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HomeMy WebLinkAbout012-1043-40-200 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Building Division St. Croix INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 563878 Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holders Name: City Village X Township Parcel Tax No: Bor en, Bruce & Jod Ids, Town of C-/,,.,j 012-1043-40-200 CST BM Elev: Insp. BM Elev: BM 5escription:p x'4&65 Section/Town/Range/Map No: ~0~ tV m ( CS I y'//V 18.30.17.284E TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing t Alt. BM 17.3 75 Aeistu n Bldg. Sewer Holding St/Ht Inlet 1~3~7~5 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to-Air Intake ROAD Dt Inlet \ Septic Dt Bottom Dosing Header/Man. '37 A)4-- 31F Sy - z . as /Da . 01 Aeration Dist. Pipe 35 Holding Bot. System f PUMP/SIPHON INFORMATION Final Grade A135 Ad VI Manufacturer Demand St Cover GPM ~T~-' -7-3 Model Number C~ -7 A J TDH Li) Friction L ss System Head TDH F, 4j. (4 - 1 Forcemain Length i Dia. ( Dist. to Well N ^ SOIL ABSORPTION SYSTEM 3• cJ BED/TRENCH Width LN o. PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS j~ SETBACK SYSTEM TO V P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type f Syste Al- CHAMBER OR I7AJ 1~ UNIT Model Number: DISTRIBUTION SYSTEM Sv Aln4 r Header/Manifold Distribution x Hole Size x Hole Spacing Ven Air Intake Pipe(s) D TJ Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only C Depth Over w A Depth Over xx Depth of xx Seeded/Sodded xx M ched Bed/Trench Center f Bedrrrench Edges Topsoil es No No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:7//7//3 Inspection #2: Location: 1508 Cty. Rd. G New Richmond, WI 54017 (SE 1/4 SE 1/4 18 T30N R17W) NA Lot 4 C.w/f~ arcel No: 18.30 7.284E 1.) Alt BM Description = I G(~ ~`--y ~-~bf u 2.) Bldg sewer length = - amount of cover GL, f /a rile, s o ~ Plan revision Required? Fal Yes W No -~s---- Use other side for additional information. SBD-6710 (R.3/97) Date Insepc o Signaty ,!Cert. No. PLOT PLAN PROJECT Bruce Boroen ADDRESS 1508 Ctv RD GG New Richmond Wi 54017 SE 114 SE 1/4S 18 /T 30 N/R 17 W TOWN Erin Prairie COUNTY ST. CROIX SYSTEM ELEVATION 99.4' BEDROOM 3 CONVENTIONAL AT-GRADE XXXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' ❑BOREHOLE O WELL *H.R.P. same as benchmark B. M. Property Line Grading is to be done to divert run-off away B-2 from system B-1 99.5' 99.4' 99.3' 99.1 ' B-3 19Ea Slope Wei I is to meet al l WDNR setbacks Area 15' below system • is to remain undisturbed Huffcutt Combo Ta k Pro 3 Bedroom House raxe Tank is to be properly bedded and provided Cry with lockdown covers 4AcreParcel with approved warning labels Property Line (not to scale) Co u n# Road GG Z S n n 7 g n 7 7 7 7~ S S R R cn Co Q W J N $ ~ ' ss a l a i 1 1 LU w aQ ss 13Sa8r,88axt t ! ! d p.l ~ J V ^~~nsx~aptl_as,:a~e« I l t l p I I I{ J~~ a ~ x t l l i i{ Ail asans 1! t 1 f I I( t~ RRma~~~li!!Jlltl m >a s i i i l l i l! 1 1 W ^~~aeesa~ts3s~s~as i { ! { i 3~$a2sAi!l:iff:1:9 M~ $aa3Spa 1 I 1 IIII I E << ++S aaasasltllltt ° > ~:a~s~:al1l111111 ~C; ~it~'3R~ 1 1 1 1 1 1 1 1 tea, A I AIR a all 11111 1 1 1 1! 1 1 2 No MM a r~8816 iCRg~ta 11 1 1 1! I 1 co CLL ~~2Aixo 1 11111 1 1 1 1 111 1 g co r°m 12 I i 11111 i l l i 111 I~ 0p, wE ~~:9glI111{11ltll~ ,roo' 0 ~s~=a11111111111t oWw 9 0 Q ^ st s R 1 1 1 1 1{ 1 1 1 1 1 U. `o _ V aW_o i 4azI ` $ R 1R= f f f f f f f f f f f f f 1 I 1 1 1 1 1 1 1 1 0 t N~ p! f l l i l l l l l / l l l IMO to g X J f f f I f f f f J f f f S ~ a I ~ ~a~=iil111tJ111{J~ j 100 N N g ~ N N ~ J Q ~1 n 1 1 1 1 1 t 1 U n. c3 m 1 1 1 1 1 1 I 1 1 I I I 00, SO o y 3 N O *M~ o r +a! Z w 0 R ab S3 S ~ $ R $ 8 8 ° Sa ~ S 01 J G DQ ~ M W W $ g N m , Z-1 1 -Apr- 0o ~N g $ M R Lip, oe a R $ OF 0~ .000 00 00000 w°-Yg ne um gg 'nlwn o • g ~ R r o m 8 a a ~ S ~ $ ~ 53^. Y S^ ~ bi R a n ~ o 1333 saw n n .Qi r r r r o ~ ~ o m m av31+ ~mnua riot r F - - ' County - - Industry Services Division '1400 E Washington Ave Sanitary Perron Number (to be filled in by Co ) l S Pi P.O. Box 7162 y°R 5°i Madison, WI 53707-7162 5~ J 7Q ° - - State Transaction Number anitary Permit Application 9 q In accordance with SPS 383.21(2), Wis. Adm. Code, submission ofthis form to the appropriate governmental unit' erenI than mailing ddress) is required prior to obtaining a sanitary permit. Note'. Application forms for state-owned 1 OWTS are submitted to P jel'AKti 's641 the Department of Safety and Professional Servies. Personal information you provide cnay be used for seGon¢t D run oses in accordance with the privacy Law, S. 1 5.04(I)(m), Stets. _ J U~j P I. Application Information-I'lease Print All Info aG n ' C O dd Properly Owner's Name ST Parcel - Property Location Property Owner's Mailing Address ~f `T L Govt. Lot _ Q - - - - l City, State - - Zip Code Phone Number ~ - ,j~F - '/A, Section / - - - role o II. Type of Building (check all that apply) Lo e / -T----- - - Subdiv ^ or 2 Family Dwelling- Number of"Bedr ision Name ooms - - - D/ 3 C /Block dd ❑ Publ is/Commercial - Describe Use I -_/L4[fr~ _l City of Icr - N ❑ _ r ❑ State Owned llescn~e Use CSM umber Village of Town of III. Type f Permit: (Check only one box oil line A. Complete line B if applicable) 4' _ New System L1 Replacement System ❑ 'Treatment/f folding'fank Replacement Only ❑ Other Modification to Existing System (explain) - - - List Previous Permit Number and Dale Is! red / - B. ❑ Permit Renews Permit Revision Change of Plumber 0 Permit Transfer to New Before Expiration Owner - - hat a > >I IV. Type of_POWTS system omponent/Device: (ChecI 111l l l yZ Ll Non-Pressurized In-Ground ❑ Pressurized In-Ground t-Grade ❑ Mound 24 in. of'suitable soil ❑ Mound < 24 in. of suitable soil Holding'] ank U Other Dispersal Component (explain Preu'catrnent Device _V. Uispersal/Treat t Area Information: f)s ersa! Area Proposed 0 Sys em Glevatiars Desi n Flow (gpd) Design Soil A lication Rate(g dsf) Dis sal Alen Required (sf) r VI. Tank ill of lvtanufacturer - Capacity m Total # to U n Gallons Crallons Units New Tanks Existing ranks w l7 a. Septic or l lolding'Pank - - - llosingCLrunber ~~4~ - - - - ---ns. Vil. Responsibility Statement- 1, the undersigned, assum a rousibility for installation of the PO1y"1 S show" soil the attached tits iies~ Phone i r plur Nam' (Print) Phtmber' lure Plumbe 's Address ( treet, City, State, Zip Cod VII ',ouuty/De artment Use Only_ - Issuir A Signature - Permit Fee Date Issued g Approved $ iven Reason for _nial IX. Condit asons for, Disapproval 3 se i4 tank, effltNertt filter and T- dispersal cell,must all be serylog ! maintained as. per management plan provided by plumber. g Att sedwit requkerne[tts midst be maintafread as pet 4polle b{e code / or__ Attach to cumptete plans tar the system and submit to the County only on paper ant less limo a Ifx x 1 i ruches in sire , 5130-6398 (R0313) • ~4 DIVISION OF INDUSTRY SERVICES ~9ART11~~r°A PO BOX 7162 o~ 1 m MADISON WI 53707-7162 3 D S Contact Through Relay P s www.dsps.wi.gov/sb/ 9~ ow www.wisconsin.gov O ss~ONA~SQ Scott Walker, Governor Dave Ross, Secretary September 16, 2013 CUST ID No. 226900 AT7N.- POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/16/2015 Identification Numbers Transaction ID No. 2306999 SITE: Site ID No. 794127 Bruce Borgen Please refer to both identification numbers, 1508 Cty Rd Gg above, in all correspondence with the agency. Town of Erin Prairie St Croix County SE1/4, SETA, S18, T30N, R17W Lot: 4 FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1443085 Revision; Maintenance required; 450 GPD Flow rate; 38 in Soil minimum depth to limiting factor from original grade; System(s): At-grade Component Manual, Version 2.0, SBD-10854-P (N.03/07, R. 1/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/O1, 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. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). All industrial waste shall be properly disposed of onsite or offsite. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil Call DITIO moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch APPRO wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to DEPT O SAF prepare, do not proceed until it dries. • Building sewers shall be insulated beyond 30 feet per SPS 382.30 (11)(c). PROFESSIONAL DIVISION OF 114DUV, • The tall grasses, shrubs and leaves need to be cut short and removed prior to plowing the surface for installation of the dispersal component (drainfield) to prevent matting under the dispersal area. • Your design still references "Dept. of Commerce" code sections. To prevent future plan review delay, please update all your plan details and/or management plans so that they are current with SPS cod . SEE CC ,.';i=SPC SHAUN R BIRD Page 2 9/16/2013 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. 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 $ 85.00 This Amount Will Be Invoiced. ,~6jv--- When You Receive That Invoice, Sally Sh aker Please Include a Copy With Your Engineering Consultant, Integrated Services Payment Submittal. (608) 264-7782, Monday - Friday 7:45 am - 4:30 pm WiSMART code: 7633 sally.shinnaker@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 "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 by SPS Chapters 360-366. t I RECEIVED Cover Page SEP'S2013 INDUSTRY SERVICES Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 8/28/13 Owner:Bruce Borgen Location:SE1/4 SE1/4 S18 T30 N,R17W 1508 Cty RD GG Erin Prairie System type: At-Grade (revision to plan ID # 2293322) Manuals Used: At-Grade Component Manual version 2.0 SBD 10854 (N. 03/07) Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01/01) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-11. Soil test 12. Filter Specifications !ALLY Shaun Bird fED ETY AND Signature SERVICES License number 2 6 00 rRY SERVICES )NDENCE PLOT PLAN PROJECT Bruce Boraen ADDRESS 1508 Ctv RD GG New Richmond Wi 54017 SE 114 SE 1/4S 18 /T 30 N/R 17 W TOWN Erin Prairie COUNTY ST. CROIX SYSTEM ELEVATION 99.4' BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' ❑BOREHOLE O WELL *H.R.P. same as benchmark B. M. Property Line Grading is to be done to divert run-off away B-2 from system B-1 99.5' 99.4' 99.3' 99.1' B-3 1 % Slope el I is to meet al I WDNR setbacks i Area 15' below system is to remain undisturbed Huffcutt Combo Tank Pro 3 Bed roo m House Tank is to be properly bedded and provided with lockdown covers Scale - 1 /4" = 10' 4Acre Parcel with approved warning labels Property Line (not to scale) Co u nt Road GG At'-grade System Sloping Site Cross Section and Flan View ti Difilkeinsioru Fect •,y,.,,.,,~.~.w.~.1•w.~•,~•'.•w ,~•'~1•ti•ti•ti•ti+,yti•~•.~•w•w•w•w.w. ".w+w"w•w.w .•w•w•w•w•w•w• Y .r. 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Ilia. observation pipe Topsoil Crap Lateral with 2" aggregate over pipe Observation pipe Geotextile With (;an Fabric •r r~r r•r rrr~ -t Ft Lateral Invert [ r•r r•r•r•r•r• r•r•r•r~r s r Topsoil Crap ti ti~~•$r;.•4•■+.w.ti. .ti.~,l.w.w•ti•w w ti w•w ti Z ~•r•.r•r■r•r•r•r•r•r•r' r r r• r•r•r•r•~ .M.ti.~•a.•w•w+'4.•'L.y.~ Ste. '6 ••'1 '1••'L•ti•+.•'ti CZ ' r ~•r r s•r.r•r•r•~ ~1 Ir r•r•~r,r.v;.r r~r,r„r,r.r~r,r M J ■ • ■r■f •r•r•r•Y r r•r 1 yti»w w•'L•'L•w M~,.y,.w w •w• ~ t L,olltoLlr ,r•rl r r•r•r•r r+r• ~ v F . k:.r..r,a' r•r:rwr~rcr.r.r.,r•r•r•r•r•r•r•r•r A S. ter', ~ - 'Plowe'd Surface. Slope Direction GL,IVL+'RAL INSTALLATION- The at--grade area is staked out along the design contour. 4?xisting vegetation is mowed and raked off the site. The basal area (1, x W) is staked out and plowed with it moldboard or chisel plow. Plowing may not proceed if' the soil is wet enough at the plow depth to form a '/4 inch soil wire when a sample is rolled between the palras of the hands. The A x 13 area is covered by clean aggregate deposited overhead by a backhoe. Special care roust be used when placing the aggregate to minimize compaction of the plowed surf ice. After the topsoil cal) is placed, the entire at-grade is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are perforated in the lower,S inches and secured in place. 03/05 lgj Page of Pressure Lateral Layout One Lateral End Mania old - - Threzlded Cleanuut Latt~ral Turn-up -_-I► 1'lu Force Main 1---- X - - Lorl r Sweep c)0 Bend Pressure System Construction Distribution Network Specificxtions.---. Lateral Diameter In. Laterals are constructed of Schedule 40 PVC Orifice Diameter fn pipe. C)rific;<,s are drilled perpendicular to _ In X (orifice Spaci n the pipe with a sharp drill bit aril face clown. _1 L-- l,atcral turn.-ups terminate with a threaded f,~Lateral Lerll~l) - cleanvut. plug, and are enclosed in a 6...13 inch Force Main Diameter - ---fll'- diameter lavia spr•inlder valve box accessible Force Main Length _ ----_.._l'-t-- from finished grade. r► r • • • Grade 6-8 Inch Lawn Sprinkler Valve Box Vage 03105 Igi septic-'.Dose '4'a . Cross Sectx.o And Pump 'Perfori anc a S~~~c~i~ . }ylllltrl~i l~+l~ttrulac+ttrrer' ~ ~ r Tank CVTfttlrrfautur crt rrr n e _l~ ] ark ivtodel ]~}urrilner Pump TblocleT l~lrxrrib~•t Sr. - tac+~turer l area i iuner ....5& . $ r• 1 ot<ti T mi kCTa~pacity - 1 Alarm U1t1del'.N1m1ht,r' j.. ' 4- 'witch l'yrpe~l Filter 1Vlctrtufi:wttlrer Total I)yrlracrnrt Y7c,ad (r'1lTT) lIt c t llllTte lVlucTel l4ber° I~levatic.:ar 1Yeeu1 Distal Pressure Notwor.k LOW; 4r111rnm Puurrp''erfo rmwice RegWred f Force T~lain LOOS 14- t latlet manhole hgim 4 ' .Abovo Grade With Manhole Min. 4" Above Cit-ade. f acking ,f)e rice. Inlet M crTe With fmckntg Devat;e ~ < 6" Below Grade Sealed 'W"atertipl'it Srcurelyi Mounted w. ~ Weathers-proof A motion i1o w Y..Y Firtis}hod Grade PYW wr w►. w ~F . T Vent IVlimr 12" _ . L)isctrrant r;t Above t3rradc 1-Y t~earr~ With vent (.;app - ,T,YYC~+--Yy'YI."Y,ty.~'!`ai~YY^Y~f~Y~P,'PywYYYY+Y i + 1'~YYrr yY"1-'M'-YY'r s L L Y 1 T Y i Y L Y t i Y q I;i + +4Yn Yi/+b+ Yl tY VYyY,",Y; I;Y~lTY 4~Y16 L 4;4L IWytYY<i-i4.°L,16 ~6'Y4.4 ,+YaP+.w;k,lyyY,,,r a `L, < t< Outlet Filter Inlet Inlet Bafflo T+ ' 1 'ivvttclr Sett(lxgs and Ikeserve C a 4r lty .1 <1,5 k Inches Volume (Jul. ' Dimension! Inches Volume (Jul. - - 1<+ (reserve) A / .Vft \1 1t~1t T3 2 Off P, 1 _ + YYI i T . (alsurrrt} ....i_..L 1. t. 0 1, Bottom I;+aV (dead) T`) 3 FF~ °•'s<~ Total vY Y~ 1 f rt'i i`L T i Ll T f DYI+T~Y i fTt~1-T1 i Pl~a' ' + Y + t + I , + + + Y/+i'S'Y<1 6++'Y+i Y~PaY Y~t't i Y i°Y++° y[ + J A + 1 1 u + i + + J f t'1 d'+'t i i'1'!'YYt <YIYYayY~Y is Y+Y IYIYi. 'Ya °Y Y b i tale +T, e6,1a1 1+Y Lai Y Y/ Y I T P 4 Y+ i Y s S P 1 Y/ Y'Y Y T D Ial ai X'r 'l1i~lJL.~~tJ"r Y ~++.~.Y~.~Vt t,~,:~k:..Lib~YMY CR:t-Rai-~x-1~>~•t-L~Y.:tr~LY.~ila_ta.1 ~L~i~1. 'u''.Al~ni..t_A: t.i~4f.. ~'.J.._kit.kl_l1.Ll_ti~.x.A_L,Y1i._l_k~Y_1.l (GETVERAL INSTAl1l.LAf. ION. Tito septicidose tank is Oodded mid back fiflud in accordance with d1t: tntatm ct°uror's product approval speaoitiodtions. Maximum depth (it bury es spwitwd tray tho inanafacturer may clot be exceeded without prior Approval. Manf►ole covers expoged to grade five all effective locking device (padlock.) installed. Piping at the inlet and outlet is of approved material, conne(Aed'to the tank with watwtight fittings, atria laid ou si:a6To roil to prevent settling or saggitr 'l'Tro force matira is sTeovetT Y»rltlr 4"K;lt. 40 PVC to fit iclt►e tine ta►dc uxuavation acrd the sicave is avaled watertighL I'loctric;al service, complier; with NB JOO and Comm 16.23. 