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040-1279-10-000(2)
1Z79-" 10-tom /6. �S. !S. /�G3 FEB 21120 ST. CROIX COUNTY COMMUNITY DEVELOPMENT FIELD INSPECTION & SERVICE REPORT INSTALLATION AUTHORIZED SERVICE PROVIDER Installation Address - p @ �C�,� Name: —irv�,s SH-. Owner Name: Street: Mail Address: O M Mail Address: 3 Z Ciro 56`^State&dl z p City 0s4-eEJ 64 State e,ea!Zi 3-140,40 Phone Fax Phones,/6>- W-7?G7 Fax e-mail t�er/766. /tGt INSTALLATION INFORMATION Model No. Blower Brand and Serial No. Date of Installation Date of last pump-out Size . A ,d EQUIPMENT DETAILED COMMENTS OF SITE CONDITIONS- OPERATION YES NO MAINTENANCE PERFORMED OR REQUIRED Electrical Panel(s) Visual Alarm Operating Audio Alarm Operating ✓ (if resent Blower (s): Air Inlet Filter Clean Blower Hood Vents Clear Excessive Noise Excessive Vibration Treatment Unit (s): Unusual Odor O' Svstem Vent Pum out Re uired: Primary Settling Zone aerobic Treatment Zone EFFLUENT: LIMIT RESULT Estimated Daily Flow H (Standard Units) 6-9 S.U. Color Clear .e . Temperature Dissolved Oxygen effluent 2 m /L Odor Slightly Musty odor i not se tic OWNER SIGNATURE TEC NI AN SI RE SERVICE DATE 60 � FIELD INSPECTION & SERVICE REPORT INSTALLATION AUTHORIZED SERVICE PROVIDER I;;str!Iation Address e !�� Name:,-Ta� O+ ner Name: Street: Mail address: d /Y1 Mail Address: S�Statet.Jf Z p City 05GC-O State ca-zip Z;�C"7-0 Phone Fax Phone&/6>- 4-77G7�F•ax e-mail 4re.-1766. l(Gt INSTALLATION INFORMATION oael No. Blower Brand and Serial No. Date of Installation Date of last pump-out Size o2 d a.►1 s-s EQUIPMENT DETAILED COMMENTS OF SITE CONDITIONS- OPERATION YES NO MAINTENANCE PERFORMED OR REQUIRED Electrical Panel(s) 'v'isual Alarm Operating Audio Alarm Operating (if resent) Blower(s): Air inlet Filter Clean t_� 3!o+,er Hood Vents Clear Excessive Noise Excessive Vibration Treatment Unit (s): Unusual Odor S+Steil) Vent alum gout Required: Prirnary Settling Zone G1 crobic Treatment Zone EFFLUENT: LIMIT RESULT Estimated Daily Flow H (Standard Units) 6-9 S.U. Color Clear az- Temperature Dissolved Oxygen effluent 2 m /L 75 Odor Slightly Musty odor not se tc OWNER SIGNATURE TE INICIAN SI A SERVICE DATE w� �� �� 60. 1Z79- /D- 60C> i9. 153 to FIELD INSPECTION & SERVICE REPORT INSTALLATION AUTHORIZED SERVICE PROVIDER Installation Address Name:7— Sar-. Owner Name: Street: Mail Address: d Mail Address: Ci(v Sw`State W1 Zi p City 0S4�_-o State c.,,y Zi n/01 U Phone Fax Phone&/S,, 4-77G7 Fax e-mail e-mail/{C47Soj �-n 4'e--466. I(6t INSTALLATION INFORMATION Model No. Blower Brand and Serial No. Date of Installation Aate of last pump-out Size A, 20J EQUIPMENT DETAILED COMMENTS OF SITE CONDITIONS- OPERATION YES NO MAINTENANCE PERFORMED OR REQUIRED Electrical Panel(s) Visual Alarm Operating Audio Alarm Operating (if resent Blower (s): Air Inlet Filter Clean -411p, JV Blower Hood Vents Clear Excessive Noise Excessive Vibration Treatment Unit (s): Unusual Odor I System Vent Pum out Required: Primary Settling Zone Aerobic Treatment Zone EFFLUENT: LIMIT RESULT ! Estimated Daily Flow H (Standard Units) 6-9 S.U. Color Clear Temperature Dissolved Oxygen effluent 2 m /L I Odor Slightly Musty odor not se tic OWNER SIGNATURE _f_IECHNICIAN SIGNATURE SERVICE DATE /d -2e43 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 561030 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: Olson, Bradley C. & Shannon E. Troy, Town of 040-1279-10-000 CST BM Elev: Insp. BM Elev: BM Description: nn Section/Town/Range/Map No: /Op 1~ G5-r 16.28.19.1563 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 6 , /W - C, /o Septic Benchmark 6.8 A00, l Dosing Alt. B kerPf n / Bldg. Sewell Holding St/Ht Inlet u St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to it Intake ROAD Dt Inlet S tic '5t -Bottom ?a0V,. s-/ 35 /3 ~y• Do 6L) 1 (0 sing 1 gy / Header/Man. / 6 9 [0 . >A^ Wo 610 Aeration Dist. Pipe Holding Bot. System G se. PUMP/SIPHON INFORMATION Final Grade ~•b Manufacturer ~ C 1. / U.- 01(~ GPM Demand St C v r av b•74 g3. -1; Model Number 15( -z 7.11 Vc v s 5.7 q Ca TDH Lift',,, 14 Friction Loss System He6.56 ad TDF~ ' Zq , /at~ 6k) tw~ 5. 6 3 9~/. 5~4 Forcemain Length ! O Dia. Dist. to Well / D 2 LL I,/ C_ 6j o L 5.7( '74. SOIL ABSORPTION SYSTEM a " r` 9 3 • S~j No. Of Pits Inside Dia. Liquid` BED/TRENCH Width Length, f jNo.,O Tren es P DIMENSIONS 56 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER Type System: I~ UN OR IT Model Number: o f NA- DISTRIBUTION SYSTEM fb / Header/Manifol # Distribution a x Hole Size x Hole Spacing Ve o Air Intake Length 3 Dia AZ6 Length T 9 .3Z ! ZS , Spacing y / g K :5Z, 1V Dia SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ~ "r Depth Over Depth Over xx Depth of xx Seeded/Sodded 1xx Mulched Bed/Trench Center Bedrrrench Edges ` Topsoil ' L'-'•`+~' [ No No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: g / Z• Inspection #2: Location: 501 Omaha R d Hudson, /WI 54016 (NW 1/4 NW 1 16 T29N R19W) Eagle Bluff Lot 31 P)p r,..~ /may/ Parcel No: 16.28.19.1563 1.) Alt BM Description = ~""P GOJt~_ 1~ 17 *9 ~ O lam-. 2.) Bldg sewer length = - amount of cover = 1 3.) Contour = 1 l Plan revision Required? ❑'s Yes No b ~~'3Y ~'S Use other side for additional information. SBD-6710 (R.3/97) Date insepctor's S' nature Cert. No. so t O.+~ati~ ~oQol dt'J l~r 0.70 ~ AA U' A tY o ~x/s~' c~e~ o~ J.~ ~ c x.s~' ~,.2Sa P P 1 W 3 orb J , e sei- Carl c~~ 4 v 1,4.IW a° Reposed o 5 8(0 ~T4t ~ be L J iJ¢lSiO~ 0 310- g3i3f1~ S.T. as ~ 3~ a SPA Ic~-~ o.