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HomeMy WebLinkAbout020-1003-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 556379 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)J. 2 & ~ 5-5-ST Permit Holder's Name: City Village X Township Parcel Tax No: Hoiden, T R. & Mer R. Hudson, Town of 020-1003-50-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: /D~, J D D 07.29.19.6E TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATIO`tm ` BS HI FS ELEV. C /0/-3 - 100.0 Septic Benchmark S~7 6- /00 D J Dosing Alt. BM U) S / of Aeration Bid Sew rnI .L 50 Holding Ht Inlet ~S r7~ , au~ 5,5 -7S 1 ~ TANK SETBACK I ORMATION St/Ht Qutlet le TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 03 S V0 A.a 9.03 S Septic , 3 D l Dt Bow jr i I~3 D Dosi > > 100 > too i Header/ an. II. S u /O/ • 5- q y' Aeration Dist. Pipe to.16- 9~/ Holding Bot. System yJ - PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand Cover GPM DT Z.S~~1 X13 3 Model Number 3~ TDH Lift Friction Los - System He TDH Ft For main Leng - Dia. If Dist. to Well Zd C-/-3 V Woe / SOIL ABSORPTION SYSTEM BEDITRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS q C SETBACK SYSTEM TO V P/ BLDG WE LAKE/STREA LEAC G Manufacturer: INFORMATION Typ~OJrSystem: ER OR r l/(/ / ! /V'j`/~) 11 Model Number: DISTRIB ION SYSTEM Header/ anif Distributio_nl T ttolIx Hole Smicina Vent to Air Intake Length Dia I' Length / Dia Spacing 2. 9 7 SOIL COVER x Pressure Systems Only X Moun r At-Grade Systems Only Depth Over Depth Over of1- xx Seed / od ed x Mulched Bed/Trench Center Bed/Trench Edges Topsoil --l Q 6,01 ~ Yes Ed No 0 Yes L,,,] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ Inspection #2:-L(/ 2 / Z Location: 1048 Pheasant Trail Hudson, WI 54016 (NW 1/4 SW 1/4 7 T29N R W) metes & bounds Lot_F<1 P rceI No: 07.29.19.6F 1.) Alt BM Description = 07 -Uv-aA-~ 2.) Bldg sewer length = -v301 - amount of cover = Plan revision Required? ❑ Yes No ii Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. ~~(~Su.nf Ti'cti l ~ ~ Exi ~ rode t !e✓. ,zs.Z.7s' O EY; s~ TI~11~►'ryy 1176 /o'e ~ r ~W ~J j~~ dSOn C.J/. SS1~/~o ~ EX~&'~~ ~+r~'s~~Ke ~c-use! 6e ~ ~ y 3.3o aG~es g"e r 3 bcd ova r.,cound f~ be l/ r end t ~ ocatk-t= y~1J's r i 0~ r ~ Q~.d L----~ L-__- low 14 SSu M ed e buv = iUll. oo,' I • I ~ S~rn bCG/alr`'J SG vF+' t 'l~r 5T-1 3c 4 becro/aeeaw(Asr! : ,I !M r°✓, C. eFFlr~~t ~tE~~e~oOed eis ~ C6de. O 70 f4ka AIL ~/Sym~c~ STF-~GDeF{/usn~~ ~ Sp~~cu i ~ wn • lE ~a vow Proposed /►'[ou~a/~ 2~.s~/rc 93~' g3 ycL~ w4ftis to" J 9 d,'sEri~u 6'rm Media. Two (z mac.-a.Cr - / ~9- I a f ''x 7f~.Z2 I,yY%8vr'%~ces Sp4c~ w~~,~. h~oC eie~ = 9y~~E 9 Qua 93.25 Crm~u'3 ■ ti~ _ ~~o~"~ f a`° o n 1 Y III I II County Safety and Buildings Division St. Croix r n°, 201 W. Washington Ave., P . BOX 7162 Sanitary Permit Number (to be filled in by Co.) $ gp F,' Madison, WI 5371 -7 a1?~ta tit Application . , State Transaction Number In accordance with SPS 381,2, ~,~iF rk /Adm. Code, submission of this form to the appropriate governmental unit ~l J 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(l)(m), Slats. Same 1. Application Information - Please Print All Information Property Owner's Name Parcel # T & Merry Holden 020-1003-50-000 Property Owner's Mailing Address Property Location 6 l(J 1048 Pheasant Trail Govt. Lot City, State Zip Code Phone Number _NW SW Section _7_ (circle one Hudson, Wl 54016 (715 386-6880 T 29 N; R 19 W ILType of Building (check all that apply) Lot # P111 or 2 Family