HomeMy WebLinkAbout032-2056-20-100
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 563857 0
GENERAL INFORMATION State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's H.-ine: City Village X Township Parcel Tax No:
Justesen & Gartman, Jeff & Lorna Somerset, Town of 032-2056-20-100
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
G`JT 16.30.19.716B10
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURE l '-13 CAPACITY STATION BS HI FS ELEV.
Septic 1' ~aQO Benchmark /D• G //6 160
01 Dosing 1~ ' ✓ ~ 7SD Alt. BM
*01 Y (7 r
n Bldg. Sewer
4-:'7 t 77 i 3
Holding St/Ht Inlet
/6.3% 167'71
TANK SETBACK INFORMATION St/Ht Outlet ~bi 111,.4 ,3 • b1 /67. 1f2-
TANK TO P/L WELL BLDG. ent t it Intake ROAD Dt Inlet /b
1 ' AM ",75
Septic / Dt Bottom
7160 ig 9(.
Header/Man.
Dosing ,1601 17 -/.Z. /
'6 3. Z
:7 A
Aeration Dist. Pipe
-7-33 / 6,
. 1
Holding Bot. System /OZ. l7 Q . a I'd 7- -:5
Final Grade Y
PUMP/SIPHON INFORMATION G Z. /Q Al. Z
Manufacturer Demand St Cover .1 fit C?
V~V~ J GPM fr: 11.x- o.a.e~- • I~ / ~i
Model Number
TDH Lifead tV 37 Friction L$9 System 3. 5 TDh-2-I Ft
Forcemain Length I D/I Dist. to Well
SOIL ABSORPTION SYSTEM 9
BED/TRENCH Width Length No. 0 niche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS •/~G✓
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION Type Of gg~~tem: / CHAMBER OR
Ax / 56 } Model Number:
DISTRIBUTION SYSTEM / l
Header/Manifold Distribution x Hole Size / x Hole Spacing f, lVe t Air Intak
d
Zb
Length Dia I' s 11- L
ngth 3 ( • ab Dia Z6 It 3. Spacing
SOIL COVER / x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center I 1 ' Bed/Trench Edges ` Topsoil es 0 No ~s Efl No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 556 155th Ave. .SSOMEER~SET, WI 54025 (NW 1/4 SE 1/4 16 T30N R1 9W) NA Lot 2 Parcel No: 16.30.19.716B10
1.) Alt BM Description = ` °f L / - (f,6 jeA,
2.) Bldg sewer length = 5 2-
- amount of cover
el
LjlZ
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Plan revision Required? 0 Yes ] No (o 34P
Use other side for additional information. I~
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SBD-6710 (R.3/97) Date Insepctor's Si ture Cert . No.
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County
=s?°AT afe and Buildings Division
! D 1 ashington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
P K Madison, W 7Q7 fiF D
ION
State
Sanitary Permit Applicatio 1_U li Transaction Number
Z 2 71 S~
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the Spr@ . °~v~e~mmental unit
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned~'9 ~ NDmitted to Project Address (if different than mailing ddress)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary Jl~J 5~
purposes in accordance with the Privacy Law, s. 15.04 1 (m , Slats.
L Application Information - Please Print All Information
Property Owner's Nam Parcel #
I- VZ-10 ~IA C-7* Al 0,3,-2- (
Property Own s ailing A ess Property Location
Govt. Lot ( (J~J
City, Stale C Zip Code Phone Number ) 4q _5,~L 1/4, Section
/ ircle one
T 3D N. R E QM
II. Type of Building (check all that apply) Lot #
Subdivision Name
or 2 Family Dwel g - Number of Bedrooms
7.~9 _.Y 4V Jt - lock #
❑ Public/Commercial - Describe Use ❑ City of
umn~ ❑ Village of
11 State Owned -Describe Use ~
ALTOwn of
u6d _ 335
III. Type of Permi • Check only one box on line A. Complete line B if applicable)
A. 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 apply)
❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
Holding Tank ❑ Other Dispersal Component (ex am) ❑ Pretreatment Device (explain)
V. Dispersal/Treatment Area Information: Cc 0 ~
Design Flow (gpd) Design Soil Ap lic 'on Ra dsf) Dispersal Area Requir (sf) Dispersal Area Proposed f) System Elevation
p, S. / 0 W `~~S ~0~ S^ /moo bd <
VL Tank Info Capacity in Total of Manu acturer
y =O L U
Gallons Gallons nits U y y
New Tanks Existing Tanks
U En ; h w C7 a.
