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018-1040-70-000
Wisconsin Department of Commerce tSafety and Building Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) 'ersonal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1 permit Holder's Name: City X Village ' (J ~wnship Knudtson, Keith e of Hammond ~ST BM Elev: Insp. BM Elev: BM Description: /~ ~M, I S T TANK INFORMATION i7 TYPE MANUFACTURER ~~ CAPACITY Septic W rQ,S~_ ~".~, ! 7.Cw Dosing / C.~O~~ 6 ~'`,1~ f/ CX3 Lion ~D ~ a Holding TANK SETBACK INFORMATION TANK TO P/L J ~+ WELL BLDG. Vent to Air Intake ROAD Septic `~ J ~~~ 7 5 Cl Dosing li7 ~ J ~/bG ~l / f r! 9 _.._ Aeration Holding PUMP/SIPHON INFORMATION ~ I .~ Manufacturer Demand ~ e ~ 6 u GPM Model Number TDH Lify 7S Frictioio oss System H~d ~~ TD~a ~ t ~j ~ J • ~ Forcemain Length ~ Dia. ~r Dist. to Well ZC> Z SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 514985 0 State Plan ID No: Parcel Tax No: 018-1040-70-000 Section/Town/Range/Map No: 18.29.17.2826 STATION BS HI FS ELEV. Benchmark 2• Z.. ~~, /~ Alt. B/M 1~ ,~ ~ ~.~., ~ J~ti.. Z ~ S(P 16~ • 7 Bldg. Sewer s.~3 ~•c. St/Ht Inlet ,7, ~ ~ 7 3`f St/Ht Outlet 1 Dt Inlet ~ Dt Bottom 16 ~ ~ g 3 ~ c~ Header/Man. .~ /DD•~ Dist. Pipe 3. ~, 1 y /6O `~ Bot. System z~ j q ~ • / Final Grade ~ • / ~/ t StCo~e;` Z, ~~~,~~ o ~T • 9~ .9' BED/TRENCH Width ~ Length ~ No. Of Tren es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /o lab /:~„ ``~.. `- `- ~~ SETBACK TION INF RM SYSTEM TO P/L / BLDG WELL LAKE/STREAM LEACHING CHA OR Manufacturer: ~` O A TypeRf {system ~ C C3 ~ I ~ /SrJ I ~/ /~` UN T Model Number: ~ ~ CG„ ~ta._ -~T . ( ` DISTRIBUTION SYSTEM l,.:e~4- Header/Manifold Distribution t Z I( Pipe(s) J ~.., ~ ( x Hole Size 4 l ~ D x Hole Spacing / Z Vent to Air Intak ~ ~ ~e 1 Length ~ Dia ~` ~ Length Dia Spacing 7 ! , .- . . ~d, ~ 1 1 ''' D SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ~~" la-/~ Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center I ` ! ~ Bed/Trench Edges ~` Topsoil ~ ~[_„_ 'Yes ~ No Yes [] No COMMENTS: (Include code discrepengies, eripns present, etc.) Inspection #1: ~ /~(/'~~ / 6~ Inspection #2: / / Location: 927 150th Street Roberts, W 54023 (NW 1/4 SW 1/4 1 T29N R17W) NA of ~,~i"~[1L. ~ Parcel No: 18.29.17.2826 1.) Alt BM Description = ~~ ~ 61 ~ Sys~k~-- ~O ~ ~~~~ ~ a ~ ~J~Z..d( ~~ b ~ b 2.) Bldg sewer length = c~--~ (S~k l{Zj, _' ` ~"""~ ~ ~ ~! Jam..- a~ 4(~:.lp~,~., - amount of cover = ~ ~ ~~ 6tie.JC~ ~gv~ {c~,~-1'd..~,- ~ ~~ ~~cc.ws~ `t ~ b~J.~ f, ~ t~ Y ~i hj ~3 ~ - Plan revision Re uired . Yes No ~ i ~ I - _ Jse other side for additional information. ~ ~~_ ~ " ~ i _~_ _ __ _ _ _ _ _ _ Date Insepctor' Signatur Cert. No. SBD-6710 (R.3/97) commerce,wi.gov Safety and Buildings Division 201 W. Washington Ave., P.O. X7162 County ~~ j i s co n s i n Madison, WI 5370 -71 mber to be filled in by Co.) Sanitary Permit Nu Department of Commerce m 5 ~ O 5 Sanitary Permit Application. StateTransacti°rtNumber submission of this form to the appropriate vem ntal Adm 21(2) Wis Code In accordance with s Comm 83 ~li.