Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
022-1030-95-150
County: St. Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT Sanitary Permit No: 579005 (ATTACH TO PERMIT) State Plan ID No: GENERAL INFORMATION L Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. parcel Tax No Permit Holder's Name: L City Village Township 022-1030-95-150 David C. Steine TOWN OF KINNICKINNIC CST BM Elev: Insp. BM Elev: IBM Description: Section/Town/Range/Map No: 11.28.18.168A-15 TANK INFORMATION ELEVATION DATA - AHI TYPE MANUFA_ APACITY STATION BS S EL Septic ~ /1h 01' Benchmark -7~ 11 1 DO - u S l 1 A ,qI i i, 5 ~W 16C) Aerator Bldg. Sewer (Iq.9g f . IDIr 1 Held4 St/Ht Inlet Ulf TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD y„ / Septic V ► ll 2' Dt Bottom Dosin (~1 Head Man ICY~v J'y ) 0 Q~ 9 Aeration Dist. Pipe 2_¢'Z 00. q Holding Bot. System J a 16041 Final Grade 1 ,O f, PU IPHON INFORMATION Manufacturer Demand K! Cover 13 IIQ+gQ r 1 GPM I I IU U-nu 1AS 9 ID0,0 Model Number ~ ~~~,✓J TDH Lift Friction L System Head TD t I p►~ 9 1 Forcemain Lengt15~ Dia. 1L11 Dist. to Well I I SOIL ABSORPTION SYSTE BED/TRENCH Width ' ^ 1 Length 1 Ner9f-Tsw* ea dC PIT DIMENSIONS W. Of Pitt Inside Di Liquid Dep DIMENSIONS U 6 1- ,{.~f 11 Ira SETBACK SYSTEM TO P/L BLDG WELL LAKE/ RE CHLEACHING AMBER OR Manufacturer. / v/ INFORMATION Type Of System: ~W ~SV 1 UNIT Model Number: r Z F/ bN , ~V1 W V G / lr ^l~ DIST N SYSTEM O Vent to Air Intake Header/ n'rf Distribution -E- 7 JxHoiesizeA5,3Z x Hole Spacing 13 A3, Pipe(s) LDiaSpacing SOIL COVER Pressure Systems Only xx Mound Or At-Grade Systems Only Mulched Bed/Trench Center IDepth Over xx Depth of xx Seeded/Sodded C 0eyes, 0 No Depth Over w~ Bed/Trench Edges / Topsoil Yes Fol No J J COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1) Inspection #2: Location: 479 OLD CEMETERY RD 3/y f' We "~r abov g ~~~~erT 1~d~1 ` iocn+ed awnq Sovfi~- /rltLj ka o s lads Cam. 1.) Alt BM Description = 06SeT6 A 1L l 61 ( r set' s in 441tP. 2.) Bldg sewer length t9 ` 1%t)` - amount of cover LA'V' oh al I! VVD, I bb, ~ >q l-- ors 0,1 1! Plan revision Required? 0 Yes No r I Use other side for additional informs on. ` Date L-,36o,ignature Cert. No. SBD-6710 (R.3/97) lay Z i t . ; ,`.III z U) m o l F-. 0 zQ L F-W Q z h XCO 8 w a w co v 7AM C o wMH0 o _ G . A O O6 tai- 6 ~o(j 4? r OP Y bat s s~ O 0' U to ~ In C) U te cm Lu a_ I- co LU _R co LL 0 L 2 xw / N ,D H•O w I. o V) 00, X41? z d~~r~ P . ~s s 6 Sodo nLf. ~ LU o CL i - RECEIVE County Safety and Buildings Division ST. CROIX ©S ~~N o 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI 53707-7162 ST. CROIX COUNTY w s:, Sanitary Pennit Application State Transaction Number Q 2 In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit V is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) r the Department of Safety and Professional Servies. Personal in formation you provide may be used for secondary 479 CEMETARY ROAD u oses in accordance with the Privacy Law, s. 15.04 l m , Stats. 1. Application Information - Please Print All Information 540 h* Property 0 wBer1sv a; Parcel # 10 022-1030-95-150 DAVID STEINE Property Owner's Mailing Address Property Location / p W1091 280TH AVE Govt. Lot 1 City, State Zip Code Phone Number NE Y NW y,, Section l I PLUM CITY, WI - " 54761 N/A T 28 N. R ril~ II. Type of Building (check all that apply) Lot # Q 1 or 2 Family Dwelling - Number of Bedrooms N/A Subdivision Name / Block # C SM LOT # 1 El Public/Commercial -Describe Use 'fff CA N/A ❑ City of El State Owned - Describe Use v yb t `~~S CSM Numbgr~ ^ zqq/ ❑ Village of t x L M Townof KINN I K.iNNIL M O N/A 1-1.10(,44 :Ir4pl III. Typ"f-Per " . eck only one box on line A. Complete line B if applicable) A. 11 !l New System Replacement System ❑ Treatment/Holding Tank Replacement Only t Fit o Exbisting ste to B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List P vious Permit Number and Date Issued Before Expiration Owner Q 0 2~ r IV. Type of POWTS S stem/Com onent/Device: Check all that a ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grad KI Mound ? 24 in. of suitable soil ❑ Mound < 24 i of suitabl soil f~ El Holding Tank El Other Dispersal Component (explain) Pretreatment Device (explain) AV V. Dis ersaVTreat ent Area Information: Design Flow (gpd) Design Soi Applica' )Rate(endsf) Dispersal Area Required (sf) Dispersal Area Pro osed (sf) System Elevation 600 1. b . 6 ✓ 600 / 100n 600 60D. 100. VI. Tank Info Capacity in Tota # of Manufacturer Gallons Gallons Units v V D„ New Tanks Existing Tanks o v A 2 2 ~Q l /Ot/L 0.. U in ,A V) U_ U n. Septic or Holding Tank 1200 0 200 1 ESER X Dosing Chamber 800 0 1 WI E S ER VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's ure MP/MPRS Number Business Phone Number PAUL KOEHLER 225410 715-246-2660 Plumber's Address (Street, City, State, Zip Code) 321 WISCONSIN DRIVE, NEW RICHMOND, WI 54017 VIII. County /De artment Use Only D Date [s2ue~d~ Issuing Agent Signature & ~ P-Oisppa Approved ved $e6it Fee 7L Jt/ (/nd Ow ven Reas r Denial IX. Conditions of gt f /8)~N5Ffor Disappro al Z t V b 1. Septic tank, effluent filter and ' a ~d d IS~hJ l bG~l dispersal cell must be _ secgd! mai . plumber. C Q~V ► fk 0,, V SC Per as per management plan provided by IVV4 2. 1 All setback is bie code(ordinances. alntained NCW ; e low Attar to complete plans for the system and submit to the County only on paper not less than 8 1R x 11 inches in size w -Nt~_ CU es N WW -00- to S~S}e'M Jalion ; pp._42, SBD-6398 (R. 11/11) V~ S V J ' ~10-T'cQ.'• FiDbc~~la..n ~lQdc~'livh clu r He k ~ :;IeP S COh~~~~~tf ~s- ~P rS~ypaRT4tE'.l' DIVISION OF INDUSTRY SERVICES 3824 N GREEKSIDE LA y HOLMEN WI 54636 P - Contact Through Relay http://dsps.wi.gov/programs/industry-services o tiG www.wisconsin.gov ~'SfON ti Scott Walker, Governor Dave Ross, Secretary June 16, 2015 CUST ID No. 224832 ATTN: POWTS Inspector MARY JO RUPPERT ZONING OFFICE HOLLISTERS SOIL TESTING & DESIGN ST CROIX COUNTY SPIA W9875 690TH AVE 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/16/2017 Identification Numbers Transaction ID No. 2549823 SITE: Site ID No. 778202 David C & Judith M Steine Please refer to both identification numbers. 479 Cemetery Rd above, in all correspondence with the agency. Town of Kinnickinnic St Croix County SE 1/4, NW1/4, S11, T28N, RI 8W Lot: 1, Subdivision: CSM # 24-5730VOL 24 Pg 5730 FOR: Description: Mound / Four Bedroom / Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1537509 Maintenance required; 600 GPD Flow rate; 30 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Ver. 2.G,- SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); 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. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. '0101 No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, ppp scats. DEPT QF The following conditions shall be met during construction or installation and prior to occupancy or use: , Q'00-S t Reminders IDN S10% OF • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. SE,~ • SPS 383.42(8)(c). Frost Protection. All POWTS components shall be protected from freezing temperatures that could detrimentally affect component operation to provide wastewater conveyance, treatment or dispersal. Wisc. Adm. Code. See SPS 382.30(11)(c). for construction limits, methods and procedures. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • 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. r MARY JO HUPPERT Page 2 6/16/2015 • Inspection of the POWTS 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. Stat • SPS 383 22(7) A copy of the approved plans specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • SPS 383.52 Responsibilities. 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). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 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. 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 Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stars 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 .fi This Amount Will Be Invoiced. When You Receive That Invoice, Charles L Bratz Please Include a Copy With Your f POWTS Reviewer 2, Division of Industry Services Payment Submittal. 08)789-7893 , 7:45 am - 4:30 pm Monday -Friday W iSMART code: 7633 9arles.bratz@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Paul R Koehler, Countryside Plumbing & Heating Inc (Plans Mailed To) r MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE ^ , . IV' j . ; 9Qj1~ Project Name: DAVID C. & JUDITH M. STEINE Owner's Name: (same) Owner's Address: P.O. Box 157 Plum City, WI 54761 Legal Description: SE 1/4 of the NW 1/4, Sec. 11, T28N, R18W Township: Kinnickinnic County: St. Croix Subdivision Name: NA Lot Number: 1 Block Number: NA Parcel I.D. Number: 022 - 1030 - 95 -150 Plan Transaction No.: Page 1 Index and title 01111119110fPage 2 Data entry SCONS Page 3 Mound drawings Page 4 Lateral and dose tank ONAILY Page 5 System maintenance specifications LOVED * HUMA 0 P PERT - Page 6 Management and contingency plan SAFETY AND • Page 7 Pump curve and specifications INAL SERVICES 1859 Page 8 Plot plan ;RIVER FALLS: - JDUSTRY SERVICES % W1 «~tlEl1!lllllltt\1t<< ORRESPONDEN Designer: Mary Jo Huppert License Number: 1859 - 007 Date: 05/13/15 Phone Number: 715 - 426 - 1775 Signature: 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 (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) Version 7.0 (R. 03/2012) Page 1 of 8 a. Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 383-44-3-in-situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of 36 inches. 609.00 Design Flow (gpd) 1.00 Site Slope 100.22 Contour Line Elevation (ft) 30.00 Depth to Limiting Factor (in) 0.60 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 60.00 Dispersal Cell Length Along Contour (ft) = 10.00 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 3.33 Lateral Spacing (ft) If N above, enter the elevation (ft) 3 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) 3.00 Estimated Orifice Spacing (ft) = 10.00 ft2/orifice 2.00 Forcemain Diameter (in) 277.00 Forcemain Length (ft) Does the forcemain drain back? Y 92.00 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 45.18 Forcemain Drainback (gal) 8.55 Vertical Lift (ft) 80.54 5x Void Volume (gal) 6.16 Friction Loss (ft) 125.72 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 32.31 System Demand (gpm) 1926 .Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 1.00 1.50 x x 1.25 x 2.00 x 1.50 x x 3.00 [23 .00 x .00 x Gallons/Inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1200.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) W Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.00 Dose Tank Capacity (gal) PolyLok Filter Manufacturer 22.24 Dose Tank Volume (gal/in) 525 Filter Model Number Weiser Manufacturer Project: DAVID C. & JUDITH M. STEINE Page 2 of 8 Mound Plan and Cross Section Views 1/10 B ' t Observation Pipe•;.:.: J A B: I L Mound Component Dimensions Down slope toe extension made. A 10.00 ft E 7.20 in H 1.00 ft K [Aft B ft F 9.50 n 1 6.67 ft L ft D in G 0.50 ft J 5.22 ft W ft 600.00 (ft2) Dispersal Cell Area 1000.00 (ft2) Basal Area Available 10.00 (gpd/ft) Linear Loading Rate 6.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.51 (ft) G ♦f 100.7 ) Dispersal Cell 101.22 (ft) Lateral Di sal Cell Invert Elevation p v 4 4 10022 (ft) Contour Elevation 1.0 % Site Slope Shading Key a Geotextile Fabric Cover m T Dispersal Cell See lateral details on 0 [ Topsoil Cap w o = 1.5 ft r ~ Page 4 for number, size, { { Subsoil Cap w .o and spacing of laterals. ASTM C33 Sand L Laterals are equally ®®Tilled Layer 0.5 ft r.-F spaced from the I distribution cell's © 4::: Aggregate o centerline in the A - } distribution cell (AxB). Project: DAVID C. & JUDITH M. STEINE Page 3 of 8 End Connection Lateral Layout Diagram Center the laterals over the A & B dimension 4b= Turn-u p rit bs I I vs lve or ai as n out pi u g FAIllaterals P are identical Holes drilled on the bottom of the lateral equally spaced Laterals &forcemain S_h 40 PVC per SPS Table 384.30-6 S ain connection via tee or cross to manifold at any point. Number of Laterals 3 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing (X) 3.08 ft Lateral Length (P) 58.52 ft Orifices per Lateral 20 Lateral Spacing (S) 3.33 ft Orifice Density 10.00 ft2/orifice Lateral Flow Rate 10.77 gpm Manifold Length 6.67 ft System Flow Rate 32.31 gpm Manifold Diameter 1.50 in Total Dynamic Head 19.26 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 SPS 316.300 WAC 4 in. min. Disconnect Tank component is properly vented E--- Alternate outlet location Forcemain diameter Weiser Manufacturer 2 in. Capacity 800.00 Gallons Volume 22.24 gal/inch A rt~ - Weep hole or anti- Dimension Inches Gallons B siphon device A 20.32 451.88 B 2.00 44.48 C Pump off elevation (ft) C 5.65 125.72 9267 D 8.00 177.92 Total 35.97 800.00 D Dose tank elevation (ft) 3" Bedding un er tank. 92.00 Alarm Manuafacturer SJE Rhombus Note: Switches Alarm Model Number Tank Alert AB containing mercury may not be used in Pump Manufacturer Gould this system. Pump Model Number 41 Pump