Septic or Holding Tank
Dosing Chamber l U/ 7SO
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS s own on the attached plans.
Plumb~ee N e (Print) Plumber's ignature RS Number Business Phone Number
P tier's Addr ss (Street City, State, Zip Code)
VIII oun /De artment Use Only
Permit Fee Date Issued jAgen re
FMApproved Disapproved $ 1-5
❑ Owner Given Reason for Denial ~3~ jX Co~ ~f FovaUReasons for Disapproval ~4x• r n
1. Septic tank, effluent filter and ~1:~F
dispersal cell must be serviced / maintained
as per management plan provided by plumber. ~cy~ Cc `
2. All setback requirements must be maintained I I
f omplete plan for the syste subm' to th County ~only /onpaper not less than 8 1/ 2$ inches ' size`' /
C.a4td UQe FLU 7 ~yw .
SBD-6 9 (~"11Illy'" `
ST. C R 0 i , T'"('` V Land Use
j j l,Y Planning & Land Information
Resource Management
Community Development Department
July 31, 2013 File#: LU87976
Jeff Justesen
615 Lemon Street
Hudson, WI 54016
Re: Land Use Permit, Filling & Grading < 10,000 sq. ft. in the Shoreland District
556 155th Ave. Lot 2 of CSM 16/4335
Parcel #32.30.19.340620, Town of Somerset
Dear Mr. Justesen:
This letter confirms zoning approval according to the plans you have submitted for filling and grading
an area of approximately 4300 square feet within 300 feet of the Ordinary High Water Mark (OHWM)
of an unnamed pond to construct a driveway, single-family dwelling, and private on-site wastewater
treatment system (POWTS) on the property referenced above in the Town of St. Joseph. Staff finds
that the proposed project meets the spirit and intent of the St. Croix County Zoning Ordinance and
Shoreland District with the following findings:
1. Filling and grading less than 10,000 square feet in area less than 300 feet from the OHWM
on slopes less than 25 percent is allowed with a land use permit in the Shoreland Overlay
zoning district pursuant to Section 17.29(2)(c) of the St. Croix County Zoning Ordinance;
2. The filling and grading will consist of excavating -3300 sq. ft. for the foundation of a
single-family dwelling, 300' driveway, and the POWTS, which will be located within 300
feet of the OHWM of a navigable wetland. The proposed driveway, single-family dwelling,
and POWTS meet the 75' setback from OHWM and other required setbacks and
dimensional standards contained in the St. Croix County Zoning Ordinance;
3. The applicant will develop an erosion control and storm water management plan featuring
areas designated to infiltrate runoff from impervious surfaces (-6900 sq. ft. total). With
conditions to install appropriate erosion control and sediment control measures e.g. silt
fence or sediment "logs" prior to beginning excavation, to maintain erosion control
measures until self-sustaining permanent vegetation is established on all disturbed areas,
to prohibit the use of phosphorous fertilizer to maintain a lawn, to submit and implement a
storm water management plan that infiltrates 944 cu. ft. of runoff, and record a
maintenance and monitoring agreement against the property for the infiltration devices,
negative impacts to the water quality of the pond will be minimized;
4. The nearby pond is -150 ft. from the proposed house and the owner will be required to
maintain the native vegetative cover within a 35' shoreline buffer zone;
5. Approval of the land use permit will include a condition that an affidavit for the stormwater
management plan be recorded against the property; and
6. The Wisconsin Department of Natural Resources has been sent a copy of the application
for review. A DNR grading permit will not be required for land disturbance less than
10,000 sq. ft. and outside the 75' OHWM setback.
Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, W154016 Fax 715.386.4686
www.sccwi. us/cdd www.facebook.com/stcroixcountyw i cdd @co.saint-croix. wi. us
Community Development Department Page 2
Based on these findings, approval of the land use permit is subject to the following conditions:
1. The applicant shall submit a stormwater management and erosion control plan for review
and approval by the Zoning Administrator prior to commencing excavation. It must
include a site plan that indicates location(s) for infiltration devices that provide a capacity
of at least 860 cu. ft. to handle stormwater runoff and indicate the locations for placement
of erosion and sediment control measures.