-~ s. ` -o ~ f~~ 3 y2~~ic~»~~ne. - ' 9~ 51A ~4 ° u~,cs~r ,r,~ AoM,osd►, ~3/~ y 3JQ ~ ~y" y ~ ~~o~~ i~'~~V-'~ ~`''"i/o~,la..s ~.5e%'//COa./uc~i0n~(i4~f-by VV 2 N Proposcor~ocw►d a-~,2s// r ~~/G ~rac(# .5~non %svn/~ ~ ~ x so'd;s~sa/ ee;/. Srs~~ ~ so/ o~na tia Qd- few ~ i c mlo a.6 a bode f{u dsor~, ~ 1 s/oI6 9.Z • 6D'L►~-t~w'. vivo ~tJ /a~ia~s LoZ`.3 ~ P/i~~~oJ/Q /.~u{~ a f /i~ r y9. w/%8 ""or~i c<s wY~rtu~y 5c~ /c -rze/!., 5,aa ce- d a E s2 : ,Q /9cv; (Tn ./JOB TraYf tfi ~ d ~~r. G/•0 119./ W l ~ ~ e; k bo,--i,-~ ProP~fy p~/ ~ os~o-~z79 is-uJa w e l~s r /OV ~a4ol Pq /,2 o{' /Z p,-o~,s.~,naw.,d s, fe. c1 -0 C, Q) C) ii 3 0 O N ^ O 60). Y to CD h C C O O C op Y E C C N w ~ N N C m O a U N N E Z C N C Q .2 -ru N -0 -O = M a) C O L H E (D a :1 0 (D E N d N aC N~ a C N O OM O N N 3 1 I,,, 76 .2 C'O :6 a ~N_ m N Cc Ot a~ E _ E•~t p 3 .g w o3mm o.°-ri V5 3: S >0 a-C c •c N ro J o p- a a) C ` 7 > ~N O) N .T. m vcaci.5a: 3ECc, wi w V 03 0 X c c W Q CO O O N a`~ E ami m a? p E N~roZEoo~N N m N (D xa N N E E or 3 m Z C° 7 C C Z O a a N a N 3 fC N = 7 m ~.C N- OC m E O C LL N CD E= a LL c FO > - ° O T- 0) C.O UO c 3 E3> a co ENpd(p N 'O NL l4 m '6 mL~ 2 W m'O N~ E Q 0 2 m Q d o O CO m *k N 3 V D 0) 0 y Z N 3:_ Z j. 00 O O N> Gm. co d m j H Z ' N O c C7 ~ a ~ O Z o 0 F+ r w O N N Z O m O~2 N C CD Cn H r N iC 'O E m ni m O d N N CN N N O N 'D U) CL Ira Il~j (0 C to F- i O p Z Q O Z C Z Lr) 4i U) Y ~ U') a+ N N E 3: E A 4) R Ol 12 CO i a R 0 CL 0 ~l N = G a .O C = O a 0 N I U) U) U) 0 F- H F- Er- mo H F- H a Z m h o W 3 33: a H w 3 3 3 m 0 0 0 m Oa a s m uaaa m o- I E 5 I E o_ M (D o M M N N 7 O V1 p O O W N (D CO N O LO O B O O ti~ W eN- Z ti~ W N Z O N O N 0 C, O O - 0 0 0 - 'O N Q C m 0 c c CO r c a m .0 N m N V O) N r U) co N O G O C.1 U) C = U N = C E >1 0 co (D Q m E m N c c m 0 0 N 0 N 30 CO m 0) CO O C •7 J 7 V' to 01 C v ~ 01 06 F- = O ai G1 c v O E t o m N O N m 'Em -0 0 (A 0 • ~►1 ' o F= O Ln o z z o v° z a w O ~ jl, I r \ ai w E d v a; m €a da • c~ ° d `3 m = (D d c E _ c .a2 _ 3 v v r A V a.2l'I0U) 0 County n I ` Safety and Buildings Division h~ `D S 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) r P Madison, WI 53707-7162 T~ -5 t~ (a/GAD Sanitary Permit Application,,. - - ° - State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate g`dvmmental it Z.7-1 4155 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 p v' e r secondary , _ / ,QQ purpos in accordance with the Privacy Law, s. 15.04(1 (m , Stats. 5 O dma_ I 1. Application Information - Please Print All formation c.c ) Pro erty Owner's Name ` b r W Parcel # 1277 6 4r_ Property Owner's Mailing Address 4~zc-N G OF Property Location / D~~- ICO(C.c~C Govt. Lot City, State Zip Code Phone Number _&21 Section ~ circle one) T M N; R Iliew W II. Type of Buil ing (check all that apply Lot # 11 2 Family Dwelling -Number of Bedro s 3 I Subdivision Name lock El Public/Commercial -Describe Use .i1 C( 11 Ci of ❑ State Owned - Describe Use CSM Number El Village of !-Town of ~f^W III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System 9-<e placement System El Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) 11 Permit Transfer to New List Previous Permit Numb and Date Issued B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber 7"7 1 '12 ~ O}~/Z3 ~ Before Expiration Owner / G IV. Type of POWTS S stem/Com onent/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade Mound > 24 in. of sum a soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ O er Dispersal Component (explain) - retreatmentDevice (explain) 514,Ja L Ammon- .S V. Dis ersaUTreat ent Area Information: Design Flow (gpd) DVe'Wo~ Ap frog (gpdsf) Dispersal Area Required (sf) ispersal Area Propos s S stem Elevatio d~ VI. Tank nfo Capacity in Total #46f Manufacturer Gallons Gallons Units o n New Tanks Existing Tanks _ w Z U 'vs h ~ is. C7 P, Septic or Holding Tank Dosing Chamber ~ VII. Responsibility Statement- I, the un ersigned, as ume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumbe 's JNP/MPRS Number Business Phone Number 3,-Ar)A1 (71 z ~/B=TT~r Plumber's Address (Street, City, State, Zip Code) 3 yo Ads 4*7 Lai e 6oy ~sce d Cst c.J/, 55~a zd VIR-CountyA[)epartment Use Only pproved end Permit Fee Da Issued Is4suing ent Signature Reas r Denial $ / 75, Z 13 IX. Condi$ai~Ti~AWWMeasons for Disapproval t• 1: Septic tank, effluent lifter and 3' Ga. ~ 0~'S r L / 1 c -c c~.. .l•ti dispersal cell must all be services / maintained !r>- i / as.per management plan provided by plumber. ~ 2. JW setback requirements mtt be maintainadd t `n ul Ud G lun I" h 0 r as per applies" owe / ordkwwoeii 4V Kzvuvalrld_4!~ Attach to complete plans for the system and submit t t County only on paper not less than 8 /2 z 11 inc in size SBD-6398 (R. 11/11) Replacement Mound PQWTS Index Tilte Sheet Project Name: Olson 4 Bedroom replacement Mound W/ Sludge Hammer S-86 ATU Owners Name: Brad & Shannon Olson Owner's adress: 501 Omaha Road, Hudson, WI 54016 Site address: Same Project Location: Subdivision: Lot 31, Plat of Eagle Bluff Legal Description: NW1/4 NWi/4, Sec. 16, T.28N., R. 19W., Town of Troy, St. Croix Co., WI. Parcel ID 040-1279-10-000 Page I Index and Title Sheet Page 2 State Approved Mound Design Page 3 POWTS Service Contract Page 4 Sludge Hammer Specification Sheet Page 5 Existing Septic Tank Specification Sheet Page 6 Pump Chamber Specification Sheet Page 7 Certification for Utilization of existing septic tank Page 8 Septic Tank Maintenance Agreement Page 9 Parcel map Page 10 Deed Attachments: Soil Evaluaiton Report by Thompson Soil evaluation Report by Hollister Mater P ber Restric d Service: James K. Thompson, Dept. of SPS Credential #30021 Signature: 5---- Date: Page 1 of 10 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (14.01/01) ,,yARTATg , Safety and Buildings 9 0~ 3824 N CREEKSIDE LA HOLMEN WI 54636 3 D ,S Contact Through Relay P ~ www.dsps.wi.gov/sb/ vtiQ S www.wisconsin.gov sfoN Scott Walker, Governor Dave Ross, Secretary March 05, 2013 CUST ID No. 30021 ATTN.