~ 2 . ; . , . . . unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned WT • Project Address (if different thanrrtailing address) submitted to the Department of Commerce. Personal information you provide may nda u ses in accordance with the Privac Law, s. 15.04(lxm , Stats. ~ S~ f ''c r f. A lication information -Please Print All anon .~ - Property O ~ner's Name Parcel # ZOUc~ o! - is _ UN~Y Property Owner's MailingA.'n s Property Location ~ ~o~ C O IX G~ /~ Yom' S - T. CRS ~E Govt. Lot , City, State Zip Code Phi l - , r ~~ y,, ~~~ y., Section ~ /~ ~ // SyD2 3 x/70 73 ^~ / (circle one) [~ E or W T ~ N; R Type of Building (check alt that apply) I I . Lot # ~ , ~ , ~ (~1" L ar 2 Family Dwe~linv - Numl.~er of Bedmoms _ _ Subdivision Natne 1 _ ~ Block # ` .dyf~C ~ ^ Public/Commercial -Describe Use 10. _ ^ City of ^ State Owned -Describe Use CSM Number ^ Village of ~-- ['own of ~i¢/YIJYCO/1/1~ ~~ ~ ~~ , ltl. T ype of Permit: (Check only one box on line A. Complete line B if applicable) '4' ^ New System replacement System ^ 'I'reatmendHolding Tank Replacement Only ^ Other Modification to Existing System (explain) B, ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner all that a 1 ~ 1 V. T e of POWTS S stemlCom nenUDevice: Che ck ~ ~ ^ Non-Pressurized In-Ground ^ Pressurized In-Ground L7 At-Grade ^ Mound > 24 in. ofsuitable soil ^ Mound < 24 in. of suitable soil ^ Holding Tank ^ Other Dispersal Component (explain) ^ Pretceatmertt Device (explain) V. Dis ersal!['rea ent Area Information: Design Flow (gpd) Design Soil Application Rate(g Dispersal Area Required (st) Dispersal Area Proposed (s System Elevation Vl. Tank Info Capacity in Total # of -Manufacturer ~ Gallons Gallons Units _ , V e, _ New Tanks Existin ~ Tanks s g / G~ /o S~`"~ B o '.-, ~ ~ ~ d ~ ~ ~ ~ T a v rn ~ rn 'w V a Septic ori{elding.?aQk ~ r,,..__ Dosing Chamber - 73 VII. Responsibility Statement- 1, the andersigned, assume responsibility for instal lion of tie POWTS shown on the attached plans. Plumber's Name (Print) ~ PI er's Signature MP/MPRS Number Business Phone Number ~,~v~ ~~ ~~T ~ ~ - 6 -- 7oc'~ Plumber's Address (Street, City, S te, Zip Code) EEl~ 7~ Y~~ "'~~ a 73 llv ~L,zvG ~~ ~~ S ,~vv,~ic., ~ .~' y?o ~ ' V ll l. Coun /De artment Use Onl ~, _, / `ItiCApproved ~~ isapprov Permit Fee $ ' Date Is Issuing A Signature LL / ~ ~ ~ o~ q l ~~Og O~ rven Reason fo nial tyw ! ff IX. Conditi~j~asons for Disapproval 7 / A i ~,~ t ~ ~_ `r^ J ( A ~ ~ . ,t ' 1. Septic tank, efflUeM filter and dispersal cell must all be services I maintainer e,~,~- t,.,Jr t~ ~..~~ as per management plan provided by plumber. ' toetback rtat~itin3ments must be maintained ~l /~I~ ~ S~~ 2. IlU // t/ Cif ' 'Attach to complete plmrs for the system and submit to the County only on per not less than ti l/2 x 11 inches to size ~ n SBD-6398 (R. 01/07) Valid thru 01/09 ~~ ~ ~. ,' 0 20 40 Onphic 9eNs (~,) t fnon - 4o tt Sanitary Site Plan For:Keith Knudtson NWI/4SW1/4 Sec. 18 T29N-R17W Town of Ham/mond - St. Croix County /. ~/ GcCtf~ ~?uirEel WELL Page 8 of 8 Existing 4 Bedroom Home FN# 9271 S0 th St. 1 C/L of ISO th Street p Grade Shot 103.00' Existing Existing ~ Septic Dry WeII Tank Proposed 4"Bldg. Sewer to be insulated to Septic Tank Proposed Wieser Concrete 1250-750 Combination Tank w/Poly-Lok PL-52S Filter Proposed 2" Sch. 40 F.M. 1% C Tree Line 2.5% \_~/_--- / 100.00' Fro~sed 10'x 100'At/Grade Mound w/a System Elev. of 99.75' 2,~ 99.00' . #2 . #1 ~i'1/'1 #1 #2 BM =Top of Spike ~ BM =Alt. BM =Top of Spike 13RP =Same ~ HRP =Same ASSUMED ELEV. = 100.00' ASSUMED ELEV. = 100.12' Q~COPV .