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HomeMy WebLinkAbout383951 014-1010-10-000Wisconsin Department of Commerce Safety and Buildings Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Lawxs.15.04 (1)(m)]. e~atets~~a~;y ^ city ^ `'~~3~~ YP~ship CST BMElev.; // ~~ Insp. BM Elev.: BM Description: r ~V r Tenn[ INFORMATION TYPE MANUFACTURER CAPACITY Septic S dU v Dosing fJ~ Hol ' TANK SETBACK INFORMATION ~ PUMP /SIPHON INFORMATION Manufacturer Model Number ~0~~ TDH Lift~,~~, Lriction Sysi J H / Forcemain Length ~' ~~ Dia. L r' TANK TO P/L WELL BLDG. vent to Airlntake ROAD Septic S s / 3 ~ ~ 3 ~-' - NA Dosing `r `~S r ~ L3 r ~ yN l NA A NA .g ~-~~. ~. ram >~ ,~ Demand ~y.~PM ,Z DH~~.Q Ft Dist. To Well yL ~ / G~ ~veTlnN t1ATA ~-~ a~3~b unt~t• n ID No.: 10-10-000 STATION BS HI FS ELEV. Benchmark ~ ~ z~(3 ~, ~ ~~. 3 Bldg. Sewer '~ Z,ZS ~ ~ , Z 4 S Ht Inlet '~ , 3 I ~ 3 Dt Bottom d ~! 0 Header /Man. ~ 3 ~ ~ R Dist. Pipe y QU Q~ Bot. System y 6 qs. r e PITS ~ No. Of Pits SOIL ABSORPTION SYSTEM BED !TRENCH Wi t~ ~ Le~gth DIMEN I N SETBACK SYSTEM TO P/L BLDG WELL LAKE/ u n INFORMATION TYPe O _ Z S ~ ~ r -~ . ~~ ( OR UNIT System: DISTRIBUTION SYSTEM Header /Manifold ~~ r~ r Length !i Dia. Z SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Topsoil InS a 10 Yes No No Bed /Trench Center Bed /Trench Edges I COMMENTS: (Include code discrepancies, persons present, etc.) ~~ b Q~ 1 ~ ~ p ~ Location: 2704 County High ay Q, Emerald, WI 54012 (SW 1/4 SW 1/4 T 1 N R15W) - 05311 5 1.) Alt BM Description =~0 6~ w~/~ 2.) Bldg sewer length - - 3~ -amount of cover = w,.~,sf br 't~`` aw,-d ~Yz" 6cyti,,oP ~D r 3.) contour = ~, 3v = ~ 3- G ~ ~ f~yr ~ ~ ~ y ~ P~f~ / bb `/ U er ~ ~ ate. / i ~ t~ ~19~ p /b v k~ b y YeIUzJ e~iu~r (,U~.S C,t~/G+~~/ S eva~~~~ y C I'tC~ w ~ (~ ~ (,.hf~ /x ~eY rrovk area a ` ` '~ ' , Plan revision required? ~7 Yes ^ No Use other side for additional information. (( / / JDate/ l ~Inspector's~ Cert. No. SBD-6710 (R.3/97) ~x f`s 1`i~vYl T 6!i`C (-c/ c~1 ( I ~ CG( li7 ,~ a Ws.r? I"~ y 1,- OV C ~ 7 Distribution Pipe(s) ~ f N ~ acing ~ 3c/Di ~ S x Hole Size ~ 3 x Hole Spacing ~- , ~3 Vent To Air Intake p a. Length ~:~ b~ ~j/ioo/ ~r~ 1'riea~P~~ ~~(GC6 ~ Sl`4,fe r,~ l lI _/~ 'insf ~(e~ec~ Ve~,la~,r'~y ~e ~o~ . 'T~-er SCr~p~o~ s~z~rr~-~ J pp //"" / p ~k. C.C~PS ol`-~' DtilG~ ~IccGCO~ /~~ ~oG~ ~h (rs ,O~ I~GC . YiP~ e1Pda~~er.~5 We r c r~ - seT' `~ Of i y'~'l~a,~ ,A ~aC~'vx,ewf ,.'? C`t-~ -~ Sanitary Permit Application safety & Buildings Division ~ In accord with Comm 83.21. V1'is. Adm. Code 20] W. Washington Ave. ~ ~ ~ ` See reverse side for instructions for completing this application PO Box 7302 ~~onsin Department of Commerce personal information you rovide ma ~ be used for secondan~ purposes ~ p ~ Madison. WI 53707-7302. (Submit completed form to county if ni: [Privacy Law, s. 15.04(1)(m)J -- - ~ -- ~ - state owned. I Attach com lete tans (to the county co ~ only) for the svste a ' i:_ndt hest; jh 8-1/2 x 11 inches in size. Counry~T G~ 1 x State Sanitary Permit Number ^ Check if vi 'o previo~applic .,ory ~•.State Pla l: D. Number I. A lication Information -Please Print all Information ~ ~'r i-- C ~ -'L cation: Property Owner Name _._ . ~ Prg~erty Location - !"Yd~ ~, ~.; ~Ge.oTl+'i t,.~l3~ZZ5~;1~5 1 -: ~ ~ ~ ~ ~ ~ ~~ ~ ~~QQ ~ r . C.