2. A pre-construction on-site meeting must be scheduled with the county staff. The applicant
will be responsible for directing contractors to implement the approved storm water
management and erosion control plans, which include installation of silt fencing, straw
waddles, and/or sediment logs between areas of exposed soil on the construction site and
neighboring property to control contaminated runoff. Photos will be taken to document
pre-construction site conditions for enforcement purposes.
3. The applicant shall obtain all applicable permits and approvals required for construction of
the driveway and house. The sanitary permit has been issued for the POWTS. The
county-approved erosion control plan may be used for compliance with Uniform Dwelling
Code requirements.
4. The applicant shall record an affidavit referencing the approved stormwater management
plan with the Register of Deeds prior to commencing construction.
5. The sanitary permit issued for installation of the POWTS will require compliance with all
conditions of the land use permit and contractors must be made aware of the conditions
regarding erosion and sediment control.
6. The applicant shall maintain all erosion and sediment control measures until permanent,
self-sustaining vegetation is successfully established on all disturbed areas of the site.
7. No phosphorous fertilizers shall be used on the disturbed areas of the site, unless a soil
test confirms that phosphorous is needed for establishing permanent vegetative cover.
8. Within 30 days of completing the project, the applicant shall submit to the Zoning
Administrator photos of the stormwater infiltration devices and disturbed areas for
documentation of compliance with conditions. Photos may be sent electronically via e-mail
attachment.
This approval does not allow for any additional construction, structures or structural
changes, grading, filling, or clearing of vegetation beyond the limits of this request. Your
information will remain on file in the St. Croix County Community Development
Department. It is your responsibility to ensure compliance with any other local, state, or
federal rules or regulations, including obtaining a building permit from the Town of
Somerset.
Please feel free to contact me with any questions or concerns.
Sincerely,
Pamela Quinn
Land Use Specialist/Zoning Administrator
Enc: Land Use Permit LU87976
Cc: Todd Dolan, Building Inspector, Town of Somerset
Mike Wenholz, Wisconsin Department of Natural Resources
Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, WI 54016 Fax 715.386.4686
www.sccwi. us/cdd www.facebook. com/stcroixcountywi cdd@co.saint-croix.wi.us
i t'ARDIVISION OF INDUSTRY SERVICES
10541N RANCH ROAD
Cil wr
%~m 9 HAYWARD WI 54843
Contact Through Relay
SP / www.dsps.wi.gov/sb/
~
Illy www.wisconsin.gov
Scott Walker, Governor
Dave Ross, Secretary
July 17, 2013
CUST ID No. 220357 AT7N.- POWTS Inspector
BRADY J UTGARD ZONING OFFICE
UTGARD PLUMBING & HEATING ST CROIX COUNTY SPIA
PO BOX 413 1101 CARMICHAEL RD
AMERY WI 54001 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 07/17/2015 Identification Numbers
Transaction ID No. 2271851
SITE: Site ID No. 792884
Jeff Justesen Please refer to both identification numbers,
459 155TH Ave above, in all correspondence with the agency.
Town of Somerset
St Croix County
NW1/4, SETA, S16, T30N, R19W
FOR:
Description: Mound, 3 bedroom residence
Object Type: POWTS Component Manual Regulated Object ID No.: 1437867
Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; Sys
Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01101, R. 10/12), Pressure Distribution Com
Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12), SSWMP Pub. 9.6; Effluent Filter C" AppR~v b ~.N
The submittal described above has been reviewed for conformance with applicable Wisconsin Admini i COX NAB $ERV, s f.
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to S
and located in accordance with the enclosed approved plans and with any component manual(s) refelp~pziC ~N
The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance -wkb
requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 5.
stats. GQppNo
The following conditions shall be met during construction or installation and prior to occupancy or use:
absorption area.
Key Item(s)
• 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. In addition, the
owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the
mound component manual are complied with. A copy of this information must be given to the owner upon
completion of the project.
Reminder
• The orientation of the mound system must be such that the longest dimension is oriented along the surface
contour per SPS 383.44(6)(a)2.
• Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual.
• Surface water drainage shall be diverted away from the system area per Mound Component Manual.
• Materials shall conform to the requirements of SPS 384.10. No fixture, appliance, appurtenance, material,
device or product may be sold for use in a plumbing system or may be installed in a plumbing system, unless it
BRADY J UTGARD Page 2 7/17/2013 1
a
is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145,
Stats.