~ 0 20 +o cNupWo en.M (lit) i ~n - ~o n Sanitary Site Plan For:Keith Knudtson NWl/4-SW1/4 Sec. I8 T29N-R17W Town of Hammond - St. Croiz County /, ~~ Gi cV~e ~''~Yrce l • WELL Existing 4 Bedroom Home FN# 9271 SO th St. C/L of ISO th Street Proposed Wieser Concrete 1250-750 Combination Tank w/Poly-Lok PL-525 Filter Proposed 2" Sch. 40 F.M. 1% p Grade Shot 103.00' Existing Existing ® Septic Dry Well Tank Proposed 4"Bldg. Sewer to be insulated to Septic Tank Tree Line 2.5% Page 8 of 8 100.011' Proposed 10' x 100' At--Grade Mound w/a System Elev. of 99.75' 0 2,~ 99.00' . #2 . #1 ~~/'1 #1 #2 BM =Top of Spike ~ BM =Alt. BM =Top of Spike ARP =Same ~ ARP =Same ASSUMED ELEV. = 100.00' ASSUMED ELEV. = 100.12' commerce.wi.gov isconsin Department of Commerce Safety and Buildings 3824 N CREEKSIDE LA HOLMEN WI 54636 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Jack L. Fischer, A.I.A., Secretary September 10, 2008 CUST ID No. 221180 DAVID B FOGERTY FOGERTY PLUMBING & PERK TESTING INC 2473 ROLLING GREEN RD SPOONER WI 54801 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/10/2010 Identification Numbers Transaction ID No. 1586592 SITE: Site ID No. 742221 Keith Knudtson Please refer to both identification numbers, 927 150TH Street above, in all corres ondencewith the aQenc . Town of Hammond, 54023 St Croix County NW1/4, SWl/4, 518, T29N, R17W FOR: Description: At-Grade /'I'ls~ Bedroom /Sloping Site Object Type: POWTS Component Manual Re ID No.: 1199552 Maintenance required; Replacement system; 600 GPD Flow rate, 40 in Soil minimum depth to limiting factor from original grade; System: At-grade Component Manual, SBl}10570-P (R.6/99), Pressure Distribution Component Manual, SBD-10573-P (R.6/99); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction orinstallation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component arm. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and ~Ol'1'`' dispersal are prohibited. 6~"*,!~ ii.S~ i • The existing POWTS must be properly abandoned per Comm 83.33 Wisc.Adm. Code. pgp~T1AE! • A Sanitary Permit must be obtained from the county where this project is located in accordance with the C requirements of Sec. 145.135 and 145.19, Wis. Stats. ~ SEE COi~4 • Inspection of the POWTS installation is required. Arrangements for inspection shall bemade with the designated county official in accordance with the provisions ofSec. 145.20(2)(d), Wis. Stat DAVID B FOGERTY Page 2 9/10/2008 • Comm 83 22(7) A copy of the approvedplans 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. Owner Responsibilities: • Comm 83.52 Responsibilities. 