Dwelling - Number of Bedrooms 3 Subdivision Name Na Block # Na ❑ Public/Commercial - Describe Use Na ❑ City of ❑ State Owned - Describe Use CSM Number ❑_,Village of L7 Town of 1/ W Na III. Type of Permit: (Check only one box i . Complete line B if applicable) A. ❑ New system Re lacement System Treatment/Holding Tank Replacement Only 11 Other Modification to Existing System (explain) P B. ❑ Permit Renewal El Permit Revision El Change of Plumber ❑ Permit Transfer to New List Previous Permit Nunn and Date Issued I~~ ro Before Expiration Owner v N IV. Type of POWTS System/Component/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade Round > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) f7 V. Dispersal/Treatment Area Informatio • S tech STF-100 effluent filter to be installed in forcemain at um dischar Design Flow (gpd) Design Soil Applicatio Rate(gp sfj Dispersal a e ire s evation 450 Gpd 1.00 Gpd/Sq. Ft. 0 r 450.00 sq. ft. 450.00 Sq. Ft. 94.902-dt 9" above 0 . ] C/o U 7sa / 3 93.25' contour VI. Tank Info Capacity in Total' # of Manufacturer d < a~ o 0 Gallons Gallons Units i / New Tanks Existing Tanks ✓ m/,, y q 17' Gtr w` U rn w C7 0. Septic or Holding Tank 0 1,000 1,000 1 Unknown X Dosing Chamber 750 0 750 1 Wieser Concrete X VII. Responsibility Statement- , 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 James K. Thom son - MPRS 30021 (715 248-7767 Plumber's Address (Street, City, S tp Code) 340 P lson Lake Lane, Osceola, WI 54020 VI . Coun /De artment Use Only Approved ❑ Disapproved Permit Fee dN Date I ued Issui Agent Si~nnatu-re El Owner Given Reason for Denial $ C ` o3 IX Conditions of Approval/Reasons for Disapproval tat/ OG ~Gfr/~L~ SYSTEM OWNER: 0) >f WVt_-4 e_1 1. Septic tank, effluent filter and dispersal cell must be serviced / maintained as per management plan provided by plumber. Q _ 2. All setback requirements must be maintained W pf kM09* plans for the system and submit to the County #IY on r t i than 8 _t2~ 111 ' hfs ' size SBD-6398 (R 11/11) 1 • ~P ~a Safety and Buildings ,p,VP&RRTME,'v~ 3824 N CREEKSIDE LA HOLMEN WI 54636 / D 9F Contact Through Relay 3 S www.dsps.wi.gov/sb/ P $ www.wisconsin.gov 9 i A~OsstoNPys~~ Scott Walker, Governor Dave Ross, Secretary October 24, 2012 CUST ID No. 30021 ATTN.- POWTS Inspector JAMES K THOMPSON ZONING OFFICE ACE SOIL & SITE EVALUATIONS ST CROIX COUNTY SPIA 340 PAULSON LAKE IN 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/24/2014 SITE: Identification Numbers' Ty & Mary Holden Transaction ID No. 2165558 1048 Pheasant Trail Site ID No. 785296 Town of Saint Joseph, 54016 Please refer to both identification numbers, St Croix County above, in all correspondence with the agency- NW1/4, SW1/4, S7, T29N, R19W FOR: Description: Three Bedroom Mound System / 10% sippe Object Type: POWTS Component Manual Regulated Object ID No.: 1397766 Maintenance required; Replacement system; 450 GPD Flow rate; 27 in Soil minimum depth to limiting factor from original grade; System(s): Ezflow Mound Component Manual, (R. 8/07), 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. P.O. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code Condi 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, APP stats. The following conditions shall be met during construction or installation and prior to occupancy or use: pIV15l4N OF SAFE Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the EE CORRI 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. A state approved effluent filter is required. 