• Maintain well and waterline set backs per SPS 383.43(8)(i). Consult the Department of Natural Resources for
well setbacks and other regulations and exceptions.
A copy of the approved plans, specifications and this letter shall be on-site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
In granting this approval the Division of Industry Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any
others who are responsible for the installation, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 250.00
Fee Received $ 250.00
- Ji Balance Due $ 0.00
Patricia L Sha dorf
POWTS Plan Reviewer , Integrated Services WiSMART code: 7633
(715) 634-7810, Fax: (715) 634-5150, M - F 8:00 a.m. - 4:45 p.m.
pat.shandorf@wisconsin.gov
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
z "$PS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to
"the Dc iartment of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered
and addressed ant Q"'300" series. For future reference, the Wisconsin Commercial Building Code will be addressed
by SPS Chapters 360-366.
s ,
.1
t
MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN
INDEX AND TITLE PAGE
Project Name: JEFF JUSTESEN
Owner's Name: JEFF JUSTESEN
Owner's Address: 615 LEMON ST.
HUDSON WI. 54016
Legal Description: NW/SE/S16/T30/R19W
Township: SOMERSET
County: ST.CROIX
Subdivision Name: CSM 1614335
Lot Number: 2 Block Number.
w
Parcel I.D. Number. 032-2056-20-100
Plan Transaction No.: ES
ICES
,tV
Page 1 Index and title
Page 2 Data entry
Page 3 Mound drawings
Page 4 Lateral and dose tank
Page 5 System maintenance specifications
Page 6 Management and contingency plan
Page 7 Pump curve and specifications
Page 8 PLOT PLAN
Page 9 SOIL EVALUATION
Designer: BRADY UTGARD License Number: 220357
Date: 07101113 hone Number. 175-760-0946
Signature:
Designed Pursuant to the
Mound Component nual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and
SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81)
Version 3.11 (R. 06/01) Page 1 of 9
}
Mound and Pressure Distribution Component Design
Site Information
R Residential or Commercial Design Note: sand fie" calculations assume a
300.00 Estimated Wastewater Flow (gpd) Table 83-44-3 in-situ soil treatment for fecal
1.50 Peaking Factor (e.g. 1.5 = 150%) eofifonn of - 36 inches.
450.00 Design Flow (gpd)
8.00 Site Slope
99.88 Contour Line Elevation (ft)
24. Depth to Limiting Factor (in)
0.50 n-situ Soil Application Rate (gpd/if) I S -7r/ O4.E? Oo T f~~trte
Distribution Ceti information J
75.00 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft)
1.00 Dispersal Cell Design Loading Rate (gpd/if)
1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point
in the distribution Y
PNssure Disribution IM'om Oon network?
c Center or End Manifald
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) (e.g. 0.25)
3.00 Orifice Spacing (ft) = 9.38 if/orifice
2.00 Forcemain Diameter (in)
100.00 Forcemain Length (ft) Does the forcemain drain back? Y
92.00 Pump Tank Elevation (ft)
3.25 System Head (ft) x 1.3 16.31 Forcemain Drainback (gal)
8.88 Vertical Lift (ft) 46.90 5x Void Volume (gal)
2.12 Friction Loss (ft) 63.21 Minimum Dose Volume (gal)
14.25 Total Dynamic Head (ft) 31.46 System Demand (gpm)
Lateral Diameter Selection Manifold Diameter Selection
in. dia. options choice in. dia, options choice
0.75 1.25 x
1 On 1.5^ x x
1_60 i x j 3 illy
1 2.00 i x
~aF~tl~)F►cllnrt) Cal,-~~fator
Treatment Tank Information "ib&uu Totai -Fank Caoauav iaaii
,000,00 Septic, T ill -apa,C scAt n
X ! t 3 .vs~ }
ut}3i tkUir;ii
nose Tank information Effluent Fiiter inrornid6on
^r:;t nn r-I33C T-~...f. _ a. :'3 f"R 4,i* r%W
r va,.+.VV wisoc' I Ob rt~ vet o%a1.y I, -u~ PCIL t i..,,#, I tC:e w.uliu.U.cuii:i
?77 nngA Tank Vnlisrna (rip inS P! ..C?F; titter IPnr;_.! ►+J;tmhar
n,:a,~~+- nr ~ of fret*i, i tar
t"IUIL-La. JLi"i° JUO i LOLN t`iir~c 1Ji a
1
Mound Plan Yield
T
'{observation Pips 3~ J
K
A
W : i B.. G -
z
t
Mound Component Dimensions
A 6.00 ft E 17.75 in H A ft K 9.Q3 ft
B 75.00 ft F 925 in I ft L 93,07 ft
D 12.00 in G 0.50 ft J It W 22.35 It
450.00 (ft2) Dispersal Cell Area 1264.39 (ft2} Basal Area Available
6.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Qbs. Pipe Piacement
Mound Gross Section View
Aggregate Dispersal Area
Finished Grade 102.65 (ft) -J►
+r{{{rr{r{rr..rf G
Dispersal Cell 101.38 (ft) Lateral
100.88 (ft)-1► invert
Dispersal Ceik 1
Elevation E D -
99.88 (ft) Contour Elevation
8,0 % Site Slope
Geotextile Fabric Cover
Shading Key Dispersal Cell See lateral details on
Topsail Cap o 0 1.5 ft ?age 4 for number, size,
[ 'SttbsoiI Cap 0 and spacing of laterals.
