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HomeMy WebLinkAbout014-1004-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 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: Brandt, Justin Forest, Town of 014-1004-50-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 02.31.15.29 TANK INFORMATION ELEVATION DATA F PE MANUFACTURER CAPACITY STATION BS HI FS ELEV. ic Benchmark ng Alt. BM Aeration Bldg. Sewer Holding TANK SETBACK INFORMATION rti 1 TANK TO P/L WELL BLDG. Vent to Air Intake Septic I Dosing Aeration ~j Holding PUMP/SIPHON INFORMATION Manufacturer D G n eA! Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHLEACHING AMBER OR Manufacturer: INFORMATION Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of eeded/Sodded T Mulched Bed/Trench Center BedlTrench Edges Topsoil xx S Yes ® No ®Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 2332 310th Street Clear Lake, WI 54005 (NE 1/4 SE 1/4 2 T31 IN R1 5W) 40 acres Lot Parcel No: 02.31.15.29 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ® Yes ® No Use other side for additional information. Cert. No. Date Insepctor's Signature SBD-6710 (R.3/97) A CF County f,1 1 Safety and Buildings Division S 4 ~t'c S ° 201 W. Washington Ave., P.O. Box 7162 6 P ' Madison, W! 7-7162 Smm`t ' Petmrt Number (to be filled in by Co.) rya ~ S< c off' $ Z OzIr S tate Transaction Nmnbsr Sanitary Permit Application QU in accordance with SPS 38321(2) Wis. Adm. Code, submission ofthis form to the appropriate go nit Z 3 19 6Z!5 is required prior to obtaining a sanitary permit. Notc. Application forms for state-owned POWTS are submitted to Project Address (if different than marling address) the Department of Safety and Professional Servies_ Personal information you provide may be used for secondary purposes in accordance with the Priv Law, s. 15.04(l)(m ,Stets I. Application Information -Please Print All Infor Lion d Property Owner's Name Parcel # 1 Lk o 0 Property, Owner's Maili g Address + 1 Property Location 1 S ~ Govt. Lot City, State Zip Code Phone Number C , i 5E Session Z O ~7 c)L~ 5 (circle one) H. Type of Building (check alI that apply) Ot t # Subdivision Na Ton R _ E or W ❑ I or 2 Family Dwelling - Number of Bedrooms me ~~~g Block # © ~C v;e S ❑ Public/Commercial - Describe Use ❑ City of ❑ State Owned- Describe Use y/~ CSM Number ❑ Village Of I / 1 , ` KTown of III. Type of Permit: (Check only one boa on line A. Complete line B if applicable) C r%-t- A ew System ❑ Replacement System ❑ TreatrneaMolding Tank Replacement Only ❑ Other Modification to Existing S g System (explain) B it Renewal Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner tem/Com em/Component/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mo m! 24 in. of 'table soil omd <24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: i i Design Flow (gpd) Design Soil Applicati Rate(gpdsi) / Dispersal Area t~ d equired (st) Dispersal Area posed (sfj System Elevation VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units „ c New Tanks E oyy~g f U a' c~ 4. C Y V d ~ H ephc Holding Tank ^ l~ tl U vim va w 0 r3. Sing Chamber fe Ol.~ ea~ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's NPI MP/MPRS Number Business Phone Number Ile -bell r ?d /zI71 Plumber's Address City State, Zip Code) 7l ~d d 6637 Ie f G e o VIII. Court a artment Use Onl ❑ Approved ❑ Disapproved Permit Fee Date Issuing t Signature $ 06 ❑ Owner Given Reason for Denial IX. Cord ' onstfor Disapproval A t~ epti 'tank, O*L*nt MW and' CO ndL % a- i1.. $~-q (bJc.Q, ex,(~ "A- dispersal cell must all be services I rnain~talrtett as per, management plan provided by plumber.; ePe-~ ~e- r I Q sett>r~►t, must 4w miiii tis 6 as per 401c bF: Clack/ ordinaticm 'i Attach to rnmplde plans for the system and submit to the Comty only on paper not less than 81l2 z 11 inches in sloe SBD-6398 (R. 11/11) I Coun Safety and Buildings Division H 