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012-2001-70-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 563829 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: Cunningham, Sophia Erin Prairie, Town of 012-2001-70-000 CST BM Elev: Insp. BM Elev: BM Description.-a Section/Town/Range/Map No: lU rVA C-ST 04.30.17.567B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURE CAPACITY STATION BS HI FS ELEV. 5 oaf 0 3-7 Septic Benchmark ~aao #.7 Ai*' Dosing .4-;t Alt. BM e.t.a & ;t ~ Aeratwn Bldg. Sewer i^ b P.66 16 5'Z _5 Holding St/Ht Inlet ' `V TANK SETBACK INFORMATION St/Ht Outtlle` T w 11717 . 5 t TANK TO P/L WELL BLDG. Pu =P nt to Air Intake ROAD Dt Inlet 6 "Lt. 9~. S tic 7 5 h 211 D o om &..•406 Je /1. 5 ~I Z. Z D sing 5Q Z I Header/Man. 2 2. -7 9 166 .7 Z Aeration Dist. Pipe q Holding Bot. System Z • / l0Q 3.0 /ad . 0 Final Grade PUMP/SIPHON INFORMATION Ad 1, 7 27 Manufacturer 1-C Demand St Cover ` b 6l l~~ GPM / ASb 3. Ia 40 Model Number 12, 3 / 4 ~Z TDH Lift JL~ Friction Loss System Head TD q 1 19 7 t Forcemain Lengtl , / Ta. Z 1 Dist. to Well yy SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length No9 f Tren s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / "15 '1 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type ystem: u'\ Ov 33 S7 UNIT Model Number: \ DISTRIBUTION SYSTEM Header/Manif / Distribution x Hole Size , x Hole Spacin / V t o Air Intake f Length_ 3L Dia _ L-0 Dia l 6 Spacing 3 3j, 4 / 316 V CL q L SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xxDepth of ~y xx Seeded/So ed Ixx nZs Depth O Center t' Bed/Trench O Edges Topsoil s ~ No 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: '~O/ Inspection #2: / Location: 1792 176th St. New Richmond Ivl 54017 (NW 1/4 NE 4 T300N R1A7W) Jewett Mills Lot 1-7&39-4(~ arcel No: .30.17.5B 1.) Alt BM Description ScX~ 2.) Bldg sewer length = t P.1'~ P/6 - amount of cover = is ~t I Plan revision Required? [C' Yes in o ~ Use other side for additional informa,J SBD-6710 (R.3/97) Date Insepctor' Signature Cert. No. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 1792 176th Street, New Richmond, Wl 54017 located at: NW 1/4, NW '/4, Section 4 , Town 30 N, Range 17 W, Town of Erin Prairie , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service July 16, 2013 Did flow back occur from absorption system? Yes No X (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1000 Construction: Prefab Concrete X Steel Other Manufacturer (if known): Unknown Age of Tank (if known): Unknown Permit number (if known) L,~& John Schmii (Li used Plumber Signature) (Print Name) MPRS 223760 (Title) (License Number) MP/MPRS -/-/G -13 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 PLOT PLAN N Project Name: Cunningham 3 Bedroom Mound Legal Description: NW114, NW1/4, S4,T30N, R17W P.I.D: 012-2001-70-000 Subdivision Name: Lot NA Township: ERIN PRAIRIE Parcel Size: 1.13 Acres SCALE: 1" = 40' County: ST. CROIX Contour Line Elevation: 98.90' Cell Dimensions: W X 75' 4 inch Sch 40 -ASTM D2665 System Elevation 99.90' Mound Dimensions: 21.14'X 92.47' 2 inch Sch 40 -ASTM D1785 Slope: 2%u 11/2 Sch 40 -ASTM D1785 A BM1 Elevation: 100.00' Top of septic tank cover BM2 Elevation: 100.60' To of cement propane tank pad SW corner ■ Backhoe Pits: CD~NT K ~ - i NCZTH PL cry /w I 1 / BeDeCeA ® Zq SLe~~ #83 ~I WtauSc WELL N O, 1_ o _ ~6 r u CONT ~2 - ~O' 2' oL'y Cc r: SL l~ j BUG y ~OjZCC rW t31ly V1 Exts, /~1 (v 2- 1. X9•Z.10 i _ _D2111Ni:,e'LJ _I E%i5 ~~Ln GARAGE I P I V E )0Wi h+ P1, County / ` Safety and Buildings Division !5T. C'e0 l )'r ! 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) t sp A RECEIVED Madison, WI 53707-7162 ~ s . ww" ~6Y.:.. 1 it it n 9; Sani Permit Application State T~ransaction(N~umber in accordance with SPS 3 wm:'Code, submission of this form to the appropriate governmental unit 5 / / is required prior to obtai a it. Note: Application fors for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of ty essional Scrvies. Personal information you provide may be used for secondary purposes in accor ith the aw, s. 15.0 1 m , Stats. 