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HomeMy WebLinkAbout014-1015-90-001I ~,. /,~ Wisconsin Department of Commerce Safety and Buildings Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) rersunai m~urrnauon yvu provice may oe usea ror seconpary purposes [Privacy Law,kS.15.04 (1)(m)]. Permit Holder s Name: ^ City ^ illa a Tow of: .ombardo, Kevin & LeAnn ~or~st ~ownsr'h1p CST BM Elev.:- Insp. BM Elev.: BM Description: ~ ~ d ~ ~ ~/ r ~i~' TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic a'D Dosing ~~~ ~~ eratlon Hold TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG_ vent to Air Intake ROAD Septic taro ~,~? y t so r ~L ~ -- NA Dosing ~r ~~ `'` NA a ion A H g PUMP /SIPHON INFORMATION Manufacturer Demand Model Number ~(jD 3'-"(( ~•,~GPM ~ Friction S ste TDH Lift ~ L ego ~ ~ TDH ~,IaZFt Forcemain Length J! ~ Dia. Z M Dist. To Well ~ ~ op ` SOIL ABSORPTION SYSTEM ELEVATION DATA coun~ Croix Sanit~r/r~~r~it No.: State Plan ID No.: s t~.# - `f~l ~Z Pa rcebTl~c_r~ ®I 5 -90-000 STATION BS HI FS ELEV. Benchmark 3 ~~. ~ 3•s ~~ ~ Z. 3 /a / ~ Bldg. Sewer ~2 ~ /~ ©/ Ht Inlet l2.29 `~ ~( St/ Ht Outlet .- .--, Dt Inlet r Z • so (~-) ~-- -~ Dt Bottom (~ , / 3 ~ 8~. S~ Header /Man. Z t S~ oo ~'S r Dist. Pipe Z ~~ rep. ~2' Bot. System -~ ~,~ i Final Grade ee 5~~ cover wt. 3-~ co~.~ c7o.a BED /TRENCH width S Length ~ No. Of renches PIT No. Of Pits Inside Dia. th DIMEN I N ~ crU I N SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM N nufacturer: INFORMATION TypeO ~ CH ER 'umber: System: ~ l~ ~ (c7D UNIT DISTRIBUTION SYSTEM ( 77_~ -h~ y~}~r ~-.a r°c-~-~''"".o``•) y~ Header /Manifold 2 ' ~ Distribution Pipe(s) /~ 4 _ x Hole Size x Hole Spacing Vent To Air Intake . Length ~ Dia. ~ ~ Length T r- S Dia. 2 Spacing 3/~(e '' (5' r` -~^ 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 Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: ~ /~2 /ao Inspection #2: a9/19/ae -~- Location: 2621 County Road Q, Clear Lake, WI 54005 (SW 1/4 NW 1/4 7 T31N R15W) - 07 5103 ~~ 1.) Alt BM Description =-Eap ~ o ~ -~,~,,,,~(Q,y(;~ 2~~ -' ~~ar~a~~" ' '~. 2.) Bldg sewer length = ~F2 -amount of cover = ~ `f~ ~ (~~ "' ~ ~'•~ ~ ~'(o v ~ ' 3.) contour = `~~ ~v, '~. ~ ~`~. (o `~ , ~~ `~ ~ L~ Plan revision required? ^ Yes ~ No ~ p 2 21 B ~ Z, Use ther si a for additional infQrma Ion. ~ s~ ~~~ q~,R~ w ~ (.,l ~¢. n~ (8 Inspe Signat re Cert. No. SBD- 710 (R.3/97) ,,bI,~4 2-~ 2~ _. Safety & Buildings Division Sanitary Permit Application 201 W. Washington Ave. In accord with Comm 83.21, Wis. Adm. Code PO Box 7302 `~SC~h.~~r~ Sce reverse side for instructions for completing this application Madison, W[ 53707-7302 Personal information you provide may be used for secondary purposes (Submit completed form to county if not Oepdrtment bf Commeree [privacy Law, s. 15.04(l)(m)j state owned. Attach com fete tans to the coup co onl for the s stem, on a er not less than 8-1/2 x L 1 inches in size. County State Sani Permit Number ^ Check if revision to previous application State Plan 1. D. Number Location: I. A lication Information -Please Print all Information prop~y location Property Owner Name ~ ~~ 1 D~,~A~pO ~taif t IJ L ~ l~ ~Jl~ I/4 N4~/4, S T ~ i N, R or W ~~ ~ [.ot Number Block Number