HomeMy WebLinkAbout018-1098-32-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
567235 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 H. &Suzanne Hammond, Town of 018-1098-32-000
CST BM Elev: Insp.BM Elev: BM Description: L Section/Town/Range/Map No:
C .2 I G Jr 30.29.17.839
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER .4
,. ,. CAPACITY STATION BS HI FS ELEV.
Septic � •�,,s, / �,. Benchmark / � � LL ��5- a 611._.2,5, ixe) 6. Of 3 Z
Dosing iAJ.06 1'.�—P z6 &, Alt.BM 3. 73 /6/ . 75
fir' &// Bldg.Sewer
rib---- Ge5 4-- C/O 3. 1 //D. ii 5
Holding St/Ht Inlet
7. 5 9 8
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. ent t Air Intake ROAD Dt Inlet `-
we4--
Septic Dt Bottom 17. / Zoo / _
Dosing t --- Header/Man.
`/t!o 1 AA- 7 Zap/ Zod 513 9�j. ,7
Aeration Dist. Pipe
5,5397. 9' 7
Holding Bot.System
4, z- 7"• `"94
PUMP/SIPHON INFORMATION Final Grade
.7E' �3 y.5� /Od .1�' �c
Manufacturer G. ,,\ Demand St Cover ( 66v/ `�
GPM '`i`' la$`j 3,75 /6/. 7�✓
Model Number Q �i 3� L/_ / 7f, <<��� �� �jl
/ 7i`Xci CiQ OL! n ,= ` (fat
TDH 'Lift/ ,i Friction Los $ System He4d53 TDH/.45%Ft nv� L f ' #'Q q -
Forcemain Lenh/ Diaz /I Dist.to Well I
SOIL ABSORPTION SYSTEM N to, LP
BED/TRENCH Width Length / No.Of Inside Dia. Liquid renchesJ PIT DIMENSIONS No.Of Pits Depth \
DIMENSIONS (.0 75 0e J/ �_ ` __
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION �� CHAMBER OR
Type Of tem: J e;(D J� 76 230 /t h� UNIT Model Number: 1
DISTRIBUTION SYSTEM torsi--
V n
Header/Manifold/ I I Distribution L✓ f / / x Hole Size /t x Hole Spacing I V @7ryf�b Air I .4e
3 15 Pipe(s) V' ��J/ / 3 3 i o 'i�"'"�
Length Dia Length 3 Dia Spacing �• 3 7 /� rat
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 1 ( .y (2-Lc—^J""—
Depth Over / Depth Over xx Depth of 4 xx Seeded/Sodded Pl u�^"�",&Mulched
Bed/Trench Center /, 7 Bed/Trench Edges Topsoil "ek El No es j No
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: /( / /ii/ 13 Inspection#2: / /
Location: 1521 73rd Avenue Hammond,WI 54015(NW 1/4 SW 1/4 30 T29N R17W) Emerald Acres Lot 32 Parcel o: 30.29.17.839
1.)Alt BM Description= i'+f 1L„, 6 bJ-Cr- -77041-0%4- csi.,..,,�+ P6 c.•/ 0
2.)Bldg sewer length= 261 I ,,1,_ t-., pot,) 0(
amount of cover= / /I/� [fit, Lo v" k
L, �y,�SC/ a
Plan revision Required? Yes to: No /I 'q 13 4 j J_QU>1 T
• `7 1 (J U T 1
Use other side for additional information. i c__
Date Inse
SBD-6710(R.3/97)
/ior's Signat Cert.No.
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County
Safety and Buildings Division '51f 6,014
i 0 S 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.)
ti P S Madison, WI 53707-7162
723~
"'~SlpfyPt
%ptat Permit Application State Transaction Number
In accordance with 1(2) Adm. Code, submission of this form to the appropriate governmental unit 2 ( (P-7 (a `
is required prior to in itary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address)
the Department of and Professional Servies. Personal information you provide may be used for secondary 3,7- / ESL / 7~ rc vE
u oses in accordance with the Privacy Law, s. 15.04(1)(m), Slats. ' 4
1. Application Information - Please Print All Information ' ~~"f_1Z4 /c/ 3-
Property Owner's Name ,t Parcel #
OCT CD 0/8 -/4798 37- -o,a o
Property Owner's Mailing Address < i3 Property Location Y-3 cl)
Govt. Lot
City, State Zip Code Phone Number 7 ,
A-4-1 /<,cS1V Section 3 0
S~~// TO 2- 3 (circle one)
T Z_ N; R/7_E or W
II. Type of Building (check all that apply)ti Lot #
VI or 2 Family Dwelling -Number of Bedrooms 3 Z_ Subdivision Name n
Block # e;-," t~-4 tl C/
❑ Public/Commercial - Describe Use !