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. • The existing POWTS shall be properly abandoned per SPS 383.33, Wis. Adm. Code. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • 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. JAMES K THOMPSON Page 2 10/24/2012 Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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). • 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. • 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. 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. NOTE: As of today's date, a refund in the amount listed in the FEE portion of this letter has been initiated and forwarded to a manager for review. The refund will be made under separate cover. Please expect a 6-8 week time period for fiscal processing Refunds will be made to the paver. 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 $ 325.00 Refund Amt $ 75.00 Arard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm `UiSM RT code: 7633 jei-ry.swirn@wisconsin.gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety & Buildings will be modified. Code references with prefixes starting with "'Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. i R ,IV F~ aerl , N2012 EZFLOW MOUND AND PRESSURE DISTRIBUTION COMPONL~1'~" ?UN Residential Application INDEX AND TITLE PAGE Project Name: Holden 3-bedroom residnetial mound Owner's Name: _y & Mary Holden - Owner's Address: 1048 Pheasant Trail Hudson, WI 54016 Site Address: Same Legal Description: NW1/4SW1/4, Sec. 7, T.29N., R.19W. Township: St. Joseph County: St. Croix Subdivision Name: Na Lot Number: Na Block Number: Na Parcel I.D. Number: 020-1003-50-000 Tonally Plan Transaction No.: OVED Page 1 Index and title •TYAND BUILDIyGS Page 2 Data entry Page 3 EZFIow mound drawings - DENCE Page 4 Lateral and dose tank Page 5 Distribution media Page 6 System maintenance specifications Page 7 Management and contingency plan Page 8 Pump curve and specifications Page 9 Attached Soil Evaluation Report Page 10 Site Plan Designer: Jefffe--sK. Thompson License Number: 30021 Date: 10/16/12 Phone Number: (715) 248-7767 Signature: Designed Pursuant to the EZFIow Mound Component Manual (N. 06/03), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) EZFIow Mound Version 1.2 (R. 02/04) Page 1 of 10 Replacement Mound POWTS Index & Tilte Sheet Project Name: Holden 3 Bedroom replacement Mound Owners Name: Ty & Merry Holden Owner's adress: 1048 Pheasant Trail, Hudson, WI 54016 Site address: Same Project Location: Subdivision: Na Legal Description: NW1/4 SWl/4, Sec 7, T.29N., R. 17W., Town of St. Joseph, St. Croix Co., WI. Parcel ID 020-1003-50-000 Page 1 Index and Title Sheet Page 2 State Approved Mound Design Page 3 Certification for Utilization of existing septic tank Page 4 Septic Tank Maintenance Agreement Page 5 Parcel map Page 6 Deed Attachments: Soil Evaluaiton Report Mater P umber Restri ted Service: James K. Thom son, De 't. of Comm. Credential #30021 Signature: Date:O,-e Page 1 of 6 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01/01) EZFfow 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 300.00 Estimated Wastewater Flow (gpd) Table 83-44-3 in-situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 = 150°/x) fecal coliform of - 36 inches. 