Property Owner's Mailing Address ~~~ ~ o x, Z-32- 7' Ti Code Phone Number Subdivision Name or CSM Number City, State P ~>~iz l.a -us w L 5 ~~ ^ City II. Type of Building: (check one) 1 ~ ^ village ~`( i or 2 Family Dwelling - No. of Bed / ~/ Town of ~Qfl~~~ ^ Public/Commercial (describe use) ~,- ~ ~- ^ State-Owned - Nearest Road I:CEiVEO t~ Go N~~ Q l "_ ~~' Parcel Tax Number(s)e l4 _ lOlS- q0 - 000 .3.15 0 III. T e of Permit: Check nT one 'bn in A. ck tltx n iin~ B if a licable 5 6. ^ Addition to A) i. New 2. ^ e cement ST3Ca~eplace f 4. Existin S stem S stem S COUN~Pgnk Onl ate Issued B) ZCINING P \ ' ber ..~ f /I (,Y'_I, ~, ^ A Sanita Permit was re ' ust^*s ued , s X I ~ ^i~ vt~~ IV. Type of POWT System: (Check t ~ ~j _ ound ^ Sand Filter ^ Constructed Wetland ^ Non-pressurized In-ground r ^ Holding Tank ^ Single Pass ^ Drip Line ^ Pressurized [ ou d ^ At- de q~ • ~ ^ Aerobic Treatment Unit ^ Recirculatin ^ Ot er: V. Dis ersal atment Area Informs on: 1. Design Flow (Bpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application lvtm~cech on Rate 6. System Elevation Elevat on ~ e Required Proposed Rate (Galslday/sq. ft.) ( ) i 4-50 450 4~a ~ ~oo.o VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons Tanks Con- Con- g Information Crete structed New Existing Tanks Tanks ^ ^ ^ ^ Sct~-` ~ t7oo -' I oc~o I 51~~ Cow g • ^ ^ ^ ^ ^ i7u-,,,, ~, . loon -' looo VIII. Responsibility Statement I, the undersi ed, assume res onsibi ' or instal lion of the POWTS rho on thReSaN ched fans. Business Phone Number Plumber's Namc (print) P mbe Sign t re (tno s n ~ _ • •t i~j, ~31 ~3~Z~ RtSnj ~tZl t3D"~I-L L ~qr Plumber's Address (Street, City, State, Zip Code) 1 ~„~,~ ~ J ~~R~ ` t {i ~~, Z 14~°I N W.l... IX. County/Department Use Only Issvin A ent Si cure (No stamps) ^ Disapproved Sanitary Permit Fce (Includes Groundwater Date issued 8` g Bn Approved ^ Owner Given initial Adverse Susgharge Fee) ~ _u _ 2~ Determination ~i s' ~ ^ X. Conditions of Approval ! eason~ for Di p oval: TrOL~"~' D/~L'6+~-- - ~ i~ ~~~~ r ~ ~ ~ ~ isconsin Department of Commerce August 15, 2000 RON E FRIEDELL 1419 13TH AVE BARRON WI 54812 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/15/2002 ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Site ID: 196458, KEVIN & LEANN LOMBARDO ST CROIX County, Town of FOREST; HWY 63 SW1/4, NW1/4, S7, T31N, R15W FOR: NEW MOUND, 450 GPD Object Type: POWT'~'stem Regulated Object ID No.: 753905 Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264-8777 www.commerce.state.wi. us Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary Identification Numbers Transaction ID No. 411682 Site ID No. 196458 Please refer to both identification numbers; above, in all corres ondence with the a en p,owT Coj~ditio~ The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes ~ ~ ~~ and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. jrAENT OF The following conditions shall be met during construction or installation and prior to occupancy or use: ~~ 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. SEE CpRRE• 3. The orientation of the mound system must be such that the mound's longest dimension is Oriente Ong the surface contour per COMM 83.44(6)(a)2. 