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) E7R,S K Madison, WI 5370 162 Sanitary Permit A- State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this f o appropriate g vemmental unit 31 J is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWT*, miffed to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be use condary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. I. Application Information - Please Print All Inform 'o Gr P Property is N e Parcel # Clev,~ t~ / ST CRo <'~ij so- DO 0 Prope 71 wner's Mailingddress ,.COG Property Location J/ d S S~ Z /Jv a s T "Govt. Lot 17 Ci , Stat Zip Code Phone Number N y, Section Z G✓ -y-+ S-ya2 7/5) ' (0!713 , 005$ (,circle one) 5 T,? N; R EorW II. Type of Building (check all that apply) 6k OjL Lot # 1 or 2 Family Dwelling - Number of Bedrooms IA. O*&_ Subdivision Name P' a Block # &re,!s El Public/Commercial - Describe Use r ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of PE Town of key-f S T OtJ 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) ❑ Permit Transfer to New List Previous Permit Number and Date Issued / B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) V 1(e' O~2 ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil C Mound < 24 in. of suitable oil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Tr atment Area Information: q, 114 Design Flow (gpd) Design Soil Application e(gpdsf) Dispersal Area Require Dispersal Area Pro sed System Elevation /8.3s VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units ~ 2 o ~ New Tanks Existing Tanks o a y re .E ~ `TD a U ~ ti ~ w c7 ~ Se or Holding Tank doh I'~ Dosing Chamber / 0 p 1 VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Pi ignature MP/MPRS Number Business Phone Number rim's 2/4/71 2/r-.76r 6 7 lumber's Address (Street, City, State, Zip Code) tYt) -77 57- VIII. County/Department Use Only Approved lsapproved Permit Fee Date I Issuing ASignature en Reason for Denial $ ~ " Z IX. Condi ' easons for Disapproval t' owffi> ffi'eptiC tank, 60luent fiRer and dls"mal ce0 must all be services I maintained eLxe. r A e_h-~- ~k wI e!1 per Management plan provided by plumber. 2. _0 >letrlack requiraments must be maintained as per appIc6ble code I adkorm . 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) p t.R , DIVISION OF INDUSTRY SERVICES 10541 N RANCH ROAD lpa~ HAYWARD WI 54843 S Contact Through Relay 3 9 P S ~ www.dsps.wi.gov/sb/ www.wisconsin.gov 0SSIONAtis~ Scott Walker, Governor Dave Ross, Secretary October 11, 2013 CUST ID No. 221471 AT77V.• POWTS Inspector DENNIS J GILLE ZONING OFFICE GILLE TRUCKING & EXCAVATING, INC. ST CROIX COUNTY SPIA 352 140TH ST 1101 CARMICHAEL RD AMERY WI 54001-2840 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/11/2015 Identification Numbers Transaction ID No. 2319525 SITE: Site ID No. 796532 Justin Brandt Please refer to both identification numbers, 310TH St above, in all correspondence with the agency. Town of Forest St Croix County NE 1/4, SE 1/4, S2, T3 IN, RI 5W FOR: Description: Mound, 3 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1453542 CONI Maintenance required; 450 GPD Flow rate; 18 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 - AF Ver. 2.0, SBD-10706-P (N.0110 1, R. 10/12), SSWMP Pub. 9.6; Effluent Filter _ DEPT O The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes PROFESS and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructedDIVISION OF and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, SEE C( 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 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. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound 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 mound 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 mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of 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 DENNIS J GILLE Page 2 10/11/2013 - is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • Maintain well and waterline set backs per SPS 383.43(8)(i). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. 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. lFee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, PaPlease Include a Copy With Your Si=634 egrated Services Payment Submittal. Pnt (7) 634-5150, M - F 8:00 a.m. - 4:45 p.m. WiSMART code: 76' )3 pat.shandorf@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed w ° ;.,,.,,4anby SPS Chapters 360-366. DENNIS J GILLE Page 2 10/11/2013 is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • Maintain well and waterline set backs per SPS 383.43(8)(i). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. 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 lett er and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. SiZ634- lFee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Please Include a Copy With Your "ewer , Integrated Services Payment Submittal. Fax: (715) 634-5150, 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 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 SPS Chapters 360-366. MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Commercial Application INDEX AND TITLE PAGE Project Name: JUSTIN BRANDT Owner's Name: JUSTIN BRANDT Owner's Address: N12420 ST RD 79 DOWNING WI 54734 Legal Description: NE SE S2 T31N R15W Township: FOREST County: ST. CROIX Subdivision Name: Lot Number: Block Number: )ITIONAL.LY Parcel I.D. Number: 014-1004-50-000 .r minaicp Plan Transaction No.: F SAFETY AND IONA SERVICESRY SERV ICES Page 1 Index and title ND Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications )NDE CE Page 6 Management and contingency plan Page 7 Pump curve and specifications _5 Designer: DENNIS GILLE License Number: 221471 Date: 10/05/13 Phone Number: 1715-268-6637 L- 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 (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) Version 6.0 (R. 04/08) Page 1 of 7 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Commercial Application INDEX AND TITLE PAGE Project Name: Aaron Beauvais Owner's Name: Aaron Beauvais Owner's Address: 502 hud st. Hudsom Wi. 54025 Legal Description: NE SE S2 T31 N R1 5W Township: FOREST County: ST.CROIX Subdivision Name: Lot Number: Block Number: Parcel I.D. Number: 014-1004-50-000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page P 6specCy Designer: QE-KMSGlLLE License Number: 221471 Date: 9/25/13 Phone Number: 1715-268-6637 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 (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) Version 6.0 (R. 04/08) Page 1 of 7 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) C Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 83-44-3 in-situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150%) coliform of - 36 inches. 450.00 Design Flow (gpd) 8.50 Site Slope 96.85 Contour Line Elevation (ft) 18.00 Depth to Limiting Factor (in) 0.60 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 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) 2.00 Estimated Orifice Spacing (ft) = 6.25 ft2/orifice 2.00 Forcemain Diameter (in) 100.00 Forcemain Length (ft) Does the forcemain drain back? ~Y 89.00 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 16.31 Forcemain Drainback (gal) 9.35 Vertical Lift (ft) 67.44 5x Void Volume (gal) 3.12 Friction Loss (ft) 83.75 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 38.77 System Demand (gpm) 17.02 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 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information 600.00 Total Tank Capacity (gal) 1000.00 Se tic Tank Capacity (gal) 42.00 Total Working Liquid Depth (in) HUFFCUTT ]Manufacturer 14.29 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 600.00 Dose Tank Capacity (gal) BEST Filter Manufacturer 14.29 Dose Tank Volume (gal/in) GF10 Filter Model Number HUFFCUTT Manufacturer Project: Aaron Beauvais Page 2 of 7 Mound Plan and Cross Section Views T .............:....3 1/10 B . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . Observation Pip J e K 5 A :5 W - :i : B . 3 . z a: L Mound Component Dimensions A 6.00 ft E 24.12 in H Aft ft K 10.64 ft B 75.00 ft F 9.50 in 1 ft L 96.28 ft D 18.00 in G 0.50 ft J W 25.97 ft 450.00 (ft2) Dispersal Cell Area 1447.15 (ft) 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 100.14 (ft) H G ♦ I F Dispersal'Cell 98.85 (ft) Lateral 98.35 (ft)--O- :::::::::::Invert Dispersal Cell :::Q : Elevation E D 3 "i 1141 X- Z.'i.. 96.85 (ft) Contour Elevation 8.5 % Site Slope # Geotextile Fabric Cover Shading Key (D C. I - Dispersal Cell See lateral details on Page 4 for number, size, 1❑ Topsoil Cap o c 1.5 ft Subsoil Cap (n c and spacing of laterals. © ASTM C33 Sand F Laterals are equally FA] 0.5 ft Typical Lateral spaced from the 0 Tilled Layer c w distribution cell's ❑5 Aggregate o centerline in the - A * distribution cell (AxB). Project: Aaron Beauvais Page 3 of 7 Center Connection Lateral Layout Diagram Force main connection via tee or cross to manifold at any point. Laterals are identical Wil I P ~ Turn-up vdball valve or IF X~IFV02+1 aterals & force main of PVC Sch 40 clean out pl u g per COMM Table 84.30-5 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) 2.10 ft Lateral Length (P) 36.75 ft Orifices per Lateral 18 Lateral Spacing (S) 3.00 ft Orifice Density 6.25 ft2/orifice Lateral Flow Rate 9.69 gpm Manifold Length 3.00 ft System Flow Rate 38.77 gpm Manifold Diameter 1.50 in Total Dynamic Head 17.02 ft Forcemain Velocity 3.96 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and Comm 16.300 WAC 4 in. min. Disconnect ----ii--ii------ Tank component is properly vented Alternate outlet location Forcemain diameter HUFFCUTT Manufacturer -r 2 in. Capacityl 600.00 Gallons Volume 14.29 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 28.13 401.93 B 2.00 28.58 P♦ ump off elevation (ft) C C 5.86 83.75 -t 89.50 D 6.00 85.74 D Total 41.99 600.00 Doe tank elevation (ft) Bedding under tank. 89.00 Alarm Manuafacturer LEVEL ALARM Alarm Model Number DVL _ Pump Manufacturer ZOELLER _ Pump Model Number N 140 Pump Must Deliver 38.77 gpm at 17.02 ft TDH Project: Aaron Beauvais Page 4 of 7 Mound System Maintenance and Operation Specifications Service Provider's Name DENNIS GILLE Phone 268-6637 POWTS Regulator's Name ST.CROIX CTY. ZONING Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 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 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 Inspect for ondin and seepage once eve 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished Grade v/ 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Aaron Beauvais Page 5 of 7 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD 10706-P (N. 01/01)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be 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 of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System 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 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 7 11 L . TOTAL DYNAMIC HEADIFLOW PUMP OMtAlAr4CE CURVt PER MtPIUTE MODEL 14014140 EFFLUENT AND DEWATERING aim 's MODEL 14GI4140 Fed 1leem Oct Lon 5 13 as 726 2>s~t t6 7.0 60 707 + T 1 IS 4.6 73 276 YF•o r 5.1 CA 250 It - -.I_- ~ 1.tJ,11CJ / _ l.fi Si 223 eta-n:;ri ` 3S 1n.7 Ift~ls 111 2 ' 136 13.7 64 25 if He-d' .2m s ,2 ,Y31 1b 4 10 e auaus UTMS 6 t6 166 240 326 FLONPt MUM - Iar rerw CONSULT FACTORY FOR SPECIAL APPLICATIONS 3AW • Electrical alternator,, for duplex systems, are available and supplied with an alarm. + Mechanical alternators, for duplex systems, are available with or without alarms. • Control alarm systems are available for 1 phase pumps used in simplex system. See FM0732. • Variable level control switches are available for controlling single phase sys- tems. • Double piggyback variable level float switches are available for variable level long cycle controls. • Sealed Qwilk-Box available for outdoor installations. See FM1420. ~M Refer to FW806 for applications above 130eF (54•C). I Y12 _L sx,s2+s SELECTION GUIDE 14014140 MODELS Control Selection 1. For automatic use single piggyaack variable level Stoat switch or Model Model Volts-Ph Mode Amps Simplex Duple double piggyback variable IevEl float switch. Refer to FM0477. N140 N4140 115 1 Non 12.0 1 or 2 g 2. See FM1228 for correct model of simplex control panel. 