❑ City of
CSM Number ❑ Village of
❑ State Owned -Describe Use
Town of ceir+°+~ p N
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. #L4ew System
❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued
B. ❑ Permit Renewal ❑ Permit Revision
Before Expiration Owner
IV. Type of POWTS System/Component/Device: Check all that apply) 1 -7 Zf
F1 Non-Pressurized In-Ground El Pressurized In-Ground El At-GradevIound > 24 id. of suitable soil Mound < 24 in. o uita a sotl
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) 144
V. Dis ersal/Treatment Area Information:
Design Flow (gpd) Desi n pplication Rate(gpdsf) Disl grsal Area Required (sf) Dis ersal Area Prop?sed (sf) System Elevation ✓
,G `
VI. Tank Info ' Capaci in Total # of Manufacturer.'
Gallons Gallons Units o v
New Tanks Existing Tanks l 40~ o y a
R
8f5 U vz w C7 i~
%Ztic'd
Holding Tank Moo
osing Chatnk cQ vv a>r
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS show on the attached plans.
P ber's Name (Print)/ Plumber's Signature M /MP umber Business Phone Number
l~uS ZzL97~ 7/j - jr 388
PI mber's Address (Street, City, State, Zip Code)
VII Count /De artment Use Only
Permit Fee Date I$sued 1sSuing Age . Sign e `
Approved El Disapproved $ 7 -2
❑ Owner Given Reason for Denial ~ ~21_') ~ )
/IX. Conditions of Approval/Reasons for Disapproval
( 3,i c%ti~L~~i (/~t, ~ - ~J,~ vim`" •,k X it~cr~ SYS OWNER, i Tc~+w
1. Septic tank, effluent filter and
g~ _ D dispersal cell must be serviced /maintained
P6" 01 /0 f as per management plan provided by plumber.
2. All setback requirements must be maintained
0 FkSft6nsfoi~.Pe s tern and submi to a County only on paper not lgg to r tMA$ bblEhtsd eiMrdinances.
( L.
SBD-6398 (R. 11/11)
9~4ART,1l DIVISION OF INDUSTRY SERVICES
10541N RANCH ROAD
HAYWARD WI 54843
3 S Contact Through Relay
P $ www.dsps.wi.gov/sb/
9 a`Gy www.wisconsin.gov
~A;PO
SSIONA~ Scott Walker, Governor
Dave Ross, Secretary
October 16, 2013
CUST ID No. 222872 ATTN.• POWTS Inspector
JACQUE M HAWKINS ZONING OFFICE
HAWKINS SOIL TESTING & SEPTIC SYSTEMS ST CROIX COUNTY SPIA
2659 150TH ST 1101 CARMICHAEL RD
LUCK WI 54853 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 10/16/2015 Identification Numbers
Transaction ID No. 2316761
SITE: Site ID No. 796263
Tom Cody Please refer to both identification numbers,
1521 73RD Ave above, in all correspondence with the agency.
Town of Hammond
St Croix County
NW1/4, SWIA, S30, T29N, R17W
FOR:
Object Type: POWTS Component Manual Regulated Object ID No.: 1452347
Maintenance required; 450 GPD Flow rate; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-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 p,pWT
and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. C'ondltl0
The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code
requirements. APOr"M
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.061 DEPARTMENT OF C
stats. pl LS:AAFEJY F A
The following conditions shall be met during construction or installation and prior to occupancy or use:
IL
• A copy of this approval letter and index sheet shall be attached to plans that correspond with the copy on fil EE CORRESP
with the Department. Changes to the approved plan must be submitted for review and approval. Failure to
properly attach the approval and index page to plans that match the copy on file with the Department may result
in enforcement action under s. 145. 10, Stats.