1. Application In ormation - Please Print All Information Property Owner's Name Parcel # - DO CJ 0p14r A M/V/ N G,14,r4ry1 ANd o kJ t-)Kc STOrJ 01Z, - Z 00 1-70 Property Owner's Mailing Address Property Location 1 7 Z 7& S I-0ee t ( Govt. Lot City, State t Zip Code Phone Number N LV y, ~L) Section LtJ tC f l /V Q W _,5-W/7 T 0 N' R ~rclE or one) H. Type of Building (check all that apply) 2 Lot # ~f Z 1 or 2 Family Dwelling - Number of Bes J l y Sub/d/ivi/s/ion, Name Q ~'1Lr.S Block# Vv ❑ Public/Commercial - Describe Use 7 ❑ City of ❑ State Owned - Describe Use CSM Number ❑ village of Townof tf2--N AeW,(,e--r III. Type of Permit: (Chec one o ine A. Complete line B if applicable) 'k Q" A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner SyCf / l 97 1 IV. TY_pc of POWTS System/Component/Device: Check all that ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ound ?124 in. of suitable soil ❑ ound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) etreatmen evice (explain) V. Dis ersal/Treatment Area Information: Des' Flow (gpd) Design Soil Applica on gpdsf) Dispersal Area Require sf) Dispersal Area Proposed (sf) System Elevation Sa - ~ 1 //Z5//` } %9- VI. Tank Info apacity in Total of Manufacturer Gallons Gallons Units 4 n v y W 11(9L ~LO I~ New Tanks Existing Tanks / d c a O t+c) P. U rA H w C7 rms. Septic or Holding Tank 14900 / 0Q 0 Z ? Z / c 5~,:~C Dosing Chamber O 6 5 0 w E S - VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's gna a MP/MPRS Number Business Phone Number Jvwj Scgin i rr Z-//t Z/~~ ZZ376 v 711-764- O Ye6 Plumber's Address (Street, City, State, Zip Code) ~S- VI oun /De partment Use Only j ! Permit Fee Date Issued Approved Disapproved Issuing Age Signature I ❑ - ❑ Owner Given Reason for Denial IX. Con UReasons for Disapproval 1. Septic tank, effluent filter and dispersal cell must .fZe-;;aryiced / maintained r as per management plan provided by plumber, 3 2. All setback requirements must be maintained -03 a$ per $For the system an 't to the County only on luVernotless than 1/2 r• in es in size SBD-6398 (R. 11/11) 9EyART, k DIVISION OF INDUSTRY SERVICES ~yti~~To~ 3824 N CREEKSIDE LA 0 9~ HOLMEN WI 54636 3 D S t Contact Through Relay www.dsps.wi.gov/sb/ P $ w www.wisconsin.gov a `o ~0 SIONA~ S~ Scott Walker, Governor Dave Ross, Secretary June 27, 2013 CUST ID No. 223760 ATTN. POWTS Inspector JOHN F SCHMITT ZONING OFFICE SCHMITT & SONS EXCAVATING ST CROIX COUNTY SPIA 616 150TH AVE 1101 CARMICHAEL RD SOMERSET WI 54025 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/27/2015 SITE: Cunningham Identification Numbers Sophia Street Transaction ID No. 2259618 1792 a a C Town of Erin Prairie Site ID No. 791972 St Croix County Please refer to both identification numbers, NW1/4, NWl/4, S4, T30N, R17W above, in all correspondence with the agency. FOR: Description: Three Bedroom Mound System / 4% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1433732 Maintenance required; Replacement system; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01101, 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. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. co The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. IDEPT No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, PROFES stats. DMSION OF The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the SEE O 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. • All POWTS component piping material shall be SPS 384, Wis. Adm. Code compliant. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • A copy of the approved plans specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. JOHN F SCHMITT Page 2 6/27/2013 Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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 Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 ~iiThis Amount Will Be Invoiced. rard M Swim When You Receive That Invoice, POWTS Plan Reviewer, Integrated Services Please Include a Copy With Your (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm Payment Submittal. jeny.swim@wisconsin.gov W,iSMART code: 7633 cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to # the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered i v.' i-Ind addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. .J MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Cunningham 3 Bedroom Mound RECEIVED Owners Name: Sophia Cunningham JUN 10 2013 Owner's Address 1792 176th Street INDUSTRY SERVICES New Richmond, WI 54017 Legal Description: NW1/4, NW1/4, S4, T30N, R17W Township Erin Prairie County: St. Croix Subdivision Name: Lot Number: 1 Block Number Parcel I.D. Number 012-2001-70-000 DITIONALLY 'PROVED Plan Transaction No. F SAFETY AND Page 1 Index and title ZONAL SERVICES Page 2 Data entry NDUSTRY SERVICES Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications • Page 6 Management and contingency plan ; Page 7 Septic & Dose tank specifications Page 8 Effluent filter information Page 9 & 10 Pump specifications and curve Page 11 Plot plan Page 12 Septic tank maintenance agreement Page 13 Existing Septic Tank Certification Page 14 Warranty deed Page 15 CSM/Map Page 16 - 18 Soil evaluation report Designer: John Schmitt License Number: 223760 Date: 6/3/2013 Phone Number: 715-760-0486 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD-10691-P (N. 01/01) and both SSWMP Publication 9.6 Design of pressure Distribution Networks for ST-SAS (10/81) and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706-P (N. 01/01) Version 7.0 (R. 03/2012) Page 1 of 18 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 38344-3 in-situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of - 36 inches. 