~ 1/4 ~ I/4, S ~- j T ,N, R or) W Property Owner's Mailing Address " ' ~ ~ °lro Number Block Number G(atJN!Y `~ 13i~ 1~i . t:J , P~~'` ST '~~ zoNlnrc aFF~cl , Ciry, State Zip Code Phone u be , _ r ..+''C. Subdivision Name or CSM Number II Type of Building: (check one) ^ City ~ I or 2 Family Dwelling - No. of Bedrooms:~~~ ^ village ^ Public/Commercial (describe use): AO Town of ~0~~ 1 ^ State-owned III Type of Permtt: (Cheek only one box on line A. Check box on !ine B if applicable) Nearest,Road ~ ~~~ A) I. ti8f New System 2. ^ Replacement 3. ^ Replacement of 4. ^ Addition to Parcel Tax Number(s) System TankOnly Existin S stem U14- IotO- 10-000 $) Permit Number Date Issued , ^ A Sanit Permit was reviousl issued IV. Type of POWT System: (Check all that apply) ~' t¢- l ~ - ^ Non-pressurized In-ground . X r ~~` ~ Mound ^ Sand Filter ^ Constructed Wetland Cis '~ ^ Pressurized In-ground I ^ Holding Tank ^ Single Pass ^. Drip Line At-gr a ~, ^ A~ robic Tr me^* t snit ^ Recirculating ^ Other: u : ~. ~ 3 ~ 0 / ' ~ . , ;. 4 t. ~ - ~~ D D s is ersaUTreatment Area Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals./day/sq. ft.) (Min./inch) Elevation 45® 4~U 456 . ~ ~-- R5.2.? --. VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed -L Aid© ~i~ Tanks Tanks S~ar~ ~ lCloo ---~ 11~ I ~iGAt~ CAMb. ~ ^ ^ ^ ^ Pump Gila . boL~ -` looc~ ^ ^ ^ ^ ^ VII Responsibility Statement I, the undersitnted, assume res onsibilirv fnr installation of the POWTS shown on the attached- Tans. Plumber's Name (print) u tier's S azure (no stamps): P PRS No. Business Phone Number .. d~ ~rizl ~ ~ 2~5b 4 15 - Plumber's Address (Sweet, City, State, Zip Code) 14t9 t3~ A~ ~i~r~v rJ I,~L 54Q;1 VIII County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) if ~ Approved ^ Owner Given Initial Adverse Surcge3ee~ ~ _ Determination ~ 3~ ~ I.X. Conditionns of Approval/Reasons for Disapproval: /~ ~1 14-« sea. ~S iM.u-~-t<- hc.. ~M.ai ~a.t.-ve-eQ c,., p~ °1~'~ ~- ULd~t~.+s[e.5 /(,e~Q,p , ~QStufi4~ i s ~dvt S~ ~ ~ ~ -~-ea.Q~ ~` ~~ cS ~/WIC~i rl~~~t~ m~ ~ -^tiA~u~ ~ `!~e-~.6't'`'~ w AKS , SBD-6398 (R. 07/00) I v r N R !• ~ ~- T ~~ <~ ~ T t/ ~1,~ IJ ~ 1 \ 410 SwF `` S~IP\ ~ ~i:'~~ Wl3W ~ \ ~ ~13A 1L*r Q ~ J • (o ~'Iv~ is. ;~IIZ -\ ~ 94 . o~ C o ~-) ~ r ~ O Pii'^ ~i3c~ Nt-,N. (Y1n>;~ ~ t.. 1 no. o Nn+.. ~ ~-t,AC, ~ikA~ 1~'cx-~ IotX~ ~A~ Cc~m 'f fit- . 'x lt?o~ .av C~t...L. ~r ~...., n ' 4 ' S ~jV~{ . To ~o~~toW I~lupos~o WLu oQmz ~~.9`~.25 ~ ~ z ~~ (,p~,p.1 to nl ~~ ~ ~~- ~ i0'd N ~~ 0 n .~~, ~o N m b M m 0 w ~, :~, ~\~ S. ~~•,~~ ~ ~ `.i;.~'y ~}.~ --- --~i-. ,w~. ~ u e 1 i a~ "~ ~ ~ N ~ ~ *. • •~~~ ~ i ~~ ~ t I ~~ ~~ a •= Jeg9 'T ~ i ~~ P ~~~ .~ 4ed - - - \ , - lJ u `~ A ~ a ~ •-~ v_ Rk 9 D C y ~~ r D ~ ~ ~ ~ ~ D n ~^ ~~ o o w O T O m y ~O x A -~ • - ~ ~ ~N v ~~ ~b 0 V O `y~ v~ 1n`~``` 5 M _1A' /~!Llll ', ~\ `~ ~* '1`~. O D to ~ ~ v ~ ~~ ~~~ Z ~X a:~ d N ~ ~ ~ N O = O ~ A Wd bb:80 i00Z-Z0-21dtl 0 y x isconsin Department of Commerce Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264-8777 www.commerce. state.wi. uslSB Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary October 27, 2000 CUST ID No.226564 RON E FRIEDELL 1419 13TH AVE BARRON WI 54812 ATTN.