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. Comm 83.54(1).. • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptaHe to the county for maintenance tracking purposes. Reports .shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 Safety & Buildings 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 to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. S/in~cerely, Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday charles.bratz@wisconsin. gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. RESIDENTIAL AT-GRADE DESIGN Pressurized -Sloping Site INDEX AND TITLE SHEET Project Keith Knudtson At-Grade Owner Keith Knudtson Address 927 150th St. Roberts WI 54023 715-651-1737 Legal Description NW1/4-SW1/4 Sec. 18 T29N-R17W Township Hammond County St. Croix Subdivision Name Lot No. Parcel ID Number 018-1040-70-000 Plan Transaction Number Index sheet Page 1 Calculations Page 2 At-grade drawings Page 3 Laterals and dose tank Page 4 Specifications Page 5 Management & contingency plan Page 6 Pump Curve Page 7 Plot Plan Page 8 Date 08/25/08 ~, ~'~~~ Designer Dave Foe License Number MPRS# 221180 Signat .Gc, ' Phone Number (715) 416-0000 pg y V`ED Designed pursuant to: c COMMERCE At-grade Component Manual for POWTS SBD-10570-P (R.6/99), and ~'~~~I.DI cs SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81} :PONDEN Version 3.11 (05/01 } Page 1 of 8 PRESSURIZED AT-GRADE DESIGN At-grade Design Worksheet -Sloping Site Flows and Site Data. Entry. (r or c) r Residential or commercial? 400.0 Estimated wastewater flow (gpd) 600.0 Design wastewater flow {gpd) 1.00 °~ Site slope 89.75 Contour elev. below lateral {ft) Depth to limiting factor {in) .60 n-situ soil application rate (gpd/ft^2) Distribution Cell Information (1 or 2) 1 Influent wastewater quality 10.00 Linear loading rate gpd/ft 10.00 Effective absorption width (ft) 10.00 Max. effective width permitted (ft) 100.00 Aggregate length (ft) Pressure Distribution Data Entry (c ore) c Center or end lateral connection 2 Number of laterals 0.188 Orifice diameter (in} e.g. 0.188 Not a final calculation 2,00 Estimated orifices acin ft p g ( ) 2.00 Forcemain diameter (in) 3.37 Forcemain flow velocity (ft/sec) 25.00 Forcemain length (ft) 92.30 Pump tank elevation (ft) ~ ~ ~ -- ~~ 3.25 System head (ft) x 1.3 ~ 6.95 Vertical lift ft / ~ 0.58 Fraction loss (ft) 2 10.78 Total dynamic head (ftj Lateral Diameter Selection Designer must select one lateral diameter Pipe diameter Design options Design d,oice 1 in 1.25 in 1.5 in X X 2 in X 3 in X Gallons/lnch Calculator {optional) Total Tank Capacity {gaf) Total Working Liquid Depth (in) Gatlin (enter result in cell G46) Treatment Tank Information 1250 Septic tank capacity (gal) Wieser Concrete Manufacturer Effluent Filter Information Dose Tank Information Pol -Lok PL-525 Filter manufacturer 773.8 Dose tank capacity {gal) A100 Filter model number 16.1 Dose tank volume (gal/in) Wieser Concrete Manufacturer Project: Keith Knudtson At-Grade Transaction Number: y or n Does forcemain drain back? y or n Are laterals at highest point? NA 4.1 Forcemain drainback (gal) 45.0 5x Lateral void volume (gal) 49.1 Minimum dose volume (gal) 33.0 System demand (gpm) Page 2 of 8 AT-GRADE PLAN VIEW D --~ D ~ 916 B Observation pipes (2 rypical~ B 100. 0 ft 1/6 B 16.67 ft W ...._ ................ ... ~ C 12.OOft ~ D 5.00 ft --t" E 2.00 ft p ~ L 110.00 ft B W 22.00 ft A x B 1000.00 ft' -L ~. Cap Typical obs. pipe. ~'~ =Total aggregate cell A x B Slotted in the lower =Plowed area L x W s^, and anchored rely. 6" AT-GRADE CROSS SECTION Synthetic fabric cover 101 Lateral :~ invert elev. 100.25 ft ~E. ... Surtace contour 99.75 ft ~~ C ~_A and system elevation ® = 12 in. topsoil and subsoil over aggregate and tapered to toes. ~~ - 6 in. aggregate below pipe(s), and 2 in. above pipe. Project: Keith Knudtson At-Grade Transaction Number: Finished grade elevation ~--- Observation pipe at aggregate toe 1 % Slope D --+ ,~ Plawed layer below L x W Page 3 of 8 PRESSURE DISTRIBUTION AND DOSE TANK Lateral Specifications I~ P ~ I~ ?(~ I~ x12 ~ x12 ~I Laterals & force main kaf PVG Soh 40 Last hde dr~led next to end cap (Pw' CdivlhA Table 84.30-5) Holes drilled on the bottom of the lateral, equally spaced • =Turn-up Abell salve or desnoutplug 0.188 Orifice diameter (in} X 2.00 Orifice spacing (ft) 25 Orifices/lateral 16.5 Lat. discharge rate (gpm) 33.0 Sys. discharge rate (gpm) 10.78 TDH (ft) Weather-proof junction box ' Final grade ~~ Lateral Diagram -Center Connection Center Lateral connection point 2 Number laterals P 49.00 Lateral length {ft) 1.50 Lateral diameter (in) 2.00 Forcemain diameter (in) 25.00 Forcemain Length {ft) Typical Pump Chamber Layout Tank component is properly vented G o q c B ~ C E o D Totals Electrical as per NEC 30o and Comm 16.28 WAC Inches Gallons 31.0 499.3 2.0 32.2 3.0 49.1 12.0 193.2 48.0 773.8 Tank full A Alarm on Pump on ~B 93.30 ft I " Pump off D Approved manho~ cover with warning label and locking devise disconnect 4" Alternate ~ outlet I - /-location 18" min. L .Approved outlet ~ joint Provide 114" weep hole or antisiphon device. ~ 92.30 ft Goulds Pump manufacturer EP04 '- ,,~, Pump model number Project: Keith Knudtson At-Grade Transaction Number: S.J.Eiectro Alarm manufacturer Tank Alert Alarm model number Page 4 of 8 At-strade System Maintenance and Operation Specifications Service Provider's Name Tri-County Sanitation ~ Phone 715-386-0114 POWTS Regulator's Name St. Croix County Zonin Office Phone 715-386680 System Flow and Load Parameters Design Ftow -Peak 600 gpd Maximum Influent Particle Size 118 in Estimated Flow -Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1250 gal Maximum TSS 150 mg/L Soil Absorption Component Size 1000.0 ft~ Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Ins ect and/or service once eve 3 ears Ins ect and clean at least once eve 3 ears Test once eve 3 ears Should test month) Laterals should be flushed and ressure tested eve 1.5 ears ins for ndin and a once eve 3 ears 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 at-grade 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 at-grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. 6. Areas within 15 feet of the downsiope toe will be protected from compaction. 7. All other construction details are as per the at-grade component manual SBD-10570-P (R. 6/99). Lateral Tum-up Detail Finished .~,~,~....•••• ---- ............... Grade 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: Keith Knudtson At-Grade Transaction Number: Page 5 of 8 At-grade 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-10570-P (R. 06199) and SSWMP Pub. 9.6 (01/81)] 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 seated 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, Stets. 