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 co deuce maybe made to me at the telephone number listed below, or at the address on this letterhead. ~~ Sincerely, / - PATRICIA L SHANDORF , POWTS P ! N REVIEWER Integrated Services (715) 634-7810, FAX: (715) 634-5150 , M-F 7:45 AM - 4:30 PM PSHANDORF@COMMERCE.STATE. WLUS cc: KEVIN LOMBARDO CUST ID No.226564 ATTN.• POWTS INSPECTOR DATE RECEIVED 07/24/2000 FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 WiSMART code: 7633 RESIDENTIAL MOI~ND bESIGN INDEX AND TITf.E SHEET t'-ojert _~~~V irJ _fi_-~-.~ ~-~1J LCUmt31~~1.~U _----___---- ()weer _~,~/ ~ n! _~ _-~ ~~tl ~iM ~3ta21~U - Address ~~x Z 3,Z Cl.~~rz. - -- Legal Description j t,J n ~~ V 'Gg~11M INGS ENCE I ownship t'"'DR.~'S i~_ _ county ~ f Subdivision Name --- -_ Lot No. !' Parcel ID Nu-nber O t ~ ~ 10 I~~ ~ ~~ V - -- Plan IU Number INDEX 51tEET MOUND CnLCUV\710NS MOUND DRAWINGS PRES. DIST. CALLS. & t.AtERALS PUMP TANK bRAWIN'>S PUMP SPECIf'ICAt_IONS SI1 PE~LAN f )esigner Y~~ ~1 21 ~(~~ 1.'~'' _ Signature - ~ __. - bate ~ ~ ~~~ ~~ ~lil~vz, PAGE ONE F~AGE Y1N0 PAGE THREE PAGE FOUR PAGE FIVE PAGE SIX PAGE SEVEN t_Icense Number Z'L~5 k,4- Phone No. ~~ I `~~ W~ ~ ''JO's-C~ Nottce~ Pampering with thre the by unauthorizAd peroony I! prohlblled. beliherate modlficatlon will result In disclplin~ry ~ctlort under s. 1As.10, Wis. Scats. ' Aug. 4 '00 6:44 FAX ~1vuNr> j~'~TEm L~~Stc~,N ~~ IVv L'tZu~l1L>vt~ PJE=C~l~1:~C.K J l.ti ~ ~ ~-°7 v W~STzs W nY~u.. I t...~1LJ S~/~TC. 45o g~- ~r.~ ~rr~ `~c~+t, ~t',~r1Zar~wJ '~t~ . 5 C,c~tir~to~2 ~~ ~G Rq •o~ USe IZ~ `~7/~tiIQA¢.D ~iVL G~s~ a~e. fYl~,ac F~~.v NU . ~,~ Lea-t~r~~.s ~- 1~Jc~ VY1~NC~v~ ~-~cu..~ mA-,, LgNGTN t 1 5, ,~., ~,~•5-~~ m Jc~LU'ir~rJ ES~imcxc~t~ ~at.K ~W~ 45o9pot, D~i(itJ ltlf'~~1~4~ KAj 450 ~ Sx. ~~atiGtJ I~J~OTH (A~ 4.5 t=~. ~~S~t;,N t,~,ucrKC~~ too ~~. ~etn H GF Ck'51.1- CF~ 1 O 1~1 . J 61N 0 ~l trT t~.1Z Upswpe Fi~,~, ~Dez~N D) 12 ~OwNSi.cp~ ~c`~,. [,~ptH ~~) 14.1b• ~n~Al. ~v .tea ~~c~v 1a.~~ q oo ~~ a N~ua ~IAmc~3'~F3r~. ~/b ~uLra 5prac,~~c, x.25' ~ur~ P ~HtJ~, tvl.. ~ ~9. Q ~ ~~PPocz-ct~~, ~,c~r~~~c~ut~~Ts 4 CoV~R. j(~t l.. ~~pTM ~ ~ N' Cov~cz. Sa ~ Dot et ~ C~~:st~Q„ t z 1 a P. 3 ~ Nr~ 5~~~ T~~ l.e+JC,~+~ (k.~ ~ ~~ ~( Ft. 'f how a s l-~f ~ ~"~~ ~~1M (Y~~ a • s~ rte. ~UTA~ lYlo~rao l.~*w-"TH ~~~ I f"(, 54.1=+• ~TOt A ~- 1rVta~aO ~ I ACM C W J 1 ~t • 30 F ~ . ~1ltS~ " ~~~1 bG (,c~rnf?AR.Ov ~R~,,,~ r: nQ~Tr -. ~-- ~ ~,, r' ---- ~T _ ~ _. - - -- --------- r t~ M1 ~ .~ Ft W t ~i .3u Ft-. ~ i~~t, 4 It1.5~4+Fr. (o a4 6t - ~- .~ pf.gty ft'- C:~Li`iE'R-V'/~j-otiJ ~ 1 ~`~ J ~AG1hlt~ ~. i ._ - - - ~,, `.~ t 5 f t? .~, ~ l_ . 1 bey • (1 ~ //~ ~~wiT~C Cpl.. ~g,U ,~ ~ 14.Ib'. 1 O'er ~~ ~, ~9 ~t 1-Z ~. ~iLc~;t'<-1" .' KLV~N~~ ~~N~ ~mf3,Af-'Q)t~ o -I 'C ~>f3.'x,crr~cr.1 C~u. 7, c,. P. A B --- ~ K G., J.7f. 2 T~ c, -~ f t-nr A M •'' ~. Z . Siar.va.e nNwoa. GecT~KT~~ I~nF~-~a Cy ~ C,O Jet- MATS Q.1 A 4 ,~\~ `.. AST n, Ga; Q ~ ~nu,.~ F~~~ ~o~e!o lA~~~t, J~I.oF ~ ~+'7c ~~ ~ AF35utZ('c~larJ G~4L mt3ol/i W il~ , GpN~s~t O~ ~GGI~.~ctiA?t; n-Jh (~1(~f~ t,a~ tN Urr~R.n~-s CgNr~een i~.~c~-. A~(~ r~~~lA. *N~ Cl=u. Vncsul~ ~ 5 ~~~n W 1 iN CjuITUTi~x't tt.k. F AF~•,c ~~ 3 ~ ~ l Aug. 4 '00 6:44 FAX i`C~i`•~SU~~ ~`~721~13T1O~ ~AL~..t~l..