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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 567211 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: Hel eson, Brian J. & Kathleen R. Hammond, Town of 018-1061-00-000 CST BM Elev: Insp. BM Elev: BM-DTes~cription: Section/Town/Range/Map No: C76 d et I ~ ~ s l 26.29.17.413C TANK INFORMATION ELEVATION DATA 5- p / D 0 D TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. • J. 7 !03.7 s /d Septic , V Benchmark f , ( Alt. BM 6 .n,,.(GL7 F ~ Aeration Bldg. Sewer q V6 Holding St/Ht Inlet /v. zS 13 . TANK SETBACK INFORMATION St/Ht Outlet TANK TO /FD/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ . q Septic ~l \l 27 47 Dt Bottom 43.7 '1^` D Dosing Head an. / 1 _ 7-7 Z-7 / s /0 Aeration L/vv Dist. Pipe, 3 S "P5 Holding Bot. System PUMP/SIPHON INFORMATION Final Grade ( r I S Manufacturer Demand St Cover / ~it X C GPM - VIt~ ~✓D 2~ op, Model Number TDH Lift Fricti n Loss System Head TDH Ft 12Z 3q v Forcemain Len 1 Dia. I Dist. to Well Dig e 0 0 2- -7 (4' Tb' q I SOIL ABSORPTION SYSTEM BEDITRENCH Width it Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ / 0 U SETBACK SYSTEM TO / P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Tye f System: f~ I / UNIT Model Number: UIZ'1t ?4 ` DIST N SYSTEM , ° f / J / °tii Hea r/Manifold istributiop x Hole Size Hole Spacing Vent to Air Intake / 'J'P pe(s) Length Dia Length / Dia Spacing ix SOIL COVER x Pressure Systems Only xx Or At-Grade Syste Depth Over Depth Over xx Depth o eeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoi Yes = No Yes El No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ G J/. 13 Ins ctwn #2:)/4/1 3 Location: 722 200th Street Baldwin, WI 54002 (SE 1/4 SE 1/4 26 T29N R17W) metes & bounds Lot r Parcel No: 26 99 17 11.1-M 9 1.) Alt BM Description = vC~ 7 "~u4[ .J J-1..G 2.) Bldg sewer length - amount of cover Plan revision Required? 0 Yes No Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. t%o i 9 ' 321 sa y :p.. 71 u I .~R . i Awr' 7 \ V ~ i ` ti L Sc tee, "se- Safety and Buwsrigs Division Qom- Number ( tobe Sued by co.) 201 W. VW► Ave., P.O. Box 7162 sanitary Permit t1At, v" 53707-7,627 l / a~ State Transec~ion Number anitary Permit Application 30 s- 3 U ? y 2 PS 311(2} Rrts Ada code, submission of this form to the appropriate govermu~l unit tl>m >n addiess) is Pn miag a sanity Pte- Note: APPiication. forms for state-owned powTS are submitted to Project Address (if diffiejeat Safety and professional Servies. Personal information you provide may be used for secondary in accordance with the Privacy Law, s 15.04(1 m Stffis. ~ v L A hcation Information - Ail Infennati4m ply s Name arc ~I V9~ Parcel # 045 .0 U 5,1( If t. J e- sG l p Location! property owner's Mailing Address 2 Q C U j sty / , Zip Code Phone V., Setxi" t city, state , f ) l ` p ~U~/Z Nry 1 /ce W ~U 4/ VLJ T N, R f Baiddhng (cheek alt that apply) Lot # Subdivision Name mily Dwelling-Numberof aedroo Block # ❑ Pdlic/Cominercaal -Describe Use _ ❑ City of CSM Number ❑ Village of ❑ State Owned- Describe Use 10 Town of t7 ~NL !4't O ~r (p. ~3 ov~ IIL Type of Permit: (Cheek only one box on tine A. Complete line B if applicable) ❑ alter M MC96M to FbEisting system (=Plain) system ❑ Twatment/Holding T Replaces>at Only ❑ New System List Previous mat kbertand Date Issrted B. ❑ Permit Renewal ❑ Permit Revision ❑ Cbew of