02/45 H Pane Wastewrao tor SEN-40 Series 4/10 hp Submersible Effluent pump, 3/4" Solids Construction Flow - Liters/Minute a 50 IUD 150 200 60 300 Cover Epoxy-coated cast iron 35 It . ~U Motor fibusirtg rpoxy-4atKI cast Iran 30 9 Impell e r Material Thermoplastic Flastonier 25 - 6 lrtnBl4#1ypB NQKI~CIp(~ - 7 V 9 zo - : 6 Volute I poxy-coated cast iron 4 w 1U - - s Mechanical 5hatt Nitrlle with carbon and Seal eetamic faces 2 4 2 s - 1 Fa4tenrrr5 Stajt'llessSte I U - - - U "haft Steel U zU 40 sU UU Upper_ slntiered'aW e Flow Gallons/Minute Bpari ik s ey arid. lodrpr at ll Lie 1 UAW yAY to- - SEN-40-NF SEN-40 specifications • • • MODEL NO. ITEM f • MINOR a 1 7.. SFN-40 115 1-1/21' FNPT 9/970 90 70 60 32 14 20 26.5 1750 8(f70 60314 17~f1'SEN-40-AF 115 1-1/2" FNP'r 9/920 80 10 60 rt2 14 20 17.5 1750 'SEN 40-/~CF FNPT 9JF(l Z0 /O 6(1 32 14= 30 28.E 't7~a0 Franklin Elelcitric 400 East Spring Street, Bluffton, IN 46714 Tel: 260.1124.2900 • Fax: 160.814.2909 Form: 996189 7.11 wwwAranklin-electric.com P'OWTS OWNER'S MANUAL & MANAGEMENT PLAN Page--- of PILIE INFORMATI SYSTEM SPECIPICATIONS Owner Septic Tank Capacity al 0 NA hermit# _ _ _ Septic lank Manufacturer I.:7 NA )ES~IGN PAR METERS ~ affluent Flke• Manufacturer I: J NA Number of Bedrooms 0 NA Effluent Filler Model 1.-l NA Number of Public Facility Units ~IA Purnp Tank capacity cal LJ NA j Estimated flow (average) D a! Purrrp rank Manufacturer I NA - - - - - - /da - .Y_ 1 Design flow (peace), (Estimated x 1.") ~ at/rya Pump Manufacturer [_t NA Soil Application Rate al/day Purnp Model / it A Standard Influent/Effluent Quality Monthly average" Pretreatment 1Jrrit VIA t=ats, Oil & Grease (FOG) 530 rngJC_ F.i Sand/Gravel Filter IJ Peat Filter Biochemical Oxygen Derriand (BOD,3) 5220 mg/t_ CJ NA ❑ Mechanlcril Aeration ID Wetland Total Suspended Solids (1'66) : l 50 mg/l. 1:1 Disinfectio'l El Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) CJ NA Biochemical Oxygen Demand (BODs) sat) mg/L 1:1 In-Ground (gravity) 1-1 In-Ground (pressurized) Total Suspended Solids (`rS5) S30 mg/L t-Grade L-1 Mound Fecal Coliform (geometric mean) s104 cfu/lutlrn, U Chip-Lkre U Other: imaxiinum Effluent Particle Size A in dia. 1] NA Other. __._..I _NA . NA °Values typical for domestic wastewater and septic tank eRluerit. Other: NA MAINTENANCE SCHEDULE Service Event Service (Frequency ilnspect condition of tank(s) At )oast once every: 7rj mont r(s) (Maximum 0 NA ear s years) IPUmp out contents of tank(s) When combined sludge and scum %Uals one-third (i~} of tank volume 0 NA ilnspect dispersal cell(s) At least once ever 1 montFr(s) y; -rear(s) (Maximum 3 years) fJ NA Clean effluent filter At least once every: +nonth(s) t_-I NA aspect purnp, pump controls & alarm At least once every; lJ ear( month(s) El NA Y 1=lush laterals and pressure test At least once every: U month s;) .,,-._ar(s) 1-1 NA lather; At least once every: 11 month(s) L] NA l7 year(s) - C3 NA MAINTENANCE INSTRUCTIONS !Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master rPiumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must linclude a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of i;;ornbined sludge and scum and to check for any back up or ponding of effluent on tho ground surface. The dispersal cell(s) shall be ivisually inspected to check the effluent levels in the observation pipes and to check fcr any ponding of effluent on the ground surface. 'rhe ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notificialion of the local regulatory authority. When the combined accumulation tit sludge and scum in any tank equals one4hird (X) or more of the tank volume, the entire contents of f:he tank shall be removed by a Septage Servicing Operator and disposer) of in accordance with chapter NFL 113, Wisconsin 14drrrinistiative Code. INd other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, land any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the coral regulatory authority within '10 days of comr letion of any service event. Prigs of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the prasenc:e of painting products or other chernicais thalt may impede the treatment process and/or damage the dispersal cell(s). if high concentrations are detected have the contents of this 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 surf4ti, During power outages pump tanks may fill above normal highwater levels. When power, is restored the excess wastewater will by discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluerilt. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to tlq'e effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to resiore normal levels within the purnp tank. Do riot drive or park vehicles over tanks and dispersal cells. Do riot drive or park over, or otherwise disturb or Commpact, 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 POWP13! antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation dram (sump purnp) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting procturilS; 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 AdministT'wive Code: ra All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. v The contents of all tanks and pits shall be removed and properly disposed of i:jy a septage Servicing Operator. ee After purnping, all flanks and pits shall be excavated and rernoved or their covers, removed and the void space filled with scpil, gravel or another inert solid material. CONTINGENCY PLAN It the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code; cornpliiiint replacement system: El A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelrn. The replacement area should be protected from disturbance and compaction and should riot be infringed upon by requiried setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in tire ne:ied for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rulers in effect at that time. Cl A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS techrioloUV a holding tank may be installed as a last resort to replace the failed POWTS. The site has not been evaluated to identify a suitable replacement area. Ul;con failure of the POWTS a soil and site evaluatlion rn st he performed to locate a suitable replacement area. It no replacement area is available a holding tank may be iristaliedl as a last resort to replace the failed POW-f& ~p/lvlound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltra•live urface. Reconstructions of such systems midst comply with the rules in eff wt at that Limey. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. 00 INiO`I- 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 IMPOSSIBLI . ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINI`9"AINER Name n `'~--~~4~~'=--~- ' Name Phone F_ Phoned SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Name r Phone 1 ~1 _ _ Phone ['his document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wsc,onsin Administrative code. K Aw. RLTER CARTRIDGE INSTRUCTIONS Mr•~rLl{Ma~r 1 rp installation ".3' F!" r Dry tit' the filter casr~ onto tim end of the nutlL-.t pipe. fo ensro-e_ it is, center all r.cnder the acc---C"- ooening, If not, them either insert mote pilae into the tank through the Outlet or soiuent Weld (glue) addit:iottal pipe anti) the otitiel pipe. While the case is still dry fitted nn thO outlet: pipe, measure the length of U-inc:h pipe heeded to brace the filter to the tank ear) wall if utilizing the t optional supplemental side: support. If side :aupphrt method is not utilized, proceed to step foul., iF' For installations utilizing the optional supplemental side support: +niverat weld the W4-inch pipe Otto the filter if aiefe support: method is not utlhwEed, proceed to step fort: Solvent Weld Elie filter case onto the outlet pipe. Insert: f.1ie filter variridge into the rase, Dressily down until the filter locks 411:4 the! hntl:nnt of t:he case. ! If a Vf{S switch is utilized ' 31 insert m'I'o the fitt:cr and lock cry 1:urninrf clockwise 901 Maintenance .t. The effluent (filter should be cleaned every time the septic. tank is serviced.. 