, Cap o c 1.5 ft Subsoil and spacing of laterals. Cap o Laterals are ea equally ASTM C33 Sand ~ ~ • o F Z spaced from the Typical Lateral Tilled Layer N 0.5 ft distribution cell's © Aggregate o I centerline in the - distribution cell (Ax6). Project: Yanish 4-bedroom residential mound Page 3 of 9 Center Connection Lateral Layout Diagram force main connection vie tre or cross to manifold at any poinr_ Laterals are rderaic al 77, P S I ~ i=Turn-up va'ball valve or IEX--- xJ+ '.xl241 Laterals&torcemanofPVC5ch40 clean out pl u g per C 0Mth9 T able 84.30.5 Holes drilled on the bottom of the lateral Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.01 ft Lateral Length (P) 49.25 ft Orifices per Lateral 25 Lateral Spacing (S) 3.00 ft Orifice Density 6.00 ftz/orifice Lateral Flow Rate 10.30 gpm Manifold Length 3.00 ft System Flow Rate 4119 gpm Manifold Diameter 1.25 in Total Dynamic Head 35.79 ft Forcemain Velocity 4.21 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and Comm 10.28 WACDisconnect 4 in. min. Tank component is properly vented < Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. F a acit 800.64 Gallons olume 22.24 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 18.34 407.99 C B 2.00 44.48 Pump off elevation (ft) C 4.66 103.53 81.92 D 11.00 244.64 D Total 36.00800.64 1 Do♦ se tank elevation (ft) r 3" Bedding un er tank. 81.00 Alarm Manuafacturer SJE Rhombus Alarm Model Number Tank Alert SJE1011421 Pump Manufacturer Goulds Pump Model Number WE07H Pump Must Deliver 41.19 gpm at 35.79 ft TDH Project: Yanish 4-bedroom residential mound Page 4 of 9 GOULDS PUMPS Submersible Effluent Pump 3885 MF PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPLICATIONS ■ Shaft: Corrosion-resistant Single phase: ■ Bearings: Upper and stainless steel. Threaded • Built-in overload with lower heavy duty ball bearmq Soedficaiiy designed for the design. Locknut on three phase automatic reset. construction, follo,.ving uses, models to guard against • All single phase models ■ Power Cable: Severe duty component damage on feature capacitor start rated, oil and water resistant. ar[ll' accidental reverse rotation. motors for maximum • ?a!~er courts Epoxy seal on motor end ■ Fasteners: 300 series starting torque. provides secondary moisture • r.~oreis stainless steel. •'/3 and 112 HP- 16/3 SJTOW barrier in case of outer jacket with 115, 208 and 230 Volt cs, a,s ■ Capable of running dry damage and to preven, oil without damage to three prong plug. wicking. Standard cord is 2C • .rl,,ert st~n,s components. '',1a-2 HP - 14/3 STOW with optional lengths are a ailable. bare leads. ■ Designed for continuous Three phase: ■ 0-ring: Assures positive SPECIFICATIONS operation when fully • Overload protection [Trust sealing against contaminants submerged. be provided in starter unit, and oil leakage. Pump Soifu; ittand!i!ig capabilities: • 112-2 HP - 14/4 STOW with bare leads. axn~!unl MOTORS AGENCY LISTINGS • D!s,~,,fu size 2" NPT. ■ Fully submerged in high- ■ Designed for Continuous CaUacit es. up to 140 GPM. grade turbine oil for lubrication Operation: Pump ratings are Tested to UL 718 within the motor manufacturer's cSA 22 2 108 stand-,tii • o_ [leads: lip to 128 feet and efficient heat transfer. a ca adlan s~,~d~,,.. TDh recommended working limits, By TL ■ Class B insulation. can be operated continuously ~cp us Association r.:_~c•,alure: Fiie rrLR38549 t'~ [ 40 C1 continuous without damage when fully + l ` Submerged. Goulds Pumps is ISO 9001 Recis!e eU. 6_0 C; intermittent J_ nu,Trbers on METERS FEET _ ~e soe toi specific HP 40 30 SERIES: 3885 I , ase and RPM 's wE,sHH e 20 'RPM 3500 SiZE `ID aka jIP. his 175,E iG WE20H -SGPM FEATURES 3c oa 5Fi 90 WE15H ■ Impeller: Cast iron, semi- a 25- over non-clog with pump-out s, E,oH _ ;ar ;-s for mechanical seal 70 EozH a 20 ur, .ection. Balanced for z ~ i 60 sn coth operation. Silicon ° WE05 oronze impeller available as a 15 so E05H I ' o ='I oprorl 35. 40. . . N Casing: Cast iron volute type 3°_El_ maximum efficiency, 20 wE03L s %Pi discharge. 10 _ ■ Mechanical Seal: SILICON o 10 2111 30 4 so 60 7i0 ao 90 00 110 l CARBIDE VS. SILICON ~ 20 130 140 150 150 GPM :ARBIDE sealing faces. 1.n zu z - -u 35.-n,3/nr steel metal parts, ,CAPACITY P!jstomers Goulds Pumps ITT Industries 2602 ~www ~Jo'.l!ds.con, 7or 9 Mound System Maintenance and Operation Specifications Service Provider's Name Dale Hudson Phone (715) 684-3378 POWTS Regulator's Name St. Croix County Zoning Dep't. 