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040-1003-50-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 563867 0 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: Schilt en, Jon & Maxine Troy, Town of 040-1003-50-000 CST BM Elev: Insp. BM Elev: IBM Descripti2~01 Section/Town/Range/Map No: tub L. I /~`0 02.28.19.19 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATI N `S HIIO FS LEV. 13 Septic 1 Benchmark -X 0'2- v 02 - Dosing Alt. BM VJAP~ Aeration Bldg. Sewer 4- 1-3 21, 2 Holding Ht Inl t TANK SETBACK INFORMATION St/Ht Outlet TANK TO I P/L, , WE L BLDG. Vent to Air Intake ROAD Dt Inlet Septic y it Dt Bottom (gyp y Dosing (CA Heade an / 1 1, 2-1 33 49/ Aeration Dist. Pipe Holding Bot. System PUMP/OHON INFORMATION Final Grade u acturer Demand St Cover ko~ GPM 41"1~ -3,- L Ql'~ Model Number TDH Li e(~ Friction ss i Syste Head T H Ft Forcemain Le gth / Dia. y/ Dist. to Well SOIL ABSORPT ON SYSTEM Y LW r BED/TRENCH Width LengthINoff Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS r 17~; i SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Typ Of System - CHAMBER OR UNIT Model Number: c DISTRIBUTI N SYSTEM r ! 6 -701-0 dh~WyL 17 Heade anifol it Disstribdo / - ` Ix Hole Size / x Hole Spacing Vent tg Air Intake Pipe(s) i Length Dial Length Dia f Spacing 2..25 3 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx ulched Bed/Trench Center Bed/Trench Edges Topsoil H Yes ®No ~ (es ~ No q COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / Inspectioq #2:j/// d /3 Location: 582 & 588 BRUMMEL RD H dson, WI 54016 (W,1/2 NE 1/4 2 T28N R19W) metes & b ) t ParEe~No: 02I28.1g(13 1.) Alt BM Description = a0[P ~t -f~ (1/<R~ ~7J~~ T 1 L L2(A (/?,er C } 2.) Bldg sewer lengthy ~ ~ , ~ _ ✓ i - amount of cover = 3 °a~ti,olf..>p. > Y2 `~a k ~r~e y' lJ' Plan revision Required? ~ Yes ~No z r Use other side for additional information. l s l P ~ J SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. Sanitary Site Plan Page 8 of 8 For: John and Maxine Schiltgen NWl/4- NE1/4 See. 2 T28N-R19W Town of Troy - St. Croix County o so 40 craphia seam ~1 inch 40 tR I 660ft x x x x x BM O Proposed PIL BM#2 = Top of 11/4"pipe staked . Elev. =103.60' Current Parcel Size is 36Acres 660 ft. x 2640' O BM Open Corn Field Proposed 6ft x 75 ft Mound Cell located along the 98 70' Contour w/a System Elevation of 100.20' S% B M3 e .01 2 Brummel Ad 2„ Sch. Maintain well and waterline setbacks per SPS >350ft. to West PIL 40 3383.43(8)(1) ~a~ed sr r`~-J X32 n~ 99.00' 98.00' 33, I0 WELL I,✓► 97.00' 10 Proposed Wieser Concrete 10001600 Combination Tank w/a Poly-Lok PL-525 Filter W Basement 95.50' Proposed Three Bedroom Home Elevation Data B#1 = 97.80' B#2 = 97.80' B#3 = 99.30' Grade at Home =102.00' BM Top 111411 Pipe, staked, and flagged HRP -Same ASSUAM ELEV. = 100.00' = Backhoe Pit County =51, Safety and Buildings Division p-s Y 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be led in by Co.) Madison, WI 53707-7162 T s 3? (r7 S*01% State Transaction Number S 7), Permit Application 07 in accordance with SP 8 1( dm. Code, submission of this form to the appropriate governmental unit 23 /-70 41 is required prior too permit. Note: Application forms for state-owned POWTS are submitted to roject Address (if different than mailing address) the Departmen Profe Servies. Personal information you provide may be used for second ` purposes in acc ce w' vac Law, s. 15.04(1 m , Stats. 