2- Open the nutlet accr_ss opening to inspect the tank acid ftltei: 3, Pump the septic tank completely, making sure to rel"tive. the 'Aticlge layer on the bottom of the tank and not just the st!"m and eftluenk. 4.. Once the effluent level has been lowered below the invert. of the, - atitlet pipe, firmly pull tip on the filter handle to disiudge the czatridge from the came, k' Slide the cartridt e u i p and Writ of the case for cleaning. ~•iS G, If it AS switch cormecteil to an alarm is ;preseni, the switch shniiid be removed by turnilr_I counterclor.:kwrise go, and cleaned with water only. 1 e 7, While holdim the cartridge on it_% side flame fiat stuface facing ogiu down) over the access ope_rtitig, rinse oft the carhidye wif:h water Only, making sure all septage material Is drised back, into the tank. 11. If VRS switch is utilized, replace by inserting irita filter' and . tiirnirig clockwise 90°, f`... 9. Insert the niter cartridge back into the cw;&, pressiu down uni:tf i y ! r tlae filter locks into the bottom of the case. ID, Replace and seoire the access opertinq ah the tank.. t: ,oat. ,.:i Iairc': 'ke S- e, wrwvwbear nsitex-om 877-'IWiLRtXERS (653-4583) Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on less than 8 1/2 x 11 inches in size. Plan must County include, but not limit to rti orizontal reference point (BM), direction and Parcel I.D. percent slope, sca di ions, arrow, and location and distance to nearest roa~.% LI± se print all information. cyye d by Date I inform G n vide may be used for seconds Law, s. 15.04 Personal you provide Y secondary purposes (Privacy t1 ~F~')A ~ / Property Owner Propelttt,ocation Q , Govt. Lot 1 /4 :!:1~1 /4 S r T Q N R/ E (o W Property Owner's Mailing Address Lot # Blockv Name CSM# 1 `!f City to Zip Code Phone Number ❑ City Q Village own Nearest Road n Construction Use. Residential / Number of bedrooms Code derived design flow rate ~>y GPD ❑ Replacement ❑ Public or commercial - Describe: ft. Parent material Flood Plain elevation if applicable Al) General comments yY~2 and recommendations: System Type / System Elevation I Bori F-11ng # a Boring (A Pit Ground surface elev. ~ : L---ft. Depth to limiting factor V"- 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 6-H A61 V1-- Anlcl- /J- 1-21~ Z Boring # Boring W 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/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ! rn GJ • v ov 'n -6 D - ) - ~;Z- Effluent #1 = BOD > 30 < 220 nv/L and TSS >30 1150 n)W ' Effluent #2 = BOD 130 mg/L and TSS < 30 mg/L CST Name (Please Print) Si re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address gate Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 540 C-2 8~ l 715-246-4516 •1 Property Owner _ Parcel ID # Page of ® Boring # ❑ Boring 4 Pit Ground surface elev. l 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 Z 11.~f t7 +Q~/ J 6 r m y / i ❑ 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 Bori El Boring ~ # Ground surface elev. ft. Depth to limiting factor in. 11 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 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/l- ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD4330 (8.6/00) Soil Test Plot PI Project Name Bruce Borgen S n Bird Address 1508 Cty Rd GG New Richmond Wi 54017 STM #226900 Lot 4 Subdivision D e 8/28/13 SE 1/4 SE 1/4S 18 T 30 N/R17 W Township ErinPrairie Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of survey iron System Elevation 99.4' *HRPSame as Benchmark B.M.* Property Line B-2 B-1 99.5' E] E3 99.3' 99.1' B-3 1 % Slope Scale = 1/4" = 10' Property Line (not to scale) County Road GG y~~ aa7 Fouin G JJ Industry Services Division " 1400 E Washington Ave ry Permit Number (to be filled in by Co.) ~P! P,0,Box7162 ` N c, A Aft Madison, WI 53707--7162 nitary Permit Application State Ti aosacionNumber In accordant fi ag 1(2), Wis. Adm. Code, submission ofthis rorm to the appropriate goven mental unit~ 3 3 G 2,2 is required id obta ng a sanitary permit, Nofe: Application forms for state-owned POWTS are submitted to Project Address (if different than lnailillg address) the Depa of S ty and Professional Servies. Personal information you provide may be used fa secondary ur oses i rd nce with the Privacy Laws 15 04(1)(m) Stars. 1. A Mica ion Information - Please Print All InfotTrtation ^ Property Ow IS Name Parcel # Property Owner's Mailinf Address N~ ° ST n, Property Location 2YCI E- City, State / - _P C ~3 Zip Code fin.. Govt. Lot_ _ J ` hone Number ;-rCO~NTy , Section 1 6(10)7 effe~, Il. Type of Building (check all that apply) Lot # N: R or - or 2 Family Dwelling --Number of Bedrooms V Subdivision Nave ❑ Pubf ic/Commercial - Describe Use Block n N ❑ City of'_ ❑ State Owned- Describe Use CSM Number SD - - ❑ iflage of _ _ P Town nr+-4~--LS 1 1. -Type of Permit: (Check--k only one box on line A. plete line B i p ficable) A. - New System ❑ Replacement System Treaty nt/Holding TNk ent Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Pen-nit Revision Before Expiration Chang f Plumb ❑ Permit Transfer o New List Previous Permit Number and Date Is--- sued-- - )wner tV• T e ofPOWTS S ,:tem/Com oneut/Device: C ---tha - ❑ Non-Pressurized In-Grou•id ❑ Pressurized In-Ground r' El HoldingTank ❑ Othe• Dispersal Component (ex pi ound? 24 in. ofsuit,tble soil ❑ Mound < 24 in. of suitable soil - V. Dis ersal/Tr'eatment Area Information: ❑ Pret ;at men[ Device (explain) / Design Flow (gpd) Design soil Ap lication Rate - r - (gPdsf) Dispe rsal Area R aired (sty Dis ~ersal Area Pro osed (sf) Sem Elevatiort- 4/ __z 5L2 VI. Tank Info C pacity in _ Total N of Manufactur - Gallons Gallons Units New Tanks c Existing Tanks--- Dh 5 ~ v o 23 b u U ~ -e _F Septic or Holding Tank U. Dosing Chamber - - VII. Responsibility Statement. 1, the undersigned, assume Plumbe 's Name (Print) 'ponstbility 1'or installation of the PO WTS shown on the attached plans. Plumber's ature MP/MFRS Num~bJe~r Business Phone Number Plumber's Address (Street, Ciy, State, Zip Code) l/ IiI cunt /De artment [Jse only 2j, Lc,/) SYN 7 Approved ❑ Disappro,ed $erm/it Fee Datte~I site so Agent ignatu ❑ OwnerG;ven Reason for Denial ~e~ f 3 ~ IX. Conditions of Approval/Rcas f rosno Disapproval. 3 rr and submit to the County only on paper not Itss Ntan S uz x I r inches iu size v7 J EW Pin 1. Septic tan a uentTjl d dispersal cell must be $e SBD-6398 (R0313) as per management plan pro ded by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. 4, o a-°i °o I N v p GF) e a 0 ~ II G M I N C ao ~ ° I d 0 E d LO x I' eo N ~ ° O IV C Z S co LL c M 0 O (O 7 3 ~ O C I 00 Q M N Z 0 C N 0) _ E N W ~ co d a _ 0 3 a o2 M W d m F- In ~ N N N N C L7 N N O Z a w m Z d 9 N U) P r N 'O o d ~ 3 Ea 'v N j M N v t mL E 7 U (n W o OQQ N ZZ o I Witt ^ m ~4 CL Q N O N d N t E CL U) Z J I v H FN- Ft- y 3 0 0 0 a m a a a w z a O O (n M O CO) J U N Z O U 0 cp 0 I 5 O Z 0 0 O O~ N )=l T o Q n C/) ~j C ~ y N o w F°- ° a-°i V Y N .c N C .S it (O m O N CY N • C (L N r~(l ~ N M C M ~0.. 7 E 'C •O o w` j m Lo C) Z N CL z €a CL m m c • ` m ~~rw'~1 y E c C S _1 A ciaa !0U)IL) i PLOT PLAN PROJECT Bruce Boraen ADDRESS 1217 172nd Ave New Richmond Wi 54017 SE 1/4 SE 1/4S 18 /T 30 N/R 17 W TOWN Erin Prairie COUNTY ST. CROIX SYSTEM ELEVATION 99.2' BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK 1000 gallons DOSE TANK SIZE 630 MOUND XXX SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of 3/4" pipe HRP same as benchmark ASSUME ELEVATION 100' Qom- 2 3Z 4 acre parcel Scale = 1/411 = 101 Tank is to be properly bedded aid provided with lockdown covers with app oved 379 warning labels N r Pro 3 bed roo m ho use Area 15' below system is to a We l I is to meet al l remain undisturbed Ar~ WDNR setbacks System is to be installed along a uniform Huffcutt Combo Tank contour, 0% deflection 4% ~ B-3 hg--~ slope ~S 97.5' N 98.2' B-2 B-1 98.5' ~i M B.M* Grading is to be done to divert . C run-off away from system 730' Property Line ba.,3 cJ~ ~4Q,GL, I(,L g, (off T ~9~eART DIVISION OF INDUSTRY SERVICES ~O PO BOX 7162 S I D S 9 MADISON WI 53707-7162 I Contact Through Relay P www.dsps.wi.gov/sb/ www.wisconsin.gov ~Oss[ONAti5~4 Scott Walker, Governor Dave Ross, Secretary August 09, 2013 CUST ID No. 226900 ATTN. POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/09/2015 Identification Numbers Transaction ED No. 2293322 SITE: Site ID No. 794127 Bruce Borgen Please refer to both identification numbers, 1508 Cty Rd Gg above, in all correspondence with the agency. Town of Erin Prairie St Croix County SE1/4, SE1/4, S18, T30N, R17W Lot: 4 FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1443085 Maintenance required; 450 GPD Flow rate; 34 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.