Phmdw D Permit Transfer to Nev, Before Expiration Owner Z)J /v IV. of POWTS tlDrvit e: Check a8 that ❑ pmssmned In Grated ❑ At-Grade Motmd > 24 in, of suitable so' Mound <24;a of suit" soil ❑ Non-Presaumd Ia-Gracmd ❑ Holding Tank ❑ Dispersal component (explain) ❑ Pwi realment Device (explav►) Q V. Area Information: Dispersal Area 1 ( Dispersal Area System Elevation ~ Design Soil i 0 1 ~l l G A' f -l Flow cgPd) II 4 <I S", 1 ~ r' j -e- 8 in Total # of M s VL Tank Info Gallons Gallons Units g New Tanks Existing Tanks oS. U ro w C7 0. W sepde nrFZoWrog T~k 1660 W f' eS e ,2 Dosft ,hamper c/ soSZ Lt/,' ~f e- VII, bility Statement-16 the mW a*aed, for i"M of the Pt)WTS tie attacied pica Num)w Business Phone/Number Plumber's Nam (Print) PI SS* Plumber's Address (Stiff, UtY, zip code) Use Permit Fee Date Issuing S, $ Z-S hb 9 Za /3 Rea~onforDenial 1 / bh_ Ix. con for ilisappreval 3~ ti w S~-~ I Ot9 P~l , 1. Septic tank, of hAnt Mer tufel J 1 Per rt ~-f +I `S rM + 1 e• :ervtt'% ntaitttal4 ~ n dispersal ce0 must all ses as per, management plan provided by'pktmber• n / 2.:::i4 teat k r «nttrtta t ba.t~c ntat d 6U fz M- C S in 111 ®eices is nine Attadi to em#,We p~ for me syaka and to ire caaNY oa 1>wr~ ku SBD-6398 (R• 11/11) DIVISION OF INDUSTRY SERVICES -oEYTMFNT 3824 N CREEKSIDE LA yti l HOLMEN WI 54636 ° s 9m Contact Through Relay 3 0 S K www.dsps.wi.gov/sb/ 9 ,l P S www.wisconsin.gov w 2 v oA~~ss1oNScott Walker, Governor Dave Ross, Secretary September 16, 2013 CUST ID No. 223475 ATTN: POWTS Inspector JOE STANG ZONING OFFICE STANG PLUMBING & ELECTRIC ST CROIX COUNTY SPIA PO BOX 263 1101 CARMICHAEL RD WOODVILLE WI 54028 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/16/2015 SITE: Identification Numbers' Brian Helgeson Transaction ID No. 2301530 722 200TH St Site ID No. 794724 Town of Hammond Please refer to both identification numbers, St Croix County above, in all correspondence with the a enc . NE1/4, SE1/4, S29, T29N, R17W FOR: Description: Three Bedroom Mound System / 3.8% slope / .7% cross-slope Object Type: POWTS Component Manual Regulated Object ID No.: 1446064 Maintenance required; Replacement system; 450 GPD Flow rate; 14 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. CON The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code A requirements. ~E• No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, O stats. PRQFE$ QNISION OF The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders: • A sanitary permit must be obtained from the county where this project is located in accordance with the SEE requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • The area within 15' downslope of the dispersal component shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • A copy of the approved plans specifications and this letter shall be on-site during; construction and open to inspection by authorized representatives of the Department which may include local inspectors. Note: County may verify dispersal cell cross-slope. If >1%, the plan shall be resubmitted to the department as an Individual Site Design. JOE STANG Page 2 9/16/2013 • r Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 azd M "Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swim@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 -ail addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed 1 by SPS Chapters 360-366. JOE STANG 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. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 and M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swim@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 aA addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed a by SPS Chapters 360-366. MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Helgeson Replacement Mound Owners Name: Brian Helgeson Owners Addrew. 722 200th St RE-6EIVED Baldwin, Wisc. 54002 N~ u 19 2013 Y SERVICES Legal Description: NE1/4, SE1/4, S29, T29N, R17W Township: Hammond County: St Croix Subdivision Name: - PROVED Lot Number. Block Number. - I SA' ErYAND JNAL DtIgTR3 Parcel I.D. Number: 18106100000 YSERV S~'RV1CE3 Plan Transaction No.: Page 1 Index and title _ • Page 2 Data entry DEjy Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot plan Page 9 Soil Evaluation Report Designer Joe Stan License Number. 223475 Date: 08/161Phone Number. 1-715-684-5166 Signature: Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01181) and Pressure Distribution Component Manual Var. 2.0 SBD-10706-P (N. 01101) Version 7.0 (R. 03/2012) Page 1 of 9 ` t r WAN.; "zo {,jrk A Y~ e' p'yf y `it ! F^'A Mound and Pressure Distribution Component Design Design Worksheet site information R Residential or Commercial Design Note: Sand fill (D) calculations assume a (R Or C) Table 38344-3 in-situ soil treatment for 300.00 Estimated Wastewater Flow (gpd) fecal co6form of - 36 inches. 1.50 Peaking Factor (e.g. 1.5 =150%) 450.00 Design Flow (gpd) :3,$ `M Site Slope 98.85 Contour Line Elevation (ft) 14.00 Depth to Limiting Factor (in) OAO In4tu Soil Application Rate (gpd/fe) Distribution Cell Information AI Dispersal Cell Length Along Contour (ft) Cell Width (ft) Dispersal Cell Design Loading Rate (gpd/fe) Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disrbution information network? Enter Y or N (C or E) a Center or End Manifold 4.29 2.14 Lateral Spacing (ft) If N above, enter the elevation ft 3 Number of Laterals of the highest pant 2.14 0.125 Orifice Diameter (in) 3.00 Estimated Orifice Spacing (ft) = 6.52 fe/orifice 1.50 Forcemain Diameter (in) 80.00 Forcemain Length (ft) Does the focemain drain back? Y 89.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 7.34 Forcemain Drainback (gal) 12.28 Vertical Lift (ft) 65.39 5x Void Volume (gal) 5.69 Friction Loss (ft) 72.73 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 28.42 System Demand (gpm) 24.46 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x x 1.25 x x 2.00 1.50 x 3.00 2.00 x 3.00 x Gaflons/lnch Calculator (optional) Treatment Tank Information 650.00 Total Tank Capacity (gal) 1000.00 Se tic Tank Capacity (gal) 39.00 Total Working Liquid Depth (in) Wieser Manufacturer 16.67 gaUn (enter result in cell B49) Dose Tank Information Effluent Filter Information 650.00 Dose Tank Capacity (gal) Best Filter Manufacturer 16.76 Dose Tank Volume (gal/in) GF10-810x18 Filter Model Number Weiser Manufacturer Project Helgeson Replacement Mound Page 2 of 9 0 D> , to 3 5 5 S t l a a f Q t L Z + a z Mound Plan and Cross Section Views J 1110 B • • - 'Observation Pipe 3 J O B A w .l. B I Mound Component Dimensions A 470.00ft ft E 21 n H 1.00 ft K f2. ft B F 9.25 in z ft L ft D in G 0.50 ft Jj , t s- ft W 2 9, f o_ ft 450.10 (ft2) Dispersal Cell Area 13~c (ft) Basal Area Available 6.43 (gpd/ft) Linear Loading Rate 7.601 (ft) 1110 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 03 .