Must Deliver 32.31 gpm at 19726 ft T D H Project: DAVID C. & JUDITH M. STEINE Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name Ron's Sewer Service Phone 715-749-0153 POWTS Regulator's Name St. Croix Coun Zoning Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600.32 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once 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) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Inspect for ondin and seepage once eve 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished Grade " • 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: DAVID C. & JUDITH M. STEINE Page 5 of 8 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 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 SPS 383.33, 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 or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil 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 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. Continaencv 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. Pretreatment 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: DAVib kDIT{I /Vi. 57E/tJE Page 6 of 8 ; L(9jGOULDS puMps Submersible WNW Pump PE Raw oft mom ~ l'f.` NP1' ' t~ ■ Corrosion resataM cmgnK*M T=:1 04°p f4o°U ` 60 Heitz . ast von bo* ff"Mum, ~Inuous when ` 115 and 230 voa ■ C7kmftpbstk 4426naged. • 8uit-in tliernal o aad r itnnpeBer and • pper Sleeve and lower APPtICAT1o11~ * Automatic models kWude a h bea►u+g 01-Idled design. wnstrucdom f loat sue. High sbeno carbon steel Specialty designed for the • Manual models avabble. shaft Motor is p de W(a = uses. ' ftw*9 fie: see Pal Motor service for e~cternled Effluenvooft Systems pE3ce chart or ctuve. • 33 HP, 3000 RPM IN Poweed . for a • • 115 vOhs tnw Pressure Pipe Syseena • PUIW » G"dtjr 53 GPM • Shaded pole design :Qukk . ' Basement Draining • Maximum had. 25' T~ ame widhe limils • H" Duly Sump► PE41 K41 Molar PM motor. De~nratering : • .40 NP, 3400 HPM poy~ Maximum capacigr: 61 GPM ` 115 and 230 voles =4 20' awward ' Maximum, head: 29 TDH ` PSC design h" duty 1613 SnW Wi PE51 Pump; PE51 Motor: 115 or 230 vottgmunding 37 TDH • 15 and 230 ~ r CanpLek unft is heavy duty, MARS W7 • PSC design Pam and compact 40, ■ Mechanical seat is cubon, SIMI. 10 35 x~, r10, so =G1 4 revers. ' T GPM 1 , , = 1 1 f i 4 1 = VUSFIM 25. X1 t--~= 1 u2 Tood to UL 776 and 0 151_ 's 1 -t I 'sra~ Al ASO&Vw 10 0 0 10 20 40 50 , . 60 7O ' ~ ~E C'T Tiu lD r," 51°6/AE 0 5 ~ 10 15 rn~ O -DmV -u mmm Y d PROpOS s E no s; OD s s~ ~ A'40p a 0 O . °~,ssFa "ift _ ROM y A c ~ _ _a r b 03 i PO 4 =CX_ b1 m CD G) O~ C/) Z 43 ~C ~o ~ . - - to a►, POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of FILE INFORMATION SYSTEM SPECIFICATIONS F ner DAVID STEYNE Septic Tank Capacity 1200 qal ❑ NA mit # Septic Tank Manufacturer WIESER la NA ==j _ DESIGN PARAMETERS Effluent Filter Manufacturer POLYLOK ❑ NA Number of Bedrooms 4 0 NA Effluent Filter Model 525 ❑ Not Number of Public Facility Units IR-NA Pump Tank Capacity 8090 gal ❑ N 4 Estimated flow (average) 450 gal/day Pump Tank Manufacturer WIESER ❑ NA Design flow (peak), (Estimated x 1.5) 600 qai/da Pump Manufacturer GOULDS ❑ N.0. Soil Application Rate .6 a(/day/ft2 fPretreia-iment Model PE41 ❑ NA Standard Influent/Effluent Quality Monthly average* Unit IN NA Fats, Oil & Grease (FOG) 530 mg/L nd/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODj 5220 mg/(. ❑ NA 0 Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other. Pretreated Effluent Quality Monthly average Dispersal Cell(s) UNA Biochemical Oxygen Demand (6OD5) 530 mg1L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L Q NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 510' ofu/100ml Q Drip-Line O Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: O NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent, Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At (east once every: 3 E3 O year(s) month(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and soum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ Nit 3 10 year(s) Clean effluent fitter At least once every• ❑ month(s) A NA 1.1 E3 year(s) Inspect pump, pump controls & alarm At least once every: 3 month(s) ❑ W, year(s) Flush laterals and pressure test At least once every: ❑ ❑ m year(s) r(s) X1 W. Other. At least once every: 13 month(s) Other: ❑ year(s) ❑ N<~ ❑ NA, MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector, POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks. measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground' surfaca. The dispersal cell(s) shall be visually inspected to cheek the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and soum in any tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 11:3, Wisconsin Administrative Code. All o Cher services including but not limited to the servicing. of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of S12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION Page 2 of _Z1 For new construction, prior to use of the POWYS check treatment tank(s) for the presence of painting that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are de ected have the conteru of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will b discharged to the dispersal cell(sl in one large dose, overloading the cell(s) and may result in the backup or surface discharge c effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restorin power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls t restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the are. within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or.elimination of the following from the wastewater stream may improve the performance and prolong the life of thq POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fiat foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; ail, painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. a The contents of all tanks and pits shall be removed and properly disposed of by a SeMage Servicing Operator. a After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert Solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant replacement system: 4 A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorptkin system. The replacement area should' be protected from disturbance and compaction and should not be infringed upon I )y setbacks from existing and proposed structure, lot lines and wells- Failure to protect the replacement area vii I result in the need for a new soli and site evajdation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. alua. ' to 7-R" Ing Vat b6 a ar U1-FiB TTLs"p Dig. N 4;NSTJEi/~~ l Orr tk ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the blomat at the. infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NC T RNTER A SEPTIC, PUMP OR OTHER TREATMENT- TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POW TS INSTAL1 F11 POWTS MAINTAINER EP e COUNTRYSIDE PLUMBING & HEATING INC KOEHLER e 71 5-246-2660 NamL75-246-2660 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name R LS SEPTIC SERVICE Name s-r-. c~ ( 2o~r~u Phone 715-425-1025 Phone -7/'5-- 3S'(P q(,ff v U This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(11. (21 & (3), Wisconsin Administrative Code. 8T. Ckb SEPTIC TAN'C WEN:AI~C AGREMViFW OWMRSHIP AND '~~.'