HomeMy WebLinkAbout004-1034-40-050 Wisconsin Bepartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
515153 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Hubinette, Sten David & Ruth I Cady, Town of 004 - 1034 -40 -050
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
/ LM I L�j 15.28.15.230A
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
r a/•
Septic 1 ` Z Benchmark T,
a OQ0
Dosing 3 Alt.
Goy P S Q t. B � ate,. 3•� s�.
freM4ion Bldg. Sewer 7 4
Holding St/Ht Inlet 7 4
,
TANK SETBACK INFORMATION St/Ht Outlet -�
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet ` y_
AlerrL
Septic 5 z /� J Dt Bottom // 96 •
Dosing J Of / Header /Man.
Aeration Dist. Pipe
l . Cp lira • 3
Holding Bot. System 2 - 55 M3
3
e
Final Grade 4725
INFORMATION 0 • /6/
PUMP/SIPHON
Manufacturer a w�`•
GPM Demand St Cgv_er / ,
i �— ,' Z?✓
Model Number
�o ,E�- �� �� G• q7• Z
TDH Lift Friction Loss System ad TDH /` 5 F
� � J
Forcemain Lengtt}�_ / Dia. it Dist. to well
76 Z 57
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length No. Of Trenc es P DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 9 5
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of S stem: 36 76 120 ` I /t UNIT Model Number:
DISTRIBUTION SYSTEM a rm
Header/Manifold J Distribution 3 x Hole Size �/ I x Hole Spacing Vent to Air Intake
J Pipes) �� g, ICO
Length lG Dia Length /�'Z Dia Spacing 3' Z . 95
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 F>F Yes [T] No Yes No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: �� / 1 2- 1 0 Inspection #2:
Location: 3079 Cty. Rd. N Wilson, WI 54027 (NE 1/4 SE 1/4 15 T28N R1 5W) >35 acres Lot Parcel No: 15.28.15.230A
1.) Alt BM Description = /j P I Q� b,4
2.) Bldg sewer length = !�
- amount of cover = /
Plan revision Required? Yes No ' l �1 3
Use other side for additional information. J
Date Inse tor's Si ture Cert. No.
SBD -6710 (R.3/97)
t
commerce .Wi.yov Safety and Buildings Division ounty
201 W. Washington Ave., P.O. Box 7162 St. Croix
t 1sconsin Madison, WI 53701 Sanitary Permit Number (to be filled in by Co.)
epartment of Commerce
Sanitary Permit Application St ate Transaction Number
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental 1721269
unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address)
submitted to the Department of Commerce. Personal information you provide may be used for secondary
p urposes in accordance with the Privacy Law, s. 15.04 1 m , Stats. 16 77 C
I. Application Informatio . L- Please Print All Information
Property Owner's Name Parcel #
Sten Hubinette SEP 3 oo y • io3y - yU
Property Owner's Mailing Address Property Location
Si Gnuin t,UUw i I � 23 A
3079 Co Rd N PLANNING & ZONING OFFICE Govt. Lot
City, State Zip Code Phone Number rwy,, 9V,, Section 15
Wilson WI 54027 -71:5 ' Y ' C ! Z '9Cv % AE (circle one)
II. Type of Building (check all that apply) Lot # T 28 N; R _15 W
X 1 or 2 Family Dwelling - Number of Bedrooms 3 p Subdivision Name
Block #
❑ Public /Commercial - Describe Use
❑ City of
❑ State Owned - Describe Use CSM Number ❑ Village of
1* %Town of Cady
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. New System X Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber =Pe:n-nit nsfer t o New List Previous Permit Number and Date Issued
Before Expiration
IV. Type of POWTS Sys tem/Com onent/Device: Check all that apply D
Non - Pressurized In- Ground ❑ Pressurized In- Ground At -Grade X Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) S
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area oposed System Elevation 1 99.50
450 0.� 450 / 450 JD9`��
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units o d
New Tanks Existing Tanks
w ortAe � a -T aU wt7 a
Septic or Holding Tank 1000 1000 1 Skaw Pre -Cast x
Dosing Chamber 642 1642 1 Skaw Pre -Cast ' ` x
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber' a MP/MPRS Number 71715 s Phone Number
Thomas D Gustum 227618
58 -1344
Plumber's Address (Street, City, State, Zip Code)
N13450 937' Street New Auburn WI, 54757
VIII. County/Depart ent Use Onlyt
,Approved El sapprove Permit Fee Date 71ued Issuing a Signature
❑Owner Give�Ram,,n De nial
$ l 93b b�
IX. Condif'"lX/Reasons for Disapproval
1. Septic tank, effluent filter and " ° " ` kege, axe t n C
dispersal cell must all be services / maintained L✓
as per management plan provided by plumber.