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 1200 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 every 3 years Alarm Should test monthly Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 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 •~~r ~~~~~~r~~~• Grade : Threaded Cleanout 5-8" Diameter Lawn --r Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project 'Vanish 4-bedroom residential mound 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 jSBD-10691-P (N.01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01)] 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 BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 ng'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 nrithin the dispersal cell. C)bservation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner: and any ;evels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically 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. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 9 A 5X/"s6- J ymdee/W, u• sidie ; t ~ ~ t e 4 e!/Z !{wy. 4,3 5fy/ s5e.e. /Z, r28/l, Q /74J. roe,/. t~ p~8 - io /d-9o-~ bc~ ~ y 7..ts~ cres /s,~ ` =is ; c►~ ~a s►•Pe- ~ ~ ► ~ /03.0' , 1 Co 95p`fro' 'yy 0 (v"u~aod ~encG Paif s C8 ~N1Lel<yc /ot Cint wood•.d ~ ``T-,ocst.`ElerC= X03, ya' L'Sc•as~y W,oOdo„ eemf, cAr•nerlaoS+E .2"x.5/0 SSawed a t~J, = /~d•A? NuI rl /d w.c. ~ ~ A~oPo~td uJ;ese.-C'o.~c~c~e WLP!?s0~- M Ex~3~.~q~p1;c o m~t't~•:P(e sap~:~~kjou,.^Pe~.+6~c.~: tr...,rd66eabano~enao~i ~.Jcode.,~w~ee /poilyLo.('P,L-SzSe~j/us.,E/`/~'~~ br 4sPtvCode. Q JAI idS !/ed s~ o~tt/ef tl f'SeCr~nd3•?, ~A.,,a lpp,r vx• /o c "-v- e. i7 f PUCE .~6~ Ex:s r,q eFf/u~E /,'.it 6D be ~e~/aced fa /cause KY o{b"ri ed ~t'P5°s la►e ~ 9r•ak~►d ' Poo t Ex~4 S(bd~,.,. , 657encC rr./3 t$o om of b '117 Sc~y ILA - 9y 33' L S7'= (Qxl:, P~. 8~'9 Jul-29-20711 11 25 AM St Croix County Plan/Zoning 715-386-4686 1/21 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer _-DilSCt Mailing Address -17'/2 115 Property Address (Verification required from Planning & zoning Department for new construction.) City/State ~ / Parcel Identification Number CS c, LEGAL DESCRIPTION Property Location '/a , Sea. T N R l W, Town of ~/S / ✓C Subdivision Plat: Lot # Certified Survey Map Volume, Page H _ Warranty Deed # C) (before 2007)Volume / v X , Page Spec house 0 yes o Lot lines identlfiable' yes 0 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wnstes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you rut ious 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: $3.52(l) 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 thr 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. Cart ification 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. I/we am/are the owner(s) ul'the property described above, by virtue of a warranty dead recorded in Register of Deeds Office. Number, of bedrooms NATURE 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 survee• map i reference is made In the warranty deed, (REV. 09/07) 2297 Wisconsin Department of CommercRCIVE SOIL EVALUATION RCKT Page 1 of 3 Division of Safety and Buildings O ~n ~ ~cA{dance with Comm 85, Wis. Adm. Coble ' A.C.E. Soil & Site Evaluations S~P County Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must St. Croix include, but not limited to: vertical pnO kQrizordal reference point (BM), direction and percent slope, scale or di r#i"6tation and distance to nearest road. Parcel I.D. 028-1018-90-000 i `;~~r ~ Please print all information. R iewe Da Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Mike Yanish Govt. Lot SE 114 SE 19 S 12 T 28 N R 17 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 412 Hwy 63 Na Na City State Zip Code Phone Number City I Village 0 Town Nearest Road Baldwin WI 54002 (651) 497-8177 Rush River Hwy. 63 1 New Construction Use: f/ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD lle-1 / Replacement Public or commercial -Describe: -'Z ? 