• POWTS INSPECTOR ZONING OFFICE ST CROIX COUNTY. SPIA 1101 CARMICHAEL RD HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/27/2002 SITE: Site ID: 201111, DOROTHY LAURSEN ST CROIX County, Town of FOREST; CTH Q SW1/4, SW1/4, S5, T31N, R15W .FOR: NEW MOUND, 450 GPD Object Type: POWT System Regulated Object ID No.: 768453 Identification Numbers. Transaction ID No. 445325 Site ID No. 201111 ]'lease refer to both identification numbers, above, in all corres ondence with the en ~.~. tC'~~~i'~~i ~ ~~ ~~ ,s~ The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes I M ~ + and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in OE " TMEA chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. /~/L. The following conditions shall be met during construction or installation and prior to occupancy or use: S~ E GORF 1. This plan action is subject to designer comments on the plan. 2. The maintenance plan for this system must be given to the owner of the POWTS. 3. The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. 4. Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. A copy. of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, PATRICIA L SHANDORF , P S PLAN REVIEWER Integrated Services (715) 634-7810, FAX: (715) 634-5150 , M-F 7:45 AM - 4:30 PM PSHANDORF@COMMERCE. STATE. WLUS cc: DOROTHY LAURSEN DATE RECEIVED 10/16/2000 FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 WiSMART code: 7633 /~ ~ J ~ MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Dorothy Laursen Owner's Name: Dorothy Laursen Owner's Address: 1319 N. W. 89th ST Vancouver WA 98665 360-696-1710 Legal Description: SW SW S5 T31 N R15W Township: Forest ' ".~',T,~, ~~~®~t y County: St Croix ~ Subdivision Name: `Y of c t ~ D BUILC Lot Number: Block Number: Parcel I.D. Number: ;ESPONDEN Plan Transaction No.: /' /i. ''1 Ll yjj2 Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 Pump specifications Page 6 Management plan Page 7 System and maintenance specifications Page 8 Site Plan Designer: Ron Friedell License Number: 226564 Date: 10!09100 Phone Number: 715-637-3020 Signature: Version 2.81 (9/27100) Page 1 of ~_ iJ c t . 19 ' 00 7:56 FAX Mound and Pressure Distribution Component Design Design Workahaet 81M R Residential or Commercial 4esign (r~ or C) IQ00 Estimated Wastewater Flow (god) 1.50 Peaking Factor {e.g. 1.5 =150%) i0.00 Design Flow (god) a.q0 Site Slope {°i6) ~3.t30 Contour Line t=levetion (ft) 8.00 t?epth to t.imiting Factor (in) 0.50 In-situ Soil Application Rete (gpolft2) Dietrlbutton Celi information 100AQ Dispersal Celt Length Along Contour (ft) = 1.00 Dispersal Cell Design Loading i~at® (gpd/ft~) 1 Influent Wastewater Quality (1 or 2) Wrseeurs Dltrrtbutlon information C Canter or End Manifold (C cr ~) 2.00 t.,ateral 3pecing (ft) 4 Number of Laterals 0.188 Orfice Diameter (in) (e.g. 0.25) 2.50 at t7rlt{ce Spacing (ft) 2.q0 Forcemain Diameter {in) 50.00 Forcemain Length (ft) 86.50 Pump Tank Elevation (ft) 3.28 system Head (ft) x ~ .3 23.43 Vertical Uft (ft) 0.ti1i~~ 3.9t3 Friction Loss (ft) ~ ~ l 15.6A Total pyni~mic Heed (f!} tlase volume > Z09b, t'ducs Lateral dla. LaMra{ Diameter 8 teetton in. dia: tlons choice 1.00 1.25 1.50 x x 2.00 x 3.00 x Treatment Tank Information 1000.00 Se is Tank Capacity (gal) Straw Manufacturer nose Tank Information 600.00 Dose Tank Capacity (gal) 1 .a7 Dose Tank Volume {gaUin) Skew Manufacturer Project: Dorothy Leursen s» 44 5325 nta: Ssnd nN (0) Calodatlpns assume a Toble 83.44-31n-alga soA treapnsnt /ur feast rAGtOr1Y1 of <. 381ochss. 