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HomeMy WebLinkAbout036-1090-60-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 563891 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Cody, Thomas D. & Eleanore Stanton, Town of 036-1090-60-000 CST BM Elev: Insp. BM E~~ BM Description: / Section/Town/Range/Map No: G.3 - 35.31.17.549B TANK INFORMATION ELEVATION DATA - 3 `1 9 i k -7 / zs6 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Q , 3 /Do . S as Septic Benchmark J 7 77~~ Dosing I Alt. B►v, Cip ✓tn. fp b tr I C~ ~ 7 , y-z `~L .7 Aeration Bldg. Sewer ea., ~ . 7 9z _ 8 Holding St/Ht Inlet gb ` 5 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet -r Dt Bottom Septic C , /6/ rV Dosing J , V Header/Man. V .7 /06 7S Aeration Dist. Pipe 3z Holding Bot. System 1 a/ Final Grade PUMP/SIPHON INFORMATION 3 3 55. Manufacturer Demand St Cover 4~rGGJ c` GPM Cc~ Z°`(Z CJL Model Number ?Z751 2 4 66 V, 4-0 r 6. 7 TDH Lift t' Friction Loss System Held 55 7DH Ft Forcemain Length / Dia. Z Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / NPIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /a -75 e SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type em: / 14 i '16 -7 ✓60 /0/4- UNIT Model Number: DISTRIBUTION SYSTEM 2 Header/Manifold rDstribution / x Hole Size x Hole Spacing Vent Air Inta e(s) t~ 1 J Length ngth 7 / Dia /1 S Spacing 3 I Z -13 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only a c Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center , 7L, Bed/Trench Edges N\,~ Topsoil ( es 0 No s No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspe ion #2: / / Location: 1835 Hwy 64 New Richmond, WI 54017 (NE 1/4 NW 1/4 35 T31 N R1 7W) metes & bounds Lot ~Paarce No: 5.31.17.549B 1.) Alt BM Description = r' i - Qt C) U 2.) Bldg sewer length = 70 -amount of cover c. e, Iz S c' c g d ti ~~II Ix) ~ Plan revision Required? Yes CAf No ID F131 - - Lf Use other side for additional information. l/ SBD-6710 (R.3/97) Date Insepctor' Signat Cert. No. rn County Safety and Buildings Division Q$'~ 201 W. Washington Ave., P.O. BOX 7162 Sanitary Permit Number (to be filled in by Co.) f Madison, WI 53707-7162 A4S cJ C. State Transaction Number Sanitary Permit Application In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appp~~p~Qriate govel it Z30 gD is required prior to obtaining a sanitary permit. Note: Application forms for state-owrkHlJ are submitt~8 to Project Address (if different than mailing address) ' r the Department of Safety and Professional Servies. Personal information you provide mayiy e~Tpfondary purposes in accordance with the Privacy Law, s. 15.04(l m , Slats. S c Ifs c ` 5 1. Application Information - Please Print All Information Property Owner's Name UNn Parcel # --Te> t4 031- -1690-1, 6 t Property Owner's Mailing Address Property Location 8~ I 5 Govt. Lot City, State 11040 Zip Code Phone Number / • L~ JV - Section S (C t W sq V t T~ N; R circl E oreo 11. Type of Building (check a that apply) Lot # Subdivision Name 21 or 2 Family Dwelling - Number of Bedrooms 1 Block # ❑ Public/Commercial - Describe Use l ❑ City of CSM Number 11 Village of El State Owned -Describe Use Of`.I kTOWnOf _5T14yi17- III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. T e of POWTS System/Component/Device: Check all that apply) ❑ Non-Pressurized In-Ground . ❑ Pressurized In-Ground KrAt-Grade ❑ Mound > 24 in, of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) Pretreatment Device (explain) V. Dispersal/Treat nt Area Information: Design Flow (gpd) Design Soil Application Rate(gpd Dispersal Area Required (sf) Dispersal Area Proposed f) System Elevation VI. Tank Info Capacity in Total # of Manufacturer Y Gallons Gallons Units = U y 12. New Tanks Existing Tanks o V ° Septic or Holding Tank 0 1 C/ Dosing Chamber g4 VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's S nature MP/MPRS Number Business Phone Number -r lAl ~A `7 t S =5~~ -~o~ Plumber's Address (Street, City, State, Zip Code) 7 14 r.