~'X~10r~~ ~'.1.`~t~F~7t~-r.1 C~l..t,, , w1~rH 4.5 ~r L~NC~~ H loo Ft- L ~-Ti~l1;,1~1~ ~ ~6'~ 1 F 1 c.ATI orJ ~ 4 ~l`r-~iitnt. CAF ~.A'fA2all..i L• it WUt,t3 ~IAM ~1~ ~ `~lb ~~e~c.n~ Dlsc.r~ar~~~ ~1~r,~i~ ~.,.r~ g per, J~t s~ fern D,s~N c~lzc~~a RTES .~~ ~--- c~ pc-'1 /. n La-rg~~ ~ D~ ~t?~- ~- `` P P ~ J- ,~-~---- i L P. 4 ~~ L~tt~a.~~ leN~,~ w5 ~~~ ~' ~lar~ ~ , WC'Li3 5~~ IrJu, ~~ ~E3R.1~..-5 TU I'IA~/F, ~UDC'• N~~ ~111M~'t'+~2 ~tlo a '~mpl,tS~JC "t"uR~,r r~,p~~;~N ~,,~CTB1z.la~- DI Am lartL~ ~. ' Z TN ~ ANDS i~JrcH Clt~~ ~- 0~7 ~~ex.e v~,a DI~Mt~-c~R.. Z" Vt,u<~s ~ Caps ~u! ~? ~~31~ao '~ ~,t,~' ; 1C~v ~ N ~ t,e Aar from ~A2o a ~~ 'I~ Q~- 0 F Tnrnt.. i~~lNn+r,r~ I,•~.r~i~ c-~~~sltl~T-orJY-~L. ~I~f1f~ 3•'L~ V rfR-'il c,r~. t-IT T 11 •U~ ~3~~bo Tc~rA~. 'Lu•'1 L N rJ'(E I ~n~e-e.fa~,~ n~.~~ ~1 ~c.l~t;sr t~,rNr la ``i~STvvn . "~~~ Mn 1+J Ida ~s ~/sc,M~ i~o_>~ ~•~ `Jt'rrr.~ ~ U~trr.~ Vc~~;r,,.z a~ l-nTec~.A~.s ~..JYT~a-1>t~ UL`tU V l~r`.l'i+\L. , f~P ~~~r m~NuFA~-~v~.~~. G~tt`~~~~~ wE~~1-1 L3:A'~~ ~lal~t- `~ '~~u.., ~ A~nQ.Y. innnNut^ncav2~2.. 5 3 ~~~F-~• ~l.nlzm nl~cU~? ~-- i 0 ~Ir.~.-.g~vr~s wc.Nes G,n~Lur~:~ n Za ,~k. 3~ ~ . zb ~ Z 3t.~4 c 5~4 ci~.f5~ ~c)~~ t,4z.3~ Yypical Pump Chamber Layout In rornbination with state approved treatment lank. lank construction gs per Comm 83.20(3) WAC. Ahhroved manhole cover with wer+iher proof ~ wArning IAbel And locking device ~~ - unclton hnx - ~ rade levels nr nrle Irvr+la i ~ ~ 9 _ _` _` J~ disconntol _ ._ -------~~ ~ AlternAle ~`-- electrir, qc hr+- NF_C 300 And ~•• •E---- ouNel fi 4" vent pipe _ Comm 16.28 Wl1C ~' ~ locnfiort 1 g° (46 cm) min. __ y 1 ~++ZTrcl~~ wnp or htnnh ------ St 3~s chnmhr•r or G f n crnnhinsrlion I:+nk - - ~~ / alarm on ~il~xr ~~„~~ __`_ pump On ___ ~ ~ +-~ r~rl ~r C >:',3 ° ' 1l pump f'1 - , . ~f- off elev. m ScF+rrc. U Ti~-.~ K 3 " (15 rrnn) 01 bedding under (ank 1 ank manufacturer SKAW -~ ' ' ~ ga1~Cowm1? f ump lank capacity 110.1 - gallin Pump tank volume /s~4Z •- •,~ 9al 1'1?( ~F;G( i<JaJ-N +~ lef~~~ I..cw'n t3PR.OC~ -~Vfrli, ~ ~ I1-.11C. ~(~~tJIILtC,~ ~---" Approved _~ otrNel Joint provide 1/4" weep hole or Anll siphon device As necessary trade levels . ' -pump IAnk manhole = 4" (10 cmy mMdmum above Itnished grAde - vent ~ 12" (30.5 cm) nthrimum Above lirrished grAde tt pump IAnk elevation m boNom of Tank ~~ ~ OF G(). F~W( ,_ ~3 .1 ~. d ,. t3 m L C7 ~'irn i ~ac.tl (Y~AR.1~. GF.;e Nni~. 1+J 13~a.cNT'h.e~ ~1.. iUU•U~ i•~ PxnL E3r~.~c-at Mwv.~c.'l4~ `Tod of ~X~Sr . 1,.~~. St (~~ 'J KI~I,J 1 ucx.~ ~ tocx.~ ~j A ~ (:.~;,ryt~c.~ I i m~~'.J it l~ .~j 1C I UG ~~.l.l~.~ IH .'3r k 111. nr4~ Ov:~RP~•L. -l ..~ ~ pSrn L ~X l St Wi~Llr ~„cx.~t i c: w 1')'Zc~~'~--~ ~. ~VI IJ ~' (.L p1~1h~ ~F3ARrOU ~~ ~ C ~ t (nl lil i~; ,,~_ • Three phase:'/2 HP - 1'/2 HP 200/230/460 V, 60 Hz, 3500 RPM. Class B insulation, overload protection must be provided in starter unit. • Shaft: threaded, 400 series stainless steel. • Bearings: ball bearings upper and lower. • Power cord: 20 foot standard length (optional lengths available). Single phase:'/3 and'/2 HP -16/3 SJTO with three prong plug. 3/a-1'/z HP -14/3 STO with bare leads. Three phase:''/z-1'/z HP -14/4 STO with bare leads. On CSA listed models - 20 foot length SJTW and STW are standard. 