2. All setback requirements must be maintained 4 ) 61J 4 4L 1J 4.b G � .
as per applicable code / ordhoces.
Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size
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• Safety and Buildings
PO BOX 7162
Co111mememl.90v MADISON WI 53707 -7162
Contact Through Relay
t(C scons'n www.00mmer sin.go
www.wisconsin.gov
e parhment of Commerce
Jim Doyle, Governor
Richard J. Leinenkugei, Secretary
September 24, 2009
CUST ID No. 227618 A77W POWTS Inspector
THOMAS GUSTUM ZONING OFFICE
GUSTUM SEPTIC SERVICE ST CROIX COUNTY SPIA
N13450 937TH ST 1101 CARMICHAEL RD
NEW AUBURN WI 54757 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 09/24/2011 Identification Numbers
Transaction ID No. 1721269
SITE: Site ID No. 751848
Sten Hubinette Please refer to both identification numbers,
3079 County Rd N above, in all correspondence with the agency.
Town of Cady, 54027
St Croix County
NEIA, SEI /4, S15, T28N, R15W
FOR:
Object Type: POWTS Component Manual Regulated Object ID No.: 1242575
Maintenance required; Replacement system; 450 GPD Flow rate; System(s): Ezflow Mound Component Manual,
(N.6/03); Effluent Filter
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed
and located in accordance with the enclosed approved plans and with any component manual(s) referenced above.
The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code
requirements.
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.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• This system is to be constructed and located in accordance with the approved plans and with the EZflow Mound
Component Manual, (6/03)
• F on Page 3 of plans is equal to 32.3 inches.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representoives 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.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Beginning October I' 2008, small wastewater holding tanks with estimated flows less than 3,000 gpd that are based
completely on approved POWTS component manuals must be submitted to the appropriate governmental unit and
will no longer be accepted by the Safety and Buildings Division for review. Please refer to s. Comm 83.22, Wis.
Adm. Code for further information.
f l
THOMAS GUSTUM Page 2 9/24/2009
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 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
Allen C Wendorf
Wastewater Specialist , tntegrated Services WiSMART code: 7633
(608)235 -0595 ,
awendorf @commerce.state.wi.us
cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M.
Thomas Gustum, Gustum Septic Service
Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in
Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings
Division of the Wisconsin Department of Commerce.
"Construction business " means a trade that installs, alters or repairs any building element, component,
material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform
dwelling code, chs. Comm 20 to 25, the electrical code, ch Comm 16, the plumbing code, chs. Comm 81 to
87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the
delivery of building supplies or materials, or the manufacture of a building product not on the building
site.
For further information, go to our website: www. commerce. wi. gov/ SB/ SB- BuildingContractorProgram.html
EZFLOW MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: Sten Hubinete Mound
Owner's Name: Sten Hubinette
Owner's Address: 3079 County Road N Wilson WI 54027
Legal Description: NE 1/4 SE 1/4 S 15 T 28 N R 15 W
Township: Cady
County: St. Croix
Subdivision Name: N.A.
Lot Number: N.A. Block Number: N.A.