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. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06; stats. The following conditions shall be met during construction or installation and prior to occupancy or use: 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. • 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 copy of the approved plans, specifications and this letter shall be on-site during construction and open to CON C inspection by authorized representatives of the Department, which may include local inspectors. A?: Owner Responsibilities DEPT OF PROFESSIO • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions DIVISION OF IN 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 SEE ORR i SHAUN R BIRD Page 2 8/9/2013 • 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. When You Receive That Invoice, Sally SPlease Include a Copy With Your Engineering Consultant, Integrated Services Payment Submittal. (608) 264-7782, Monday - Friday 7:45 am - 4:30 pm WiSMART code: 7633 sally.shumaker@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm I POWTS OWNER'S MANUAL & MANAGEMENT PLAN page __-`or FILE INFORMATION SYSTEM SPECIFICATIONS Owner F &r Septic Tunk Capacity b`TZ~ al [3 NA Permit # Septic T;.tnk Manufacturer - F NA DESIGN PARAMETERS Effluent Filter Manufacturer ~ ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Commercial Units NA Pump Tank Capacity 30 al ❑ NA Estimated flow (averag,r3) -gal/day Pump Tank Manufacturer ZZLIZ? - A Design flow (peak). (Estimated x 1.5) J aVda Pump Manufacturer 17 NA Solt Application Rate D, aUda lftz Pump Model O A Influent/Effluent Quality Monthly average' Pretreatment Unit A D Sand/Grgvel Filter ❑ Peat Filter Fats, Oil & Grease (FOG) S30 mglL ❑ Mechanical Aeration Wetland Biochemical Oxygen Demand (BODS) 5220 mg/L Total Suspended Solids (1 SS) 550 m /L ❑ Disinfection a Other Manufacturer Pretreated Effluent Quality KNA Monthly average"" Dispersal Cell(s) Biochemical Oxygen Demand (BODE) 530 mg/L L7 In-grOLnd (gravity) ❑ In-ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ At-grade ound Fecal Coliform (geometric mean) 51o' cfu/100ml ❑ Drip-lire ❑ other Maximum Effluent Particie Size Y Inch diameter Values typical for domestic (non-commercial) wastewater and septic tank effluent. Values typical for pretreated wastewater. MAINTENANCE SCHEDULE - Service Event Sorvice Frequency Inspect condition of tanw:(s) At least once every a months ear(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scijm equals one-third (Y,) of tank volume Inspect dispersal cell(s) At least once every 0 month. ear(s) (Maximum 3 yrs.) Clean effluent filter At least once every 13 month-~ ear(s) v year Inspect pump, pump controls & alarm At least once every 17 months (s) ❑ NA Flush laterals and pressure test At least once every ❑ months r(s) DNA Other At least once every 17 months ❑ year(s) ❑ NA I Other. At least once every ❑ months ❑ year(s) ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certfications: Master Plumber; Master Plumber Restricted Sewer, POWYS Inspector, POWYS 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.effiuent 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-turd (Y,) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator aid disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS component:., pretreatfinent components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for th,3 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 operz1or prior to use. Page of START UP AND OPERATION For new construction, prior to use of the POW['S check treatment tank(s) for the presence of painting products or other chemicals thr-jt may, impede the treatment process andlor damage the dispersal cell(s). If high concentrations are detected have the contents of thl, 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 at,ove normal highwater levels. When power is restored the excess wastewater will big discharged to the dispersal cell(s) in one large close, overloading the cell(s) and may result in the backup or surface discharge of effluenlt. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to tl* effluent pump or contact a Plumber or POWTi 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 POWT,r3: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation dream (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 POINTS 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 chaptQr 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 property 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 :,roil, gravel or another Inert solid material. CONTINGENCY PLAN If the POINTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code comphlint replacement system: E3 A suitable replacement area has beer evaluated and may be utilized for the location of a replacement soil absorption systelm. The replacement area should be prolected 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 neled for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rule<l in effect at that time, ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances In POINTS technologN a holding tank may be installed as a last resort to replace the failed POINTS. he site has not been evaluated to id(mlify a suitable replacement area. Upon failure of the POINTS a soil and site evaluation must be performed to locate a suitable replacement area. if no replacement area is available a holding tank may be Installedl as a last resort to replace the failed POW S. nd and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the Infiltrative surface, Reconstructions of such systems must comply with the rules In effect at that time. C<WARNING>;* SEPTIC, PUMP AND OTHER TREATMENT T)kNKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO t4OT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O~ A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER r~J POINTS MAINTAINER I __Name ft, c~~i n/ L7 L r _ _ - Name wlrel1?~ l - Phone Phone ~/J = 46 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Name Phone 9,1j 61 l v _ Phone This document was drafted In compliance with chapter'IPS 383.22(2)(b)(1)(d)&(f) and 383,54(1), (2) & (3), Wisconsin Administrative Code. E V UG , ?p13 Cover Page Es Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 7/ 25/13 Owner: Bruce Borgen Location:SE1/4 SE1/4 S18 T30 N,R17 W 1508 Cty Rd GG Erin Prairie System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan i 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-11. Soil test \ 12. Filter Specifications cross section - C'xr~uQ !u Rda-l Qe, J Shaun Bird AE LY Signature License nu r226900 AND E .VICES SERVICES . CE PLOT PLAN PROJECT Bruce Boraen ADDRESS 1217 172nd Ave New Richmond Wi 54017 SE ' 1/4 SE 1/4S 18 /T 30 N/R 17 W TOWN Erin Prairie COUNTY ST. CROIX SYSTEM ELEVATION 99.2' BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK 1000 gallons DOSE TANK SIZE 630 MOUND XXX SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of 3/4" pipe HRP same as benchmark ASSUME ELEVATION 100' Cty Rd GG 4 acre parcel Scale = 1/4'1 = 10' Tank is to be properly bedded and provided cal with lockdown covers with approved °o Q379 warning labels N r Pro 3 bedroom house Area 15' below system is to Wei I is to meet all remain undisturbed WDNR setbacks System is to be installed along a uniform Huffeutt Combo Tank contour, 0% deflection B-3 4% 0 slope 97.5' B-2 B-1 98.5' B.M.