4.50 Geli Width (ft) Are file laterals the highest aint in the distribution Y network? Enter Y or N If N above, enter the elevation R of tha highest point. 5.63 ftZ/orifiC9 Do®s Ehe forcem8in drain back? Y Enter Y or N 8.18 ForCemain Drainbadc (gal) 90.53 5x Void Volume (gal) Does volume 98.89 Minimum Dose Volume (gal} 64.21 System lhmand (gpm) Manifold Diameter Selection in. dia. o ions dyoice 1.25 1.50 Z.00 x x 3.00 x Gsllons/lncit Calculator (optional) Total Tank CBpao~ty (gal) Total Working Liquid Depth (in) gain (enter result In cell 848) Sfttuent Filter lntannatton abet Filter Manufacturer A100 Finer Model Number Page 2 of 8 $171 S t~i•1 ~, F {~4~ 1 ~~ m o P. 1 Mound i'Ian View Mound Component Dimensions A 4.50 ft E 22.16 in H 1.00 ft K 10.77 ft 8 100.00 ft F 10.00 in r 10.84 ft L 121.54 ft D 20.00 in G 0.50 ft J 8.04 ft W 23.38 ft 450.00 (ft2) Dispersal Cell Area 1534.09 (ft2) Basal Area Available 4.50 (gpd/ft) Linear Loading Rate 16.67 (ft) 1/6B Obs. Pi a Placement p Mound Cross Section View Aggregate Dispersal Area 1- 1 . 1~.} ~ ~ ~ ObservationPipe 3~ ' K O [] ~ ~ ~ ... -t -~ _I -1 L l Finished Grade 97.10 (ft) G H I F 4;' - Dtsperaal Cell 95.77 (ft) Lateral 95.27 (ft)--- ~`~`~ Invert Dispersal Cell "':~ ~ ; ~ ~ ~ '~ t Elevation E D .3~; ., .• .~ 1,, .• ,• .', I 1 i 1 1 1 ~•1 ~ I I l I J I I ~ I I 1 I I ~t 1 I l ~:'1 1 I ~ J 1 'r i I 4 I~.. ~ I i ' y^ I '.1 t i f l .:1. L~ I ,;1. a I a :'l 't .~,.. ,;1 .. k 1 7.. -.~~t ' 93.60 (ft) Contour Elevation 4.0 °r6 Site Sloe Shading Key ~ g Dispersal Cell Geotextile Fabric Cover Q ~ Topsoil Cap Q '~'"~' Subsoil Cap ~ a ~ ~ .L J • ~ ` ` ~ ~ ~ See lateral details page 4 for number of ASTM C33 Sand :~ Y ~ F ' laterals, sire and Q Tilled Layer [5] Aggregate ~ v $ yplcal Lateral 0.5 ft 1 ~ ,~ ~ 5 ' , s acin L r p 9 ate als are t d cen ere in the AxB ------- A -----* distribution cell. Project' Dorothy Laursen Page 3 of Oc,t. 19 ' 00 7:56 Lat+~rsl Lay®ut Ciisgrsm Rero. maln oomnotlon W~ er or Dross ro man~fa~0 at any point, »... •+TumupwrMtlwhregr ItX Oleafttwtplua t~olee ddNed On the lottttrr- Of the latrral. Number of Laterals 4 Urlfipa Diameter Lateral Diameter 1.50 in Orifice Spacing (x) Lateral Length (P) 49.34 ft Orilicss per Lateral Lateral Spacing (S) Z.00 ft c~riflce Density Lateral Flow Rats 16.05 gpm Manifold Length System (=1ow Rate 6x.21 gpm Manifold Diameter Total Dynt~rnlc Heed 15.64 ft Fordmain Velocity Laterals art Idantlo al S Latar~is & forge main of PVC 9ch ~p per CON9N Tablr'sd,30-Et FAX Doss ~'sra~ ingortnatiion Elstbfoal a;per NEC 300 and ---~«~r Comm f6.Za! WAC _.~.--~--, a~conned Tank oamponent le property vented Straw ~' Cs aci 600,00 Volume 16.a7 Manufacturer Gallons gal/inch --- I A 6 C D glmgrneion Inches K3auons A 18.44 303.67 B 2.00 32.94 C 5.99 98,59 G 1 Q.00 184.70 Total 36.43 ~ 800.00 Locking cover whh wamirfg label and locking dsvlce and eeated vredertl8ht 4 In. tnkn. <----- Alternate outlet lootrtlon Fo-oamatn diameter ~ 2 in. Weep hole or an<I- viphon devloe P~mu +08 etevatlon it $7.33 4pose tank elevretlon A 88.50 Alarm Manuafat~urer S J l:lectro . Alarm Model Number 101 ~'ump Manufacturor Goulds ~~ Pump Model Number I1N605H I "- pump Must peNver BA.21 gpm at 15.64 ft TDH Project: t7arvthy Lauraen ~' 4-~-5325 ~~uts~o~ ' Page 4 of 8 ~-~ lo~r~~ov P. 2 ~~GOULDS PUMPS e ~t ~~ r °y s ~~r METERS FEET 40 r 35 30 D Q W ~ 25 Z zo D J Q 15 H t0 5 0 Submersible Effluent Pump METERS FEET 30 ~~ MODEL: 3885 ,~ 9y t1o 100 90 N eo r yp U 70 :y 60 so ~y 40 r 30 20 ~ ~~,• 10 0 0 1 0 2 0 3 0 4 0 50 60 7 0 80 90 100 110 120 130 14 1 0 U.S.