3. See FM0712 for correct model of duplex control panel. E140 E4140 230 1 Non 6.0 1 or2 3 ~ 4 cA~ Io1r BN140 BN4140 115 1 Ituto E2.1 NI InstA%gon of controta, protecdon devl+es and wlrhy should 1rg done by A qualified BE140 BE4140 230 1 Auto ' GCe need elewfd.rk M efeCifieaf and safe,, coda should be followed IncNdirp the rums' recent National FJectrk Code (NEC) and the Occupatlonaf Safety end He** Act (OSHA(. 'Single piggyback switch included. RESERVE POWERED DESIGN For unusual conditiors a reserve safety factor is engineered into the design of every Zoolier pump. MAE M. PQ BOX 16W SNP I& X4# C@W An PWd 0 copyrtphM 2006 Zoaw Co. M dghb m"rwC. I , k•i MOM /,4 -e _ % - Q. _ r o~ is ( ~ i I Y I f I 19 y, $PAT ~Visconsin SOIL EVALUATION REPORT #2120 Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings Steel's Soil Service Attach complete site plan on paper not less than 8'/Z x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. -014-1004-50-000/, I Please print all information. Rev" wed ' Date Personal information you provide may be used RE ar'lVE (Privacy Law, s. 15.04 (1) (m)). C~ y v~~ (p r Property Owner Property Location Arron Beauvais SEP 15 2 Govt. Lot na NE1/4, SE1/4, S2, T31N, R15W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 502 Hud St si urx~ na 40Acres City State one Number city I Village [ Town Nearest Road Hudson WI 54025 715-247-5525 Forest 310Th St YNew Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD L Replacement Public or commercial - Describe: na Parent material Arland, Sandstone uplands Flood plain elevation, if applicable na ft. General comments Mound Design, system elevation 98.35ft based on contour line elevation 96.85ft. 18 inches minimum ASTM 33 Mound sand. and recommendations: Boring F1 Boring # l pit Ground surface elev. 97.85 ft. Depth to limiting factor 20 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 1 0-9 10yr3/2 none sil 2msbk 0 cs 1vf 0.6 0.8 2 9-20 10yr4/4 none sic[ 2msbk mfr cs na 0.4 0.6 3 20-36 10yr8/1 c2d 7.5yr 5/6 ;andstoni Residum na ns na .0 .0 Boring 2 Boring # 1 Pit Ground surface elev. 97.85 ft. Depth to limiting factor 20 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 1 0-10 10yr3/1 none Sil 2msbk 0 cs 1vf 0.6 0.8 2 10-20 10yr4/4 none sicl 2msbk mfr cs na 0.4 0.6 3 24-36 10yr8/2 v- c2d 7.5yr 5/6 ;andstoni Residum na ns na .0 .0 " Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 S30 mg/L and TSS <30 mg/L CST Name (Please Print) Signature: CST Number David J. Steel Y 248956 Address Steel's Soil Service Date Evaluation Conducted Telephone Number 1699 150th St New Richmond, WI 54017 8/1/2009 715-760-0347 SBD-8330 (R.07/00) Property Owner Arron Beauvais Parcel ID # 014-1004-50-000 Page 2 of 3 Boring F3 Boring # Pit Ground surface elev. 94.85 - ft. Depth to limiting factor 18 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 1 0-9 10yr3/2 none sil 2msbk mfr cs lvf 0.6 0.8 2 9-18 10yr4/4 none sicl 2msbk mfr cs na 0.4 0.6 3 18-24 10yr4/4 c2d 7.5yr 5/6 scl om na aw na .0 .0 4 24-36 10yr8/2 c2d 7.5yrt5/6 andston Residum na na na .0 .0 Boring Boring # Pit Ground surface elev. ft. Depth to limiting factor in. F-1 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 Boring F-1 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 ' Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BODS < 30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) Steel's