3885 CANADIAN STANDARD ASSOCIATION sp APPLICATIONS ```.. /' Specifically designed for the following uses: • Homes • Farms • Trailer courts • Motels • Schools • Hospitals • Industry • Effluent systems SPECIFICATIONS Pump: • Solids handling capabilities: 3/" maximum. • Discharge size: 2"NPT. • Capacities: up, to 128 GPM. • Total heads: up to 123 feet TDH. • Mechanical seal: silicon carbide-rotary seat/silicon carbide-stationary seat, 300 series stainless steel metal parts, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • Single phase:''/3 HP, 115 or 230 V 60 Hz,1750 RPM; '/2 HP, 115 V, 60 Hz, 3500 RPM; '/2 HP -1'/z HP 230 V, 60 Hz, 3500 Built-in overload wi ~~• N' automatic reset. Class B insula ' n. a ~ ,ro2 `", 4 Goulds Pumps, Inc. METERS FEET 0 20 x a 15 0 J a 10 ~fflu~~~~: ~~aG~~ i ~ ... 10 20 30 40 5~1 60 70 80 90 100 110 120 130GPM I 1 I I 10 20 30 m3/h CAPACITY Effective May, 1994 11 63885 F~ATUtiES Impeller: Cast iron, semi- open, non-clog with pump- out vanes for mechanical seal protection. Balanced for smooth operation. Silicon bronze impeller available as an option. Casing: Cast iron volute type for maximum efficiency. 2" NPT discharge adaptable for slide rail systems. Mechanical Seai: Silicon carbide vs. silicon carbide sealing faces. Stainless steel metal parts, BUNA-N elastomers. Shaft: Corrosion-resistant stainless steel. Threaded design. Locknut on three phase models to guard against component damage on accidental reverse rotation. Motor: Fully submerged in high-grade turbine oil for lubrication and efficient heat transfer. Designed for Continuous Operation: Pump ratings are within the motor manufacturer's recommended working limits, can be operated continuously without damage. Bearings: Upper and lower heavy duty ball bearing construction. Power Cable: Severe duty rated, oil and water resistant. Epoxy seal on motor end provides secondary moisture barrier in case of outer jacket damage and to prevent oil wicking. 0-ring: Assures positive sealing against contaminants and oil leakage. au _. --- . -.._ __ ..- ---... - __. T l_ ._- ..._ -- .- -- .-_ __ _ _. _._.. ._._ _.__ __ SERIES: 3885 SIZE: ~/," SOLIDS 80 E1 _. ... _. .......... ._ .. ._..._ __.. ..- --- - - -- ~ 5 GF~luf RPM: VARIOUS 70 so Et 5Fr - Es 50 40 EO H 30 2 1 0 _ 0 I Aug. 4 ' 00 6:42 FAX P. 1 ~I ' .: ' Mound System Management Plan ' Pursuant to Comm 83.54, Wis. Adm. Code ark The eeptie tank shall be maintained by an Individual certlAed to service septle tanks under a. 281.x8, 5tgts. The contorts of the septtc tank shall be dlaposad or In accordance w-th tvR 113,'Nle. Adm. Ccd®. The operating condition of tho sept4o tank and outlet filter shell be assessed at least once every 3 years by Intspectlon. 