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HomeMy WebLinkAbout040-1004-95-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 561 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 042 0 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: Swanson, James & Susan Troy, Town of 040-1004-95-000 CST BM Elev_: ,l Insp. BM Elev: BM Desc%ipt or. a Section/Town/Range/Map No l1 V I Ql~ l~ _ff, ' I / -yl 02.28.19.32A TANK INFORMATION ELEVATION DATA , / /4:5 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM 4,6 7 Aeration f- ldg. Sewer Holding St/ nleY 93 .-7 TANK SETBACK INFORMATION St/Ht outlet l TANK TO P/L WELL BLDG. Vent to 'r Intake ROAD Dt Inlet Septic Dt Bottom j -7 > 35 i Header/Man. ? CI Z AM ./19 A)A- Z-5 Aeration Dist. Pipe 39 /aa , / Holding Bot. System ~q I I r PUMP/S HON INFORMATION Final Grade 2'. 9 I$ u acturer Demand St Cover r ~n o q _ 7 4~ GPM Model Number 6 ~ k-~" ~S U~'t 3 kola TDH Lift Friction Loss System Head TD F = ~"i5te al 6 , o'Z. 1 !Z 5 r Forcemain Length Dia. i / Dist. to Well nn 2.$ Z _ Co ~d~ 3 L~ -F-5 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 7z 5 wz~ _ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. INFORMATION, A CHAMBER OR xtem: 750 UNIT Model Number J DISTRIBUTION SYSTEM l09 6~v , v~a~- _ L Header/Manifold Distribution 1,5 / S Ix Hole S e If x I-HoleSpacing V Air Intake Length / Dia Len ~ Length s • 37 Dia / pacing 3 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/ sy~s. xx Mulched Bed/Trench Center (O U Bed/Trench Edges Topsoil No Yes : N. / . a f 1r 4' COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ 2/ Inspection #2: 7,1 v / Location: 530 Cty Rd U dson, WI 5401 (SE 1/4 SE 1/4 2 T28N R19W) >35 acres Lot rcel No: 02. 8.19.32A 1.) Alt BM Description = L 2.) Bldg sewer length = 'Lrj G L! S `OLI`" S P*4%- amount of cover C*;Z g ~ Plan revis T= ryr ion Requiredti ❑ Yes No Use other side for additional informationSBD-6710 (R.3/97) Date ctoi S nature Cert. No. CoIW Safety and Buildings Division c: D $ _ .r 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI 53707-7162 5(01647 Sanity lication State Transaction Number In accordance with SPS 38321(2), Wis. of this form to the appropriate governmental unit t=i- P is required prior to obtaining a sanitary permit Note: Application farms for state-owned POWTS are sub" to Project Address (if different than nailing addffn) _ the Department of Safety and Professional Servies. Personal information you provide maybe jwd fo~,etn 1113 SAD Kn in accordance with the Privacy Law, s. 15. 1 m , Stats. J 61 L Application Information - Please Print All Information Owner's Name ' ( # / 6 D D - f 64n Property Owner's Mailing Address Property Location / 51. Govt Lot C 32 City, state ( Zip Code Phone Number section 25--3-7-2 (circk 000, T N R E L~tl II. Type of Building (check all that apply) Lot # 1.x'1or 2 Family Dwdlmg - Numb. Of Bedrooms Subdivision Name koLVL- Block # D Aa4 ❑ public/Commercial - Descnlx use V!~ ❑ City of CSM Numb. ❑ Village of ❑ State owned -Describe use ~i X 7S I~Town of e40r. III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ew System ❑ Replacement System ❑ Treatment/Holding Tank Replt Only ❑ Other Modification to Existing system (explain) B List Previous Permit Number and Date Issued . ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Own. IV. Type of POWTS S stem/Com nent/Device: Check all that a I ❑ Non-Pressurized In-Ground ❑ Pressurized la- round ❑ At-Grade 8lound 2:24 in_ of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) Pretreatment Device(explain) V. Dis rsaVrrea ent Area Information: Design Flow (gpd) Design Soil Application Dispersal Area Required Dispersal Area (s System Elevation <<2y 7 VL Tank Info Capacity in Total # of Manufacturer u Gallons Gallons Units U New Tasks Existing Tanks a 525 U h o, in w C7 G, Septic or Bolding Tank Dosing Chamlxr Q VII. Responsibility Statement- 1~ the undersigned, assnme responsibility for'ustallatio f the POWTS shown on the attached plans. Pl 's Name (Print) Plum MP/1vIPRS Numb. Business Phone Number Plumber's Address (Street, City, State, Zip Coo0e) .;4 f 4 7' oan /De ailment Use O VIC Permit Fee D ent Si Approved s 62 5 as $ 3 ^ Let Gives Rea~fmi IA- Condit f~VER(lteasons for Disapproval \ OF OJe~ t'i r~ DL 1. Septic tank, effluent filter and 3, CO Q o"~ L dispersal cell must all be servlees !maintained mi l0( '3 DQ(M%v'P^ as per management plan provided by plurnbeR: / / / 1. ~1#se auk rec ements tnuet b® maintaitt ,I` ~D 1i Cj -u inn. Jlj~ ~a~✓ (i S fU~ ~ P~ ~ ode l +r•~. 7 J Attack to cempfeoe plans for the system and submit to only on paper not less than 8 in x 11 iaches in sine Zee: I -;:p - 10j406 Gtsel i61~,,rd SBD-6398 (R. 11/11) Q ic~IL ~~G r ~ ~r~- Grµ•' ~ I ~ ~ntir4RTltp.~T DIVISION OF INDUSTRY SERVICES 3824 N CREEKSIDE LA HOLMEN WI 54636 ® Contact Through Relay www.dsps.wi.gov/sb/ www.wisconsin.gov ~OsSlScott Walker, Governor Dave Ross, Secretary March 26, 2013 CUST ID No. 648443 ATTN.- POWTS Inspector ZONING OFFICE KEITH E KNUDTSON ST CROIX COUNTY SPIA 927 150TH ST 1101 CARMICHAEL RD ROBERTS WI 54023 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/26/2015 SITE: Identification Numbers James & Susan Swanson Transaction ID No. 2224979 County Hwy UU Site ID No. 789230 Town of Troy Please refer to both identification numbers, St Croix County above, in all correspondence with the agency. SETA, SETA, S2, T28N, R19W FOR: Description: Four Bedroom Mound System / 6% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1419352 Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Version 2.0, SBD-10691-P (N.01101), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01/01); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. P'O'W The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code Conditt requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. 4E The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • A copy of the approved plans specifications and this letter shall be on-site during construction and open to inspection by authorized rppresentatives of the Department which may include local inspectors. KEITH E KNUDTSON Page 2 3/26/2013 e Owner Responsibilities a 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. a The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). ® In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in'the approved plans. a 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 Industry Services 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 erard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jeny.swiin@wisconsin.gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. KEITH E KNUDTSON Page 2 3/26/2013 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. m The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). o 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. a 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 Industry Services 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 theowner 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 erard 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 Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. A MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE - r ~ ~ MqR 2,6 413 Project Name: James and Susan Swanson Mound System 2 ~&/~~lqr,oy ` Owner's Name: James and Susan Swanson SFAVIC16S Owner's Address: 412 4th St. Hudson W154016 Legal Description: SE1/4 - SE1/4 Sec. 2 T28N-R19W Township: Troy County: St. Croix Subdivision Name: Lot Number: Block Number. Parcel