] ASTM C33 Sand :5 / F Laterals are equally
Tilled Layer c 0.5 ft Typical Lateral spaced from the
NJ Aggregate distribution cell's
centerline in the
A distribution cell (Ax8).
Project: . EFF jUb + E~Er~! Page 3 of 9
Center Connection Lateral Layout Daigram
Force main connection via tee or cross to manifold at any point. Laterals are = 'V
}E P
+1= Turn-up -rN"batl valve or
X -3 t 0L_ , x12 Lateratis & force main of PVC $ch 40
aleanout plug i 1 per COMM Table 84.30-5
Holes drilled on the bottorn t f thhe lateral. ! l
Nr of Laterals 4 Orifice Diameter 0.188 in
x Diameter 1.25 in Orifice Spacing (X) 3.20 ft
L 1,
gh (P) 36.80 ft Orifices per Lateral _ 12
L ` ing (S) 3.00 ft Orifice Density 9.38 ftz/orifice
L Rate 7.86 gpm Manifold Length 3.00 ft
wr Rate 31.46 gpm Manifold [diameter 1.50 in
- is Head 14.25 ft Foreemain Velocity 3.21 ft/sec
Dose Tank Information Locking cover with warning
_ label and locking device and
sealed watertight
;ca: as ~ NFC 300 and -
cmm i,8 iNA
4
C Disconnect
a"
Tank: , or>ant is Pro*k' 'y' vented Alternate
location
Forcemain diameter
weiser Manufacturer 2 in.
Capacit 750.00 Gallons
Voluble 20.27 gal/inch 1
1 Weep hole or anti-
Dimension Inches Gallons S siphon device
l
A 25.88 524.63
1 i
2,00 4fl_~ U F~ ump off elevation (R)
C 312 92750
D 6.00 121.62 D ~
Total 37.00 7 :0.00
Dose tank elevation (ft)
Redding un er tank. _ 92 00
Alarm, Manuafactuver LEVEL
Alarm Model NUM el DLV
I , ~0
Purnp Manufacturer GOULDS 1y
Vr""
Pump Model Ni. mbcr EP05
i'ut p !Must uu+ YL- 3'-_46 gpm at 14 25 tt ..l t rl;
Project. iLit a iu6 i ~vLNl Pdje 4 of 0
Mound System Maintenance and Operation Specificaflons
Service Provider's Dame UTGARD Phone 715-760-0946
POWTS Regulator's Marne ST- CROIX Phone 715-386--4680
System Flow and Load Parameters
Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in
Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L
Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L
Soil Absorption Component Size 450 ftz Maximum FOG 30 mg/L
Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL
Service Frequency
Septic and Pump Tank Inspect and/or service once eve 3 ears
Effluent Filter Should inspect and clean at least once eve 3 ears
Pump and Controls Test once eve 3 ears
r 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
INSPECT FILTER ONCE A YEAR
Miscellaneous Construction and Materials Standards
1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap,
and are secured in as shown in the mound component manual.
2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code.
3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. ,Adm. Code.