~Ci t~3'+C FORM Owner/Buyer if' € M iing,&ddr Property Addr=f ZoJun arta S ep for now comimction.) Pzrcul rdenti.ication. Nwnber P0 7". 4 eq C' C' PrOPerty Location Tti CJ ~t i Subdivision 6-5m -9 COrtified Survey , Lot y M4V Warrfint Volume Page --r__ Volume Yes uo Pa # Spec mouse . Lot Iincs identifiable C~M yes ' + Curt ` +CA, I0 IA'Mr tie and mainmwwc- of yMn' tnaii sttatanoe eousists afpnmPi~ out the septic tank evet d I# its its Fret tnra fallu M to banae wastes, pm. e systGZti can faacNan of Me se t{G tank as a lea ree yaws or sorsncr, ifneeded, by a licensed putnpex th . What you put into respowdbt"lities are specified in §C.ornm. 83.3"1(1) and ice Ma pier the WA via to du,po system. OWmt;r suaintenaruce ~F !Z - St, Croix County Satsi}a~y Wince. owper The 1?~+P~S' awsssr agrees to spbnut to St Creix Coup p vast ~ ~ ' 3a~ P bar, sMcted Pttzr or a 1 GnsedpD eC c°rdifir 3isp &M sigged by the Mter less than 113 Rtll of sly m is in proper operating ~ ct On and/or (2) after ape and 8 that (1) r 116 an site pu 8 of riacessHr ary), the septic tank is VWC, stnnd$rds £thG underaipod have rear/ the above ra"keMents artk herein, as set by the Department ofCa aV4 agree 10 maintain she private seat age disposal to f- Wqatem isa wiitt the chr xcattan stafiz~g that yarn ru stir has beau uta Ge the AeP nt of Mat mal Resoomes, State oCris Dep+u 4 xt within 30 days cif the f bVe year eVira a on t be completed and settttaed to the St. Croix County a g & Uwe certify that all stateznetx" this fQnu art taste to the beef of my lour knowe. Properly deson'bed above, by v tt o fa fiy doed recorded io Register o[Deeds Office. III am/are the awnct(s) of the C Any information that ns misrelrrageataci n3 y result in the ,sauitauy permit being revoked Tacludo with this Irevoked by the Planning & wing DeFcr€t refertr~ is made in the warranty r= ~ wananty Pram tl~e Register of Deeds Office and a copy afthe certified survey map if deed. (RzV. 06108) f . Receipt for Payment of Real Estate Property Taxes for 2014 02/OW=5 Parcel 3 I ~ TOWN OF KINNICKINNIC Computer 022-1030-995-150 ST. CROIX COUNTY Bill 307593 Payment pate: 01/31/2015 Total Land: 61,300 Batch: 022016 Tot. Improve: 22,50o Receipt 1185 Total Value: 83,800 EstFair Mkt: 0 Ratio. Total Amount Due: 1,222.46 Lottery 1.0199 Total Amount Paid: 1,222.46 Loy Credit; 0.00 General Property Tax paid: 1,222.46 Property Address: 479 OLD CEMETERY RD Special Assessment Paid: 0.00 Spial Chares Paid: 0.00 Vol./Page: 24 /5730 2402/107 Delinq uuent Util. Chrg Paid: 0.00 Section/TawnlRange: 11-28N-18w Private Forest Crop Paid: 0.00 Acres: 14.110 Woodland Tax Law Paid: 0.00 Managed Forest Land Paid: 0.00 Legal Description: Interest paid: 0.00 SEC 11 T28N R10W PT E 1/2 NW Penalty Paid: 0.00 1/4; FKA LOT 4 OF CSM 10/28 Balance Due Postponed: 0.00 61 EXC CSM 19-4944 FKA CSM 2 BelaocweDue Dehrrquent: 0.00 0--5153 OUTLOT 1; NKA CSM 24 -5730 LOT 1 (14.110AC) Overpayment: 0.00 Gash: 0.00 Check: 1,222.46 Note: #13681 Judith Steine If Paid By Check, Tax Receipt Is Not Valid Until Check Has Cleared All Banks. RECEIVED BY: TOWN KINNICKINNIC TREAS / BRENDA LAVALLEY n 1142 RIFLE RANGE RD { V11~ ~J n-c- L~((~~ ((v4wwx, RIVER FALLS WI 54022 61T SS ~-1i'141Aktl', C t ),V S`jli h S Y Q GARY B MQNROE ~ ~.~Q.• MARY K MORSETH tU 8975 CGy1 PATH INVER GROVE NEIGH MN 55076 ~Io r c„ y S^ All - 1 - -JI x ~ N N I _ t ga ~ ,ja ¢ t9 ~i6 a~ g [fit t ~ I- I ~ I~ x I v ~ ~ ~I fl' ` I PI ~I i O 1 t / -41 C C` B~ D I, C ~ x ~b I C NI ~ I~, I b b'' ~ao.ioo . 71 Ap d Y o d ~ d' CO y(~ o o~ D m 6 v iie'sieeuaus ~G(' 2s ~'f R~w150'+LLN.~ ` I ~(oP n ~P<o• V PROJECT 3 x myll m 'ay 8- S(EINE y m A3g9g5~ `!1 VEf s . RECEi Wisconsin Department of Commerce MAY O J 2013SOIL EVALUATION REPORT -Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not I&Wi fxN11 Inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. ro, percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 5/ 50 Please print all Information. II R awed by Date Personal infomtallon you provide may be used for secondary purposes (F& cY L~ t H 1 Property Owner Property Location k1 i- k (i e yj >t, p $G Govt. Lot ,S L 1/4 Vjj 114 S Tag N R E (a W Property Owner's Mailing Addre§s Lot # Block # Subd. Name or CSM# 9 1 7► 1 CS 1 vd zo 9S3 City . State Zip Code Phone Number ❑ City ` ❑ Village Town Nearest Road t r' Filh 1J )T ISA 0 ( ) e GTE NL New Construction Use: ® Residential / Number of bedrooms Code derived design flow rate 4jo GPD Replacement ❑ Public or mmercial - Describe: Parent material _M1 19 11,61' Ssr►d ~4t&n lo Flood Plain elevation if applicable FL ft. General comments and recommendations: I S-ta' OL rn. p k n / ~~M~n (~t~lCd e~ 5a r cI Boring # ❑ Boring I I 1 Pit Ground surface elev. ft. Depth to limiting factor, = in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDsW In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef1#1 •Eff#2 0-14 L sal c .24 C), p.0 3 um W IL a tb n. o D Jo 0_'o 0 El Booing # Boring ❑ Pit Ground surface elev. 9 ft. Depth to limiting factor _ in. Soil Application Rate Horizon . Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 d-Ili loYR 3 z h CS 9-t 6. L 6.9 Z --24 1 k4 3 - s s aU-f D f1. 212 Om '94 C5 , t?. 6' Effluent #1 = BODS > 30 < 220 mg/L and T >30 < 150 m _ 91L ' Effluent #2 =GODS < 30 mg/L and TSS < 30 myL CST Name (Please PM):k IV( fZ2, Sig a CST Number V. 0 Address ,r r- _ Date Evaluation Conducted Telephone Number .1 on„ C ni A f v I it i R594 Property Owner Q f'k P P I a A o e Parcel ID # X? & 3 G Q S '150. page of _3~ F Boring # t❑ Boring ICI. Pit Ground surface elev.qfL~ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDffF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Etf#1 •Eff#2 d 4 7 C. n v 5 3 l-4 7.s R4 17, 1 G b w6-- -5 i d 0 ~a - 10-0 Boring # ❑ Boring ❑ ❑ Pit Ground surface elev. IL Depth to limiting factor 1^ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots "E GPD Eff#2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. E Boring # ❑ Boring ❑ Pit Ground surface elev. .ft. Depth to limiting factor in. Roots Soll GPD/ft~ ApplicatioA Rate . Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary In, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. E E • Effluent #1 = BODS > 30 < 220 mg1L and TSS >30 < 150 mg/L " Effluent #2 = BOD, < 30 mg/L and TSS < 30 mglL The Department of Commerce is an equal opporlvinit~ service provider and employer. If you o need assistance tance to access services or need material in an alternate format, please contact the department 608-264-8777. ssD4M ta.mrow _ i _RNRo oz2-ions=9s-~sa PLOT PLAN - -----~-3 v V~Ud~ ~"'gin., ~ d IN ~v mask M sP~ k~ rv ):P val 92A FZ-0-5 ELTa.Q 5~ . 1 qq, 2 BF-A 99,583Et.a8~ 9fG,74' r w _ Qm.2. TOP Reba✓ t~ Se.t~ EL n - , lob -6 rV~ypr P-Al 4 05/10/2013 08:23 AM Parcel 022-1030-95-150 PAGE 1 OF 1 Alt. Parcel 11.28.18.168A-15 022 - TOWN OF KINNICKINNIC Current FX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 01/20/2011 00 0 Tax Address: Owner(s): O = Current Owner, C Current Co-Owner 0 - MONROE, GARY B GARY B MONROE C - MORSETH, MARY K MARY K MORSETH 8975 COFFMAN PATH IVER GROVE HEIGHTS MN 55076 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ` 479 OLD CEMETERY RD SC 4893 SCH DIST RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 14.110 Plat: 5730-CSM 24-5730 022/2010 SEC 11 T28N RI 8W PT E 1/2 NW1/4; FKA LOT Block/Condo Bldg: LOT 01 4 OF CSM 10/2861 EXC CSM 19-4944 FKA CSM Sec-Twn-Rn 40 1/4 160 1/4) 20-5153 OUTLOT 1; NKA CSM 24-5730 LOT 1 Tract(s): ( 9 (14.110AC) 11-28N-18W NW Notes: Parcel History: RETIRED 2010 FOR 2011; KEPT SAME PID, Date Doc # Vol/Page Type ONLY ADDING SETBACKS (168A-15) 06/21/2012 958611 AGREE 022-1030-95-150 09/13/2010 922441 24/5730 CSM 04/01/2008 871865 CSM 01/26/2006 817258 more... 2013 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 05/03/2012 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 50,000 22,500 72,500 NO AGRICULTURAL G4 8.000 1,300 0 1,300 NO AGRICULTURAL FOREST G5M 4.110 10,000 0 10,000 NO Totals for 2013: General Property 14.110 61,300 22,500 83,8000 Woodland 0.000 0 Totals for 2012: General Property 14.110 61,300 22,500 83,8000 Woodland 0.000 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code . Category Amount Special Assessments Special Charges Delinquent Charges 00 Total 0.00 0.00 RECEIVET' l Wisconsin Department of Commerce MAY 0 9 2013SOIL EVALUATION REPORT -Page I of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code UMT~r County Attach complete site plan on paper not Its I ~ ~f p2 x 11 inches in size. Plan must S include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. / percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 5 ` 5 0 Please print all information. R ewed by Date in ILIM. Personal information you provide may be used for secondary purposes (Face 1 / 2 Property Owner Property Location J © rk G' t4 ('jg1 1 Govt. Lot y 1/4 1/4 S J T oq N R d E (or W Property Owner's Mailing Address Lot # Block It Subd. Name or CSM# 9 1 Nm -Ter 1 _ OS '4 At t) -5V vJ 2 d Sl 5' 3 City . State Zip Code Phone Number ❑ City _ ❑ Village [P Town Nearest Road New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate /d(s GPD ❑ Replacement ❑ Public or g°mmercial - Describe: Parent material "7 ~`l A t~ t S od "'O'n E° Flood Plain elevation if applicable 941 D ft. General comments and recommendations: 1,1;014 ( 0- th pko-l ic,, e) 540 n Boring # ❑ Boring I ( I 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/ftz in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 6-14 I v 9rh C a 6 d, Z / --3- ✓x 5 k Tr L 0.4 0.64 3 3 y 4 I; 9. S rS c u m hi A- C 51 t~ C. 0.0 F2-~ Boring # ❑ Boring ❑ Pit Ground surface elev.q ft. Depth to limiting factor r. in. Soil Application Rate Horizon . Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 i 0-16 faYR 3 z - s- hh cs 9-t a 2 16 --2L W Y&41-3 - Sr` / r s b? UT 6, 3 -2 ,S" 2_ r b o C 5 t 'f- 0,0 6, C is * Effluent #1 = BODS > 30 < 220 mg/L and T SS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Prin) _ 1 Als Sig at CST Number r / Address o --'>S S. n Date Evaluation Conducted Telephone Number .I ©nh C r) / {I I_/i, o (illy fro lit I l~L.~ "7-'1/1._. In I tho9 Z5 1,0.4 lr Property Owner Q rtt P. N n n___ T_ 0 _ Parcel ID # Q-J :3 Page of Boring # ❑ Boring q F71 ® Pit Ground surface elev..gd ft. Depth to limiting factor_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture, „6t cture Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color -Gr•:1Dz. Sh. *Eff#1 *Eff#2 3 •4A 1-5-r94/4 9. i G s rv S i o -24 46•_ F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor In. E-Eff#l pplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *042 F Boring # ❑ Boring ❑ Pit Ground surface elev. A Depth to limiting factor in Soil Appiicaton Rate L Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 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. SBD-8330 (R.07/0D) _uE-~na~ Q~2-►s=:9s-~s~ PILOT PLAN } wjl v rd, nWL T F~ ~'~,v Q lN,~°t~v rn~y ` SUrneRL JdQdO qq, ti ~fl, ?4 T' qc', 5 83 fit. q9.'~ Qm 2 -roe S6 '1 F-L, ~ tL Sq County Safety and Buildings Division T ! % 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Sp fKl Madison, WI 53707-7162 State Transaction Number Permit Application linad s) In accordance w 383.21 Adm. Code, submission of this form to the appropriate is required prior governmental unit St ai " a sanitary permit. Note: Application forms for state-owned POWTS bmitted to Project Address (if different than mai the Department of Safety and Professional Servies. Personal information you provide may be used _ ~nr purposes in accordance with the Privacy Law, s. 15.04(l m , Slats. 