• This system is to be constructed and located in accordance with the approved plans, and the "Mound
Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD-10691-P (N.01/01).
• This system is to be constructed and located in accordance with the approved plans and with the "Pressure
Distribution Component Manual for Private Onsite Wastewater Treatment Svstems Version 2 0" SBD-10706-P
(N.01/O1).
• 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
moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire,
the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not
proceed until it dries.
• The system was designed to meet the influent quality defined in SPS 383.44(2)(a) The quality of influent
discharged into a POWTS treatment or dispersal component consisting in part of in situ soil shall be equal to or
less than all of the following:
JACQUE M HAWKINS + Page 2 10/16/2013
1. A monthly average of 30 mg/L fats, oil and grease.
2. A monthly average of 220 mg/L BOD5.
3. A monthly average of 150 mg/L TSS.
• SPS 383.54(3)(b) O The servicing of an anaerobic treatment tank for a POWTS shall occur at least
b frequency o
when the combined sludge and scum volume equals 1/3 of the tank volume.
• The inspection, maintenance and servicing reports shall be submitted to the governmental unit within 30
calendar days from the date of inspection, maintenance and servicing.
• The owner is responsible for the operation and maintenance of the private onsite wastewater treatment system
(POWTS) in accordance with SPS 383 and the approved management plan
• The owner of a POWTS shall be responsible for ensuring that access opening covers remain locked or
secured except for inspection, evaluation, maintenance or servicing purposes.
• Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for
the POWTS described in this approval.
• Provide a copy of the approved POWTS plans and this letter to the owner.
• Prohibit vehicle traffic and soil disturbance within 15 feet of the downslope edge of the mound pursuant to
"Mound Component Manual Version 2.0" SBD-10691-P (N.01/O1; R. 10/12).
A copy of the approved plans, specifications and this letter shall be on-site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
In granting this approval the Division of Industry Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any
others who are responsible for the installation, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 250.00
This Amount Will Be Invoiced.
When You Receive That Invoice,
Edwin A Taylor Please Include a Copy With Your
Wastewater Specialist, Integrated Servi s Payment Submittal.
(715)634-3484, Monday - Friday 8:00 am To 4:30 pm WiSMART code: 7633!
edwin.taylor@wisconsin.gov
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
1
t
MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: Tom Cod Mound
J ~ i
Owner's Name: Tom Cody
Owner's Address: 1521 73rd Ave.
Roberts WI 54023
Legal Description: NW1/4- SW1/4 Sec. 30 T29N-R17W
Township: Hammond
County: St. Croix
Subdivision Name: Emerald Acres
Lot Number: 32 Block Number: Na
Parcel I.D. Number: 018-1098-32-000
Plan Transaction No.: S.
Page 1 Index and title f~y
Page 2 Data entry
°
Page 3 Mound drawings
Page 4 Lateral and dose tank ~MNIERc
Page 5 System maintenance specifications e I Gs
Page 6 Management and contingency plan
Page 7 Pump curve and specifications EN ~E/
Page 8 Site Plan
Designer. Jacque Hawkins License Number: MPRS#222872
Date: 09/23/13 Phone Number:
Signature:
Designed 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 (011$1) and
Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01)
Version 7.0 (R. 03/2012) Pagel of 8
Mound and Pressure Distribution Component Design
Design Worksheet
Site Information
(R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a
300.00 Estimated Wastewater Flow (gpd) Table 383.44-3 in-situ soil treatment for
1.50 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of r_ 36 inches.
450.00 Design Flow (gpd)
8.00 Site Slope
97.50 Contour Line Elevation (ft)
28.0 -Depth to Limiting Factor (in)
0.40 I -situ Soil Application Rate (gpd/ftz)
Distribution Cell Information
75.00 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft)