~;s (ft) H t frrirr~Ivor G I F DispersalCel[ (ft)Lateral l•r;s (ft)-► Invert Dispersal Cell = 'D t Elevation E s ® ❑ gq,353. (ft) Contour Elevation 3 - % Site Slope Geotextile Fabric Cover Shading Key Dispersal Cell See lateral details on Q 0 Topsoil Cap c 1.5 ft Page 4 for number, Ir- © f}'{r Subsoil Cap 0.2 0 size, and spacing of 0 ASTM C33 Sand t4 IN - a (T F laterals. Laterals are Tilled Layer e 0 0.5 ft Typical Lateral equally spaced from the 0 Aggregate c Q5 distribution cell's l centerline in the A distribution cell (AxB). Project: Helgeson Replacement Mound Page 3 of 9 Mound Plan and Cross Section Views 1/10 g J Observation Pipe K . O A W - I Mound Component Dimensions A 6.43 ft E 2 H 1.00 ft K t t, 10 ft B 70.00 ft F 9.25 in 1 1. -33 ft L 9 3.78 ft D 22.00 in G 0.50 ft J 8, 3a ft W a6.1 `t 450.10 (ft2) Dispersal Cell Area 1300.oo (ft2) Basal Area Available 6.43 (gpd/ft) Linear Loading Rate 7.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 103.45 (ft) ► .rfi rrr.... G * H 1 ,Jrrrrrrrr 2 rrrrrrr~...., •1 * .rfrrrfrffrrr r {r{i% F Dispersal Cell 102.18 (ft) Lateral 101.68 (ft)-► Invert Dispersal Cell D _ = t Elevation E. . : : `99.85 (ft) Contour Elevation 3-90 $4.% Site Slope Geotextile Fabric Cover Shading Key 0 Dispersal Cell See lateral details on 10 0 Topsoil Cap c n 1.5 ft Page 4 for number, Q rrrrr r - Subsoil Cap w O r4ho size, and spacing of 17,31 ASTM C33 Sand F laterals. Laterals are Tilled Layer = 0.5 ft Typical Lateral equally spaced from the Q 0 Aggregate v distribution cell's centerline in the - A distribution cell (AxB). Project: Helgeson Replacement Mound Page 3 of 9 End Connection Lateral Layout Diagram Center the laterals over the A&Sdimension 40=Turn-up udbali vahra or claanoutplug P AN laterals are idendoal iF X- l Holes drBled on the bottom of the lateral s equally spaced Laterals &forcernaln Sch 40 PVC per SPS Table 384.30-6 S T Force melt connection Wa tee or cross to maroc" at any point. Number of Laterals 3 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing (X) 3.11 ft Lateral Length (P) 68.42 ft Orifices per Lateral 23 Lateral Spacing (S) 2.14 ft Orifice Density 6.52 fe/orfice Lateral Flow Rate 9.47 gpm Manifold Length 4.29 ft System Flow Rate 28.42 gpm Manifold Diameter 1.50 in Total Dynamic Head 24.46 ft Forcemain Velocity 5.16 ft/sec Dme Tank Informati on Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and SPS 316.300 WAC Disconnect 4 in. min. Tank component is properly vented E- Alternate outlet location Forcemain diameter Weiser Manufacturer 1.5 in. CaPacitYl 650.00 Gallons Volume 16.76 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 21.54 361.06 B 2.00 33.52 C P♦ ump off elevation (ft) C 4.34 72.73 89.91 D 10.90 182.68 D Total 38.78 650.00 ink elevation (ft) 3" Bedding un er tank. 89.00 Alarm Manuafacuurer SJE-Rhombus Controls Note: Switches Alarm Model Number Tank Alert 1 containing mercury may not be used in Pump Manufacturer Goulds this system. Pump Model Number 3887 EP05 Pump Must Deliver 28.42 gpm at 24.46 ft TDH Project Helgeson Replacement Mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Joe Stan Phone 715-684-5166 POWTS Regulator's Name St. Croix County Zoni Phone 715-386-4680 System Flaw and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450.1 