Parcel I.D. Number:
Plan Transaction No.:
Page 1 Index and title Q W •� sal6�
!Q/ Page 2 Data entry Q' �1t10Yti
Page 3 EZFIow mound drawings colid �O
Page 4 Lateral and dose tank a� MERC OS
Page 5 Distribution media ��OF COM
Page 6 System maintenance specificationPpR'�M�NFQCI A�0
1 Page 7 Management and contingency plan0 OS p Sp
Page 8 Pump curve and specifications
SlA Page 9 Plot Plan SEE GOFtREs
Designer: Thomas D. Gustum License Number: D1201
Date: 09/18/09 Phone Number: (715)- 658 -1344
Signature
Designed Pursuant to the
EZFIow Mound Component Manual (N. 06/03), and
SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81)
EZFIow Mound Version 1.2 (R. 02/04) Page 1 of 9
,i
EZFIow Mound and Pressure Distribution Component Design
Design Worksheet
Site Information
(r or c) r Residential or Commercial Design Note: Sand fill (D) calculations assume a
300.00 Estimated Wastewater Flow (gpd) Table 83 -44 -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)
2.50 Site Slope ( %)
97.25 Installation Contour Line Elevation (ft) F - 1 - 0 - 0 - .0 - 0 - 1 Contour Length Available (ft)
9.00 Depth to Limiting Factor (in)
0.50 In -situ Soil Application Rate (gpd /ft
Distribution Cell Information
9.00 Cell Width (ft) 3-4, 6, 7, 9, or 10 Only 50.00 = Dispersal Cell Length (ft)
1.00 Dispersal Cell Design Loading Rate (gpd /ft
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) a Center or End Manifold
3.00 Lateral Spacing (ft) If N above, enter the elevation (ft)
3 Number of Laterals of the highest point. [-
0.156 Orifice Diameter (in) (e.g. 0.25)
2.75 Estimated Orifice Spacing (ft) = 8.33 ft /orifice
2.00 Forcemain Diameter (in)
75.00 Forcemain Length (ft) Does the forcemain drain back? Y
88.00 Inside Pump Tank Elevation (ft) Enter Y or N
4.55 System Head (ft) x 1.3 12.23 Forcemain Drainback (gal)
11.00 Vertical Lift (ft) 66.68 5x Void Volume (gal)
1.37 Friction Loss (ft) 78.92 Minimum Dose Volume (gal)
16.92 Total Dynamic Head (ft) 29.08 System Demand (gpm)
Lateral Diameter Selection Manifold Diameter Selection
in. dia. options choice in. dia. options choice
0.75 1.25 x
1.00 1.50 x
1.25 x 2.00 X
1.50 x x 3.00
2.00 x
3.00 x
Gallons /Inch Calculator (optional)
Treatment Tank Information 642.00 Total Tank Capacity (gal)
1000.00 1 Septic T ank Capacity (gal) 39.00 Total Working Liquid Depth (in)
Skaw _Manufacturer 16.46 gal /in (enter result in cell B49)
Dose Tank Information E ffluent Filter In formation
642.001 Dose Tank Capacity (gal) ( Orinco Bio -Tube Filter Manufacturer
16.671 Dose Tank Volume (gal /in) FT0822 -14 Filter Model Number
Skaw IManufacturer
Project: Sten Hubinete Mound Page 2 of 9
Mound Plan View
1/10 6 Observation Pipe : ' ' ' ' J
'••
K .•: x . , = n. s. �..: �.... ,.. °......:,;�:�:.,:.,: ° a: a ,:,: ......'.::.:.n:. ;pax.
�. . B l .
................ ............................... I
•.•.•. ..•.•.
L
Mound Component Dimensions
A 9.00 ft E 29.70 in H 1.00 ft K 13.09 ft
B 50.00 ft F *. TUO in z 12.89 ft L 76.18 ft
D 27.00 in G 0.50 ft J 10.47 ft W 32.36 ft
450.00 (ft Dispersal Cell Area 1094.59 (ft) Basal Area Available
9.00 (gpd /ft) Linear Loading Rate 1 5.00 (ft) 1/10 B Obs. Pipe Placement
Mound Cross Section View
Aggregate Dispersal Area
Finished Grade 101.50 (ft) -►
G t H
F 1 . ::.: Dispersal Cell 100.00 (ft) Lateral
99.50 (ft) Invert Elevation
Dispersal Cell
Elevation F D ::
::.....