450.00 Design Flow (gpd) 10.00 Site Slope 93.25 Installation Contour Line Elevation (ft) 110.00 Contour Length Available (ft) 27.0 Depth to Limiting Factor (in) 0.60 In-situ Soil Application Rate (gpd/fe) DistVution Cell Information 6.00 Cell Width (ft) 3, 4, 6, 7, 9, or 10 Only 75.00 = Dispersal Cell Length (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/f:2) 1 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution C Y Pressure Disribution Information network? Enter Y or N (c or e) E Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation (ft) 2 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 2.00 Estimated Orifice Spacing (ft) = 6.0$ ft2/orifice 2.00 Forcemain Diameter (in) 30.00 Forcemain Length (ft) Does the Forcemain drain back? Y 86.50 Inside Pump Tank Elevation (ft) Enter Y or N +5' S#A4-r6,CH F#We_g 6.50 System Head (ft) x 1.3 4.89 Forcemain Drainback (gal) 7.00 Vertical Lift (ft) 67.38 5x Void Volume (gal) 0.60 Friction Loss (ft) 72.28 Minimum Dose Volume (gal) 14.10 Total Dynamic Head (ft) 30.48 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x x 1.25 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons/inch Calculator (optional) Treatment Tank Information 750.36 Total Tank Capacity (gal) WLP1000 Septic Tank Capacity (gal) 37.00 Total Working Liquid Depth (in) Wieser Concrete -1 Manufacturer 20.28 gal/in (enter result in cell 1349) Dose Tank Information Effluent Filter Information 750.36 Dose Tank Capacity (gal) Poly Lok Filter Manufacturer 20.28 Dose Tank Volume (gal/in) PL-525 Filter Model Number Wieser Concrete Manufacturer Project: Holden 3-bedroom residnetial mound Page 2 of 10 Mound Plan View ............:.:.:.:.J 1/10 B ' ' . Observation Pipe K. ,~1----~ T L F A 5 W B'. I . 1 L Mound Component Dimensions ft A 6.00 ft E 16.20 in H i1ft ft K Aft B 75.00 ft F 12.00 in z ft L ft D 9.00 in G 0.50 ft J W 450.00 (ftz) Dispersal Cell Area 1366.07 (fe) 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 96.00 (ft) H rfI/f!I/IffNf/JI{,(..YfJJ/ffI//fIJ/I I F „ Dispersal Cell 94.50 (ft) Lateral Invert Elevation 94.00 (ft)-► :~:6 Dispersal Cell Elevation D Q. = = 5 ,ci,?::).,.{.. y'. _ ::.'4~'{"•..' { J. , i S -5. 93.25.(ft) Contour Elevation 10.0 % Site Slope Typical Dispersal Cell Shading Key a T- See Page 5 10 ® Topsoil Cap c c Geotextile Fabric over 7i 0 ft }/!}}}}J 0 Subsoil Cap ~o 2.0 ASTM C33 Sand •c Z ° : -C• i' Tilled Layer 0 0.55 ft EZFIow Media c . -A See details on page 4 for number, size, and spacing of laterals. Laterals are located in the 4" gravity distribution pipes as shown on page 5. Project: Holden 3-bedroom residnetial mound Page 3 of 10 End Connection Lateral Layout Diagram Place Appropriate Lateral Diagram From Right Below ♦ - Turn-up wrball valvoor 010snoutptuy P I 1st orifice Ioemed at z IF xOrifices point up except every 51h S one points down for dr~, FCw* M* aoruueaior► W4" 01 aros5 to man'+old at ang POW, latvals & rores mm of PYc Sch 40 AM Idterats klerticat wth orifices equally spaced. (l" COMM T" $4.304) Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.04 ft Lateral Length (P) 74.22 ft Orifices per Lateral 37 Lateral End (Z) 0.78 ft Orifice Density 6.08 felorifice Lateral Spacing (S) 3.00 ft Manifold Length 3.00 ft Lateral Flow Rate 15.24 gpm Manifold Diameter 1.50 in System Flow Rate 30.48 gpm Forcemain Velocity 3.11 ft/sec Dose Tank Information Locking cover with warning label and locking device, and / sealed watertight Electrical as per NEC 300 and 1~ Comm 16.28 WAC 4 in. min. Disconnect Tank component is properly vented E-- Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Capacity 750.36 Gallons Volume 20.28 