[ ° 1o CAPACITY 20 3o m3mr Pump Specifications '/3 through 1'/2 HP Up to 130 GPM Maximum head to 123' Discharge size 2" NPT Solids: 3/4' maximum R'~ 7(100 (;puldg r'urnps Elleclive rnbm~ry. ?000 n~nfi~ 2( Q = 5 1! V Q 4 Z ~~ ~ 3 D 2 H 1 PM Pump Specification Features and Benefits •All models feature silicon carbide mechanical seal faces for superior abrasive resistance and extra long life. • Cast iron semi-open non-clog .. . , • • ~ ~ ~ ~ Mound System Management Plan Pursuant to Comm 83:54, Wis. Adm. Code '/z H P Up to 75 GPM Maximum head to 18' Discharge size 2" NPT Solids: 2" maximum Mntnr 4r J' ITT Industries P9 ~ ~~ ~ Sgctic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 28(.48, Stets. The contents of the septic tank shall be disposed of in accordance wiH1 NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet fitter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation: The finer cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the fltler is equipped with an alarm, the finer shall be serviced if the alarm is activated continuously. Intermittent flfler alarms may indicate surge flows or an impending continuous alarm. The septic tank shag have Its contents removed when the volume of sludge and scum ht 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 shaft advise (fie 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. Pum k The pump (dosing) tank shall be inspected at least once every 3 years. AN switches, alarms, and pumps shall be tested to verify proper operation. If an effluent firer is installed within the tank it shall be Inspected and serviced as necessary. 0 2 4 Mound System Management Plan Pursuant to Comm 83.54,Wis.Adm. Code Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s.281.48,Stets. The contents of the septic tank shall be disposed of In accordance with NR 113,Wis.Adm.Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm,the filter shall be serviced If the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have Its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment,maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However,If such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump(dosing)tank shall be inspected at least once every 3 years. All switches,alarms,and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter,and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic(other than for vegetative maintenance)on the mound Is not recommended since soil conpaction 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 for frost protection. Influent quality Into the mound system may not exceed 220 mg/L BOD5, 150 mg/LTSS,and 30 mg/L FOG for septic tank effluent or 30 mg/L BOO5,30 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 peformed 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 4 inches considered as an impending hydraulic failure requiring additional;more frequent monitoring. General This system shall be operated in accordance with Comm 82-84 Wis.Adm.Code,and shall maintained in accordance with its'component manual(SBD-10572-P(R.6/99)or SBD-10690-P(N.11/00)j and local or state rules pertaining to system maintence 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. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank,pump,pump controls,alarm or related wiring becomes'defective the defective component 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. Questions on the operation or maintence of this system should be directed to your designer,installer,service provider,county zoning office or local health inspector. See Page 7 for the name and telephone number of your local POWTS regulator. Project: Dorothy Laursen Page 6 of B Mound System Maintenance and Operation Specifications Service Provider's Name Friedell Plumbing Phone 715-637-3020 POWTS Regulator's Name St Croix Zoning Phone 715-386-4680 System Flow and Load Parameters Design Flow- Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow-Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect once a year and clean once every 3 years Pump and Controls Test once every 3 years Alarm h S ould test monthly Pressure System Laterals flushed and pressure tested once every 1.5 years Mound Inspect once every 3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted or perforated and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30(6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion. Lateral Tum-up Detail Finished •.............. .. Grade 6" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral --- -- Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Dorothy Laursen Page 7 of 8 311- G- RA isi --.` 1 4tiv R:::,'-''I--, -,, - . . * j \ 3n R.,., •1d cJe. . --------- _ _______, r fl O Penn is-oc,w nli >Ev_ et.. 100.0' 5'rs'f. To Eou0(4..) 93.10 (',o01120R, NA,,. A FL, (., 10 146 Ct-rr, `(iz. E * Po,,cs, P 1.0e3L . Loc,Al ton1 nl Lrc, `_i(Ey11C,-1-n01c. ' {Ri)me CMr1mt3E.s Ic., jkt\Q laocl toot 3Al., COMB. TNJ L biersZ e�" 95.45 `i 'Svc, PPE 4 .5 X IDc lr flt, • l..et,t_, Ti c r 1i 13.3r) X I _ .54- D v ts2 t\Lu, 5 5 0f P) • Wisco~in Department of Commerce SOIL EVALUATION REPORT Page ~ of Div;sion of Safety and Buildings u, aa.w~um~w mu, vvuun v.,, rr,a. r~wn. vwc County 5~ L' RUi ~ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must inGude, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. C 1 q - I V I t~ - l~0 ' 000 Please print all information. ~_, Reviewed by Date Personal information you provide may be used for secondary p ~(~il~i~cyrLaw; s;%T5~04 (t) (m)). ~ '~ ~ I Property Ow r "~/ ~ n-e ~ Props Location ~ Y; V®~~`~ ~~v~~~ ` 1~~ GovC:/tot ~L,} 1/4$I,J1/4 S 5 T ~ji N R t5 (or)W Property Ownets Mailing Address ~~ ~ I3~9 N ~ ~- ;`~ Lot # ', '• lock # Subd. Name or CSM# , • ~, ~ UO City State Zip Code Ph n.;w,Number ST GROIX ^Ci~jij ^ Village Town Nearest Road ~A~JcovJe~. WA 9~~5 ( " ~9~- t .TY E 1~ Ov..~s~ Ga Nw•~ Q ~J New Construction Use: ® Residential / Number oX~ddpoams ~~` a derived design flow rate 4~7© GPD ^ Replacement , ~1 ^ Public or commercial - Desk; Parent material U I~KQrvU ~ Flood Plain elevation if applicable , Q . f!. General comments G i and recommendations: m butA1 p J `(5TH ~ ~ ~'t"nM ~~ O ~ ~ SKST ~cr~r~r~~Jl7tro L'D~trJ2 q3. (o I Boring # ~ Boring ®Pit Ground surface elev. Q4' •~ ft. Depth to limiting factor ~ ~P in. "T`~ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i ~-~ 10 R 2 St l 21mSbl 1M 1 S ern- 5 •8 Z ~- io 5 S t l Zmb ~5 t = 5 •~ I(o 5•~~. 