1. Application Information - Please Print All Information Property Owner's Name 00 cel # r a rA a 1 r~ Sr ~a - 3~i - 5d Property Owner's Mailing Address / Property Location -4 q 1 E! IN Govt. Lot *y Phone Number E Section City, State / Zip Code e% v eo( F4 ('S s/7d L / 5~ 3,04 " q 5_:5 T La N, R ~ circle one] Eo H. Type of Building (check all that apply) Lot # Subdivision Name 19 1 ily Dwelling - Number of~Bedrooms Block r~ ommerci -Describ Use V0L / 3 ❑ City of CSM ❑ village of l ❑ State Owned - Describe Use 1j I Town of I~S 1 yd i I t I Z i Yr Yy I 't J -n d III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ~y III New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that a 1 ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade X Mound >24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Pretreatment Device (explai ❑ Holding Tank ❑ Other Dispersal Component (explain) V. Dis ersaUTreatment Area Information: all, bc Design Flow (gpd)/ Design Soil Application Rate(gpdsf) Dispe Area Required (sf) Dis Area Proposed (sf) S -stern © ✓ d , /~a '1( pG V/ 1 o6 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o j ai New Tanks Existing Tanks 4) / v y in w ry a Septic or Holding Tank )1 vs, Dosing Climber 1750 VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number gay ► ~a~ ss , ~~a~-~ Plumber's A~dydress (Street, City, State, Zip Code) T 9)V 1 . Coun /De artment Use On 111 Permit Fee Date Issued uing Agen Signa e !Approrov ❑ Disapproved c C ed $7 ✓ is 3 00 ❑ Owner Given Reason for Denial _ IX. C%"t6'RYal/Reasons for Disapproval fill 7 1. Septic tank, effluent filter and ,A/o r►/44r 1-ta dispersal cell must be serviced / maintained S CG~ C ~ as per management plan provided by plumber. 56- 2. All setback requirements must be maintained 0Y 11 A for the system and submit fi We~C~ou~nty only on pa not less than 8 1R x inches in size _ F G2,~✓"„~" ~ 7~/ ODD ~,C~// ~(~L/sL lit'' St!`~~~~'ta~~~'~'CQ'~(~~~D'hi rt~.S-f~L~ O ~~h/~ite~ G'~ny SBD-6398 (R. 11/11) j VARTMg~T Safety and Buildings a 3824 N CREEKSIDE LA 0- \'pHOLMEN WI 54636 3 D S Contact Through Relay www.commerce.wi.gov/sb/ 9~ S cw www.wisconsin.gov ~OssroNA~'~ Scott Walker, Governor Dave Ross, Secretary April 09, 2012 CUST ID No. 220554 ATTN.- POWTS Inspector CARL P HEISE ZONING OFFICE TOTAL EXCAVATING ST CROIX COUNTY SPIA N8618 1090TH 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/09/2014 SITE: Identification Numbers Bruce Monroe & Mary Morseth Transaction ID No. 2072181 479 Cemetery Rd Site ID No. 778202 Town of Kinnickinnic Please refer to both identification numbers, St Croix County above, in all correspondence with the agency. SE1/4, NW1/4, S11, T28N, RI 8W FOR: Description: Four Bedroom Mound System / 1% cross-slope Object Type: POWTS Component Manual Regulated Object ID No.: 1366385 Maintenance required; 600 GPD Flow rate; 30 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD-10691-P (N.01/01), 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. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code PRIVATE SEWAG requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.0 Con stats. The following conditions shall be met during construction or installation and prior to occupancy or use: A PP Reminders: tDIYISI; a • The float switch shall be a type that does not contain mercury. 2009 Wisconsin Act 44 prohibits the installatio of float switches or relays that contain mercury. Please specs an a ternative product prior to apply' sanitary permit". S CORRESPON • All lateral access boxes shall be located outside of the EZflow units. • 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. CARL P HEISE Page 2 4/9/2012 • A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of 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. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250:00 ' Fee Received $ 250.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swim@wisconsin.gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety & Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept..of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. :-CEIVEL APR 0 4 2012 E- Y& BUILDING; Tota Excavating, N8618 1090th River Falls, WI 54022 Tel (715)426-1777 Fax (715)425-7314 TITLE SHEET MOUND SYSTEM FOR _ BEDROOM RESIDENCE LOCATED IN THE ,5j~-_1/4 OF THE 1' tJ1/4 OF SECTION, T Q& N, R J8 W TOWN OF 1 ,rjWICJ6v~&tC COUNTY, WISCONSIN. INDEX PAGE 1 OF 7 TITLE SHEET ?ally PAGE 2 OF 7 SYSTEM MANAGEMENT PLAN PAGE 3 OF 7 PLOT PLAN PAGE 4 OF 7 PLAN VIEW - CROSS SECTION VED PAGE 5 OF 7 DISTRIBUTION PIPE LAYOUT ~~~"VGS PAGE 6 OF 7 PUMPING CHAMBER CROSS SECTION PAGE 7 OF 7 PUMP PERFORMANCE CURVE NCE PREPARED FOR ar(ucz MONRUr4FMKNor .Sr-r/4 -1 7f'C~MF7'~~Y 7zD - a t>~ 9 Fkt LS ter 5_q02 2 . PREPARED BY Carl Heise CST/MPRS 220554 W9905 710th Ave. River Falls, WI 54022 Cell 651-492-8594 Fax 715-425-7314 This plan has been prepared in accordance with the SBS Manual t v v d a,c, S~~r g ~ ~gLL o= 0ird►~a~Y~ hf" c ?roe Q / So wcES~R tarU gill 41 ~pr~e ~ z Oa~7ret b b~ Ta,.{c, w ~.tdaGa ~ f7bL TANK SHAu_S IrEok e,e 06 Nor C6r1 f ~~i a r '7iS~r~r ~a ~ L _ _ - _>r.Lq_9a1 - i►,gP~cTio,$ L Q8,'1 Bhl 2 TO seJ- ~ys.rt~Ydr I\T SD1fl FL, ~ n h Good f Lxk,~. V~ 4 cS Approved Barrier Cover Fill Material Distribution Celt Cap- flG~ X ' T - - `Tilled Area - ~i - Slope Figure 3. Detailed cross-section of a mound D C), Cross Sectian Of A 1►tound gYstem Usin F Q A Std For TM Absorption Arta G A __s2__. Ft. F. I , I h, Ft. ~a.4 dhQr~ Ft. ~(SF • Y, e10 F t PVD ► Alternate Position L J)~_ Ft. W 18r Ft. of - Force Main . L. - 4%bservoticn Pipe-~ tox A l i ~TtIP) Ford From a Distribution std Of YZ - 2 r2 Pipe Drain Rock I ~M Observation Pipe Permcnent• Marker . P! pe or Rods Plcn Yew Ot. Mound Hein A Sod for The Absorption Ar~Q `r' t.';c".. ' - . -•te-;;:- -a-.. _ , t;.>.: dQW~`.=::-GSM' ~;:y; ~i:. •-f :.eG•:. . ~1T4~Y"ia`v~~ M~-•.i.'' .:•-r~..s:.:~:t - ,-f9 L 1'1 iJ EV 1LLERS 11'1 ice. . 1v-iL r f Distribution Pipe Layout Page of Place the holes at the bottom of the distribution pipes at equal spacing. Remove all burrs from the pipe and holes. Extend the end of each lateral up with the use of long turn or 45, fitdzg to a point witbia six inches of the fhal grade. Terminate the ends of the laterals with a valve. threaded csp or threaded plug. Provide ace;ss from final grade for the valve; thresde3 ap or threaded plug. Y~,p~cs~ t. trcass st~ur~ pVC D C.- Lateral M=nrf~ol~ V\t C.- _ J~aiS3 ?'i: Y t z/1 x,2 x : Y ltttrtl Ctrgth - P ist~' on 'n~ ' P l.t~rtJ V \ ~ t~ cam-( O/~• t LG e (o" (IrI P, Au. a. - _ rfct. Aux • i--1=oCC~ nty.• . P 4 8.7 Ft Hole "Diameter inch S--L~_Ft . Lateral " winch(es) X 22 Inches Manifold " Z inches Force Main inches #of holes/pipe 21 Invert. Elevation of-Laterals i n' 5 Ft. G.P.M. Page_~? Of_.7 SEPTIC TANK 6,PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" VENT PIPE 12" MIN. ABOVE GRADE & WEATHERPROOF 2:251 FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE ZWITH CONDUIT MANHOLE COVER FINISHED GRADE W/ PADLOCK E 7, WARNING LABEL y ;~-4" MIN. 18" IN. 6" MAX. ~l 1 INLET i' WATER TIGHT SEALS GAS- , TIGHT I rA PPROVE D A SEAL OINTS WITH APPROVED ALM PPROVED PIPE PIPE O N ' ONTO C OLID SOIL PUMP OFF ELEV . FT. OFF RISER EXIT D ERMITTED ONL F TANK ~L q3p MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAL SPECIFICATIONS SEPTIC / DOSE ,S TANK MANUFACTURER: h) Le, r) NUMBER DOSES PER DAY:' «Oy-Zf. TANK SIZES: SEPTIC j6 GAL. DOSE VOLUME INCLUDING DOSE r1$o GAL. FLOWBACK: 141, 3 GAL. ALARM MANUFACTURER: Sit ec v 0 CAPACITIES: A = ~ INCHES = 4()() AL. MODEL NUMBER: 1 d ~ -11 CORRESPONDENCE SWITCH TYPE: YYievc r~ B = 2 INCHES = 32,2 GAL. PUMP MANUFACTURER: CGt;IrLr- C = B, INCHES = )q~, Z GAL. MODEL NUMBER : 15 SWITCH TYPE: mrvcwr~ D = L INCHES = _L N. Oq GAL. REQUIRED DISCHARGE RATE 55.4 GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . . FEET + _ FEET FORCEMAIN X FT/100 FT. FRICTION FACTOR . . qj FEET TOTAL DYNAMIC HEAD = FEET INTERNAL-DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH ; DIAMETER LIQUID =Tg i,,~.