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 19.44 394.16 C B 2.00 40.56 _t Pump off elevation (ft) C 87.50 3.56 72.28 D 12.00 243.36 D Total 37.00 750.36 J Dom se tank elevation (ft) Min. 3" Bedding under tank. 86.50 Alarm Manufacturer SJ Rhombus Alarm Model Number SJE 1011421 Pump Manufacturer Goulds Pump Model Number EP04 Pump Must Deliver 30.48 gpm at t .b 1WF'f0 ft TDH Project: Holden 3-bedroom residnetial mound Page 4 of 10 EZFIow Distribution Cell Media Layout 6.00 Cell Width (ft) 1.50 Sidewall to Lateral (ft) Distribution Cell Cross-section Arrangements Drag appropriate drawing to space below. 6 ft Wide 668"(9 Component Legend ® 6" EZFIow Bundle - EZ0601A, 5 or 10 Foot Lengths 12" EZFIow Bundle - EZ1203H, 5 or 10 Foot Lengths 12" EZFIow Bundle - EZ1203HP, 5 or 10 Ft Lengths O 4" Distribution Pipe With Pressure Lateral Inside Tumup Enclosure - - - - Lateral Distribution Cell Plan View Layout - Typical 6.00 Cell Width - A (ft) 75.00 Cell Length - B (ft) Center Connection Lateral Layout Diagram Drag appropriate drawing from left to space below. Force Main _y - nifold •r E Project: Holden 3-bedroom residnetial mound Page 5 of 10 NGOULDS PUMPS Submersible Effluent Pump EP04 3871 EP05 APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses: heat transfer. ■ Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion • Farms manual operation. Auto resistance. sP' Canadian Standards Association • Heavy duty sump matic models include Motor Housing: Cast iron • Water transfer Mechanical Float Switch for efficient heat transfer, Goulds Pumps is ISO 9001 Registered. • Dewatering assembled and preset at the factory strength, and durability. . SPECIFICATIONS ■ Motor Cover: Thermoplastic FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. 3/4' 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: 1'/2" NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) Intermittent. METERS FEET 1 10 1 • Fasteners: 300 series 9 -4. -4--5GPM stainless steel • Capable of running 30 dry without damage to 2.5 FT s components. 25 0 7 - - W { Motor: x - - • EP04 Single phase: 0.4 HP, - ,i 115 or 230 V, 60 Hz, 1550 a RPM, built in overload with~o~0 5 15 - -fi automatic reset, -EPOS fl -j 4 - - • EPOS Single phase: 0.5 HP, o i 115 V or 230V, 60 Hz, 1550 3 to RPM, built in overload with - - automatic reset. 2 • Power cord: 10 foot 5 standard length, 16/3 1 - - - SJTOW with three prong L____ grounding plug. Optional 20 ° °0 l0 20 _ 3 40 s GPM foot length, 16/3 SJTW with three prong grounding plug o 2 4 6 8 10 1 71 ~ml/ (standard on EP05). CAPACI40•V6G60 Mr/ miirn S,w Goulds Pumps ITT Industries © 2002 Goulds Pumps 80 Effective September, 2002 83871 Mound System Maintenance and Operation Specifications Service Provider's Name James K. Thompson Phone 715 248-7767 POWTS Regulator's Name St. Croix County Zoning De 't. 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 WLP1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 if 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 Ins ect for ondin and seepage once eve 3 ears Other 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 EZFIow mound component manual. 2. Dispersal cell media conforms to EZFIow products approved for use with the EZFIow Mound Component Manual approved 6/3/03. EZFIow media is covered with an approved geotextile fabric. 