1.00 Dispersal Cell Design Loading Rate (gpd/ftz)
1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point
in the distribution Y
Pressure Disribution Information network? Enter Y or N
(C or E) C Center or End Manifold
3.00 Lateral Spacing (ft) If N above, enter the elevation ft
4 Number of Laterals of the highest point.
0.156 Orifice Diameter (in)
2.33 Estimated Orifice Spacing (ft) = 7.03 ftz/orifice
2.00 Forcemain Diameter (in)
80.00 Forcemain Length (ft) Does the forcemain drain back?
90.00 Pump Tank Elevation (ft) Enter Y or N
4.55 System Head (ft) x 1.3 13.05 Forcemain Drainback (gal)
7.67 Vertical Lift (ft) 67.41 5x Void Volume (gal)
2.00 Friction Loss (ft) 80.46 Minimum Dose Volume (gal)
0.00 In-line Filter Loss (ft) 34.46 System Demand (gpm)
14.22 Total Dynamic Head (ft)
Lateral Diameter Selection Manifold Diameter Selection
in. dia. option s choice in. dia. options choice
0.75 1.25 x
1.00 x 1.50 x x
1.25 x 2.00
1.50 x x 3.00
2.00 x
3.00 x
Gallons/Inch Calculator (optional)
Treatment Tank Information _ Total Tank Capacity (gal)
1000.00 Septic Tank Capacity (gal) _ Total Working Liquid Depth (in)
Skaw Precast Manufacturer gal/in (enter result in cell B49)
Dose Tank Information Effluent Filter Information
642.33 Dose Tank Capacity (gal) Best Filter Manufacturer
_16.47 Dose Tank Volume (gal/in) GF-10 Filter Model Number
Skaw Precast Manufacturer
Project: Tom Cody Mound Page 2 of 8
Mound Plan and Cross Section Views
1
1/10 B ' ' ' ' ' ' ' Observation Pipe J
s'. A
I
L
Mound Component Dimensions
ft
A 6.00 ft E 13.76 in H [Aft ft K Eaft
B 75.00 ft F 9.50 in I ft L ft
D 8.00 in G 0.50 ft J W 450.00 (ft2) Dispersal Cell Area 1171,88 (ftz) Basal Area Available
6.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement
Mound Cross Section View
Aggregate Dispersal Area
Finished Grade 99.96 (ft)
H
G
.JJJJ/JJJJJJJJJJJJJJJJJ... I
///!/!I/J//!J////I JJJ/////J✓J///JJ
I F Dispersal Cell 98.67 (ft) Lateral
98.17 (ft)-► Invert
Dispersal Cell
Elevation
97.50 (ft) Contour Elevation
8.0 % Site Slope
.0 Geotextile Fabric Cover
Shading Key a I Dispersal Cell See lateral details on
0 Topsoil Cap = 1.5 ft - Page 4 for number, size,
0 !!!!JJJJ Subsoil Cap and spacing of laterals.
ASTM C33 Sand Laterals are equally
is F spaced from the
Typical Lateral
Tilled Layer c 0 5 ft distribution cell's
Q Aggregate o centerline in the
_ A distribution cell (AxB).
Project: -Tom Cody Mound Page 3 of 8
Center Connection Lateral Layout Diagram
Force main connection via tee or cross to nTan00101at anq paint. Laterals art identical
.q.
P S
I
Tenn-up wPbsl l vallWe or IE. XX---3 f t xr2 u112 1.9terotts & forcemein SCh 40 PVC
a#asnoutplug :pet' SPS Table 354.30-6
Holes drilled on the bottom of the lateral.
Number of Laterals 4 Orifice Diameter 0.156 in
Lateral Diameter 1.50 in Orifice Spacing (X) 2.37 ft
Lateral Length (P) 36.74 ft Orifices per Lateral 16
Lateral Spacing (S) 3.00 ft Orifice Density 7.03 ftz/orifice
Lateral Flow Rate 8.62 gpm Manifold Length 3.00 ft
System Flow Rate 34.46 gpm Manifold Diameter 1.50 in
Total Dynamic Head 14.22 ft Forcemain Velocity 3.52 ft/sec
Dose Tank Information Locking cover with warning
label and locking device and
sealed watertight
Electrical as per NEC 300 and
4 in. min.
SPS 316.300 WAC Disconnect
i
Tank component is properly vented F- Alternate outlet
location
Forcemain diameter
Skaw Precast _ Manufacturer_ 2 in.
Ca aci 642.33 Gallons
Volume 16.47 al/inch A
g
Weep hole or anti-
Dimension Inches Gallons B siphon device
A 20.11 331.29
B 2.00 32.94 C P~ ump off elevation (ft
C 4.89 80.46 -f r - 91.00
12.00 197.64
D
D
Total 39.00 642.33
Do♦ se tank elevation ft)
3" Bedding un er tank. 90.00
Alarm Manuafacturer SJE. Rhombus Note: Switches
Alarm Model Number Tank Alert 1 containing mercury
_ may not be used in
Pump Manufacturer Goulds this system.