* Grading is to be done to divert run-off away from system 730' Property Line Mound System Cross Section and Plan View o------------------------------------ n - J ' menA sio i - - Feet 7777777 B I D T r.ry.+.r.r}!}r. r•r.+y'. r. . •4••.•YL.YL.L.M1.1.M1. L.L.I~ 4.4.L.L .4. : }}rvey •J:nY1.1.5i. •L•M1jM1f1•L• r 1+.L•••t{1:1fi J.r•r•J.!}+.f•f. J1rM1r~Jyf.J.r.f. f.f}r• • .r• . .f•r}•:f}.L•M1.L • • M1 f fLfL.1.M1.4.L.L•411{.r.r. A • 4rL•fyJ~f 4 f•{ , r r~~ 1ti• - r•r.r.r.JM1 .4.Lr4i JwM1r4r •{Lµtf ..r.f.{•f.r.{.{.r. i}J~}i . J.r.r.J y{ir1{•+L•L{ I •'5.1.1.4.4 1i•. • • L r•fY~lR}iJ}J•F~•}Lf}J} ..L M1. .M1•LfM1.Y1. 1111{ / .,....r,.{{{•f.J.i~•Ai' L}}}}}}i:5}}L•~'J}r•~•vLf}F:}}i:i}• r•r•+•+•J}i}i}{'}}{}' L l{{{y{L{L,{{ ' f{{~{~.Lj4 1•{1.M1. L. L Lr1.L1tif4.M1.YYYM1 r r4r4 4.M1 L s. r-{• •rv.J.r•r• I Y•f •fY•f•/•r•l• .J=i}i:}y.J.r•J:i}i. i} YM1 \{1+ L r~.' YYYYYYYL{Yti{M1r r~{L{•{•r.r J}d r•rV•f~f•l1! 1LJ}f•J• 1•+•J.r•r•r•r•r•J JM•f}f}J}J 1 ti•4.4•YY1.1.4•YYL•L•L•L.L• r•r•J•J• I 8 i I I I I I J I I q, K 2 r - --------~2 L _ _Slope L_ '1 = Topsoil = ASTM C-:33 r = Clean aggregate = 4 in. sch. 40 pvc i~r4r1i: I ' Cap Material sand fill - •45{Y1 /z to 2 ,z in. dia. observation pipe Geotexti le G H Fabric +•Jif L+iftiftiJtilti~ti tiJ. F y, +•3•i 1r r 4F1f•r}r}r. ' 1' t ,R~ A' ~ Ft Contour Plowed Surface Slope Direction GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or chisel plow. Plowing; may not proceed if the soil is wet enough at the plow depth to form a''/4 inch soil wire when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/07 lgj Page of Pressure Lateral Layout Two Laterals End Manifold Threaded ` Cleanout Lateral Turn-up plug Manifold s M All -X-► Long Force Main Sweep 90 Bend Distribution Network Specifications T Yresk-ure System Construction Lateral Diameter _ ln- Manifold Diameter ln. Laterals are constructed of Schedule 40 1'VC Orifice Diameter in. 4197 pipe. Orifices are drilled -perpendicular to X(Orifice Spacing _ In. the pipe with a sharp drill bit and face clown.. L Lateral Length-_ - Ft. Lateral turr -ups terminate with a threaded M (Manifold Length) ~ Ft. cleanout plug and are enclosed in a 6-8 inch Force Main Diameter In, diameter lawn sprinkler valve box acecssible -Force Main Length l1 l trom finished grade. • • • • • Gracie • • • :~j::: • • • • 6-8 Inch Fawn Sprinkler Valve Box 03/0519) Page--- ol s i Septic-Dose Wank CrosS Section And Plump Performance Specifications Tank Manufacturer Pump Manufacturer Tank Model Number L9 Pump Model Number n~ Total Tank Capacity 3 Alarm Manufacturer Max. Bury Depth Alarm Model Number n L v Switch Type Filter Manufacturer 1 _ Total Dynamic Head (TDH) -Feet F lter Model Number i Elevation Head Distal Pressure Network Loss Minimum Pump ~'erfornzance Required Force Main Loss GPM j , Ft T DH Total ! S /o _ outlet Manhole Min. 4" Above Grade With Locking De, lice. Inlet Manhole Manhole Min. 4" Above Grade With Locking Device < 6" Below Grade Sealed Wad-might Securely Mounted , Weather-proof q/1, Junction Box ~I a`, >!IM1 alA. ,M>~ II.II.1 Finished Grade awl Will Vent Min. 12" Disconnect Above Grade Means " With Vent Cap Outlet Filter - Inlet het Baffle Inlet X, > • A . 14" Switch Settings and Reserve: Capacity ; Weep Tank Volume = GPI Hole Dimension Inches Volume Gal. ' (reserve) A off Elevation C :~la B : 2 Vow Bottom (dose) C , J 2z (dead) D / S- D Elevation Ft Total > 1 > > P • • . > > f • • ~ Y f'!a1<Y~Y'!`fa~~ a1 a>a>a4 Y•>'!<>a> 0 f s<><+ >'1 I'>'>~>'+ >'l .<:aat<.<.<<i<{.<<< <a< {<<t <{a <<1<a.<.<<<.f<, <ai:a1•{>a•.'{~i{:.•a•<< a<<<.< GENE is bedded and 'back filled in accordance with the GENERAL X NSTALLA1'ION. ]-he is/d a teak the manufacturer's product approval specifications. Maximum depth of bury as. specified, by the Manufacturer may not be, exceeded without prior approval. Manhole covers exposed to grade have an effective 10+31cing device (padlock) installed. piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent setting or sagging. The force main is sleeved with 4" Sch. 40 `p'VC to bridge the tank excavation and the sleeve. is sealed watt-Tught. Electrical ice complies with NEC 300 amI Comm 16.23. P e of 02105 ` . W SEN-40 Series 4/10 hp Submersible Effluent Pump, 3/4" Solids Construction Flow - Liters/Minute 0 50 100 150 200 250 300 cover Epoxy=coiited cast iron i3t 35 F 11 Motor Wt~iIsit?g . oily=c tom 10 30 - 9 Impeller Material Thermoplastic Elastorner 25 Et ~mp~f~r 43'p~ iQil C~x?g t:.'. 7 20 - - s v Volute Epoxy-coated cast iron 15 - - 5 F~owQor SJITN ; i f to 0 : 4 = Mechanical Shaft Nitrile with carbon and 10 3 Seal ceramic faces 2 s F stell rs nStainlesq sta~j, r 1 0 r 0 Shaft Steel 0 20 so ao Uppori'slnt4etLjaevq s~. . Flow - GailonslMinute £3&xlr1 .c w4j'r17>I~efll D-15` - I # "80 J _ SEN-40-AF SEN-40 Specifications SEN 40 509211 4110 115 1-112" _FNPT 9/420 8Q 70 60 45 26 32 14 23 26 5 1750 2*t 17,* 8 i; . 64 ? 5 11 A1 7d", 6Q`.;'$ i? Ole SEN-40 AF 509213 4110 115 1-1/21, ' FNPT 9/920 80 70 60 45 25 32 14 r D 27.6 1750, 'i N-4 F # a21, tez9. aQa 70.,E :BQ 17gQ,' Franklin Electric 400 East Spring Street, Bluffton, IN 46714 Tel: 260.824.2900 • Fax: 260.824.2909 www.franklin-eiec: tric.com Form: 996199 7.1'1 jE~E1~E® S IL EVALUATION REPORT page 1 0#1371 Departm t of C merce P in rdance with Comm 85, Wis. Adm. Code Divisio,~ty nd Bu** ZQ05 L Steel's Soil Service, Inc. Attach complet n 99 paper n V/2 x 1 inches in size. Plan must County St. Croix include, but no it o* refere point (BM), direction and parcel I.D. percent slope, sca 111 A tion and distance to nearest road. ZyY Tint aff infonnation. Reviewed jjr Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Borgen, Bruce Govt. Lot na SE1/4, SE1/, S18, T30N, R17W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1217 172nd Ave 4 na CSM Vol. 12, Pg. 3389 ( z!J S() City State Zip Code Phone Number City ❑ Village ❑ Town Nearest Road New Richmond WI 54017 715-246-5679 Erin Prairie C Rd GG New Construction Use: ® Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ public or commercial - Describe: na Flood plain elevation, if applicable na ft. Parent material Silty sediment and underlying reddish sandy loam till General comments Mound Design, system elevation 99.40ft based on contour line elevation 98.40ft. and recommendations: Boring # ❑ Boring pit Ground surface elev. 99.70 it. Depth to limiting factor 34 /in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDh12 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 0-9 10yr3/1 none A 2msbk dfr a if .6 .8 2 9-21 10yr4/4 none sid 2msbk dfr cs ivf .4 .6 3 21-34 5yr4/4 none SI om mfr gw na .2 .6 4 3460 5yr4/4 f2d 7.5yr5/6 sl/scl om mfi na na 0 .0 Boring # ❑ Boring ® Pit Ground surface elev. 98.90 ft. Depth to limiting factor 47 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 0-10 10yr3/1 none A 2msbk dfr cs 2f .6 .8 2 10-21 10yr4/4 none sid 2msbk dfr cs if .4 .6 3 21-47 5yr4/4 none SI om mfr cs na .2 .6 4 47-60 5yr4/4 none scl om mfi na na .0 .0 ` Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD5 <_30 mg/L and TSS <_30 mg/L CST Name (Please Print) Signa CST Number 248956 David J. Steel Address Steel's Soil Service, I Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 8/16/2005 715-760-0347 SBD-8330 (R.07M) 17-11 Property Owner Borgen, Bruce Parcel ID # Pending Page 2 of 3 F3 Boring # ~ Boring M Pit Ground surface elev. 97.30 ft. Depth to limiting factor 60 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Ef1#1 *Eff#2 1 0-10 10yr3/1 none sil 2msbk dfr cs 21' .6 .8 2 10-22 10yr4/4 none sicl 2msbk dfr gw if .4 .6 3 22-60 5yr4/4 none sl om mfr a na .2 .6 ❑ Boring # F1 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/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 *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#1 *Eff#2 Effluent #1= BOD? 