fe Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Freauency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 years Alarm Should test month Pressure System Laterals should be flushed and pressure tested every 1.5 ears Mound Inspect for ndin and seepage once eve 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished . • Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Bail Valve Distribution /7"P Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project Heigeson Replacement Mound Page 5 of 9 Mound System Management Plan Pursuant to SPS 30.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals ISBD-10691-P (N.01f01), SSWW Publication 9.6 (0181), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01101)) and local or state ndes pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or purrs tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shag be In accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or ptanp tank manhole risers, access risers and dyers should be inspected for water tightness and soundness. Access openings used for service and assessmard shag be seeded 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 shah be secured by an effective kicking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shag be maintained by an individual cerfi ied to service septic tanks under s. 28148, Stats. The contents of the septic tank shag be disposed of in accordance with NR 113, Wfs. Adm. Code. The operating condition of the septic tank and outlet titer shag be assessed at best once every 3 yeas by Inspection. The outlet filter shag be cleaned as necessary to ensure proper operation. The Star cartridge should not be removed unless provisions are made to retain solids in the tank that may slough elf the filer when removed from its enclosure. 9 the filter is equipped with an Glenn, the filter shag be serviced if the alarm is activated continuously. Irdermgtent tsar alarms may icdkete surge flows or an impernding continuous alarm. The septic tank shall have is Ooiten8 removed when the volume of skrdge and scan in the tank exceeds 113 the liquid volume of the tank. N the contents of the tank are not remw4ed at the time of a triennial assessment, maintenance personnel shag advise the owner of when the next service reeds to be performed to maintain less than m8xim m scum and sludge aeon In the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, 9 such products are used they shall be approved for septic tank use by the DepaMrent of Commerce. Pump Tank The pump (dosing) tank shad) be inspected at least once every 3 yam. AN switches, alarms, and pumps shag be tested to verily proper operation. If an etguent filter is installed within the tank it shag be inspected and serviced as necessary. Mound and PI essim Dk*tm tionn Svstam No treft or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shag be seeded and mulled as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (otter than for vagetall" rnakftnence) on the mound Is not recommended since sod compaction may hinder aeration of the infiltrative surface within the mound and snow compaction In the winter will promote frost penetration. Cold weather ffwWsbons (Ott-February) dictate that the mound be heavily mulched ae protection from freezing. Influent quality iKo the round system may not exceed 220 m91L BOQ,150 mgfL TSS, and 30 mglL FOG for