Pump Model Number EP05
Pump Must Deliver 34.46 gpm at 14.22 ft TDH
Project: Tom Cody Mound Page 4 of 8
J
Mound System Maintenance and Operation Specifications
Service Provider's Name Powers Sanitation Phone 715-246-5738
POWTS Regulator's Name St. Croix County Zoning Phone 715-386-4680
$yeftm Flow and Load Parameters
Design Flow - Peak 450 gpd Maximum Influent Particle Size 118 in
Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L
Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L
Soil Absorption Component Size 450 ftz Maximum FOG 30 mg/L
Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL
Service Froggency
Septic and Pump Tank Inspect and/or service once eve 3 ears
Effluent Filter Should inspect and clean at least once eve 3 ears
Pump and Controls Test once eve 3 ears
Alarm Should test month)
Pressure System Laterals should be flushed and pressure tested eve 1.5 ears
Mound Ins t for ndin and see pa e 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 vt
6-8" Diameter Lawn - Threaded Cleanout
Sprinkler Valve Box Plug or Ball Valve
Distribution
Long Sweep 90 or Two
45 Degree Sends Same
Diameter as Lateral
Project: Tom Cody Mound Page 5 of 8
Mound System Management Plan
Pursuant to SPS 383.54, Wis. Adm. Code
This system shall be operated in accordance with SPS 382-84 Wises. Adam. Code, and shall maintained in accordance with its' component
manuals [SBD-10691-P (N.01101), SSWMP Publication 9.6 (01181), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N.
01 /01)) and local or state rules pertaining to system maintenance and maintenance reporting.
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death.
Septic and pump tank abandonment shalt 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.
$etrtlc Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic
tank shall be disposed of in accordance with Nit 11$, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be
assessed at least once every 3 years by inspection. provisions
The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless arm, the
are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped
titter 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 113 the liquid volume of the
tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of
when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank.
The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products
are used they shall be approved for septic tank use by the Department of Commerce.
j?ttmo 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 finer is installed within the tank 4 shall be Inspected and serviced as necessary.
l,~nd and Prmiia Distttbutlop Svstam
No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be
seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for
vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the
mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the
mound be heavily mulched as protection from freezing.
Influent quality into the mound system may not exceed 220 mg/L BOD5,150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30
mg/L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 104 du/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 and 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 G inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
Cotrtinaencv 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 wrong becomes defective the defective component(s) shall be immediately
repaired or replaced with a component of the some or equal performance.
It the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or
replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal
media, and related piping, and replacing sold components as deemed necessary to bring the system into proper operating condition.
See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider.
Pent Unite
The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection
units are attached as separate documents and are considered part of the overall management plan for this system.
I
Project: Page 6 of 8
Page 7 of 8
GOULDS PUMPS Submersible
Effluent Pump
1
EP04
EP05
3871
APPLICATIONS • Fully submerged in high ! EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower
grade turbine oil for tic enclosed design for heavy duty ball bearing
Specifically designed for the lubrication and efficient improved performance. construction,
following uses: heat transfer. ■ Casing and Base: Rugged
• Effluent systems thermoplastic design provides AGENCY LISTING
• Homes Available for automatic and superior strength and corrosion
• Farms manual operation, Auto- resistance." Standarcls O"
• Heavy duty sump matic models include
• Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end
• Dewatering assembled and preset at the for efficient heat transfer, in "C" or 7".)
factory. strength, and durability.
SPECIFICATIONS ■ Motor Cover: Thermoplastic GorldsPwpsisISO9001 ko axed.
FEATURES cover with integral handle and
• Solids handling capability: float switch attachment points.
'la" maximum. ■ EP04 Impeller: Thermoplas- ~ power Cable: Severe duty
• Capacities: up to 60 GPM, tic Semi-open design with rated oil and water resistant.
• Total heads: up to 31 feet, pump out vanes for mechanical
• Discharge size: 1'12" NPT, seat protection.
• Mechanical seal: carbon-
rotary/ceramic-stationary,
BUNA-N elastomers.