- POWTS Inspector JAMES K THOMPSON ZONING OFFICE ACE SOIL & SITE EVALUATIONS ST CROIX COUNTY SPIA 340 PAULSON LAKE LN 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/05/2015 SITE: Brad & Shannon Olson Identification Numbers 501 Omaha Rd Transaction ID No. 2214558 Town of Troy Site ID No. 788540 St Croix County Please refer to both identification numbers, NW1/4; NW1/4, 516, T28N, R19W above, in all correspondence with the agency. Lot: 31, Subdivision: Eagle Bluff FOR: Description: Four Bedroom Mound System / 12% slope / Pre-treatment Object Type: POWTS Component Manual Regulated Object ID No.: 1415565 Maintenance required; Replacement system; 600 GPD Flow rate; 80 in Soil minimum depth to limiting factor from original grade; System(s): Ezflow Mound Component Manual, (R. 8/07), Pressure Distribution Component Manual - Versi.on 2.0, SBD-10706-P (N.01/O1); S-86 SludgeHammer Aerobic Treatment Unit, 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. P! Q. V No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, Cond stats. APPR The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders DJVJS10N OF SAFETY Al • 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. E CORRESP • The application for a sanitary permit shall be accompanied with documentation that the master plumber or master plumber-restricted service who is to be responsible for the installation or modification of the POWTS, has completed approved training on the proposed POWTS technology or method or has documentation that approved training will be provided during the installation of the POWTS. • The application for sanitary permi 1 be accompanied with legal documentation of all the components requiring servicing at an interval o k12 onths or less shall be recorded on the deed for the property. If this is not present, a sanitary permit can no issued. • 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. r JAMES K THOMPSON Page 2 3/5/2013 • The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • 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. • 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. 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 the POWTS shall be responsible for ensuring that the operation and maintenance occurs in accordance with this chapter and the approved management plan under 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. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swim@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. JAMES K THOMPSON Page 2 3/5/2013 • The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • 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. • 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. 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- 0 The owner of the POWTS shall be responsible for ensuring that the operation and maintenance occurs in accordance with this chapter and the approved management plan under 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. 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 2 Fee Received $ . 250.00 Balance Due $ ,0.00 d~e OP ~ ~q~ Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swim@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. RECEIVED EZFLOW MOUND AND PRESSURE DISTRIBUTION COMPONENT DN j 2013 Residential Application INDEX AND TITLE PAGE 'N~UST~y SERVICES Project Name: Olson 4 Bedroom Residential Mound W/ ATU Owner's Name: Brad & Shannon Olson Owner's Address: 501 Omaha Road Hudson, WI 54016 Site Address: Same Legal Description: NW1/4 NW1/4, Sec. 16, T. 28 N., R. 19 W Township: Troy County: St. Croix Subdivision Name: Plat of Eagle Bluff Lot Number: 31 Block Number: Na Parcel I.D. Number: 040-1279-10-000 r s. dally Plan Transaction No.: VED Page 1 Index and title iD BUILDINGS Page 2 Data entry 01 Page 3 EZFlow mound drawings Page 4 Lateral and dose tank DE~I Page 5 Distribution media Page 6 System maintenance specifications Page 7 Management and contingency plan Page 8 Pump curve and specifications Page 9 POWTS Agreement Page 10 SludgeHammer ATU Speicifications Page 11 Attached Soil Evaluation Reports Page 12 Site Plan Designer: s K. Thompson License Number: 30021 Date: 02/26 13 Phone Number: (715) 248-7767 Signature: Designed Pursuant to the EZFlow 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) Pagel of 12 EZFIow 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 8344-3 in-situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 = 150°/x) fecal coliform of - 36 inches. 