@ t:6tsR Fa T`i e i T.:r w 7 r~~. - F~_N4_ ~L` 1 ( 1~1 A IUI I~~a A "7 r TOTAL DYNAMIC HEAD/CAPACITY HEAD CAPACITY CURVE PER MINUTE -EFFLUENT AND DEwaTERING MODEL 152/153 MODEL 152 153 J 50 Feet Meters Gal. Liters Gal. Liters 153 5 1.5 69 261 77 291 :2 a0 10 11 61 231 70 265 t52 15 4.6 53 .201 61 231 a T 20 6.1 44 167 52 197 30 _ 25 7.6 34 129 42 159 8 - 30 9.1. 23 87 33 125 20 35 10.7 22 85 0 40 12.2 11 42 4 - Lock Valve: 38.0 Ft. (11.6m)144,0 Ft. (13.4m) 10 014501 011 20 40 60 80 100 GALLONS 6 l /4 LITERS 0 80 t 60 240 320 3 27/32 4 5/6 FLOW PER MWUTE 3 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS _ Timed dosing panels available. I ® 3 27/32 Electrical alternators, for duplex systems, are available and supplied with - an alarm Variable level control switches are available for controlling single phase 1 systems. ' I • Double piggyback variable level float switches are available for variable level long and short cycle controls. l • Sealed Qwik-Box available for outdoor installations. See FM1420. • Over 130'17. (54'C.) special quotation required. l 1521153 Series 12 1/8 1521151 MODELS Control SNecdon taod.l vorts•Ph mode Sln11ex Ou lex s 1/a N152 ' 115 1 Non aS 1 2 or 3 IL I BN152 ! 115 .1 rub 8 5 4rAded 2 or 3 staoea E152 : 23D 1 Non 4.3 1 2or3 BE152. 230 1 Auto 4.3 YrAded 2or3 N153 : 115 1 Non 10.5 1 2or3 Bk153 115 1 Auld 10.5 Inckded 2or3 SELECTION GUIDE E153 230 1 Non 5 3 1 2o,3 1. Single piggyback variable level float switch or double pggyback variable " float BEi53. 230 t 1 Auld 5.3 Included 2ar3 switt9l. Refer to FbA0477. a CAUTION 2. See FMO712 for tarred model of Electrical Akernalor E I)& All msWiation or controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10 TM used as a owdml activator, spa* duplex (3) 1•censed electrician. All electrical and safety codes should be followed Including the most OC fb8t recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAL 7M P.O.OW 1047 £ Labloft'Xy 4a? f1 Run tdrrbdlrarsof.. Si0A To. 3U9 N4Cane Rtar Road _ e Laufal. KY 40211.1961Y plftfRl PllMf' !O. (3" 776273(• 1(M 92d PUAfP hirp:MvwW Z0*11*r tom FAX (SM 7743424 0 Copyright 2001 Zoeller Co. All tights reserved. k ' III Q° O II II O C _ N r- a0 N U C O N N V N u O d U Qj cq N O C6 LC) u U~ U Uli O N O U m IWHI co cfl E CO U N C2 u d O w O U 2 Q cn Y d U O Q cn 00 U a CO N d co u> ~ v v z cO N OJ v O LL CO o cn o 04 cfl w ~ Lf7 CMO cn J. O~~ w o ( J Ow ¢o LU CO~ LLJ LL- Y p F- U LL LLI U) Z OLn Uf LLI M r- U -1 ►n m a vU J N L¢L Z Q~ V RRR~Ie N J 0 C= 1 l~d1 dMdmF- LU -j -i YO- i tO Z Q \\\\\u\\\\\\\\\\\\\\ F- w 0Q JrtF-JF- F- d d O O 0 _0 _0 M -I tv hor n 9'> O= LFFi cnc0 0;u r- A Z cn C 00 G) cN cn C Z c _ 0 ' O n r m G-) n m ' 0 0C zX c S?o m n ~ o cn = zm c z m -i m m .=A X m cn m ~ Z o ~j o Z \LI'S v o - 0o cr o W N ~ .p, W O W W W ~ O CTl N A Ali _ o rY Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. 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 for frost protection. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG. 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 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [SBD-10572-P (R. 6/99)] 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. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions on the operation or maintenance of this system should be directed to your county zoning or health inspector. Oct-19-2010 01:59 PM St. Crcix County Plan/Zon ng 715-386-4686 1111 ST. CROIX COUNTY .92PTIC TANK MAINTENANCE AGREEM)~NT AND OWNERSHIP CERTIFICATION FORM Owner/311yer _ alw egu'c~ ~7 J / 'fog- -2f ! o S'e Mttilitlg Address _ 5J7S' -76 Property Address Ql ~P e ~s GC/~ do7 3 (Verification required front Planning & nin'S for now constiucti6n,) City/State Parcel Identification Number L UAL DIESCR PTION Property Location _,~k '/q Sec. -U_, T _aLN R W, Town o / Subdivision Plat: Lot # Certified Survey Map # 9aio J ~.f , Volume, Page # Warranty Deed # l5( 5 (before 2007)Volunte Page # Spec house yes o Lot lines identiliablo - yes 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 fttnction of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities arc 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 waslewaier disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessury), the septic tank is less than P3 Rill of sludge. 1/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards sot fortlt, herein, us set by the Department of Commerce and the Department of Natural Resources, State of Wisemsin. 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 this form are trite to the best of my/our knowledge. 11we am/are the owner(s) of the property described above, by rrmnty deed recorded in Register of Deeds Offlem Number of bed •ooms a0A SIGNATURE OF PLICANT ATE ***Any infotmation 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) i llllll 41111 11111 dill Illll Ilill 1111 llllli 1111 ills # 8 7 1 8 6 5 1 871865 STATE BAR OF WISCONSIN FORM 2- 2000 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO., WI RECEIVED FOR RECORD THIS DEED, made between Lee Christianson, a married person, 04/01/2008 03:20PM Grantor, and Gary B. Monroe and Mary K. Morseth, husband and wife, as WARRANTY DEED Survivorship Marital Property, Grantee. EXEMPT I Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE: 11,00 the following described real estate in St. Croix County, State of Wisconsin: TRANS FEE: 699.00 Outlot 1, of Certified Survey Map filed in Volume 20 of Certified Survey PAGES: 1 Maps, page 5153 as Document No. 817258, located in part of the NE 1/4 of the NW '/4 and part of the SE of the NW '/4 of Section 11, T28N, RI 8W, Town of Kinniekinnic, St. Croix County, Wisconsin; being part of Lot 4 of Certified Survey Map recorded in Volume 10, page 2861. Recording Area AETIIM V. { eYn,,bn n n d 10 117 "M LMSEMM Exceptions to warranties: 33001T UMMORSOUTN.WK160 Easements, restrictions and rights-of-way of record, if any, 846488 MOfAP0U6► W SM 2211 022-1030-95-150 Parcel Identification Number (PIN) This is not homestead property. metro Legal Services Dated this 26th day of March, 2008. FDIRET 946488 A 855845 \'.rD 47'.392 * e Christianson r * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) _,0hPC1 YOW ST. CROIX COUNTY. )Ss. authenticated this 26th day of March, 2008NOtary public !