I.D. Number: 040-1004-95-000 %S. Plan Transaction No.: natty Page 1 Index and title WED Page 2 Data entry ( AND BUILDINGS Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications 3PONDENCE Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Designer: Keith Knudtson License Number: MPRS# 648443 _ Date: 03/15/13 Phone Number. ~ 1-2 Signature. z Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01161) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) Version 5.1 (R. 06/06) Page 1 of 8 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 8344-3 in-situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 =150%) fecal coliform of 36 inches. 450.00 Design Flow (gpd) 6.00 Site Slope 98.50 Contour Line Elevation (ft) 24.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/ft) Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) E Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 2 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) 2.50 Estimated Orifice Spacing (ft) = 7.50 ft2/orifice 2.00 Forcemain Diameter (in) 55.00 Forcemain Length (ft) Does the forcemain drain back? ~Y 84.50 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 8.97 Forcemain Drainback (gal) 14.50 Vertical Lift (ft) 67.32 5x Void Volume (gal) 1.22 Friction Loss (ft) 76.29 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 32.31 System Demand (gpm) 20.27 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x x 1.25 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallonslinch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1000.00 Se tic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser Concrete Manufacturer galiin (enter result in cell B49) Dose Tank Information Effluent Filter Information 602.82 Dose Tank Capacity (gal) Pol -Lok Filter Manufacturer 11.82 Dose Tank Volume (gal/in) PL-525 Filter Model Number Wieser Concrete Manufacturer Project: James and Susan Swanson Mound System Page 2 of 8 Mound Plan and Cross Section Views 1110 B J ::Observation Pipe K , oS•4.1.1 1°4+LQL'4•L•4.1.4•L"yyyy4.L•yS~ '4.4•b•L.L.b•b^4.1.4.4'5.1.4•L.1• . 1.1.4.4 T l•.".l...l.J•l.J..^.l •l.l,l.l.J.l. r.f.l J.l.r.f.r°l,t°J. r.J..••J.J.I~l.J•l Nf.f.J. 1.b.1.1°1•.1.1•LJ:1~.4. L.L.4:.°.. y.4f ~Lf:Ja."+".°L.J*•d:d e°~J':t T~° f'a'~l'f' A b1.1.L•~4 .4.L.b1.4.4• °P1+1•L°'.•1.4.4.1.1.1 ~4 ~1•L+1.1^1.1.1 SK•1.4^1 ,~•d.l^t•" l.J.t.t.f•J.l.l.fe d^f.l l•l•J°.^°l.t"l•J•. J•l.d.f°f.l.. l.l.J.f°J. i. •S.1•b•1.1.4b:1.1.4+°.•4.4.1.1.4•'I..L.1.4.4.1.1.1.•..L,b.1.4.1.L:R~.b.•.+1.1.1x1°1.1^L.L.i•4.L l•tl"•.••.+•.F•.°•J•d'•.P•1'•d°°t•ayj•1.f•f•f.1.J°J.?.J.J.f.f.f.t•1.:..!'•f•t..`..••.••l.l•.••e"•.••J•t,l..•. IYi I L Mound Component Dimensions ft A 6.00 ft E 16.32 in H Aft ft K gift B 75.00 ft F 9.50 in z ft L ft D 12.00 in G 050 ft J W 450.00 (ft) Dispersal Cell Area 1177.59 (ftz) Basal Area Available 6.00 (gpdtft) Linear Loading Rate 7.50 (ft) 1110 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.29 (ft) rrrr.~yrrrrr.. G H I F Dispersal Cell 100.00 (ft) Lateral 99.50 (ft) Invert Dispersal Cell [ D Elevation 98.50 (ft) Contour Elevation 6.0 % Site Slope Geotextile Fabric Cover Shading Key DispemYal Cell See lateral details on 10 ® Topsoil Cap _ c. 1.5 ft Page 4 for number, size, C L•1 L;ti'1`°' 1.4:1.1.4.1.1•L and spacing of laterals. rrrrrrr Subsoil Cap •J• J.; • l i l t dD O _ l^.'.f.l.l•l.f• t.l.. .d.f.f•:. Laterals are equally L^4.1 e1'.~ n1: 1 ~4•b.4 p1 x4..",.4.1 l,l'•i l.f 1. ASTM C33 Sand .a 1•b .'n.•4.ti.1 0 Tilled Layer 0.5 ft f.l•. t.l f. F spaced from the ~ o L,e, Typical Lateral- b ; distribution cell's lt.Y frf d J~lll Aggregate ~ o ~ a•f.J.r -.~^J.r^.' ;.J.f.: •f. ,1.4n^^^4o4.4.1.Lu1 L^L^L•".+4.