600.00 Design Flow (gpd) 12.00 Site Slope 92.60 Installation Contour Line Elevation (ft) 95.00 Contour Length Available (ft) 80.00 Depth to Limiting Factor (in) 0.60 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 6.00 Cell Width (ft) 3, 4, 6, 7, 9, or 10 Only 50__00_1= Dispersal Cell Length (ft) 2.00 Dispersal Cell Design Loading Rate (gpd/ft) 2 Influent Wastewater Quality (1 or 2) Are the laterals the hight oint in the distribution es Y Pressure Disribution Information network? Enter Y or N (c or e) a 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) 1.50 Estimated Orifice Spacing (ft) = 4.55 ft2/orifice 2.00 Forcemain Diameter (in) 60.00 Forcemain Length (ft) Does the forcemain drain back? Y 85.00 Inside Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 9.79 Forcemain Drainback (gal) 7.60 Vertical Lift (ft) 30.99 5x Void Volume (gal) 0.97 Friction Loss (ft) 40.78 Minimum Dose Volume (gal) 15.07 Total Dynamic Head (ft) 27.19 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 (optional) Treatment Tank Information 1001.88 Total Tank Capacity (gal) 1250.00 Septic Tank Capacity (gal) 36.00 Total Working Liquid Depth (in) Wieser Concrete Manufacturer 27.83 gal/in (enter result in cell 1349) Dose Tank Information Effluent Filter Information 1001.88 Dose Tank Capacity (gal) Zabel Filter Manufacturer J 27.83 Dose Tank Volume (gal/in) A-100 Filter Model Number Wieser Concrete Manufacturer Project: Olson 4 Bedroom Residential Mound W/ ATU Page 2 of 12 Mound Plan View T 1/106: J Observation Pipe l~J l - K: 5 A W :.:.:.:.:.:.:.:.:.:.:.:.:.;.:.:.:.1..:.:.:.: B I :::a::::::::::::::::; : 40 • L Mound Component Dimensions Down slope toe extension made. ft A 6.00 ft E 14.64 in H lift ft K Eaft B 50.00 ft F 12.00 in z ft L ft D 6.00 in G 0.50 ft J W 300.00 (ft2) Dispersal Cell Area 1000.00 (ft2) Basal Area Available 12.00 (gpd/ft) Linear Loading Rate 5.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 9510 (ft) H G ♦ y?"'~^`z lll,l/,.,lll 11/11111/.': ` j ,1l//I111!!///1111 llll!/!/,If/f ire'.., F Dispersal Cell 93.60 (ft) Lateral 93.10 (ft)--► - y:.6" Invert Elevation Dispersal Cell CJ ; ; ; Elevation . D 3 92.60 (ft) Contour Elevation 12.0 % Site Slope Typical Dispersal Celli Shading Key a See Page 5 10 Topsoil Cap o Geotextile Fabric over /11,111, Subsoil Cap 0 2.0 ft ASTM C33 Sand ci 4) 4- F ® Tilled Layer Q Q 0 © EZFIow Media o H OT See details on page 4 for number, size, and spacing of laterals. T Laterals are located in the 4" gravity distribution pipes as shown on page 5. Project: Olson 4 Bedroom Residential Mound W/ ATLI Page 3 of 12 End Connection Lateral Layout Diagram Place Appropriate Lateral Diagram From Right Below E P •i Turn-upadbaiiva"orcloonoutplug z 1 st orifice located at z k- x-~f Orifices port up except every stn T one points crown for drat"e_ Force main oor~ion via tee or caoss to ma *old at a4 point. Lmofafs & f(xce main of PVC Sch 4tl AN laterals identical with orifices equally spaced. (per COMM TaW 84.30.51 Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing (X) 1.52 ft Lateral Length (P) 49.32 ft Orifices per Lateral 33 Lateral End (Z) 0.68 ft Orifice Density 4.55 W/orifice Lateral Spacing (S) 3.00 ft Manifold Length 3.00 ft Lateral Flow Rate 13.59 gpm Manifold Diameter 1.25 in System Flow Rate 27.19 gpm Forcemain Velocity 2.78 fttsec Dose Tank Information Locking cover with warning label and locking device, and sealed watertight Eiectrical as per NEC 300 and Comm 16.28 WAC 4 in. min. Tank component is properly vented Altemate outlet location Forcemain diameter Wieser Concrete Manufacturer T_ 2 in. Volume 27.83 gal/inch A Disconnect Weep hole or anti- Capacity 1001.88 Gallons Dimension Inches Gallons B siphon device A 20.53 571.48 B 2.00 55.66 C Pump off elevation (ft) _t - C 1.47 40,78, F 86.00 D 12.00 333.96 D Total 36.00 1001.88 - Dose tank elevation (ft) Min. 3" Bedding under tank. - 85.00 Alarm Manufacturer SJ Rhombus Alarm Model Number SJE 1011421 Pump Manufacturer Zoeller Pump Model Number BN151 Pump Must Deliver 27719 gpm at 15.07 ft TDH Project: Olson 4 Bedroom Residential Mound W/ ATU Page 4 of 12 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 asem"(@ 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 4" Distribution Pipe With Pressure Lateral Inside Turnup Enclosure - - - - Lateral Distribution Cell Plan View Layout - Typical 6.00 Cell Width - A (ft) 50.00 Cell Length - B (ft) Center Connection Lateral Layout Diagram Drag appropriate drawing from left to space below. Force Main - ft Widd End Manifold Project: Olson 4 Bedroom Residential Mound W/ ATU Page 5 of 12 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 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 30 mg/L Septic Tank Capacity 1250 gal Maximum TSS 30 mg/L Soil Absorption Component Size 300 ft2 Maximum FOG 10 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 Ins ect or 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 1.86 Feet Distribution Lateral Lateral Cleanout Project: Olson 4 Bedroom Residential Mound W/ ATU Page 6 of 12 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 [EZPlow 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, Slats. 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 svm 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 levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continency 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 deflective 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: Olson 4 Bedroom Residential Mound W/ ATU Page 7 of 12 Septic System W/ Diversion Valve Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10705-P (N.01/01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank Septic tank servicing mechanics comply with SPS 383.54(1)(e). Septic tank to be located within 150' of service pad, with bottom of tank to be 5 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. 