1'he outlet filter shall be cleaned as neeessan/ to ensure proper operatlvn. ~'he Altar cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the Alter when removed fmm Its enclosure. If the Alter is equipped with an alarm. the filler shall be serviced if the alarm 18 activated continuously. Intermittbnl Rlter 8larms mAy Indicate surge flown or an Impending COr~llnuous alarm. The septic tank shalt have its contents removed when the volume of sludge and scum in thg tank exceeds 1!3 the liquid volume of the tank. It the Contorts of the tank erg net remover) at tta9 tim9 of a Irlennlsl assessment, maintenance personnel shall advise ate OWnCr of When the next s6rvlc8 reads to be performed to maintain less lhBn maximum scum and sludge accumulation In the tank. Tt1e addition of biological or chemtcat additives to enhance septic tank performance is geherally not required. WowBver, If such products are used they shalt be Opproved for septic tank use by the Department of Commerce, Safety and ~uitdings Olvislon. P ' e pump (dosing) tank shall be Inspeucted at tees! onc© every 3 yearn. Au switches, alarms, and pumps shalt he t~PSted lv verity proper opetaUon. If en effluent Alter is Installed within the tank It shall be inspected and serviced as necessary. 1Nqun~ and PTeaeuje t7lstrtbutlvn Svatem No trees or shrubs should be ptentad on the mound. Plantings may be mgde around the mound's perlm®ter, and the mound shall b~ seeded and mulched as nece~aary tv prevent Aroaton and to provide some Orptbctlon from frost ponetrctlon, rraffjc: (other than for vegetallve maintenance) vn the mound Is not recommended since soli compaction may hinder aeraaion of the lnflltratlve surface within the mound and snow compaction In the winter wilt promote frost penetration. Cold weather Ingtailetlona {Qctober-February) dictate that the mound be heavily mulched for frost protection. Influent quality Into the mound system may not exC9ed 220 mg/~ FlO03, 150 mglt_ TSS, and 30 mg/L FOG. InRuent flow may not exceed maximum design Aow SpeCltled In the permit (or this lnstatiatlon. The prt9eaure dlsWbutlon system Es provided with a rushing point at the end of each latera+, and it is recommonded that each lateral be Rushed of accumulated solids at least once ovary 18 months. When a pressure test Is performed It should be compered to the Initial test when the system was Installed to determine If prltlce clogging has occurred and If grltice clganing (g redulred to maintain equal dfetrtbutlon within the dlspbrsat cell: Obaervatlon p6pes within the dispersal ceN shall be checked for effluent ponding_ Ponding levels shall be resorted to the owner, and any levels above 4 Inches considered a9 an Impending hydraulic failure requiring addrggnal, more frequent monitoring. nano 7hla system shall be operated In accordance with Comm 8Z•84 Wfs, Adm. Code, and shall maintained In accordance with its' component manual (S}30-10572•P (F~. 8199)j and local or state.rules pertalning to system maintenance and maintenance reporting. Np one should ®ver enter a septic or pump tank since dangerous gases may t)e present that could cause death. Septic and pump tank abandonment shall be In accordance with Comm 83.33, Wls. Adm, Coda when the tanks are nv longer used as PpWT9 components. SepUe or pump tank manhole risers, access risers and covers ;should be inspected for water tightness and soundness. Access openings used for sesvfcs and assessment shag be seated watertight upon the Cgmptetivn of servlca. Any opening deemed unsound, defective, or subleci to failure moat be replaced, E:xpoved access openings greater than e-Inches In diameter shall be aeWrod by an oeective locking devise to prevent accidental