• .ti centerline in the * A distribution cell (AxB). Project: James and Susan Swanson Mound System Page 3 of 8 End Connection Lateral Layout Diagram LateoalscWetedaverth A& dimension ♦n Tum•upWbeltvahmeoral0anoutplua i All laterals art identical (E )C ( H41 is drNled on bDs bottom of th! Eattrat ewa" spaced Fo®ce main connection Via tt+8 or aoss to mans M at ~Wqpoint. Laaetals & lotee main of PVC Sah O (pet COMM Table e4AWS) Number of Laterals 2 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 73.37 ft Orifices per Lateral 30 Lateral Spacing (S) 3.00 ft Orifice Density 7.50 fe/orifice Lateral Flow Rate 16.16 gpm Manifold Length 3.00 ft System Flow Rate 32.31 gpm Manifold Diameter 1.50 in Total Dynamic Head 20.27 ft Forcemain Velocity 3.30 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and Comm 16.28 WAC 4 in. min. Disconnect Tank component is properly vented F- Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Capacityl 602.82 Gallons Volume 11.82 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 30.55 361.05 B 2.00 23.64 C P♦ ump off elevation (tt) C 6.45 76.29 85.50 D 12.00 141.84 D Total 51.00 602,82 Do♦ se tank elevation {ft Bedding un er tank. 84.50 Alarm Manuafacturer S.J. Electro Alarm Model Number Tank Alert Pump Manufacturer Goulds Pump Model Number EP05 Pump Must Deliver 32.31 gpm at 20.27 ft TDH Project: James and Susan Swanson Mound System Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name =St owers Sanitation Phone 715-246-5738 POWTS Regulator's Name xCounty Zoning Office 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 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month should be flushed and pressure tested eve 1.5 ears Pressure System n nd see a e once eve 3 ears Mound for ndin a 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 mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished , Grade of 6-8" Diameter Lawn - Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: James and Susan Swanson Mound System Page 5 of 8 Mound System Management Plan Pursuant to Comm 83.64, V ft. Adm. Code General This system shall be operated in accordance with Comm 824A Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01)) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaAed as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter Is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 113 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 104 dull 00 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. Contlnuencv Plan if the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pnetreabnent Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 8 Page 7 of 8 MGOULDS PUMPS Submersible Effluent Pump ;l' EP04 . 3871 EP05 APPLICATIONS *Full y submerged in high ■ EP05 Impeiler: Thermoplas- ■ Bearings: Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses: heat transfer. ■ Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion • Farms manual operation. Auto- Cmadian Srs Assodetlon • Heavy duty sump matic models include resistance. • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "C" or 7".) factory. strength, and durability. SPECIFICATIONS ■MotorCover.Thermoplastic Gall rdsPmpsisW9W18agstered. FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. '14" maximum. ■ EP04 Impeller: Thermoplas• 0 Power Cable: Severe duty • Capacities: up to 60 GPM, tic Semi-open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: V/2" NPT. seal protection, • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40cQ continuous 140OF (60cC) Intermittent. METERS FEET • Fasteners: 300 series 10 stainless steel. y 30__. sGPM . • Capable of running dry without damage to $ 2.s FT components. 25 0 Motor: _ • EP04 Single phase: 0.4 HP, v_ 6 zo 115 or 236 V, 60 Hz, 1550 RPM, built in overload with c 5 15 automatic reset. a 4 Epos • EP05 Single phase: 0.5 HP, o } 115 V or 230V, 60 Hz, 1550 3 10 RPM, built in overload with EP04 automatic reset. 