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 Lateral Ends at Last Orifice Where Variable Length Cleanout Begins Long Sweep 90 or Two 45 Degree Bends Same EZFIow Media Diameter as Lateral 2.06 Feet Distribution Lateral Lateral Cleanout Project: Holden 3-bedroom residnetial mound Page 6 of 10 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 ]EZFlow Mound Component manual 6/3/03 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 113 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. Puma 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 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 4&Ms above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan *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 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Holden 3-bedroom residnetial mound Page 7 of 10 • So, ~ eda cu~u~'ar~~o, ' phCA,Scc,nf T~'ai l ~ ♦ EXi~i~c, ~t^a.de 21L✓. ,2.x1.75, U AA~ #2292 v. iY~• C' ~ct% r 7 7%7-M. tic./ i EX6~9 tSwvf'tSD~6e /~-useo( 6ei nq 3.30 &(,r-es ~cu'a t 3 b c d, IV-' you" d do be l/ ~ Cock Cvm~oh~n-~E. i ~ \ vcrtwt= ~zJ cr ~ end. ; ~ ~ Rca( Deut' o s~ Fab n X94 SSU MGd t a /r10. 00.E \ ■ ~Xis£~ 6u,'/aG'''°J s~ \ if 5; ryf 3c34 30 el -~w o Gla.n 6~I n~ 44r~~c%oaed ~.5 ~r Cc°id¢. 8S 3 S , 9 Propose-1 P ca."." b ~r h w 7SD 14 ka ~'./6crG.t pv-m~odsGl~~t. 9.~zs ' . 'd 2 i Mar't,Csc~C.c~ /a wn ~ • e Propc -5- No 4-1(1-6 2..?. Y'/,~ 9.?.3d ' 9 w/ ~ z 7S' d;510-1-sa/cQ// 41 x:11,7 Ee-F/a.> - 9_ a~,sfrilcc 6vn In,d,a. Two (~J Y c~a.Ct / _ d ~ ,off a.~ 'X 7s/,z.2 "~%"rrr':~'•ces sPk«l ~p,///~ elev = 95!~~f 9 Q~o~x 93 ss'Crm~v ■ _ N - j5r0 a° o n ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) (-J/. located at: o~&) '/4, .5cL) '/4, Section 7, TownN, Range 1,9 W, Town of 5~ . ~'ose , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (the).") appear(s) to be functioning properly. Most recent date of inspection or service - 13 20,/ 2 Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: _da gallons minutes Tank Capacity: U60 Construction: Prefab Concrete Steel Other Manufacturer (if known): z, mow Age-oqank (if known): 1.411 ermit mber (if known) ecd4:/o. 6/e 1rised Plumber Signature) (Print Name) Si i (Title) (License Number) 1II116 2 S. 2-d / 2 (Date) Form to be completed by licensed plumber (Dept of Comrnerce Chapter and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 1 13 Wisconsin Administrative Code) Rev. 9/2008 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/4r Mailing Address Property Address (Verification required from Planning & Zoning Department for new construction.) City/State S J Parcel Identification Number '5-0 - CDC LEGAL DESCRIPTION Property Location 5u)'/4 , Sec. _ 7 , T _-~:LN R W, Town of 56. "7ToSS2Pk Subdivision Plat: q kid y4& zl , Lot # Certified Survey Map # nck , Volume - , Page # - r - /~anty Deed (before 2007)Volume Page # 2 S Spec house D-ym E-ft-o_ Lot lines identifiable es ~ 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 ftmction of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(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 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. Uwe certify that all statements on this form are true to the best of my/our knowledge. i/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms AAA. WV_Q_=z &/A ATURE OF APPLICANT(S) DATE 4: Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Inciude 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) 6. aV Er` 2293 Wisconsin Department of Comm rce SOIL EVALUATION REPORT Page 1 of 3 A.C.E. Soil & Site Evaluations Ilk, , Division of Safety and Buildings rdance with Comm 85, Wis. Adm. Code SEP 