• Temperature:
104"F (40°C) continuous METERS FEET
140" F (60cC) intermittent.
• Fasteners: 300 series t o
stainless steel. a 30 s GPM
• Capable of running
dry without damage to a 251r
components. zs
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Motor: x
• EP04 Single phase: 0.4 HP, y 6 20
115 or 230 V, 60 Hz, 1550
RPM, built in overload with r 5
automatic reset. a 4 J6C
i
• EP05 Single phase: 0,5 HP, o _ EPOS
115 V or 230V, 60 Hz, 1550 3 10
RPM, built in overload with
EP04
automatic reset. z
• Power cord: '10 foot s
standard length, 16/3
SJTOW with three prong
SJJTW with o 00 10 20 30 . _ _40 50. _ GPM
foot lenrgtgh, 16/3 Optional
three prong grounding plug
o z a s a to 12 m3n,
(standard on EP05).
CAPACITY
Goulds Pumps
2 2001 Goulds Pumps ITT Industries
Effective May, 2001
83871
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Wisconsin Det-artment of Commerce SOIL EVALUATION REPORT V42 Page of 3
-Divis:;A.of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
Cra
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.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 0 f f) - -3 2 _ a(/6
Reviewed b Date
Please print all information. r `
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
~ ~ • ~2
I I - 19 b
Property Owner Property Location
R~ch>art~ Govt. Lot IVW 1/4 Sw 1/4 Sap T Zq N R / Z E (or)g
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
153 -ee Tr. ~mera)d es
City State Zip Code Phone Number ❑ City ❑ Village [g Town Nearest Road
l 01~ //,z /S2:7 f-4 S71-
New Construction Use: Residential / Number of bedrooms Code derived design flow rate y SG l G O® GPD
❑ Replacement 7- ❑ Public or commercial - Describe:
Parent material / Flood Plain elevation if applicable ft.
'T-
General comments , / `~e [mil C~-2 ~ f , q'~f, ~ ,
and recommendations: 7 J~ ~t r ;1 L
('GVl ~c~ r e(t U . 9 ~•S'o ~
* 1f~
Boring # ❑ Boring a ,OUN7`!
a pit Ground surface elev. c, , 2^ 20tdNGOPf tCt.,.
ft. Depth to limiting factor
Soil pl' tion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary- Roots, PD/ftz
in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
0-16 l r JZ ; Zm-sbk C-5 I v~
3 ! y C2P -755 r Y/(o ms n I - - . -7 /-2
F Boring # ❑ Boring
Pit Ground surface elev. ~ZO ft. Depth to limiting factor 44 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
6-12 10 ( ) Si l Zm-abk • J 1.3
2 lZ-Z8' (o r 913 .SL Zm l n-rR- cs - 5 4
3 22' 5 ra limes IVP
* Effluent #1 = BOD5 > 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) i lure CST Number
A d4 maker-
Z s33a9
Address Date Evaluation Conducted Telephone Number
2113 - - ht7~e se-r~ Cc)1 LFoZ 5 /2-0,0/ C71s)Zy7-yaaS
Property Owner 540 y4 Parcel ID # Page 2. of 3
FS] Boring # ❑ Boring 31
pit Ground surface elev. qS. (00:_ 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. •Eff#1 'Eff#2
-I O x312 50 2 Idc r ~S Iv
Z II- id 1 - cl vrns& Mer CS -
❑ 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/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2
F-1 Boring # ❑ Pit Boring
❑ 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. 'Eff#1 'Eff#2
• Effluent #1 = BOD5 > 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 (R.07/00)
PAGE .3 OF -3
NAME LOT# 37- LEGAL DESCRIPTION w YSW 14 ,S 30 121 ,N,R,, I? E(or~
SCALE: 1"= yCf -
BM 1 ELEVATION /00 0
BM I DESCRIPTION D v C
BM 2 ELEVATION of ;t • 0
BM 2 DESCRIPTION k p o / "j2V C- Se C' 3 O
SYSTEM ELEVATION t7g, F, a I
SYSTEM TYPE Moo rub Sy<$ I e wz
-1'
CONTOUR ELEVATION 177.6-0
I
i
o•
Z 3~ 39~ s
a e t ; AA- = C Q
9G• S~
00
~o0otkc ~
~C j
SIGNATURE DATE 5-
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer /o.~-+o c1 SvZ /V~
Mailing Address 3 A C/ !C d h. tom. "S 77Y07--.3
Property Address t 7 3se-tl G V c
(Verification required from Planning & Zoning Department for new constructs n.)