- J Tc t,e-c LE A 11x7 0_ VIII. County/Department Use Only Proved ❑ Permit F'ee Date Issu d Issuin ent Signatur ❑ O ven Reason For Denial $ z /6 7 IX. Condi easons for Disapproval pl I 1. 1;eptiC tank, fi_. u anh filteriu .3~ Ua/` i ~~0 ' i A. d 1 " ~o c bvC~ {~C rsal oetGmusE all dispe 13-m y - t as per management plan provided by'ptumbgr, 2 iA# i at k regllb'eft,nts must be tr1411141146d A-ra, r n /iCJ JIS per q*klbie 066 fWdiMW4*. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. 11/11) HARDIN - SEPTIC SYSTEMS Po' A z, ,i . v e, -*7<-s Clog - Lj PA - f~ ~qo~ To ~ } OL4SE i. 3d~ %IDID a\ , `Q4V S' z .PAo N i ~13 or r 91 r _P { s . 9w1'TME~ DIVISION OF INDUSTRY SERVICES Ste?' ron 10541 N RANCH ROAD p HAYWARD WI 54843 3 0 $ r k Contact Through Relay S hG~ www.wisconsin.gov A ~ ~OSSIONALS~ Scott Walker, Governor Dave Ross, Secretary September 10, 2013 CUST ID No. 824825 ATTIC- POWTS Inspector BOB J HARDINA ZONING OFFICE HARDINA SEPTIC SYSTEMS ST CROIX COUNTY SPIA 477 170TH AVE 1101 CARMICHAEL RD TURTLE LAKE WI 54889-9187 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/10/2015 Identification Numbers Transaction ID No. 2301809 SITE: Site ID No. 794771 Tom Cody Please refer to both identification numbers, 1835 Hwy 64 above, in all correspondence with the agency. Town of Stanton St Croix County NW1/4, NE1/4, S35, T31N, R17W FOR: Description: At grade, 3 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1446215 D` Maintenance required; Replacement system; 450 GPD Flow rate; 48 in Soil minimum depth to limiting factor from ICON original grade; System(s): At-grade Component Manual, Version 2.0, SBD-10854-P (N.03/07, R. 1/12), Pressure APPr'' Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01101, R. 10/12), SSWMP Pub. 9.6; Effluent Filter )ep'r OF & The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative CodesPROFESS10N and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be const- Slog OF 1ND 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.145.0 5>~ COR stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Key Item(s) • In the event this soil absorption system malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described the At Grade Component Manual are complied with. A copy of this information must be given to the owner upon completion of the project. Reminder • The orientation of the at grade system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the at grade per At grade Component Manual. • Surface water drainage shall be diverted away from the system area. • Materials shall conform to the requirements of SPS 384. SPS 384.10. No fixture, appliance, appurtenance, material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system, unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. BOB J HARDINA Page 2 9/10/2013 < • The existing POWTS must be properly abandoned per s. SPS 383.33 Wis. Adm. Code. • Anchor tank as necessary to negate buoyant forces per SPS 383.43(8)(g). • Insulate building sewer per SPS 382.30(11)(c). 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. Sincerel , Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Patricia L Shandorf Please Include a Copy With Your POWTS Plan Revie er, t5)63 rated Services Payment Submittal. (715) 634-7810, Fax: 4-5150 , M - F 8:00 a.m. - 4:45 p.m. WiSMART code: 7633. pat.shandorf@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Rote: 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. BOB J HARDINA Page 2 9/10/2013 • The existing POWTS must be properly abandoned per s. SPS 383.33 Wis. Adm. Code. • Anchor tank as necessary to negate buoyant forces per SPS 383.43(8)(g). • Insulate building sewer per SPS 382.30(11)(c). 