0 5 '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, verdi%l andigg r enCe point (BM), direction and percent slope, scale or 0060 iNii~'rib and location and distance to nearest road. Parcel I.D. 0-1003-50-000 i~ Please print all information. Re ' wed Dale Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ( l Property Owner Property Location Ty & Merry Holden Govt. Lot NW 1/4 SW 1/4 S 7 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1048 Pheasant Trail na na Na City State Zip Code Phone Number J City _j Village VI Town Nearest Road Hudson WI 54016 (715) 386-6880 Hudson Pheasant Trail New Construction Use: iel Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD J Replacement Public or commercial - Describe: Parent material Glacial till Flood plain elevation, if applicable na General comments and recommendations: Site suitable for mound system with 9" of ASTM-C33 sand placed on 93.25' contour. Infiltrative surface elevation to be 94.00'. Boring # J Boring YJ Pit Ground Surface elev. 93.65 ft. Depth to limiting factor 30" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence- Boundary Roots 'Eff# 6PDItt.Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-5 1Oyr3/3 none sl 2fsbk dsh cs 2fm 0.6 1.0 2 5-18 1Oyr4/4 none sl 2fsbk dsh chnr 2fm 0.6 1.0 3 18-30 7.5yr4/6 none sl 1 csbk mfr cw 1 f 0.4 0.7 4 30-42 7.5yr4/4 f2f7.5yr5/8 si Om mvfi - - 0.2 0.3 E Boring # J Boring Pit Ground Surface elev. 90.50 ft. Depth to limiting factor 40" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots "Eff#1 PDHFEff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-7 1Oyr4/3 none I 2fgr ds cs 2fmc 0.6 0.8 2 7-21 1Oyr4/4 none Ifs Osg ml cw 1fmc 0.5 1.0 3 21-40 7.5yr4/4 none sl 2f&msbk mvfr gw 1fm 0.6 1.0 4 40-70 7.5yr4/4 f2f7.5yr5/8 sl&scl 1csbk mfr - 1vf 0.2 0.3 L " Effluent #1 = BOD5> 30 < 220 mg and TSS >30 < 1 0 mg uent #2 = BODS <30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signatu CST Number James K. Thompson S_._--- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 8/13/2012 715-248-7767 Property Owner Ty & Merry Holden Parcel ID # 020-1003-50-000 Page 2 of 3 3 ] Boring # -j Boring bl Pit Ground Surface elev. 91.43 ft. Depth to limiting factor 27" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots *Eff#1 D/ *Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-8 10yr3/3 none sil 2fgr ds Cs 2fmc 0.6 0.8 2 8-18 10yr4/3 none sil 2fsbk dsh cw 2fmc 0.6 0.8 3 18-27 10yr4/3 none sil 1fsbk dsh cw 2vf,fm 0.4 0.6 F 5 4 27-39 7.5yr4/6 fld 7.5yr5/8 sl 2fsbk dsh gw 1vf,f 0.6 1.0 39-62 7.5yr4/4 f2d 7.5yr5/8 scl 1 csbk mfi - - 0.2 0.3 4] Boring # J Boring „ Pit Ground Surface elev. 94.13 ft. Depth to limiting factor 50 in. Soil Application Rate GPDfW Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-8 10yr3/3 none sil 2fgr ds as 2fmc 0.6 0.8 2 8-21 10yr3/3 none sil 1thinpl ds as 2fmc 0.4 0.6 3 21-50 10yr4/4 none sil 2msbk dsh cw 1fm 0.6 0.8 4 50-61 10yr4/4 f2d 7.5yr5/8 sil 1m&csbk ds cw 1fm 0.4 0.6 5 61-83 7.5yr4/4 f3d 7.5yr5/8 sl Om mfi - - 0.2 0.6 LI Boring # Boring lei Pit Ground Surface elev. 94.15 ft. Depth to limiting factor Q" in. Soil Application Rate F-51 - - Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rood *Eff#1 GPD/W *Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-24 10yr4/6 m1d 7.5yre5/8 sl fill na na aw 2fmc 0.0 0.0 2 24-60 10yr5/2 m1d 10yr4/4 sil 1msbk ds as 1fmc 0.4 0.6 3 60-72 10yr3/3 none ? sil 2msbk dsh cw 1fm 0.6 0.6 r 5 4 72-86 10yr5/4 f2d 7.5yr5/8 sil 1m&csbk ds cw 1fm 0.4 0.6 86-100 7.5yr4/4 f3d 7.5yr5/8 sil Om mfi - - 0.0 0.2 * 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. A.C.E. Soil & Site Evaluations SBD-8330 (R07/00) ~O .2s1.7s' Noe 7y'l'OSelr-y .