�},:� ��.'�.'4`'�.,�`�' 4 ' �:�.�,.. ���:�ti'K w, �, ;; �e` 4. k` 4.' l:. k�.' v. ��.-: .K�,;'�:''<��;�K'+..�:'c'�. °'• �. ;;- c�;. �. �<.' ��.4.`''<:'u.'.:`.'',:'`.c.K�_
Contour Elevation
2.5 % Site Slope
Typical Dispersal Cell
Shading Key a See Page 5
0 Topsoil Cap c a
® Subsoil Cap Z.2 2.0 ft Geotextile Fabric Cover
t
[-] ASTM C33 Sand
ti «.rti.1.ti
Tilled Layer c y 1 tire. er; rr. �s rs F
0.5 ft
EZFIow Media c �_ tirti. ti �::�� ° ti
See details on page 4 for number, size, and spacing of laterals.
Laterals are located in the 4" gravity distribution pipes as shown on page 5.
Project: Sten Hubinete Mound Page 3 of 9
End Connection Lateral Layout Diagram
Place Appropriate Lateral Diagram From Ri ht Below
0- Turn- up1FcwcJnpJu9
P
to__ catsr,,ctcn
Tyr S#. 5i
Number of Laterals 3 Orifice Diameter 0.156 in
Lateral Diameter 1.50 in Orifice Spacing (X) 2.85 ft
Lateral Length (P) 49.23 ft Orifices per Lateral 18
Lateral End (Z) 0.77 ft Orifice Density 8.33 ft /orifice
Lateral Spacing (S) 3.00 ft Manifold Length 6.00 ft
Lateral Flow Rate 9.69 gpm Manifold Diameter 2.00 in
System Flow Rate 29.08 gpm Forcemain Velocity 2.97 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 Alternate outlet
!^cat ;cn
Forcemain diameter
Skaw Manufacturer 2 in.
Capacity 642.00 Gallons T
Volume 16.67 gal /inch A
Weep hole or anti -
Dimension Inches Gallons B siphon device
A 19.78 329.70
B 2.00 33.34 C Pump off elevation (ft)
_t C 4.73 78.92 ~ 89.00
D 12.00 200.04
Total 38.511 642.001 D
Dose tank elevation (ft)
,_/ r__ 1 TFn _ 77 Bedding under tank. ~— 88.00
Alarm Manufacturer S and J Electro
Alarm Model Number 101
Pump Manufacturer I Franklin Electric
Pump Model Number SE- 40H -AF
Pump Must Deliver 1 29.08 gpm at 16.92 ft TDH
Project: Sten Hubinete Mound Page 4 of 9
EZFIow Distribution Cell Media Layout
9.00 Cell Width (ft) 1.50 Sidewall to Lateral (ft)
Distribution Cell Cross - section Arrangements
Drag appropriate drawing to space below.
9 ft Wide
Component Legend
® 6" EZFIow Bundle - EZ0601A, 5 or 10 Foot Lengths
12" EZFIow Bundle - EZ1203H, 5 or 10 Foot Lengths
12" EZFIow Bundle - EZ1203HP, 5 or 10 Ft Lengths
O 4" Distribution Pipe With Pressure Lateral Inside
0 Turnup Enclosure - - - - Lateral
Distribution Cell Plan View Layout - Typical
9.00 Cell Width - A (ft) 50.00 Cell Length - B (ft)
Center Connection Lateral Layout Diagram
Drag appropriate drawing from left to space below.
Force Main --��
9 ft Wide
End
Manifold
Project: Sten Hubinete Mound Page 5 of 9
Mound System Maintenance and Operation Specifications
Service Provider's Name E Gustum Septic Service Phone 658 -1344
POWTS Regulator's Name I ST.CROIX I Phone 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 ft Maximum FOG 30 mg /L
Type of Wastewaterl 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 and clean at least once every 3 years
Pump and Controls Test once every 3 years
Alarm Should test monthly
Pressure System Laterals should be flushed and pressure tested every 1.5 years
Mound Inspect for ponding and seepage once every 3 years
Other
Miscellaneous Construction and Materials Standards
1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap,
and are secured in as shown in the EZFIow mound component manual.
2. Dispersal cell media conforms to EZFIow products approved for use with the EZFIow Mound
Component Manual approved 6/3103. EZFIow media is covered with an approved geotextile fabric.