4. Tillage of the basal area is accomplished with a mold board or chisel plow.
Q1 C
mound structure and other,';s*.., be,4 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 30 or Two
45 Degree Bends Same
Diameter eas Lateral
ti< .s ...3 d" .iv..t Lar LEAN pct6i 5 Z J
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 7'
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner ~'U S.TS Septic Tank Capacity Wiesen- gal ❑ NA
Permit # r-
S 7 Septic Tank Manufacturer COAJ64 M ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer /IC ❑ NA
Number of Bedrooms 3 ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units --ptAIA Pump Tank Capacity gal ❑ NA
Estimated flow (average) 3CFO gal/day Pump Tank Manufacturer ❑ NA
Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer U1, ❑ NA
Soil Application Rate 0 • S gal/day/ftz Pump Model 0 NA
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ~.Nq
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODE) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD5) 530 mg/L ❑ In-Ground (gravity) ❑ In- ressurized)
Total Suspended Solids (TSS) 530 mg/L ~NA ❑ At-Grade ~nd
Fecal Coliform (geometric mean) 510' cfu/100ml ❑ Drip-Line
Maximum Effluent Particle Size /e in dia. ❑ NA Other: ❑ NA
Other:
1 Other:
❑ NA
❑ NA
*Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: '3 a mpnth(s► (Maximum 3 years) ❑ NA
lil-fear(s)
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA
Inspect dispersal cell(s) At least once ever ❑ onth(s)
y' 3 &7'y r(s) (Maximum 3 years) ❑ NA
Clean effluent filter At least once every: month(s)
l ❑ year(s) ❑ NA
Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA
❑ year(s)
Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA
❑ year(s)
Other: ❑ month(s)
At least once every: ❑ year(s) ❑ NA
Other:
❑ 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 surface.
The dispersal cell(s) shall be visually inspected to check 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 scum 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 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 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.
Page 2 of ?i
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents
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 be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
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 area
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 the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
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.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• 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 fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement stem: 4~ 11 'e
suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation 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.
T ted to iekmtify Fe ef the -site
aluati a o ing ank
e aie ~D}-/!13 C~ID~J
be '
Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
«WA »
SEPTIC, PUMP AN NT OXYGEN. DO NOT
ENTER 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
e
POWTS INSTALLER POWTS MAINTAINER
Name e.4-IV ( Name
Phone PS - - Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY /
Name Name ST. GkD l C~UN
Phone Phone
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
. RGOULDS Runes
Submersible
Effluent Pump
4
~z EP04
& EP05
Seri
es
APPLICATIONS • FuNy subme in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower
Specifically designed for the grade turbine it for tic enclosed design for heavy duty ball bearing
following uses: lubrication a efficient improved performance.
heat transfer. construction,
• Effluent systems ■ Casing and Base: Rugged
• Homes Available for omatic and thermoplastic design provides AGENCY LISTING
• Farms manual n. Auto- superior strength and corrosion
• Heavy duty sump matic models dude resistance, sF" 85 As~~«~
• Water transfer Mechanical Switch ■ Motor Housing: Cast iron rde # ut3a9
• Dewatering assembled a preset at the for efficient heat transfer, Goulds Pumps is iso 4oot Registered.
factory, strength, and durability.
SPECIFICATIONS ■ Motor Cover: Thermoplastic
• Solids handling capability: FEATURES cover with integral handle and
'/4' maximum. N EP04 Impell : Thermoplas- float switch attachment points.
• Capacities: up to 60 GPM, tie semi,-open ign with ■ Power Cable: Severe duty
• Total heads: up to 31 feet. pump out vane or mechanical rated oil and water resistant.
• Discharge size: Vh" NPT. seal protection.
• Mechanical seal: carbon-
rotary/ceramic-stationary,
BUNA-N elastomers.
• Temperature:
1041F (40"C) continuous
140" F (600C) intermittent, METERS FEET
10 _ !
• Fasteners: 300 series
stainless steel.
9 I
• Capable of running 30 i v_
dry without damage to
components, t z s
7 j -
Motor:
• EP04 Single phase: 0.4 HP, v s 20
115 or 230 V, 60 Hz, 1550
T s
RPM, built in overload with
automatic reset. iss - -
J
• EP05 Single phase: 0.5 HP, 4
115 V or 230V, 60 Hz, 1550 i EPOS
RPM, built in overload with 3 to`w"
automatic reset.
Z I !
EP04
• Power cord: 10 foot standard length, 16/3 r !