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. Slncerel , Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Patricia L Shandorf Please Include a Copy With Your POWTS Plan RevievKer, tegrated Services Payment Submittal. (715) 634-7810, Fax: 5) 634-5150, M - F 8:00 a.m. - 4:45 p.m. WiSMART code 7633, pat.shandorf@wisconsin.gov x `t► cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Dote: 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 a "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. RESIDENTIAL AT-GRADE DESIGN Pressurized - Sloping Site INDEX AND TITLE SHEET Project CODY Owner TOM CODY Address 1835 HWY 64 NEW RICHMOND, WI 54017 Legal Description NW,NE,S.35,T.31N-17W Township STANTON County ST. CROIX ^ALL-Y Subdivision Name Lot No. r~ Parcel ID Number 036-1090-60-000 y C S f;C Plan Transaction Number d - VES i Index sheet Page 1 Calculations Page 2 At-grade drawings Page 3 - cwC Laterals and dose tank Page 4 ES`'C' Specifications Page 5 Management & contingency plan Page 6 Site Plan 1'=40' Page 7 Pump Curve and Specifications Page 8 Filter maint. Page 9 Att. Soil test Page 10 Designer ROBERT HARDINA License Number 824825 Signature T~ Phone Number 715-986-2508 Date 08/19/13 Designed pursuant to: At-grade Component Manual Ver. 2.0 for POWTS SBD-10854-P (N. 03/07, R. 01/12), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01, R. 10/12) Version 7.0 (11/12) Page 1 of 10 PRESSURIZED AT-GRADE DESIGN At-grade Design Worksheet - Sloping Site Flows and Site Data Entry. (r or c) _ r Residential or commercial? 300.0 Estimated wastewater flow (gpd) 450.0 Design wastewater flow (gpd) 2.00 % Site slope 94.50 Contour elev. below lateral (ft) 48.00 Depth to limiting factor (in) 0.60 In-situ soil application rate (gpd/ft^2) Distribution Cell Information (1 or 2) _ 1 Influent wastewater quality 6.00 Linear loading rate gpd/ft --f0_ Effective absorption width (ft) 10.00 Max. effective width permitted (ft) 75.00 Aggregate length (ft) Pressure Distribution Data Entry (c or e)~ c Center or end lateral connection 2 Number of laterals 0.156 Orifice diameter (in) e.g. 0.25 Noi a final 2.00 Estimated orifice spacing (ft) cab attan 2.00 Forcemain diameter (in) 2.08 Forcemain flow velocity (ft/sec) _ 50.00 Forcemain length (ft) y or n ~ Does forcemain drain back? 85.00 Pump tank elevation (ft) y or n Are laterals at highest point? 4.55 System head (ft) x 1.3 NA 9.00 Vertical lift (ft) 8.2 Forcemain drainback (gal) 0.47 Friction loss (ft) 33.5 5x Lateral void volume (gal) 0.00 In-line Filter Loss (ft) 41.7 Minimum dose volume (gal) 14.02 Total dynamic head (ft) 20.4 System demand (gpm) Lateral Diameter Selection Gallons/Inch Calculator (optional) Pipe diameter Design options_ Design choice Total Tank Capacity (gal) Designer 1 in Total Working Liquid Depth (in) rnust select 1.25 in x Gal/in (enter result in cell G46) one lateral 1.5 in x --X -W diameter 2 in x Treatment Tank Information 3 in x 000 Se tic tank capacity (gal) HUFFCUTT ,Manufacturer Effluent Filter Information Dose Tank Information BEAR Filter manufacturer 627.0 Dose tank capacity (gal) -]Filter model number 14.9 Dose tank volume (gal/in) HUFFCUTT' Manufacturer Project: CODY Transaction Number: Page 2 of 8 AT-GRADE PLAN VIEW 10.00 ft 1/6 B Observation pipes (2 typical) A B 75,00 ft D-~ D 1 /6 B 12.50 ft C 12.00 ft W C D 5.00 ft E 2.00 ft L 85.00 ft D T B W 22.00 ft A x B 750.00 ft^2 Cap Typical obs. pipe. = Total aggregate cell A x B Slotted in in the lower 6", and Plowed area L x W anchored securely. = 6° AT-GRADE CROSS SECTION Svnthetic fabric cover 96 2g ft Finished grade