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = BODS - 30 mg/L and TSS <_30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (P-07100) steers Soil service. Inc. STEEL'S SOIL SERVICE INC. 3 of 3 David J. Steel Bruce Borgen 994200 th St. CST-POWTSM SEl/4,SE1/4,S18,T30N,R17W Baldwin, WI 54002 Lic. 4248956 Town of Erin Prairie, St. Croix Co. Direct 715- 760-0347 CSM Vol. 12, Pg. 3389 Lot, 4 Fax 715-684-3449 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. Legend N 1" = 40' ♦ = Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe • = Alt Benchmark Ele. 99.70 ft Top of 3/4" pvc pipe D = Borings Boring Elevations BI = 98.90 ft B2 = 98.90 ft B3 = 97.30 ft a 77 ~'3 A'I B4 = .00 ft ~Q4 Q, o S /6 - 6 ,s i ^ ~ w • e 4p7* Cd WA~ AM TO Im 9OtM LIM OR 1NE SE 1/4 _ OF SEC110N ,0 Womp s M AS== 10 WAR NSWUWW- LF -----ay -NOWOrWV 5(' aW 48 fill, iC5 ICI 6104 4 loll !3-.- iii t f'~ I M4. V 20JV ICI .r ~ r {!w Ac . 1.1 1Ct0' i ~ # i J . ~t f ~ 3C AltrJOIR u d+ ~gir- fill - lot V SHEET 1 OF 2 SHEETS CARTRIDGF ~r'~l~~~ll~lf~urrl 'a"Y'~'r« .x I:iry ift kltt, llftlyl' weal , BYrfr~etrYitt all'YY1Mi' i•}YW Wdx:MrYiyF 4 I~IF ti+~ tWtY nP t~hit arrf tank ifrYlrplilt 1.h! rrtt IrYrrrllrg« i! rra fJrk# tYrpe 1«i rrnattrYr it Ju- Il(pw" klaff nr wrJn Nlrrt vltYrrt} fW 1b11 Wll'ftrll• IhStlrt f/ItrYD 1lflyu atrlb tfeui t~fWa) addithrlrrr,, llf attar tJnt tlnliari .ii t 15t~ ar, vuhNir tftes e• of Nfi~lwr fl plat ,rtlai itl dull Wry 1#f4tid trfl full tfllt 11i, ist"t tribbtYxrri 11.tY }trpMlytMl ""MO, 4t n awe,lci f tw, brtlK a, Moo ►Yltwf kk► ~rrl WronlutrYjtutwl#YI,Y tzYal„avar>a tt ruldtr 1/8r tiwllt Ittr.! uuld# M tltllllilrrtl ,41 r}l.tr.taf 1,r srt9tU Ylllfx• 1.1 1lytytk lmoifrlyd bf aut tltflkw, :l i"~;•:tY it f'lit' wilkomistim's utlfh~irl xdMuaM WOfd kit" sW•-4"'1' 1 x V1 91ltl tiNltiultx1 rsit4»Nltyll Y111Y ull8xrlll, 1rru ttd '1'u sl'i`lx nxu rapli,'u the f*h*r r bt tl. Yf ~lrlas IsirtY, 4pl~,rrd slrNpurt hrdl'ltxirf i,; lYix} ' 4101 hl! Wald t11y 111tcl a::arW trlttu Vhe I rtdkk { rYiprY, [tYaa«YI B1re, dfihvr .,e,O~r tlr4 t:~ri:+r, , r } awht:rlr}grr irrlYt tFla Vero ttrtallrifl~~ dtlwh ►lllrff Ch'n 6141' lriekr; I#tttt tits M1YW:ir+a ql• :vrr ii' ax Vil5 t~wJtt;#r in Mkfli:!a..L etmrr&r ilrtrx ddir, liPltxr itwi dsrt IC #xy t!N tparill , Y1p.~~r~W~~yy'yy • r, •~f1rrR~b "^'w.~'w7S ` r~y'~ 1. i4111}I,.j1~*4} 1 I.. t'h+cr etfiltf~nk t}lkur sllu7rllrl tie r:lerrdrYYfrl lrtretry 1$r Ytt 1.ftt1 rhasflClr. inalr I 5tlrufrr~rtJ. 1. Upaltl t1Yt1 ut,Nlrtt Ytra:USd uvtgraerrtu kYt Ifirip aiut t14 ttrrllt, 411t1 tlllfxtY I 9, f~ilbYp t1,r, anpttc tdnfr n/ i1CgtNy, rlYulkjt stint to rtstnlnYN1 th,l syu~tYg Jttyae' 00 kitrr btlftakY, alp 1:1118 t,lvg{ and rtvt,{ 4et t"•ra tsualirl Olod rB9`fwunt. ;I !)bees ldiw wltltwrd lYrvert hurls I1traYa fawlal Yrrl kYltla►v thtt 11!1.4}Yl' lri thrl - y crtttlat I OMI tirrrrl /j V DUN up Kith tlrnr a<lltvr irstrlxfltY to IlJtdoda t' curl'rflEga tmrw t6u r:arwa. + fP fltt w 81111M t1,1t rel'Irww Up :rnd .sr 1a: +.rY'the 4aww #04 i ttilitJlrfj tf, Yt sx Mks sw}lYfr 1l11ltlNtrl:tarf lrr uxt« I0161#r1 ib i1owillr#. kite ~Wiff;ll w1 shaauW lrus raYYaorned by trlYnnYry mYlYrrrrturrJtrt9alryw i}t7~~ W1rd t~bybyr} wJkh wut~rr t,rily. , r,. While haltlklq 9:1x1 drswul uVaiY d}ta :ta;Y:tlt.1'w a f~tb Nail W':9 11idd ff Jr11a fihl it/fiixrlrp iarbipl Dill 411 'la 'w• `Pt only, erialthty Hurd tlti ua ~ ~v U1{l ilia 0111{;ridila Milt 'rl rx 110 . lotr'rturitrl 16t ril o"d 111 0 B- ll'' Vltr; swltc:h ay utffixwrlr YyN rlwl.eY 0 Nr#'lj tfrli itarrL.. °1' ~ 1:trt'wflrtp r Idaltuufwv t1xl~ r Ov 111661th" loft! #iirtoi' aiYal i i~d~~l«. t i 9. 1484*f-9 thKr lfflar r:wltrhfiftt biwk faY1,r ffle } - the all-w, hmkaa 11*0 flan 11OH- v, ltd' 44Yw f:Vt6b. Artla,9111 aIuVIVr► 1/lrtiY 111.i4tl N#HCw and Swore tflli 4tt:Vwlr4 trilallllllp all tine fy11rU.. ` Inb .41 ..Ic°7r:,'9n1;'1r:0af,li 'rr,:...rlt,r4awY• ` ~f+~'btu'YN.,~MaUt`I'riyllltlf'~Nfawlt:rfrlrMl. ~'~1~'"~'~.~~'~~,~'~~a'~i ~''~►ar~~~+.~.kii~;~.~ r 6 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGIREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Ruyer Mailing Address _112-1 7 Property Address S-22 (Verification required ' Planning & Zoning Departnicrit for new construction.) City/State ~ aroel Identification Nu niter D ^ /0 ~(-S 020V LEGAL DESCRIP'IJON Property Location Sr '/a '/4 , Sec. / 0 , T 319N Rj`7W, Town of Subdivision Lot 20 '0 7~ Certified Survey Map # - KO -7 ~ ~ Vol ame Page Warranty Deed # Volume Page Spec house ye no Lot line., dentifiable (90 SYSTEM MAI NTYNANCZ 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 yea?.s or sooner, ii deeded, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste, disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Plamiing & Zori ig Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted pluniber 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 T/we, the imdersigned have read the above requirements and agree to mainlain the private sewage disposal system with the standards set forth, herein, as set by the Department of Comrnerce 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 ' droonis _ ell, SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being rsvoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) KATHLEEK H. WALSH REGISTER OF DEEDS State Bar of Wisconsin Form 3-2003 3'r• CROIX CO., MI QUIT CLAIM DEED RECEIVED FOR RECORD Document Number Document Name 042/23/2007 09: 30AM QUIT CLAIM [DEED EIP-MF'i # REC FEE: 11.00 THIS DEED, made between John H. Jacobson TRANS FEE : 115.50 CE)PY FEE : ("Grantor," whether one or more), CC FEE : and Bruce Borten and Judy Borten PAGES. 1 ("Grantee," whether one or more). Recording Area Grantor quit claims to Grantee the following described real estate, togetherwith the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin Name and Return Address ("Property") (if more space is needed, please attach addendum): r e I~So v ~r_>w Part of the SE 1/4 of the SE 1/4 of Sec. 18-T30N-R17W, Town of Erin Prairie, St. r0k. Croix County, Wisconsin, being Lot 3 of Certified Survey Map recorded in Volume 1 a \'l 1 `1 A~ e . 12, Page 3389 as Doc. No. 569105, being f eRTitre 4 of Certified Survey Map recorded September 23, 2005 in Vol. 20, Page 5074 as c. No. 807275. TOGETHER WITH AND SUBJECT TO an ment for ' nt drive as shown on said Certified Survey Map. 012-104340-200 This deed is given to relinquish all rights, title and interest the Grantor has in the Parcel Identification Number (PIN) property hereinabove described. This is not homestead property. (is) (is not) Dated -z.U • h b (SEAL) 2Z . (SEAL) * ohn H. Jacobson (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) t / authenticated on STATE OF 13CONSt ~1 ) o~T. eR.orK )ss. COUNTY ) * TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on ECErn6P,#_ Z.b . L 00& (If not, the above-named John H. Jacobson authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the foregoing THIS INSTRUMENT DRAFTED BY: instrument and acknowledged the same. I Attorney Kristina Ogland 4 1A Hudson, WI 54016 * c:, ..2.11 t If - PUSS Notary Public, State of lSCO t ~C My Commission (is permanent) (expires: AO O >r7 (Signatures may be authenticated or acknowledged. Both are not necessary.) PA7RICIAA. DEn,r J NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDEN IE QUIT CLAIM DEED © 2003 STATE BAR OF WISCONSIN 0 NO.3-2003 = * Type name below signatures. INFO-PROT" Legal Forms 800-655-2021 ~0~ 3 810 -7 275 VOL20 PAGE 5074 KATHLFM H. ALSH REGISTER OF DEEDS ST. CROIX CO.. WI ` 0 0 B RECEIVED FOR RECORD $ 09/23/2005 09:30AN N CERTIFIED SURVEY MAP z