4 f k='~h Parent material Glacial Till Flood plain elevation, if applicable Na General comments and recommendations: Site suitable for mound system with 12" of ASTM-C33 sand placed on 101.00' contour. Infiltrative surface elevation to be 102.00'. Boring # Boring Pit Ground Surface elev. 95.73 ft. Depth to limiting factor >47" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 -Eff#2 1 0-12 1Oyr3/2 none sit 2fgr ds gw 2vf,f 0.6 0.8 2 12-19 1Oyr3/4 none sit 2fsbk dsh gw 2vf,f 0.6 0.8 3 19-30 7.5yr4/4 none sit 2msbk dsh cW 1vf,f 0.6 0.8 4 30-47 7.5yr4/4 none sicl 1 msbk mfr - - 0.2 0.3 Boring # Boring Pit Ground Surface elev. 101.98 ft. Depth to limiting factor 28" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 `Eff#2 1 0-14 1Oyr3/2 none sit 2fgr ds gw 2vf,f 0.6 0.8 2 14-28 1Oyr4/6 none sl 2msbk dsh gw 1vf,f 0.6 1.0 3 28-41 7.5yr4/6 f2f 7.5yr5/8 sl 2msbk dsh cw 1vf,f 0.6 1.0 4 41-58 7.5yr4/4 m3p 7.5yr5/8 S Resid Om mvfr - - 0.0 0.0 Effluent #1 = BODS> 30 < 220 m /L and TSS >394150 mg/L Effluent #2 = BOD5 < 30 mg/L and TSS <30 mg/L CST Name (Please Print) Sig ture: CST Number James K. Thompson _ 3602 Address A.C.E. Soil & Site Evaluatio Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 9/4/2012 715-248-7767 Property Owner Mike Yanish Parcel ID # 028-1018-90-000 Page 2 of 3 [-3 ] Boring # Boring Pit Ground Surface elev. 96.90 ft. Depth to limiting factor 24" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/2 none sil 2fgr ds gw 2vf,f 0.6 0.8 2 10-24 10yr3/4 none sl 2fsbk dsh gw 1 vf,f 0.6 1.0 3 24-38 7.5yr4/4 none -S Resid Om dsh - - 0.0 0.0 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 P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring # -I Boring F-1 _J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 5> 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 (807/00) A.CE. Soil & Site Evaluation s • E1u3~~y9~adce(Cdaa,~ UU , Jfiee ¢ ya,'; s 4 p~ ~ S!/L /~~y G3 SEy~tSEXY StC,l2, T.'18A; P !7'c~; ~PPrvX, Tq. of /occ,C.>, o ~pcl. X018 -lO~a%SD-Gno a 6 anckned b orrow p/t 92 Ar4.B E7erl` _ /03.90. ° elev. =10% F. /`~f~C ~ _ - -95.0' Q¢r1 a! _'To/°oF'~ocJGOda~' ' ' - - - - •8' - - .~cePosf. (~uk:~. Assumc.cf elc~l: = icy ct~' Slope- 1117 VZ' - 9.~ 08 %w mole 8 41 Elegy ~ yi~y' 0 K u9aed~n . ~b.ca~6a..d~lc~das F•nce ~sr code. _ I pvafs -T L7Q /'r7 m o f' v1 1. b I k ¢Itv.ut bcc;ld 86.E i7 I~I i Sl.ea( ~I 1 IIlf1111111 VIII II1ll III11 111111111111111 fill N11 State Bar of Wisconsin Form 2-2003 * 8 5 4 C3 8 6 1 WARRANTY DEED 854386 KATHLEEN H. WALSH Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD THIS DEED, made between Ervin R. Kooiman and Alice C. Kooiman, husband 06/25/2007 12:OOPM WARRANTY DEED and wife EXEMPT I REC FEE: 11.00 ("Grantor," whether one or more), and Michael G. Yanish and Susan M. Yanish, TRANS FEE: 945.00 husband and wife 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 Recording Area interests, in St. Croix County, State of Wisconsin ("Property") (if more 1'QiVJi6P4V4Ln)f1", s T8AC7 & TITLE space is needed, please attach addendum): 1200 HOSFORD STREET, SUITE 201 Part of SE 1/4 of SE 114 of Section 12, Township 28 North, Range 17 West, St. HUDSON, WI 54016 Croix County, Wisconsin described as follows: Commencing on East line of said / Section 12, 848.11 feet North of SE corner of said Section 12; thence North on said East line 257.0 feet; thence West parallel with North line of said SE 1/4 of SE 1/4 417.42 feet; thence North parallel with said East line 208.71 feet to said North line; thence West on said North line 453.58 feet; thence South parallel with said 028-1018-90-000 East line 465.71 feet; thence East 871.0 feet to Place of Beginning. Parcel Identification Number (PIN) This is homestead property. (is) (isQW0 Exceptions to warranties: Easements and restrictions of record. Dated Ta-e,, 19-0D7 - (SEAL) c"i-eM1 {SEAL) * Ervin R. Kooiman (SEAL) . 0 D~ (SEAL) * * Alice C. Kooiman AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. authenticated on ,LANE ST. CROIX COUNTY) j . STATE OF WISCONSIN Personally came before me on -YK 5L,6n7 : the above-named Ervin R. Kooiman and Alice C Kooiman TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me wn to the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) ins W---enand knowledged the same. THIS INSTRUMENT DRAFTED BY: Thomas A. McCormack Noate of WISCONSIN Baldwin WI 54(102 is permanent) (expires: o2pi~ ) (Signatures may be antheotkated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED STATE BAR OF WISCONSIN FORM NO. 2-2003 "Type name below signatures. ® State Bar of Wisconsin 2003 INFO-PROTM Legal Forma • (800)65&2021 • inroprdorms.=n 1 of 1