elevation Lateral Observation pipe invert elev. 95.00 ft at aggregate toe E 2 % Slope Surface contour 94 50 ft C A and system elevation ® = 12 in. topsoil and subsoil Plowed layer over aggregate and tapered to toes. below L x W = 6 in. aggregate below pipe(s), and 2 in. above pipe. Project: CODY Page 3 of 8 Transaction Number: PRESSURE DISTRIBUTION AND DOSE TANK Lateral Diagram - Center Connection l P I<- X--3}E 112# x12-)I Laterals & force main of PVC Sch 40 Last hole drilled next to end cap per SPS Table 384.30-6 Holes drilled on the bottom of the lateral, equally spaced • =Turn-up wlball valve orcleanoutplug Lateral Specifications 0.156 Orifice diameter (in) Center Lateral connection point X 1.97 Orifice spacing (ft) 2 Number laterals 19 Orifices/lateral P 36.45 Lateral length (ft) 10.2 Lat. discharge rate (gpm) 1.50 Lateral diameter (in) 2.00 Forcemain diameter (in) 20.4 Sys. discharge rate (gpm) 50.00 Forcemain Length (ft) 14.02 TDH (ft) Typical Pump Chamber Layout Approved manhole cover with Weather-proof warning label and locking device Foxent ' 4„ Final grade disconnect is Alternate ed outlet location 18" min. Electrical as per NEC 300 A(' Approved SPS 316.300 WAG outlet Tank full joint Inches Gallons JA Provide 114" A 25.3 376.7 Alarm on weep hole or = B 2.0 29.8 B antisiphon C 2 8 41 7 Pump on device. o D 12.0 178.8 86M ft C Totals 42.1 627.0 pump off D 3" Bedding under tank .4 - 85.00 ft ZOELLER Pump manufacturer §TE RHOMBUS Alarm manufacturer BN 152Pump model number 101 Alarm model number Project: CODY Transaction Number Page 4 of 8 At-grade System Maintenance and Operation Specifications Service Provider's Name ROBERT HARDINA Phone 715-986-2508 POWTS Regulator's Name ST. CROIX CO ZONING - Phone 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 750.0 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Inspect for ponding and seepage once eve 3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the at-grade component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The at-grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. 6. Areas within 15 feet of the downslope toe will be protected from compaction. 7. All other construction details are as per the at-grade component manual SBD-10854-P (N. 03/07). Lateral Turn-up Detail Finished \ Grade 6-8" Diameter Lawn - Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution ' , - 7 Lateral Long Sweep 90 or Two 95.00 ft 45 Degree Bends Same Diameter as Lateral Project: CODY Transaction Number: Page 5 of 8 At-grade System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall maintained in accordance with its' component manuals (SBD-10854-P (N. 03/07, R. 01/12), SSWMP Pub. 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706 (N. 01/01, R. 10/12)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume o 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. Pub 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. At-rarade and Pressure Distribution System No trees or shrubs should be planted on the at-grade. Plantings may be made around the at-grade's perimeter, and the at-grade 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 at-grade 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 at-grade be heavily mulched as protection from freezing. Influent quality into the at-grade system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 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 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continaency 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 at-grade 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 renovating the biologically clogged absorption and dispersal media, installing new piping, and replacing other 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. Transaction