septic tank effluent or 30 mg1L BODs, 30 mgfL TSS,10 mgfL FOG, and 104 duJ100 mL for highly treated affluent. Influent flow may not exceed maximun design flow specified in the pemnt for this installation. The pressure distribution system is provided with a finishing point at the end of each lateral, and it Is recommeridedi that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test a performed it should be compared to the initial test when the system was ietaged to determine if orifice dogging has occurred and if orifice cleaning is required to maintain equal distribution wain the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Pondmg levels shall be reported to the owner, and any levels above 6 itches considered as an iripendirg hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of is corrWouents 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 wring becomes detectre the defective component(s) shall be Immediately replied or replaced with a component of the sane or equal performance. If the mound component fags 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 erg if toe leakage occurs or by removing biologically dogged absorption and dispersal media, and related piping, and replacing said eomponaft 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 kcal POWTS regulator and service provider. Prratraatnrerrt Unfit The Information and schedule of mananagement and maintenance for preeeetb W devices such as aerobic tneatrrlent units or disinfection units are attached as separate docmwft and are considered part of the overall management plan for this system. Project" Page 6 of 9 ITT GOULDS PUMPS Wastewater PERFORMANCE RATINGS COMPONENTS Gallons Per TOW (f7 ~ } Minute No Description EP04 EP05 1 Impeller - - 5 53 2 Base 10 /6 10 46 62 3 Pump Casing 15 36 55 4 Mechanical Seal 20 21 46 5 Ball Bearings 7 25 0 33 6 5 0-Rings 30 - it 7 Power Cord 5 8 Oil Fdled Motor 3 g Motor Housingl Stator Assembly 10 Motor Cover z METERS FEET 10 1 9 30, 2 Y, 416 T D 14 +-ZSFT p 7 - - - 6 20j 4 p - EPOS 3 2 - r - EP04 - - 0 1_0__------ 20 0 40 50 GPM 0 2 4 6 8 10 12 M'/h CAPACI 2 8.4/ 2 ~ M 3 ?a ~ 7 64" ' zx 7Z a ~t I~" i T.. 3 a. YY ..i ^y 4 I ~ci 05127/08 TOE 09:32 FAX 715 386 4688 ~ ST- C'aM COUP Y SEPTIC TANK AGREENfWT AND OWNERSHIP CERTMCATION FORM OwnerlBuye:• I19 6 l l e ` Q So kN. Mailing Address 2 UG S~ Property Address / 9(Vaific8 ioa mquiW from P%Naiirg & Zoairq Departmeat €w mw wm*mion.) CitylStste Parcel Idesitific~ticm Number f G C7 G p a c~ LEG" Property Location K. Sec. . T 2 N R 7 W, Tows of Subdivision Plat- Lot # Certified Survey Map # , volume - - page ~ Warranty Deed # - <9L (before 2007)vokme / 2 5 9 , Page # -3 7 AIARMENAMM bYPaW • f ."r N Lot Rm ski C yes 10 so `MM`rrrr Y i ~ AND OVAGR CAT Unproper use and a oce ofyoarsgdc sysftm could ceselt inits pea ae>ailera b hnni C -w-pa Props woe eon ofpumping out the septic teat evaytlaee years ar noeeey if needed, by a Rc wand pnmpet: VWyon put into the systees qei i~t the fnoetioia+pftix se}~c was a m+ealmmts~e io Ole'waste~posd syslatn t)umd' ar~attoe apaspecified m - Si-SZ(l j sacs is Cie~er 12 - St G1r+oocCseiety S~j► The property owna agrees to sabmk to St. Craix C mty Planning & Zoairg: Department a boa form. signed by the owner aad by a mmar plmnbar jowaey mm plumber, cast led phmdper or s 8cessed p wAper verifying diet (1) dwon-site - wastewm r disposal symem is is proper gperatia8 eo nditien andkw (2) Aw inspaxion sad pusiag (iifaeressary). the septic task is kw dm 113 fat ofshrdw- t/wet the vadersgaW have read dte above rOqultl,nem and agree to untialain Nrepdvate wwqp dkposd'system wide the m 6ortb, bmio, as set by tba Dqunnmatof and dw Depukom t of Ndond Resauwes. 