3. Aii graviiy and pressure piping materiais conform to the requirements in Comm 84, vvis. Aura. 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 vl
6 -8" Diameter Threaded Cleanout
Lawn Sprinkler Plug or Ball Valve
Lateral Ends at Last Orifice Where
............. ............
Variable Length Cleanout Begins
Long Sweep 90 or Two
45 Degree Bends Same
EZFIow Media Diameter as Lateral
2.05 Feet
Distribution Lateral Lateral Cleanout —�
Project: Sten Hubinete Mound Page 6 of 9
Mound System Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
General
This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its'
component manuals [EZFlow Mound Component manual 6/3/03 and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining
to system maintenance and maintenance reporting.
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death.
Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as
POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access
openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound,
defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an
effective locking device to prevent accidental or unauthorized entry into a tank or component.
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the
septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter
shall be assessed at least once every 3 years by inspection.
The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless
provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped
with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows Oran
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 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 BOD 150 mg /L TSS, and 30 mg /L FOG for septic tank effluent or
30 mg /L BOD 30 mg /L TSS, 10 mg /L FOG, and 10 cfu /100 mL for highly treated effluent. Influent flow may not exceed maximum
design flow specified in the permit for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral
be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial
test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal
distribution within the dispersal cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and
any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
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(s) shall be immediately
repaired or replaced with a component of the same or equal performance.
If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or
replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and
dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating
condition.
See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider.
Project: Sten Hubinete Mound Page 7 of 9
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Xisconsin Department of Commerce
SOIL EVALIJA 1 ORT p 1 of 3
Division of Safety and Buildings f ` \ "` " ` *° Gustum Septic Service
in accordance with ComrrA'Vvjb xdm. Code•.r`
' Attach complete site Ian on paper not less than 8'% x 11 inches in siz •-Pii ri mu
P P P P �. y u ..* St. Croix
include, but not limited to: vertical and horizontal reference pant (Bluth, direction anQQ''!
percent slope, scale or dimemsions, north arrow, and location an P ,.D. DU y -/Q 3 — O _ D6 o '/O A
Please print all information. i
Re Date
Personal information you provide may be used for secondary purposes (Prim10cy L86 S. 1
Property Owner "" \ Prope 4 * '•
Hubinette, S ten ti.' Govt• �� NA A,4N1/4 SE 1/4 S 15 T 28 NR 15 W
Property Owner's Mailing Address Subd. Name or CSM# 3v
3079 County Road N ' �/a:,.. - n/a N/A
City State Zip Code Phone Number �j City Village le Town Nearest Road
Wilson I WI 1 54027 1 715 772 - 4711 1 Cady I County Road N
j New Construction Use 10 Residential / Number of bedrooms 3 Cone derived design flow rate 450_ GPD
Replacement Public or commercial - Describe:
Parent material loess Flood plain elevation, if applicable n/a
General comments
and recommendations: Recommend mound system along 97.25' contour.
0'65f L 6
M L"i B oring # 1g Boring
Pit Ground Surface elev. 97.4 ft. Depth to limiting factor — in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft'
1 0 -5 10yr3 /2 none sill 2mcr mvfr as 3f,1m 0.5 0.8
2 5 -9 10yr3 /4 n one sill Zmsb mvfr cW if 0.5 0.8
r 3 9 -li 10yr4 /4 none sill 2msbk mfr cw - 0.5 0.8
c2 -3d 1py�7/1
4 11 -15 10yr4 7.5yr5/8 gr. sill 2msb mfr cw - 0.5 0.8
5 15 -25 7.5yr4/6 m31 5 y8 yr, sil 2msbk mvfi - - 0.5 0.8
Boring # _k,6 Boring
Pit Ground Surface elev. 96.4 - ft. Depth to limiting factor 9 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G
1 0 -5 10yr3 /2 none sil 2mcr mvfr as 3f,1m 0.5 0.8
c
2 5 -9 10yr5/3 none sill 2msbk mvfr cw if 0. •�
3 9 - 10yr5/4 -. 10 Syr5 /8 7/1
7 sil 2msbk mfr cw - 0.5 0.8
4 12 -17 10yr4 /4 _ c2 75y °5 8 7/1 sil 2msbk mfr cw - 0.5 0.8
5 17 -24 7.5yr4/6 m T yrg /1 gr. sil 2msbk mvfi - - 0.5 OS
Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD S mg/L and TSS <30 mg/L
CST Name (Please Print) Signature: CST Number
Tom Gustum 227618
Address Gi stum Septic Service Date Evaluation Conducted Telephone Number
New Auburn, WI 54757 8/1/00 715- 658 -1344
1 f
Property Owner Hubinette, Sten -- — Parcel ID # - — _ - - - -_- -- Page y__2_ - of _ 3
F3 ] Boring # 16 Boring 1 1
Pit Ground Surface elev. _. -_ 97.4 ft. Depth to limiting factor 11 in.