City/State Parcel Identification Number CD w 98 2 60 O
LEGAL DESCRIPTION /
Property Location '/4 , Uw '/4 , Sec. 30 , T N R r 7 W, Town of A/ a A.-" ~e A-C
Subdivision Plat: ~m^ r/t a Id Or,G rS' , Lot # 3z,
Certified Survey Map # , Volume , Page #
Warranty Deed # 9~ 0 3~ (before 2007)Volume `Page #
Spec house l yes o Lot lines identifiabl)1 4es i 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 §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that ( l ) 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 3
ern- JAI 0 /1 rl Y
SIGNATURE )6F APPLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
11 JIIII
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8162345
State Bar of Wisconsin Form 3-2003 TX:4133003
QUIT CLAIM DEED 980535
BETH PABST
Document Number Document Name REGISTER OF DEEDS
ST. CROIX CO., WI
06/14/2013 2:19 PM
THIS DEED, made between Max A. Hansen and Nancy L. Hansen, EXEMPT#• NA
husband and wife REC FEE: 30.00
TRANS FEE: 135.00
("Grantor," whether one or more), and Thomas H. Cody and Suzanne M. Cody, PAGES: 1
husband and wife as survivorship marital property
("Grantee," whether one or more).
Grantor quit claims to Grantee the following described real estate, together with the
rents, profits, fixtures and other appurtenant interests, in St. Croix Recording Area
County, State of Wisconsin ("Property") (if more space is needed, please attach addendumj: Namc and [return Address
~hS.ev~
Lot 32, Plat of Emerald Acres in the Town of Hammond, St. Croix County,
Wisconsin.
~yv~ Cvt.t_K
018-1098-32-000
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Dated
.""jU kSEAL) (SEAL)
* sN$~ ~~i~ +MaxA. Hansen
n V(~~l)
r ~ S % ncy Hansen
~s v N~
AUTHENTICATION ~0 Z ACKNOWLEDGMENT
Signature(s) i V CO1 ATE OF j,() )
s ) ss.
IZZ
authenticated on i~o- ~'E Ord ix COUNTY)
~ 11~1-
Personally came before me on '7UR e Iq .7 3
* the above-named Max A. Hansen and Nancy L. Hansen
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me known 'toy be the person() who executed the foregoing
authorized by Wis. Stat. § 706.06) instrument atd ackno, ed ed the same
THIS INSTRUMENT DRAFTED BY: *t ,csoi
Maxfield E. Neuhaus - Attorney at Law Notary Public, State of
River Falls, WI 54022-0138 My commission (is permanent) (expires: O~-/~~ ~ArS )
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
QUIT CLAIM DEED 02003 STATE BAR OF WISCONSIN FORM NO. 3-2003
*Type name below signatures. INFO-PROTM Legal Forms • (800)655.2021 • infoproforms.com
1 of 1
Parcel 018-1098-32-000 10/21/201P AGE 3 08:54
1 E 1 OF A 1
P 1
Alt. Parcel 30.29.17.839 018 - TOWN OF HAMMOND
Current ❑X 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 H & SUZANNE M
THOMAS H & SUZANNE M CODY
323 WILDWOOD CIR
ROBERTS WI 54023
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description " 1521 73RD AVE
SC 2422 SCH D ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 2.500 Plat: 09-033-EMERALD ACRES 1/35 018-02
SEC 30 T29N R17W PT NW SW EMERALD ACRES Block/Condo Bldg: LOT 32
LOT 32 (2.500AC)
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
30-29N-17W NW SW
Notes: Parcel History:
Date Doc # Vol/Page Type
06/14/2013 980535 QC
11/22/2002 699552 2057/282 WD
09/10/2002 689889 9/33 PLAT
2013 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 11/04/2008
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.500 51,100 0 51,100 NO
Totals for 2013:
General Property 2.500 51,100 0 51,100
Woodland 0.000 0 0
Totals for 2012:
General Property 2.500 51,100 0 51,100
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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