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 t1e assessed at least once every 3 years by inspection. The outlet fitter 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. tf 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 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. PUmD Tank The pump {dosing) tank shall tie inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent fitter is installed within the tank it shall be inspected and serviced as necessary. At-orals and Pnassure Distributton Svstem No trees or shrubs should be planted on the at-grade. Plantings may be made around the at-grade's perimeter, and the at~rade 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 att~rade 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) dilate that the at- grade be heavily mulched as protection from freezing. Influent quality into the at-grade system may not exceed 220 mg/L BODS. 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 rt shoukt be compared to the initial test when the system was instalk~d to determine ff orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution wtthin the dispersal cell. Observation pipes within the dispersal cell shall be chedked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continaencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the at-grade component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if tce leakage occurs or by renovating the biologically dogged absorption and dispersal media, installing new piping, and repladng other components as deemed nek~ssary 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. Project: Keith Knudtson At-Grade Transaction Number: Page 6 of 8 Page '7 of 8 GOULDS PUMPS ~` ~ ',; Submersible Effluent Pump 3 V / ~ EP05 I~Nii, lull a,~4;~x r APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: 'h" maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1'/s" NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N etastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) inisrmittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. •EP05 Single phase: 0.5 HP, 115 V or 230V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length,16(3 SJTOW with three prong grounding plug. Optional 20 foot length, 16/3 SliYV with three prong grounding plug (standard on EP05). ®2001 Goulds Pumps 4~i ITT Industries Effective May, 2001 83871 • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- matic models include Medtanical Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller: Thermoplas- tic Semi-open design with pump out vanes for mechanical seal protection. METERS FEET 10 9 30 s 25 7 -_ x _v b 20_ s _ 15 ..,_.. ~ a ........:. 0 ~ 3 10 z 5 1 0 00 ^ EP051mpelter: Thermoplas- tic enclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance, ^ Motor Fbusing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover: Thermoplastic cover with integral handle and float switch attachment points, ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING Canadian Star>dards Atsoeiatlotl (CSA listed model numbers end in "C" or "F".) Gards Punps is ISO 900t RegsOered. 5 GPM z.s FT 0 2 4 6 8 10 12 m3/h cnpnanr Goulds Pumps Wisconsin Department of Commerce DiviBion of Safety and Buildings SOIL EVALUAT10N REPORT J Page / of 3 m aowrwnoe wan ~.urnrr ate, vv .