- - - -- - -- Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots S,pD($t
*Eff#1 *Eff#2
i
1 0 -5 10yr3 /2 none sil 2mcr mvfr as 3f,lm 0.5 0.8
I
- - - - -- - - - --
2 5 -11 1 0yr3 /4 none sil 2msbk mvfr cw 1f,lm ! 0.5 0.8
-- -- - -- - - - - - -- - - - -- - - - -- - - -r - -
3 11 -18 10 r4 4 c2 -3d 10yr7 /1 sil 2msbk mfr -
Y / 7.5yr5/8 i cw 0.5 0.8
c2 - 3d 10yr7 /1
4 18 -24 7.5yr4/6 7.5 /8 gr. sil 2msbk mfr - - 0.5 j 0.8
j I
F —I Boring # Boring
j Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots WOW
*Eff#1 *Eff#2
I
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Boring # B
F7 , j Pit Ground Surface elev. ft. Depth to limiting factor in.
- -- -- -- Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure I Consistence Boundary Roots - --- - OPD/fL. - -_- --
*Eff#1 *Eff#2
I
I
* Effluent #1 = BOD,> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 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.
Property Owner Hubinette, Sten Parcel ID # — __ ______ __— Page _ 2 - - of 3
F3� Boring # 16 Boring
Pit Ground Surface elev. -_- 97.4_.__ ft. Depth to limiting factor 11 - in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
*Eff#1 *Eff#2
0
1 -5 10 r3 2
-- - - - - -- _ _- =: , as 1 3f l m 0.8
0.5
Y / none A i 2mcr mvfr �� I I
P 2 5- 11 10yr3 /4 none sil 2msbk mvfr cw I 1f,1m 0.5 0.8
3 11 10 r4/4 c2 - 3d 10yr7/1
— --
y 7.Syr5 /8 sil 2msbk mfr cw - 0.5
7 5yr5 /8 0.8
c2 -3d 10yr7 /1
4 18 24 7 Syr4 /6 9r. sit 2msbk mfr - - 0.5 0.8
F-1 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 GPD /ft'
*Eff#1 *Eff#2
I
I
❑ Boring # -j Boring
j Pd Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots -GPDW_ --
*Eff#1 *Eff#2
i
I �
* Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 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.
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March 6, 2008
Sten Hubinette
3079 Cty. Rd. N
Wilson, WI 54027
Code Administration
715- 386 -4680 RE: Parcel # 004 - 1034 -40 -050 - Computer #15.28.15.230A
Land Information & Dear Mr. Hubinette:
Planning
715 - 386 -4674
The above parcel currently has a Soil and Site Evaluation Report on file with the
Real Property Planning and Zoning Department that indicated the need for a replacement of the
715- 386 -4677 existing Private On -site Wastewater Treatment System ( POWTS). Enclosed is a copy
Recycling of the report for your review.
715- 386 -4675
The soil report was completed on 8/1/00 by Certified Soil Tester Tom Gustum, but as
yet no permit has been issued for a replacement POWTS. Department staff will be
conducting a site visit this spring to determine if there is any visible indication of a
POWTS failure, such as surface discharge of wastewater, on your property.
We will notify you of any findings of POWTS failure, which will be documented as a
violation of Sanitary Code 12.1.F.4.d & e. Please feel free to contact us if you have
concerns regarding POWTS maintenance or how to proceed with replacement of the
POWTS servicing this dwelling.
ly,
Pamela Quinn
Zoning Specialist
Enc.