31st of Wmoorpi. Cardficatioastafwgdudyoarsap&syakaabaabasmwintokedmnstbeeampbudsadreteenedbdeSt.eroacounyP & ZoanrgDepareoo~a,w - 30dagaaftitethneeyeaarc*wfi=dwIr- Uwe cer* that all its an this are true w 6e: best of mylourkwwledge. Ywe &W= dw owner(s) of *e tcronaw described above. by virtue of a warranty recorded in Regisie r ofDoub Office. N of trey STMOMM OF T(S) DATE `Any boa distis uiwgxm led grey tee in pipe story bdng z+ dwd by ie Pith & ZO tig Dgp=*wnt. l em& wdb this aWficaaaoa recorded warranty deed ivmtw Rgpstar ofDamb Office sad a copy of fie certified stvey map if -morence a made is the warranty seed. (REV. OftT10% .95-27-68 11:48 TO: FROM: 715 386 4686 Pei STATE BAR OF WISCONSIN FORbI ! - 1982 WARRANTY DEED Do b VOL tom, 1.'DACE T)7 !I I ii Jon E. Bergin and Faye V. Bergin, , said Jon E. Bergin a/k/a REGISTERS OFFICE husband and wife ~ ST. CROiX CO.. WI Jon R. 2-4=-gin ! ~i Reord for Record conveys ana warrants to riri an J s.elgespnpd AUG 2 5 1997 Ka thl,,Fan R=Helgeson, husband al•1d wife, I. $:00 A ii a c s- J v i v n r c h i p--ma-r-it•a.l p r-Q r t.y,_ 1 ! `S( LJ Re Isisr of Deeds THIS SPACE RESERVEC FOR RECORDING DATA i - - _ I NAME AyOp~ the following described real estate in Croix I; AND RC-TURN ADDRESS I County, •"```t State of Wisconsin: I~ II I~ I' 018-1061-00 PARCEL IDENTIFICATION NUMBER 1 Part of the SE1/4 of SE1/4 of Section 26, Township 29 North, Range Ii 17 West, St. Croix County, Wisconsin, described as follows: Commencing at the NE corner of said SE1/4 of SE1/4; thence West 264 feet; thence South 193 feet; thence East 264 feet; thence North 193 feet to the point of beginning. ~I II TRASFER i $ 3.6. I I FEE i t ; I ~I This 1 S homestead property. II (is) XXXX-AX I~ Exceptio:ttowarranties: Easements, restrictions and rights-of-way of record, II if any. 4 1 II I I~ 1 * . h Dated this f day of _ August A.D., 19 97 r II (SEAL) c'L''l X3r~1~ (SEAL) II Ii Jon Bergin - - Faye V. Bergin r (SEAL) ; (SEAL) II I) AUTHENTICATION ACKNOWLEDGMENT i M Signature(s) State of Wisconsin, 'I I! II St. Croix ss. County. .~i !I authenticated this _ day of 19_ Personally came before the this 7 day of August 19 9 7 , the aba,ve named ! fond Bergin and Faye V. ! I I; - Bergin, husband and wife, - I TITLE It EMBER tiTATE BAR OF WISCONSIN' (if not. Brenda Poulin a author•xed by §706,0o. Wis..5;ats.) Notary Public to me kn g~' to be the person who executed the foregoing Sl<lte of Wisconsillnstrumet td acknowledge th ame. THIS INSTRUMENT WAS DZAFTED UV Attorney Kristina Ogland`-_ Hudson, WI -54016 rota , Public. _ County. Wis 1,,.. x atithrnnralcd of aikn)n)ICCII;I•ii I;olh arv riu ~ r commlFSrnt is permanent' (If of}t., slat ~~."•,~~~)~t date • . , . - • ...i.. . - . d I,: as mot.