6 1. Application nformation - Please Print All Information Property Owner's Name ' ~/,G P U p r L on 01- a-T)a Property Owner's Mailing Address ST C~r y Location /I \ 3Z 44. "~f G I l i- Eiovt. Lot C J N City, S e Zip o e Phone Number n } Section (circle one O l0 ` T N; R_ E or H. Type of Building (check all that apply) Lot # ~ Subdivision Name is 1 or 2 Family Dwelling - Number of Bedroom 6 L Block # ❑ Public/Commercial -Describe Use /C• ❑ City of CSMNumber ❑ Villageof El State Owned -Describe Use ~ ~ ~ G✓~ ❑ Town of III. Type of Permit: Ch k only one box on line A. Complete line B if applicable) A. O 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 (Q IV. Type of POWTS S stem/Corn onent/Device: Check all that applyl, a s l U ❑ 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 (explain) ❑ Pretreatment Device (explain) V. Dis ersaVTrea ent Area Information: / Design Flow (gpd) Design Soil Application R e(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed System Elevation /oa VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units P0 L ;4o V/ 2 0.2 New Tanks Existing Tanks w U rn ~ v~ u, C7 P. Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum ' Sign a MP/MPRS Number Business Phone Number j• -/73 Plumber's Address (Street, ity, Zip Code) -e r 7~ d 2- 3 VIII. Coun /De artment Use Only Permit Fee Date Issued Issuing Signature proved 9 =rove I L I rven Reason for Denial 7 / DL Conde ' easons for Disapproval 3 Ql ~oV SLR O ~t~. 0..vr`- 4'n $ipfid'tank, ef'iltantMerand G4vt~j~J~ o,~ 0 ~ 4•`) NA 0 0,0_ l,5 dispersal cell.must all be services 1 Maintained ~~v bey / as per management plan provided by plue►ber. 2,;slack juwemdnta nmct be rsiaintat) . , is 666 t ~.n cSl o A. is I ^ A, ('o vclZ Attach to complete plans for the system and su mit to thafenty only on paperer' 1 than 8 ln~ lch - In -s SBD-6398 (R. 11/11) J' 6l~ 5 5~-ew, 6 o-6r, j c~C~ l 9~p.~xT4rprv o DIVISION OF INDUSTRY SERVICES 3824 N CREEKSIDE LA pS' 9 HOLMEN WI 54636 3 ®S Contact Through Relay www.dsps.wi.gov/sb/ P 9~ w www.wisconsin.gov OA ~OsscScott Walker, Governor Dave Ross, Secretary July 31, 2013 CUST ID No. 648443 ATTN.• POWTS Inspector ZONING OFFICE KEITH E KNUDTSON ST CROIX COUNTY SPIA 927 150TH ST 1101 CARMICHAEL RD ROBERTS WI 54023 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/31/2015 SITE: Identification Numbers Jon & Maxine Schiltgen Transaction ID No. 2273704 582 Brummel Rd Site ID No. 793096 Town of Troy, 54016 Please refer to both identification numbers, St Croix County above, in all correspondence with the agency. NW1/4, NE1/4, S2, T28N, R19W FOR: Description: Three Bedroom Mound System / 5% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1438613 Maintenance required; 450 GPD Flow rate; 20 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.0110 1, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01101, 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. CON The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. AP DEPT OF No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, PROFESSI stats. ~~Vrs'O The following conditions shall be met during construction or installation and prior to occupancy or use: N OF IN Reminders: • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. SEE CQRRE • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • A cop, of pproved 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. KEITH E KNUDTSON Page 2 7/31/2013 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 PO WTS 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 . This Amount Will Be Invoiced. Gerard 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. jerry.swim@wisconsin.gov WiSMART- 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 x "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to 1 the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed t ,.by SPS Chapters 360-366. II KEITH E KNUDTSON Page 2 7/31/2013 Owner Responsibilities: I • 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 This Amount Will Be Invoiced. Gerard 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. jerry.swim@wisconsin.gov WiSMART code: 703 cc: Edwin A Taylor, Wastewater Specialist, (715) 6314-3484, 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 and addressed in a "300" series. For future 'reference, the Wisconsin Commercial Building Code will be addressed :bk Q?S Chapters 360-366. MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN RECEIVED Residential Application INDEX AND TITLE PAGE J U L 2 5 2013 Project Name: Jon + Ma)dne Schiltgen Mound INDUSTRY SERVICES Owner's Name: Jon + Maxine SchRgen Owner's Address: 582 Brummei Rd. Hudson WI 54016 715.425-5572 Legal Description: NW1/4 - NE1/4 Sec. 2 T28N-R19W Township: Troy County: St. Croix Subdivision Name: Lot Number: Block Number. NALI Rp Y Parcel I. D. Number: 040-100335-0000;, Sq~ EQ Plan Transaction No.: 0 NAC rYAND r ,VSTRYRv S Page 2 Index Data title SSRV~CFS P entry Page 3 Mound drawings Z . Page 4 Lateral and dose tank Page 5 System maintenance specifications NpFNCE Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Designer: Keith Knuitson I-Whse Number MPRS# 648443 _ Date: 06126/13 Number: _ Z.S"/' Signature: Designed Pursuant to the Mound Component Manuel for POWTS Version 2.0 SDB-10691-P (N. 01101), and both SSWMP PuNication 9.6 Design of Pressure Distribution Networks fir ST-W (01181) and pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01101) Version 5.1 (R. 06106) Page 1 of 8 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 83-44-3 in-situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 = 150°/x) fecal colifonn of 36 inches. 450.00 Design Flow (gpd) 5.00 Site Slope 98.70 Contour Line Elevation (ft) 18.00 Depth to Limiting Factor (in) 0.50 In-situ Soil Application Rate (gpd/ftz) Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ftz) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disrlbution Information network? Enter Y or N (C or E) E Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 2 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) 2.50 Estimated Orifice Spacing (ft) = 7.50 ftz/orifice 2.00 Forcemain Diameter (in) 66.00 Forcemain Length (ft) Does the forcemain drain back? Y 89.40 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 10.77 Forcemain Drainback (gal) 10.47 Vertical Lift (ft) 67.32 5x Void Volume (gal) 1.47 Friction Loss (ft) 78.09 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 32.31 System Demand (gpm) 16.48 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x x 1.25 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser Concret (manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 603.36 Dose Tank Capacity (gal) Pol -Lok Filter Manufacturer 16.76 Dose Tank Volume (gal/in) PL-525 Filter Model Number Wieser Concrete Manufacturer Project: Jon + Maxine Schiltgen Mound Page 2 of 8 Mound Plan and Cross Section Views 1/10 B ' . ' ('.'1' J Observation Pipe ts1 K •L^L L•L•"..L•L:• L:L•L•L.L S•L L+1'1.1.1•°,"L 1 1.1 "+,•S•L L°°.•L•L - •1:LLL• 11.1.1.•••1: L:ti. 1.1• l•J•l+l•.,;••• " l•l•r•: •J•l J•r•l• .••l•l•r• J•r"r•l•l•l•:+1 :••l•l• l:l:•ti•1•°."...,•1.1.4•.•1"1:"s•"••1.1.1.1• •1.1.1'1 A 1.1.1.1 f~•j, 1+1.1.1•'4"1"L•S•1.1•• Jl•l•J^r•n'^d°l•r•l"1.1.1.1•:•1•""s J•,"•n^.l•r. 1•l•l•l•.J ~.'•J•.l •J•J'•r. ~..~i.~ "1.1.1.L.L.•+,L,+••h"1.•..,..1.•..1.1.1.1 4.1+1.1.1 1.1x1.•..1+L•L+Y J'•1•JM•r •1• l•r•l•l•:•hi•1•l•l•l•r•l •J"1.1.1.1•,• J•l•l•l•J^ •J+r••`+J"1 •J• l• 1.1•L•L•L•L•L•1.1.1.1.1•L.Y1~°,~1•°.••,•1.1•°,+1••.•1.1.1.1.1.1.1•L•1•L•"••1••. J• 1.1•l•J•1•J•l•J•l•J•J•ie:+r•J•. •l•l•1•l•1•J•1.1 •l•r•J•1 l•r•J•r•,°•.^; r.J; W B I L Mound Component Dimensions A 6.00 ft E 21.60 in H 1.00 ft K 10.33 ft B 75.00 ft F 9.50 in z 10.91 ft L 95.65 ft D 18.00 in G 0.50 ft J 7.28 ft W 24.19 ft 450.00 (ftz) Dispersal Cell Area 1268.38 (ftz) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1110 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.99 (ft) . I F 100.70 (ft) Lateral Dispersal Cell 100.20 (ft)-i► Invert D Dispersal Cell vaI do Ele n L + ~,h} + Y s~ 47xJ ? ..y y+..