Number: Page 6 of 8 Project: CODY HARDII,,, 5 1'TIC SYSTEMS -25 = tea R Z... + V'E'a-v -2cs -(l v o ()A K LO A 1t -t n b/ -rD , _ y o x , PLC,'' J~ > Z IVA 34, . ~n 2 W P's N~ 6 : r tJa W W PUMP PERFORMANCE CURVE MODEL 151/152/153 50 14 45 153 12 40 n 35 10 152 v 30 ® 8 25 151 J 6 20 15- 4- 10- 2- 5 0- 10 20 30 40 50 60 70 80 90 100 GALLONS LITERS 0 40 80 120 160 200 240 280 320 360 FLOW PER MINUTE 014508 w~'A ONsf~ FILTER CARTRIDGE INSTRUCTIONS .200 TH Installation STEP 1 Dry fit the filter case onto the end of the outlet pipe to ensure it is centered under the access opening. If not then either insert more pipe into the tank through the outlet or solvent weld (glue) additional pipe onto the outlet pipe. STEP 2 While the case is still dry fitted on the outlet pipe, measure the length of 3/4-inch pipe needed to brace the filter to the tank end wall if utilizing the optional supplemental side support. If side support method is not utilized, proceed to step four. STEP 3 For installations utilizing the optional supplemental side support: solvent weld the 3/4-inch pipe onto the filter case. If side support method is not utilized, proceed to step four. STEP 4 Solvent weld the filter case onto the outlet pipe. Insert the filter cartridge into the case, pressing down until the filter locks into the bottom of the case. STEP 5 If a VRS switch is utilized: insert into the filter and lock by turning clockwise 900. Maintenance 1. The effluent filter should be cleaned every time the septic tank is 1 w serviced. 2. Open the outlet access opening to inspect the tank and filter. ° w „w~'~►s 3. Pump the septic tank completely, making sure to remove the sludge i 9f 4C , layer on the bottom of the tank and not just the scum and effluent. 4. Once the effluent level has been lowered below the invert of the outlet pipe, firmly pull up on the filter handle to dislodge the cartridge from the case. 5. Slide the cartridge up and out of the case for cleaning. 6. If a VRS switch connected to an alarm is present, the switch should be removed by turning counterclockwise 900 and cleaned with water only. T' 'c 7. While holding the cartridge on its side (large flat surface facing ; down) over the access opening, rinse off the cartridge with water ` only, making sure all septage material is rinsed back into the tank. 8. If VRS switch is utilized, replace by inserting into filter and turning clockwise 900. 9. Insert the filter cartridge back into the case, pressing down until the filter locks into the bottom of the case. 10. Replace and secure the access opening on the tank. BEAR ONSITE- FILTER CARTRIDGE - FIVE-YEAR LIMITED WARRANTY Bear Onsite filter cartridges are warranted to be free of defects in material and workmanship for five (5) years from the date of consumer purchase. BEAR ONSITET" Filter Case -Lifetime Limited Warranty Bear Onsite warrants the filter case will be free of defects in material and workmanship during normal use for the period of time the original purchaser owns the product. If a defect is found in normal use, Bear Onsite will, at its election, repair, provide a replacement part or product, or make appropriate adjustment. Damage to a product caused by accident, misuse, or abuse is not covered by this warranty. Improper care or malfunctions resulting from units not installed, operated, or maintained in accordance with instructions provided will void the warranty. Proof of purchase (original sales receipt) must be provided to Bear Onsite with all warranty claims. Bear Onsite is not responsible for labor charges, removal charges, installation,or other incidental or consequential costs. In no event shall the liability of Bear Onsite exceed the purchase price of the product. VNMb""j%51bmvw 