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. Septic tank manholes 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 the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October-March) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BODS, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Effluent flow shall be alternated between dispersal cells on a two-year schedule by use of diversion valve. Effluent to be diverted from new mound dispersal component to old dispersal cell at 4 year anniversary of new system installation. Old cell to be utilized for a 1 year period. Afterwards, effluent dispersal to be alternated between cells to allow use of each cell for a two year period. 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. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248-7767 or the St Croix County Zoning Department at (715) 386-4680. Pg.,! of f Z i it H PUMP PERFORMANCE CURVE TOTAL DYNAMIC HEAD/FLOW MODEL 1511152/153 ~ PER MINUTE 14- 45- 153 EFFLUENT AND DEWATERING 12 ,o MODEL 151 152 153 35- to- 152 Feel Meters Gal. Ulent Gal. uteB Gal. Uwe 30 s 1s so tag ae 281 n 291 10 3fl 61 231 70 265 8 151 5 4.6 38 53 201 Si 231 0 s 20 8 110 44 187 52 197 r g 20 .6 18 61 34 129 42 159 0 ' 30 9.1 - 23 87 33 125 T v H 35 10.7 - - - 22 85 4 l0 40 12.2 - - - - 11 42 Shut-off Head: 301E (911 3811. (11.Bm) 441E (13.4m) ' 2- 5 0146088 0 10 20 30 40 60 fiD 80 1 AUDNS LITERS 40~8D 10 1 0 39 3~; h 4R Model 151 Models 1521153 CONSO z" FACTORY FOR SPECIAL APPLICATIONS 67732 6174 978 Tin 45'6 327172 45e - • ed dosing panels available. -7- • Electrical altemators, for duplex systems, are available and supplied with an alarm. 3 78 3 27732 -f}- 4 j • Variable level control switches are available for controlling 374 3 27W single phase systems. • Double piggyback variable level float switches are available ---~i for vtrriFltle level long and short cycle controls. • Sealed Qwik-Box available for outdoor installations. See FM1420. ~ I ~ • Over 130"F. (54T.) special quotation required. I I ~ 15111521153 Series v++lt6 i j 12118 151/152/153 MODELS Control Selection ilodr! Volh•Ph Mods Am simplex Duplex - 4 51/8 N1541 115 1 Nan 6.0 _ 1 _ 2 or 3 - - BN151 1151 Auto 8.0 Included 2 or 3 Et 51 230_1 - Non 3.1 1 2_a 3 BE151 230 1 Auto 3.2 _ Included 2 or 3 SK24" SK2064 N152 115 1 Non 8.5 1 2 or 3 BN152 115 - 1 Auto 8.5 Included 2 or 3 E152 230 1 Non 4.3 1 2 or 3 DE152 230 1 Auto 4.3 Included 2 a 3 N153 115 1 Nan _1_0.5 1 2 or 3 BN153 115 _ 1 Auto 10.5 Included 2 a 3 Et53 i 1 Nan 5.3 1 2or 3 SELECTION GUIDE 6E153 30 1 Auto 5.3 Included 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float 4 CAUTION switch. Refer to FM0477. zw,J :wr of Controls, protactton devices and wring should be done by a qualified 2. See FM0712 for correct model of Electrical Alternator E-Pak. Ali eiectri ai and safety codes should be toilowed including the most 5~erl n, .,trc cone t NEC) an;: the Occupabonal Safety and Health Act OSHA; 3. Variable level control switch 10.7125 used as a control activator, specify duplex (3) or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. - - - NAIL TC: P. O. BOX 16347 ` !ousvire, KY 402580347 NandfactimsOf.. ou To.' 48 Cane Run Road ~~1i6+1<6t~/V o SHIP ® Louvilk, xr 40211.1961Pu,lvs SvcE /999 PUA4P 778. 273 htrpJAvww2o*11er com PL/MP (502) FAX (502) 774,M24 80 ® Copyright 2004 Zoeller Co. All rights reserved. (J~ , $ off' 42 Document No. POWTS AGREEMENT Owner name and address: Bradley C. Olson 501 Omaha Road Hudson. WI 54016 This indenture, made by "owner" and their successors in interest, own a POWTS (Private Onsite Wastewater Treatment System) requiring regular monitoring and maintenance in accordance with the manufacturers recommended Return to: procedures. These procedures must be performed by a manufacturer authorized service provider licensed by the State of Wisconsin to perform these services. James K. Thompson Results of these procedures shall be reported to the appropriate Governmental 340 Paulson Lake Lane Unit as required by code. Osceola, W1 54020 Location of PO WTS• Parcel ID#: 040-1279-10-000 501 Omaha Road; Lot: 31 Block: Na . Subdivision/CSM: Plat of Eagle Bluff being part of NW'/4NW'/~ 16, T. 28 N. R. 19 WT n. Of Troy, St. Croix Count Wisconsin. Parcel Number: 040-1279-10-000 POWTS DESCRIPTION: Sludge Hammer S-86, pre-treated effluent discharged to mound dispersal component. OWNERSHIP RIGHTS AND RESPONSIBILTY FOR POWTS: Property "owner" as described holds sole ownership rights. "Owner" is responsible for insuring inspection, operation and maintenance of POWTS. (O er signal e) - (Date) ((honer signature) (Date) Acknowledaemenr ese na ed, Bradley C. Olson, known to met be the person executing the foregoing instrument. Subscribe and sworn to bef e this day of 2013. OTARY PUBLI , Stat of Wisconsin My Commission Expires: September 6 2015 Instrument Drafted By: James K. Thompson Slud SludgeHammer• Group Ltd. 336 S. Division Rd. etoskey, Ml 49770 geHammer® P Ph: 1.231.348.5866 Toll Free: 1.800.426.3349 Fax: 1.120.834.3102 www.SludgeNammer.net SludgeHammero Specifications The SludgeHammer® represents the first significant advance in Aerobic Bacterial Generator biotechnology since we presented our original technology over five years ago. During that period, this technology has been installed in thousands of units. Drawing on this extensive experience coupled with an active R&D program directed by the originator of the ABG concept, Dr. Daniel Wickham, we have dramatically improved on the original with the SludgeHammer®. " specifications S-86 unit S-46 unit Recommended Recommended for larger residences for single-family and commercial residences up to applications 4 bedrooms. Dimensions: Column diameter at