2- • Power cord: 10 foot 5 standard length, 16/3 1 i......: SiTOW with three prong grounding plug. Optional 20 0 00 10 _ x.20 30 , so.-_ _ GPM foot length, 1613 SJTW with three prong grounding plug i 8 (standard on EP05). 0 2 4 6 10 12 nr3/h CAPAaTY Goulds Pumps ® 2001 Goulds Pumps !TT Industries Effective may, 2001 B3871 f 00 0 00 ~o O O U w U ti ~ \ U ~ .O ~ C L~~ OOi 00 e g v~ ti O ~ u ~y ~ z n ~ m > ~ as v' w 0 o g w o ` a a s" a a o Z o ~ ry` ~ aj o ~ 4 o ~ 00 00 o U 0 a N w Ev ~ O pO oa ~ 140w o m i c a OU p fi ° U N a u N N Uj y N t j ti II ~t ~ of ti 0 0 t o a o a a Q ~ o 0 N a a u a N 3~ C ~ cp, G \I- O n RECEIVED pap Of tNfemneln ~opaltnolKCf cansYlelis SOIL EVALUATION REPORT 3 0jvM nofSafe sndRutdngs sr CROP +ii"Vfl,.ah corrrn S5. wls. adrn. Code Attaeh oomplM. sis pkn on paper net less titian 8 Vt x 77 inches in size. Plan muse irat,rntirtilferl anditiorizDrrtaineimenoepokt dtePoll and noel ca S=ova 3Z pereertitelape.eeateatdrnenelane.ttioAltiarrow.andloserortianddistarraetoltieerestMIS - l BE mil, mw*.mwbmomdftr~.~.-.,~p.~..~a, I ~ ~L~ It y ~1- 3 Pmpert omw PMP"Locnm C}- p GoVL Lot 1M - 114 S a T N R E vwnWsMWWAddren LAID Bkxk# sled. Nmsqtj~W 4112- X* r l-. - - : As 3 7S~ c~ly Stale Zp Cade ❑ city ❑ vap M?vm Nearest Road v trs :31 ar'N'mcad*ucoon Uasr ResidwMfNun+tre WlhpQ%m , m 3 Gods derived design flow rate 5/Sd GPD ❑PapMmnmt ❑ pt7pr Parent ntiaterII e. . good Pteiti elaration wapp ksme & (NUMW w r0kAf1Vl4r- ° . © ph Qround usloc a etev d nepn b Nrrr%V factor Z~ in. Sol Appftlam Rat liorimo n Daplh Dom* I 'I cdor Radom Rate Deaoipiorr Terdure Stlldtite C.olodslence Boundary RDOIS - OWN kL Mused tan. Sc Gbet._tyolor GY. szSh. Vm law / 7 '-2 G s - e/ hr •C 5- w 1 gpRl~~ ~❑7. ~B i~ pit Q mWarsfeoeebv 9t. t. Dept ft 6 W g dor 1S` I Awkeft Rate .Horiaon Depllti Dommorrt Gow Redca Daeo %*m Terre Mraftre Cansislinm Mumlery Roots tn. Murom am w- Cat Caton ft Sh. ' 7-mr r?5 7S e n '~urtttf=80D X30<T1DmpR.andT5S~30<15Dmgll ~ S2=BOD <3D~andiSS<3DergIL CST Name (Please' Prim CSi tJratber Adtiess ~..y EtiaMrairrr t7wtidrrciad Telephone Number W-X mmmyo.-SAW pay d0 ~Vo ldw,/ jJ =,P Page ~ of - sot - Rate 466M. DopNi Daatia~t Cdo Fwoe omnv en TeISlIB Sml sm i a+cs 8ouldwy. _ Roots i1. Mumms CAL Ss. Cost Color car. QL aL 057s F z owFA cs F 3 ZZIgr SIX FIYC ow S C-" H Gloaedalr6aeaiel►. Dep~lbttmtilgiaaor h tit cum HaFaon t l Opidl~slt tiedoicDeaadpton To"& S't"m coma a'm 8 mft Roots GPM h tlun®et C& ft Clone Ciolor 61: SL Sh 'E~1 'Eta ~80,hv# ❑ ❑ Pk 67ovadaar6oeaisic fE Daplb b I N hm for iti Sot Ra4a tloltaon 040- DamLmst RadollDmoblon_ TOWNS ammome Omateleaoe emff dsy Rods epow h UNION Qa. Sz Coal Odor ar.St ML 't~$1 'Btt2 'E#ua~t f=t ~~~?~DslplLaadT8~ ~18f►l~plt. `Ubmt8<Z=8M 130mpll.sldTU530M lL TdsDepa:tateat ofCo>llota[ca ie alt e9w1 oppot~igaexrlcept~lrfdet aad Heed mistanc~to aoeasaetvilxaor _ tlxd mlatetil~ in as altecatee foemec. please COMM tae d"paetnlaat at 608-266.3151 or TfY 608-26 4M.. - smau.~eg r fl U i. 11 n \ ~ ~C A _ 'Aj 0 ~a 9 0 w R o v;l ~ ~ r y yw ~ 1 J V ~ t Y ~ 1 c,t ~ ~ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer James & Susan Swanson Mailing Address 412 4th St Hudson Wi. Property Address b t,,~ ~ (Verification required from Planning & Zoning Department for new construction.) City/State Hudson Wi. Parcel Identification Number 040-1004-95-000 LEGAL DESCRIPTION Property Location SE '/4 , SE '/4 , Sec. 2 , T 28 N R 9 W, Town of Troy Subdivision Plat: Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume Page # Spec house 17yes0no Lot lines identifiable Elyes[]no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(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. 