- wow /+,,, ,,,~~ Attach complete site plan txt paper not less than 81/2 x 11 inches ~ size `+an° "7 r . Indtfd@, but not limited tD: vertical and horizontal reference pant (BM), Parcet I.D. percent slope, scale ~ dimensions, rwrih afrow, and location and distance to n D t7 - D ^ ,~D Please print ad information. Re ' by Date , Persansd information You P-ovide may be used for secondary ptvpos Law, s. 5.04 ( (mj). 9 ~ ~$ Property Owner ~ P L , ` Govt. 114 114 T N R ~ E (o~ Property Owner's Mailing Address 1 ~ # Block # Stfbd Name a CSMix S~ T~ S Q ~ ~ -- Cily State z~ Code G~~,G OF ~, ^ ~~ Near est ~` ( ) ` sT_ ^ New Construction Use: L_r ReSldential /Number ~ Code derived design flow rate ~Q/ GPD (~'keplaoen-ent ^ Pubdc tx corrsr>erciaf - Desaibe: _ - Parent material .~ Flood Plain elevation if appicable ~~~ ft. General T ~i~fQr~ and recornmertdations: /~ v^~~ / ~~ # ^ Bonng ©Pit Ground surface elev. • /6 ft. Depth to Ikrirdrxi factor > in. Sod Rabe Htximn Depfh Dom~t Rtaiox Description Texhxe Structure Consist Botxfdary Roots - GP DIfP in. Mtfrtsed Qu. Sz. Cont Color Gr. Sz Sh. 'Eif#1 'Eff#2 / - 6 sx~ s Z ~ / .S L ~ -3 S - SL j - ~o -r s m L Z' ~s #~7. B~i`>s u Pit Grind surface elev. ~ ft. Depth to laniting factor '~ 9 ~. Sod Rate Horizon Depth Dtaranartt Redox Description Texture StrucUre Consistence Boundary Roots GPD/fF in. Mttnsel Qu. Sz. Cont. Color Gr. Sz. Sh. ~',E 'Etf#1 'Eff#2 1 -- L 2 -- a' 3 . -. Z s _ s mSl ~ -- t. - ~~ 7 'Effluent #T = Bt7D > 30 < ZZO mgll ert0 TS'S >~ _< l0U rrtgll t = nw ~ ~ mglt arra r a~ = ou mgr CST Ntltne Pmt) CST Number Addrr~s SL1~D/ E Conducted Telephone Number ~ y73 ,eo GG~v ~ ~~~~ IZ.D Spa®.mr~P u~r ~~/3 /,~ ~ CAL 7>s - 5`l6 ~ooo 7 ~'Z i ~' Parcel ID # elf' ~'~~ " 70 -~ Page Z of -~ proPe~Y Owner _/-`ill ? U Borirg t `-~ # ^ Pit Ground surface elev. ~ 7fO ft. Depth ~ 9 factor ~ in. c~ ication iRate Horimn Depth Dominant Redox Description Texhme Strudure Consistence Boundagt Roots GPD/tf ft#9 'Eff#2 •F - in. Munsefl Clt3. Sz. Cont. Color Gr. Sz Sh. 7 -- - ~ 7 2-S S ~ s ~'~.il/Tt'D 0 Pit Groin surer elev. ft. D®pth to ~. soy lion Rate ~~ # ^ e T t SUudue Cor-sistence Boundary Roots GPDN'E< Horizon Depth ~. Dominant t4~ssfl Redox Description Qu. Sz Cord. Color ur ex Gr. Sz. Sh. 'Etf#1 'Eff#2 Q Boring # ^ ~9 Grot3rxl surface elev. ft. Oepth b 1'ani6rg facsor in. ^ Pit SoN Rate ots R GP DIfP Horimn Depth in. Dominant [1Ata>Se1 Redoot Description- Qu. Sz. Cord. Color Texhxe Sinx~re Gr. Sz Sh. Corr3istenoe Botu>dary o •EtT#1 'EB#2 ~. ~. • Effluent #1 = BODs > 30 < 220 mgil. and TSS >30 < 150 mglL ' ~ftluent #2 = BOD, _< 30 mglL and TSS <_ 30 mglt. 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. SB0~8330 (RbNO) _ ~ ~__-- c C~ Q w ~-----~ C~ m N 0 ~---- ~~ r a~ a a 0 ~~ ~q A Q ~I~ ~ ~ ° '~ ~ # ~ 11 11 U tt Il 1) \ Q ~~ ~~ ~-~~ x ~c x 4 F ~ ~ ~ ~ ~~ ~0 1~i ~ ~ 11' ~ ~ C ~'" b °O q N --C ~~ A ~ w w ?~~ "_ ~~ ~N `1\ Opo~~t+~ $o~ ~€ ~ ..; ~. ~\~ ~~r tit; 1.~NtL 1v1x1tv~.t~JNANt;L AUi~L;MENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address Property Address (Verification required from Planning & Zoning Department for new construction.) City/State LEGAL DESCRIPTION Parcel Identification Number ©/~ ~~~ .