450.00 Design Flow (gpd) 4.00 Site Slope 98.90 Contour Line Elevation (ft) 24.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) C Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation (ft) 4 Number of Laterals of the highest point. 0.188 Orifice Diameter (in) 2.50 Estimated Orifice Spacing (ft) = 7.50 fe/orifice 2.00 Forcemain Diameter (in) 60.00 Forcemain Length (ft) Does the forcemain drain back? Y 88.00 Pump Tank Elevation (ft) Enter Y or N 3.25 System Head (ft) x 1.3 9.79 Forcemain Drainback (gal) 11.49 Vertical Lift (ft) 67.32 5x Void Volume (gal) 1.92 Friction Loss (ft) 77.11 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 39.32 System Demand (gpm) 16.66 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 1.25 x 2.00 x x 1.50 x x 3.00 2.00 x 3.00 x Gallonslinch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser Manufacturer gaUin (enter result in cell B49) Dose Tank Information Effluent Filter Information 650.00 Dose Tank Capacity (gal) PolyLok Commercial Filter Manufacturer 17.00 Dose Tank Volume (gaUin) 525 Filter Model Number Weiser Manufacturer Project: Cunningham 3 Bedroom Mound Page 2 of 7 Mound Plan and Cross Section Views T -::1/10 B J Observation Pipe T }5` A W B I 40 L Mound Component Dimensions Down slope toe extension made. A 6.00 ft E 14.88 in H 1.00 ft K 8.74 ft B 75.00 ft F 9.50 in z 9.00 ft L 92.47 ft D 12.00 G 0.50 ft J 6.14ft W 21.14 ft 450.00 (ft2) Dispersal Cell Area 1125.00 (fl?) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.69 (ft) G * H 1 T F Dispersal l " Cell 100.40 (ft) Lateral 99.90 (ft)-► - Invert Dispersal Cell 3 E = D 3 Elevation 98.90 (ft) Contour Elevation 4.0 % Site Slope Geotextile Fabric Cover Shading Key m c. I Dispersal Cell See lateral details on 1.5 ft Page 4 for number, size, 1❑ _ Topsoil Cap c Q- . Subsoil Cap o and spacing of laterals. ASTM C33 Sand .-`0a Z Laterals are equally g Tilled Layer 0.5 ft Typical I ateral F spaced from the n5 Aggregate v c ? I distribution cell's centerline in the A * distribution cell (AxB). Project: Project: Cunningham 3 Bedroom Mound Page 3 of 7 Center Connection Lateral Layout Diagram Force main connection %ia tee or cross to manifold at any point. Laterals are identical ri =39 -IF P S •=Turn-upwfball valve or I<- X~IEal2 W2~ Laterals MorcemaktSch40PVC cleanoutplug per SPS Table 384.30.6 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.188 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 36.69 ft Orifices per Lateral 15 Lateral Spacing (S) 3.00 ft Orifice Density 7.50 ft2/orifice Lateral Flow Rate 9.83 gpm Manifold Length 3.00 ft System Flow Rate 39.32 gpm Manifold Diameter 2.00 in Total Dynamic Head 16.66 ft Forcemain Velocity 4.02 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 WAG 4 in. min. Disconnect Tank component is properly vented ' Alternate outlet location Forcemain diameter Weiser Manufacturer 2 in. Capacityl 650.00 Gallons Volume 17.00 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 20.80 353.59 C B 2.00 34.00 Pump off elevation (ft) C 4.54 77.11 88.91 D 10.90 185.30 D Total 38.24 650.00 Dose tank elevation (ft) Bedding un er tank. 88.00 Alarm Manuafacturer Septronics Note: Switches Alarm Model Number TM-1 I containing mercury may not be used in Pump Manufacturer Zoeller this system. Pump Model Number 152 Pump Must Deliver 39.32 gpm at 16.66 ft TDH Project: Cunningham 3 Bedroom Mound Page 4 of 7 Mound System Maintenance and Operation Specifications Service Provider's Name John Schmitt Phone 715-760-0486 POWTS Regulator's Name St. Croix County Zoning Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once 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 ponding and seepage once every 3 years 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 Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Cunningham 3 Bedroom Mound Page 5 of 7 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 (01181), 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 BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5, 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. Continency 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: Page 6 of 7 D Z x 544" AS 84» REOD 43" z z m C ~ D W A m UP 7'. \ m 4" S D N 3" 461" I 5" r I co D N 0 38" m rD- m v ~ D ° 0 I I N UP 40" v 4" CAS , g ~ m 0 m z c 0 r~* c: z > 41" ~ -4 D D m N I D I cn m D r ro g c ~ ? -z+ Dv Si m D in z 0 D z z O^ D O~+D cw*Rmcomf o Z r -t0 R ~mz Zr-7C 0 n OgZ D =ZOrOZr*rDOO~ xX u OrV1 O D ~AO (nA0 =C0lf0==AArZ coo mm m n m g <x ccn rri n ;u c -4 °zo mNO -r°~~.qp-rw1n ~ O ID ZO o m U) r rl+ ~Z~ 0 1 Fj a, cx- all m O OAFn m Dm _ O D 8% =A N I*1 D r1* Cm O o~ tnmy I m $01)C$ U) Z Zm = ON cn p~ Dr _ ~0. n v U 7zC o o ^c N ~o -0 oz z 0c) mmRi mm o v~ D O 10 ;u D < z w to 0 C-1 = C ~ to rr nD Dg r v m m C7m n m o D 2r-z r~ O A 0 -0 ;a Z v mo F N n1 < v m p H Z A ; z z m D D c D v0~ 8;0 y, Z 4 -v z c o K m r--n c K-u M * 0 o -r1 CD 00 fZ ;a D 3 m ;o A-4 _o m~ m D ;a r c M r o ;u H Z A m O ~ m \ U) KP1000/650-MR o m NIENER CONCRETE DRAWN BY: SIRE SR 1 4`=1'-0` PIS-POUR: SEPTIC MANUAL DATE JANUARY 2010 DATE:. PO POUR: \ Z W3716 US HWY 10 MAIDEN ROCK, WI 54750 o REVISED JAN. 2010 800-325-8456 RLE: ■MOW/W-W V • o Filters PL-525 EFFLUENT FILTER (COMMERCIAL) Polylok, Inc is pleased to add its new commercial filter to its existing i line of quality effluent filters.The PL-525 is rated for over 10,000 GPD warm (gallons per day) making it one of accessibility s ~c the largest commercial filters in its e7te/S1O" ~"~e class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the new Polylok PL-525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1/16" removed for cleaning, the ball will filtration slots Rated for over float up and temporarily shut off 10,000 GPD the system so the effluent won't leave the tank. No other Fllter on the market can make that claim! Accepts 4" & 6" SCHD. 40 Pipe PL-525 Maintenance: The PL-525 Effluent Filter should operate efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If the installed filter contains an optional alarm, the owner will be notified - by an alarm when the filter needs servicing. Servicing should be Gas deflector done by a certified septic tank Automatic shut-off pumper or installer. ball when filter 1. Locate the outlet of the U.S. Patent No# 6,015,488 is removed septic tank. 5,871,640 2. Remove tank cover and pump tank if necessary. PL-525 Installation: 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the tank. Make sure all solids fall 4 or 6 outlet pipe. If the filter is not centered under the bads into septic tank. access opening use a Polylok 6. Insert the filter cartridge back Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL-525 filter into completely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic tank cover. q SECTION: 2.20.047 QL/ ITY P/MP6 iYCE 19, 7 FM1919 0110 Supe rsedes Product information presented iW here refls conditions ac time PUM® 1108 of publication. Consult factory regarding discrepancies or inconsistencies. MAIL T0: P.O. BOX 16347 • Louisville, KY 40256-0347 visit our web site: SHIP TO. 3649 Cane Run Road • Louisville, KY 40211-1961 www.zoeller com (502) 778-2731. 1(800) 928-PUMP • FAX (502) 774-3624 COMPARE THESE FEATURES • Durable cast iron construction 151/1521153 EFFLUENT SERIES • Model 151 comes standard with a glass-filled polypropylene base (For Pump Prefix Identification see News & Views W52) • Corrosion resistant powder coated epoxy finish • Stainless steel lifting handle "DOSE=MATE" • Assembled with stainless steel bolts • Non-clogging engineered thermoplastic vortex FOR SEPTIC TANK - LOW PRESSURE PIPE (LPP) impeller design AND ENHANCED FLOW STEP SYSTEMS • Model 151 -1 /3 HP passes 1/i spherical solids EFFLUENT • Model 152 -.4 HP passes 1/4" spherical solids SUBMERSIBLE • Model 153 -112 HP passes 34" spherical solids 1%" NPT DISCHARGE • Motor - 60 Hz, 3450 RPM, oil-filled, hermetically sealed, automatic reset thermal overload protected Model N152IN153 • Carbon/Ceramic seals High Head cco _U S • Upper sleeve bearing and lower ball bearing running Tested 10 ULSMndardUL778 Effluent in bath of oil MWC69WtoCSA Standard CSA22.2 No. 108 • 20 ft. UL Listed power cord with molded 3-wire plug • 1 NPT vertical discharge MODELS AVAILABLE • BN and BE standard models include a 20 ft. variable N151/N152/N153 & E151/E152IE153 nonautomatic level float switch BN151/BN152/BN153 & BE1511BE15ME153 °F °C packaged with Piggyback Variable Level Float