top: 12" 12" Column diameter at base: 15" 15" Total height: 36" 36" S Electrical Service*: 110 V, 60 hz. - 15 amp. 110 V, 60 hz. - 15 amp. Power draw: 60 watts - 1 amp 40 watts - 0.5 amp - Air delivery rate: 3.5 CFM @ 2.0 psi 1.7 CFM @ 2.0 psi Liquid mixing rate: 30,000 gpd @ 4 foot depth 22,600 gpd @ 4 foot depth Fixed film utilization factor: 350 gal./ft2/day 240 gal/ft2/day Organic digestion rate: 3-6 lb/BOD/day 1.5-3.0 Ib/BOD/day Minimum depth of tank: 40 inches >w/60 watt pump 40 inches > w/40 watt pump Maximum depth of tank: 60 inches 60 inches The SludgeHammer= Single chamber tanks: Minimum 800 gal. Minimum 500 gal. continues to meet UPC Maximum 2,500 gal. Maximum 1,500 gal. code and the IAPMO IGC 180-2003 standard Multi-family or for Aerobic Bacterial commercial installations: S-86 Sludgehammers® can be Generators. installed in multiples with Domestic supplemental air diffusers. SludgeHammer= Group Ltd, headworks strength: 5-10 lb/BOD/day for single provides design consultation S-86 with supplemental air. and engineering for industrial applications and High strength loads: Contact your local dealer community scale systems. for design details. Visit wwrr.SludgeHammecnet for information on availability *These are U.S.Standards. in Syour area as well as for can SludgeHa adapt m to mer the G eroleup, garical at. Model S-400/600 IMO - MARPOL 1APM0 STANDARD dealership opportunities. requirements/sandardsof Certified by NSF to MEPC-152 (55) 16C 180-2003 any country in the world. NSF/ANSI Standard 040 International Alr pump 120 VAC Air line In beeln Service HOW ; Effluent niter Inlet, - t ".•'qy '~e~n way y outlet Aerobic Bacteria _ Vigorous G tioo System circulation 01/20/12 of l~-r 1 3 Ex•'s~~~ sco6c.~..~~'~' ~ /dtc.K / SidtRCG be Pr;V~s;oh O 5-810 ~fTk 160 SIC. Vd-lut. U i173 //~dir~ Sib ` P~rY.i~nlE~'~ccrtrf / `JP~~/CCc~i ons, 0 9) 9&JYI ' G• /~db~o.Q. • 5eVl eda/lia6-o07 t 6 y ;iA ti3 u~,es~Co„on4e 7Aomo-u~ i3/(j y 31l) y~oh~ ~~r-"+~ to``"yQC1a.K A6deoa/uu4, ,,a by 2 ProPoscd~ou,zd at,Z s~S// r 107/A Bro o(~ -11,&-non 0/svn ~vvP xso'dls~rsq/ee//:5y5-6" so/ Oinapia& a rzN f~ be 9.x/C 10-6 G" a,6 odd /{u dson, c.J 1. Ss/o/L 9? • ~'eor, Maur, ~cvo ~LJ /a a.Cs 4w- 31, P/a ~EoJ/e at I r y9..~~'w~%8"oric~3 nwn~y~ 5cc /c rza/1, -~m cedaf s2. /9cv; Tn . a/ Ti-o), 3~. Groik do., (,7 ~e tiba~„~~oro~O~fy 71-is-~vo w e.IIS /OCR ~rrrn 7 P~oµ~SCd rn o c~nd s, ~.e. ~ . 1,2 o 12 POWTS SERVICE CONTRACT The proper operation and maintenance of the components listed below will significantly influence the performance and life expectancy of the POWTS (Private Onsite Wastewater Treatment System). This agreement authorizes A.C.E. Soil & Site Evaluations, L.L.C. personnel (Service Provider) or their representative access to the POWTS components during regular business hours to perform regular inspections and routine maintenance of those components. It is herby agreed by and between Purchaser and Service Provider that in consideration of the payments provided for herein, Service Provider will provide a manufacturer trained and State licensed inspector to perform periodic inspections of the POWTS components as set forth below. Service Provider will prepare a written inspection report after each inspection containing any recommendations for the operation, maintenance, and or repair of the POWTS deemed appropriate by the Service Provider. A copy of the report will be provided to Purchaser and the appropriate Governmental Unit. Service Provider will supply additional services, parts, or labor only after authorization by purchaser. This agreement does not assume any responsibilities or obligations that are normally the responsibilities and obligations of the purchaser and does not cover any costs associated with operation, maintenance and or repair of the POWTS. In no event shall Service Provider be responsible for any special or consequential damages, including but not limited to, loss of time, injury to person or property, or incidental economic loss due to equipment failure for any reason whatsoever. This agreement shall remain in effect for a period of tw (2) ears from the date of POWTS installation, and will be automatically renewed each year thereafter nl s amended or cancelled by either party with 30 days written notice. T is agreement may be cancelled by Purchaser only if replaced by a service contract with another service provider authorized to inspect and maintain the specific POWTS components in question. Purchaser agrees to pay Service Provider the sum Of 125.00 per inspection. Four (4) inspections will be provided over the first two-year period at six-month intervals. Payment for the first four inspections will be included in the cost of the POWTS design. One (I) inspection per year will be conducted thereafter with inspection fees billed at the time of inspection. POWTS DESCRIPTION: One (1) Sludge Hammer S-86 pre-treatment unit installed in existing 1,250 gal. septic tank, discharging to 1,000 gal. pump chamber and demand dosed to mound dispersal component. POWTS Location: 501 Omaha Road, Hudson, Wisconsin, located in: NW '/o NW of Sec. 16, T. 28 N., R. 19 W., Tn. of Troy, St. Croix Co., WI, Parcel # 040-1279-10-000 Owner name and address: Bradley C. Olson 501 Omaha Road Hudson WI 5401 (OwneKsignatur~f (Date) Service Provider: it & Site Evaluations, L.L.C. 340 P a u I s n Lake Road Osceola, 1 54020 5---- zs ZD/, ice Provider signature) (Date) Instrument Drafted By: James K. 