S1TW with three prong
grounding plug. Optional 20 I `
0 00 I i
foot length, 1613 SJTW with 10 20 0
40 50 GPM
three prong grounding plug
(standard on EP05). 0 2 4 6 8 10 12 m /h
/ CAPACITY
® Goulds Pumps
r 2003 Gould% Dump,
Effective July, 2003
tt
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Wisconsin Department of Commerce SOIL EVALUATION REPORT page f
Division of Safety and Buildings ~ tom,
in Luce with Comm 85, Wis. Adm. Code
/t
County
Attach complete site plan on paper not le s1haR44f'2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and p d'!4-c ~J
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 3 2 -2o , O
Please print all information. Re ewes b _ G+ bhte
sh
nation you
vi ay sect for secondary purposes (Pri~ Law, s. 15.04 (1) (m)).
Personal i rr pro
y Location
ert
P f r U~ T
t. Lot,~L/(,t~ 1/4 S T3 ON R/ E (or W
e
Property Owner's Mailing Address j Lot uName CS! JW
~i y 3
city State Zip Code Phone Number ❑ City Village fia Town Barest Road
(
DRINew Construction Use esidenYial / Number of bedrooms Code derived design flow rate yJ -0 GPD
Io ' _
❑ Replacement Public or commercial - Describe:
Parent material Flood Plain elevation if applicable
General comments 4300" 40 06WAII
n n•
and recomunendations:
C sT_ M u pfd
System Type' f System Elevation
I Boring # Boring
pit Ground surface elev. ~ ft. Depth to limiting factor 34.2 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff# 'Eff#2
77
F
Boring 'S ❑ Boring
a
® Pit Ground surface elev. ft. Depth to limiting factor ~ in.
Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `E 'Eff#2
7' r S
Effluent #1 = BOD > 30 < 220 mg& and TSS >30 < 150 mgA. ` Effluent #2 = BOD 130 mg/L and TSS < 30 mg/L
CST Name (Please Print) Sigma CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 5401 f 715-246-4516
~ ~1-0~5 3
r7 I
a
Property Owner _ Parcel ID # Page of
Boring # Pit Boring
Ground surface elev. ft. Depth to limiting factor in.
11D Soil Application Rate
Horizon Dep Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff°
Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#2
.J
F-1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
❑ a Boring # Boring
Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil ication Rate
Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BODS < 30 mg/t- 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-9330 (ROOD)
Property Owner Parcel ID # Page of
Boring # ❑ Boring '
pit Ground surface elev. I ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
3
r
•J
F-l
❑ Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
I
I
I
F-1 Boring # ❑ C1 Pit Boring
Ground surface elev. ft. Depth to limiting factor in.
• Sal ication Rate
Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 •Eff#2
I -A
Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mgll- ` 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 (8.6/00)
3 aF 3
% Soil Test Plot Pla dh` ; ka
Project Name Jeff Justiesen Sh ird
Address 615 Lemon St.
Hudson Wi 54016 M #226900
Lot Subdivision Dat 6/20/11
N W 1/4 SE 1/4S 16 T 30 N/R19 W Township Somerset
❑ Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of 1" pipe
System Elevation TBID *HRpSame as Benchmark
to 155th Ave
P.L.
Scale is 1" = 40'
unless otherwise
noted
Pro 3
Bedroom
house
150'
150'
100' 250'
B-2 B.M.*
15'
99' 30 180'
B-1 70'
98' 20'
97' B-3
35 '
8% Slope
Property Line
Jul-'15-2011 07.22 All St Croix County plan/Zoning 715-386.4486
1/3
Project Name JeffJIJEWesen 501, Test Plot PT
Addroaa Spa ird
Hudson Wi 4016
Lot - 6ubdivlslon 'M #226900
oat 5/20111
W 114 Sl= 1148 16 T U N/ 'OW 4- Township Somerset
Boring a Wall PL property Line County 8T. CROIX
L OM o,r np Assume Elevation 100 ft, Top of 1 n pipe
system Elevation Tep WpSame as Benchmark
to 155th Ave
P.L
Scale is V 40'
Unless otherwise
noted
Pro 3 0
i Badroom
liQttae
S pp~
1S0'
25 W
100' ~BMII•' 1
99' 30'
9x ' UN~ S
10_ r°' ~ i`S inc-e 46
07'
8,10 slope
Proporty Line S~ LoT Z
U l
cg
a4-
o I s~ kle,
ST. OIX COUNTY
SMp14C TANX MAINTENANCE AGREEMENT
AND
CERTIFICATION FORM
J I/
OwncrA3uyer
Mailing Address -~~Property Addrits.