Switch • Operates at temperatures to 130(54) in effluent 1/3_4 & 112 HP,1 Ph 115V or 230V applications • All models include a 11W x 2" PVC adapter fitting Note: The sizing of effluent systems normally requires variable level float(s) controls and properly sized basins to achieve required pumping cycles or dosing timers with nonautomatic pumps. POWDER COATED TOUGH ZiJ-F4tZ1")ff !!J. Model BN152IBN153 MAIL TO: P. O. BOX 16347 High Head Louisville, KY 40256-0347 Effluent SHIP TO: 3649 Cane Run Road Louisville, KY 40211-1961 (502) 778-2731.1(800) 928-PUMP FAX (502) 774-3624 Z Manufacturers of... ~O /p p ® ra.4L/TY PUMPS FNCE 19,7 0 Copyright 2010 Zoeller Co. All rights reserved. TOTAL DYNAMIC HEAD/FLOW 5 LL PUMP PERFORMANCE CURVE PER MINUTE 50 MODEL 151/152/153 EFFLUENT AND DEWATERING 14 45 153 12 MODEL 151 152 153 Feet Meters Gel. Liters Gal Lkers Gal. Liters ° 35 10 152 5 1.5 50 189 69 261 77 291 ~ 30 10 3.0 45 170 61 231 70 265 15 4.6 38 144 53 201 61 231 a 1125 15, 20 6.1 29 110 44 167 52 197 F 25 7.6 16 61 34 129 42 159 6 20 30 9.1 - - 23 87 33 125 35 10.7 - - - - 22 85 ,5 a 40 12-2 - - - - 11 42 10 Slwt-0Ir Head: 30 d. (9.1m) 381E (110„) 44 It. (13.4m) 2 0145088 5 9 Model 151 Models 1521153 10 20 30 40 50 60 70 80 90 100 GALLONS 87!32 671 LITERS 0 40 80 120 160 200 240 280 320 360 3718 4581 3719 46e FLOW PER MINUTE 014508A CONSULT FACTORY FOR 3718 _ 3718 SPECIAL APPLICATIONS j 3We 3718 • Timed dosing panels available a • Electrical alternators, for duplex systems, are available and j j 1 yr WT supplied with an alarm • Variable level control switches are available for controlling I single phase systems • Double piggyback variable level float switches are available I for variable level long and short cycle controls • Sealed Qwik-Box available for outdoor installations - See 12 J8 FM1420 ~ • Over 130°F (54°C) special quotation required I 415„6 sin 15111521153 Series Q-~j j SK2444 SK2064 1511152„53 MODE ts contra selection Model Voss-Ph Mode Amps simplex DO- N151 115 1 Non 6.0 1 2 or 3 BN151 115 1 Auto 6.0 Included 2 or 3 El 51 230 1 Non 3.2 1 2 or 3 BE151 230 1 Auto 3.2 Included 2 or 3 N152 115 1 Non 8.5 1 2 or 3 "ELY agblY" BN152 115 1 Aulo 8.5 Included 2o(3 (PmD 6 dlsd,arp pipe E752 230 1 Non 4.3 1 2 or 3 not included) BE152 230 1 Alto 4.3 Included 2 or 3 N153 15 1 Non 10.5 1 or3 BN153 115 1 Alto 10.5 Included 2 or 3 E153 230 1 Non 5.3 1 2or 3 BE153 230 1 Auto 5.3 Included 2 or 3 SELECTION GUIDE OPTIONAL PUMP STAND P/N 10-2421 1. Single piggyback variable level float switch or double piggyback variable level Reduces potential clogging by debris float switch. Refer to FM0477. Replaces rocks or bricks under the pump 2. See FM0712 for correct model of Electrical Alternator E-Pak. Made of durable, noncorrosive ABS 3. Variable level control switch 10-0743 used as a control activator, specify duplex Raises pump 2" off bottom of basin (3) or (4) float system. Provides the ability to raise intake by adding sections of 132" or 2" PVC piping a catrnoN • Attaches securely to pump All installation of controls, protection devices and wiring should be done by a qualified • Accommodates sump, watering and effluent applications licensed electrician. All electrical and safety codes should be followed including the NOTE: Melee sure flm is free from obstructim most recent National Electrical Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. 0 Copyright 2010 Zoeller Co. All rights reserved. PLOT PLAN N Project Name: Cunningham 3 Bedroom Mound Legal Description: NW114, NW114, S4,T30N, R17W P.I.D: 012-2001-70-000 Subdivision Name: Lot NA Township: ERIN PRAIRIE Parcel Size: 1.13 Acres SCALE: 1°=40' County: ST. CROIX Contour Line Elevation: 98.90' Cell Dimensions: W X 75' 4 inch Sch 40 -ASTM D2665 System Elevation 99.90' Mound Dimensions: 121.14'X 92.47' 2 inch Sch 40 -ASTM D1785 SI0pe: 2% 11/2 Sch 40 -ASTM D1786 BM1 Elevation: 100.00' Top of septic tank cover BM2 Elevation: 100.60' Top of cement ro ane tank ad SW corner Backhoe Pits: cvun/T K - t400-TH PL C.T y ~ r ® Zee 5cor'~ 83 3 BEoeCCA ly J gt HbuSc W eLL ~ J - / ooo1650 a W - ST/ 1) , -I/ 101c SL t, cy/Nu ~Z - Cz0' 2'' P0, v, y F©~LCc rNNiN ~ cx/sn t, , 21.1NX9Z•y~ ~ - DrZ~N~-~etJ ~ Exrs~ GNU T. r11OiJND - - - - -r 0002#4L S. GARAGE D P I v a 5OUT14 PL, fI t L- ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerMuyer Sophia Cunningham and/or Carol Preston Mailing Address 406 Maple Street, Woodville, WI 54028 Property Address 1792 176th Street (Verification required from Planning & Zoning Department for new construction.) City/State New Richmond,Wl Parcel Identification Number 012-2001-70-000 LEGAL DESCRIPTION Property Location NW 1/4, NW 1/4 , Sec. 4 , T 30 N R 17 W, Town of Erin Prairie - Subdivision Plat lut.