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POST-POUR: z W3716 US HWY 10 MAIDEN ROCK, N 54750 ° REVISED JAN. 2012 800-325-8456 FILE: W1250-MR ~0. 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POST-POUR: \ Z W3716 US HWY 10 MAIDEN ROCK, WI 54750 ° REVISED JAN. 2012 800-325-8456 FILE: 1RP1000-MR , G o7<ia ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEIVIENT FOR UTILIZATION OF EXISTL"NG SEPTIC TAN1{(S) This is to certify that I have inspected the existing septic and/or dose t,nk presently serving the followim-, residence: (Street address) 501 C9MC kg IQoeud _ _ _ located 1 - ~,JSection ~I~o~~~n ;Z-6' \ I~ailge- W, TOW11 Of _7r'ON, St. Croix County Wisconsill. Upon inspection, I certify that I have found the tai~<(s), to the best of my k110%vledge, will conform to the requireillents of Comm. 84.25, and it (thee) :.appear(s) to be functioning properly. .Most recent date of inspection or service Did flow back occur from absorption system? Yes No J (it no, skip next line.) Approximate volume or length Of time: -,yja- gallons _ nl;llU S Tank Capacity: / ;Zs-0 Construction: Prefab Concrete Steel Other Manufacturer (ifknown): _e 0 ank (if known):'~~s - Permit nu nber (if 1:110~vn) ~,Z9p/~ ~5,~~~ d (_eensed Plumber Signature (Print Iname) (-Title) (License Nuunber) N/lP/.N,ll'RS (Date) Form to be completed by licensed plumber (Dept of Commerce Chapter and s. 14 .06, Wisconsin Statutes) or':icensed disposer (N1- 1 13 \\%isconsi;: Administrative Code) 1Zev. 9%2008 76~1a ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/-- '6" d $r S n~ Q/Sda') Mailing Address eaccl Property Address (Verification required from Planning & Zoning Department for new construction.) / City/State I =W/ Parcel Identification Number ~Sle 12 LEGAL. DESCRIPTION Property Location /14J '/4 , '/4 , Sec. 16 , T ;Z6 N R_ZY_W, Town of 7;7,a Subdivision Plat: 6a1e Lot # 31 . Certified Survey Map Volume - , Page # Warranty Deed #~p0~ (before 2007)Volume , Page # Spec house 0 yes no Lot lines identifiable yes 0 no SYSTEINI 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 tine 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. [/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 Planniml & "Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this f are true to the best of my/our knowledge. 1/we am/are the owner(s) of the property described above, by virtue of a warr ty deed recorded in Register of Deeds Office. Number of bedrooms V A V/ /I n 2 SIG i A URE A LICANT(S) DATE `s*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 it' reference is made in the warranty deed. (REV. 09/07) Py 9 o7ri6 7 1tV ► 1 , 1 2.. a1553f~S 3' 33 5 8 ► ►1.477 ACRES, % W / 1.055 ACRES 17 . / $ 7,354 S.F 1 45.953 SF. _ M.277 ACRES 1.4'x0 ACRES .600 S.F. Oi -t 64.04 ~ y1 ~ 2 5 SF.. , m i b C34 i t gt' N' r~ 03 . N 13- w lop -cs2- - a 33 63 41173~,.~ --.i'ce C65 C SW 00 S1 8 Zoop'►n Z 20, T 1 30 QO • i ? o 1.228 ACRES C61..7!~ v► N ► O= a 1.29ACRE S~ 53,509 S.F. 1414 ►58.580 SF,/ 32 f •r A• _ N 1 331 ~ 4% 1 ' J3 ► 34 1 ►w 29 r v ,1 ' $ t r~ ► + g 1.093 ACRES 35 t' w tt,, ' 2 ► 47,619 S.F. 36 - > 1.063 A S a s^► s i0 A s~6 .289 S.F. ► 7 , ~•1, Q ' P11 4 / • 21 SF. 1 134. " W t 4/ . W v~ CJ ~ ~ 9 6. 1' S 28 27 1N , 1.200 ACRES / 1.238 A / 52.284 S.F. , Q- 53.906 I L4,7 1 ' _ ~J ~ 3OOJW JTH LK OF THE NE 1/4 OF THE NE 1/4 120. 52- If TEMPORARY CUI.-OE-SAC _UNPLA T TED LAND EASEMENTS. R=80' . D ALL ANGULAR ~ I o 2~ 80 .00' UNPL A T ES SHOW. I 'ULES AND URCHASING OR R I ATE TOM BOARD There are no objections to this plat with respect to 00J)A(a~~ ~ Secs. 236.15, 236.16, 236.20 and 236.21(1) and (2), Wis. Stets. R I tIT-0F-WAY JAMESD. WINS s TO 10' 425' r~ LOT IS A Chi fiedU U1 "Ar- 20_@L NWFAIM C .14wRa `9'~ 1•.~Q XTURES AS t A nistra n 4*STREET EXTENSION. 9~~d i Document No. II I II I I I II II I I I I III I I I I I I i POWTS AGREEMENT 8 1 3 8 6 7 1 Tx: 4112001 974784 BETH PABST Owner name and address: REGISTER OF DEEDS ST. CROIX CO., WI Bradley C.Olson RECEIVED FOR RECORD 501 Omaha Road 03/11/2013 4:00 PM Hudson, Wl 54016 - EXEMPT This indenture, made by `owner" and their successors in interest, own a REC FEE: 30.00 POWTS (Private Onsite Wastewater Treatment System) requiring regular PAGES: 1 monitoring and maintenance in accordance with the manufacturers recommended Return to: procedures. These procedures must be performed by a manufacturer authorized James K. Thompson service provider licensed by the State of Wisconsin to perform these services. Results of these procedures shall be reported to the appropriate Governmental 340 Paulson Lake Lane Unit as required by code. Osceola, WI 54020 Location of POWTS: Parcel ID#: 040-1279-10-000 501 Omaha Road; Lot: 31 Block: Na , Subdivision/CSM: Plat of Eagle Bluff being part of: NW'Y4NW'/., 16, T. 28 N., R. 19 W., Tn. Of Troy, St. Croix County, Wisconsin. Parcel Number: 040-1279-10-000 POWTS DESCRIPTION: Sludge Hammer S-86, pre-treated effluent discharged to mound dispersal component. OWNERSHIP RIGHTS AND RESPONSIBILTY FOR POWTS: Property "owner" as described holds sole ownership rights. "Owner" is responsible for insuring inspection, operation and maintenance of POWTS. ( er signaler (Date) Z (Owner signature) (Date) Acknowledgement: ese na ed, Bradley C. Olson, known to met be the person executing the foregoing instrument. Subscribe and sworn to bef a this day of - , 2013. . nsm TAR,, LI tat of Ji 'e~:; . My Cofnmi'ssion Expires: Se' tem r 6 2015 i J U:R vInstrumef~d• By, • latfi& i4. oThompson t ~wMw1rNH~`~' ` 1 of 1 illlil illll IIIII 11111 IIIII Iilli Ills Illlfl IIII Till State Bar of Wisconsin Form 3-2003 856902 QUIT CLAIM DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number Document Name ST. CROIX CO., WI RECEIVED FOR RECORD 08/03/2007 11:00AM THIS DEED, made between Bradley Charles Olson and Shannon Elizabeth Olson, QUIT CLAIM DEED husband and wife EXEMPT i 16 ("Grantor," whether one or more), REC FEE: 11.00 and Bradley C. Olson and Shannon E. Olson, Trustees of the Bradley and Shannon PAGES: 1 Olson Joint Revocable Trust dated August 1, 2007 ("Grantee," whether one or more). Grantor quit claims to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach Recording Area addendum): Name and Return Address Jennifer A. O'Neill Lot 31 of the Plat of Eagle Bluff in the Town of Troy, St. Croix County, I•ommen Abdo Caw Firm Grandview Professional Building Wisconsin. 