4 b ;~i~ ~ ~' 2 5c~i 2mabk m r-- - ~ 4 . h ~, a 2 Boring # ~ 6cring ®pit Ground surface elev. R4 • ~ ft. Depth to limiting factor T in. Soil Appligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 5-t° 1oY25 5- 2w•bK m ~~ t 8 ~j`((Z 2.5~te- 7- SC> I Zv-~ ab K rn 1 - • ¢ :' ''~ £CEI : ', r? ~ ~~ 0 ~~ i ~V/ tmuem ~~ = esws ~ au ~ ceu mgrs ana i as Hsu ~ »v mgi~ u~ucrn ne - ovus _ vv m}y~ alw ~ vv ~~~ ~~ ten: CST Name (Pie Print) Signature ,,,~,~'-"~ 1"1 C'Ut~ ~ i ti ~-r~~ Address Date valuation Condu d Telephone Number ~ ~-~~ I3rt"Ati/ BARRo1J ~4u~Z ~~ ~ do (`1t5~63~-icyZU •. ~ ~t) 5 Parcel ID # Page L- of - Owner i'ra'erty _ 3 Boring # ^ Boring ®Pit Ground. surface elev. 93. ~ ft. Depth to limiting factor in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture .Structure Consistence Boundary Roots GPD/ft= 'Eff#1 'Eff#2 in Munsell Du. Sz. Cunt Color Gr. Sz. Sh. . 5 • ~ G-q IO~i'i~31z Si 1 2msbk t S • - 51 2rr tm 1 -" , 5 ~ _ a., ~.,., a 1, 2.5Yr~ ~- 0 ~2sr 5c:1 Z+rab k m ~ -- ^ Boring Boring # ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots .E~GPD/ft.E~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ^ Boring Boring # Ground surface elev. ft. Depth to limitlng factor in. ^ Pit Soil Appliption Rat Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •E~GPD/ft Eff#2 in. Munsell Du. Sz. Cont Color Gr. Sz. Sh. ' Effluent #1 =GODS > 30 < 220 mglL and TSS >30 < 150 mglL ' Effluent #2 = BODE < 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. sen-an~o tR.a~ooY ~~ 5~~~- ~~.~.~ ~Rop~2T`1 bw~~f~, ~ `~or~rH~t l.AU2S~r~9 ~tzpp~tt.Ty Lc~,c,AlaonJ Swy4, Sw~ St.c. 5 T3i~ R~5W ~t3 ~~4 ~ 1 ~ ~ ~~~~- - ~ ~ ~~ ,B~ Z ~ '~ U~ ~ ~ a3 ~m ~ ... ~~ ~~ ~~ ~~ 8, ~ ~. -- ---, ~ ~Q.o pos~ro , F3U~ . SiT~ i ~''^ Z 0 Co µw~ Q -~~N ~•_~a c~~ f L•7 1vt-B~-JC.H Mra1zK ~1.. ~pp.o' (~~A~-T i3~N~~- mac~~c. ~~. q 5. L5 ~~~V `~ FLAu 1-.1 i4" g~w- ~~~ op o~F' iii "pit. 'PtP~ a ~~a~a Nc~u~~ ~l+ $~ °14.3 ~ ~c~~ ~RI:~D~LL~ ~2..Z(o5(oC~' ~~83 ~3. t ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer L'~OROTH '~ CAUR~~~J Mailing Address ~~ D~ c Property Address a ~ a ~ ~ u~ Q (Verification required from Planning Department for new construction) City/State Parcel Identification Number o 14 - t o t o -- I t7 - 00~ ~~ . goo~u~1 Pte" / LEGAL DESCRIPTION ~ ~~~ Property Location ~ %,, S W '/,, Sec. ~, T_~_N• RJ~W, Town of i Subdivision .Lot # CertiCed Survey Map # Volume ,Page # Warranty Deed # 54 ~f~3? .Volume I i q to ,Page # (002 Spec house ^ yes tl~ no Lot Lines identifiable ~ yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result is its pr+ematrrrafailure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a tcu;atmcnt stage in tha waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner. and by a masterplumber, journeymanplumber, restrictedplumber or a liceasedpumpcrverifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septictank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agnx to maintain the private sewage disposal system with the standards net forth, heru:in, as set by the Deparfznent 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 Zoning OflYCC within 30 days of the throe year expiration date. / / SIGNATURE OF APPLICANT DATE OWNER_ CERTIFICATION I (we) certify that all statements on this form are tnre to the best of my (our) knowledge. I (we) am (arc) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. r~ l~9/ o v SIGNATURE APPLICANT DATE «««««« Any information