-H Lot # 37L-. Certified Survey Map # , Volume Page # y Warranty Deed # 1( efore 2007)Volume Page # Spec house 11yeslBno Lot lines identifiable []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 function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/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 Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. 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 booms W3 1 _ 06/ / 25 / 13 PO SIGNATURE 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. 04/12) L, vwl_ Tedancy-or'Lif 867.(345) ar . i m tion'_oflnterestiNnationini Property [S. M7.0461 _cQtm G.qn - - _ Decedents Name.- - r ( - - - I Arnold F Cunningham State - Address _of Decedent at Date-of Death . I REGISTER'S OFFICE D7 eta-lt'scilmvrly. ny ».,att t_ X71 w1V~R~.~✓. vvr - -~r~~ - - - - _ - Social secix* Numbef : dG"i fAf RttC tt Date of Death _ March -<.=-19 '2 %YY T S -10,32 - - h _r - - - _ .presentatton ct Death-Gertitfcale - _ y = - d rn .,oi the.decedent's:death cerEficate 16;,-- 1992 - r'of Deed's signature.. _ Date ~'~istd p¢ pEt~i sr- This Interest ~in-,real estate is terminated under (check one): _ , , , < Record this docurmnt w7h the Register of Deeds - , _rea! estate is /c3cated. 1fLtlTe_aovn„ry whens the _ 867.045=which p"enainG to r at property. us v.h"sch the decedent was a )ant tenant haQ a-r4ndors-er-mortgagee's.+nfe est or_had a-Ide'estate. You must provide a copy- o9 I Recording fee is $5 as per s. 867.045,-867.046. J - - - - - lhe deed estaeiising-fonrtenan~ l - _ Return ic. _s 81;7.046 which peria+n5 to (~i) real property of adecedent specified in a marital I . _ lifCperfy=agieemer and-a o to-(.)zvrAvcrship_rot!nt-+i_p(oper1y_Jyqu must_p,,oviae a + _ - 1 _t the deed es-abhsh;ng sur;nvorShip marital property:) - -Presentation of real propeity-taxbill. Present whit this document a copy of h5e real property tax bill for each parcel for the Yea- rnmedrawly,preceding &cedenrs death. v~ Presentation of beed establishing joint tenancy er survivorship marital property: This deed ,s-found to volume/reel 602 page/fmage 120 of (check one) Records Deed Description of the real estate. Include. only the extent of ownership (or vendor or mortgagee's interest) in land at the time of the decedect's death: If the extent of land is exactly the same as on the deed a copy of the deed maybe attached to describe the real estate The legal de'sc;tipuon-of-the property is as follows: (it more-space is,0eoded, attach pages See following page DECLARATION: 1• we declare that this document is, to the best of my (our) knowledge and belief, true, corrcu and complete and is in l i:r' .C,t$t"t^ /ll.nnrn -na o is nrarfarl atfach narns.I contorm+ty with the provistonsctiu - f i ~.,.n~,r,.a rnb,t~•seartl neiniivi ijiriti iu vc%cvci i y v • . w-_ Name and Address of Person Hecetving i%rpperry I Date :[-ITa- -yaV,__M 2 Sophia S, Cut,.ningham (al kl n Sofia) Wife r 1792 176th. 'St;, 4,7. - y - - _Ney Richmond ht2 54017 % AUTHENTIUAiIUN'gr faC, iCrvurvvj~r~Fa rvrcc. _+~~yy Yrw nr,n..n +.amnrl wrcrv,fcl wac,`rr li, ~ucfgrC ri]9 r~i$~ tY 1Lq ° x_ ~...c T---- ' , ,...,_...r c:.,.ua...o ~t.,.,tm.y>. r,t;,ar i~+s:x\ - _ - ~ • . authorized to admtmtef an oatn Sophia S (as per s 706.06. 706 071 ySA Cunningham i,vni'3 c~b'~.n •,;s • Print or type name J8ri4.q3 v ..r °~fatecfYrsoaurc> S*_,i Croix Tw,w -v i~.l.• ,v,.mrcc:rn s.rrwr-~ y/1,3 ~ 7w.7 I' Not- 7 ~^%,SC6ltLfliiE~'-•1E(l+vre.'.r~ v . w .nrlnirym nr iv i:r-'-•ei _ i 'sTA^ SAR Q ti•es sPAets ia~tttw~".>~1Foa:f~ot0~+wd~+!~. r { 6 r - REGISTF-2S`7FFiE , .tom-,~~ _ R ~~:bra i _ - s~ u~oac coo was. -:C w ` -'R~~ -*~7•,r.~ca~:_: 74; h _778-t-10 ~ ~ t (a !-so 'known as CY, Y ZZ.4 To - -.y'3.i ~ lftit0 ita► $ Cot1Rt} cjr7,i _ e' x Tex Key No 4~=`ss-,'b~ !-""Ri1Q-it`s ~a+ept =tit.~e=~ar.a-~= t7.vu Z®Q~ ~Ea`srsiia _ - - *h,:Lots ' 39E- ►:'40,,='~il 4i diad ,44 t~ ge ~4ie"r vi;th . ~ios~o=t I~ip.~ ~e2e 4S antd -46 lyiatg Souther!"y 'of "tie Sc~t~~ierly . t€.~- a Griion~ir -a _ .rain Ws A litved 4u$ Bnd==__ _ ' -~~~~C✓a~s7 .~3'i.et i~1 7W-W_~r- = ~r 234 '$L+£ '~~17=fg1 ►St: ~+4~Z _ (t z M_ s " V. Xsoo~acs bbe at = 6 ©O SQ®tzof. Iata ! and Z. . ~t _ T is ~~s -=1a-:,.s,~~ia?mot"~aa. of raa~ltsad coh£retwc`t _betrr,*eii tYieae -par~;3es - _ - 1978, =Yo2 =577,:_Page: 40 Ail • ^4 _ I r. - FEE f~rtizLs, AOt homestearf pro7erty _ _ _ - F:zrrpRlon`to warm ties., Dntr d thia__. _..dav of,' 1929 y ! . r t S E A L) SEAL)' . 