Soil Service v - ~ STEEL'S SOIL SERVICE 3 of 3 David J. Steel Arron Beauvais 1699 150th St. CST-POWTSM NE1/4,SE1/4,S2,T31N,R15W New Richmond, WI 54017 Lic. #248956 Town of Forest, St. Croix Co. Direct 715-760-0347 40 Acres Fax 715-246-0318 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this test may or may not be as shown, as permanent lot lines were not established at the time the soil test was conducted. Legend N 1"=40' = Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe • = Alt Benchmark El 100.45 ft Top of 3/4" pvc pipe = Borings Boring Elevations B1 = 97.85 ft B2 = 97.85 ft B3 = 94.85 ft B4 = 0.00 ft ;.87 fi- ~w b -7 6' 4, ;7 _ fi~ ' ~ IIIIIIIIIIIIII 1111111111111 1N 8042 42 STATE BAR OF WISCONSIN FORM 2 - 2000 Tx:403o667 Document Number Corrective WARRANTY DEED 945953 THIS DEED, made between Aaron Beauvais, A Married BETH PABST REGISTER OF DEEDS Person, Grantor, and Justin Brandt, A Single Person, ST. CROIX CO., WI Grantee. 11/18/2011 2:00 PM Grantor for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, EXEMPT#: 3 Wisconsin: REC FEE: 30.00 PAGES: 3 This deed is being recorded to correct the spelling of the Grantor's last name as shown in Warranty Deed dated September 4, 2009, recorded September 8, 2009 as Document No. 903391 Recording Area Name and Return Address: `3 Edina Realty Title, Inc. 400 South Second Street, Suite 115 Hudson, WI 54016 Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any. 014-1004-50-000 Parcel Identification Number (PIN) This is not homestead property. Dated this q~ c~ u'~' , V~~ J g (AV, t o ~I ~ Aaron Beauvais I t t I: n j WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2-2000 1 of 3 i I f AUTHENTICATION ACKNOWLEDGMENT 1 Signature(s) STATE OF ~~((/]~~SI COUNTY OF S~ `NIX authenticated this Personally came before me this (I I i the above Aaron Beauvais, A Married Person, to me TITLE: MEMBER STATE BAR OF WISCONSIN known to be the person or persons who executed the (If not, foregoing instrument and acknowledged the same. authorized by §706.06, Wis. Stats.) N THIS INSTRUMENT WAS DRAFTED BY Aw~m UVAUL I L' U'1 Martin D. Henschel c-lha nA 15 a 6800 France Avenue South, Suite 410 Notary Public, State of Wisconsin Edina, MN 55435 My commission is permanent. (If not, state the (Signatures may be authenticated or acknowledged. expiration date:) Both are not necessary.) 'Names of persons signing in any capacity must be 9 typed or printed below their signature.~.~ WISC,'~. I 1 wry j . * BARBARA J ~ } BURKE U qRY PV } s I k I } } ft { t (I } } F' is i I WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2.2000 2 of 3 Legal Description The East One-Half of the North One-Half of Southeast Quarter of Section 2, Township 31 North, Range 15 West, St. Croix County, Wisconsin, except the East 2 rods thereof, previously conveyed to Town of Forest. ~ t i k i t 3 3 of 3 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Justin Brandt Mailing Address N12420 State Road 72 DD Property Address 2~33~ 310th Street (Verification required from Planning & Zoning Department for new construction.) City/State Glenwood City parcel Identification Number 014-1004-50-000 LEGAL DESCRIPTION Property Location NE ,/4 SE 1/4 , Sec. 2 , T 31 N R 15 W, Town of Forest Subdivision Plat: , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house 0yesao Lot lines identifiable El yesono SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe 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 warn ty deed recorded in Register of Deeds Office. Number of bedrooms 3 10/18/13 SIGNATURE 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. (REV. 04/12) ~ Y f v v ` } 1 1. ry. , I Yr ~ ~~:ti '4 Z5 -I, R< . R• . +'4 is : ~ ~ `I'y,.t< ° ,i'. N~* r'f~;RF`•~ g.s s ~kt •S 'i` riff 44 the e ' i. v lkl. ,L ,R&f~• , 'XIN C . i+' c'ars' a ~'c. '.e ~ : °r~• ~ & ii • + . 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