~ '14~c.. y x .?t. ' u'~ ~ w 98.70 (ft) Contour Elevation 5.0 % Site Slope - .0 Geotextile Fabric Cover Shading Key m a I Dispersal Cell See lateral details on 1 Topsoil Cap a 1.5 ft ~L'L a. 1 Y111.1•" 1.1K•1•L"1.1.1 Page 4 for number, size, O 0 A T •'^L:1"11:°°1d1:1ee :t" Q Subsoil Cap and spacing of laterals. Subs T -.n .,•1• J~r1s'` Laterals are equally r` 1.J• :,x"~.^p ,4,0.+° ubs C33 Sand 1° S ASTM Tilled Layer m 0. ft ytia Typical Lateral r r° F spaced from the c ;.e•o.ti : ? 1~ distribution cell's © Aggregate ~ o j~_ :;:La° R.~R+" =Sin,:.:" •.:q,:y;ti ~ centerline in the - A distribution cell (AxB). Project: Jon + Maxine Schiltgen Mound Page 3 of 8 End Connection Lateral Layout Diagram Laterals ctnt overtheA dimension ♦.Turn•upwtballvslvoorof"noutplug `I P AN lattrals art identical IF X---~ W is deified on the bottom of the lateral e4pally spaced S F090Q main oonntc "via tte or OrOSS to martilokl H -WMpohx. Laterals & force main of PVC Soh 40 (per COMM Table 84.30.51 Number of Laterals 2 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 73.37 ft Orifices per Lateral 30 Lateral Spacing (S) 350 ft Orifice Density 7.50 fe/orifice Lateral Flow Rate 16.16 gpm Manifold Length 3.00 ft System Flow Rate 32.31 gpm Manifold Diameter 1.50 in Total Dynamic Head 16.48 ft Forcemain Velocity 3.30 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and Comm 16.28 WAC I 4 in. min. Disconnect ------!ll--- Tank component is properly vented X. Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Capacityl 603.36 Gallons Volume 16.76 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 19.34 324.15 B 2.00 33.52 C Pump off elevation (ft) C 4.66 78.09 90.23 D 10.00 167.60 D Total 36.00 603.36 Do♦ se tank elevation (ft 3" Bedding un er tank. 89.40 Alarm Manuafacturer S.J. Electro Alarm Model Number Tank Alert Pump Manufacturer Goulds f Pump Model Number EP05 Pump Must Deliver 32.31 gpm at 16.48 ft TDH Project: Jon + Maxine Schiltgen Mound Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name Powers Sanitation ~ Phone 715-246-5738 POWTS Regulator's Name St. CroixCounty Zoning Office Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service FreQuency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test monthly Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Ins ect for pondin and seepage once eve 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished Grade v1 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral I Project: Jon + Maxine Schiltgen Mound Page 5 of 8 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with W component manuals [SBD-10691-P (N.01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be seated 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 fitter 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. Intermittentfilter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 113 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution Syom 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 BODS, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine If orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continaencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in Its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system Into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. PretmatMord Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 8 • Page 7 of 8 RGOULDS PUMPS Submersible Effluent Pump li EP04 3871 EP05 ,V 0 APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses: heat transfer. ■ Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion • Farms manual operation. Auto- canadien Siandarcls Association • Heavy duty sump matic models include resistance. • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA fisted model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "C" or "F") factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic souk's Paqu is Aso soot llK-o:wed FEATURES cover with integral handle and • Solids handling capability: Float switch attachment points. 