ST. CROIX COUNTY GOVERNMENT CENTER
1 101 CARMICHAEL ROAD, HUDSON, WI 54016 715 - 386 - 4686 FAX
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PLANNING & ZONING
July 28, 2008
Sten Hubinette
3079 County Road N
Wilson, WI 54027
RE: Failing sanitary system at 3079 County Road N
Further described as the NE' /2 of SE' /4 of Section 15, T28N R 15W,
Town of Cady - Parcel # 004 - 1034 -40 -050 Computer #15.28.15.230A
Code Administration
715- 386 -4680
Land Information
Dear Mr. Hubinette:
�
Planning The St. Croix Count Planni and Zoning Department, as the "governmental unit for
715- 386 -4674 y 9 g p g
the regulation of private sewage systems" pursuant to Wis. Stats. 145.20(1)(a), shall
Real Property investigate violations of the private sewage system ordinance and shall issue orders to
715- 386 -4677 abate the violations per Wis. Stats. 145.20(2)(f).
Recycling This office has received a soil test (Gustum 2000) that indicates your existing POWTS
715- 386 -4675 as a Category 1 failing system pursuant to Wisconsin Administrative Code Comm.
81.01 (92) and Section 145.245(4)(b) Wis. Stats., which includes discharges to surface
water and /or zones of saturation. The existing system is also considered a human
health hazard as defined in Wisconsin Administrative Code COMM 81.01(128) and
Section 254.01(2) Wisconsin Statutes.
Pursuant to the St. Croix County Code of Ordinances, Chapter 12 Sanitary Ordinance,
subchapter 12.1(F)(4)(d) when a failing POWTS is identified it shall be brought into
compliance with Wisconsin Statutes and Wisconsin Administrative Code and
12.1(F)(4)(e) the discharge of domestic wastewater or effluent to the waters of the State
or to the ground surface is prohibited.
This letter constitutes an order to abate the above - referenced violation.
You are required to have the system replaced by November 1 2009 Any plumbing
work required for compliance by replacing or repairing the failing system shall be
performed by a plumber who is licensed in the State of Wisconsin. A list of plumbers
can be provided at your request.
St. Croix County participates in the Wisconsin Fund Grant Program, which is a financial
assistance program that may provide funds to property owners by reimbursing a portion
of the cost of replacing or rehabilitating failing private sewage systems. All work,
however, must be completed before applications can be submitted to the Department of
Commerce. If you are successful in receiving a grant through this program, an
administrative fee is due and payable to this office at the time you receive your grant
award check
Failure to comply with this order and with the provisions of the St. Croix County Code of
Ordinances, Chapter 12 Sanitary Ordinance, or any order issued in accordance with
this ordinance shall be subject to a penalty as provided in Section 12.8 (B) (2) (a).
Penalties include forfeitures of not less than $10 per violation or more than $1000 per
ST. CRO1X COUNTY GOVERNMENT CENTER
1 10 1 CARMICHAEL ROAD, HUDSON, W1 54016 715 - 386 FAx
violation as /or be subject to injunctive relief. Each day a violation exists is a separate violation.
Res ctfully,
Ry n Yarri gton
Zoning Technician
Cc: Town of Cady
ST. CROIX COUNTY GOVERNMENT CENTER
1 10 1 CARMICHAEL ROAD, HUDSON, W1 54016 715386 -4686 FAA
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner /Buyer STe,r\ e
Mailing Address 36 2�
Property Address 30 "j C,� -.,_ 1A1 N
(Verification required fro Tanning & Zoning Department for new construction.)
City /State Parcel Identification Number 064 1631— � 65C)
LEGAL DESCRIPTION 6 236
Property Location 7 '/4 , A)C '/4 , Sec. )5 , T N R 15 W, Town of �.