^}'tQ ~f,NConSEn Personally came before me this March 26, 2008 the above * - named Lee Christianson, a married person to me known to be the person(s) who executed the foregoing instrument and TITLE: MEMBER STATE BAR OF WISCONSIN acknowledged th s me. - (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY *Cheri Brown Frain & Bergman Notary Public, State of Wisconsin Peterson, - Steven H. Bruns My commission is permanent. (If not, state expiration date: 50 East Fifth Street, St. Paul, MN 55101 2/27/2011 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature WARRANTY DEED STATE BAR OF WISCONSIN FORM NoZ-2000 sue. RECEIVft' Wisconsin Department of Commerce MAY O 9 2013SOIL EVALUATION REPORT -Page -L- of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code 7Y County S Attach complete site plan on paper not IKs~a~IfN 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 0 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. "f Please print all information. R sewed by _ Date G~ 2 Personal information you provide may be used for secondary purposes &A L 1 Property Owner Property Location FJ ~-wC ~1 ref t r 5C t Govt. Lot r_ 114 k11/4 S' T q 8 N R` E (or W Property Owner's Mailing Addrees Lot # Bloyk # Subd. Name or CSM# 9 ) C~~f , ew I Csln At 9 s V.1 2D S~s3 City . State Zi Code Phone Number ❑ City ❑ Village Town Nearest Road D ~T c ) ICs n/ t ~Y ~lsJ:C 402 Z, I New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate D~ GPD ❑ Replacement ❑ Public or gommercial - Describe: Parent material "17)1 i9 U,GY 9.nd olbp ' Flood Plain elevation if applicable JEJ ft• General comments ,ri► dkn ~~~j;, ~~~~ca S~ and recommendations: I h ota, d ( n 0- Boring # Boring Do ( pit Ground surface elev. ~1-1,115-- ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 6-14 ( z, 19 Yn Y Cr 6 0. ~O z -1 ra s T r t, 0.4 Q. 3 3~- 4 I; S ° c 0 m C 0. 0.0 arc' 0. 4 Boring # ❑ Boring . ❑ Ground surface elev. ~s ft. Depth to limiting factor in. pit Soil Application Rate Horizon . Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 6.9 I o,Y6 loya 3 z s hh cs a~ 6 2 16-141 1a 24 3 - Sr` s01 0. 3 -2 ~,s 2 0 n s ti 0 G, f '20 9~ 10 W7 5 " Effluent #1 = BODs > 30 < 220 mg/L and T S >30 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Prin) _ CST Number x7r%~' ~A V- Address , Date Evaluation Conducted Telephone Number 1L -2 as - ,'3 / .I o~ti c n1 a I i e .c.-, ~ ~ w Acv R594 Property Owner Qhk t! O Q'a 0 G Parcel ID # Page of _ 3] Boring # ❑ Boring ® Pit Ground surface elev. g/. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/1`12 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 v 41 -3 ° c I m t-n s -V~, A b, 6 3 0 si'1~4 f 17, Z,, G W6- s i v n o ❑ 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/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I --T J ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. A Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 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. SBD-6330 (R.07=) nNRO oz2 ►c 5.9s-isa PLO T PLA N g_- ti 13,5 d AGe~ E5 f f ~J a, Q►~ v ~v, trv~~ J N. t/ IN ti`tty may Sf Mkt + rv 1 a oa \ L 0 Q C? D 92A f1.. q 45 b i ~ cil, 2 10 Lt-gip q~,583Et.a8'I C-~Ot -70P - RebAl +~a S6o,, E'Lc~4 i _ hI b~ . r V-C-1Dr FL Sai.~ 08:23 AM Parcel 022-1030-95-150 05/10/2013 PAGE E 1 1 OF 1 F 1 Alt. Parcel 11.28.18.168A-15 022 - TOWN OF KINNICKINNIC Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 01/20/2011 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - MONROE, GARY B GARY B MONROE C - MORSETH, MARY K MARY K MORSETH 8975 COFFMAN PATH INVER GROVE HEIGHTS MN 55076 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description 479 OLD CEMETERY RD SC 4893 SCH DIST RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 14.110 Plat: 5730-CSM 24-5730 022/2010 SEC 11 T28N R1 8W PT E 1/2 NW1/4; FKA LOT Block/Condo Bldg: LOT 01 4 OF CSM 10/2861 EXC CSM 19-4944 FKA CSM 20-5153 OUTLOT 1; NKA CSM 24-5730 LOT 1 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) (14.110AC) 11-28N-18W NW Notes: Parcel History: RETIRED 2010 FOR 2011; KEPT SAME PID, Date Doc # Vol/Page Type ONLY ADDING SETBACKS (168A-15) 06/21/2012 958611 AGREE 022-1030-95-150 09/13/2010 922441 24/5730 CSM 04/01/2008 871865 WD 01/26/2006 817258 CSM more... 2013 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 05/03/2012 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 50,000 22,500 72,500 NO AGRICULTURAL G4 8.000 1,300 0 1,300 NO AGRICULTURAL FOREST G5M 4.110 10,000 0 10,000 NO Totals for 2013: General Property 14.110 61,300 22,500 83,800 Woodland 0.000 0 0 Totals for 2012: General Property 14.110 61,300 22,500 83,800 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 06905 Tx:4005375 922441 `~►►►""'~a~~~ BETH PABST D v z m (n z p 0 REGISTER OF DEEDS ■ ■ O O? m 4 :'N i A -0 - C 1 ~ ST. CROIX CO., WI ~+r N u,'"g ;n ; o = 3 c~ o Z RECEIVED FOR RECORD c ID- "o a "gym 09/13/20103:41 PM A o n r yzi -Q n 1c'0 = u~ _ Zz Orn EXEMPT N/A m o ° m rn 0 $ REC FEE: 30.00 0 m %,Oi••......... N z COPY FEE: 3.00 m z' zp O Z PAGES: 2 rn c z O " TTp mz c m --A CD g ~ z o ~~\I/~S,~FQ 0 n oz ~•n0 mmD v o N \ 4 z 0m ti -4 Q - m-~~~v~O~cncns~~ \ ~R ~s \G~~4 0 z Z O ~Ypmm= = J' \ m~pD Om 7, r 1(9 -11 m C) -n (b z-moom z>0 m mX~~ OQmNmZ JR, ~s \ co DD0Z_D 0 ppT OD 7b -I mTm=jo OZO \CJ 61 A~ Z gc05 Zm-0c'' -zg:j p:x) DU„= a pG M I 2~2NPZK'Zocs mim gov~~ zm ~N f no' _ D m~Oac'y5~ m mom m0 0 mw to Z OZ-n ~ W '.FROM O.H.W.M. r = I. 0 z C7 '11 I m cn Its m 25 ~•O IN NV 2 D A D to .........N I I--+) Z zz 0 31 a' O Q I~ Z~ I' IA Z' G I~ 4 m O p CD cn cn N) O INI~ N o oQ QnJ h•C) =rte lO U N to I~ I~ In o o"-~ - m z D W _ IvJ n z Z z -4 -1 0) ~p x T- 10 - 0 p c~G I C m pi I~ I0 III m ,~5 - - - _ p N I .w m -Ni n -n ° _ o Tx m 00 ct) o n rn <O..i~ Z - a 'o OKI K Z C0 z m 3Cm~ 0 m mZ,A D O 04 m7 D 0 .Z W • m 2 r II A_ N Z m 0 m CA z -40 K m? W N ° S00°20'33'E NORTH SOUTH 1/4 LINE S00°20'33"E O ~j n Z z 3447.20' SOO°20'33"E 639.99 1312.23 z P p (D (NO0°20'41 W z m 90 UNPLATTED LANDS z 50 k ^ - - - z N m BEARINGS ARE REFERENCED TO THE NORTH - SOUTH 1/4 LINE BEARING o S00°20'33"E. ST. CROIX COUNTY COORD. SYSTEM. 1 of2 Vol. 24 Page 5730