Z -
Es-
(Verificatii= required f sin Ranting & Department or new constriction.)
Cft}°'State 'V V T Parcel`Identi cation Number
2
LEG F; UTION
Property Local icon Sec. , T ."56N R~W, Town of
Sodivision Plat:
Certified Survey Map # O L~ a L, Voiurne page #3s
Warranty Deed # ~ / 3 (before 2007)Volume , Page #
Spec house n ycsAno Lot lines idm6f abk~ yes 0 no
SYSTEM N, M,jNTZNAN!Q t AND QWNI~R CERTIFICATION
improper use and mainvenamaof yow septic system could result is its promiswre failure to handle wastes Proper
maintenance consists of pumping out the septic tank every dwee 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
its pf) ;sibilitics we specified in §Comrn, 8352{1} and in Chapter 12 - St. Croix County Sanitary Ordinance-
The property owner agttes to submit to Ss. Croix County Planning & ;coning Department a certification form, signed by the
owner and try a master plumter, jotuneymw plumber, restricted plurroer or a licensed punWer verifying that (1) the on-site
wastewater dv;poatat system is in proper operating condition and/or (Z) a(tcr inspection and pt"mping (if ilecessary►, the septic tank is
;,-ss rha"i 1;1 ttdf of sludge,
i/we, the undersigned have read the above mquircments and a8rW to maintain the priveAt sewage disfwsel system with the
standards set fortIL Herein, as set by the Deparm"t of Commacce 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 &
Zontag Departinent within 30 days of the three year expiratiati date.
1/we semi€y that all statements on this form are true to the best of mylour knowledge, liwe am/are the ow"ier(s) of the
property describes above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number- of W rooms.
"
SIGN RE OF APPLICANT(S) DATE
"*'Any fnformati n that is misrepreseetted may result in the sanitary permit beuig revoked ey the Plamiur, & Zoning Department.
include with this application a worded warranty decd from the Register of Dacds Offtc: and a copy of 113U 4t;rtifie:d yurvcy reap It
reference is made i"t the war awry bieed.
(~l.v_ loss Mai .5Ps 3 S2 2Ba W~~
State Bar of Wisconsin Form 1-2003 8 0 3 2 6 0 6
WARRANTY DEED Tx:4023502
Document Number Document Name 938802
BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
THIS DEED, made between M.L. Johnson Development Inc a Wisconsin 07/13/2011 3:02 PM
corporation EXEMPT#: NA
("Grantor," whether one or more), REC FEE: 30.00
and Jeffrey Justesen and Lorna Gartman husband and wife TRANS FEE: 334.50
("Grantee," whether one or more). PAGES: 1
Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area
estate, together with the rents, profits, fixtures and other appurtenant interests, in St.
Croix County, State of Wisconsin ("Property") (if more space is needed, please attach Name and Return Address
addendum): David J. Estreen
That part of the Northeast Quarter of the Southwest Quarter (NE 1/4 of the SW 304 Locust Street
1/4) and part of the Northwest Quarter of the Southeast Quarter (NW 114 of the SE Hudson WI 54016
1/4), Section 16, Township 30 North, Range 19 West described as follows: Lot 2
of Certified Survey Map recorded in Volume 16 of the Certified Survey Maps, page F
4335 as Document No. 684384, St. Croix County, Wisconsin
032-2056-20-100
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free
and clear of encumbrances except: easements, restrictions and reservations, if any, of record.
Dated .John A;epm, etI c.
(SEA (SEAL)
ike John nsident
* (SEAL) (SEAL)
*
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) M.L. Johnson Development Inc a
Wisconsin corporation by Mike Johnson its president STATE OF )
) ss.
authenticate on ;-r/_0_Z,) I COUNTY )
Personally came before me on
*Kristina O land the above-named
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing
(If not, instrument and acknowledged the same.
authorized by Wis. Stat. § 706.06)
THIS INSTRUMENT DRAFTED BY:
Notary Public, State of
Kristina Oeland, Estreen & 021and My Commission (is permanent) (expires: )
304 Locust Street, Hudson, WI 54016
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003
99 name below signatures. INFO-PROTM Legal Forms 800-655-2021 www.infoproforms.com
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