\tl. 11\:i itl \\'I V( l)\~I\ _•.ct.a i l\',)aN I I I I III III Wis. Dept. of WWII Safety Of Softly =0RA s SOIL EVALUATION REPORT pop of accordance with SPS 385, Wis. Adm. Code Attach complete not less than 81/2 x 11 inches in size. Phan must COW* SL Croix include, but not vertical and horizontal reference point WA), dueclion and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel LC' 018106100000 Please print all inf waWn. Rev / Da/ ParBalar information you provide may be Deed for Second by ~~/L' Nti cry purposes (privacy Law. s. 15.04 t11(M))- Property Owner Property Location Bean Helgeson Govt, Lot EVE 1/4 SE 1/4 S 29N R 171E (CO W© Property Owner's MaM" Address Lot # t010dc # CSW 722 200th St. ~2 CRY State Zip Code RmeAurriher lle" 01JNearest Road Baldwin Wisc. 54002 ( 7115-684-2744 ~ ~ Haninanirld Nry 2 St Use Residential / Number of bedroans 3 Code derived design flow rate _,_T 50 Q Public or commercial - Describe: Pan RfaPD nernt Glaciel Till Flood Plain elevation if applicable r~ ,44 ,T neral comrnerts p recommendations: 0-11 b / l 3 Mound System 1 1,1 / > c''f.. --"__~rnrnai~ ContourEl.99,85 7i~ ~ L 4"_ L,... J Boring Q Boring # Q Pit Ground surfaceelev. 100.65 1t. Dept, to king faces 14 in Horizon Depth Dominant Color Redox Description Texture Structure sWwm ndery Roots " Sol GPD/ft ' Rate in. Munsell Qu. Sr- Cant. Color Or. Sz. She 1 _ 0.3 10YR3/3 v 1 lfbk dsh as 3 0,4 0.6 2 3.,9 10YR4/2 - sil impl dab as _ 2 0.4c 0,6 3 9-14 7.5YR414 srl impl mfr cs 1 0.4c 0,6 `l 14-26 7.5YR5/4 f1f7.5YR6/6spWS sicl lmbk mi cw 0.0 0.2 # ° Bona - 94.95 16 Pit Ground surface elev. ft. Depth to limiting factor in. Sol Appicabon Rate Horizon Depth Dominant Color Redox Description Texture Structure sistence ndary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#l 1 0-4 10YR3/3 1 fbk dsh as 3 0.4 0.6 2 4.11 10YR4/2 - sil lmpl dsh as 2 0.4c 016 3 11-16 7.5YR4/4 l mpl mfr cs i 0.4c 0.6 4 16-26 7.5YR5/4 flf7.5YR6/6 gvis Biel lmbk mvfi m'►' - 0.0 0.2 E~llluant #i BOD , 30 < 220 mg& and TSS >30 5150 4 CST Name (l'base Prloq Etl~rent #2 = a 30 mgll. and TSS 30 mgA.. Signature/ ' CSTNrrrnher Thoams W. Gedatus eat U11 962178 Address Date Evaluation Conducted Telephone Number Stang Plumbing & Electric P.O.Box 263 Woodville, Wisc. 54028 8/14/2013 715-684-5166 SBD-8330 (111/11) B Property Brian Hel n 3 Parcel ID # 018106100000 Page 2 of 3 Owner Swing ~ Boring - Q pit Ground surface elev. 99.65 16 Depth to lr►ilin9 fadorM. Rate - $04 Horizon Depth Owninant Color Redox Description Texture structure onsistence Boundary— Roots GPD/ft z in. Munsell Qu, Sz Coat Color Gr. S?_ Sh. I A" 1 0-4 l0YR3/3 I ltbk dsh as _ 3 0.4 0.6 2 4-11 10YR4/2 sil I !Ml dsh as 2 0,4c 0.6 3 11-16 _ 7,M4/4 sd l pi mfr cs 1 0,4c 0.6 4 16-26 7,5YR5/4 fl f7,5YR6/6 spots sicl lmbk mvfi cw 0.0 0.2 Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Sol &MjEOM Horizon Depth Dominant Colas Redox.. Rabe Desc iption Texture Structure onsistence Boundary Raft GPDM in•. Hansel Qu. Sz, Cont, Cola' Gr. Sz, sh, IM, E Ring Boring # Spit Ground surtace elev. R to im' Depth ftg factor in. Application Rate Horizon Depth Dominant Color Redox Sal Desadon Texture Stricture ce iBourdary, Roots WD_M Z In. Munsel Qu, $z, Cont, Actor Gr. Sz, Sh, ff#l ff#2 Efluent#1= BOD s > 30 < 220 mg& and TSS >30 _S I50 mg& ' Eftwo #2 ~ BOD s 30 mg& and TSS < 30 mgll. The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistarioe to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay, ssoa~ear~purn» -7 2- FF--- d c~ r~ ~ E e ` _ N yY s E `lYJ s .r -T 17 kJ `-17 A cam- q ~7 a fl 2 T-f f vim- L l n~k__.~:, N s~ EL /Ob•65 i{' r t ~ 0 E L qq.~S E-C. /ot~.v ~0, , 52 . T6p off' we l 1 s ; 9 2 1 p C) 9-~!;