//dew o`'~~ P j/ O r1 cvl~YSCJI~S; St 7,T19it:, T. o~hkcdso17, SeP6e #0~6-/dV3-SD ~-~b i EX 6'~ r~t'tSv rc-ust( /Zic t y 3.30 acres O al e It 3 bed c~o+~ a i~Focvnd be C/ t S"deAcl- Ift eadt j0/i~n'~. ~,✓u~ tlea► a4- t ~ , ~ OuX t R~.J Dec,r os,B~:n ~ T 5Sl~ ontd C lei; a IcV. 40. . C3 t • ~ l • ~ ~,dd;,~.a~"cs,acr code. `n g S S as Man,'Cu i' /a wn o h U 1 8 9 9 P 251 680 1 9,c^ KATHLEEN H. WALSH REGISTER DEEDS Document Number TRUSTEE'S DEED ST- CROIXOCo., WI RECEIVED FOR RECORD THEODORE M. HOLMES, a/k/a Theodore Holmes, a/k/a Theo M. 05-29-2002 8:30 AN Holmes, as Trustee of the THEODORE M. HOLMES REVOCABLE LIVING TRUST, dated March 2, 1998, and Donna Eve Holmes, wife of TRUSTEES DEED Theodore M. Holmes, for a valuable consideration conveys without EXEMPT • warranty to TY R. HOLDEN and MERRY R. HOLDEN, REC FEE: 11.00 husband and wife, as survivorship marital property, Grantee, the following TRANS FEE: 580.20 described real estate in St. Croix County, State of Wisconsin: CCERT OPY FEE: PPAAGGES - Y F E A PARCEL OF LAND LOCATED IN THE NORTHWEST QUARTER OF THE SOUTHWEST QUARTER (NW 1/4 SW 1/4) OF SECTION SEVEN Recording Area (7), TOWNSHIP TWENTY-NINE (29) NORTH, RANGE NINETEEN (19) Name and Rat um Add, s WEST, MORE PARTICULARLY DESCRIBED AS FOLLOWS: THE EAST 252.75 FEET OF THE WEST 1219.5 FEET OF THE SOUTH ~Un /917 500.0 FEET OF THE NORTH 1150.0 FEET OF THE NORTHWEST QUARTER OF THE SOUTHWEST QUARTER (NW 1/4 SW 1/4) OF / SECTION SEVEN (7), TOWNSHIP TWENTY-NINE (29) NORTH, RANGE NINETEEN (19) WEST, SUBJECT TO A ROAD RIGHT OF WAY OVER THE NORTH 33 FEET THEREOF. 020-1003-50-000 TOGETHER WITH AN EASEMENT FOR INGRESS AND EGRESS (Parcel Identification Number) OVER A 66 FOOT WIDE ROAD EASEMENT DESCRIBED IN A DEED RECORDED IN VOLUME 513, PAGE 454, AS DOCUMENT NO. 322982, IN THE OFFICE OF THE REGISTER OF DEEDS FOR ST. CROIX COUNTY, WISCONSIN, TOGETHER WITH THE OWNER'S RIGHTS AND OBLIGATIONS AS DESCRIBED IN SAID DEED TO SHARE EQUALLY IN THE ANNUAL COSTS OF SNOW REMOVAL AND ROAD MAINTENANCE OF THE SAID ROADWAY. I Donna Eve Holmes signs this deed to relinquish any homestead and/or marital property rights she may have, but does not join in any of the warranties. Dated this day of , 2002.. 'DONNA EVE HOLMES HEODORE M. HOLMES, a/k/a Theodore Holmes, a/k/a Theo M_ Holmes, Trustee AUTHENTICATION Trustee ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ST. CROIX COUNTY Personally came before me this -AA4 day of 2002 authenticated this day of the above named Theodore M. Holmes, as TrustLK of the Theodore M. Holmes Revocable Living Trust, dated May 2, 1998, and Donna Eve Holmes, to me known to be the signature persons ho executed the foregoing instrument and _a / type or print name ack a the same. TITLE: MEMBER STATE BAR OF WISCONSIN sign r (If not, type or Art In A I/C~ S. ~ authorized by ' 706.06, Wis. Stats.) ......,,Notary Public St. Croix County, WI (S HEM; THIS INSTRUMENT WAS DRAFTED BY My comn)i sign is permanent. (If not, stat~1f4ettori a ~c ROBERT F WALL 1;'NO~yypR` 'Names of persons signing in any capacity shatlQ typed~T , printed below their signatures. Z 4~ Pug. C c i 5 s.~'".......•' GOB. '~,iyrM~QN~q N l►d Information Profeazionala Company Fond du Lac, 1M2conoin 800.655-2021 4 07r-6' G8E C L UD w z x. L w LU 009 LZ? ti? U. CN t CQ m W ~.a gs~ o ~