that is mis-represented may result in the sanitary pernsit being revoked by the Zoning Department. •«•««« «« Include with tlrts application: a stamped warranty decd from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed . lU•'7U,'UU b1UN 1~t:51 F,aI QUO (3flU8f188 DILL CILaPFELLES TOii'Iv<; ~. ' ' ,]~~y~j~"r I~ STAY t' (t.. )F WIS(.UNSIN'fgltrN f _ LPB2 WAKRANTY DEED _. .. _._ ~OCUMEIJ7 !JO. I - -__-_ ~o~ 11~Pacf6(l2 l _ Raudu~h E._ hrLpbe. z s~n~1e person, _ cmn ays and warrnms m 1)ot'Othy j). t g~lX~1L~ the f7Anu'Mg dcscriLcd real r!:nl^ IR .___ $t . C~Q1X CvYmy, Stncc o(Wucatstn; REGISTER'S OFFICE sT. cflax co., wl ~~~ auG 2 6 Is9s at 9:so a M -rdrtlar nl Deodn iHIC ,PACE rtEfiERVFp FCR RFMnOu+G OA+~ NAN[ Ar•~!1!1'Vr OuAf.'e5 Landrn:lrk Bank 77.i Th1Yd AVP'111P ~ Clear Laka, WI 54005 I~ ~D ~ ~ ,~ a~~ D14~10U9-y0/014-1009-45/ nMCel n7ENtlrlpAl N NUM Fp - Olyl-1010 ~ c O 1~~ of SWJr, anri ~W~ o.f. SW~, Secti,pn 5 3] IS except Lot 1 of Crrr, d Survey 1Hap in Vol. "11", haRe 3130. Uoc. No. D5; St- Croix County, Wi.ocbns.i.tt. - ~~ TRANSFER !. Cc5 ~-) I' i ~~ this i.s nOL• homentead progeny. (.,1 'a not) ~~ P i Exr.rtlortfoNrnrnncicc: Municipal and zoning ordfnancQC of record and recorded easements, ,-ascYictions and reservations. 4 Antdllur 23Cd~_deyo(_ AI aUSt ----~---------- 6EaL) - ~, (suL) n(.cTlCCNnGATIOiV Signnurc(z) nmhcniicnted this clay of , 19~- 95 .-_ , n.~.. io . ~a~4~ ~ ~ • tsut) Rat1dOlDh E:. Pziebr (SCAU ACKNOWLEDGMENT Sfalc of Wiecuasin, Polk , ~~~r~ SS. Pcreona!ly come befart me Ibis day of Au uo t ) ~ named Rando.LDh E. Pr3,ebe nd. _ authorized by 5%OU UC, Wi;, Sl;lu.) ---..----- --___----_-.__._ In mr knewl to he flee' ~ M wha taeemrd the Iorcgolug I11S1 hlpr'nl iRrl t TM15 EVgi(i~MEN~ WAS UHAFiED BY / f ~ ;+: Bert_ D._ PeterSer-. AttU~l&.~t Law, ~f ~ <,~tEJ ~i Bert D.•9' I~.' „, •r ; Cleaz~,ake . WI ,54005 - MMnry Public, ` ~' _ ~-- Coumy, Wis. (3ignauurr m5y he ,,~rfhrnneplod or acknrn.ledhcd. Ik.1h mr not My cunumasinn Is nem. I(,If(1, sole trpirnUan dme; ncccczary) d ~~-' smrr sl lxrw,mzl6nlnR;n alp rip+rny.haoldlrt•ryy.J sl primed 6tlew lhN. uhn.lvla. ~ _.. ---.- ...,. :.. ....:~,y w'SRpAN1r 0EErr sinr[nAt Q~wryCnN~iN W.Ep.p.lwll f)nllr (:p. yc li r..n No. 1-Het ....-... ~.,~. TITLL--` MCb1tIEN.5TA1'[ OAR Of WISt:C)N51N ~] U O 1 Cv (G I G 70. 3S~' SCALE FOR QUARTER SECTION ~ Each side large blue squares= 10 chains, 40 rods, 660 feet; area of square 10 acres. 400 Ft. 1 Inch Each side small red squares=2.5 chains, 10 rods, 165 feet; area of square .625 of 1 acre. ~ o i -1 G~~ / 7.~~tH Gte lat8/2tN I ~~y I ~ ~D~.OT Ny ~ 4 u ~se.rJ I I W --- I G1C /67B/1tY Ire-> ,' Q/~ .. %~ I ~ 7S~ ~q bon 0!`l- I/7tb - Ib - vvv - I 't~`1,~s' o M I. /~Qr Yi/I O't~Q /E 4°/C ,C~oko ~/ ~arrs.:e~¢ ~ ~/ C ~ ~'7~, I o Lo F t l ~qG ~~~8 v 3~ ~~u \` `~ ~~ o ~cr T ~•n_' r/ //45~~'3 ~ --/~j/0'/ if Le ~a` ~- ~' h,~ rry,e,~ t/r9 ~~ Nd%z / `~ --- E I I I f' /~1 ~ a CSVY1 U 132Z~ ~rou~ ~ y4~ ~.3rv,:tFS(ra- ~ SGT/s,p m -- - i\^V R - --~ .. _ .. . t. ~ [. SCALE FOR QUARTER QUARTER Each side large blue squares= 5 chains, 20 rods, 330 feet; area of square 2.5 acres. SECTION, 200 Ft..= 1 Inch Each side small red squares=1.25 chains, 5 rods, 82.5 feet; area of square .15625 of 1 acre. PRONTO LAND MEASURE 20-40 MAP SHEET PRONTO LAND MEASURE _ .. CoOY~iBht. 1967, James Hamilton Adair, Plint, Michigan