Subdivision Plat: , Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # (before 2007)Volume , Page #
Spec house C yes _1 no Lot lines identifiable 17 yes i 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 §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site
wastewater disposal system is in proper operating condition and /or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
1 /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
I /we certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms
r
SIG ATU OF APPLICANT(S) DATE
** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
r)OCi.IMENT NO. WARRANTY DEEP s sPA:.� wESER�'ED FOR RCCOROtNQ DATA
STATE BAR OFWISCONSIN FORM 2 -1988
462 75M_ PAGE
P_ rlSTER'S FFir
ST. CROIX CO., W!
..... -- ---- ..---- --' . .. . . .. ....... ..... - ................................. ---------- Recd for Record
- ---- -... -- 7
Mae --- 3199!
-------- •- -• - -•- - 1.40
conveys and warrants to ------ -- -- - ---•- _... - .- ..--- -_------ --- - ---
Sten Daiid IT- binette and Ruth B - Hubinette, huei,,and --- ------
and wife as__ survivorship marsta_1_- _propert-_y. --- Req%WofDee&
• .. .. .. .. ............... ..- ----------------------------------------------------
-- '--- -- ---
--- - - -- --------- - - - - -- - •- - - - - -- .._.. --- - - - - -- • - - -- �IF FkDEjt.t�L S6al;IN F�;vU L�' t1
.. ........ ...._-- .___- _..._ -_.. __- .-- ._- _....... -__... .- -_ -_.. __- .- _..- ..__- .__..- ._..._... . -._ R�TU !i TO �.
... - -- ---- - - - - - -- ..... ................ 717 MAIN I REET
-- -- -- - -- -• -- - -- - - - -- --- - -' - -. ..-- - - - - - -- • ------- - MFNOTMONIE '011 54 75 i
the following described real estate in ......... St..__C.raix ................ .....County,
State of Wisconsin:
saz rsrcei Na: _------_-------------------
Southeast Quarter (SEJ) of the Northeas� Quarter (NE4) and the
Northeast Quarter (NEJ) of the Southeast Quarter (SE}) in Section Fifteen
(15), Township Twenty -eight (28) North, Range Fifteen (15) West, St. Croix
County, Wisconsin.
qs_. _ 0
i
1:
This i8 ---- ------------ -- homestead property.
(is) (19
Exception to warranties: None
Dated this .- _-`-'-• Z t1� . ---.September. - •... 19...9Q..
J ...... day of
t � -- ....... ,
.... (SEAL) i C't,''- e� rL _ t/_" � .............. (SEAL)
Mary Ja eer
r- ----(SEAL)
--..(SEAL) .... C0. --- ._.... Cti�..._....
j 3 • --- --Catherine__F....Peer ...... .................... li
i
AU.THENTICATI0N ACKNOWLEl GMBNT
Signature(s) -----•----------------------- --------•-- ------ ----- --•--•--- STATE O ::ISCONSIN
--------- ---- -- ------•--- ----- ------------------------------------------------ - Count y.
authenticated finis -------- day of___ ____ ___ _____ ______ ____ __ 19 ------ C�Personally carne before me this _- .!:._... -_._ -_day of
- - -- --- -------- -- ---- ------ 19_._. the abovA named
Mar y Jane Peer and Pe
• ----- ---- ---- ----------- •-- ------ -- -- - = T
TITLE: MEMBER STATE BAR OF WISCONSTN
a,
(If not_ ________............ _--------------------------------------- ------------ . t - ..._- __ -._ -.- / . ,, �_- F• �� • �tY �..
authorized by 706.06, Wis. Stats.) to me knoa/h to be the pergo / n _ _ -i -! pv1�oecuLe 4,-tfie
foregorng .kgt�d O1fv1RdAe the sawa� v
THfS JNSTRUMENT WAS DRAFTED BY �-
-- _
Brent D. Skinner
-•
- - -- ------ --- ---- --- ------ - - ------ ---- - ---- --- - - --
Menomonie WI 54751 _ ' >• c7on
----� - --- -- ---- ---- --- -•----- - My Public . 1-�t � . - (If '_.. • pi L
nq gl,L1t.+Ya,.la?AI:Pti cTY xe.cnnwTedoed. Bo h
My Commission is fmanent. (If 'Ytot,.,,t@
are not necessary.) - date: -L� 1 `6 .... ................... ....
STi+TF. SaR Oi C•ISCO vSl Stock No. 1 3002