1/4" maximum. ■ EP04 Impeller: Thermoplas- ■ Power Cable: Severe duty • Capacities: up to 60 GPM, tic Semi-open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: 11/2" NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (401C) continuous METERS FEET 1401F (609C) intermittent. 10 • Fasteners: 300 series - stainless steel. 9 30 . s GPM • Capable of running dry without damage to B 2.5 Fr components. 25 c 7 Motor: _ • EP04 Single phase: 0.4 HP, 20 115 or 230 V, 60 Hz, 1550 s i. RPM, built in overload with o s'. Q automatic reset. • EP05 Single phase: 0.5 HP, o 4 _ . . , _ _ 1.. 11 . EPOS 115 V or 230V, 60 Hz, 1550 3 10, RPM, built in overload with EP04 automatic reset. 2- • Power cord: 10 foot s... _ standard length, 16/3 1 SJTOW with three prong grounding plug. Optional 20 a 00 10 ° 20 30 41 0 50 GPM foot length, 1613 SJTW with three prong grounding plug (standard on EP05). 0 2 4 6 a 10 12 rw/h CAPACITY Goulds Pumps 0 2001 Goulds Pumps ITT Industries Effective May, 2001 83871 Sanitary Site Plan Page 8 of 8 For: John and Maxine Schiltgen NW1/4- NE1/4 Sec. 2 T28N-R19W Town of Troy - St. Croix County 0 20 40 G-plda Solo (F-t) I Inch - 40 tt 660 ft. X x x x x - Bl t p Proposed P/L BM#2 = Top of 11/4"pipe staked. Elev. =103.60' Current Parcel Size is 36Acres 660 ft. x 2640' O ALBM Open Corn Field Proposed Eft x 75 ft Mound Cell located along the 98.70' Contour w/a System Elevation of 100.20' 5% 8 #3 Is Brummel Rd. Pmposed 2„Sck Maintain well and waterline setbacks per SPS >350ft to WestP/L 40 Force Main 383.43(8)(1) Proposed 99.00' 102.00' • WELL 97.00' 98.(X1' Proposed Wieser Concrete 10001600 Combination Tank w/a Poly-Lok PL-525 Filter Walkout Basement Elev. - 95.50' Proposed Three Bedroom Home Elevation Data B#1 = 97.80' B#2 = 97.80' B#3 = 99.30' Grade at Home =102.00' AL BM = Top 11/41' Pipe, staked, and flagged * EMP -Same ASSUMED ELEV. - 100.00' = Backhoe Pit ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Jon & Maxine Schiltgen Mailing Address 582 Brummel Rd. Property Address 588 Brummel Rd. (Verification required from Planning & Zoning Department for new construction.) City/State HudSOn Wi. Parcel ldentificationNumber 040-1003-35-0000 LEGAL DESCRIPTION Property Location NW '/4 , NE '/4 , Sec. 2 , T 28 N R i 9 W, Town of Troy Subdivision Plat: Lot # Certified Survey Map # Volume , Page # / Warranty Deed # 3 q Jp b 6 (before 2007)Volume Page # 2 i~ Spec house Oyes[Zlno Lot lines identifiable Oyes[]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. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 3 S 4-/ /3 SIGNATUR, YOOF 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) "tCL4s"r_ 3F STATE 2A,=t G.F -Yr.G [Rf 3 MY - a r- Scn i tL=e7, a-d Grace 3 a ion_ 1 Sc r l r en... n e - F c''~.3,t t_ er_t_ husband and if as joint tenan---~ tl_~ s".,.b.a m.rs caee.^.e«~ _"_?_r ?9-SEE7c.n 1. ~.ol.E 3 nd, _ °J~1 i ~ _ s w[stira'. p ltr:.. 1:... a_<~ c'e S%r-6•r~' ,:-..y <S9rsr _-St. ....C ro Y_ 7 The 1:est a 1'fr of the Te. e s t Kalf of the Fjortheast ^o FCa; , Qua ter and ali of the 'Northtrest Quarter; ,ta.rL in 33.®£.. - Section 2, rz'oT nship 28 North,, Range 19 .est. G3 c:rcnto Together arit.h the benefits of, and subject to, ,hat certain acreement dated March 20, 1914 and recorded on March 21, 1914 in "144", sag 321: SUBJECT ALSO TO RIGHT-OF-EAY Easements Granted to t. Croix Counts Electra Cooperative by instrument= r cord-ed in the office- of the Rcc_ 5 s; e of Deeds for St. Croix County in "263", pages 95 and 96. This deed is given in performance of 3 Land Contract b tc•.een the part; dated August 23, 1965, recorded August 21, 1969 in the Gffice of the Register of Deeds for St. Croix County, '.7isconsin, its Volume 454, Page 443, Document #297609, and is exempt from the payment of the E-~Fiscorsin Real Estate Transfer Tax. ° Exceptior, to :•:arranties; Existing highways and easements of record and the mortgage caiven by the above reamed grantees to United States of America acting through Farmers Home Administraty.on dated August 21, 1969, recorder's in the Office of the Register of Deeds for St. Croix County, Wisconsin, on August 21, 1969 in Volume 454, Page 445, Document =297610. Hudson,, Wisconsin .22nd e:,78,. Si•:.NED AND SEALED EN' PFC5E•;c'F. 4)F FEE r_ ;~.