1d i 11 i id rW 4AM (SI At.). ":r ~-i-•~ {s ^(St:,~L) ° - Isabel--E Ward - - - AuT14E-14TICAT10r2 ACKNY LEQL'i.4•.EMT 5iKnatarca authenticated this _Jiay of S9 ATF OF WISCONSIN t"e_.. Cruz s. _ Coui t'. 7 Cis_ Personally came before me, the day of the shore names rl#r^-,t 3f:v c-rp-rr: tx,A.> ftr.' Wit1"`rll:tt\3 iJ. ttlli r,.. Y 'W'g_si n►+A T~esthmli Ti`s Wa,...Y ,1r t; t_ atithar Husband _finatMd1rA - tze•d ts~• :Q...t)h, tt'{s. _t.rtti.: - 'r' - This instrumew wa., dratte•i - ..~14 T k _ to to me known to be• tvLl w5li vy tl•G)t uteri dlio fore a JbcifrlA~ ec+ci~~tl e going ittes Nmvnt an 5 J e k 4w s '[StKr,nt.ttrg§ may he ,tuthCrt:c.+!n,i :rci..n,u'r.iv• ~.1. 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I ° IL a •2 u a 75 0 (a A U (L 0 U) U "isco n SOIL EVALUATION REPORT #2138 Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings b=., IN. . , Steel's Soil Service Attach complete site plan on paper not less than 8'/z x 11 inches in size. PI~~J~~ust n St. Croix include, but not limited to: vertical and horizontal reference point (BM), direte4ryapd~ .D. u s Parcel I .D. percent slope, scale or dimensions, north arrow, and location and distance to nea r Please pri-ru formation. *300471, Re ewed B ` Date Personal information you pr e d condary purposes (Privacy Law, s. 15 0 u,<,l (P ~j Property Owner Property Location Sophia Cunningha Govt. Lot NW1/4, NW1/4, S4, T30N, R17W Property Owner's Mailing Address Lot # Block: Subd. Name or CSM# 1792 176th St na na Ward Addittion city State Zip Code Phone Number City VillageI Town Nearest Road New Richmond WI 54017 715-698-2107 Erin Prairie 170Tn St New Construction Use Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD rte' Replacement - Public or commercial - Describe: na Parent material Sattre silt loam outwash plains and stream teareces Flood plain elevation, if applicable na ft. General comments Mound Design,system elevation 99.50ft based on contour line elevation98.50ft. Minimum12 inches ASTM 33 mound sand and recommendations: t-47% /CAD .,te /1 _ ftf /v Boring # Boring Pit Ground surface elev. 98.90 ft. Depth to limiting factor 32 in. Soil Application Rate Horizon Depth U Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eft#2 1 0-8 10yr 3/1 none sil 2msbk mfr Cs 2f 0.6 0.8 2 8-32 10yr4/4 none Sid 2msbk mfr CS if 0.4 0.6 3 32-68 7.5yr4/6 flf 7.5yr5/6 vfsl lmpl mfr cs na .2 .6 4 68-96 10yr6/4 na ms osg ml na na .7 1.6 Horizon 4 has Inch wide bands of 7.5yr5/6 om sil mfr with redox features. 72Boring # - ' Boring 7 Pit Ground surface elev. 98.90 ft, Depth to limiting factor 24 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 1 0-8 10yr 3/1 none sil 2msbk mfr cs 2c 0.6 0.8 2 8-24 10yr4/4 none sicl 2msbk mfr gw is 0.4 0.6 3 24-36 7.5yr4/4 c2d 7.5yr5/6 scl 2msbk mfr Cs na 0.4 0.6 4 36-50 7.5yr4/6 c2d 7.5yr5/6 sl om mfr na na 0.2 0.6 Horizon 4 has 3inch wide bands of 7.5yr5/6 om sil mfr with redox features. * Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 m /L * Effluent #2 = BOD5 <_30 mg/L and TSS <_30 mg/L CST Name (Please Print) S na CST Number David J. Steel 248956 Address Steel's Soil Service Date Evaluation Conducted Telephone Number 1699150th St New Richmond, WI 540 5/9/2013 715-760-0347 SBD-8330 (R.07/00) Property Owner Sophia Cunningham Parcel ID # 021-2001-70-000 Page 2 of 3 73Boring # Boring J Pit Ground surface elev. 98.C-P ft. Depth to limiting factor 32 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 70#1 'Eff#2 1 0-8 10yr 3/1 none sil 2msbk mfr c5 2f 0.6 0.8 2 8-32 10yr4/4 none sicl 2msbk mfr cs if 0.4 0.6 3 32-68 7.5yr4/6 fif 7.5yr5/6 vfS1 impl mfr cs na .2 .6 4 68-96 10yr6/4 na ms osg ml na na .7 1.6 Horizon 4 has 3inch wide bands of 7.5yr5/6 om sil mfr with redox features. _ 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#t •Eff#2 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= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#t `Eff#2 ' Effluent #1 = BODS> 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. Steel's Soil Service SBD-8330 (R.07/00) 3of3 STEEL'S SOIL SERVICE David J. Steel Carol Preston 1699 150th St. CST-POWTSM NW1/4,NW1/4,S4,T30N,R17W New Richmond, W154017 Lic. #248956 Township of Erin Prairie, St Croix Co. Direct 715-760-0347 Ward Addition Fax 715-246-0318 Legend N 1"=40' ♦ = Benchmark Ele. 100.00 ft Top of septic Tank Cover 74 = Alt Benchmark El 100.60 ft Top of cement propane tank pad SW corn, Borings Boring Elevations B1 = 98.90 ft B2 = 98.90 ft B3 = 98.50 ft B4 = 0.00 ft 7 car , ~ 9 f'L Cot, "17 I't ~a rent n st ► 21 aN'~~ qb -y ~ 4.,z A_A • AS BUILT SANITARY SYSTEM REPORT ,_R , - , TO TNSHIP II ~ T26 N R W _LL j, ADDR 5S ST. CROIX COUNTY, WISCONSIN. DIVISZO / *44 C 4W , LOT LOT SIZE • PLAN VIEW Distances & dimensions to meet requirements of H62.20 _ SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I ! 