877-M-1-FILTERS 053-083) Wis. Dept. of Safety and Professional Services SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with SPS 385, Wis. Adm. Code CountyST. CROIX Attach complete site plan on paper not less than 8 1/2:x 11 inches in n must include, but not limited to: vertical and horizontal reference point (BM)fn a . Parcel I.D. 010-1 7-30-000 percent slope, scale or dimensions, north arrow, and location and distance to) d. Please print all information. Oc~ 07 Re wed by Dat Personal information you provide may be used for secondary purposes (Privacy Law,'s. ) (m)). ~l I I Property Owner o, Property Location TOM CODY 0.0 NW NE 35 F#1N 17 0 Govr~l[ot 1/4 ~/4 S E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CS 1783 HWY 64 City State Zip Code Phone Number ity Village ■ own Nearest Road NEW RICHMOND WI 54017 NTON ® HWY 64 4bU ® New Construction Use[] Residential / Number of bedrooms Code derived design flow rate GPD El Replacement ® Public or commercial - Describe: Parent material OUTWASH Flood Plain elevation if applicableN/A ft. General comments RECOMMENDED MOUND CONTOUR= 94.5 and recommendations: Boring # 11 Boring 96.0 52 n 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 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 * ff#2 1 0-9 10YR3/3 -0- SIL 2MSBK MFR W 2M .6 .8 10YR4/6 -0- IL 2MSBK MFR CW TF- .6 .8 3 28-52 7.5YR4/6 -0- SL 2MSBK MFR CW N/A .6 1.0 52-65 7.5YR4/6 SL 2MSBK N/A N/A N/A /A ® Boring # Boring 94.5 50 ' 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 s in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2 1 0-12 10YR3/3 -0- SIL 2MSBK MFR GW 2M 6 .8 2 10YR4/6 -0- SIL MSBK FR CW 1F .6 .8 3 30- .5YR4/6 -0- SL MSBK MFR CW N/A .6 1.0 4 - .5YR4/6 C21D5YR4/4SL SL MSBK MFR N/A N/A N/A N/A * Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Pont) Signatu CST Number ROBERT HARDINA 824825 Address Date Evaluation Conducted Telephone Number 77170th AVE TURTLE LAKE WI 54889 7-25-13 715-986-2508 SBD-8330 (RI 1/11) ' Y HARDIN ..SEPTIC SYSTEMS 04925 afi OA w . ~f A 11 ' r O ell j 9 v q Z ZA V3 r • t -TD E L'Y 6 o . s r i s County Safety and Buildings Division / C e6 o< I's ; d$~ 201 W. Washington Ave., P.O. Box 7162 Sanitar y Permit Number (to be filled in by Co.) Madison, WI 53707-7162 Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit / v / ~ is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Addre (if different than mailing address) the Department of Safety and Professional Servies. Personal information a may be used for secondiyd'y, purposes in accordance with the Privacy Law, s. 15.04 I m , - f S /I. w Saft 1. Application Information - Please Print All I m on Pa Property Owner's Name INK& 'I U M ~Z l2 L~ s C~ 03A b10 -Lo -600 Property Owner's Mailing Address C Q ctv?yerty Location _ O/ Sq~ Govt. Lot City, State Zip Code Phone Number Y, ~JC- y,, Section * ~ 7 R I C rt /P4O Al~ 4_' / I v 1 (circle one) CW * T _3 N; R 17 E orCO II. Type of Building (check all that apply) Lot # XI or 2 Family Dwelling - Number of Bedrooms Subdivision Name # ~Zli1?tt~f Block .e ~S ❑ Public/Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use CSM Numb ❑ Village of / Rlown of rT r v III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System ❑ Replacement System Only El Treatmen Tank Replacement Other Modification to Existing System ( Plain) B. El Permit Renewal El Permit Revision El Change of Plumber List Previous Permit Number and Date Issued ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that a 1 ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound> 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treatmeat Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (st) Dispersal Area Proposed (sf) System Elevation I VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units a U $ N New Tanks Existing Tanks a a ^a cue 0 a` U ~n in iw CJ 0. Septic or Holding Tank Dosing Chamber U & 10 VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb='s Si a MP/MPRS Number Business Phone Number 1 / 7 / y - 1 j~ 5e n! w Plumber's Address (Street, City, State, Zip Code) 417.7 t7a*~' AJ --rye cc L VIII. oun /De artment Use Only pproved El Disapproved Permit Fee Date Issued Is mg Agen Signature ❑ Owner Given Reason for Denial 3a 13 GCl~rt~.. IX. Conditions of Approval/Reasons for Disapproval 3 / • Q/Yl SYSTEM OWNER; s ys / t 1. Septic tank, effluent filter and -71d a 4 dispersal cell must be..servi.ced / Maintained ~s as per management plan provided by plumber. ~G7 uK IiY6 1 em and su it t the County only on paper of less than s 11 inches i size 'Ali c as per applicable co a/ordinances. ~y, r C!~~ y` SBD-6398 (R. II/11) HAR:IDIN A S PTIC SYSTEMS P 9 4 DNS. _ ID W Irl P r P ~ t ~y Wis. Dept. of Safety and Professional Services SOIL EVALUATION REPORT Page / of Division of Safety and Buildings in accordance with SPS 385, Wis. Adm. Code C untyST. CROIX Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 04 0 1 @2;1 30 099- percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 0 3-'(4- & Please pri 11 information. Reviewe by Date 4 Personal information yo 'd y~u r secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~~1 f ~1Nr'Vh- 0 [ a/~ TOM CODY Owner Property ILVotipn NE ~~35 31 17 Govt. Lot VWW/ 4/ 1/4 T N R E (or) W ProDerty Owner's Mailing Address Lot # Qs~c # r Su~'111, la/tie or CSM# HWY 64 X1'0 ~J City State Zip Code Phone Number []City Vlla'* ■ own Nearest Road NEW RICHMOND WI 54017 NTON ® HWY 64 ® New C 'on Used Residential / Number of bedrooms Code derived design flow rate GPD ■ Replacement ® Public or commercial - Describe: WASH Flood Plain elevation if applicableN/A ft. General comments RECOMMENDED MOUND CONTOUR= 94.5 and recommendations: , ( / , - • ` LJ L „ .3 Boring # 11 Boring 96.0 52 R Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#l * ff#2 1 0-9 10YR3/3 -0- SIL 2MSBK MFR GW 2M .6 .8 9" 8 10YR4/6 -0- IL 2MSBK MFR CW 6 8 3 28-52 7.5YR4/6 -0- SL 2MSBK MFR CW N/A .6 1.0 52-65 7.5YR4/6 SL 2MSBK N/A N/A N/A /A Boring # ❑ Boring 94.5 50 R Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 *#2 1 0-12 10YR3/3 -0- SIL 2MSBK MFR GW 2M 6 .8 2 - 10YR4/6 -0- SIL MSBK FR CW 1F .6 .8 3 30- .5YR4/6 -0- SL MSBK MFR CW N/A .6 1.0 4 - .5YR4/6 C2D5YR4/4SL SL MSBK MFR N/A N/A N/A N/A * Effluent #1 = BOD > 30 < 220 mg/- and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) gnatur CST Number ROBERT HARDINA 824825 Address Date Evaluation Conducted Telephone Number 77 170th AVE TURTLE LAKE WI 54889 7-25_13 715-986-2508 SBD-8330 (Rl1/11) CODY 036-1090-60-000 Property Owner _ Parcel ID # Page of Boring # ®Boring 94.5 48 ■ 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 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 1 -10 10YR3/3 0- SIL 2MSBK MFR GW 2M .6 .8 2 OYR4/6 0- SIL MSBK MFR CW 1 F ,6 ,8 3 29-48 .5YR4/6 -0- SL M SBK MFR CW N/A 6 1.0 4 - .5YR4/6 C2D5YR4/4SL SL MSBK MFR N/A N/A N/A N/A Boring # Boring 93.0 50 R. 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 Y in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * 01 * ff#2 1 -9 10YR3/3 0 SIL MSBK MFR GW 2M .6 .8 2 9-27 10YR4/6 -0- SIL 2MSBK FR CW 1F .6 .8 3 27-50 .5YR4/6 -0- SL 2MSBK FR CW N/A .6 .8 4 50-65 .5 YR4/6 C2D5YR4/4SL SL 2MSBK FR N/A N/A N/A N/A ❑ Boring # S 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 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * 02 * Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD 5 < 30 nuft and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-8330Test (Al]A INS.: SEPTIC SYSTEMS 3o~3 mp / `t 92:495 Did K 