or unauthorized entry Into a lurk or component. Sc9ntlnae~CV ~iet1 . It the septic tank or any of (ts components become defective the tank or component shall be repaired or replaced to keep the system In proper oparating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the de(ectlvg component shall be Immediately repaired or replaced with a component at the sand or equal pe+ormartce. if the mound component (alts to scoop! wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced 1n its' present locatlort by Increeying basal area If toe leakage occurs or by removing blologlcally clogged adsorption arvd dtaperas! ~tedta, and related piping, end replactngfaald components ae deemed necessary to brN7 the system Into proper operating candltlon. ' Questions on fhb vperatlpn or maintenance or Ihlq syt9lem BhoVld be dlrevt0d t0 y-Ur uoVnty zoning or he:llth inspb~tor. ~O?tat;, ', ~CgV'+N ~ l.~An1N Lo+..~p~t~ SOIL DESCRIPTION REPORT PROPERTY OWNER P ~ /~°- G Page of PARCEL I.D.# Boring # Ground ~ lev. ~- ~'~ft. Depth to limiting factor in. Boring # Ground elev. ft. Depth to limiting factor in. Boring # Ground elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Mottles T t Structure Consist n B nd R ts 2 in. Munsell Qu. Sz. Cont. Color ex ure Gr. Sz. Sh. e ce ou ary oo Bed ,Trench f Remarks: Remarks: Horizon Depth Dominant Color Mottles T t Structure Consistence Bounda Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color ex ure Gr. Sz. Sh. ry Bed ,Trench Remarks: Boring # Ground elev. ft. Depth to I limiting factor in. Remarks: SBD-8330 (R. 07/96) Soil Test Plot Plan Project Name b~ ,en ~~s~~~s` Byro Bird Jr. Address o?a ~ ~ ~,7p~h fit- Lot ~ Subdivision --~ Date _ ~.~~. ~- 1 /4~~1 /4S~T~ N/R~W-.- Township ~r~~~ Boring O Well PL Property Line County v G~~i~ BM or VRP Assume Elevation 100 ft. Na`~~.,,Q,i~t~T~~fl~sri T/r' o f ~~,~~ /off. ~ System Elevation ,91 ~ ~ *HRP Sw~~ ~ ~~f~~ ~~ ~ ~ L~~ 'J r~ ~~° /o~ ~ _ ~,~ o ~°~ 3~~~~ ~3y l°~' ~ ~~~ 1 qs D ~ ~ ~~ . B~^~~ ~~6 f~ . . 1~3~° ~~~ Scale 1/4" = 10 Ft. Wlien Dimensions aren't stated ~~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ~~=$~1i N ~ ~Aa11J ~f.~AR-~]U Mailing Address Property Address ~(o~. l Cou~~~ Try r I-C N ~J~ Q 5~!/4, ~1 iJih St=c7 T3 t ni 1Z t 5~J ToW of` ~t~sT / (Verification required from Planning Department for new City/State C;~~ ~~ ~~~ ~ Parcel Identiftcation Number O 14 -lot 5° 90 - ~ LEGAL DESCRIPTION Property Location ~ '/,, N ~` '/,, Sec. Z_, T 3 i N-R t ~_W, Town of 1=oR.~sT Subdivision .Lot # Certified Survey Map # _._- .Volume .Page # Warranty Deed # _ (< o ~' (~ q I .Volume / `~3 .Page # ~ Spec house ^ yes ® no Lot lines identifiable ^ yes ^ no SYSTEM 1•'IAAINTENANCE Improper use and maintenance of your septic system could result is its prematnnafailure to handle wastes. Proper maiabeaance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in tha waste disposal system. The propcriy owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner. and by a mastetplumber, jonrneymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commence 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 Office within 30 days of the three yeapr expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this fonn are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * ***** Any information that is mis-represented may result in the sanitary pernrit being revoked by the Zoning Department. ***** * ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed !' Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanitary Permit Number Z c"~ Number of Bedrooms Design Flow -Peak (gpd) Estimated Flow -Average (gpd) Septic Tank Capacity (gal) l?fl~ Soil Absorption Component Size (ft2) z-- Type of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absor tion Component Design Flow -Peak (gpd) ~~ Z Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 Tab le 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). 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 ` Management Plan for a Septic Tank and Soil Absorption Component 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 scum and sludge 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 an 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. 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 the tank. No one should enter a sepfic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other Treatment of holding tank may contain lethal gases, and rescue of a person from fhe interior of the tank maybe difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 i Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. 3 ~. - V + .i_. _ `l - .4:. This Deed, made between Denn]s ~. i31~~~~iaria t:. Btxese~ h~~ wife. _ - _ . _ _ Grantor, cQr,~.le~s and warrants to .,_j}g~p~. LombardP.An'~ i nAnn tt_ i,~-snbarda, h~sbana uud wiYc. ~~ v ~w;', ~' ~ ate CQ3181!dBl~t~rl, COnvdyb 6.nd ~uarrarlt8 t4 Grertiee ti'te ~,r]l~wliag c~iCtibt}d rea! eatsta in„~ St. Croix County, Stott: of Wtsconein ~~~ ~ ~~ 1~~/~ , Y ~ l F~ . , ad,; ~ ~-s OlA-3015-70; ~-101590 Parcel Weruirtcacion mbar (Pltij This ~„ homestead pr~perry. ~( ~,~~ ; ~'`.!' :.: Sec. ?-T311~ -R15Y~' except the 1\brth 104=1 feet cf the West 1t~4 feet thereof, St, Croix County, ',l; j i ~FAI: ~~~ept:oa, io warranties; ~?sserrtnnts, restrictions err: r.gltts-af-way of r®card, if any MMM,...~~1` ,y r' Dateu this ~~J`~ da.,% of A!t~ust; 1999, ~~ , ~~ " s E. A]iese ?~1 i__1_~___- _- Mar a Sllgae ••..•~~ TT .,....~.._W_.~..._..._,.._~,.__.~___._....... ---- ___....._......_.._._..,..._ AC K'~Cl1'VLFDG)til ENT ALi'i`t1N i 1t::A'I1(JIV SignP~ute!s} a1W3erttl~-sesi tniu ,,^,,,,~ day of ---T .~ ~ .~._._..,_ TITLE: MEM$ER STATE BAR OF V!riSCONSIN (If not, authorizod by ~ 7t7fi.06, Wta. Stets.)', Tl]IS 1NSTRUMt3NT WAS DRAI'T~[) @Y Attorney Kristine Q~land Htsd:an, Wf 34©16 (5ignaturea may be authenticated or acknowledged, IHarki are not nCCt9~ary , S'TATIv CrF W]SCUNS]1\ } ~_ ~~ a ~b. ~ puni}' ? Personally. came befa~c me this «~-'J~ .day of August, 1499, rite above named Dennis ~. Bliose and ~~rio ~ Bl1u~.~]Y,{Ps' __ _ _ _ __ _ _ _ to ma known to bt the person(s) who executed the foregolrtg instrument and acknowledge the acme. * .~ '~ Notary Public. 5tste! of Wl~sin tun ~ iwt is perrnay~~f ttot, state expiration date: f'd7RTf gf"~tSGbNStN of pioorauna signlttg in any eapttcity a]tott]d Ix typejd or printed below thou slgnaatrea w,uta~tror}r ii a1r•rs eeft ov w>RCt ~oyua ~, : • saes .\