REC FEE : 13.00 CA to w z z 1Z0 PAOC~FEE: 3.00 c r m4 n > CA Z o~ Fn 0 °z z z g ?iSz z C > z m z g 2, m BEARINGS ARE REFERENCED TO O m r= m m Q THE SOUTH UNE OF THE SE 1 /4 as ;0 C) m 7= OF SECTION 18 T30N. R17W. WHICH 4 -5 gig Q g IS ASSUMED TO BEAR N89'52'23"W. N~ n~ ~ ~m ~g IOo Is C71 _ o c _MNnIPLATTED LANDS OWNED BY UTHERS _ - - Nooro2's2"w - - - - 50' S0' 235.15---- NOO'02 52 W 252.46 00 m i0O z ~ I~ IP z 4i i,i I I ;Li~i o vNi~°" N 131 ~w U'S w :I0-19)i IUD I&D ,-N-r r~* I uNi ~~iGl Gi I noo _ N0214222" , Z g~Ri o I - NOOro2'52"W 257.26' C ID° I~ j► w z~z° 0 co to I~ i~l ► 0 i~iQp 92 mu) ICI rn I:Bc 1 I'S ► z v ~1 Igo I i` rrnri CPS c'J 02 gig co I I ov'o r^ vmo~ IC (f 7iu • o vXm c 1010 w ; ~vmi g i~io (AZ~ ny I(r~lc~i o t I C Jz S rnm ngE -n ~ IT& ~=j 'Ap ~ 143.55'' g' 232.50' a z z _ SOO'03' "E 376.0_5' w NOO'OO'oo"E G m 2651.41 v wm m - m z -i C T H "GC" " n r N FO- _OWNEDD BY (DCT ; F=Rs_ z cma,v zNm zN ST o" >p? C Wzi ' ao m a TF cnvzg :0 a Q H ~~m S~ .,a O O rQ p o n a 1= -n CA m =1 cn CCnm ern 0 N` ) s V V Z SHEET 1 OF 2 SHEETS Vo1.20 Page 5074 r~fB~z,r`~d o~~~ f3i4fi r ~r r . fa2~ ~i~ ~ a cE~ s 9r yS q § i{{ I I I i t II II II II II II m II £ II I I ~ II II Q~ II i~ 1 I i~ qq I 1 j ! i~ I I II a II i II G/fib I I II II II II II II i II it II II I 1 _ _ _ I II I II II II II j I I i I I ~ I I i A II (M I I II 11 ~ II fl I I I I II ~ II II II II II II II I I I II II II II II II II II II II _ _ I I II II II II II II II II II II II II II II r II II II m II II II I' II II it II 11 I t'D II II II II II II II II II II II II II II II I II II II II II II II II II II II II II II II II II II II II II II 11 II I I I I I I M II II ml EM Im it II II I I I I " - - II II II II II ~ II II II II II' lN' I I l e' II q ° $~i 1e HAFFN92 CON8TRUOTION€~F It~F➢~~ ~H7 BRUCE JUDY SORC~EN RESIDENCE 1 Ipay. I I s• i II ' I II II II II II II II II II I II II I II ~;qmv ii I I 1II I I I I I I iam:. I I I II Ij II I I I I I II 11 11 II II II II II II II II II II II II II II II II II II II A II II II II ~mI II F< II 4y II II 33R II II II II 11 II II II II II II II II Ii II II II II II II II II II II II II II I _-JI II II II II I i ~ ~ ~ I I II II I~ Im,, I I - _ F < I I 4 ~ I I II II II II I I 1 I I I I II raw' f-0• ~ I I I I r--- II II I 1 II 11 II I I II dd I I 1~1y1 I I II II II II II II II II II II II II II II II II II II I s.-0. I I s-Ik• I I I'a4' I'-0'r '!99 9t Yii E Q NAFFNER CONBiRUGiION i 4 Hi 9 p - b BRUCE JUDI' BORGEN RESIDENCE legg papi{ i a eee~~~ Y ii~ i gF~ aj; i~~~~539$~e~~E,~ ~eA N To' 30 V 9' S 3 a f------- O e i F~ k~ R~ k! k! k! k~ N ~ G iG 4~ i Y ~ P J € 69€ ~P I € Fop a€ € 7~E~a~l ~E~€ i~ € D A B A 4 s a, I In 4 1'-b' 1•-Ilb' II•A" 6N' u ; Q sg SIR B•-0. I E l 0 0 If I s Q Q 6 - - - - - - - - - - - - - - - - - ,~yy s 6 s s; ~ ~ I S 40 ~ q I ~ I as I s I ~ n 1f I A g S ~ I i u a I }I ~n ~ ~ YAP I ~ [Ii A6 • q I .v pl~ F S Ie I€ e4 ilk ~ ' p 9Ipp I P~ b [iC I 66 FF I P I S d a i s p~ _ B'loll• ____q ° _ a PP I 3 ~ 4 B t I ~I _ . g 0 O 1 I'd k s `a a. X13 q I; OO O DD = a .•a BAM 6E• •ua re-wa• r'ay' e'Ag• n'aa• u'-P so'o• [ $ y4 HAFFNER CONSTRUCTION ,~a~ F2d ~Appr~e~d~~ t7 ~ BRUCE 4 JUDY BORCzEN RESIDENCE PI! Mill T-0' yp`-0• .......................i is ~ s `k d ~ e ti e p I I s4 I s b 13W jim I ' ~I I I , 'q a '-41V 7-VI: k s r .M 1 6 D J ~ b S F 1 f L I I e ' O I d t I I dE I I . v Y 0 s c~ ~ ~ b I I~ ~ n NO - 91 i I f b 1 b'-I11, b'dy' 6'dy' BO'O' 6 H HAFFNE3 GONs RIIOtION Lo BRUCE 4 JUDY BORDEN RESIDENCE STEEL'S SOIL SERVICE INC. 3 of 3 David J. Steel Bruce Borgen 994 200th St. CST-POWTSM SE1/4,SE1/4,S18,T30N,R17W Haldwh4 W154002 Lie. #248956 Town of Erin Prairie, St. Croix Co. Direct 715- 760.0347 CSM Voi.12, Pg. 3389 Lot, 4 Fax 715-684-3449 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. Legend N 1" - 401 A - Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe • - Alt Benchmark Ele. 99.70 ft Top of 3/4" pvc pipe 13 " Borings Boring Elevations B1- 99.90 ft 132- 98.90 ft B3 - 97.30 ft e'- 37 a 0 s `t-oc o EaS b~£ 989b 98£ 96L 6u1uoZ/ueld juno:) xioj: qS Wd 8b 6o £60Z-9Z-1nf $ Ol! wi/~ ~FivF-D s IL EVALUATION REPORT #1771 of merce in rdence with Comm 85, M. Adm. Code Page 1 of 3 DiuitUO nd BulA 17 2005 steel's 5011 service, tno Attach tom Is n poper X x 1 inohes in size. Plan must County Include, but no~ sal efere point (9M), dlroclion and St. Croix U" L/ A percent sbpe, ace ~i ,on and dlatanos to nearest road. Parcel I.D. 17 tint 1111 Information. Reviewed By Data , VY t Personal information you Provide may t>a used for "Cmdery Purposes (privacy Law, s.16.04 (1) (m)). 'C Property Owner Property Loeatlon (AA VZ40 f 6 Borgen, Bruce Govt. Lot na SE114, SE11 , 618, T30N, R171►V Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1217172nd Ave 4 na CSM Vo1.12, Pg. 3389 Z p f City State Zip Code Phone Number City Village Z Town Nearest Road New Richmond WI 84017 715-240zo79 Erin Prairie C Rd GG ® New Construction Use: ® Residential 1 Number of bedrooms 4 Code derived design flow rate 600 Opt) ❑ Replacement Li Public or commercial - Describe; no Parent material SII sediment and underlying reddish sand loam till Flood plain elevation If applicable na ft, General comments MoundDeign_system elevation 99, b sod on contour line elevation 981% and recommartdationo; EKI R Boring # Fj goring pit Ground surface elev. 99.70 _ ft. Depth to limiting factor 34 in. goti Application Rate Horizon Depth Dominant Color Radox Description Texture Structure Consistence Boundary Roots GPD/ft* In. Munsetl Qu. Sz. Cont. Color Gr. Sa. Sh. *EWI 'Effffz 1 0-9 10yr3/1 none 511 2msbk dft Cs if .6 .8 2 9-21 10yr4/4 none ski 2msbk df'r CS ivr .4 .6 3 21-34 5yr4/4 none A om mfr gw na .2 .6 4 34-60 5y+r4/4 f2d 7.5yr5/6 sl/scl om mfl na na 10 .0 BI Boring 0 L] Boring / 111-JJJ M Pit Ground surface elev. 98.90 fL Depth to limiting factor 47 w iin. 8oi! Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistent Boundary Roots GPD& in. Munsall Qu. Sz. Cont. Color Gr. Sz. Sh. 1 040 10yr3/1 none sll 2msbk dfr Cs 2f .6 .S 2 10-21 10yr4/4 none SIC[ 2msbk dfr CS if .4 .6 3 21-47 5yr4/4 none SI om mfr CS na 2 ,6 4 47-60 SYM/4 none scl om mfl na na .0 .0 *Effluent 01 BCDb> 30 < 220 mq& and TSS >30 < 150 mg/L ' Effluent #2 m 500,E30 mg/L and TSS 5.30 mg/L CST Name (Please Print) Slgnattrr ; CST Number David J. Steel 248959 Address Steel's Sall Service, I Date Evaluation Conducted Telephone Number 894 200th at. Baldwin, WI 54002 $1113/200fi 716-760-0347 asu.es a (A07/m bA 989b-98£-96L 5uiuoZ/ueld djuno:) xioj:) ;5 Wd 8fi'l0 £lOZ-9Z-lnF Property owner 90rgeq Smm ~ Parcel ID#-Pendlao Page -.L -of 3 Boring Boring I 1 Pit Ground surface elev. 97.30 ft, Depth to limiting factor --N- /In. gall Application Rate Nolfzzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Ou. Sz Con. Color Gr. Sz. 8h. 'EfAM4 •Ef ft 1 0-10 10yr3/i none sil 2msbk dfr cs 2f ,6 .8 2 10-22 10yr4/4 none sic[ 2msbk dfr gw if .4 .6 3 22-60 5yr4/4 none SI om mfr a na .2 .6 ❑ Boring # C 1 Boring ❑ Pit Ground surface alav, ft. Depth to limiting factor in. Boil AppllwWri Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Houndary Roots OPPMe In. Munsell Ou. Sz. Cont, Color Gr. Sz. Sh. +E1Mn +EM ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft depth to iimliing factor in. Sall Application Rate Horizon Depth Dominant Color Redox oeecrlption Texture Structure Consistence Boundary Roots GPD/W in. Munsell Ou. Sz. Cont, Color or. S& Sh. 111#1 *002 ` Effluent #1 = 801)r5-30 S220 mg/L and T80 a30 :150 mg/L ' k'tiluent #2 = GODS 30 m9A. and TSS - 30 mg/L The Depm1ment of Commerce Is an equal opportunity service provider and employer. If you need assistance to ooow services or need material in an alternate fbrmat, please contact the department at 608-266-3151 or TTY 608-264-8777. seanso (a mroat sheers sea OW M AtG b/Z 989b-98£-6tL 5uiuoZ/ueld juno:) xiouD is Wd 8b tO £tOZ-9Z-lnf