400 South Second Street, Sure 210 Hudson, WI 54016 Subject to Declarations of Covenants, Conditions and Restrictions for Eagle Bluff, recorded in Vol. 1589, Page 516, as Doc. No. 638946, as appearing in 040-1779-10-000 the office of the Register of Deeds for St. Croix County, Wisconsin, and such Parcel Identification Number (PIN) other easements, restrictions and reservations of record, or in use, and the This is homestead property. "Buyer" obligations contained in the Purchase Agreement for this lot. (is) (is not) Dated 1;>00 / ;~44 -(SEAL) (SEAL) ' Bradl Ch les Olson 1 Vt~ u - /jC: C ~ro7 (SEAL) (SEAL) Shannon Elizabeth Olson AUTHENTICATION ACKNOWLEDGMENT Signature(s) of Bradley Charles Olson and Shannon Elizabeth Olson STATE OF WISCONSIN ) authept' ed I A. Rust 1, 2007 ) ss. COUNTY ) Personally came before me on TITLE: MEMBER STATE BAR OF WISCONSIN the above-named (If not, authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the foregoing THIS INSTRUMENT DRAFTED BY: instrument and acimowledged the same. Jennifer A. O'Neill - Lommen Abdo Law Firm s Hudson, Wisconsin Notary Public, State of Wisconsin My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. QUIT CLAIM DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 3.2003 - Type name below signatures. 7 of 1 V r 2314 Wisconsin Department ofComr: SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings 'W ~ accordance with Comm 85, Wis. Adm. Code C.E. Soil & Site Evaluations Attach complete site P e' ~tdltt w * i r.: County ix ~+"than 8%x 11 inches in size. Plan must h04127W0~000 include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. jRevd Please print all information. P ersonal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1) (m)). Property Owner Property Location y D13112113 Brad & Shannon Olson Govt. Lot NW 1 jNaor 16 T 28 N R 19 W Property Owner's Mailing Address Lot # Block # SubdSM# 501 OmahaRd. 31 na at Of Eagle Bluff City State Zip Code Phone Number J City Village arest Road Hudson WI 54016 Troy Omaha Road J New Construction Use: !/f Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD f/ Replacement J Public or commercial - Describe: Parent material Glacial till Flood plain elevation, if applicable na General comments and recommendations: Site suitable for mound system with 6" of ASTM-C33 sand placed on 92.60' contour. Maximum available contour length = 70'. a Boring # _I Boring 0 Pit Ground Surface elev. 93.75 ft. Depth to limiting factor 108" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GIRD/le in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10yr3/3 none sil 2fgr ds as 2fmc 0.6 0.8 2 9-25 10yr3/6 stone sit 2fsbk ds cw lfmc 0.6 0.8 3 25-38 1Oyr4/4 none fsl 1csbk dh gw 1fm 0.2 0.6 4 38-46 1Oyr4/4 none fsl Om dh cw 1vf 0.2 0.5 5 46-64 7.5yr4/4 none sl Om dh cw - 0.2 0.6 6 64108 7.5yr4/6 none fsl 1fsbk dh aw - 02 0.6 7 108-116 10yr812 none ss resid. Osg ml - - 0.0 0.0 Boring # - I Boring e Pit Ground Surface elev. 91.17 ft. Depth to limiting factor 80" in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-6 1Oyr3/3 none sil 2fgr ds as 2fmc 0.6 0.8 / 2 6-38 1 Oyr4/6 none sil 2fsbk ds cur 1 fmc 0.6 0.8 ✓ 3 38-46 1Oyr4/4 none fs Osg dl aw 1fm 0.5 1.0 4 46-66 7.5yr4/6 none fsl 1 csbk dh cw 1 of 0.2 0.6 5 66-80 7.5yr3/4 none %I Om dh cw - 0.2 0.5 6 80-132 1Oyr8/2 none ss resid. Osg ml - - 0.0 0.0 * Effluent #1 = BODS> 30 < 220 /L and TSS >3 < 150 mgA- * Effluent #2 = BOD 1130 mg/L and TSS <.310 mg/L CST Name (Please Print) Sig ture: CST Number James K. Thompson 72(~------ 3602 Address A.C.E. Soil & Site Evaluation Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, W154020 2/13/2013 715-248-7767 r PROPERTY OWNER: Brad & Shannon Olson SOIL AND SITE EVALUATION 23.t4 Page of 3 PARCEL I.D.# 040-1279-10-000 A.C.E. Soil & Site Evaluations REPORT MEMO No redox. features are present, allowing the existing conventional dispersal cell to remain in place and be reserved for future use. Soil conditions and replacement system area are very restricted, resulting in inadequate area for an in-ground dispersal cell installation. Accordingly, a mound system must be installed with a shorter dispersal cell than preferred. Proposed design should include a diversion valve to allow the future reuse of the currently biologically failed dispersal cell, alternating between the new mound and the older system. o,~ah4 ~oQd t~ l~'r Q7Q~ ~ ~ o C;x;sE;~y cue!/ a~ F d ~4,4y~ ti~ RZ r ~ ~ ~ a c Xi Sfinq ~ Sa~gO ~ S~bedrelc~►-~ .4-/cry ba /dccaC / /cesn~ 416r,- w ~C s,c(anCG 3 4Ct~~ ~a Sib 91,0 Y soryraSoY) ~3/C 3 ILL Brao~~ .3~non O/.s~.n ~F du 0156,V7, Li t. 6-Vo/l, ~ wY¢r1 u~yy Scc r. ze~1, Q /9cv; 7-77- a Ti oY~ cr•aix Cro ~ /oC79 io-u/o ~.3of'2