- ~p --~j Property Location ~'/4 ,, ~-N~ %4 ,Sec. _„~,~~, T ~N R. '/ 7 W, Town of `7'~~,~rosz~ / Subdivision Certified Survey Map # Volume ,Page # Lot # ~--- Warranty Deed # -~ 7 ~ ~,~ ~ ,Volume ~ y9 ,Page # / ~-3 Spec house yes Lot lines identifiable ~$ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its pmematfue fa>Zute 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 wasfie disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in (~apter 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, restricts plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating conditionand/or (Z) after inspection and pumping (if necessary), the septic tank is less than 1!3 full of sludge. Uwe, the undersigned have read 8~e above ~ and agree to maintain the private sewage disposal system wide the standards set forth, herein, as set by dre Department of Commerce and tl~e Department of Natural Reso~uces, State of Wisconsin. Certification stating that your ceptic system has been maintained must be completed and reUm~ to the St. Croix County Planning & Zoning Department within 30 days of @re three year e~iration date. Ilwe certitfy that all statements on this form are true to the best of mylour imowledge. Uwe amaze the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of oo SEPTIC TANK F TE A ARM NO YES ~~ ~~~ ,/ IG A OF LI ANT(S) s ~ DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Departrnent. *** 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. oaios) =r. ~- ;- ;. Y t `,. t= f' I (: i f t= ~: ~~: ~' Ir t': t: (=. ~~~ I`; k~ ~° i f i_ f,YliF C%~'+~~+A lA'll f t:` ~_-. f' ;:- `; STATE -~F WiSCOr;SI9d C_'IRCUIT COU?ZT ST .. CROI}{ OUNTY _______-__---------------------------------------- -----.----r------- - In re the ;narria~ae or: I~~Y iC;~~i L1T5ifi~ , yeti ~r Toner, and Respondent. ABRIDGA3EI~T OF JUDGl~1E,IT OF DIVORCE Case Plo. 81FA262 ~~ Tl!e Judgment of Divorce entered in the above-entitled i action on tine ).Sth day of January: 1982, contains the following jprovisiar~s pertaining to real property and secured interest in real pro~sert}~: The Respondent shall be awarded all right, title, and interest ih 'the rzsidence of the parties located at Route 1, ;Roberts, Wisconsin, and legally dc-scribed as: TY:e ;youth 260 feet of the West 238 feet of the north- west Quarter (NW';) of the Southwest Quarter (S`++ts) of Section 18, Township 29, Range 17; and Petit~.oner shall be divested of ail right, title, and. interest thexein, and saved harmless from any and all liability thereon. Y hereby ce.r•tify that the forea~aing abridgment of 3udgmEnt of divorce in the above-entitled action is true and accurate. Dated at /y~~r,:~'» , Wisconsin, this day Gf July, 1?82. S~ I -; a~ R~GtSI~S ~F~#~E R~c'd. icr R~rd this 15th dQy of ~ulY A. D. 7g 82 Qs 11:30 ~.. t~A: ~~, E ~~~i ~t+h-ark r Clerk q~ Cq~r~ ~f ~ ~ ~ r• '~ .~.,,..,....,, J Deputy lark ;~~ .••`+~t;•tsj~~#.s• Stata of dVtsoanb = ~ • ,. t f _ 'r County of St. Crdx =" ~ d,y ~~ * • " f horehy terE6fyr lhat fh+`f Y""~"'~~°li'3 '~' ~r . trea end correct ce~y of •fKa ~itginal.gr- filer anc! of record ira my cff:ed•~ii'l~'MS~~ Altest~day of ~ 1 a Mar u®rii Kobytarczyk C of ~: _ ~ Q t - ~ s _v ` ~ .,o-. ., ~ ~ ~ ~ ._'' , _ ,,. .. .. _ _._ -_ ~~~' Y- . _ - ~ .