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 Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on Xthisf are tr ue to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a wed recorded in Register of Deeds Office. Number of bedrooms 04/05/13 SIGNA OF APPLICANT(S) DATE *A /y 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 if reference is made in the warranty deed. (REV. 04/12) State Bar of Wisconsin Form 1-200 1111 8 0 4 9 7 8 6 WARRANTY DEED Tx:4036775 Document Number Document Name 951127 BETH PABST REGISTER OF DEEDS THIS DEED, made between Susan M. Swanson, James R. Swanson, Courtney M. ST. CROIX CO., WI Swanson and Rodney J. Swanson, each conveying an undivided 6.2% interest 02/21/2012 1.21 PM . EXEMPT#: 16 ("Grantor," whether one or more), and The James R. Swanson and Susan M. REC FEE: 30.00 Swanson Trust Agreement dated February 24, 2009. PAGES: 1 ("Grantee," whether one or more). Grantor for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in Name and Return Address St. Croix County, State of Wisconsin ("Property") (if more space is William J. Radosevich needed, please attach addendum): 502 Second Street The East 1/2 of the Southeast 1/4 of Section Two (2), Township 28 North, Range Hudson, W1 54016 19 West, except parcel deeded to St. Croix County for highway purposes as described in Document recorded in the Register of Deeds Office for St. Croix County,. Wisconsin in Volume 802, Page 548, *See Below The South 1/2 of the Northwest 1/4 of the Southwest 1/4 of Section One (1), Parcel Identification Number (PIN) Township 28 North, Range 19 West, except parcel deeded to St. Croix County for highway purposes as described in Document recorded in the Register of Deeds This is not homestead property. Office for St. Croix County, Wisconsin in Volume 802, Page 187. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible, in fee simple and free and clear of encumbrances except: *Parcel Identification Numbers: 040-1001-80-000 040-1004-70-000 040-1004-95-000 Dated February -20 , 2012 (SEAL) (SEAL) James . Swanson *Sus' wans (SEAL) (SEAL) tneranson * Rodney J., wanson * tour I AUTHENTICATION ACKNOWLEDGMENT Signature(s) James R. Swanson, Susan M. Swanson, STATE OF ) Courtney M. Swanson and Rodney J. Swanson. } ss. auth ruary 0, 2012 COUNTY) Personally came before me on *William, J Rado vich the above-named TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: William J. Radosevich Notary Public, State of 502 Second Street, Hudson, WI 54016 My commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 02003 STATE BAR OF WISCONSIN FORM NO. 1-2003 1 Oyge name below signatures. INFO-PRO- Legal Forms • (800)655.2021 • intoprolorms.com A- Parcel 040-1004-95-000 03/19/2013 08:40 AM PAGE 1 OF 1 Alt. Parcel 02.28.19.32A 040 - TOWN OF TROY Current [X1 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner 0 - SWANSON, JAMES R & SUSAN M TRS JAMES R & SUSAN M TRS SWANSON 412 4TH ST N HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 2611 SCH DIST OF HUDSON SP 1700 WITC Legal Description: Acres: 39.347 Plat: N/A-NOT AVAILABLE SEC 2 T28N R1 9W 40 AC SE SE EXC PT TO CO Block/Condo Bldg: HWY AS DESC 802/548 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 02-28N-19W SE SE Notes: Parcel History: Date Doc # Vol/Page Type 02/21/2012 951127 WD 02/14/2012 950772 WD 01/10/2011 930280 WD 01/03/2011 929764 WD more... 2012 SUMMARY Bill Fair Market Value: Assessed with: 185581 Use Value Assessment Valuations: Last Changed: 11/09/2009 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 17.840 3,300 0 3,300 NO UNDEVELOPED G5 21.507 71,900 0 71,900 NO Totals for 2012: General Property 39.347 75,200 0 75,200 Woodland 0.000 0 0 Totals for 2011: General Property 39.347 75,200 0 75,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00