~,,f>-T._.i _•_-_.SE:AL: Norbert p „chz.ligcn Grace ~1. Schi_'tgeii . EAL. ISEAL; Norbert P. Schiltgen -anc Grace MI. Schiltgen, his wife, .uthent t^.ted -i,t 22nd_ ~,E ,f &4a rcY+ t.s _78. Jo~gfn D IIey'llood Title: Member Slave gar .f ::vsronsln NX}d9el X-MNX Authorized under Sec. 745.76 viz- STATE OF WISCWISIN ' e s. Counv v. °etsnn.llo am.• before me. th.s d.y of tie .b=..e nam,d t,. me Lz -1. ,r. .r ;he pers•:n witu executed the , reg. ng -.ns-:rum n. end acke%-:lerged the %a:ne. r Tht: -tru-nent was drafted Lv John D. HeyGiood, [attorney at Lai Hudson, Wisconsin 5-4016-- Votary Public wtc- •Phc use -;f wtsnFS .es cptto n.t. - My C.usm+s pion (Eapvresi rIsr. times c/ prrc,as ctrrtm¢ sn anv c..pact-v shou]d be tvp°d ,r printed below their ssons"Pe.. 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Raols In. fAmoa1 cW. s~ C acadw AgLaL SIL ~esi 'Sig2 AY Alf, S& ~z > le .o a LS K F -Ar .7 -?IV .S' CS - - •6 w F-I # 0 Q i BwoaAdsa~r6aoeaioK~„_it t>tpi~biNiAgtaelor say t~ 11 mom QLaL cmac*r OEM # 0 On +a~rwa at o aftaftwomr I. ..adman Davb- D=aAAW"M ii 0aaai$M T"m ftahm cwmw~ a-, ..I a r~ e+~ead r a°`` OLftcaao*r ftftft •Nraat~2=BOO~,S~owiD~-swd'Igt~S-7 orm Qn~i. _ eDap eatatt oranoaiss~eiptop~ei rse~loepo#i&md gy=„ ,~,~.~eba==d=ssarrtoesor decd 0000 td naifatadla pimra coaaaot &Pmftw at amnia SI a-rff GOB,%44M.- - r i. ~tyA) d- MAXI'yc ~e Li f'~jrvt ~ ✓ YZ,r- ss-~ 2 sCa~e ~ n- 5/0 7s , asturnc /eo.O ic~Y' /"1~ e 4 7- p, e - No we/I ~ y t T. ~ / 1 Q i `t 02 a t 4 ~ leV,?/j"V 97 m r y'P.a 99. r y,,P y7.8 ~ 9q 3 Esc. ivz.y 11 7~ Cnu~t/~tfl' 9` 8' saJ9e Parcel 040-1003-50-000 07/09/2013 10:36 AM PAGE 1 OF 1 Alt. Parcel M 02.28.19.19 040 - TOWN OF TROY Current 0 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner JON M & MAXINE SCHILTGEN 0 - SCHILTGEN, JON M & MAXINE 582 BRUMMEL RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 582 BRUMMEL RD SC 2611 SCH DIST OF HUDSON SP 1700 WITC Legal Description: Acres: 36.000 lat: N/A-NOT AVAILABLE SEC 2 T28N R19W 40 AC W1/2 W 1/2 NE lock/Condo Bldg: i Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) Z n l~{ U 02-28N-19W V O Notes: Parcel History: Date Doc # Vol/Page Type 2013 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 11/09/2009 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 31.000 5,100 0 5,100 NO UNDEVELOPED G5 2.000 100 0 100 NO OTHER G7 3.000 28,000 109,600 137,600 NO Totals for 2013: General Property 36.000 33,200 109,600 142,800 Woodland 0.000 0 0 Totals for 2012: General Property 36.000 33,200 109,600 142,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 312 Specials: User Special Code Category Amount Total Special Assessments Special Charges Delinquent Charges 0.00 0.00 0.00 Q o ~ CD I ° 4n v p v► a b+o d I a c M O N qb O C y y ~ y I of ~ ~ r I 3 I ayi I w ~ I 0 Z c rn I Li c o -o a~ 3 ¢ o O N Cl) Z N O W E € o Z o N cli IL N 3 F- m N C w O Z g d Z y o N H r LL E N N ~O N a N • O a ~ ~ N O Q Q 0 lC Z Z Z N w ~ I o d I E ~a ~ 3 d I Jy 0 c hiw a"i o G G a` n 0 N F , E ' v FN- I- ~I 0000 a •N aaa a_ a w O Co o 0 rn~v I!~°n'r- z D co 0 o Iw N O O E LO co C a N S _d Q Z i6 ~ N N O Cd C p C V N a°i y 7 _N ~r V ~ O C ~ N c c U _O O I C O a) C C IC N O O S2 N N N C O N N N 0-4 O N j L ad+ 7 C L N • O O O H co a Z 0 co Z Z (n V ::4 L: a. 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