47- Qottj r ~33p,J As k ~ tS _r j S ` ~rD _o 100 , 1 , C, Q ` 1 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer l t-A rz- Mailing Address ~~cY u & Property Address C) (Q (4 ' _LL (Verification required from Planning & Zoning Department for new construction.) City/State n 6W11 t l~v2c~nA~ Lo Parcel Identification Number 103 la Io5c) 60 moo LEGAL DESCRIPTION Property Location ht c-) 3/4 ,t~l E '/4 , Sec. 3 T 11 N Rfl_W, Town of 6-r-A ^YTo Subdivision Plat: Y , Lot # Certified Survey Map # , Volume , Page # vIT CLk'A1 qty Deed # / & (2 (before 2007)Voluma~-'---l~ Page # (1/~ Spec house 17-1 yes E no Lot lines identifiable ❑ yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. Spy 3n.'51(() The property owner agrees to submit to St. roix 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 Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms _ J'_ . 8//b//5 S ATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. EV. 09107) 2~ l~ U 2 S 9 1 P 6 0 3 ?65296 t !f STATE BAR OF WISCONSIN FORM 3 - 1998 QUIT CLAIM DEED ISEDREGSTER OF DEEDS ST. CROIX CO.. WI Document Number , - - - RECEIVED F RECORD C- i This Deed, made between 06/09/2004 09:30Al1 I~ OUI TEXET # B EED Grantor, it i and REC FEE: 11.00 li COPY E: 10 FF14.1 W4 CC FEE: Ij }i L~ Grantee. iPAGES: 1 Gra~otqu}i claims to Grantee the following described real estate in 'j ( U I County, State of Wisconsin: Recording Area f:! YT`t ~Y L G ry G I h, a_6 !1~ C f• b G r C i' Name and Return Address Co ~h~hc~s 1N 737 cE~ re tlke. pl a C& cf it / k~~/ C C-_ b i In rw i w aJ ~/7 ~Yr J W J 813 -f c- t ll Q - ~OGQ-C ~J 9rcel Identification Number (PIN) S J y / ea S~` Yt7 C h~g p This ~ homestead proper wv t ty. (is) (is not) ,c (j It i a i Together with all appurtenant rights, title and interests. I' II Dated this day of II s (SEAL) (SEAL) ~t I I~ (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMINT Signature(s) _ State of Wisconsin, ss. 12 _41157 & JJJ i Count . authenticated this day of PeA o ll came before me this l~ day of it . _14~pwthe above named o it 'Am14s O e 1A TITLE: MEMBER STATE BAR OF WISCONSIN to { (If not, me known to be the person 5 who executed the foregoing i authorized by §706.06, Wis. Stats.) instrument and acknowledge the same. i! E! THIS I TRVMENT WAS DRAFT BY u Notary Publia ~~~~e~F~~cnncin i+ Notary lic, State of Wisconsin My dg(nmission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are notd 3 necessary) • Names of persons signing in an ca i must be typed or printed below their signature. - STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., inc. QUIT CLAIM DEED FORM No. 3 - 1998 Milwaukee. Wis. Parcel 036-1090-60-000 08/29/2013 04:54 PM PAGE 1 OF 1 Alt. Parcel M 35.31.17.549B 036 - TOWN OF STANTON Current FX-1 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 0 - CODY, THOMAS D THOMAS D CODY C - CODY, ELEANORE LE ELEANORE LE CODY 1783 HWY 64 NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 1835 HWY 64 SC 3962 SCH DIST NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 1.840 Plat: N/A-NOT AVAILABLE SEC 35 T31 N R1 7W 1.84A PRT NE NW COM Block/Condo Bldg: 737'W OF NE COR S 486', W 183', N 486', E 183' TO POB Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 35-31 N-1 7W Notes: Parcel History: Date Doc # Vol/Page Type 10/04/2006 835891 QC 06/09/2004 765296 2591/603 QC 07/23/1997 479/502 2013 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/28/2011 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.840 29,200 81,300 110,500 NO Totals for 2013: General Property 1.840 29,200 81,300 110,500 Woodland 0.000 0 0 Totals for 2012: General Property 1.840 29,200 81,300 110,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch M 133 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00