3 ~ i I 1 ~ I / 1 I I I i , d I L_ i J, T I I I I i i. PjjZx~j 1 Indicate Nan~h nnaw ;'TIC TANK(S) MFGR. CONCRETE STEEL S cat e `r NO. of rings on cover Depth - DRY SPELL NCHES NO. of - width length area , no. of lines- width length_ area ~depth~ o~ top of pipe :z//' ;RELATE - , • S ..all RATE " - AREA REQUIRED ~ AREA AS BUILT 4' ,claimer: The inspection of this system by St. Croix County does not imply complete :z•oliance with State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liability for item operation. However, if failure is noted the County will make every effort to :•~rine cause .of failure. ":;ASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. `INS OR DATED IMER ON JOB LICENSE NUMBER f i Z'ff REPORT OF INSPECTION-INDIVIDUAL SEWAGE SYSTEM • San.i Lary Penmi.t State Septic St. Croix Count NAME Tawndh.cp N Locat.iog t Wkl() section SEPTIC TANK I 1 Size Ala 'd 9attons. Numbers ob Compartments ~ Diztance Fnom: Wett it. 12% on greaten stope it Bu.itd.ing_ it. We.ttands ~ . H.ighwaten =6t. DISPOSAL SYSTEM Diztance From: Wett S 12; on greaten. .6tope it. Bu.itd.ing2 _q 6x. W ett ands Ft. _ H.ighwaten ---R it. FIELD DIMENSIONS: Width o6 tnench_it. Depth o6 rock b etow t ite %4 in. Length o6 each tine it. Depth of hock oven t.ite 9 in. n. Number. 96 Zines Z/ Depth o6 tite below grade i Totat .length o6 tines % y 6t. Sto pe o6 trench - kn pe& 100 it. D.i.s Lance between tines it. Depth to b edro ch it. Tota.t absonbt.ion area-&~-1-6t2 Depth to groundwater - it. 0 ..Requited area it2 Type ob Coven: Pape on StAaw PIT DIMENSIONS: Number ob piKta Gnavet around pit.s yes no Outs~.de diamDepth below intet it. . Totat ab~sonb 5t 2 A 2 Area n ~rn INSPE-C TLTLE AP RL VED W DATE L S 197 REJECTED DATE 197 - ~H 115 Rev.9/76 REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION: %,k_Y4, Section _'~-T-b-N,RZZ~ (or) W, Townsh'Lg-or Municipality 4-;,12 &2aX 6e Lot No. , Block No. County - 7• C41,5~ ub ivislon Name Owner's/Buyers Name: Mailing Address: ¢ TYPE OF OCCUPANCY: Residence- No. of Bedrooms - COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS LL,2 £-2.!Z PERCOLATION TESTS 2 SOIL MAP SHEET NAME OF SOIL MAP UNITSL PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN/IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- ' i a P- If tP-lit la2_ P- 3 1721 Ire _S4 3 P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, NUMBER INCHES TEXTURE, MOTTLING AND DEPTH TO BEDROCK OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- r RJ!S 1,` 76 A& B- c-, B_ 7 B- B- PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the pcation and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. . E f f , as j~ f , r a Y e s 3 1, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. Name(print) Certification No. tf=Z21 , Address Name of installer if known c'. Copy A -Local Authority CST Signature PLB 6 7 State and County State Permit # . Permit Application County Permit # 7 + for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: f A-Ir B. LOCATION: Section Tk N, R, 0 (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township 46111 C. TYPE OF' O~CCUPPANCCY~Commercial *Industrial *Other (specify) *Variance Single family 0- Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY ~'2Q Total gallons No. of tanks % HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete-X, Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate ~4~1~2;~JeToal Absorb Area sq. ft. arc New Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top)No. of Trenches Seepage Bed: Length j -Width.AW_Depth ~Tile depth (topNo. of Lines Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land d Distance from critical slope WATER SUPPLY: Private X Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, NAME .,,U l J i;,i.E s' ~IaC' C.S.T. # sue:? ( and other information obtained from , (owner/builder). Plumber's Signature MP/MPRSW# Phone Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. i : a 1 t! O Q f s t w E E i 3 a f Do Not Write in Space Below - FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application 1!, -'30 -77Fees Paid: State 10 County Date O - 7 Permit Issued/Rejected- (date) 7- 2-77 Issuing Agent Name Inspection Yes State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78